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Community Forum: Politicians face single-payer test

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Posted on August 21, 2014 |
By Paul Ralston



This week’s writer is Rep. Paul Ralston, a Democrat representing Middlebury in the Vermont House; he is not running for re-election. He is also chief executive officer of Vermont Coffee Co., a Middlebury business.

“Single payer” is the buzzword of Vermont’s 2014 election. A candidate’s pledge to support single payer is the litmus test for some. Big money — mostly from out-of-state unions — is flowing into Vermont to support candidates who pass the single-payer test.

So, what’s the big deal? If the state delivers on its promise — the same or better health care at a lower cost — we’re ALL going to support single payer! This is really a non-issue.

But, perhaps Vermonters are starting to have doubts. The single-payer political action committee, Vermont Leads, has found only 10 candidates out of the 34 contestants to endorse in the 2014 legislative primary races. (Full disclosure: If I were running for re-election, I assume I would have passed the test and gotten an endorsement, too, because I voted for Act 48.)

Voters now have seen how poorly the state has performed in its first attempt at health care reform, and they are rightfully more cautious about supporting something that has yet to be described. Blind support of a program that has no clear definition is like agreeing to buy a new car before you know how many miles it gets to the gallon, what it costs, or what the monthly payments will be. The design and implementation of Vermont’s health care exchange has been a disaster, and no one disputes that. As a legislator who voted for the bills that created our exchange, I am culpable on some level for this failure, because the Legislature didn’t insist on more safeguards and checkpoints on the rollout. Single-payer legislation must be much more carefully crafted and robust, and no one should agree to buy this thing until they know what it is. We know we want a new car, but we need to see the sticker.

The question for voters should be: Do we want candidates who will insist on what was promised, or should they act like lemmings marching to the sea? What if the single-payer system does not provide universal access to health care? What if it rations the quality or quantity of health care? What if it is more expensive than our current cost? Do we want candidates to vote for single payer regardless of access, quality or cost? This seems to be the real issue.

Unfortunately, we won’t know the answers to these questions by the primary on Aug. 26. We likely won’t know by the November election either. So what’s a voter to do? Sometimes, the past is the best predictor of the future. We need to elect legislators who will pursue the promise of single payer but not allow another health care debacle to occur in Vermont. That’s what I intend to do.

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