Single Payer Isn't Dead: How States Are Keeping the Movement Alive
August 3, 2010
By Michael Corcoran truthout | Op-Ed
The grassroots single-payer movement in Vermont reflects
the growing belief that the fight to make health care a
human right must come from the states. But will the
passage of federal reform get in the way?
When Barack Obama signed the Patient Protection and
Affordable Care Act in March, many thought the long and
tedious stretch of legislative wrangling and endless
debates about health care reform had come to an end and
the prospects for further meaningful reform would be
shelved for years or decades.
But while the country was consumed with the incredibly
narrow debate in DC, dictated largely by drug and
insurance lobbyists, anti-abortion politicians and a
collection of conservative Democratic senators with
close ties to the insurance and drug industries, another
significant health care battle was taking place hundreds
of miles to the north, in the tiny little state of
Vermont, population, 600,000. By the time Obama signed a
federal health care bill into law, the Vermont Workers'
Center was almost two years into its "Healthcare is a
Human Rights campaign," which had the unambiguous goal
of abolishing for-profit health care in the state and
passing a statewide, single-payer health care system
that guarantees health care as a right to all
Vermonters. In May, the Vermont Legislature, under
constant pressure from this growing people's movement,
passed a bill that could possibly lead to Vermont being
the first state to pass a single-payer health care
system, setting up what could be a crucial phase of the
fight for health care justice.
If Vermont is able to break this ground, the
implications could reverberate well past the borders of
the Green Mountain State. The fight for statewide
single-payer here reflects a growing belief among health
care activists that the path to a universal public
system, will not take place in Washington, DC, where
moneyed interests have a death grip on the legislative
process, but through state houses across the country.
Further, the effort in Vermont may prove to be the first
test case of the "state innovation" language in the
federal reform bill and could indicate if Obamacare will
ultimately serve to enable statewide single-payer
systems or if it will kill them. Finally, the movement
in Vermont also highlights a fascinating debate over the
rhetoric of health care reform. Should advocates point
to the significant savings associated with single-payer
health care and the unsustainability of the current
system? Or should the primary emphasis view the fight
for public health care as a matter of basic human
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Federal Reform: A "Distraction" to the Fight for Health
For the last year, James Haslam, long-time director of
the Vermont Workers' Center, paid only scant attention
to the massive fight in Washington over health care
reform. "In many ways the argument in Washington was
something of a distraction for us," he said in an
interview with Truthout, from his home in Burlington
Vermont. "The debate gave some people the impression
that healthcare would be fixed. But to us it was clear
that what they did in Washington does not address the
crisis, because they preserved the current profit
system. We thought it was important to define healthcare
as a human right."
Indeed, the reform that eventually passed in DC is
memorable not only for its scale - some $900 billion in
federal spending over ten years - but also the fact that
it failed to fundamentally change the private,
for-profit basis of the United Sates woeful health care
system, which leaves more than 46 million without
insurance and is the most expensive in the world. Not
only did Congress fail to even consider some kind of
public, guaranteed, universal system, the likes of which
exists in every developed nation on the planet, but
progressives could not even muster through Congress a
minuscule "public option," that had been understood as
the major consolation prize that would ensure
liberal/left support for Obama's health care reform.
So the Workers' Center, unlike many progressive
organizations, chose not to rally on behalf of federal
reform and instead dutifully set out to "get people to
think about healthcare as a human right," as Haslam
describes it. The first year of the campaign began ever
so cautiously. Rather than narrowly focus on a specific
piece of legislation, or even the details of
single-payer health care, organizers simply made their
way across the state, passing out surveys and listening
to stories from those who had been left behind by the
health care system. Many of them were from the tens of
thousands of uninsured Vermont men, women and children.
The group held hearings in every corner of the state -
from St. Albans to Brattleboro - and heard gut-wrenching
story after gut-wrenching story: women who stayed in
abusive relationships so their children would not lose
health insurance; a hobbled logger who continued to work
one of the world's most dangerous jobs on a bad knee
with no insurance ("life is scarier when you step out of
the woods," he said); families with insurance still
facing bankruptcy, because the coverage did not protect
them from financial ruin.
"From talking to people, we came to learn that people in
Vermont really did believe that healthcare was something
that everyone should have and that it should not be
treated as a commodity," Haslam said, noting that 95
percent of those polled by the Workers' Center, believed
health care to be a human right.
