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Vermont citizens gathered at the state capitol to promote single-payer healthcare in this file photo.

Vermont's Governor Sadly Has It Wrong. Now IS the Time for Single-Payer Everywhere

Andy Coates

On Wednesday, Vermont’s governor, after campaigning for single payer for years, announced that he would not work to pass single-payer legislation in Vermont this year.

“Single payer” is shorthand for a reform that will replace the present wasteful and chaotic system of private health insurance, Medicare, Medicaid and out-of-pocket cash payments with a single public finance system that will redirect resources in order to guarantee access to all necessary care for everyone, which would include many essentials not covered by any present plan.

Governor Peter Shumlin, in his press conference, stated that “now is not the right time” for single payer.

I disagree.

The time for a single-payer system is now. Our patients in every state urgently need it.

Indeed, the people of Vermont, including the state’s physicians, nurses and other caregiving professionals, have repeatedly affirmed their support for single-payer reform.

Vermonters throughout the state understand that an equitable health care system must be truly universal and must remove all financial barriers to medically necessary care. They recognize that a public single payer is an essential incremental step toward these goals.

The people of Vermont have said health care should be regarded as a public good, much like fire protection, and not as a commodity you buy on the market. Gov. Shumlin was elected to office in considerable part because of his championing of this view.

Single-payer activists in Vermont have pointed out that by eliminating the unnecessary and wasteful role of private insurance companies – middlemen who put their profits above the interests of our patients — resources will be liberated to improve the health of all.

Dr. William Hsiao, the Harvard health economist who Gov. Shumlin recruited to study the impact of single payer in Vermont, estimated that a single-payer-like reform (not a true single payer, since there would still be multiple plans, including private plans) would achieve an overall savings of over 25 percent on health care spending (10 percent delivery system savings, 8.5 percent overhead savings, 5 percent reduction in fraud and 2 percent saved through lower malpractice costs.)

Gov. Shumlin stated that the costs of his proposed reform would be too great, saying, “The taxes required to replace health care premiums with a publicly financed plan that would best serve Vermont are, in a word, enormous.” (The governor’s finance proposal would have instituted an 11.5 payroll tax on employers and a progressive income tax of zero to 9.5 percent, depending on income.) The governor did not dwell upon the fact that the taxes he cited would be less, on average, than the exorbitant and burdensome premiums and out-of-pocket costs that presently weigh heavily upon households as well as employers.

Gov. Shumlin also invoked “risk of economic shock” as a reason to turn away from single payer — the idea that the transition to a Vermont without private health insurance, a Vermont without profiteers lining up to make a buck off the suffering of the sick, would prove too threatening to the social order.

Gov. Shumlin has made many speeches about the need to liberate Vermont, and indeed the United States, from the corrupting and corrosive influence of profit-seeking in health care. Yet from its inception, the enabling legislation for reform in Vermont – Act 48 – allowed a continuing role for private insurers alongside public payers. Lawmakers therefore dropped the term “single payer” from its text.

The continued presence of multiple payers in the proposed Vermont reform necessarily canceled out many of the administrative savings that would be attained by a true single-payer system and opened the door to multi-tiered care along the lines of what the Affordable Care Act currently represents.

It’s important to note that the Affordable Care Act has increased the influence of the big insurers and other private interests in our health care system. Strengthening these forces has hurt our patients and the profession of medicine in all states, including Vermont.

The announcement by Gov. Shumlin, a leading light in the Democratic Party, thus shows the difficulty that individual states face in trying to disentangle themselves from these private corporate interests. It shows why physicians and Americans as a whole need to step up the demand for a deep-going, national reform – an improved Medicare for all.

It is time to put the interests of patients first, ahead of political expedience. Now IS the time for single payer in Vermont and in the nation. It is the only reform that will cover everyone, save lives, and save money. Mr. Shumlin, of all our nations’ governors, knows this well.

We pledge to redouble our efforts to press for national legislation – such as H.R. 676, the Expanded and Improved Medicare for All Act – to achieve the goal of universal access to high-quality, affordable care. We invite Gov. Shumlin to rededicate himself to the cause of a public national health program.

As Hillel, the great ancient sage, famously asked, “If I am not for myself, who will be for me? And, if I am only for myself alone, then what am I? And, if not now, when?”

Now is the time to press forward, not retreat. Our patients do not deserve to wait.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.

Andy Coates

Dr. Andy Coates is president of Physicians for a National Health Program. Dr. Coates is chief of hospital medicine at Samaritan Hospital in Troy, New York, and an assistant professor of medicine and psychiatry at Albany Medical College.

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