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Vermont Legislature Votes to Begin Designing 'Single-Payer' System
MONTPELIER, Vt. - Vermont lawmakers made clear Friday that recently enacted federal health care reform did not go far enough toward a public model, passing legislation that could bring to the state the "public option" health insurance rejected by Washington or even a Canadian-style single-payer system.
Cover us all: Advocates of a single-payer health care system rally on the University of Vermont campus in Burlington before a 2009 White House-organized forum. By a vote of 91-42, the Democratic controlled House passed its own version of legislation passed earlier by the Senate. Both bills call for designing a single-payer system, in which a government agency would administer and make all payments for health care.
The House version calls for that as well as a parallel design of a system with a public option for health insurance, meaning a system in which a health insurance program offered by the government would compete against those offered by private companies. The House's version also would expand previously enacted reform efforts.
Either system would require federal approval.
The Senate focuses on single-payer as the goal, but also calls for two alternative designs. Differences will have to be worked out in a conference committee of three members from each chamber, and it's not clear what Gov. Jim Douglas, a Republican, will do with the bill.
Heidi Tringe, the governor's deputy chief of staff, said Douglas likes parts of the bill but has "strong concerns" about others. He has not said if he would sign it, veto it or let it become law without his signature.
Douglas doesn't like the single-payer or public option ideas because the federal health care law blocks states from pursuing any such plan until at least 2017, Tringe said. "We'd spend $250,000 to design these options, but we couldn't hope to implement them until 2017 at the earliest," she said.
The governor likes provisions to expand existing efforts to control costs and slow hospital budget increases, Tringe said. He does not like a provision requiring drug companies to disclose to the attorney general when they provide free samples to doctors' for distribution to patients, she said.
The legislation has "the dual goals of providing affordable coverage to every Vermonter, with access to health care in the right time and in the right place, and secondly to contain the costs of health care over time," Rep. Steven Maier, a Middlebury Democrat and chairman of the House Health Care Committee, told his House colleagues.
What Democrats called a new effort by Vermont to act as a laboratory pushing health care in a more progressive direction, Republicans called a fool's errand.
"Rather than focusing our efforts on ensuring that we can take full advantage of all of the resources that will be provided to states through the new federal law, we are setting Vermont on a completely different course than the rest of the country," said House Republican Leader Patti Komline.
Part of the bill calls for setting up new teams of nurses and other health care professionals to manage individual patients' cases. It's modeled on the Vermont Blueprint for Health, a program that Douglas has touted, which began with a few teams managing treatment of diabetes, heart ailments and other chronic diseases.
House Republicans said the state can't afford to expand that effort now, given its current budget crunch.
Sen. Doug Racine, chairman of the Senate Health and Welfare Committee, said the Senate version of the bill focused mainly on designing a single-payer system, with the two still to be determined alternatives. "It's just a difference in emphasis" between the House and Senate versions, he said.
Vermont's efforts to create a public option or a single-payer insurance system could run into trouble because either would require the federal government's OK so the state could continue receiving Medicaid funding from Washington, Racine said.
But Racine, a Democratic candidate for governor, said inaction is not an option. He said the state's health care costs are expected to grow from about $5 billion in 2009 to $6 billion in 2012. That $1 billion difference about equals the state's entire general fund budget, he said.
"We need to make basic, structural reform if we're going to get costs under control," he said.
63 Comments so far
Show AllAll I can say in praise of single-payer is that I am a Viet Vet and LOVE the system that COULD be the same for ALL out there.
I went yesterday and had some warts removed, got a prescription for skin cancer cream ($250), and counseling for
P.T.S.D., and meds for same and walked out with no damage to my wallet and the stress that entails.
I hope Vermonters will lead the way so ALL can have the same high-quality, care-when-needed attention. The only reason not to is purely political and corporate welfare-oriented.
Right on, Kucinich2012, I enjoy VA Healthcare, also. While I have a small co-pay for prescriptions, it was nothing like the copays I had with HMO's the whole time I was working full time(at least I had health insurance subsidized on the job for me and my family). I am too young for medicare, but would probably stay with VA healthcare if possible. All it took was 4 years of my youth donated to the USN to receive this fine care. Doesn't seem fair, that I have that for the rest of my life, while my wife still doesn't have it even while employed. We priced insurance recently, and found the reality of the situation was deductibles that would never be met while paying premiums every month to the profits of the corporations. Now THAT doesn't seem fair.
