The Vermont Workers Center’s Healthcare Is A Human Right Campaign will be delivering thousands of postcards to the Vermont Legislature on Jan 6, 2010 at noon. If you haven’t already signed a postcard, please sign one at www.workerscenter.org/Jan6postcard. If you can attend, please email kate@workerscenter.org.

Our campaign fully supports the concept that healthcare is a human right and that health care cannot be traded fairly as a commodity (as is the case in the current U.S. multi-payer market-based health insurance system). I support pursuit of a single-payer system in Vermont in the interim while working on a national system. This is suboptimal but realistic.

I support a national single-payer health insurance system (Medicare for All) as evidence shows it is the only system that can be reasonably expected to extend medical and dental coverage to all Americans in a cost-effective manner. More than $300 billion annually would be saved in lower administrative costs; $100 billion in drug costs due to improved bargaining power with pharmaceutical companies; and $40 billion in eliminated costs for the currently ‘uninsured’. As such, Democrats and Republicans alike should support a single-payer system.

It is mystifying to see how the Democratic Party has pursued the more politically-expedient compromise of further institutionalizing our current broken system with ‘reform’ that leave millions without health insurance and many more millions without dental insurance, and won’t extend coverage for years anyhow. It is similarly surprising that the Party would give a bonanza to the insurance industry by imposing a mandate such that millions of healthy young people will be signing up for private insurance. Finally, there is little reason to believe the ‘reform’ will ‘bend the curve’ in any meaningful way. I believe it will dramatically increase the national debt or be curtailed in the first place in the ensuing years to prevent that from happening.

The biggest irony of the single-payer debate has been the Republican Party’s (and business’) refusal to consider the cost-savings of a single-payer health insurance system. The savings would lead to a significant stimulus to the economy as a consequence of improved competitiveness, profitability, and job creation. It appears that raw ideology has usurped serious thinking.

I believe our three congressional representatives (Senators Leahy and Sanders, and Representative Welch) should vote against any reconciliation health care bill that is similar to the recently passed House and Senate bills. There is an opportunity for a Vermont revolution leading to the export of robust Vermont values of fairness , reasonableness , and decency to the rest of the country.

Our congressional representatives should insist on an open and public debate about the potential merits of a single-payer system by the President and Congress.

They should also insist on a renewed professional and ethical commitment to public service by disposing of any PAC funding that may have established a conflict of interest, and thus, potentially clouded their objectivity. In the absence of such a ‘return to sender’, they should recuse themselves from voting on the matter. Such ethical requirements are standard for non-elected federal government officials and should be followed by elected officials as well.

History would judge such courage, enlightened thinking, and leading by example generously.

Objective data show that the only moral and economic solution to our health care crisis is a transformation from the current market-based multi-payer health insurance system to a single-payer system (Medicare for All). Hundreds of billions of dollars would be saved annually due to decreased administrative costs ($300-400 billion); better drug price leveraging ($100 billion); improved preventive care, quality, and choice; and elimination of ‘uninsured’ costs ($40 billion). A single-payer system would result in universal medical and dental coverage, cost-effectiveness, improved quality, enhanced choice and career flexibility, elimination of an overhead stranglehold on business competitiveness, a stimulus to our economy, and job creation.

Anti-fraud and tort reform should be included, each potentially saving $40-50 billion; the latter would neutralize legitimate charges that its omission is hypocritical in a bill touted as comprehensive reform.
 
Why the business community and Congress have not embraced single-payer reform is mystifying because it is a win-win for all (except for insurance and pharmaceutical companies). One would expect that Republicans and Democratic voters more concerned about fiscal responsibility and access, respectively, should support it. In the absence of leadership teaching about the issue, ideology bias clouded Republican judgment, and perception of idealistic unrealism led to Democratic giving up. For Congressional representatives, more cynical explanations may be more accurate because they should know better. Objective assessment of the evidence cannot be reasonably expected in the face of conflicts of interest from acceptance of significant PAC funding.
 
There are positive aspects to the proposed bills, including expansion of coverage via Medicaid and subsidies, and community rating precluding adverse risk selection for ‘pre-existing conditions’. These should be enacted rapidly in concert with anti-fraud and tort reform and with funding by removing the tax exclusion for employer-sponsored health insurance for high income earners.

This deficit neutral strategy would allow breathing room to tackle transformational reform, because on balance, the negatives outweigh the positives in the current bills: Expansion of coverage and universal community rating do not go into effect for years after which millions will remain uninsured and more without dental care; Medicare funding for safety-net hospitals is diverted to insurance companies also gifted a mandate bonanza of millions of healthy young customers; funding is inequitable because of taxation of Cadillac policies rather than high-income earners; and accounting gimmicks are likely to lead to unrealized fiscal assumptions.

The Public Option considerations, deleted from the Senate bill, would have addressed few Americans and transferred costs for sicker enrollees to the public. As state programs have not led to economically sustainable universal coverage, these would probably not ‘bend the curve’ nationally either. That Vermont received special consideration, in the company of Nebraska, does not validate the virtues of the proposed bills nor should it lead to the lauding of our representatives’ ingenuity. Most notably, enactment of the bills will usurp real reform, resulting in investment of additional hundreds of billions of dollars in a failed system. We will have ‘won a battle’ but ‘lost the war’.
 
In early December, Senator Sanders submitted Senate Amendment 2837, proposing to replace most of the Senate bill with language from his previous single-payer bill (Medicare for All) (S. 703). The Amendment was scheduled for a floor debate but was withdrawn after negligible Democratic support. In the absence of co-sponsorship, I presume Senator Leahy would not have supported it.

I believe Vermonters should request that Senator Leahy: (1) explain why he did not co-sponsor Senator Sanders’ Amendment; (2) inform Senate leadership he will vote against the current bills, forcing consideration of true reform (including Medicare for All); and (3) explain how representatives’ acceptance of PAC funds does not cloud objectivity, create a conflict of interest, and professionally necessitate recusal from voting (unless funds were ‘returned to sender’).

This was a missed opportunity for promoting Vermont values of fairness and reasonableness, securing a legacy of enlightened leadership, and marginalization of industry special interests. But it is not too late because each Senator currently has effective veto power. Rather than relinquishing the Vermont representation’s power to lead by automatic caucusing and putting Party ahead of Country, Senator Leahy can force leadership back to the drawing table, providing an opportunity for truly transformational reform to be debated.

History would judge such courage generously.