Note: I originally wrote this for a non-Vermont audience, so I cover material that’s known to people here on GMD but didn’t want to reedit it completely –julie
per today’s Burlington Free Press:
Vermont can fix its health-care system by moving to a single-payer plan that would provide all residents with health coverage, end the claims chaos for doctors and cost most employers and workers less, a consultant told the Legislature on Wednesday.
For those unfamiliar, Vermont’s got three viable political parties: Democrat, Republican and Progressive. We currently have Democrats running the Governor’s office and with sizable majorities in both the Senate and House. When you combine those numbers with the progressive, those majorities grow. In the Senate, it’s 22 Democrats to 8 Republicans (Pie Chart). In the House it’s 94 Democrats, 5 Progressives, 48 Republicans, and 3 Independents (Pie Chart).
Here’s what’s important to remember about such sizable Democratic majorities in Vermont: not all politics here run directly across party lines. We overrode a Governor’s veto of same sex marriage with the help of a few prominent Republicans and we lost one Democrat on that veto override (he didn’t have the courage to vote against it– he just didn’t bother to show).
That said, we are in a different position now than we were two years ago. When we passed same-sex marriage, we had a Republican governor and needed an override. Now that Peter Shumlin, one of the Senators who pushed really hard to get same-sex marriage passed, is governor, we no longer have to think in terms of super majorities and overrides. We have to think in terms of leadership in the House and Senate, and committee chairs. If this is going to be stopped anywhere, it will be there.
Before I go on, I want to clarify a couple things here: there is solid opposition to any form of single payer plan. People will oppose “government health care,” and despite the fact that this is a complete misnomer (single payer is not single provider), it’s one of those cries that gets people kind of crazy. So messaging is important on this.
We have the tea party in Vermont, just like everyplace else, and they will show up to protest and harass and they’ll write incoherent letters and gin up controversy and try to corner you and explain the Federal Reserve to you. It’s not a pretty sight.
But they don’t have the foothold that they have in other parts of the country. Presuming to speak on behalf of the many Vermonters who have some amount of sanity left, I’ll just note that we’d like it to stay that way. They may cause trouble, but they also tried to primary one of those Republicans who supported same-sex marriage and it kind of failed, spectacularly, so I’m not too worried about them at this juncture.
I’m, frankly, much more concerned about Democrats right now. Democrats hold all the power in this scenario. Governor Shumlin wants this, and campaigned on it.
Currently, the plan most in favor is a “public/private hybrid plan.” The full draft of the report presented yesterday is available here, though there seems to be something wrong with the file at the moment ’cause I opened it and it makes no sense. An extremely vague summary is available here as well. Neither of these things are helpful. I primarily posted the draft link so that when a more useful version pops up, we have it for reference.
There are a couple pitfalls with the plan as I currently understand it, and I’d like to see how these are addressed.
First, the idea is to use payroll taxes and taxes on businesses to pay for the plan. I have no problem with this, but on a state level, how will it work? If I live in Vermont but work in New Hampshire, will my wages be taxed additionally? If I work in Vermont, but live in New York, will I have extra taxes taken out without any benefit? These are small questions, but not unimportant ones and without the ability to review the plan in detail, they will persist. They will also be the sort of questions that people opposed to single payer will use to pick away at it, so the messaging on this sort of thing needs to be clear a.s.a.p.
Secondly, do we have the infrastructure to implement the plan? The suggestion is that we contract out the claims processing system through a private bid. We do a lot of outsourcing our IT in Vermont and I think it’s a mistake when we go out of state or even out of state government for this sort of thing. We pay ridiculous numbers of dollars to companies who charge us thousands to fix small problems and hold us hostage to their demands because we’ve invested so much in the inferior software they’ve built for us that we have to continue. I’d much rather see us spend less money, hire a small IT team in-house and build it from inside. This involves a more hands on approach, but it also requires that the people involved in building it be invested and accountable to their own community.
Some of the opposition is going to complain about job loss, claiming that people responsible for medical claims processing will lose work and it will put people out of business. So I have a suggestion for neutralizing those complaints: as part of the new system, offer an incentive for people to rehire those displaced. I.e., if we do use a private partner for claims processing, give them a credit for hiring people who already work in claims processing, such as paying 50% of the first three months salary of any Vermonter displaced by this plan during the first five months of its implementation. It will mute opposition and keep people employed in Vermont.
The strongest benefits of this plan are fairly straightforward:
Universal care: if done right, this will provide health care for everyone in Vermont. That alone is tremendous.
Better business climate: people will tell you that business are opposed to single payer. Not all are, and some see the value of it. This is Paul Millman, president of Chroma in Bellows Falls, VT, being introduced by Bernie Sanders, and assisted by Peter Shumlin:
Shorter version: we’d rather spend our money on taxes than spend it on health care costs.
Moving away from a profit model: we’ve got no reason to make profit a part of health care, but that’s our system. Insurance companies are therefore invested in their bottom line and not the care of their people. That needs to change, and it needs to change today.
I want to just note: this is not a done deal. We have conservative Democrats in Vermont, and some of them have positions of power in the House and Senate. We need to push them, and push them hard at times. This is a battle, and it’s not going to be won by wishing or hoping it happens. It takes work, effort and planning. As we should all know by now, having Democrats in power is no guarantee of anything, but it’s am important step.