(comment posted twice)
"...the reality of the situation was deductibles that would never be met while paying premiums every month to the profits of the corporations...." I think that pretty much sums up what Americans will find Obamacare turns out to be. Insurers will get around requirements to accept those with preexisting conditions by creating deductibles and premiums so high that those people still can't get the insurance, yet will have to pay a penalty. I was appalled to see yet another reason for fury in this article -- that Obamacare doesn't allow states to create their own single-payer plans until 2017... and this past week, headlines indicated that by 2016, 4 million Americans will be paying fines for not purchasing insurance. The timing thus seeks to make sure the ins. cos. get at least a year of forced national payments one way or the other. The whole thing is sickening beyond belief (no pun intended).
It always refreshing to see people, who enjoy a benefit other smay not have, wanting that benefit extended to all. This puts community above the self and I think this required for a society to progress.
And it is also good to hear compliments of the VA system, which really is a full- blown British-style, "socialized" medical system - not a Canadian style "single payer" system.
All the Brits that I know that have vacation homes here in the States hate their socialized government including their health care system and say if we are not careful we will end up like them. Hmmm.
Do all the Brits you know pay for health care while staying in their vacation homes here? Do they pay emergency room expenses? How do paying vacation home expenses, US health insurance expense if they have it, taxes, and living expensess here in the US fit into their overall budgets, which must also accommodate all their British home, tax, transportation, etc., expenses. My impression is that these folks have debts up to their ears or lots and lots of discretionary income. Either way, they are not the type of people to judge a health care system by.
Provided Brits have the right holiday insurance, any medical expenses incurred in the USA will be covered by the UK National Health Service. As you can imagine, no sane Brit travels to the States without this cover. That isn't to say there aren't some right-wing free-marketeer Brits who hate the NHS. But even our Conservative candidate for Prime Minister, David Cameron, knows the worth of the NHS (his severely handicapped son, who died recently, required and received constant medical care - free at the point of delivery, as we say - from the moment he was born).
Very good commentary, Richsmith2.
Considering their ownership of these "vacation homes", no doubt on Cape Cod or the like, what minority economic CLASS to these Brits belong? Of course the wealthy capitalist class hates the NHS. And so?
Or was that your point - that only a wealthy minority, which a democratic government is under no obligation to give favors to, don't like the NHS?
This is another example of Obamacare saddling the states with additional unfunded mandates and limiting states' rights.
Every time we vote for a candidate or incumbant with a D or and R after their name on the ballot we exacerbate this problem and work against any solutions.
Every time we vote for a human being we will be "saddled" with problems. Politics is not fair or rational. Should we stop voting? It is our duty to be active and involved. It is one price of living in a free society. We need to get beyond hopelessness.
We are working on a single-payer system here in California as well. The legislature has passed it twice, but the Governator has vetoed it both times. Once we get rid of him it is very likely to pass here. The conflicts with federal funding and restrictions can be overcome. I applaud the actions of the Vermont legislature! We can address our health care deficiencies by passing single-payer in individual states. That is how the system won eventual acceptance in Canada. Once Canadians saw it working all provinces wanted it.
Have any of the candidates for governor said they'd support SB840? Brown, Whitman, and Poizner are apparently going to have a 3-way debate. Which ones have said they'd sign it?
None to my knowledge have said they would support Single Payer in California.
You can bet the farm that Poizner and Whitman would definitely NOT support it.
And according to my sources Brown has said he would veto it because, "There isn't any way to pay for it".
This will be a major uphill fight even if Brown does win and is convinced to sign the legislation. Afterall, according to the conservative Lewin Group, in 2005 they did an analysis of the bill and announced that it would create a $300 billion surplus in California over ten years if enacted. Brown would have a hard time arguing with that scoring.
The problem is, that even if all those stars aligned and Brown signed the legislation, the insurance corporations would promptly qualify a statewide initiative for the 2012 election to kill the bill. I think if they did that it would be defeated.
But even THEN, at the beginning of 2013, there would be a fight between the state and the feds over Medicaid dollars.
And Harry Reid placed a "poison pill" in the HCR bill that says it will take a "Super Majority" of 67 votes to "amend" it.
Which means it would be a practical impossibility to get 67 Senators to vote to change the date from 2017 to 2013.
And let's be clear. Neither the Democrats or the Republicans who are owned lock, stock and barrel by corporate America, want states to become successful models for Single Payer.
Thus the 2017 date. By then the "exchanges" will be fully entrenched in all the states and it will become a practical impossibility to fight them.
The Democratic Party is not a friend to Single Payer, "Improved Medicare for All" "Not for Profit" healthcare.
The sooner we all realize this, the better. Then perhaps we will develop the courage to move ahead with a new party that will reflect all of our ideals. Neither the Republican or Democratic parties do this, nor will they ever.
We should not stop voting. We should stop voting for crooks - as much as possible. But if we vote least-worst often least drifts quickly to worst.
I think you're right that it may eventually pass one state at a time until it gets to a tipping point in Congress. At any rate, there is not reason to not press for so popular an issue at every level. In no society so far as the US from being itself a current colony have corporations been able to shut this out in some form.
