Vox - Vermont Gov. Peter Shumlin told reportersthe "time is not right" to move forward on single-payer health care. Shumlin has been a huge single-payer advocate, and his administration has spent years trying to set up a public insurance plan to cover all Vermonters. If Vermont does not move forward on single-payer, it will be seen as a large set back for other states interested in testing out the model.
Vermont has long had a two-pronged approach to building a single-payer health care system. First, they would figure out what they would want the system to look like. Then, they would figure out how to pay for it.
The state passed legislation outlining how the single-payer system would work in 2011. And ever since, the state has been trying to figure out how to pay for a system that covers everybody. Most estimates suggest that the single payer system would cost $2 billion each year. For a state that only collects $2.7 billion in revenue, that is a large sum of money.
Dr. Andrew D. Coates, president of Physicians for a National Health Program - Governor Peter Shumlin, in his press conference, stated that “now is not the right time” for single payer.
I disagree.
The time for a single-payer system is now. Our patients in every state urgently need it.
Indeed, the people of Vermont, including the state’s physicians, nurses and other care giving professionals, have repeatedly affirmed their support for single-payer reform.
Vermonters throughout the state understand that an equitable health care system must be truly universal and must remove all financial barriers to medically necessary care. They recognize that a public single payer is an essential incremental step toward these goals.
The people of Vermont have said health care should be regarded as a public good, much like fire protection, and not as a commodity you buy on the market. Gov. Shumlin was elected to office in considerable part because of his championing of this view.
Single-payer activists in Vermont have pointed out that by eliminating the unnecessary and wasteful role of private insurance companies – middlemen who put their profits above the interests of our patients — resources will be liberated to improve the health of all.
Dr. William Hsiao, the Harvard health economist who Gov. Shumlin recruited to study the impact of single payer in Vermont, estimated that a single-payer-like reform (not a true single payer, since there would still be multiple plans, including private plans) would achieve an overall savings of over 25 percent on health care spending (10 percent delivery system savings, 8.5 percent overhead savings, 5 percent reduction in fraud and 2 percent saved through lower malpractice costs.)
Gov. Shumlin today stated that the costs of his proposed reform would be too great, saying, “The taxes required to replace health care premiums with a publicly financed plan that would best serve Vermont are, in a word, enormous.” (The governor’s finance proposal would have instituted an 11.5 payroll tax on employers and a progressive income tax of zero to 9.5 percent, depending on income.) The governor did not dwell upon the fact that the taxes he cited would be less, on average, than the exorbitant and burdensome premiums and out-of-pocket costs that presently weigh heavily upon households as well as employers.
Gov. Shumlin also invoked “risk of economic shock” as a reason to turn away from single payer — the idea that the transition to a Vermont without private health insurance, a Vermont without profiteers lining up to make a buck off the suffering of the sick, would prove too threatening to the social order.
Gov. Shumlin has made many speeches about the need to liberate Vermont, and indeed the United States, from the corrupting and corrosive influence of profit-seeking in health care. Yet from its inception, the enabling legislation for reform in Vermont – Act 48 – allowed a continuing role for private insurers alongside public payers. Lawmakers therefore dropped the term “single payer” from its text.
The continued presence of multiple payers in the proposed Vermont reform necessarily canceled out many of the administrative savings that would be attained by a true single-payer system and opened the door to multi-tiered care along the lines of what the Affordable Care Act currently represents.
Today’s announcement by Gov. Shumlin, a leading light in the Democratic Party, thus shows the difficulty that individual states face in trying to disentangle themselves from these private corporate interests. It shows why physicians and Americans as a whole need to step up the demand for a deep-going, national reform – an improved Medicare for all.
2 comments:
America will NEVER have single payer until citizens first negate the pre-tax-dollar income tax advantages granted to employer purchased health insurance. Since it is politically impossible to take away the pre-tax-dollar income tax treatment enjoyed by employer purchased health insurance, "individual mandate" Americans should demand an EQUIVALENT VALUE income tax deduction IDENTICAL to that enjoyed by employer purchased health insurance. Refundable tax credit subsidies can be maintained for those below a certain income level. Following this reform, a merger of America's employed and unemployed health insurance risk pools will result. When employed Americans suddenly find themselves dumped onto the obamacare exchanges (since there no longer will be any income tax advantage to employer purchased health insurance), those Americans will quickly demand single payer. See: https://www.youtube.com/watch?v=c7LGTE40JTQ
Coates correctly points out that the Vermont proposal was never a Single Payer system.
Don McCanne, Coates' compatriot at PNHP: "Gov. Shumlin has provided a very valuable lesson for all of us. He did almost everything possible on a state level to try to establish a single payer system within Vermont. He has established the fact that, beyond all doubt, a bona fide single payer system is impossible to enact and implement on a state level without comprehensive enabling federal legislation.
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