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Single-Payer in Vermont, A State of Healthy Firsts
Vermont is a land of proud firsts. This small, New England state was the first to join the 13 Colonies. Its constitution was the first to ban slavery. It was the first to establish the right to free education for all — public education.
Today, Vermont will boast another first: the first state in the nation to offer single-payer health care, which eliminates the costly insurance companies that many believe are the root cause of our spiraling health care costs. In a single-payer system, both private and public health care providers are allowed to operate, as they always have. But instead of the patient or the patient’s private health insurance company paying the bill, the state does.
It’s basically Medicare for all — just lower the age of eligibility to the day you’re born. The state, buying these health care services for the entire population, can negotiate favorable rates, and can eliminate the massive overhead that the for-profit insurers impose.
Vermont hired Harvard economist William Hsiao to come up with three alternatives to the current system. The single-payer system, Hsiao wrote, “will produce savings of 24.3 percent of total health expenditure between 2015 and 2024.”
An analysis by Don McCanne, M.D., of Physicians for a National Health Program, pointed out that “these plans would cover everyone without any increase in spending since the single-payer efficiencies would be enough to pay for those currently uninsured or under-insured. So this is the really good news — single payer works.”
Vermont Gov. Peter Shumlin explained to me his intention to sign the bill into law: “Here’s our challenge. Our premiums go up 10, 15, 20 percent a year. This is true in the rest of the country as well. They are killing small business. They’re killing middle-class Americans, who have been kicked in the teeth over the last several years. What our plan will do is create a single pool, get the insurance company profits, the pharmaceutical company profits, the other folks that are mining the system to make a lot of money on the backs of our illnesses, and ensure that we’re using those dollars to make Vermonters healthy.”
Speaking of healthy firsts, Vermont may become the first state to shutter a nuclear power plant. The Vermont Legislature is the first to empower itself with the right to determine its nuclear future, to put environmental policy in the hands of the people.
Another Vermont first was the legalization of same-sex civil unions. Then the state trumped itself and became the first legislature in the nation to legalize gay marriage. After being passed by the Vermont House and Senate, former Gov. Jim Douglas vetoed the bill. The next day, April 7, 2009, the House and the Senate overrode the governor’s veto, making the Vermont Freedom to Marry Act the law of the land.
Vermont has become an incubator for innovative public policy.
Canada’s single-payer health care system started as an experiment in one province, Saskatchewan. It was pushed through in the early 1960s by Saskatchewan’s premier, Tommy Douglas, considered by many to be the greatest Canadian. It was so successful, it was rapidly adopted by all of Canada. (Douglas is the grandfather of actor Kiefer Sutherland.)
Perhaps Vermont’s health care law will start a similar, national transformation. The anthropologist Margaret Mead famously said: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Just replace “group” with “state,” and you’ve got Vermont.
Denis Moynihan contributed research to this column.
69 Comments so far
Show AllI applaud Vermont's Single Payer but fear that any local (state or otherwise) single payer is doomed because it will be a magnet for the sick and uninsured. I wish articles like this would include basic, essential information, like how it is to be funded. Vermont is not Saskatchewan. We urgently need a national single payer!
Also, although a trivial detail, Vermont is not the first to shut down a nuclear power plant - the Humboldt County nuclear power plant was shut down in 1976
Although more medically needy people may move to Vermont, more small businesses may move to Vermont from adjoining states, which may prompt adjoining states to enact single-payer to keep small businesses from fleeing.
Also, I believe the Humboldt nuclear plant in California and Trojan plant in Oregon were shut down by their respective owners, rather than by government mandate?
Also, Maine Yankee, which was shut down due to the cost of NRC-mandated safety improvement that would be required.
Humboldt was shut down by the owner as a result citizen activism over seismic vulnerability.
That is a very good point. Businesses should not have to pay for their employees health insurance! What a dumb idea. Or maybe it worked once when times were different? But not having to worry about that complex issue would surely attract business and that would surely make their state governments grovel low enough to have to swallow the bitter taste of...humility - by making a 180 degree turn-around and institute a single-payer system. Oh joy.
Years ago, long before I retired, I went into HR to request a form to complete so my employer could pay for my house and car insurance. The suit and tie guy looked at me and asked, " What the fuck are you talking about ? " I explained that since they pay part of my health insurance, I am sure they could get a deal for house and car OR pay me what is due and I will buy my own health insurance. About five years later HR guy told me he now understood.
It will also be a magnet for employers looking to get out of the big expenses of providing employee healthcare benefits. I suspect that there will be time-of-residency requirements as well.
