Vermont & Single Payer: McDonough, McCanne, Eaton, Early & Knowlton Sound Off
Vermont & Single Payer: McDonough, McCanne, Eaton, Early & Knowlton Sound Off
The Demise of Vermont's Single-Payer Plan
John E. McDonough, DrPH, MPA, New England Journal of Medicine, April 23, 2015
NEJM article and audio: http://www.nejm.org/doi/full/10.1056/NEJMp1501050
On December 17, 2014, Vermont Governor Peter Shumlin publicly ended his administration's 4-year initiative to develop, enact, and implement a single-payer health care system in his state.
In reality, the Vermont plan was abandoned because of legitimate political considerations.
In many states, legislators continue filing bills to establish state single-payer systems. Because of Vermont's failure, their path is both clearer and more difficult. Any other state considering this path will find obstacles similar to Vermont's.
In the early 1990s, I served as a Massachusetts legislator who took a turn as the state's leading single-payer advocate. After years of failure, I reluctantly concluded that single payer is too heavy a political lift for a state. Though the economic case is compelling, our body politic cares about more than just economics. In 2011, many observers thought that Vermont, a small and progressive state, was the ideal locale in which to try single payer. No more.
At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans. If advanced by the right leaders at the right time, the logic of consolidation may become glaringly evident and launch us on a new path. If such consolidation is to occur, like it or not, I believe it will happen federally and not in the states - and no time soon.
From the audio:
“People who like the state approach refer to how the Canadian health care system started with the adoption of universal coverage for hospital services in the province of Saskatchewan back in the 1940s, and that is the idealized model. I just am unclear, unsure, doubtful how relevant that model is in an advanced developed system like those in the United States and the fifty states at this point.”
(John McDonough is a professor of public health practice and director of the Center for Executive and Continuing Professional Education at the Harvard TH Chan School of Public Health.)
Comment by Don McCanne, MD:
Professor John McDonough, as an academic and as a legislator, has long been in the trenches with single payer. He knows what he is talking about.
The problem with using Saskatchewan as a model for reform in the United States is that Canada began with a clean slate whereas we have complex federal and state financing systems that will need to be replaced. States alone cannot do it without federal action.
Though we need federal reform, it will not happen in the immediate future since the politics are not in alignment. We need to intensify our efforts with the basics: education, coalitions, and grassroots organizing.
Until we get the politics aligned, activists should continue advocating for whatever state reforms are possible that would move us closer to health care justice. But do not let up in the least on the drumbeat for a single payer national health program - an improved Medicare that would cover everyone.
(Don McCanne’s Quote of the Day, April 24, 2015 ~ http://www.pnhp.org/news/2015/april/john-mcdonough-on-vermont%E2%80%99s-single-payer-lesson)
Sandy Eaton, RN:
"Who knows the mind of a Democrat?" - one of my favorite quotes from the movie Reds. It's time to dust off the pitchforks. Time to climb the hill in Montpelier, Boston and DC to drive out the lobbyists. As for John, he made the smooth transition from social democrat to New Democrat. If he couldn't get single payer through the Massachusetts legislature in the '80s, then no one could, so it's time to move on, just like Ted Kennedy in Congress a decade earlier.
Don McCanne will apparently grasp onto anyone who lends credence to his own single-payer-is-futile-at-the-state-level position, including mis-identifying McDonough in this fashion. He was a big ally of the Duke and Rob Restuccia's Mass Health Care For Some in pushing mandated benefits, circa late 80s - and was not, as I recall, such a great champion of anything better, then or now!
You probably saw this - fortunately, VWC is not quite as defeatist as Professor John, although it certainly is saddled with overcoming the resistance of quite a few present-day state legislators of McD's old Bay State political cast ...
