March 2011, Week 2


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Mon, 14 Mar 2011 21:43:47 -0400
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Vermont's Struggle for Single-Payer Healthcare

By Steve Early | March 10, 2011

Published on The Nation (http://www.thenation.com)


After years of political frustration, Earl Mongeon had
to see it to believe it. Often, when he finishes his
twelve-hour night shift at IBM in Essex Junction,
Mongeon heads home for breakfast and a few hours of
brush clearing on his sixty-acre lot in Westford. In
mid-January, the 55-year-old microprocessor assembler
and workers' rights advocate hopped into his car and
drove in the opposite direction, to Montpelier. There,
at the state Capitol, Mongeon and other supporters of
single-payer healthcare gathered to hear Senators
Bernie Sanders and Patrick Leahy, Congressman Peter
Welch and new Democratic Governor Peter Shumlin explain
that last year's national healthcare bill--a costly mix
of subsidies to private medical plans, some insurance
market reforms, Medicaid expansion and a mandate that
people buy coverage if they don't already have it--isn't
good enough for the Green Mountain State. The top state
and federal officeholders pledged to work together for
something better. "We firmly believe we can be the
state that passes the first single-payer system in the
country," Shumlin declared.

Mongeon and other supporters of single-payer have
marched and lobbied for years, most recently under the
banner of the Vermont Workers' Center and its
"Healthcare Is a Human Right" campaign. Their tireless
activism had a lot to do with spurring Vermont's
singular display of independence and political unity.
Two weeks earlier, several hundred VWC supporters
descended on the legislature on its opening day. State
House and Senate leaders, including some recent
converts to the single-payer cause, paid fealty to the
grassroots movement. Before a boisterous crowd of union
members and community activists, 71-year-old Peg
Franzen, a VWC leader and disability rights advocate,
hailed the "people power" that had persuaded
legislators to commission a detailed study of options
for universal healthcare last year. In late January a
joint session of the Democrat-dominated legislature
received a 203-page report from Dr. William Hsiao, the
Harvard healthcare economist hired to develop a road
map for reform. Hsiao's research team identified
fifteen hurdles to creating the system they
recommended: universal coverage with equal access and a
common benefit package that includes community-based
preventive and primary care, as well as control in the
escalation of health costs.

Undaunted by the roadblocks ahead, Shumlin's special
assistant for healthcare, Anya Rader Wallack, went
before a joint legislative committee on February 8 to
unveil H. 202, "An act relating to a single-payer and
unified health system." Wallack spelled out a
three-stage reform process, spanning at least four
years but beginning with the creation of a Vermont
Health Reform Board to control costs and streamline
payment methods. Wallack described Vermont's current
system of multiple private and public payers as "too
complex and misguided," noting that it leaves "more
than a quarter of the state's population potentially
facing healthcare bills that send them to bankruptcy."
On behalf of the governor, she insisted that "this
craziness must stop. We have to get insurers out of
managing medicine and allow providers to use technology
and appropriate quality oversight to get waste out of
the system."

The perfect storm for fundamental reform seems to have
arrived in America's second-smallest state, but the
wind is blowing rightward elsewhere in the country,
with the new Republican majority in the House voting to
repeal the Patient Protection and Affordable Care Act,
which they brand "Obamacare." Red-state attorneys
general and their GOP governors are challenging the
constitutionality of PPACA by focusing on its
controversial individual mandate. Healthcare reformers
in Vermont aren't happy with President Obama's scheme
either. That's why they're trying to create a social
insurance system that would sever the connection
between coverage and employment and make access to
medical care a "human right" for the state's more than
625,000 citizens. Marketplace competition and
profiteering--given a renewed lease on life nationally
by PPACA--would be phased out locally as soon as
possible. If single-payer works in Vermont, its backers
envision the state becoming the Saskatchewan of
America, just as Canada's thinly populated but left-led
prairie province paved the way for Medicare-for-all
north of our border fifty years ago.

Getting from here to there will not be easy. The Green
Mountain State's single-payer initiative could be
delayed unnecessarily by the implementation timeline of
PPACA. Under that law, every state must have health
insurance exchanges in order to get the hundreds of
millions in new federal dollars to subsidize private
benefits. Unless PPACA is amended--as President Obama
recommended on February 28--any pilot projects headed in
a single-payer direction would be delayed until 2017.
In the now GOP-dominated House, Representative Welch
has introduced a bill authorizing the federal waivers
needed for Vermont to become "a laboratory for
innovation and excellence" in three years, rather than
six. As the New York Times reported on March 1, Welch's
bill has "no Republican co-sponsors, making its
prospects for passage uncertain at best."

