Vermont Gov. Won’t Pursue Single Payer Health Care This Year

Gov. Peter Shumlin earlier this year (Wilson Ring/AP)

Gov. Peter Shumlin earlier this year (Wilson Ring/AP)

Gov. Peter Shumlin of Vermont announced on Wednesday that his state would not pursue single payer health care in this coming legislative session.

Shumlin blamed a sluggish economy for his decision. The taxes required for single payer would prove too burdensome for Vermont, a state that has downgraded its revenues twice this year.

The taxes required to implement single payer would include an 11.5 percent increase in payroll taxes and up to a 9.5 percent increase in income taxes for every Vermonter.

Shumlin added: “Making fundamental changes in our health care system — nearly 20 percent of our economy — is a huge undertaking, and one that must be done with care.”

You can read Shumlin’s prepared remarks here.


New England Journal Of Medicine: Lessons From Vermont’s Single-Payer Plan

Vermont moves ahead with its unique, publicly-financed insurance program” (“Amy the Nurse/flickr)

We devote a great many pixels to Massachusetts health reform, but of course it’s really Vermont that’s attempting the boldest state-level experiment, with its push toward a single-payer system.

So how’s it going? Very nicely indeed, according to a piece just out in the New England Journal of Medicine titled Lessons from Vermont’s Health Care Reform.

I tend to derive most of my lessons from mistakes I make, but this piece focuses on what Vermont has been doing right, and others may want to emulate as Obamacare takes hold. In brief:

Policymakers and stakeholders in other states can learn some lessons from Vermont regarding ACA reform. First, engaging stakeholders while providing transparency at each stage of reform builds support for transition efforts. Second, the adage “work smarter, not harder” applies to the enormous task of implementing health care reforms: a central board can coordinate all implementation efforts, reduce redundancy and bureaucracy, and improve transparency. Third, the development of a health insurance exchange presents opportunities for state-specific health care innovation. And finally, instead of resisting the inevitable federal reforms in the name of federalism, states may capitalize on federal financing opportunities to build new state health programs and realize cost savings.

Readers, anyone want to question this positive view? In particular, perhaps, Josh Archambault of the Pioneer Institute, considering this 2011 post? It includes this memorable repetition: “There are many, many, many, many, many challenges ahead for VT before successful implementation.”

Update On Vermont, As It Moves Toward Single Payer System

Vermont moves ahead with its unique, publicly-financed insurance program” credit=”Amy the Nurse/flickr

Kaiser Health News revisits Vermont, which approved a single-payer health system last year, but has yet to figure out some critical details — like how to pay for it. In the meantime the state is working to build a new health exchange — a requirement of the new federal health law — that will serve as a foundation of the future, publicly-financed insurance program.

KHN’s Jessica Marcy reports:

Gov. Peter Shumlin’s administration this week offered a bill to the legislature that lays out a plan for building the exchange, a type of marketplace for individuals and small groups to buy health insurance. The proposal would combine the small group and individual health insurance markets, would bar the sale of health insurance to individuals and small employers outside of the exchange and would define a small employer to be 100 employees or fewer instead of 50, which had been under consideration. The bill also seeks to clarify how the state should integrate Medicaid, the state-federal health program for the poor and disabled, into the exchange.

Under the new system, an independent five-member panel called the Green Mountain Board will also be in charge of reviewing hospital budgets and defining final Certificate of Need as well as making health insurance rate decisions. That board is also working on a transition to a single-payer health system. Continue reading

Single-Payer State: What Can We Learn From Vermont?

In our continuing coverage of Vermont’s grand experiment to become a single-payer health care state, here’s a recent dispatch from our intern, Fran Cronin:

On May 26, Vermont’s newly elected governor, Peter Shumlin, signed Act 48, a new law that will eventually create the nation’s first single-payer health care system.

Vermont Gov. Peter Shumlin

At a panel this week sponsored by the Blue Cross Blue Shield Foundation of Massachusetts and held in downtown Boston, four experts offered their thoughts — some which might serve as lessons for Massachusetts as we embark on phase two of health reform, with a focus on containing costs while offering quality care.