After Single Payer Setback: Union Members Face Multiple Threats in Vermont
Steve Early, CounterPunch, April 23, 2015
Liz Nikazmerad is a rarity in American labor: a local union president under the age of 30, displaying both youth and militancy. For the last two year years, she has led the 180-member Local 203 of the United Electrical Workers (UE), while working in the produce department of City Market in Burlington, Vermont. Thanks to their contract bargaining, full-time and part-time employees of this bustling community-owned food cooperative currently enjoy good medical benefits.
But that wasn’t always the case in Nikazmerad’s past non-union jobs, nor is it any assurance that UE members won’t be forced to pay more for their health care in the future. To curb medical cost inflation and related cost-shifting to workers, the UE has long advocated that private insurance plans be replaced with publicly funded universal coverage.
Four years ago, a newly elected Vermont governor, Peter Shumlin, took a promising first step in that direction at the state level. His Democrat-dominated legislature passed Act 48, which laid the groundwork for creating a comprehensive public insurance plan called Green Mountain Care (GMC).
Not all activists deemed GMC to be truly “single-payer,” because of potential legal or political obstacles to the inclusion of Vermonters currently covered through Medicare, the Veterans’ Administration, and even some “self-insured” plans offered by local employers. However, Act 48’s blueprint for getting everyone else into a more rational, cost-effective healthcare system, financed by taxes, was generally hailed as a great breakthrough.
Unfortunately, the Affordable Care Act (ACA) first required Vermont to operate a private insurance exchange until 2017, when a federal waiver permitting further experimentation might be granted. Despite this unhelpful delay, Shumlin was still re-assuring Vermonters, as recently as last fall, that a brighter health care future lay just a few years ahead.
By January 8, when the governor began his third term, that promise had dimmed so much that Liz Nikazmerad and several hundred others weren’t there to applaud his inauguration in Montpelier. Instead, frustrated advocates of health care reform staged a sit-in at the state capitol, chanting and singing, unfurling banners and refused to leave in protest against the governor’s abrupt abandonment of universal health care six weeks after his re-election.
“People had fought for this a long time,” Nikazmerad says. “It was a huge win and to have the rug yanked out like that was very upsetting. People were very emotional about it.”
Escalating Labor Protests
By the end of day, the UE leader and 28 others - now known as “The Statehouse 29” - faced multiple criminal charges, including resisting arrest, despite the peaceful nature of their capitol sit-in. The cases against 18 were later dropped; other participants settled by paying a fine or promising to do community service work. Their still controversial reproach to the governor has, since January, become the first in a series of angry labor sorties to Montpelier.
During the current legislative session, the bitter recriminations over the governor’s health care retreat have morphed into broader controversies about workers rights, contract concessions, and what the Vermont Progressive Party (VPP) calls Shumlin’s “austerity budget.” On April 11, 500 state employees, school teachers and other union members rallied at the state house to protest threatened budget cuts and state worker lay-offs. Among the demonstration sponsors were the VPP, the Vermont State Employees Association (VSEA), and the Vermont Workers Center, which is also building for another big labor gathering on May Day in Montpelier.
“I’m tired of being asked to give back more and more of my wages and benefits, “ state highway department plow driver Ed Olsen told the crowd. “The state always wants to balance the budget on the backs of hard-working Vermonters.”
Alison Sylvester, a leader of the Vermont NEA, added her union’s voice to the “Fight Back” rally and hailed public teachers successful defense of their right to strike. After a brief public school work stoppage in South Burlington last fall, Governor Shumlin publicly endorsed the idea of banning such strikes, which have been legal in Vermont for fifty years. It took several months of frantic lobbying by hundreds of teachers to kill this idea, by a two-to-one margin, in a Vermont House vote in early April.
About Face On Single Payer
Shumlin’s most publicized betrayal of past labor allies occurred,with little advance notice, on December 17. That’s when he called a press conference and declared that “now is not the time to ask our legislature to take the step of passing a financing plan for Green Mountain Care.” The 58-year old governor, a multi-millionaire former business owner, had already postponed the day of reckoning on how to fund universal coverage for more than two years, until he was narrowly elected for the third time. (In last year’s gubernatorial race, Shumlin greatly outspent his Republican challenger, but won by only 2,500 votes; his 46 percent showing would not have been sufficient without conservative vote-splitting by a Libertarian candidate.)