And, aside from irrelevant diferences in topography, vegetation and types of agriculture, how is Vermont different from Saskachewan? Sask. has a huge area and very thinly populated areas, but those factors would favor Vermont.
For some additional "basic, essential information" here is a link:
http://news.consumerreports.org/health/2011/05/vermont-establishes-road-map-for-single-payer-health-care.html
Apparently, many of the details of the plan are still to be worked out.
It's great that Vermont has broken the ice on this. Maybe it will get other states off the dime, like California, where the state legislature has twice passed single payer legislation only to have it terminated by the gubernator, Arnold Schwarzenegger. Now we've got a Democratic governor, Jerry Brown. It'll be interesting to see what the Democrats do.
To qualify you'll have to be a state resident which will put enormous pressure on
surrounding states like mine in New England to do the same. I've already spoken
to my state rep and they will promote in my state if it looks like it's working in
Vermont. Sick people will always be treated but at much higher public cost if
they do not have early access to health care. BTW Vermont is Saskatchewan.
I lived in Canada in the early 60's and I watch on CBC the efforts of Douglas
and PM John Diefenbaker to ram this through. They are Canadian Heros. It will probably be funded with a payroll withholding tax which is fine because you
won't be paying through your employers for private insurance. The total cost
will be 24% less overall. It should be the same nationally. FICA witholding
insures everyone.
WOW!!! It's good to hear some positive news for a change. Go Vermont! Go Bernie!
Bernie did this? When he submitted an bill to extend Medicare to all, the Republicans said "BOO!", and he pulled the bill.
And apparently he also pulled the wool over people's eyes.
Some positive news for a change...oh isn't it good! Let's have more!
Vermont, you do us progressives proud!
HECK yes! Finally, some good news for a change! In the midst of the complete assinine Alice-in-Wonderland insanity that is happening to this whole country on almost every subject, it is truly inspiring to see that at least somewhere, someone is getting it right. Ironically, I have always loved Vermont since I was a little kid (I have always lived in the midwest) and took a trip there with my folks one summer. I have always longed to go back there and live, albeit more for the scenery and peaceful beauty than any other reason. Looks like now I have even more reason to love Vermont!
The parasitic insurance companies just shuddered. Single payer is coming and they can't stop it.
Now watch as they desperatly try to get the Obama administration to deny Vermont the needed waiver. Oh the money they will throw at this one.
And since the parasitic insurance companies are now MORE powerful due to the Democrats, they will succeed. They don't mind throwing money at this one - after Obamacare, we STILL have to buy their insurance. It's actually our money they're throwing.
Good point. But there's also going to be a lot of squirming. People have been hit hard in their own electorates and the'y're not going to tolerate much more crap from these Republicans. Watch.
What are you talking about? This was illegal prior to HRC. This was made possible by "Obamacare."
>>Vermont Gov. Peter Shumlin explained to me his intention to sign the bill into law: “Here’s our challenge. Our premiums go up 10, 15, 20 percent a year. This is true in the rest of the country as well. They are killing small business. They’re killing middle-class Americans, who have been kicked in the teeth over the last several years. What our plan will do is create a single pool, get the insurance company profits, the pharmaceutical company profits, the other folks that are mining the system to make a lot of money on the backs of our illnesses, and ensure that we’re using those dollars to make Vermonters healthy.”
What statement could be more relevant?
All Nation states should focus on the health and welfare of its citizens over and above the profits made by the Corporations,
Yes profits IS A DIRTY word when as a result of ever increasing profits going into the pockets of the smallest handful people are left to die due to poor health care. Or left to die because the air they breath and the water they drink is poison. Or go hungry. Or sleep in the streets. Or cannot get an education.
You mean the purpose of an economy is to benefit society?
Well knock me over with a feather. I thought it was to benefit the already rich and powerful.
"I thought it was to benefit the already rich and powerful."
It was, that's because they control the real economy. These guy's are the engines of economic activity because only they can provide jobs. There is no other way to do that. Any right-winger will confirm that.
Do not believe the silly propaganda that a government can provide jobs, as it is said FDR did. That's a false rewrite of history by raggedy-ass socialists. FDR actually prolonged the depression by trying to provide jobs. Herbert Hoover had the depression well in hand before FDR screwed things up. Ask any neo-con.
Any good Republican or Libertarian, the truly wise in economic matters, will explain to you the necessity of allowing mysterious market forces to run rampant, even to the point of bringing down economies and impoverishing populations.
Read Milton Friedman and Ayn Rand to appreciate the profound wickedness of trying to regulate these immutable economic forces. Any ill-advised attempts to do so, you will find, is an insult to the Divine Creator who designed these forces and decreed that they should not be messed with.
