Will Colorado Become the First State to Implement Single-Payer Health Care?

Tuesday, 20 October 2015
by Michael Corcoran, Truthout | Report

The fight for a statewide single-payer health-care system has shifted from the Green Mountains to the Rocky Mountains: Colorado citizens are about to put single-payer up for a statewide ballot referendum in the 2016 election. If voters approve, the state constitution will be amended to create a statewide, publicly financed, universal system for the first time in US history.

After a long struggle, Vermont's proposal for a similar plan died in January 2015, after a decision by the governor to abandon the plan. Green Mountain Care, as it was known, is the closest any state has come to implementing a public health-care system that covers everyone. So the failure was a major disappointment for advocates for social justice everywhere. But the setback didn't stop activists in states across the country from pursuing similar reforms. Many in these states watched events in Vermont closely - to see what worked and what didn't and to avoid the pitfalls that proved fatal.

Colorado has been especially active, and activists are set to turn in more than 150,000 signatures (about 99,000 are required) to put health reform on the 2016 ballot, said Lyn Gullette, campaign director for ColoradoCareYES. Organizers say they are optimistic that their strategy will succeed where Vermont's failed - and that when ballots are cast in 2016, public, universal health care may become a reality in Colorado.


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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.

Post-Tour Q & A with Gerald Friedman

Mike Huntington relayed these questions to Gerald Friedman. Clarifications in red are Mike’s.


Q. What’s your opinion about the wisdom of individual states achieving single-payer healthcare rather than working politically to achieve a national single-payer system?
A. With our national government gridlock, states’ efforts are needed even though they may not achieve economies of scale and other benefits of national health insurance. We need to start with a few states in order to match the success of OECD countries in providing the best healthcare to the most people at the least cost.

Q. How can we handle the mechanics of single-payer at the state level? We don’t have the administrative machinery of Medicare to achieve a 2% overhead. (We can’t even build an exchange.)
A. A state single payer plan will be far simpler than the exchanges. Billing could be handled through phone terminals at each provider’s office and healthcare credit cards or smartcards.

Q. What changes should Oregon make for a state-level effort to achieve health care for all Oregon?
A. Get the feds on board regarding Medicare and Medicaid. Learn how the VA is negotiating prices for pharmaceuticals.

Q. Is the co-pay is less likely to prevent the patient from making an appointment and getting needed care than a deductible?
A. Dr. Friedman prefers neither although the co-pay could be administratively simple.

Q. Is there any movement by the people toward single-payer in Massachusetts since healthcare costs are not being controlled by Romney Care?
A. Yes! There is a strong movement for single-payer healthcare in Massachusetts. One third of the legislators (13/40 in the Senate) favors single-payer. Donald Berwick is running for governor, calling for single-payer.

Q. What do you think it will take to achieve a national single-payer system?
A. It will take determination by single-payer supporters. Right now it’s time for the ACA to play itself out.

Q. How can we get around the federal employee benefit plans, federal retirees, and other plans over which the state has no control?
A. We can ignore them if we offer the health plan to everyone in the state.

Q. Are you confident that the assumptions you made in HR 676 (Medicare study) are applicable at the state level?
A. No, they are not.


Q. What kind of taxes would you recommend here in Oregon? (Remember we are one of the few states that does not have a sales tax and that depend heavily on personal income taxes to meet the state’s needs.)
A. A top rate would be 9% but this would be deductible from federal income tax assessment. The top federal tax would be 38% making the total 47%.

Q. What type of taxes might people accept?
A. Rich people will probably favor payroll tax, while businesses and corporations will favor an income tax.

Q. What lessons have we learned from Vermont? Do you think they are applicable to Oregon?
A. Vermont and each state will have to deal with the fact of imposing a very large tax. Vermont’s bill based on health care as a human right was passed but without funding explicitly outlined. Now Vermont is struggling to answer funding questions.

Q. You recommend payroll taxes as a part of the formula to finance a single payer plan but with different levels of tax at different income levels. Would the employers match the payroll tax paid by employees? Would large and small employers pay the same percentage?
A. Yes, but in reality both the employer contribution and the employee contribution come from the employee as part of the negotiated salary/benefits package. All payroll taxes are really from the employee. Any amount of payroll tax paid by the employer represents foregone wages negotiated away from employees. Workers wages have been relatively flat over the past twenty years as US business productivity and CEO incomes have dramatically risen. -- Mike Huntington.

Q. How would a single-payer system save money for a small business, that is, one with 50 or fewer employees?
A. A business owner would have personal savings because of reduced or eliminated insurance premiums. Business would increase because consumers would have more money. Employees would be healthier, more productive and reliable. There would be a decreased payroll tax. Recruiting employees would be easier. Even if a business does not qualify for or take advantage of a tax credit through the ACA or does not offer health insurance to its employees (the owner must offer health insurance to employees if the business pays for the owner’s policy) the owner as an individual will save money under a single payer system like everyone else. Everyone else will have more money to spend because they will be paying less for health care. -- Mike Huntington.