Lesson One: Everything Is Political

Anya Radar Wallack, Ph.D., and Special Assistant to Vermont’s Governor Shumlin for Health Care Reform said Shumlin’s campaign was centered around health care reform, and that the new governor successfully explained to voters how Vermont’s health care system was failing them. He also laid out an economic argument for change. When Shumlin was campaigning, Wallack says, health care spending had tripled between 1992 and 2009 and had exceeded the national average. He made it clear that change was important for consumers.

Lesson Two: Buy-In For All (Or, Don’t Forget Hillary’s Health Care Disaster)

William Hsiao, Ph.D., K.T. Li Professor of Economics, Director of Health Systems Program, Harvard School of Public Health took Shumlin’s vision and detailed how it bring it into reality. To develop a viable plan, says Hsiao, you have to first understand the political stakeholders: politicians, insurers, physicians, hospitals, big business, the Chamber of Commerce, and grass roots organizations. “You have to identify the barriers [to change] and navigate around them.” “Like a game of chess,” says Hsiao, “you need to get to checkmate.”

Of the host of structural recommendations Hsiao made, Vermont accepted four. They are: the creation of an independent board that will facilitate direct negotiations between providers and recipients and the de-coupling of health insurance from employment; (According to Hsiao, the United States is one of the few advanced nations in the world with this insurance model. “De-coupling,” he says, “would be a huge step forward.”) Third, instead of employers paying for insurance, the state would implement an employee payroll tax to cover the cost of the state’s insurance fund. With a large and centralized asset pool, the state could make access and care more uniform. “We need to bring the uninsured up to the same level of care as the insured,” says Hsiao. Fourth, aggressively launch a public-private partnership. With a modest 625,000 people, Vermont is uniquely positioned to align itself with the states largest insurer, Blue Cross Blue Shield of Vermont. (If Hsiao’s calculations are correct, he says Vermont could save $500 million per year with a single payer system. )

Lesson Three: Test Out A Bunch Of Ideas, And Don’t Be Afraid To Nudge

Michael Frasier, a democratic representative in the Vermont State House of Representatives says Frasier says much of the credit for the bill’s passage comes from “a good election” and perhaps even a little Velcro. In trying to nudge the legislature forward, he says, “You have to throw things up on the wall and hope they stick.” Continue reading

The ‘Monstrosity’ Health Care System: 3 Problems, 1 Vermont Solution

Harvard health care economist William Hsiao

Sometimes when I think about the American health care system, I want to cry. It’s so hopelessly Byzantine, so dysfunctional, so exorbitant compared to other developed countries.

But it was oddly comforting to listen to Harvard’s William Hsiao, one of the country’s leading health care economists, speak last night at Brookline’s 16th annual Public Health Policy Forum. He has a gift for distilling down the complexity and making it all seem less hopelessly tangled — and what happens now in Vermont, where he’s helping to engineer the historic push toward a single-payer system, will show whether he’s right. Here, nearly verbatim — because he inspired me to try to type his every word — is what he said:

The American health care system has three major problems:
1) The uninsured
2) Quality of care
3) Affordability and rapid cost escalation.

If you were in President Obama’s shoes, how would you solve this?

I’d like to argue that the problem is systemic. It’s not one problem. There are several very fundamental causes all linked together, creating these three phenomena that we call problems. So what are these causes and how is Vermont attempting to solve these fundamental causes?

The first cause: Our health insurance is linked to employment, so if you’re not employed, or your employer does not offer insurance, you’re out of it. Basically, all advanced economies have moved away from that. We’re one of the few remaining to tie our health insurance to employment.

We’ve created a monstrosity of administrative complexity.

Secondly, we rely on many insurance funds — public or private, for-profit or non-profit — to insure people. We have a patchwork, so consequently you can do risk-selection: If I’m an insurance company, I would not want to insure anyone with gray hair like mine. I’d want to go to Silicon Valley and insure healthy young people. We created an insurance system that encouraged insurance companies to exclude the less healthy people and only insure the healthy.