Note how Libya (and soon Syria), which attempted to reign in these forces, now endures the humanitarian bombs and missiles of God's emissaries, the 'international community', which, at great expense of life and treasure, is now in the business of killing and maiming in order to bring democracy and free enterprise (actually the same thing in their lexicon) to misguided nations with controlled economies.
It is the rich and powerful that comprise the 'international community', working tirelessly to defend us from the godless forces which would try to regulate the sacred and always mysterious market forces. It is for this reason that the economy functions for their benefit.
Show your patriotism. Cheer the rich. Oppress the poor.
Brava! Brava!
I now live about 20 minutes from the Vermont border..Hmmmmm, maybe I will just tiptoe across the border and stay awhile.
Vermont rocks!
Now perhaps Vermont's legislature can take a bigger step and call for a Constitutional Convention to eliminate Corporate Personhood.
Vermont is fast becoming a civilized outpost within a barbaric country. Good for them.
Indeed!
Congratulations Vermont!
California used to be at the vanguard of forward thinking in the States but no longer showing that sign. Now that center stage for the progressive movements has been taken by the front liners such as Vermont and Madison Wisconsin. Things are changing indeed.
Vermont also has a strong seccessionist movement (Second Vermont Republic). It is also the site of the last human stronghold in the Zombie Apocalypse from I Am Legend.
Hmm... Will it be a haven in the years to come?
Vermont is so cool.
This is uncharacteristically sloppy reporting by Amy Goodman . . . and others who have echoed the leading falsehood of this piece--namely that Vermont has enacted some sort of single-payer system.
In fact, it has done no such thing. The bill retains the stranglehold of private insurers and drug companies on the state's health system--in fact, all it does is clarify the means of enforcing the repugnant Affordable Care Act in the state while paying vague lip service to the idea of creating a single-payer system some time in the misty future.
For a reasonably accurate assessment of what's really in this bill, see the following statement from Phyisicans for a National Health Plan (PNHP):
http://www.pnhp.org/news/2011/may/vermont-health-law-spurs-fresh-interest-in-single-payer-reform-doctors-group
The only question is why so many progressives are purveying misleading information about the reality of this Vermont bill, which in essence differs very little from the bitter gruel served up by Obama and the Democrats in the form of PPACA.
Here's my hunch: many single-payer activists invested huge amounts of time and energy in pushing for a single-payer bill in Vermont--and have now turned so much of their attention (mistakenly, in my view) to achieving single-payer through the slow crawl of a state-by-state slog, even though there's no guarantee that Congress will ever pass the waivers needed to allow state single payer plans. Thus overcommitted to this doomed state-by-state strategy in general and to the Vermont fight in particular, they cannot face the grim reality staring them in the face: they have been rolled again by the oily Dems, just as badly in Vermont as they were in Congress during the national health-care reform debate of 2008-2010.
This is what happens to organizations that spend nearly all their resources and energy pleading and begging (the euphemism is "lobbying") bought-off Democrats rather than thinking about how to build an independent mass movement for single payer.
Just look at the plethora of PDA (Progressive Democrats of America) types on the board of the leading single payer groups, and you'll see why this is a movement so misguided and so deluded that it now, in perverse Orwellian inversion of reality, celebrates yet another grim defeat as a glorious victory.
Only if one does not consider direct democracy
Not sure what you mean.
The healthcare reform bill in Vermont is not single payer in any respect.
So if single payer is what the majority of Vermont's citizens want, then this is another subversion of any concept of democracy, much less direct democracy.
Thanks for this link, teddieballgame.
The statement is concise and informative.
You're also correct to note that this relatively dry précis suggests that the legislation cannot fairly be lauded as actually enacting a true single-payer system, and deserves a polite golf clap-- if that-- rather than cheers and huzzahs.
I don't dispute your unsentimental speculation regarding the question of why this event is being hyped and spun as a breakthrough for a single-payer approach. You seem to be much more involved in the issue that I'll ever be, and your assessment seems plausible enough to me.
However, I also think that here again is a circumstance in which well-meaning opinion-shapers seek to "accentuate the positive" as a means of eliminating the negative. This is obviously a guess or hunch of my own-- I don't pretend to get inside of anyone else's heads.
I'm "just sayin'" that apart from the narrow, specific, deliberate reasons single-payer activists may overstate the facts and implications of this measure, there's a general philosophy that spreading the most favorable and plausibly optimistic interpretation is good for morale, and also generates positive "buzz" that may influence public opinion.
