Why Vermont Failed to Enact Single Payer? (Part 1)

Guest Opinion by Dr. Samuel Metz on the Lund Report:

Its collapse was a legislative failure, according to this author, which Oregon legislators deserve support so the same problem doesn't befall us.

Drawing unwanted national attention to his tiny state, Governor Peter Shumlin pronounced Vermont’s quest for universal health care Dead On Arrival. This statement broke the hearts of activists who previously cheered passage by the 2011 Vermont legislature of Act 48, the first step toward America’s first statewide universal care plan.

But this collapse was no ordinary failure. It was not a failure of universal care, or of single payer, or even of Gov. Shumlin himself. This was a spectacular failure of a very different nature, and one with valuable lessons for Oregon. But we must learn the right lessons, not the wrong ones.

The Wall Street Journal called this a failure of universal care to reduce costs. Not true. Not only was the universal plan never implemented, all predictions in Vermont’s universal care study, prepared at the request of the legislature by Dr. William Hsiao, remain valid. Regardless of costs, universal care in Vermont would still provide better care to more people for less money. Dr. Hsiao’s conclusions are corroborated by more than two dozen other studies in 14 states that come to the same conclusion.

Megan McArdle of Bloomberg View called this a single payer failure. But this was not a single payer failure because Vermont did not enact single payer. Vermont made a valiant effort to provide universal health despite many federal laws, including Medicare, ERISA, and the Affordable Care Act, that make single payer impossible in any state. Instead, Vermont created a work-around in which Green Mountain Care, the proposed state health care program, would have included less than 60% of its population; Vermont’s proposal included multiple payers, not just the state single payer.

James Haslam, executive director of the Vermont Workers' Center and a respected leader in Vermont’s campaign for universal care, labeled this as Gov. Shumlin’s failure. But as tempting as it is to blame the messenger, this failure was not Gov. Shumlin’s. Governors do not enact legislation; legislatures enact legislation. Vermont’s 2011 legislature dared to establish a universal care plan, but it left enactment of the taxes to fund that care to the 2012 legislature. The 2012 legislature left the task to the 2013 legislature. The 2013 legislature left the task to the 2014 legislature. When the 2014 legislature left the task for the 2015 legislature, Gov. Shumlin did not need a Hebrew prophet to read the writing on that wall. He simply stated the obvious: No Vermont legislature in the foreseeable future would take that responsibility. He pronounced the death; he did not kill the patient.

The collapse of the Vermont plan was a legislative failure, clear and simple.

For the record, Gov. Shumlin and the majority of legislators were Democrats.

No matter how expensive health care becomes, private insurance costs more than single payer. In every population – the poor, the sick, the elderly, employees of large businesses who self-fund, our veterans – single payer costs less.

But Vermont legislators did not believe they could vote for replacing insurance premiums with single payer taxes and still get re-elected. Neither did Gov. Shumlin.

Gov. Shumlin attributed the death of Vermont’s universal care plan to runaway healthcare costs and the increased taxes needed to pay those costs. Both are true: Vermont’s healthcare costs are rising (like every other state) and higher taxes would be necessary to match them. But universal care does not generate higher healthcare costs. It converts what we currently pay privately (i.e., employer premiums, family premiums, deductibles, co-pays, out of network payments, and excluded medication costs) into taxes. Premiums, out of pocket payments, taxes – it’s all our money, just different labels.

And while the efficiency of single payer reduces total healthcare costs (not dramatically – most studies, including Dr. Hsiao’s, suggest a modest 5-10% reduction), the primary advantage of single payer is guaranteed access to healthcare that costs less, that removes fear of bankruptcy, and that does not depend upon employers.

What is Vermont’s lesson for Oregon?

Our legislators need our unequivocal support before they will make bold decisions: not just to enact universal healthcare (like Vermont), but to create the tax plan to fund it (unlike Vermont).

Legislators will not respond to our need for universal healthcare unless we tell them. Legislators will not vote for new taxes to fund universal healthcare unless they know they have our vote if they do. Enabling our legislators to avoid the debacle of Vermont requires us to take our message directly to their offices: We want universal care. We want them to make it happen. And we will vote for them if they do.

We must give our legislators courage (and our votes) to do the right thing. That’s Vermont’s lesson for Oregon.

Samuel Metz, MD, is a private practice anesthesiologist in Portland. He has collaborated with Oregon State Sen. Michael Dembrow on passing the HB 3260 study of financing options for universal health care in Oregon. Dr. Metz can be reached at S@SamuelMetz.com. More information about the HB 3260 can be found at www.OregonStudy.org.

Jan 8 2015

Get involved today with the Oregon campaign for publicly funded universal health care.  Attend our the Rally on the Capitol Steps on February 11, and attend our monthly meetings.

As Vermont Goes, So Goes [Oregon] the Nation?

Three years ago, Peter Shumlin, the governor of Vermont, signed a bill creating Green Mountain Care: a single-payer system in which, if all goes according to plan, the state will regulate doctors’ fees and cover Vermonters’ medical bills.

Green Mountain Care won’t begin until at least 2017, but Vermont liberals are optimistic. “Americans want to see a model that works,” Senator Bernie Sanders told The Atlantic in December. “If Vermont can be that model it will have a profound impact on discourse in this country.”