Administrative hassle

Third, because we have so many insurance companies, everybody — doctors and nurses and nurse practitioners — has to deal with each one differently. We call that competition. We call that pluralism. What happens then? If you’re a practitioner, you’re going to spend your time dealing with multiple insurance companies. This is what doctors call “administrative hassle.” Continue reading

Vermont Gov. Signs First In Nation Single-Payer Health System Into Law

Vermont makes history with the nation's first single-payer health care system

It’s official. Gov. Peter Shumlin signed into law the first single-payer health care system in the U.S. reports:

The legislation sets up a framework for developing an implementation plan for Green Mountain Care, a universal, unified health care system. The bill creates a five-member board that will oversee the development of a benefits package, a reimbursement system for doctors and hospitals, and a financing system to support the universal health care plan. The law also contains provisions for Vermont’s federal insurance exchanges…

The governor spelled out a vision in which health insurance coverage would be decoupled from employment and the financial burden now borne by employers would be lifted; in which providers who are having difficulty surviving in the current system are compensated fairly; and in which uninsured and underinsured Vermonters will have access to health care. The bill lays out a timeline for the implementation of the complicated plan over a three-year period. Though the Shumlin administration hopes to launch Green Mountain Care in 2014, it could be 2017 before the system is in place because of certain federal requirements.

Med Students Rally For Vermont Single Payer System

Medical students show support for a single payer health system in Vermont

Medical students from Vermont and neighboring states are heading to Montpelier this weekend to rally in support of a publicly-funded, single payer health system for the Green Mountain state.

A press release from the group, Physicians for a National Health Program, quotes Harvard Medical student Jonathan Takahashi on why he supports the plan:

“Through my training in medicine and public health thus far, I have seen firsthand how much the current lack of a unified and equitable health care system is a stumbling block in doing the work I care about. This is why action to improve health care, through measures such as implementing a single-payer financing system, is important to me.”

Sen. Bernie Sanders, I-Vt., and Gov. Peter Shumlin, D-Vt., both of whom have been outspoken advocates of single-payer reform, are scheduled to speak at the 1 pm rally Saturday at the Vermont Statehouse, the physicians group says.

Earlier this week over 200 physicians from around the country, including 13 from Massachusetts, said they would seriously consider relocating to Vermont if it were to implement a single-payer system.

Read our interview here with one of the students planning to attend the rally.

Docs Willing To Move To Vermont For Single Payer System

Some doctors say they're willing to move to Vermont if a single payer system is enacted

More than 200 doctors from 39 states and the District of Columbia say they’d consider moving to Vermont if that state switches to a publicly financed single-payer health care system, according to affiliates of Physicians for a National Health Program, an organization of physicians who advocate for single-payer national health insurance.

Many of the doctors mulling a move are in primary care, according to the Vermont chapter of the physician’s group, and while most are from nearby states, doctors from California, Oregon, Washington and Hawaii also said they’d consider moving to Vermont under a single-payer system.

The group asked physicians from around the nation to sign an open letter to the Vermont Legislature in support of the single-payer plan. Doctors could also check a box if they would consider moving to Vermont if a single payer system was enacted.

Eighty Massachusetts doctors signed the letter; 18 checked the box.

Dr. Rachel Nardin, a neurologist at Cambridge Health Alliance, is one of them. She said the current health care system, even with the reforms in Massachusetts, is so demoralizing, she would strongly consider leaving Massachusetts for Vermont if that state had a single-payer system.

“Practicing medicine in our current system is wretched,” Dr. Nardin said in an interview. “Instead of caring for people, we’re fighting with insurers to get what we need for our patients — it’s depressing. For the chance to just care for patients, and not have these fights, sure I’d move.”