So even if it isn't REALLY quite the same as implementing a single-payer system-- and regardless of whether "single-payer" is the means to health-care salvation it's come to symbolize-- it's at least a beginning of a beginning, a spark that should be fanned madly.
Incremental-change reformers probably think that by wildly cheering on and commending the parties who enabled this legislation, they're helping to give traction to the meme that there's a way out of the present government- supported insurance-corporation stranglehold on health care.
This approach doesn't sit well with inveterate cynics, who reflexively distrust the touting of silk linings to sow's ears. Experience teaches us that indulging in this kind of "therapeutic optimism" typically leads to the empty, bankrupt enthusiasms of "Yes, We Can!"
But believers will suggest that we sit on our wet blankets and rotate.
Hmm so you're saying we need to stand firm. Yes, that's probably right, we should not budge from what we see as being right. Incremental, shrinkamental. What has it done for us lately? Why be half-wrong when we can be fully right! And why are they pussyfooting again?
teddieballgame, Not surprisingly, people disagree on the meaning of "single payer" --
"In a single-payer system, both private and public health care providers are allowed to operate, as they always have. But instead of the patient or the patient’s private health insurance company paying the bill, the state does."
Oh well, it seems like a step toward "single payer," even if not going all the way. Especially if it will cover EVERYONE. How do you think Vermont's plan will compare to the Massachusetts law? The systems in place in European and Asian countries?
I think of all these things in terms of the 2012 elections, when strong progressive voices ought to be heard. If Vermont can be viewed as leading the way, even if not perfectly, that adds strength to the progressive call for "single payer."
Actually, the definition of single payer is noncontroversial--it means that only one entity pays doctors, hospitals, and labs for their services: a publicly financed single risk pool composed of an entire population or cohort. I add "cohort" because U.S. Medicare is a single-payer system, but only for one cohort--seniors. Canada has a single-payer system for the entire population.
With multiple private insurers still in play, you have multiple payers--so the system is, by definition, not single payer--unless you want to stretch the meaning of the simple word "single" beyond coherence.
So Amy Goodman simply gets it wrong when she writes that single-payer systems have always involved a variety of payers--not true in U.S. Medicare, not true in Canadian Medicare, not true in the UK--all true single payer systems. Contrary to what Goodman states above, no private insurers are allowed to operate in those systems.
There are multiple-payer systems, such as the one in France, that allow nonprofit private funds and insurance companies to operate in a tightly regulated system--hence multiple payers--but that's another story--whatever the virtues or drawbacks of such systems, they are not single payer.
The United States is the only advanced industrial country that allows unregulated profiteering in the main sources of health-care funding. There is nothing in the Vermont bill that puts any clear restraints on that system--there's a lot of "maybe" and "someday," but try taking "maybe" and "someday" to the store to buy your food and see how far you get.
"So Amy Goodman simply gets it wrong when she writes that single-payer systems have always involved a variety of payers--not true in U.S. Medicare, not true in Canadian Medicare, not true in the UK--all true single payer systems. Contrary to what Goodman states above, no private insurers are allowed to operate in those systems."
Not sure where you;re getting your infomration but there are private health insurers operating in the UK.
Also, US citizens eligible for Medicare can also buy private health insurance.
q
"Also, US citizens eligible for Medicare can also buy private health insurance."
But that is because Medicare does not cover everything. The so-called "medigap" policies are designed to cover what Medicare does not cover. And, like all private insurance plans, the premiums keep jumping up. When I hit 70 I was told that my premium went up a lot because I had reached a "plateau" age. Funny, 72 was another one. I can hardly wait for 73.
Private health insurers are allowed to offer boutique, high-end coverage in the UK and France and other European countries--but they are barred entirely from the main, publicly financed source of health-care funding that covers 95 percent of the population.
In the United States--and still in Vermont--private, for-profit insurers control the main sources of health-care financing.
We're talking about the main sources of health-care funding, not marginal high-end boutique coverage.
The Vermont measure retains the stranglehold of private insurers on the main sources of healthcare funding. That is not single-payer--it's not even remotely civilized by the standards of the rest of the industrialized world.
If people want to celebrate this as some kind of major victory, it's only going to breed confusion and complacency in the face of the reality of how little was gained in Vermont and how much remains to be achieved.
teddieballgame (May 26 2011 - 4:24pm) -- So you're saying Harvard economist William Hsiao mistakenly refers to the Vermont plan as "single payer" in the quote, "The single-payer system, Hsiao wrote, 'will produce savings of 24.3 percent of total health expenditure between 2015 and 2024'”?
