WSJ on Vermont’s single payer effort

The Wall Street Journal
December 22, 2014
Vermont's Single Payer Washout

Last week, in a reversal that deserves more attention, Democratic
Governor Peter Shumlin announced that Vermont would no longer create
America's first statewide single-payer health system.

Single payer is the polite term for socialized medicine and the ultimate
goal of the political left.

At least the Governor deserves credit for admitting failure. His
ideological comrades are rarely dissuaded by the prospect of economic
damage, as ObamaCare proves. But Mr. Shumlin has succeeded in making
Vermont a national model: By admitting that single payer will make
health care both more expensive and less efficient, he has shown other
states what not to do.

http://www.wsj.com/articles/vermonts-single-payer-washout-1419293404

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Vermont
H.202
Bill as Passed by the House and Senate, 2011

"An act relating to a single-payer and unified health system"
changed to
"An act relating to a universal and unified health system"

(H.202 is a 213 page bill. The first 135 pages were deleted and the
remaining pages are a rewrite of the entire bill.)

Sec.2(a)(6):

The director, in collaboration with the agency of human services, shall
obtain waivers, exemptions, agreements, legislation, or a combination
thereof to ensure that, to the extent possible under federal law, all
federal payments provided within the state for health services are paid
directly to Green Mountain Care. Green Mountain Care shall assume
responsibility for the benefits and services previously paid for by the
federal programs, including Medicaid, Medicare, and, after
implementation, the Vermont health benefit exchange.

http://www.leg.state.vt.us/docs/2012/bills/Passed/H-202.pdf

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Comment by Don McCanne

As was fully expected, the conservative and libertarian pundits are
inundating the Internet and other media vehicles with celebratory
commentaries on the theme that Vermont Gov. Peter Shumlin's withdrawal
of his single payer proposal is proof that single payer is more
expensive and less efficient than other health care financing systems.
The Wall Street Journal editorial excerpt above is selected as a leading
example of these right-wing responses. The problem with these comments
is that H.202, the Vermont reform legislation, IS NOT A SINGLE PAYER
PROPOSAL.

Even many single payer supporters have it wrong. They claim that Gov.
Shumlin gave up for political reasons, and, if he had persevered, he
would have been successful in establishing the first state-level single
payer system in the U.S. Again, the problem is that H.202, the Vermont
reform legislation, IS NOT A SINGLE PAYER PROPOSAL.

Posted above is a link to H.202. During the legislative process, the
bill was renamed, deleting "single-payer" from its title. If you check
the document at the link, you will see that the original bill was
red-lined out, and the bill was entirely rewritten. All references to
"single-payer" were removed.

The crucial phrase in the except above regarding waivers and agreements
is "to the extent possible under federal law." It was known at the time
the revisions were being made that Sec 1332 ACA waivers, Sec 1115
Medicaid waivers, the narrowly defined Medicare demonstration waivers,
and the ERISA limitations on employer-sponsored plans were so limited
that it would be impossible to establish a bona fide single payer system
through unilateral state action alone, nor through a cooperative effort
with the Obama administration. Comprehensive federal legislation would
have been required, and that clearly was not forthcoming from this or
the next Congress. Legislating a wish list does not equate with clearing
all of the hurdles that only Congress can effectuate.

The reason that this message is being reemphasized again today is that
there has not been a loud enough voice in unison emphatically rejecting
the claim that Vermont's experience is proof that single payer cannot
work. Single payer never had a chance, considering the inertia in
Congress. This was not a single payer failure. Do not remain silent when
that claim is made. Single payer has been proven to work well in many
other nations.