The 2015 session of the legislature was expected to take up the challenge of Act 48 financing in January. With the acquiescence of key legislators, Shumlin short-circuited that debate by issuing a highly unfavorable status report of his own, which seemed to validate past single-payer criticism by the Vermont GOP and conservative Democrats. According to Shumlin, the latest projected cost of universal coverage would double the state budget in its first year alone, while requiring onerous new payroll and income taxes.
“In my judgment,” the governor stated, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” The VWC, which helped mobilize statewide support for passage of Act 48 four years ago, countered the governor’s claims by releasing its own plan for financing Green Mountain Care in a manner more equitable than the state’s current market-based system.
One hundred economists endorsed the VWC approach, which relies on progressive taxation. The VWC also struck back with a clever “whiteboard” video, entitled “The Time is Now: Healthcare Financing for Vermont, Explained in Three Minutes.” But, of course, neither that quick tutorial on health care reform math or the VWC’s full report garnered the media attention - or had the same legislative clout - as Shumlin’s self-demolition of Green Mountain Care.
From bad to worse in Montpelier
In his state budget address in January, Shumlin had another surprise for his past labor friends. He presented the 5,500-member VSEA with a choice between re-opening its current contract and agreeing to give-backs or face hundreds of layoffs. These steps were necessary, he announced, to close a fiscal year 2016 budget deficit, projected to be $112 million, which soon become the main preoccupation of his administration and its legislative allies.
Legislators representing the Vermont Progressive Party (VPP), the nation’s most successful third party formation, urged their Democratic colleagues to raise needed revenue by capping tax deductions for the wealthiest Vermonters and taxing capital gains on the same basis as earned income. (For more on the VPP, see here.)
Neither the Democratic leadership nor the governor wanted to do that. So his administration is instead seeking $8.8 million in state worker concessions, and the Democrat-controlled House has already OKed cuts in social programs like heating assistance for low-income households.
In 2008-9, VSEA members agreed to a 3% pay cut, followed by a freeze, under Shumlin’s Republican predecessor. When Shumlin ran for governor in 2010, he promised to be more labor friendly and find better ways to pay for state programs, including the projected single-payer-like plan. Now he is scapegoating unions that backed him and health care reform, complaining that state workers’ scheduled pay hike this year is unreasonably high. “There aren’t too many Vermonters who are getting a 5% increase this year, “ Shumlin told the press on April 11.
The governor’s about-face on Green Mountain Care reflected more than revised estimates of its cost and feasibility. The troubled 2013 rollout of Vermont Health Connect, the state’s ACA-mandated private insurance exchange, adversely affected public perceptions of the longer-term goal of single payer. Among those most upset were lower-income people previously covered by state-subsidized plans who ended up paying more out-of-pocket when insured through the new exchange.
“Over the last few years, the Shumlin administration hasn’t done anything to give Vermonters confidence that we could handle being innovators in health care,” says Chris Pearson, a Progressive state rep and vice-chair of the House Committee on Health Care. “There were just too many bad headlines about the nightmare of enrolling, computer problems and cost over-runs.”
As a result, the popularity of Green Mountain Care is not what it was even a year ago. Pollsters working for the Vermont NEA found 55 percent of those surveyed in favor of the concept then, while 42 percent were opposed. A slight majority remained in favor even if implementation required, as it would, a large tax increase to capture health care system revenue currently coming, in myriad forms, from individuals and employers, in both the private and public sector.
After the recent flurry of negative publicity about Green Mountain Care - much of it generated by Shumlin’s own disputed cost estimates - 64-percent of Vermonters polled in February said they supported the governor’s new position, only 20 percent were opposed, and 10 percent were unsure. Even a majority of Democrats polled said they favored his abandonment of single payer, for the time being.
