This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series. By Michael Corcoran
As Republicans seek to throw millions of Americans off insurance this week, progressives are, once again, playing defense. Activists are going full bore to stop the Cassidy-Graham bill, which is opposed by virtually every health organization of significance. The legislation, which grows more contemptible with each passing day, would lead to about 41,600 deaths a year, according to a report released yesterday by the Annals of Internal Medicine.
"We cannot be silent while Congress plays political games with the lives of our patients," said Dr. Carol Paris, president of Physicians for a National Health Program (PNHP), in a statement sent to Truthout.
The Damage Done: The Consequences of Shumlin's Surrender in Vermont
Critics of single-payer in the media repeatedly point to its so-called "failure" in Vermont as a reason why proposals can't work. Vermont made major progress on a single-payer bill in 2010 but Gov. Peter Shumlin abandoned the effort in 2014, controversially citing costs -- and not political obstacles -- as the reason.
Shumlin added to this narrative last week as he once again defended his 2014 decision to abandon single-payer. As the Cornell Policy Review points out, three state-commissioned studies concluded that the proposal would be "economically feasible" but was "scuttled by political barriers and poor management."
"Single-payer didn't fail in Vermont," said Jessica Early, a health care justice organizer for Rights and Democracy Vermont. "We never had single-payer because politicians did not have the political will to follow through on it."
Indeed, what happened in Vermont was not a failure of policy, but of politics. With a once-supportive governor and an impressive grassroots campaign, the state passed Act 48. This initial structure was based on designs drawn up by Hsaio, the creator of the Taiwan's system, who was commissioned by the state for this purpose. He concluded that a single-payer payer system could "immediately produce" savings of 8 to12 percent and then 12 to14 percent over time.
However, on the heels of a close election, Shumlin and other top Democrats lost the courage to follow through, giving fodder to critics ever since. "The way Shumlin handled it, he really set the whole movement back nationally," Friedman said.
What happened in Vermont was not a failure of policy, but of politics.
"This surrender is all the more remarkable because the Green Mountain People's Republic is the ideal socialist laboratory," observed The Wall Street Journal in an editorial celebrating the death of reform in Vermont. Yet this reading of the situation grossly misrepresents what happened, as PNHP founders Steffie Woolhander and David Himmelstien concluded in a report. It notes that Shumlin took cover by citing an inherently flawed economic analysis of the plan which counted costs, but not savings. "The report by his staff estimated zero administrative savings from its proposed plan. It also projected zero savings on drugs and medical devices," Woolhander and Himmelstein said.
Vermont's Next Fight: Primary Care for All
Deb Richter, former president of PNHP and one of Vermont's leading health care advocates, recognizes that, in the aftermath of the demise of Green Mountain Care, a new approach must be taken. Her idea is to push for a narrower first step: universal primary care. Richter's hope is that this plan would be enacted with a long-term goal of reaching other sectors until, in time, every sector will be financed publicly. This is similar to how the Canadian universal health system was created.
"I wish we could pass a bill to finance single-payer tomorrow, but this is not the reality we face," Richter said in an interview. "This is another way forward. All of us need primary care whether we are sick or healthy."
The costs lack the "sticker shock" of single-payer, costing Vermonters less than $50 each annually in new spending, according to a study commissioned by the state legislature at Richter's urging. It has the support of much of the Vermont grassroots, including Rights and Democracy, while the Vermont Workers' Center has expressed qualified support "insofar as [the policy] is financed fully and equitably through progressive taxes."
Richter is hoping the bill will be introduced in 2018, although many fear Gov. Phil Scott will veto the law, should it get that far.
Vermonters are paying the "tax" of rising health insurance premiums, which is eating into their household budgets.
When asked if Scott would veto the bill, his chief of staff, Jason Gibbs, told Truthout that the administration's goal is "achieving universally affordable health care for every Vermonter in ways that reduce the percent of household income spent on care and insurance, without raising the percent of household income spent on taxes."
The goal of providing care that would cost less and not result in any new taxes is a rather ambitious goal, especially given that Gibbs added that Vermont "cannot afford to experiment with ideas that are not mathematically verified to be the best path to universally affordable comprehensive care." Not being open to new taxes -- even if they reduce costs overall -- indicates a lack of interest in shifting toward any kind of public health care.
"Vermonters are paying the 'tax' of rising health insurance premiums, which is eating into their household budgets," Richter told Truthout in response to Gibbs' comment. She notes the administration's criteria would rule out most Republican staples, such as high-risk pools, managed care and health savings accounts.
"All of these have been tried and have not been shown to reduce system costs," she said.