When you have a blog like this that a lot of people read, I’ve found you just never know what people are going to react to. Case in point my diary from yesterday expressing my…displeasure…with the latest bill in the Vermont legislature which is designed to move us toward a single-payer health care system. While I, once again, agree with the goal, I take issue with the content of the bill – and in particular the piss-poor communication strategy designed to promote it – a strategy seemingly designed to pick needless fights and utterly confuse potential supporters.
Well, I didn’t know the half of it. Putting aside for a moment its supporters who apparently have only just discovered GMD and decided to make their point by name-calling (yeah, cuz THAT works SO well), I get an official email from Vermont Health Care For All which takes us to a whole new level of debate (I don’t know who sent it. I doubt it was Richter. Last time I got email from this address, I believe it was Terry Doran, but I can’t say for sure).
Bear in mind, this is an email sent to someone who has for many years supported the cause of single-payer healthcare – even inviting their comments during the Catamount discussions. You might think, then, that the tone might be persuasive. That they might feel the need to make their case as to why I should become a supporter of the bill, despite my frustrated misgivings.
HOO-boy, would you be wrong about that. The email I received is below the fold. It consisted of my original diary interspersed with the sender’s responses, so I’ve tried to replicate that format in the blog’s CMS format.
Be advised: if political catfights make you queasy, skip this diary…
Championed by Deb Richter and Con Hogan, the bill is sponsored by a Republican and two Democrats, but no Progressives.
Not true: Some of the bill’s strongest supporters are Progressives.
A weird point of contention. I didn’t argue that Progressives didn’t support it. In fact in the next sentence I stated they did (“On the other hand, it is quite the topic of organization at the Progs’ official site, including on the Prog Blog. “). I was wondering why none of them sponsored it. I thought this was odd.
What it probably is, is yet another sign that this bill was developed in a slap-dash way. I suspect every single member of the Prog caucus would’ve signed on, along with quite a few other Dems. It would’ve been helpful to spend the extra day to get their names on it.
The bill itself has gotten as much attention for its organizing slogan
as its content (“Take Back Vermont Healthcare,” which has only served to piss people off by evoking “Take Back Vermont” – Richter has since announced a change in its advertising gimmick – and hopefully a reconsideration of
career choice for whatever communications person thought such a name was a good idea).
Some of us – not all – still think it’s a good name because 1. It
rehabilitates a perfectly good concept trashed by the reactionary right wing during the civil unions debate and 2. it perfectly captures what we wish done. The fact that Progressive websites or blogs are in a tizzy over this says more about them and their focus and goals than about us.
Got that? If you think, as Julie said, that “Fags Go Home Healthcare” is offensive, it’s just your problem, as a stuck-up blogger. Sheesh. Get over it. What, are you a fag or something?
Even the advocacy website set up for the bill makes it painfully hard to find out anything at all (not a strategy that inspires confidence, which adds to the general sense of chaos around the “grasstops” effort)
Well, perhaps. It’s how you see it.
It’s your website, folks. What is it you want people to see? Come on!
304 would set up the State of Vermont to become the functional single insurance payer for Hospital care. The idea is that, once implemented, regular premiums will come down 40%, paperwork will be dramatically streamlined and reduced, which could bring down rates even further, and it ultimately becomes a cheaper and more cost-efficient way for the State to meet its Medicare and Medicaid matching burdens. In fact, the bill depends on Vermont being able to pool its Medicare and Medicaid federal monies to cover the system.
Many no’s in the above. Not an insurance payer at all. A payer of health care services. This is a pretty big difference. Administrative paperwork savings don’t bring down insurance rates. The bill has provision to raise the money in case Medicare and Medicaid waivers are not obtained. Under the Bush administration there’s little likelihood they could be.
Now THIS was what we call a “teachable moment.” From my perspective, in this case anyway, it strikes me as a distinction without a difference, at least from a user-end perspective. But no explanation was forthcoming. Just another statement I’m expected to take as fact without explanation.
And the result is that everybody can go to the ER and be paid for.
This is the Hospital Association line of defense.