Dr. Nardin, who is also co-chair of Massachusetts Physicians for a National Health Program, said she recently cared for an uninsured woman with Lou Gehrig’s disease, a progressive neurodegenerative disorder also known as ALS. “Because she had no insurance, I couldn’t get her a hospital bed, or a wheelchair, I couldn’t get her the most effective medication, I couldn’t get her anything that would maintain her dignity,” Dr. Nardin said. “It is so unnecessarily cruel.” (Ultimately, the patient received help from a private charity.)

“The beauty of single payer,” Dr. Nardin said, “is that people have insurance from cradle to grave and when you get sick, you can worry about being sick and how to get better, you don’t have to worry about how you’re going to pay for care.”

Here’s another Mass. doctor, Suzanne King of Lenox, advocating for the Vermont single payer plan in an opinion piece in The Berkshire Eagle today.

Heading North To Rally In Single-Payer-Land

A recent Vermont rally

There’s a new cause that calls for getting on the bus. Next Saturday morning, (3/26), dozens of Boston-area medical students and others heading into health care careers plan to board buses for Montpelier, to rally at the State House in support of the single-payer system that Vermont leaders aim to create.

“We’re going up there trying to hammer home the message that as students and other health professionals from out of state, we want to see Vermont lead the way, and be able to point to Vermont as an alternative,” said Sim Kimmel, a third-year Harvard medical student and one of the buses’ organizers. “Some people have gone as far as saying that if Vermont were to have a single-payer system, they would pledge to move there.”

Click here for information on the rally, which is slated to include Sen. Bernie Sanders and Governor Peter Shumlin (who was on Radio Boston last week explaining the state’s plans.) Here, students explain why the rally is important to them.

Sim says the Boston contingent hopes to gather about 100 students for the 8 a.m. buses from Back Bay and Harvard Square, and they’ll be joined by colleagues from around the Northeast at the rally.

“It’s quite clear from the experience in Boston and in Massachusetts and around the country that we’re not organizing health care in a reasonable or rational way,” he said.

But, I asked, wouldn’t a single-payer system — the government-controlled type used in Canada or England — mean that as a future doctor, he’d earn less money?

“That’s not exactly clear, but even if it meant that, I would still support it,” Sim said. “Physicians spend so much time fighting with insurance companies and filling out paperwork, and so much of the cost of health care is lost in administrative waste. Having a single-payer system would essentially reduce that work so I could spend time doing what I actually want to be doing, which is seeing patients.”

For anyone tempted to dismiss the bus-riders as idealistic youth, it’s worth noting that support for a single-payer system among American physicians is surprisingly strong, surveys have found. The rally is being organized by Physicians for a National Health Program and the American Medical Students Association.

Vermont Begins Roll-Out Of Single-Payer System

I love watching Vermont. With its tiny population and utopian bent, it can do things other states can’t — like break the ground for state-sanctioned gay marriage and, now, a single-payer health care system. While Massachusetts continues to wait for the Patrick administration’s payment reform proposal, the Vermont leadership began rolling out its more radical single-payer plan yesterday.

The Associated Press reports today in the Brattleboro Reformer here:

MONTPELIER — Vermont lawmakers got their first detailed look Tuesday at Gov. Peter Shumlin’s plan for moving the state toward a single-payer health care system, as his administration unveiled legislation that would use a provision of the new federal health care law as a springboard for a more ambitious state plan.
The first part of a three-year plan to build the new system would include setting up the sort of state-based marketplace for health insurance, or “exchange,” envisioned in the law passed by Congress a year ago. But instead of the multiple exchanges many other states are envisioning, Vermont would have just one covering the entire state population of about 625,000, said Anya Rader Wallack, Shumlin’s special assistant for health reform.

In addition, the bill would set up a new Vermont Health Reform Board whose main mission would be to control costs. It would set budgets for networks of doctors, hospitals and other providers and design the systems under which they would be paid. Wallack said the intent was to move away from a system that pays providers for each appointment or procedure — the so-called “fee-for-service” system — to one that sets a budget for keeping a certain number of people healthy. Continue reading