No to Shumlin’s Phony Bill: Single-Payer Now

Single-Payer Activists Hoodwinked in VT

The snows of VT are melting and the call has gone forth for demonstrations in Montpelier in favor of single payer on March 25. Medical students from as far as New York City are urged to trek north with words like these: “The newly elected governor (of VT), Governor Shumlin, ran on a platform supporting single-payer, and since his election the legislature commissioned William Hsiao, a Harvard economist, to develop three potential plans for the state, one of which is a single-payer plan.”

But is it a single payer plan? As we shall see, it would be kind to call that a “mischaracterization.” Here is the analysis of Drs. David Himmelstein and Steffie Woolhandler, founders of Physicians for a National Health Program (PNHP), a beacon of principled struggle for single payer through the thick and thin of Bush and Clinton, right up to the Obama presidential campaign.

“The proposed Vermont health reform legislation includes two distinct elements: clear plans to rapidly implement the deeply flawed federal health reform (PPACA) in Vermont; and a vague outline of a single-payer plan that might be implemented six years hence if the feds were to allow it.” Emphasis mine.) So far it does not sound too good – a version of ObamaCare right off the bat and a “vague outline” of a single payer plan that “might be implemented in six years” if the denizens of the Imperial City so dispose.

Himmelstein and Woolhandler continue:

In contrast to the bill’s detailed prescription for implementing PPACA, the sections on the single-payer plan leave much to the imagination, punting decisions on critical issues to a board appointed by the governor. It seems that the board is to determine whether critical services like long-term care are included in the benefits package; whether co-payments will be affordable or daunting; how hospitals, home care agencies, nursing homes and doctors will be paid; and whether capital funds are to be allocated separately from operating funds (the sine qua non of effective health planning). And the bill includes no plan for funding the single-payer program.

Himmelstein and Woolhandler go on:

Happily, the legislation would enroll all Vermont residents (regardless of immigration status) in the single-payer plan. In one critical area the bill seems to come down on both sides of the fence. While it would proscribe the sale of private coverage that duplicates the public plan if the single-payer program is implemented, it would also allow employers to opt out of the plan.

One ray of light but the clouds soon gather again.

Finally, its uncritical embrace of the latest health policy fad – Accountable Care Organizations (ACOs) – would bolster the role of private insurers, at least in the short run. The bill calls for pilot projects in which an ACO would receive capitation payments which would cover all care for a defined population, including long-term care, prescription drugs, etc. Insurers are the only organizations in Vermont with the financial muscle to take on such “full risk” contracts.

In sum, the Vermont bill evidences good intentions and bold promises, but leaves the make-or-break decisions about restructuring health care financing for a later date. This “kick the can down the road” approach is worrisome in a state where the governor and Legislature change every two years, and where multi-stage health reforms have been enacted in the past, only to see the planned reforms abandoned without being implemented.

Then Himmelstein and Woolhandler bravely conclude:

In this context, ongoing mobilization of a broad-based single-payer movement will be critical. Such a mobilization can bolster the governor’s evident enthusiasm for the single-payer project and maintain the courage of the Legislature as they face the inevitable onslaught of corporate opposition to real health care reform.

So one must ask, does one build a movement for single payer by working for a bill that guarantees something else, with only vague promises of a better tomorrow? One can have different opinions on this matter, but when this writer hears that Governor Shumlin has enthusiasm for the single payer project, he thinks back to a state Senator from Chicago who was downright passionate about single-payer until he got sufficiently close to the presidency. Then Obama bade a quick good-bye to single-payer. It has been my experience that the single-payer movement in general and the VT movement in particular has been susceptible repeatedly to the blandishments of Democratic Party pols to the point where naivete would be a kind way to describe it, and the same was true when Obama reigned in Chicago.

The very fact that Governor Shumlin has to tack on a single-payer promise to his awful bill is testimony to the strength of single-payer sentiment in VT. Thanks to the solid research and frank appraisals of PNHP activists like Woolhandler and Himmelstein, the battle for public opinion has been won by single-payer not only in VT but in most of the nation. What is lacking is the willingness to move from polite argument and reliance on Democratic pols to militancy and an independent path.

Shumlin said from the first that there would be no single-payer if he were elected and that it might materialize if he were elected more than once. Was it really hard to figure out what that meant from a pol? What is lacking is the recognition that this is no longer a discussion; it is a fight. And unfortunately the effort in VT looks stuck in that same quagmire. Those demonstrating in Montpelier would be wise to call a spade a spade and label the governor’s plan as the betrayal it is. The demand in VT should not be single payer later, maybe in six years. The cry should be “No to Shumlin’s Phony Bill. Single-payer Now.”

John V. Walsh, @JohnWal97469920, until recently a Professor of Physiology and Neuroscience at the University of Massachusetts Chan Medical School, has written on issues of peace and health care for several independent media. Read other articles by John V..

8 comments on this article so far ...

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  1. Vic Anderson said on March 7th, 2011 at 12:36pm #

    And make It GO VIRAL throughout US! SINGLE-PAYER OR Single term(ination)!! ESPECIALLY for PROMISE-reneging Obameh!!!

