PNHP Comments about the Wall Street Journal Article on Vermont's Single Payer Effort

The Wall Street Journal
December 22, 2014
Vermont’s Single Payer Washout

Last week, in a reversal that deserves more attention, Democratic Governor
Peter Shumlin announced that Vermont would no longer create America’s first
statewide single-payer health system.
Single payer is the polite term for socialized medicine and the ultimategoal of the political left.
At least the Governor deserves credit for admitting failure. His ideological comrades are rarely dissuaded by the prospect of economic damage, as ObamaCare proves. But Mr. Shumlin has succeeded in making Vermont a national model: By admitting that single payer will make health care both more expensive and less efficient, he has shown other states what not to do.

Vermont
H.202
Bill as Passed by the House and Senate, 2011

“An act relating to a single-payer and unified health system”
changed to
“An act relating to a universal and unified health system”

(H.202 is a 213 page bill. The first 135 pages were deleted and the
remaining pages are a rewrite of the entire bill.)

Sec.2(a)(6):

The director, in collaboration with the agency of human services, shall
obtain waivers, exemptions, agreements, legislation, or a combination
thereof to ensure that, to the extent possible under federal law, all
federal payments provided within the state for health services are paid
directly to Green Mountain Care. Green Mountain Care shall assume
responsibility for the benefits and services previously paid for by the
federal programs, including Medicaid, Medicare, and, after implementation,
the Vermont health benefit exchange.

***

Comment by Don McCanne of PNHP

As was fully expected, the conservative and libertarian pundits are
inundating the Internet and other media vehicles with celebratory
commentaries on the theme that Vermont Gov. Peter Shumlin’s withdrawal of
his single payer proposal is proof that single payer is more expensive and
less efficient than other health care financing systems. The Wall Street
Journal editorial excerpt above is selected as a leading example of these
right-wing responses. The problem with these comments is that H.202, the
Vermont reform legislation, IS NOT A SINGLE PAYER PROPOSAL.

Even many single payer supporters have it wrong. They claim that Gov.
Shumlin gave up for political reasons, and, if he had persevered, he would
have been successful in establishing the first state-level single payer
system in the U.S. Again, the problem is that H.202, the Vermont reform
legislation, IS NOT A SINGLE PAYER PROPOSAL.

Posted above is a link to H.202. During the legislative process, the bill
was renamed, deleting “single-payer” from its title. If you check the
document at the link, you will see that the original bill was red-lined
out, and the bill was entirely rewritten. All references to “single-payer”
were removed.

The crucial phrase in the except above regarding waivers and agreements is
“to the extent possible under federal law.” It was known at the time the
revisions were being made that Sec 1332 ACA waivers, Sec 1115 Medicaid
waivers, the narrowly defined Medicare demonstration waivers, and the ERISA
limitations on employer-sponsored plans were so limited that it would be
impossible to establish a bona fide single payer system through unilateral
state action alone, nor through a cooperative effort with the Obama
administration. Comprehensive federal legislation would have been required,
and that clearly was not forthcoming from this or the next Congress.
Legislating a wish list does not equate with clearing all of the hurdles
that only Congress can effectuate.

The reason that this message is being reemphasized again today is that
there has not been a loud enough voice in unison emphatically rejecting the
claim that Vermont’s experience is proof that single payer cannot work.
Single payer never had a chance, considering the inertia in Congress. This
was not a single payer failure. Do not remain silent when that claim is
made. Single payer has been proven to work well in many other nations.