Vermont’s Bill: Is it Single-Payer Health Care?
Q: Vermont’s Senate just passed a major health bill that many are calling a single-payer plan. Is this the case?
A: No. The best we can hope is that it's a step in that direction.
While single-payer health reform is supported by a majority of Vermont residents, including the governor, Peter Shumlin, who ran on a single-payer platform, the present legislation in Vermont falls far short of the improved-Medicare-for-all system the state needs to assure high-quality, comprehensive, and affordable care for everyone.
Single-payer activists in Vermont and throughout the nation have been hoping that Vermont would be the first state to create a nonprofit, single-payer system of financing health care, with all the health benefits and savings such a system would bring. However, largely because of pressure brought to bear by powerful vested interests, combined with a dense thicket of federal laws and regulations obstructing state-level single-payer plans, the legislature is now mulling over a much lesser reform.
Vermont may still be first state to get there, it is just going to be a longer and harder struggle because of the federal obstacles in their way.
Q: Why is Vermont trying to pass something now, when the Obama administration’s plan hasn’t even been implemented yet?
A: Like many other states, Vermont is facing a huge budget deficit, and rising health care costs are a major concern. If they don’t get costs under control, they know they will not be able to expand coverage to everyone. Paradoxically, the best way to control costs is to cover everyone—kicking out the private insurance middlemen and creating a single-payer health care system. The federal plan, also known as the Patient Protection and Affordable Care Act (PPACA), doesn’t do that. It still leaves 23 million Americans uninsured in 2019 and the private insurers at the center of our health system.
Q: How would you describe the bill in Vermont right now?
A: At best, the Vermont bill declares an intention, or aspiration, to establish a publicly funded “universal and unified health system” three to five years hence. It speaks of health care as a “public good,” which is positive, and calls for cost containment by reducing administrative expenses and by health system planning and budgeting. But it places its main emphasis on the state’s compliance with PPACA.
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The present bill, unlike its initial draft, doesn’t even use the words “single payer.” Of course, those words alone wouldn’t make the legislation a real single-payer system. There has to be progressive taxation to fund the program; the benefits have to be comprehensive; Medicare and Medicaid would need to be folded into the program; private insurers would have to be proscribed from offering competing basic coverage; co-pays and deductibles would have to be banned; and so forth. These measures are not in the bill.
Finally, even if all those provisions were in the legislation, the Legislature still wouldn’t be able to adopt single payer before 2017 because the federal health law won’t allow it. Senator Bernie Sanders and Governor Shumlin are lobbying President Obama to move up that date to 2014, but even three years’ delay is too long. Many states have passed “universal health care plans” only to repeal or roll them back a year or two later because costs were hard to control without a true single-payer system.
Whether the necessary provisions to create a true single-payer system in Vermont are ever enacted depends a lot on a new 5-person board set up to oversee health reform in the state—not to mention how strong the single payer movement is going forward.
Q: Are single-payer activists in Vermont discouraged?
A: Absolutely not. Single-payer activists have been working in Vermont for years to educate people about the need to treat health care as a public good—like fire protection or education—not a private commodity. They’ve clearly made headway in the battle for public opinion; the legislative process has been extremely energizing.
This is a marathon, not a sprint. Vermonters know that, and have inspired the whole nation by the force of their demand for change. More than 200 doctors from 39 states have told us they’d seriously consider relocating to Vermont if it were to implement a single-payer system. And over 200 health-professional students from throughout the Northeast—and some from as far away as the West Coast—recently rallied at the Vermont Statehouse to say they want single payer now.
Q: Do you think that health care will ever be a human right in this country?
A: The road to a national single-payer program may wind through states like Vermont or we may pass national single-payer legislation (e.g. H.R. 676) first. The only thing for certain is that this is an important movement for anyone who cares about health care or fighting corporate control of our democracy.
I do believe that we will achieve the right to health care, just as we won the battle over abolition and women’s suffrage. But in Vermont and nationally, we need a true single-payer program to make health care universal, sustainable and affordable.
Ida Hellander, M.D. wrote this article for YES! Magazine, a national, nonprofit media organization that fuses powerful ideas with practical actions. Dr. Hellander is health policy director for Physicians for a National Health Program.
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