Single-payer also faces resistance from big business,
inside and outside the state. (A taste of that was
provided six years ago by antiunion IBM, which held
in-plant meetings for 6,000 workers to warn them that a
single-payer bill, then pending before the legislature,
would require $1 billion in new taxes and force
businesses to leave.) A former state legislator from
Putney, Governor Shumlin is also part owner of a family
business that made him a multi-millionaire. In the face
of blunt opposition from his fellow employers, he has
pitched single-payer as a way to make Vermont more
"business friendly" by curbing healthcare costs, which
have doubled in the past decade. Many of the
entrepreneurs affiliated with Vermont Businesses for
Social Responsibility do seem to favor decoupling
health insurance from employment, although not
necessarily via a single-payer system. The more
mainstream and politically influential Associated
Industries of Vermont displays little enthusiasm for
moving to a publicly funded plan financed by payroll

Speaking at a union conference in Burlington over
Martin Luther King Day weekend, Mark Dudzic of the
Washington, DC-based Labor Campaign for Single Payer
Health Care warned about a deluge of anti-single-payer
propaganda. "There will be a massive mobilization of
corporate power to smash any state single-payer
initiative," he predicted. "Vermont is going to be one
of the first battlefields in that fight." In unionized
workplaces--including those represented by the state's
two largest unions, the Vermont Education Association
(VEA) and the Vermont State Employees Association
(VSEA)--some single-payer advocates worry not enough is
being done to educate and mobilize members, whose own
negotiated medical benefits are currently at risk. In
Vermont, as in other states, there's growing taxpayer
resentment at paying for coverage that most
private-sector workers don't have anymore, whether
unionized or not.

At every teachers union bargaining table in Vermont,
management is seeking bigger premium contributions,
part of a larger giveback trend that has triggered
several strike threats. No group of union members has a
bigger stake in building a viable tax-supported system
of universal coverage than public employees--because
their healthcare is already publicly funded by state,
county or municipal governments. Nevertheless, as VWC
activist and VSEA member Leslie Matthews notes, her own
union has not been leading the struggle because some
workers are "apprehensive that healthcare reform could
lead to erosion of hard-won benefits." In reality,
Matthews argues, "it's the rising costs, increasing
inequities and cost shifts in our current healthcare
system that will ultimately bring us down. As union
members, our access to affordable healthcare will only
be secure when all working people have access to
affordable healthcare."

Workers' Center director and lead organizer James
Haslam does report that the American Federation of
Teachers, the Communications Workers of America and the
AFL-CIO have all increased their funding of VWC
activity. Other national groups, like the Universal
Health Care Action Network, have created a "Help
Vermont Win! Campaign Fund" to channel more resources
into the fight. In late March Physicians for a National
Health Program will send nursing and medical students
to Vermont to rally support for single-payer. And on
May 1 the Jobs with Justice-affiliated VWC will sponsor
its biggest May Day "March on Montpelier" ever--to adopt
the strongest possible version of Shumlin's plan.

The new governor's commitment to the cause is a case
study in how Democrats could behave elsewhere--on
healthcare and other issues--if their party faced more
challenges from the left. Before his run last fall,
Shumlin's only previous bid for statewide office was a
failed campaign for lieutenant governor in 2002. His
candidacy, as a Democrat, was undermined when 25
percent of the electorate backed Anthony Pollina, a
Progressive Party member and longtime single-payer
backer who now serves in the State Senate. In last
year's crowded Democratic gubernatorial primary, all
the candidates played a game of healthcare reform
one-upmanship that helped solidify support for
single-payer. Shumlin won the free-for-all by just over
200 votes, even though he was not the preferred nominee
of the VEA, VSEA or state AFL-CIO.

In the general election, Shumlin's opponent was Brian
Dubie, an affable Republican who garnered some labor
support based on his membership in the Air Line Pilots
Association. In the last month of the campaign, the
race was very close. That's when the state's big-foot
independent socialist stepped into the ring. Rallying
his own grassroots base, Bernie Sanders held a series
of GOTV events for Shumlin that helped the Democratic
candidate gain favor among working-class Vermonters who
might otherwise have drifted toward Dubie. Shumlin
ended up winning by less than 2 percent of the vote.

At a Nation book-signing event in Boston in February,
Shumlin's white-haired, 69-year-old helper was welcomed
by local activists. In his discussion with them,
Sanders noted that single-payer has become "absolutely
mainstream" in Vermont because "we've been talking
about the issue for thirty years." But he warned that
further grassroots organizing was needed because "this
is by no means a done deal." Back home, the Vermont
Workers' Center and allied groups are taking nothing
for granted either, as they gear up for a spring
offensive in Montpelier to keep single-payer from
getting bogged down in the public policy equivalent of
Vermont's fabled "mud season," which has never been
kind to new models seeking traction, much less the fast

(Steve Early has been writing about Vermont politics
since 1970. He was an organizer and contract negotiator
for the Communications Workers of America in New
England for 27 years. He is a longtime single-payer
advocate and the author, most recently, of The Civil
Wars in U.S. Labor, just out from Haymarket Books. He
an be reached at [log in to unmask])


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