MONTPELIER – If you wake up at 9 p.m. with a high fever, a worsening cough, or a child who just doesn’t seem right, you don’t have many options. You can wait and worry or you can go to the emergency room.
More and more Vermonters are choosing the latter. Not because they want to, but because they feel they have no other choice.
Health policy experts have long estimated that roughly one-third of emergency room visits are not true emergencies. That statistic can sound like an indictment of patients. It shouldn’t be. It’s an indictment of the system.
People go to the emergency room because they can’t get a primary care appointment. Because offices are typically closed at night and on weekends. Because they don’t know if symptoms are serious. Or because, for many, the ER is the only place that will always take them.
In other words, what looks like overuse is often a failure of access.
This matters now more than ever in Vermont. Our hospitals are under extraordinary financial strain. Insurance premiums remain among the highest in the nation. And our primary care workforce is stretched thin, with too few providers and too many patients.
These problems are not separate. They are deeply connected.
Emergency rooms are the most expensive front door in the healthcare system. A visit can cost well over a thousand dollars, sometimes much more. The same issue treated in a primary care office might cost a fraction of that. And when care is delayed or fragmented, small problems can become big ones, leading to hospitalizations that are far more costly and far harder on patients.
So, we find ourselves in a cycle: limited access to primary care drives more people to the ER; higher-cost care drives up insurance premiums; and rising costs put even more pressure on hospitals already operating on the edge.
If we want to get serious about costs, we must get serious about where care begins. That is where the idea of universal primary care comes in. At its core, universal primary care means guaranteeing that every Vermonter can access timely, affordable, and convenient primary care without worrying about cost at the point of service. It means same-day or next-day appointments. Expanded after-hours care. And a system designed to catch problems early before they escalate.
The potential benefits are straightforward. Fewer unnecessary emergency room visits. Better management of chronic conditions. Less strain on hospitals. And, over time, lower overall costs.
But it is important to be clear-eyed. This is not a silver bullet.
Expanding primary care access requires upfront investment. Vermont already faces a shortage of providers, and any reform must address workforce challenges head-on. And not every ER visit that appears avoidable truly is patients make decisions based on the information they have in the moment.
Still, the direction is hard to ignore. For decades, our health care system has invested heavily in acute and specialty care while under-investing in primary care. We have built a system that excels at treating crises but struggles to prevent them.
And we are paying for it.
As policymakers debate hospital budgets, insurance rates, and long-term reform, it may be worth asking a simpler question: are we putting enough resources into the front door of our health care system?
Because if that door remains hard to access, Vermonters will continue to do what anyone would do—go where the lights are on, and the doors are open.
We can keep debating how to pay for health care. But until we address how it is used—and where it begins, we will continue to chase costs rather than control them.
I hope the Vermont House addresses this issue soon.
David Yacavone represents Lamoille-Washington in the Vermont Legislature, including Elmore, Morristown, Woodbury, Worcester and Stowe.
