Opinion: The long fight for a single-payer system is not dead
Gov. Shumlin’s decision to suspend moving forward on the financing package for single payer in the coming legislative session does not mean that the dream of health care as a public good in Vermont is dead. At his press conference announcing his decision to not pursue single-payer financing in 2015, the governor stated that “now is not the right time.” But he also made clear that Vermonters must not abandon the goal of universal publicly financed health care stated in Act 48.
Opinions differ on whether the governor was correct in his judgment that this was not the “right time.” While the consensus is that such a plan would never have passed the Legislature now, and it would have had to be tweaked anyway to prevent it from going into deficit in the fourth year, the irony is that its $2.6 billion price tag is less than we Vermonters are already paying in premiums and out-of-pockets. Furthermore, the plan the governor described had many excellent features, as it left the vast majority of Vermonters paying less for health care than they do now, and it had a high degree of coverage (a 94 percent AV) meaning that out-of-pocket costs would be minimal.
But if passing an entire single-payer financing package in one fell swoop is indeed too heavy a lift for our legislators at this time, we should remember that there are still ways to follow through on Act 48. Many other countries have implemented health care as a public good in stages. Even our own Medicare program in the United States began as a program only for hospital care.
We should also remember that this governor is not a latecomer to the idea of a publicly financed health care system for all. As early as 1996, he co-sponsored a single-payer bill (the lead sponsor was Sen. Cheryl Rivers) in the Senate. As Senate president, he spoke at public events throughout 2009, including at a small business event at the Statehouse that April. He asserted that single payer was the only way forward, and he continued to advance the cause throughout that year. He eventually contacted Professor William Hsiao in December 2009, and asked him to testify in the following legislative session, which he did.
As the governor and many legislators and certainly many people in Vermont still hold the goals of Act 48 dear, there is no reason we should take the position that single payer is dead. What is important now is that we think of ways to get to the goal — health care as a public good for all Vermonters rather than merely a market commodity for all Vermonters — even if it takes more time and is done in stages.
In thinking of advancing the goals of Act 48, we need to understand that proposals which tinker with the present private insurance-based system are different from proposals that create health care as a shared universal public good. But any proposal that makes a sector of health care both universal and public represents progress. And, when a sector of care is publicly financed and universal, it not will not only provide a service to all Vermonters, but also create the best opportunity for cost control. Only when funds are pooled for a sector of care can prices be kept in line.
Vermonters who favor the idea of health care as a common good — because it is more just, and also more efficient — must continue working to change what is politically possible, so that we ultimately get the publicly financed health care system Vermonters so desperately need. But, let’s remember that in making his announcement in December, the governor did not say, “single payer is dead.” What he did say was, “A fairer and more rational and more sustainable way to pay for health care is worth fighting for. Our time will come.”
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