I also note in Wikipedia,
"The legislature of Vermont, including both the Democratic and Progressive Party, endorses single payer health care and has hired William Hsiao, the designer of Taiwans single payer health care system, to design three possible systems of universal health care, one being a single payer model. Governor Peter Shumlin supports this move. . . . The Vermont health bill H.202, will lead to the creation of Green Mountain Care, a private/public single payer exchange system that will give universal coverage to Vermonters and create an electronic system of medical records in an effort to make the system efficient and accessible. . . . In April 2011, it passed the Vermont Senate." [Footnotes elided.]
Respectfully, I stand by my statement that there seem to be varying interpretations of the meaning of "single payer." I think it unlikely that the Vermont governor, legislature, and William Hsiao would all totally misunderstand the term.
I'm still interested in whether you admit that the Vermont plan would provide universal care. In that alone, it seems like progress.
You're right--Vermont hired Hsiao to help design the system; he proposed several main variants--three, I think--one of which was a true single-payer system, which was the one Hsiao recommended as likely to achieve the greatest cost savings--but this variant was rejected by the Vermont legislature and was NOT the version finally adopted, which expressly deletes any mention of single payer.
There is not a whiff of single payer in this bill. There is the vague promise of someday turning the state's private insurance exchange into a publicly financed entity to compete with private insurers--the notorious "public option" redux. But even that much of a concession to public financing--itself far short of single payer--is included only as a vague intention or promise, not as an imminent reality--and we all know what promises from Democrats are worth. And vague promises from that quarter? Fuhgettaboudit.
The Democrats' notorious PPACA bill also envisions a system of "universal" care--a dystopian "universe" dominated by the private insurers. That is still, alas, the "universe" that prevails in Vermont.
What we need is not misleading euphemisms like "universal care," which can all too easily be appropriated by the spinmeisters and PR sharpies of the insurance/pharmaceutical juggernaut to veil their malign intent to trap everyone--the whole "universe" of the American population--in their Web of overpriced, undercovered "products."
What we need is a universe of healthcare that is predominantly publicly funded by fair progressive taxation rather than by extortionate premiums and copays and deductibles. The system that still prevails in Vermont and the rest of the country is, alas, a universe away from that goal.
teddieballgame (May 26 2011 - 5:44pm) -- The Wikipedia article I quoted mentions the fact that Hsiao developed three plans, only one of which was a single payer plan. Everyone seems to have overlooked the fact, which I think you've correctly stated, that the legislature didn't adopt the single payer plan. For example, the Wikepedia article doesn't make clear which of the three was adopted. Neither of the two articles currently running in CD mentions that there were three proposals.
So the governor and other people who are directly involved, not to mention Amy Goodman, have failed to point out that the system adopted was not the single payer one. It seems to me that this is your argument. The belief that a single payer system will be developed later (five years?) appears to be the reason the governor et al. are saying Vermont is going single payer. I don't see that as a lie or an untruth; just as failure to properly explain the details. And I agree that this makes single payer in Vermont pie in the sky. Which is a little better than anything else we've got in the U.S., other than Medicare with its limited pool of beneficiaries.
TEDDIE: Thank you for the excellent, well-informed posts. I learned something here, gracias!
In other words, Vermont has a "public option". I still find that to be good news, but I understand what you're saying. Vermont doesn't have a real single-payer system.
At this point, there's not even a real public option. See my other posts in this thread.
Thank you for bringing that up but who's behind all this? It's one thing to realize that our Congressmen and women protected their donors against a rogue state when Obama's health care system was being drawn up (they must have great lawyers) by putting such a clause in that would prevent competition till 2017 but to say that Vermont is an accomplice? That is shattering. Perhaps they need better lawyers? Or maybe they are weak in demanding all conditions be met that are needed to make single-payer work? Naive? They have got to make those conditions be right otherwise this is just a farce.
teddieballgame...THANK YOU ! You got it right. It is amazing how many in Vermont and here at CD fell for the political propaganda. How could Amy have been so misinformed ? The Vermont Plan leaves insurance companies in. That is NOT real Single Payer. Calling it Single payer is a political scam.
All of this erroneous publicity will have a negative effect and hinder the establishment of Federally Qualified Health Care Clinics. These clinics are not the answer either, but they are better than nothing which is what we have now. The bottom line is that so far the people have lost, and the insurance companies have won.
Yes, many thanks to teddieballgame. I'm also surprised to get bad info from Amy.
Thanks for the link. Hmmm . . . follow the money.
Well, someone has to lead the dumb sheep (the rest of us) out of the wilderness. Why not Vermont?