Josh Goodman is a former staff writer for GOVERNING..E-mail: firstname.lastname@example.org
In Vermont, single-payer health insurance isn't just something progressives dream about. Instead, it's quite possible that this year's governor's race will prompt the state to pursue a single-payer system -- depending on who wins tomorrow's Democratic primary and the general election.
That became clear to me when I spoke with Deb Richter, chair of Vermont Health Care for All, a group that's pushing for a single-payer system. I'll get to the politics in a moment, but the policy of the matter is interesting too.
Vermont already has been aggressive about expanding access to health insurance. As a result, only 10% of Vermonters overall and 7% of Vermont children are uninsured, rates that are substantially better than the national average. The federal health care reform law is designed to expand access even further. In that context, why would Vermont consider a new plan for universal health care?
Richter said there are a couple of reasons for her push. She argued that many Vermonters are underinsured or have health insurance with deductibles they can't afford. She also argued that doctors are suffering because of low Medicaid reimbursement rates and that a single-payer system would help with that problem. In essence, Richter sees single-payer as a solution to a health care system that has become too expensive to work for either patients or doctors. If the state provides everyone with health insurance, she argues, administrative costs will drop. “The real savings come from the uniformity and universality,” she says.
Health insurance companies argue, of course, that only the competition they provide can keep costs down. But, Vermont's legislature is sympathetic to Richter's argument. The Vermont House approved a bill to move the state toward single-payer in 2005. The Senate approved a different plan that year and the compromise the legislature reached was eventually vetoed by Governor Jim Douglas, a Republican.
Now, Douglas is retiring, giving Democrats an opportunity to take the governor's mansion. The legislature has hired William Hsiao, a Harvard economist, to report by next February with three health care plans, one of which will be a single-payer system. Everything could be falling into place for Vermont to pursue single-payer next year. Or, it could not. "The majority of the Democratic legislators are for single-payer," Richter says. "The real question is whether they would stick their necks out and work for it without leadership from the governor. My answer to that is no.”
Richter is volunteering for Peter Shumlin, Vermont's Senate president and a vocal supporter of single-payer. She said that of the Democratic candidates besides Shumlin, Matt Dunne is the most committed to the concept. She doesn't think any of the Democrats would veto a single-payer bill, but the others are more tepid, indicating they'll consider it or support a public option or wait and see what federal reform produces.
Republican Brian Dubie opposes single-payer. I suspect that a general election between Dubie and Shumlin or Dubie and Dunne would center heavily on the issue. If Shumlin or Dunne wins in November, it's quite likely the state will pursue single-payer, although how far it could go in this direction without federal government approval is an open question.
When Janet Napolitano left office in Arizona last year, Republicans in the state got a golden opportunity to do as they pleased. They've used that opportunity to the fullest, pursuing a variety of long-time conservative causes (on immigration and many other issues). With Douglas leaving, it's possible that liberal Democrats will soon have their own golden opportunity in Vermont.
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