Q. What happens to the liability of corporations that have guaranteed future health insurance to retired employees?
A. Corporations (especially multistate corporations) will be relieved of their liability and should jump at the chance to do so.

Q. A tax on financial transactions (“Tobin tax”) should be supported by those who are concerned about stability in the economy. What are some of these groups, and are they actively seeking a Tobin tax right now?
A. National Nurses United and the progressive Caucus of Congress led by Keith Ellison of Minnesota support a Tobin tax. (In other words, liberals and labor.)

Q. Are there financial/cost studies available that a non-financial person can see and understand regarding how or whether universal healthcare payment is viable?
A. Yes. Go to the national PNHP website and enter Gerald Friedman in the search window. Also go to dollarsandsense.org for a two-page summary by Dr. Friedman.


Q. What is rent-seeking?
A. It is making a monopoly out of business to increase one’s profits. Examples are big Pharma’s ever-greening of drug patents; also hospitals and insurance companies buying up physician practices.

Q. Do you expect the pharmaceutical industry, hospitals, and medical equipment makers to argue against a single payer system? Are they going to do this right now, do you think?
A. Not now but later, yes, these companies will pour hundreds of thousands of dollars into a media campaign opposing any single-payer proposal that appears to pose a threat to them.

Single-Payer Advocates Hit Capitol With New Sense Of Reality

Advocates for a single-payer “Medicare for all” health system are fanning out across Capitol Hill this week, lobbying members of Congress.

Photo by Karl Eisenhower/KHN

But years of mostly fruitless struggles – and watching the intense opposition to the much less sweeping Affordable Care Act – appears to have left them with a much more clear-eyed view of what it will take for them to accomplish their goal.

“This is tough stuff,” Sen. Bernie Sanders, D-Vt., told a roundtable of advocates he convened in the Dirksen Senate Office Building. “Single-payer health care bills – it ain’t going to take place here in Washington. I suspect it’s going to take place, as it did in Canada, with a state [Saskatchewan] going forward. I hope it will be my state.”

Indeed, Vermont in 2011 passed legislation that would make it the first state to create its own single-payer system, called “Green Mountain Care.” The experiment is set to launch in 2017, the first year that’s allowed under the Affordable Care Act. But key decisions about exactly how the plan would work, in particular how it would be financed, have yet to be made.

Meanwhile, those who have been pushing for a system that would effectively end private insurance say there’s no question they have the facts on their side.

“What we know about single-payer has zero to do with the merits,” said Robert Weissman of Public Citizen, referring to widespread charges by opponents that single payer systems are inefficient and can deny care. “We have proven alternatives in every other industrialized country in the world – better outcomes at less cost.”

More here.

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.

Not far enough? Health care for everyone isn’t a question of realism – it’s a moral necessity

This article was written by two medical students, Gabriel Edwards and David Mealiea. They have really good insight into what ails our health care system, and what we need to do to heal it.

"The patients we described above are just a few of those millions of Americans struggling with the effects of being uninsured. But additionally, we have an epidemic of inadequate coverage among Americans who are insured. Without solving the latter, we won’t adequately help the former even if we managed to insure every man, woman and child in the country. Getting everyone on board with health insurance is an initial step, but if everyone is on board a vessel which is slowly sinking, we haven’t gone far enough. In theory, paying for insurance should result in adequate, affordable health care. In reality, it doesn’t. And that brings our entire approach to financing health care into question.

We believe that health care reform has to go beyond tethering more Americans to our current, dysfunctional system. But the only way that we can evolve toward a better system is to transcend the scope of the current debate that has dominated mainstream discussion. One of the effects of the battle to pass, preserve and implement the ACA has been the way it has framed this debate as a simple dichotomy between the law’s articulated vision and the status quo.

We write this article to encourage fellow students to consider another way, one that imagines a system that can serve all Americans’ needs. We have seen the financial and human costs that have resulted from our current system. Whether we choose to acknowledge it or not, the suffering of those without adequate access to health care weighs on us all, economically and spiritually. Reform should strive to bring people together in the task of improving the well-being of all Americans and not, as Dr. Margaret Flowers said in an opinion piece in Al Jazeera, to lower “the bar for what is considered to be adequate health insurance coverage.”

Our national conversation has been dominated by the question of insurance, and as much as we have one of our own, shouldn’t the purpose of insurance be to create a pool as wide as possible so that those of us who are sick can benefit from the support of those of us who are well? Other industrialized nations have managed this; here in the United States, Medicare and the Veterans Administration have managed the same for subsets of our own population, and are popular and operate with minimal administrative cost when compared to private insurance companies. Why wouldn’t a single unified system, then, encompassing all Americans, most effectively accomplish this? One simple enough not to crumble under the weight of its own complexity and in the face of an opposition that would rather profit from the fragmented status quo?"

Read the full article here.