Uhhhh… yeah, so?
But if that were so why aren’t they going now?
They ARE going now! ERs are being used as primary care by the uninsured in lieu of preventative care. I thought this was a given in this debate.
Their care would be absorbed by a cost shift.
Yes – I get that that’s the argument. I’m just not seeing any particulars beyond a big fat “trust us.”
Sure, some increase might occur under H.304, but that’s a technical problem, not a policy problem.
Newsflash: That’s a reality problem. That makes it a political problem. And that means,, if you’re serious about passing a bill, you need to address it, otherwise don’t bother – it’s all an exercise in futility.
A 40% premium decrease is not only a dangerously murky figure, the idea that premiums would drop just because it’s “the law” is deceptively simplistic. There is no mechanism by which they have to drop that much under those circumstances.
Why murky? All the numbers are not Richter’s or Hogan’s. They are the JFO’s. And yes there is a mechanism. Talk to BISHCA.
Murky because the “Take Back Vermont HC” website simplistically suggests that the law will mandate a commensurate 40% drop in insurance premiums, rather than shift the equation by which insurance companies make their case for rates before regulators. The argument may be made that they should drop – and they may or may not. Suggesting that the law states unequivocally that they will is deceptive.
Also painfully murky is the $115 million figure thrown out as the amount of administrative overhead that will be reduced. Maybe, maybe not. There
are not $115 million worth of medical, budgetary line-items cleanly segregated under the “waste and abuse” column. This is not unlike the rhetoric used by Republicans to attack social programs – rhetoric that creates a self-servingly simplistic picture that – among other things – completely ignores the quantum effects of implementing radical change.
Again, figures are JFO’s. No one has said there is $115 million in administrative savings. The figure is $66 million and of course it is not set in stone.
“Of course” indeed. My point is that the website suggests it is.
I used to be the admin for Planned Parenthhood of Northern New England’s practice management system. These arguments that there is a lot of needless bureaucracy tied up in the delivery of services due to multiple payers is true – but when advocates try to give that figure a specific monetary value, they’re making huge inferences that amount to leaps of faith – and such leaps do not help their credibility.
There’s also the Hospital Association’s argument: that this will simply further encourage people to use Hospital ERs as the medical care of first resort, rather than seeking preventative care. The proponents response is basically “no they won’t”
.
No it is not basically that. See above.
The “see above” referred to was a link to the very web page I’d referenced that drew me to the conclusion in the first place. Oh well.
Finally, there’s the issue of paying for it. The website offers this on their faq:
4. How will we pay for H.304?
a. We have some numbers derived from work by the Joint Fiscal Office.
b. One example would be a 5.5% payroll tax plus a $200 fee for each Vermonter under age 65.
c. The Legislative committees that deal with revenue can figure it out.
a: Well, that’s nice.
b: Great. More regressive taxes.
c: Punt.
You missed the qualifying” one example”.
Sure didn’t. Just wasn’t impressed. How about an example that actually demonstrates you take these issues of funding and fairness seriously? Honestly, you’re gonna take a me to task because what you wrote is inadequate? Bizarre!
There are other examples using a surcharge on paid Vt. income tax (progressive), sales tax increase (not), etc.
Great!
How about putting those in the website?
Dare we say we’re doing our best, and spending time quarreling with you over this does seem rather stupid.
So why are you quarrelling with me, then?
Your characterization of the bill and
us is nonsense.
Seemed “rather stupid” for just a moment, I guess.
You can always read the bill yourself, check out
sources, and tell your readers about it.
I believe that’s exactly what I did.
Premiums will come down x amount because we say they will. X amount will be saved from paperwork because we said so. People wont lean on ERs for primary care because they just won’t. It’ll get paid for because
ways and means will fix it, no problem.
And perhaps most extreme of all, the federal government will let us do whatever we want with medicare and medicaid money because they will.
Added together, the rhetoric underplays so dramatically the fundamental changes and the fiscal impacts of what it would wreak as to seem almost deceptive, and it does so in a kind of patrician, leave-it-to-the-experts style that only feeds the worst stereotypes about liberals.
