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Governor Unilaterally Denies ‘Single Payer’ Health Care

After three years of closed door negotiations with business interests, Governor Shumlin ignores healthcare financing facts and decides that a publicly-financed universal health care system is too expensive.

Note: In 2009 when most of the healthcare community’s attention was on the health reform process in Washington, DC, the people of Vermont led by the Vermont Workers Center were quietly organizing their own healthcare campaign using the human rights framework. This framework is based on five principles: universality meaning that all people are included; equity meaning that all people get what they need so they can be included; transparency meaning that people have access to information; accountability and participation.

Vermonters across the state knocked on doors, held educational events and rallies and successfully passed a bill in 2011 that designated a path toward a publicly-financed universal healthcare system. While it was not a true single payer system because it did not create one system for everyone, it was supposed to create a public insurance called Green Mountain Care that would be available to everyone who did not have another source of health insurance.

Governor Shumlin ran on a platform of support for single payer health care and won in 2010. He publicly committed to putting in place a single payer health care system in Vermont. He worked closely with members of the Vermont Health Care is a Human Right Campaign and the Vermont Physicians for a National Health Program to design the system. Then an odd thing happened when it came to determining the way that the system would be financed.  As you’ll read below, Shumlin violated the human rights’ principles of transparency, accountability and participation by excluding the public and health financing experts, instead he had three years of closed-door meetings with people in the business community.

A multitude of studies at the state, national and international levels show that the most cost-effective healthcare system is a single payer system. It is the best way to guarantee that everyone can receive the health care they need, and it saves money by simplifying the administrative process, through bulk purchasing and by using global budgets for hospitals. The current system in the US is the most expensive system in the world. By maintaining that system, Shumlin is choosing the most expensive path and is maintaining the inequities, medical bankruptcies and the needless suffering and death that are inherent in the current health system.

The Affordable Care Act has placed the United States further down the road to a privatized, unequal and expensive system by subsidizing private health insurance and further privatizing our public insurances, Medicaid and Medicare. We need to do the opposite by cutting out the private health insurers that have the incentive to deny and restrict payment for care in order to make maximum profits. Ideally our single payer system would be at the national level and there is national legislation. Congressman John Conyers has introduced HR 676 Expanded and Improved Medicare for All in every congressional session since 2003.

There is a national consensus for a single payer healthcare system according to polls of Americans. And there is also strong opposition by the industries that profit from the current system. We’ve always known that attaining a single payer healthcare system would be difficult as the people need to be organized and mobilized to overcome those who profit from insurance, for-profit hospitals and over-priced pharmaceutical drugs.

Vermonters tried to demonstrate that they could organize and overcome that opposition at the state level, but they were betrayed. They must not give up and none of us must give up our determination to fight for a healthcare system that includes everyone. We cannot let failure weaken our resolve because the only path to ultimate success is overcoming failure. Together, we can win and we will win someday.    – Margaret Flowers

Healthcare Is a Human Right campaign responds to Shumlin’s failure to act on universal healthcare.

Vermont Workers’ Center Statement

Today the Healthcare Is a Human Right Campaign released the following statement in response to Governor Shumlin’s failure to move forward with universal, publicly financed healthcare in Vermont. Tomorrow, Healthcare Is a Human Right supporters will be at the Vermont statehouse at 12pm for a rally and creative photo opportunity denouncing the Governor’s failure to act.  

Statement by the Healthcare Is a Human Right Campaign:

“The Healthcare Is a Human Right (HCHR) Campaign expresses its deep disappointment in the failure of Governor Shumlin to act on the will of the people of Vermont to ensure universal, publicly financed healthcare in our state. This inaction is a slap in the face of many thousands of Vermonters who suffer from poor health and financial hardship in the private insurance market that sells healthcare as a commodity to those who can afford it. The HCHR Campaign reminds the Governor that healthcare is a human right, and that our government has an obligation to ensure that right. Our government also has a responsibility to enact state law, and Act 48, passed in 2011, clearly requires Vermont to take actions to provide healthcare as a public good to all residents by 2017.

We all currently pay for our hodgepodge healthcare system  – we just don’t paid in a way that leads to giving people access to care. Moving to a different financing mechanism has nothing to do with raising new money. Vermont’s businesses currently pay 80% of all private insurance premiums. Most of these businesses are large employers; they pay the lion share of health insurance. Individuals who fall sick also pay a big chunk – through roughly $800 million in out-of-pocket costs. The Governor’s task at hand was to shift private payments to a more equitable, public financing mechanism. His task was not to find new money.

The HCHR Campaign does not believe that the Governor showed sufficient commitment to identifying alternative public financing mechanisms for a service that is already being paid for by all of us. Over the past three years the Administration developed its financing ideas – the same ideas the Governor now claims make public financing impossible – behind closed doors, without public participation or broader input from the many experts in universal healthcare financing, but in close consultation with a select group of businesses. The Governor missed the deadline set by Act 48 to submit a financing plan in early 2013, thus failing to meet its obligations under the law. The proposals the Governor has presented now are not based on the principle of equity. By shielding big businesses from continuing their payments for healthcare at the current level, the governor made his financing plan both inequitable and unviable.  An equitable financing plan would have shown a clear path to sufficient and sustainable funding by maintaining big businesses current payments for healthcare costs and thus avoiding a cost-shift to small businesses and individuals.

The Governor’s misguided decision was a completely unnecessary result of a failed policy calculation that he pursued without democratic input. Without formally repealing Act 48 and without a democratic process of deliberation, the Governor’s unilateral decision is completely inexcusable and unacceptable. A decision of this magnitude requires the voices of the people of Vermont to be heard.

The many thousands of people that are active in the HCHR Campaign will not acquiesce to this undemocratic decision. The people of Vermont do not have the time to wait on a Governor who has consistently broken his promises. The HCHR Campaign will keep on fighting for our right to healthcare, and we call on our legislators to join us in this fight and move forward with an equitable, public financing plan for universal healthcare in our state.”

The following statement was released by Dr. Andrew D. Coates, president of Physicians for a National Health Program:

Today, 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 today 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.

Today’s 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.

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