  2. dschoales said on March 7th, 2011 at 12:44pm #

    Partial information viewed from afar is an unreliable basis for passing judgment. We in Vermont are working really hard to get as close as we can to universal health care with a single-payer system, and it is demoralizing to read this kind of half-accurate drivel. Please visit some of the following to find out what is happening and what we are up against as we work toward “perfect.” Then please MYOFB.

  3. Mpower9 said on March 8th, 2011 at 1:06pm #

    “Just say, ‘No'” really doesn’t cut it. That would leave us nowhere.

    Instead, the Vermont single payer advocates are daily in the legislative committees trying to make improvements to the legislation. It’s been a long hard road and it will be longer and harder still before we are done. If we are to step down the road to the implementation of single payer beginning in one small state, we have to recognize and deal with the fact that we do not call the shots at the federal level which currently provides much of the funding for health care in Vermont and potentially will be providing much more. If we just say “No.”, all that will happen is that the single payer provisions will be removed from the bill and we will be left with the federal compliance provisions and not single word about how to move forward on real health care reform.

    No one here has pulled punches in their criticism of the bill, but we are trying to keep single payer alive in the face of an onslaught from major instate corporate employers (such as IBM) carrying the water for the pharmaceutical and insurance interests. Just say “No” is just what they want. Instead, we are militantly keeping our legislators’ feet to the fire. (However, we do draw the line at actually spitting on members in the committee room.)

    Not being a Dem, I feel no need to defend Gov. Shumlin (who has many policy failings) but to compare him to the President is unfair. I do not remember Obama vigorously campaigning on “single payer” (whatever he may have said in the past). Nor did he propose legislation with that language. Shumlin did both. (As to his comment about implementation not until after his reelection. Vermont has two-year terms so that will be in November 2012, if it happens.)

    Himmelstein and Woohandler are right in their criticisms of the bill, describing its weaknesses, but I did not hear a call for “Just say ‘No.” I would advise Vermont single payer supporters to stay in the fight and follow their advice to “bolster the governor’s evident enthusiasm for the single-payer project and maintain the courage of the Legislature as they face the inevitable onslaught of corporate opposition to real health care reform.”

  4. jvwalshmd said on March 8th, 2011 at 2:02pm #

    To dschoales:
    I am glad you agree that Himmelhandler’s criticisms are correct. From that it follows as the night the day that the bill should be opposed and single payer called for now.

    As far as Obama and single-payer, he got the support and money and time of the single payer community in Chicago including some folks I know personally. But when he reached the point where the presidency was in sight then he gave the SP crowd the proverbial finger and became the insurers’ prostitute.
    Shumlin is doing the same thing IMO and he is a buddy of Obama apparently.

    You guys have the best of intentions up there, with the exception of a few Democrat Party operatives in your midst – but you are being played. And it has been going on for too long.

  5. dschoales said on March 8th, 2011 at 2:13pm #

    Thanks for your help. It must be nice to see things so clearly. I don’t know what we would do without the wisdom of people like you.

  6. Michael_Corcoran said on March 13th, 2011 at 5:48am #

    I agree with the PNHP analysis that the single-payer movement must continue to push for single-payer; it seems to conflict with the proposed rhetoric of the author, who wants to emphasize killing the current bill. I think it is too early in the process to take that kind of step.

    The connection between Shumlin and Obama is pretty tenuous. I mean yes, both are Democratic politicians subject to the failings of the party and its ties to big business. But, Obama did not have a state-wide health reform bill, he was merely a public supporter of single-payer and then (predictably, once he got close to power, as the author notes) abandoned his support to illicit support from insurance and drug companies, as well as the national party.

    Shumlin, meanwhile, had Hsaio write three plans and he did, and a fight remains over what the final plan will look like. If Shumlin runs for president and rebuffs his intellectual support for single-payer, than we can compare the two.

  7. Michael_Corcoran said on March 13th, 2011 at 5:56am #

    Although I will say this: my understanding was the Hsaio felt he wrote the bill so waivers, not an act of Congress, could expidite the process of implementing state-wide single-payer. And the Congressional Delegation was going to introduce a bill to try and expedite the 2017 state innovation language.

    Why was that plan abandoned? This is a curveball of sorts. The bill that got the three plans written was not designed to implement the insurance exchanges as mandated by ObamaCare, but to bring a single-payer plan to a vote. Why not vote on single-payer, and let the feds fight it in court? Or apply for waivers? Or lobby for legislation?

    Seems like a major concession to just accept the 2017 State Innovation Language. This was my worst fear of ObamaCare that it would be single-payer’s undoing in Vermont. And it seems to have, so far, unfolded that way.

  8. carlberdahl said on March 13th, 2011 at 10:27pm #

    We are so excited for the rally in Vermont! Students want single payer, and we want it now!! Some of us are Vermonters, and many are from out of state. We are coming together to stand in solidarity with large scale movements for single payer already happening in Vermont.

    Please note that the correct date is actually Saturday March 26. Join us at 1pm at the Statehouse! All are welcome.

    Single payer now!