It may be that many proponents don’t understand what’s in the bill. It may be that proponents have been talking to the same old people (e.g.each other) about health care for so long, they no longer feel the need to make a comprehensive case for single-payer, assuming everyone is on their side. It may be that they’ve decided some “radical creep” is called for by sneaking up on people with a dramatic change in the system to show them, despite themselves, that its not so bad once they’re steeped in it.
Whatever the reason(s), proponents seem to have fallen back on vague sleight-of-hand with a touch of snake oil to bypass what really needs to happen to create such fundamental change.
What needs to happen is exactly what happened with the Great Society laws, and even the New Deal; a broadly, clearly, honestly stated commitment to fundamental change.
So far, that consensus is not in play around this bill. I have some
sympathy, as to make such a case, you need someone in a leadership position to stand up and advocate aggressively. Rep. McFaun is trying to play that role, but his platform isn’t broad enough.
Nor is he getting the right kind of support from advocates who have him speaking at the same forums to the same people who are always at these things. The use of “Take Back Vermont” suggests that advocates have some intellectual understanding that they need to look beyond this crowd, but the crude offensive sloganeering demonstrates either how little they
bothered to really consider the best way to do that, or how ill-equipped they are to understand those people.
In any event, the half-hearted “just do it” quality of the bill and the support for it aren’t doing the cause a lot of favors.
Don’t how to respond to such a load of misrepresentation. Only to say that this is exactly how Canada’s system started, by financing hospital care province by province. It’s not as hare-brained as you seem to think. You’re largely wrong or misinformed or determined to misrepresent the details.
Yeah, that’s it. I’m determined.
Whatever.
Your distress seems to be about the name TakeBackVermontHealthcare, about the website, about the organization, about what you assume are our attitudes, about our honesty, etc.
That covers a lot of it. I’m also distressed about a bill that will never ever pass because of how its written, packaged and presented. I’m very much in the category of people who need a single-payer system, so I don’t like to see time wasted like this.
If you are so troubled, why is it you don’t form a group to work against H.304 or form one to work for a single-payer bill if you can get a legislator to propose one.
Why do you assume I haven’t done work for nonprofits that promote single payer? Oh that’s right, because I’m not cheerleading your bill, your website, and your communications strategy!
Yessir, that’s pretty hard proof.
Attacking people trying to accomplish what they see as the right thing in health care reform right now is self-indulgent and pointless.
Yeh, I know. “Shut up and fall in line.” I get that a lot.
Doesn’t it just suck how people don’t respond well to that?
If you have useful ideas we will listen to them either in person or by email. We need useful ideas, not carping.
What you “need” is to learn how to persuade.
Because you really, really, really suck at it.
Just for kicks, here’s the rest of the email, which consisted only of the rest of my original diary:
….but… wanna hear the punchline?
I’m still glad to see it.
The bill will fail. Miserably, and for a variety of reasons. The whole thing is a leap of faith on many, many levels.
But it’s simple existence does three things:
One, it furthers the single-payer argument in a more concrete way than we’ve yet seen.
Two, it sets the bar for real health care reform closer to where it should be, and hopefully will inform whatever new bill actually emerges from the legislature this year.
Three, it puts a spotlight on the need for flexibility on federal
money and points out the real necessity for federal support to move towards single-payer, or something really resembling single-payer.
These are all good things. Necessary and important things. If I were a legislator, I couldn’t in good conscience vote for it in this form, but that same conscience would demand I not abandon it – rather that I get involved and really take it on to make sure I was part of the solution. I hope other legislators and advocates see it that way.
Richter and Hogan are doing a service by promoting this. Representatives McFaun, Obuchowski and Ojibway may not be doing themselves any favors among their peers putting forward such a flawed bill, but this conversation is in desperate need of a push to the next step, and this is one way to do that.
It could be argued that a screwed-up bill is worse than no bill, as it delegitimizes the overall approach, but don’t think so. Single-payer is the direction the argument is headed, and there’s no changing that .
