What’s Happening to Single Payer Health Care in Vermont?

For several years we’ve been looking forward to Vermont establishing the “single payer” health care system, Green Mountain Care (GMC), that was approved by the Vermont Legislature in 2011 as Act 48. Governor Peter Shumlin first won election in 2010 with a pledge to make Vermont the first state in the nation with a single payer system. While it was known that the bill didn’t include the financing mechanism, the difficulties seemed surmountable. Yet for the next few years, the Governor delayed plans for financing the new health care system. The Legislature was finally scheduled to pass a GMC financing plan in 2015, when on December 17, instead of presenting his recommendations, the Governor announced that in his judgment, now was not the right time to ask the Legislature to pass a financial plan for Green Mountain Care. On December 30 his detailed report on the funding mechanism was released.

Shumlin shocked everyone by declaring that he had given up on single payer because it would be too expensive. Critics say that once Shumlin resolved to abandon single payer, he cast the program in the most negative light possible because it was not politically viable in the context of his loss of popular support and against the backdrop of a lagging state economy. They say he could have proposed a financing plan that cost $1 billion less than the one he presented to the public.

Green Mountain Care was never a pure single payer system. It anticipated there would still be Medicare, federal employees, military, large-employer-sponsored insurance plans and payments from the private insurance of people who live outside Vermont.

Professor Gerald Friedman, UMass economist who has studied single payer financing extensively, has analyzed Shumlin’s financing proposal. The essence of his conclusion is: The Governor’s report makes the case for universal public coverage in Vermont. The ultimate economic bottom line is whether better health care can be provided at a lower cost to the community. By these criteria, the GMC program would be a success. Shumlin’s report reaches conclusions that support implementing Act 48 even under conservative assumptions. Moreover, the report understates revenues, primarily by providing for lower contributions from upper-income households and hospitals. It also has no savings from state-drug purchasing and none are explicitly included from health care administration, even though replacing private insurers with a state entity will certainly reduce health insurance administration and billing and insurance related operations.

A good analysis also appears in VT Digger with the telling title SHUMLIN BUILT ‘LEAD AIRPLANE’ FOR SINGLE PAYER.

On January 8 the Healthcare Is a Human Right Campaign, led by James Haslam, and many other organizations held a rally followed by a march to the State House in bitterly cold weather. Hundreds of people packed the State House at a sit-in demanding single payer healthcare during Governor Shumlin’s State of the State address following his inauguration. They demanded the Speaker of the House commit the Vermont Legislature to schedule a public hearing on Shumlin’s financing proposal by January 29th. 29 protesters who refused to leave were arrested. More than sixty organizations have recently signed a letter, "Now is the Time for Green Mountain Care." The fight for single payer goes on.

Alice Swift