The midterms politics of single payer in Vermont: Will Shumlin's Democrats blow it?
From Valley News:
[H]ealth reform remains a key issue facing [Vermont Governor Peter] Shumlin, the Democrat who currently occupies the corner office in the Statehouse, and his leading challengers: Republican Scott Milne, a travel agency owner from Pomfret, and Libertarian Dan Feliciano, an Essex management consultant.
Three polls since late August showed Shumlin with a double-digit lead, making him one of four Democrats rated a likely winner in a fall governor’s race by the RealClearPolitics.com website.
State Sen. Anthony Pollina, a Progressive who has long called for a single-payer health care system in Vermont, said that he expected Shumlin to win re-election, but expressed concern that winning by a narrow margin or with only a plurality would leave him with his “mandate to move ahead with single-payer greatly dampened.”
Not to be too cynical, but does Shumlin have national ambitions? So, mission accomplished?
In 2011, Act 48 wrote into law Vermont’s commitment to reform health care. It established the Green Mountain Care Board to rein in spending and laid out a framework for establishing a “single-payer” insurance system by 2017.
And now an explainer, like we rarely see outside Vermont, unless some brave soul writes an Op-Ed or a letter to the editor:
Single-payer insurance systems, such as exist in Canada and many other developed countries, include all residents and pay for health care with revenue collected through broad-based taxes. Some critics of the current health care system in the United States have advocated for single-payer insurance to replace the current system, in which most commercial insurance is tied to employment and premiums are paid by employers and employees. Although millions of American service members, veterans, seniors and low-income families get coverage through government programs, an estimated 42 million people lacked health insurance in 2012, according to the Kaiser Family Foundation.
Single payer was a plank in the platform of Shumlin’s successful run for governor in 2010. He said his signature on Act 48 would “launch the first single-payer system in America, to do in Vermont what has taken too long” for the country.
But even as the Shumlin administration embarked for the distant shore of single payer, it had to navigate the shoals of the 2010 Affordable Care Act. Along with a requirement that everyone have health insurance, that federal law made each state responsible for giving its residents a way to shop for commercial insurance on a website built and operated by the state, the federal government, or the two together.
And the waiver ObamaCare forces states to get to "experiment" with single payer isn't the only problem.
Vermont, like 15 other states and the District of Columbia, chose to build and operate its own website. The federal government set aside $171 million to pay for that work.
Things didn’t go well. Vermonters found they couldn’t use the new website, dubbed Vermont Health Connect, to pay premiums or to make changes or correct mistakes in their coverage.
Vermont Health Connect finally ran aground on Sept. 16. That’s when Shumlin announced that the website would shut down “temporarily to complete ongoing operational, technical, performance and security improvements.” That was the best way to be prepared for the open enrollment period due to begin on Nov. 15, he said. Administration officials later disclosed that the shutdown came after federal regulators directed the state to beef up security on the website.
“We’ve had disappointment after disappointment with the Vermont Health Connect website,” Shumlin said when he announced the shutdown. “I have been very frustrated that the website remains incomplete.” Shumlin’s rivals shared his disappointment, but didn’t stop there. ..
The website problems had repercussions for the whole health care reform undertaking. Vermont Health Connect’s travails, Shumlin said in an interview, had “undermined the confidence of Vermonters in believing that government can get health care right.”
Now that is Mission Accomplished.
But Shumlin blamed some of the problems on the Affordable Care Act, which put the onus on state and federal health exchange websites to “strengthen the insurance companies in the business of health care.” Instead of offering “a public option like Medicare,” he said, “they made it more complicated.”
Oh, gawd. Insanely, Shumlin confused the Medicare brand with the "public option" magic sparkle pony brand. And he's just wrong: The so-called public option is just that, an option, one among many, so it simplifies nothing.
Vermont’s single-payer system would be simpler, he promised: “We’re going to contract out the state of Vermont’s health insurance to one insurer instead of seven or eight.”
Oh, gawd. We tried that in Maine, with Dirigo Health Care, and it didn't work. And can Shumlin really believe that this "one insurer" won't have every incentive to sabotage the program?
Hospital operators remain skeptical.
Act 48 set a 2013 deadline for the administration to come up with a plan to raise the roughly $2 billion that Vermonters now pay for health care in the form of employer and employee premiums and out-of-pocket costs.
In a recent interview, Shumlin was unapologetic for missing — and ignoring — that deadline. “We’re trying to put together a financing package that nobody’s ever done before in America,” he said. “It’s incredibly complicated.”
Shumlin also dismissed “this political myth out there that we’ve got the plan but we’re just hiding it and not ready to show it.” Administration officials have said that a proposal for what would be covered by single payer will be put on the table during December. Shumlin said that the financing plan would be disclosed in January.
Another PR disaster.
The major party candidates both see a role for government in fighting soaring health care costs. Said Shumlin: “The whole reason for doing this is to stop spending as much money as we’re currently spending now, to bend the cost curve.”
Jeebus Cripes. Not only does Shumlin appropriate Democratic weasel-wording on "bending the cost curve" -- saving $400 billion a year doesn't "bend" the cost curve, it hacks a huge chunk out of it -- the purpose of a health care system is saving lives and preventing suffering, not saving money.
Feliciano, in an interview, offered a more conventional, if somewhat toned down, Libertarian critique of health care reform: “I don’t believe that … the government can do a good job of managing health care.”
Feliciano said individuals shouldn’t be required to have health insurance but that hospital emergency rooms should still be required to treat anyone needing emergency care. Vermont should continue to participate in the Medicaid program, which covers health care for low-income people, but the Green Mountain Care Board could be shut down.
“Health care is a business,” said Feliciano, who according to his LinkedIn page worked as an insurance company consultant and manager from 1998 until 2004. “That’s what drives my thinking.”
Dear Lord. And Shumlin is treating health care as "a busines," exactly like his libertarian opponent. But health care does not work like a business; it's not amenable to neo-liberal market-based solutions.
One despairs. If this is how a Democrat frames the issues in the People's Republic of Vermont....