Letter: Vermont Should Stay the Course on Single-Payer

To the Editor:

Gov. Peter Shumlin has been steadfast in his commitment to designing a universal health care system in our state, and he has huge support from Vermont providers and consumers. Michael Costa is the financial guru hired who, with a top flight team of experts in Montpelier, is designing several scenarios for how this will work. It is highly complex, as he says, and they must do impact studies as well as crunch the numbers, and I hear them to be committed not to have the entire burden fall on Vermont’s businesses, especially small businesses.

But if we in Vermont can shed the monstrous costs of for-profit insurance companies that admittedly are in business to provide dividends to investors and astronomical CEO and administrative salaries (high even for the corporate CEO expectations in America), we will have set up a model for other states to follow and improve on. What must be repeated over and over again is that for-profit insurance companies are not in the business of providing health care.

If Vermont can meet this challenge with all the federal roadblocks and right-wing corporate funds being poured into the state to block this people’s movement, many other states will want to have a look. Think of having this universal health care system for public employees. What would this do in reducing tax burdens on all of us? We already support fire, police and schools in the public interest to provide a civil society; I’d like to know that the people serving me in restaurants and elsewhere are healthy and taking care of their well-being just as I feel the protection from police and firefighters.

So we support Gov. Shumlin, we are glad he gave this talk to Dartmouth graduate students (“Shumlin: Timing Is Key for Single Payer,” front page, Jan. 28), and we look for their understanding and help as we organize health care providers in Vermont to stay the course and work with us toward a health care system such as others in Western democracies already benefit from.

Ann Raynolds, Psy.D.


VT Health Care For All Board of Directors

Valley News

Single Payer Rises Again

As the ACA takes effect, an alternative gains ground at the state level

When Sergio Espana first began talking to people, just over a year ago, about the need for fundamental changes in the U.S. healthcare system, confusion often ensued. Some people didn’t understand why, if the Affordable Care Act (ACA) had passed, people still wanted to reform the system; others thought organizers were trying to sign them up for “Obamacare.”

Healthcare is a Human Right Maryland, the group to which Espana belongs, is in pursuit of something else: a truly universal healthcare system that would cover everyone and eliminate insurance companies once and for all. Espana and many others in the growing movement see opportunity in the renewed discussion around healthcare reform as the ACA’s insurance exchanges go into effect.

They believe that the ACA’s continued reliance on (and subsidies of) private insurance simply aren’t good enough. People are still falling through the cracks, employers are trying to dodge the requirement that they provide insurance for their workers, and many states refused federal subsidies to expand their Medicaid programs. What these activists want is a program that would replace existing insurance programs, cover everyone regardless of their employment status, and be funded by the government, with tax dollars. Such a plan had strong support when the national healthcare overhaul was being crafted in 2009—including initial backing by President Obama—but the president and Congress decided it wasn’t politically possible and passed the ACA as a compromise.

More here.

Wondering what Vermont is up to these days?

Vermont Tests Single Payer and the Country is Watching

By Darshak Sanghavi, M.D., and Sarah Bleiberg
KevinMD blog, Jan. 28, 2014

While the Affordable Care Act, or Obamacare, has been criticized by its opposition as “socialized medicine,” it relies heavily on private health insurance. On the other end of the political spectrum is the idea that a government-run single payer system, similar to Canada’s, is the best way to deliver health care. (This is sometimes shorthanded in the U.S. as “Medicare for All.”) However, this system has been believed politically impossible here—until now. In May 2011, Governor Pete Shumlin of Vermont signed into law “An Act Relating To A Universal And Unified Health System,” House Bill 202 (HB 202), establishing a single payer health care system beginning in 2017. In passing this legislation, Vermont has become a closely watched laboratory for health reform.

What are the pros and cons of a “single payer” system?

In general, single payer health care means that all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate, and citizens receive the same health benefits, regardless of their ability to pay.

There are a number of proposed benefits to a single payer system. Currently, providers must follow different procedures with each of many insurance companies to get paid, creating an enormous amount of administrative work. Under a single payer system, providers might reap significant savings from reduced administrative expenses, and be able to focus more on delivering care. As with Medicare, a single payer system may also give the state stronger leverage to negotiate lower rates for drugs, medical devices, payments to providers and other expenses, resulting in lower overall costs. Additionally, a single payer system provides universal access to health insurance, which eliminates the problem of the uninsured.

More here.

Can Vermont's Single-Payer System Fix What Ails American Healthcare?


The Affordable Care Act's turbulent implementation has ruled the news cycle, but across the country states like Vermont are experimenting with their own plans.

Governor Peter Shumlin signed a revolutionary single-payer plan, Green Mountain Healthcare—the culmination of decades of work by progressive politicians in the state—into law in May 2011. The new system aims to guarantee universal insurance coverage, improve benefits for those who are currently underinsured, include universal dental care and vision care, and increase the Medicaid reimbursement rate to doctors in order to avoid cost-shifting.

Read the full article in The Atlantic.

Vermont working toward universal health care in 2017

As states open insurance marketplaces amid uncertainty about whether they're a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.

The state has a planned 2017 launch of the nation's first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.

Read further.