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.”