Bernie Sanders = Tommy Douglas....
No, we shouldn't stop voting. But we should stop voting for Democrats or Republicans. Neither party is worth of our votes. Both major parties are sold-out corporate tools. I'm voting Green, mostly because I like the Green Party platform of economic and social justice and equality, and because the Green Party is not the Republican or Democratic party.
This is an initial effort for state rights to lead states away from the expensive futility of insurance company health programs. The "for profit" health care industry owns the U.S. Congress, but not the states.
Any governor in his right mind who has to deal with his own budget must recognize the insanity of the present system. All the U.S. governors need to get together to figure a way to "end run" the U.S. Congress.
Vermont is shaming New Hampshire's motto "live free or die".
Beautiful!
Minnesota, too, needs only a new NON-Republican governor in order to enact the Minnesota Health Plan developed by state senator John Marty and co-sponsored by a third of the legislature.
Tim Pawlenty, now seeking to "help" America the same way he helped make Minnesota "better off without raising taxes," will at last be out of the governor's office, where he used his veto power (and improperly used, as the courts will soon show, his power to unallot in case of unexpected shortfalls) has again and again cut funding to social services and health care for the poor.
The Minnesota Plan would be funded by taxes on individuals and businesses based on the ability to pay. It would be managed by a separate body elected by county boards from around the state. No governor could again pull a Pawlenty and leave our poorest, often mentally ill people without access to care.
The Minnesota Health Plan would cover every resident without exception, would pay for preventive care, home health care, drugs and eye glasses, et cetera, and all care you and your freely chosen provider consider medically appropriate.
We, too, will have to seek Federal waivers, but I believe Senator Bernie Sanders will submit an amendment to the current program allowing states to develop single-payer systems at once.
Think how much better America would be without the leeches of corporate health and Wall Street.
Add a severe dollar limit on political funding, restrict votes to warm bodies and a whole host of other evils deriving from a corrupt lobby driven government would fade away.
Oh how I wish I lived in Vermont instead of Arizona!
Vermont is a cool state. It's also a very short car trip across the border to
Canada when you need to visit a civilized country to unwind a little
can 300,000,000 people fit into Vermont?
I hope that the US Congress can be persuaded to provide a waver for Vermont. In fact I even hope that they provide wavers for those states on the other side that object to mandated private health care also. Let Alabama and Texas promote the Republican alternative of Health Care Savings accounts and let California, Pennsylvania, Vermont, Massachusetts, go for Single Payer. Let the states that think that Obamacare is just fine keep it if they want it. I'd love to see the whole Obamacare boondogle unwind. We might even get conservative allies-- I'll support your waver if you'll support mine. Let at least a couple different flowers bloom and a few years later let us see what fruits fall from the tree, (too many metaphors?) What alternative will really serves the best interests of the people? If there is any virtue to federalism it is the ability to experiment and learn from experience. My guess is that if just a few states can flip Single Payer the whole country will voluntarily go that way in short order.
California is another state where the legislature has passed single payer legislation only to have it vetoed (several times) by Republican governors, the latest being the Gubernator.
Contrary to what many think, both state and federal studies have shown that introducing single payer would actually save money. Canada, with its single payer system, spends something like 2/3 per capita of what the US spends, with better health outcomes.
Right now, in Pennsylvania, four Republicans are blocking a vote on a economic impact study (EIS) of SB 400 - the Pennsylvania Senate's Single Payer Bill. If you live in PA, please, right now, contact the following scumbag Republican Senate leaders:
Jake Corman (717) 787-1377
Chair, Senate Appropriations Comittee
http://www.jakecorman.com/contact.htm
Dom Pileggi (717) 787-4712
Senate Majority Leader
http://www.senatorpileggi.com/contact.htm
Donald White (717) 787-8724
Chair, Banking and Insurance Committee
http://www.senatordonwhite.com/contact.htm
Joe Scarnati (717) 787-7084
Acting Lieutenant Governor/President Pro Tempore
http://senatorscarnati.com/connect.htm
As is the case in Pennsylvania, these rural (one suburban) Republican scumbags seem to wield undemocratic power over Pennsylvania's urban majority. Please be sure to mention that you will not accept being told to go away because you "aren't in their district." The EIS is supported by 34 of the 50 senators and they are using their positions to prevent your own state senator from proceeding with majority opinion.
If all Vermont has to do to have single payer is to give up Medicaid funds from the federal government, then Vermont should simply do it. Single payer cover those getting Medicaid now as well as all others in Vermont and do so for one third less by cutting out the health insurance industry parasites.
AD
Marian Cole
YES!!!!!!!!!!