A Different Approach
At the core of every action and statement made by the
Workers' Center, was its emphasis on human rights. It is
noteworthy just how much this approach differed from
reform efforts in Washington. While Democrats in DC were
obsessing over "bending the cost curve," cutting the
deficit, and other technical (though vitally important)
elements of health care reform, in Vermont, the bulk of
the rhetoric used avoided that approach. The Workers'
Center often cited the Universal Declaration on Human
Rights and held events to correspond with its
Anja Rudiger, the Right to Health Program coordinator
for the National Economic & Social Rights Initiative,
has assisted with health care campaigns in Vermont and
elsewhere. She says the language of human rights is
being adopted by an increasing number of organizations
and individuals as they attempt to build movements.
"A human rights focus puts humans at the center. It is
about people's experiences and about people's needs and
it is a very powerful approach to get people in all
kinds of communities involved," she said in an interview
This approach may seem simple, but it does take
discipline. After all, the finances of statewide single
payer remain persuasive. According to a study
commissioned by the Vermont Legislature in 2006, Vermont
would save $51 million a year if it switched to single
payer. Still, Haslam insists, the focus should not be on
cold economics. "It's important that the debate over
healthcare reform not only be about how to finance a
system," he said.
The difference in rhetoric - and policy goals - is not
the only reason why reform in Vermont is so different
than in DC. While reform in Washington was largely
hammered out in closed-door meetings between politicians
and industry officials, in Vermont, the drive for change
has come from the bottom up - at rallies, committee
hearings and parades. "In Vermont, a few hundred votes
can make the difference for a politician," Haslam said.
"The people have a much larger voice on what goes on
than in Washington ... we had people from our campaign
at almost every single related committee meeting,
telling their stories."
Building the System
Even in Vermont - home to a self-identified socialist
senator and Ben and Jerry's ice cream - passing single
payer will be no easy task. A bill that could have been
a stepping stone to single payer was passed in 2005,
only to be vetoed by Gov. Jim Douglas. This led to a
private-public compromise, Catamount Health, that has
been hampered by state budget issues, ever-rising
premiums and low enrollment.
With Governor Douglas not seeking re-election,
single-payer activists are no doubt keeping a close eye
on the 2010 Vermont gubernatorial race, which is
expected to be a battle between Vermont's conservative
Lt. Gov. Brian Dubie and the winner of a hotly contested
democratic primary. Organizers express optimism that any
of the Democratic front-runners will be favorable to
their position. Senate President pro-tempore. Peter
Shumlin, who in July received a key endorsement from
former president of Physicians for a National Health
Program Deb Richter, may be the most friendly to the
cause. In a letter to the Barre Montpelier Times Argus,
Richter and other health professionals called Shumlin,
"the only candidate who has shown unwavering support for
a publicly financed universal health care system in
Vermont." (A similar dynamic exists in California, where
the Legislature has passed single-payer bills twice in
recent years to have them met with vetoes from Gov.
Arnold Schwarzenegger, who is termed out in 2010).
"Whoever is the governor, we think we can work with them
to pass a bill," Haslam says, confidently. Nonetheless,
others have lingering fears that the Legislature will
punt by passing another half-measure, or using federal
reform as an excuse to hold off on anything dramatic.
Others fear Dubie, who polls ahead of all the Democrats,
may win the election and simply veto any meaningful
But despite the many political obstacles, the Workers'
Center continued to fight, and at the end of the 2009
legislative session, got behind S.88, which calls for
three health care systems - all to be based on human
rights principles - to be designed. Among the three
systems to be designed will be a single-payer system and
organizers' hope is that S.88 will lead to a new health
care system in the near future.
While the grassroots movement may be focused on human
rights, designing a system will require a hard look at
the economics of dramatic reform. And to handle this
task, the Vermont Joint Fiscal Committee (which handles
legislative business when the session is out), has
assigned Dr. William Hsiao, the creator of the
much-praised Taiwanese health care system, which has
dramatically lowered costs and increased coverage since
it was implemented in 1996.
Single-payer activists have celebrated this selection as
a sign that the Legislature is serious about reform. "We
are at the door step of history," noted Walter
Carpenter, a volunteer for the Workers' Center.
For Carpenter, a Montpelier resident who nearly died at
the hands of the system when he suffered liver disease,
the issue is personal. "In the last of my four
operations for liver disease, I had lost my job, was
turning yellow again and had to negotiate the price of
my own life," he told Truthout.