Inside the state legislature, friends of Act 48 still hope to emerge from this legislative session with an authorized study of the VWC’s financing plan, the governor’s contested findings and a publicly funded primary care plan that has been proposed by some single payer advocates as an incremental step toward Green Mountain Care.
Organizing Challenges Ahead
Sometime in May, the legislative wrangling in Montpelier over budget cuts, health care, and workers rights will be over for this year. But the challenges facing Vermont Progressives and labor-community organizers will remain daunting. Chief among them is sustaining a now seven-year-old campaign to make “healthcare a human right” after such a demoralizing setback. While continuing to assist private and public sector workers involved in strikes and contract fights, the Vermont Workers Center plans to do more grassroots organizing around the shortcomings of Vermont Health Connect coverage.
Within the VPP, its statewide organizer Kelly Mangan has “gotten a lot of member feedback about running a candidate for governor next year.” This is something her third party refrained from doing in the last three election cycles, to avoid putting a Republican in office - who would have opposed Act 48 from the outset or shelved it sooner than Shumlin did.
Now, the growing estrangement of labor voters from the Democrats could lead to Shumlin’s replacement by a Republican. One likely candidate for the job is Lieutenant Governor Phil Scott, the affable GOP incumbent who defeated Vermont Progressive Party (VPP) candidate Dean Corren last November by a 62 to 34% margin, with no Democrat on the ballot.
Any backlash against Vermont Democrats next year, though, might be salved by further VPP legislative gains. Last fall, seven Progressive state reps and three senators were elected, creating the VPP’s largest delegation in Montpelier ever. In March, Progressives captured four seats on the Burlington City Council, where the VPP has jousted with a centrist Democrat mayor.
But, next year, personal health problems may prevent state senator Anthony Pollina, the VPP’s most experienced statewide standard-bearer, from running for governor. (In 2008, he placed second in a three-way race). At the moment, Vermont’s most successful progressive politician, US Senator Bernie Sanders, seems more intent on seeking executive office higher than any available in Montpelier, where, as governor, he could help get Vermont back on the single-payer road.
In his not-yet-official campaigning for the White House, Sanders speaks regularly to out-of-state audiences about the need for a “political revolution.” Unfortunately, on his own home turf, the wrong kind of one may be brewing, fed by working class alienation from business-oriented Democrats.
(Steve Early began writing about Vermont politics in 1968. He is a former New England organizer for the Communications Workers of America and the author, most recently, of Save Our Unions, from Monthly Review Press. That book reports on single payer campaigning and progressive third party building in Vermont. Early can be reached at Lsupport@aol.com.)
I am not surprised. He has only, historically, been a single payer advocate in voice but never in practice. God forbid, he would then have to go up against the corporate forces (and their allies in the Democratic and Republican parties) and restrict (or eliminate) the industry’s ability to make a killing off of a miserable (for workers) private health insurance system. Since those are ostensibly the folks he pals around with, that ain't gonna' happen from him or any of the other "liberal" policy wonks any time soon. At least he acknowledges that something has to happen in the next 15 years but I'll bet if you go back to what he said 15 years ago you'd get approximately the same rap/convenient untruth about "perhaps 5 to 15 years from now … " All of these guys are shills (inadvertently or by choice) for the insurance industry who are are scared to death to stare it down and who blink at the slightest suggestion of a threat by them. Shumlin is the perfect example of what happens to a Dem or a Repub when the high rollers get a hold of you and say things (make threats) that make you change your tune. Not sure what Shumlin thought was going to happen but you can bet that when you threaten that industry you better be prepared to pucker up because you are in for the ride of your life. Decent trade unionists more than most folks know how to respond to these types of threats spewed by the corporate bullies. We hear them all the time from one set of negotiations to the next. This is not that complicated an issue and just saying "no" to corporate threats is as good a starting point as any.