The federal government has absolutely no Constitutional right to dictate to the states how they provide health care to their people. Vermont should be the first state to nullify Obama care on 10th amendment grounds. What possible legitimate argument could they have anyway if Vermont is implementing a single payer system, UNLESS the real reason for Obamacare is to give the private insurance companies an absolute monopoly.. Gee they wouldn't have done it for THAT reason would they???
Well, there you have it now, don't you.
Unfortunately, as mentioned above, the feds can withhold Medicare monies. Now there's some incentive to toe the line.
*Comment deleted by site administrators for violating our Comment Policy*
see: http://www.commondreams.org/comment-policy
Stick to the topic at hand
"Either system would require federal approval."
Baloney. Nothing requires federal approval. The federal government does not have the approval of the people. And so the idea that anything requires federal approval is beyond lunacy. Vermont will have single-payer health insurance and the federal government will just have to eat kaka.
"the state's health care costs are expected to grow from about $5 billion in 2009 to $6 billion in 2012."
That means the state's healthcare costs are increasing at a rate that would reach 2x the 2009 cost in 2021. But the insurance godzillas publicly estimated 2.5x in ten years, significantly more, and in fact a full 5x the cost in other "industrial" countries.
Most USans will approve the mega-racket because they have no concept of self-determination or economic reality. The relevant economic reality is that someone creates a demand that is in turn filled by supply. You have to demand what is in your own better interest, else the elites make your demands for you, effectively enslaving you. Try demanding healthcare at the value in other "industrial" countries. If you are really ambitious, demand the value of healthcare in Cuba.
There is no way the Feds will give single payer in one state a chance to demonstrate Its superiority to the rest of the country.
Somebody would ask why can't we have a system like this for the whole country.
So the Feds will answer: The insurance companies are paying me a fortune to make sure the country gets shitty health care.
And then hell will freeze over.
"...There is no way the Feds will give single payer in one state a chance to demonstrate Its superiority to the rest of the country..."
They already have... Hawaii.
Thanks for the correction
Hawaii does not have single payer. Hawaii has "employer mandate" meaning every employee over 19 hours per week must be offered a choice of plans paid for by their employer, to which the employ may optionally add premium payments to boost coverage.
I lived and worked in Hawaii under this system, accepting the basic coverage, and it turned out to be very good. I received excellent care, including plenty of preventive care, and prescriptions at almost no cost.
This is where the feds are continually overstepping their power: single payer, environmental laws, marijuana laws. Under Obama and Democratic majorities, in 2010 this is unacceptable.
Dear sincerious,
"Under Obama and Democratic majorities, in 2010 this is unacceptable."
The Democrats don't have an effective majority. They need 60 or more votes in the Senate to pass legislation. If we want to see what changes Obama can make during his presidency the people will need to vote in a sufficient majority of Senators as well as maintain the House majority.
BTW, Federal Laws can be beneficial when it comes to laws and regulations in one state that would affect neighboring states. An environmental example would be federal regulations concerning the discharging of waste water into rivers and streams. A state may not feel the effects of this pollution if the river runs into an adjacent state.
I do agree with you, however, there are many areas of state law the Feds should butt out.
You better believe I'm kicking myself for leaving Vermont. I lived there twice and returned to Virginia 30 years ago, reluctantly. Every day I miss the sanity that passes for daily life in Vermont. (As a side note, when Brattleboro passed an ordinance authorizing the arrest of Bush, I have never been prouder.)
The few progressives left in Congress tried to counter the ability of the federal government to block such a move but were finally beaten down. It's encouraging to see these pockets of courage and determination in a few places in the US. Also heartening to read some of the posts here that insist the feds can't block a state from adopting single-payer.
Enough for now . . . want to check out the real estate ads in Burlington.
A friend of mine moved to the "Brat" 30 years ago and never looked back. A couple of towns in Vermont did the same. Lake Champlain and only a couple of hours from Montreal, whats not to love..
What is it about these people?!
A state producing thinking and reasonable politicians who provide farsighted and healthy legislation, to benefit everyone!
Reading this, I feel like the rest of us are in the Dark Ages.
Look at what Arizona produces!
Wonderful, if a state wants to enact single-payer on its on, it has to wait until 2017, and still has to hope the Federal government approves it. Another reason this Democratic health care bill give-away to insurance companies was a stab in the back to the public.
you got that right. If there ever was a doubt in your mind that the parties are both playing on the same side, then this should nail it. It's us against them. They got all the marbles, we got the numbers. Lets see how this plays out. Will the masses sit back and take it on the chin again?
Go Vermont!!!
Is it not time for the various states to secede from the corruption of DC and join Vermont for a more perfect union?
This is great. We need to do this state by state. Get to work.
Brad Bauerly