Will Obamacare Derail Statewide Single-Payer Efforts?
Perhaps, the worst possible conclusion would be if a
movement in Vermont managed to secure a historic health
care victory, only to be killed by the very federal
health care reform that some overzealous commentators
praised as "the greatest social achievement of our
But this is entirely plausible. One major element of
planning a new system is dealing with the federal
government. The final version of federal reform includes
"state innovation" language that address the ability of
states to create their own health care systems. These
systems, according to a memo by the Center for Policy
Analysis, "could delay implementation of state
single-payer plans." Igor Volsky, writing for Think
Progress, says the federal reform might be "a major set
back for single-payer advocates":
"States that still chose to pursue their own plan, will
have to reconcile their programs with the federal
requirements for Medicare, Medicaid, FEHBP, Indian
Health Service and, most importantly ERISA - a 1974 law
that, among other things, preempts states from enacting
legislation that is "related to" employee benefit plans
... States will have to go to Congress if their reform
affects the health insurance offered by large
Rep. Dennis Kucinich (D-Ohio) had pushed hard to include
an ERISA waiver, but it was dropped from the final bill
- yet another painful example of progressive impotence
in this legislative process. More trouble for statewide
single-payer advocates occurred when the date for when
states could opt out and make their own systems was
pushed back from 2014 to 2017 - three years after
statewide exchanges will go into effect.
This, according to Michael Briggs, communications
director for Sen. Bernie Sanders, (I-Vermont), was an
unfortunate and inexplicable tweak to the final bill.
"Bernie (Sanders) has encouraged statewide single-payer
for years. He was the one who pushed for and implemented
provisions that would allow states to experiment. But,
for complicated reasons I don't fully understand, the
date that these states could start experimenting was
pushed back until 2017," he said in an interview with
This could mean that even if Vermont is able to pass
through a single-payer bill in one of the next
legislative sessions, it may require an act of Congress
- a place notorious for not even giving single payer a
passing glance - to allow such a transformation to take
place. It is hard to grasp what a cruel irony it would
be if Obama's health care legislation became the death
nail for statewide single-payer movements across the
But not all are so pessimistic. Dr. Hsiao, in an
interview with Truthout, said he felt the new federal
legislation, "left quite a bit of room for state
innovations," and was confident the state could secure
the needed waivers should Vermont push legislation
Senator Sanders, too, has encouraged Vermonters to push
through a bill. "As a long-time advocate of single-payer
I'm glad the state is going to have a study," Senator
Sanders told The Nation. "I think the result of it will
show that the most cost-effective way to provide
universal, comprehensive health care to every Vermonter
is through a single-payer approach. What the Vermont
legislature has done is very important, very positive
and I strongly support their efforts."
Sanders added that he "will be going right into the
President's office and making the fight on the floor of
the Senate that Vermont should be able to become a
laboratory and go forward with a single-payer program.
And I think if it works in Vermont many other states
will want to do the same thing."
Could Vermont Lead the Way?
Sanders has a point. Washington has proven to be
entirely unwilling, or incapable, of truly standing up
to entrenched special interests. Indeed, the Canadian
single-payer health care system was created in much the
same way as Sanders envisions for the United States,
with one province taking the lead and others following
in turn as the positive impacts became obvious.
"Vermont, being a smaller state could be a demonstration
site. And it can show states across the country how we
can bend the cost curve," said Hsaio.
"The battle for healthcare as a human right in Vermont
is also really a battle for healthcare for people all
over the country," Haslam said.
This is precisely why the battle for single-payer health
care in Vermont ought to be seen as a national struggle.
The reform talks in Vermont may not involve close to a
trillion dollars, but the type of change that could come
out could represent a fundamental change in the way a
state delivers and finances health care. And if it
works, it could spread.
In fact, formidable statewide single-payer movements are
forming all over the country and making the case that
health care should be a human right - in Montana,
Pennsylvania, New Mexico, Minnesota, Maryland,
California, and elsewhere. It is clear that private,
for-profit health care is unsustainable and that
Washington, DC, is not capable of addressing the issue.
So, the responsibility to end this crisis now falls on
grassroots movements across the states. Will Vermont be
the first domino to fall?
This work by Truthout is licensed under a Creative
Commons Attribution-Noncommercial 3.0 United States
License. By Michael Corcoran | truthout
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