Before you dismiss that prospect as wishful thinking, consider: That’s how national health care happened in Canada. A third party’s provincial experiment paved the way for national reform. In 1946, the social-democratic government of Saskatchewan passed a law providing free hospital care to most residents. The model spread to other provinces, and in 1957 the federal government adopted a cost-sharing measure that evolved into today’s universal single-payer system.

Full article here.

NOTE: We are working hard to pass a similar bill in Oregon. Sign up for our newsletter updates, Like us on Facebook, and Follow us on Twitter to keep informed and see how you can help.

Oregon small business owners favor universal health care: survey

From the Portland Business Journal:

A majority of Oregon’s small business owners support universal health care, and although they lack information about federal health reform and the state’s health insurance exchange, they are eager for more information, according to a survey by Main Street Alliance of Oregon.


Cover Oregon: Oregon's New Health Care Exchange

Learn how Cover Oregon can help you at this meeting on August 20.

Cover Oregon is our state's insurance exchange.  Insurance Exchanges are being set up to provide an on-line consumer-friendly way to find affordable health insurance plans for every uninsured individual and small business, with individual subsidies based on need.

Learn about the co-ops that will join for-profit insurance companies to offer coverage.

Campaign for Single-Payer Building Up Steam in Oregon

Inspired by Vermont's success in establishing a state-run program, Health Care for All Oregon to start a grass roots public outreach campaign
Christen McCurdy

August 30, 2012 -- The effort to establish a single-payer system in Oregon isn't dead. A group called Health Care for All Oregon has existed in Oregon for about 20 years, but its corporate identity was
passed on to a newly formed group this January, said Dr. Mike Huntington, a Corvallis oncologist who serves as the organization's chair. So far the group includes a board and a coalition of 53 groups – including healthcare organizations, community groups and labor organizations – devoted to educating the public and eventually attempting to pass legislation guaranteeing healthcare for all of Oregon's citizens.

Huntington said the renewed campaign has taken inspiration from what organizers in Vermont were able to accomplish. Single payer bills were introduced in Vermont for more than 25 years, but were
unable to get legislative approval until a widespread public education campaign around the theme of health care as a human right raised enough public interest that voters put pressure on legislators to pass the bill.

“It takes more than just very good, logical, irrefutable arguments,” Huntington said. Right now, the group is focused on talking to coalition members and in the coming months will provide training and public outreach events to discuss its public education campaign, which will still emphasize healthcare as being a human right – but also differentiate the proposed reforms from those that have already been passed at the state and federal level.

“Our focus is, first of all, educating, informing the population about the need for universal access and a good quality healthcare system, in addition to the state and federal legislation that has already been passed or is in the process of being implemented,” Huntington said. “Even with the best possible system there will be huge problems or huge deficits.”

Huntington said the Oregon Health Plan was originally designed with some tools similar to those used in countries with single-payer care systems, including a list of procedures that should be prioritized for coverage, with immunizations and other preventive treatments taking highest priority. That reform was hamstrung because officials intended to fine-tune the list every year based partly on public input, which violates a clause in the Americans with Disabilities Act, which prevents the state from discontinuing coverage for services it has covered in the past.

“There were a number of reasons it was shackled, really, that had little to do with how well it was designed,” Huntington said.

Part of the success of the campaign message is that it's simple, Huntington said, adding that proponents of healthcare reform have to become more comfortable speaking in sound bites. Even so, he added his own qualifier to the message:

“I would qualify that 'healthcare is a human right,' it doesn't mean you get an MRI if you have had back pain for two weeks,” Huntington said. “It means you get the healthcare you need, when you need it.”

“Conservative critics would respond, Healthcare is not a human right,” said Portland anesthesiologist Dr. Samuel Metz, who’s involved with coalition but clarified that he was speaking on his own behalf to The Lund Report. “Here's where I'm in the minority: I believe we can be more successful if we point out that providing healthcare is not a goal, it's a tool.”

Even if people are ideologically opposed to the idea of providing healthcare for others, pointing out that they're already paying for care for the uninsured – in the form of higher insurance premiums and higher costs for services – can help persuade them that providing insurance upfront will help control those costs.

In 2011, House Bill 3510 – which was introduced by Rep. Michael Dembrow (D-Portland) proposed single-payer healthcare in Oregon – failed, but went further than sponsors expected. Part of the problem, Metz said, was that the bill's sponsors were mostly Multnomah County Democrats, but some Republicans showed interest in its potential to control costs: he estimated that 40 percent of the cost of healthcare is administration. Metz also noted that CEOs of three major Oregon insurers – Providence, Kaiser and Legacy – have been quoted on record as favoring single-payer healthcare, even while lobbyists for the insurance industry fought it.

“These are all fairly insightful people, and they're not speaking for the industry,” said Metz, adding that the Canadian healthcare system actually started with one province – Saskatchewan – creating a single- payer system, with several others following suit until the country decided to nationalize the program.

“We're the only country that lets 44,000 people die each year because they don't have insurance. We think it's normal in the United States that if your insurance won't pay, you have raise $150,000 at a bake sale. We think that's normal,” Metz said. “It doesn't have to be this way.”