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“Utopian Fantasy?”: Bernie Sanders’s Single-Payer Health Care Plan Failed In Vermont

When Sen. Bernie Sanders regales his campaign crowds with a portrait of The Way Things Are Going to Be, his “Medicare for All” program takes center stage. In a Sanders administration, the candidate promises, every man, woman, and child in America will share in a government-run, government-funded health-care system.

But the single-payer system that Sanders is evangelizing isn’t just a figment of progressive utopian fantasies. Single-payer health care has already been tried—and failed—in Sanders’s home state of Vermont, where the proposal collapsed under its own weight last year before it was ever implemented.

Deciding why it failed in Vermont is key to whether you buy into the candidate’s promise to extend the program nationwide.

According to critics, from The New York TimesPaul Krugman to USA Today’s editorial board, Sanders’s single-payer plan is something between a well-intentioned fool’s errand and a political pipe dream, an unrealistic idea that has been proven not to work in the senator’s own backyard.

But closer to home, activists say Vermont’s failure even to implement its plan for universal health care was a failing of political will, not the policy itself. In better hands, they say, the policy can still work. To know the difference, it’s important to understand how Vermont got so close to single-payer in the first place.

In 2011, the state’s Democrat-controlled legislature approved a government-run, government-financed health-care system for all Vermonters. The state’s new Democratic governor, Peter Shumlin, signed the bill into law after campaigning on a pledge to enact single-payer himself. A cost estimate of the program, known as Green Mountain Care, was ordered, but long delayed.

Elections came and went, including Shumlin’s own 2014 reelection, which was so close Vermont law required the final decision to go to the legislature after Shumlin failed to win a majority of the vote in November. As the state waited for the legislature to take up the election results, Shumlin announced that he would not pursue single payer after all when the long-awaited financial projections showed “the promise and the peril” of a single-payer system. The promise, of course, was a chance to give nearly every Vermonter reliable access to quality health care.

But the very real peril came in the cost for the program, an estimated $4.3 billion a year, almost the size of the state’s entire $4.9 billion budget. To make up for the $2 billion shortfall, taxes would have to go up, a lot. Businesses would see an 11.5 percent payroll tax increase, on top of whatever they chose to provide for employee health care, while individual income taxes could jump by up to 9 percent. The report recommended against moving forward “due to the economic shock and transition issues,” and Shumlin agreed.

“I wanted to fix this at the state level. And I thought we could,” Shumlin said in a statement issued with the financial report. But he called implementing single-payer health care in 2015 “unwise and untenable.”

Despite the ominous budget projections at the time, single-payer advocates now say they believe Shumlin’s decision was purely political.

“Right up to the last gubernatorial election, Gov. Shumlin was saying he was going to do everything he could to make single-payer health care a reality in the state. That was quite frankly why we didn’t run a candidate against him,” said Kelly Mangan, the executive director of the Vermont Progressive Party. “Almost immediately, he turned around and said, ‘Oh, yeah, we can’t afford single-payer health care. It’s not going to happen.”

Mangan described single-payer advocates today as “fatigued and very disheartened.” As Vermont’s state budget continues to be squeezed by Medicaid costs, she said the possibility of returning to the issue any time soon seems unlikely. She also worries that Vermont’s example will damage future prospects nationally. “I think it will have a ripple effect. People will use it as an excuse to do nothing by saying, ‘If they couldn’t do it there, then it can’t be done,’” she said.

Dr. Gerald Friedman, an economics professor at UMass-Amherst and a part-time Vermonter, has worked with Sanders to develop and calculate the cost of his plan and says the budget wasn’t the problem for the Vermont proposal. The governor was the problem.

“On the economics, it would have been cheaper, but the governor just lost the political will,” Friedman said.

But the professor acknowledged that any national health care proposal from Sanders would face the same political headwinds that Shumlin ran into. “It’s going to be a tough road, and Vermont is a lesson,” he said. “It’s unfortunate that it happened the way it did.”

Even with the Vermont debacle in the rearview mirror and Friedman’s own projections that Sanders’s “Medicare for All” would cost north of $14 trillion over 10 years, the politics of single-payer are still working for Sanders. The latest Kaiser poll showed 81 percent of Democrats favor a “Medicare for All” proposal, while 60 percent of independents favor it, too.

Clinton has dismissed Sanders’s proposal as unrealistic and a danger to the reforms that have already been enacted through the Affordable Care Act. That argument seems to be falling flat in New Hampshire, where the latest WMUR poll showed Sanders trouncing Clinton by nearly 30 points. But at least Clinton can count on some support when the campaign gets to Vermont. Gov. Shumlin, who will not run for reelection, has announced he’s with her.

 

By: Patricia Murphy, The Daily Beast, January 25, 2016

January 26, 2016 Posted by | Bernie Sanders, Single Payer, Universal Health Care | , , , , , , , | 1 Comment

“The Problem Is The Politics”: Sanders’ Single-Payer Plan Is A Distraction

If you’ve successfully landed on the beaches, but your forces are still taking heavy fire, what do you do? Do you concentrate on trying to hold the line and make further advances or do you sit in a circle and design a better landing craft?

The problem with Bernie Sanders’ health care vision isn’t the vision. His raw outline for a greatly simplified and less expensive health-care system is excellent in theory. The problem is the politics — the reality of which battle-scarred Hillary Clinton clearly has the better grasp.

This was the message Clinton tried to convey in the Sunday Democratic debate. Her most potent point on health-care reform centered on recalling the “public option” fiasco during the fight for the Affordable Care Act.

The public option was to be a government-run health plan competing with the private offerings in the health-care exchanges. It was a no-brainer to keep the insurance companies on a shorter leash. But, as Clinton noted, “even when the Democrats were in charge of the Congress, we couldn’t get the votes for that.”

John E. McDonough, a health policy expert at Harvard, has also been through the health-care wars. As a Massachusetts state legislator, McDonough led an unsuccessful campaign to bring single-payer to his liberal state. In a recent New England Journal of Medicine article, he explained why a similar effort in Sanders’ own state of Vermont failed.

Vermont was the great hope for we fans of single-payer. (I was waving pompoms.) The state is progressive and one footstep from Canada. Gov. Peter Shumlin was totally onboard. He spent four years trying to make a single-payer plan happen. Three major-league studies showed that it was economically feasible.

But even in Vermont, a clear public mandate for single payer never materialized. A rebellion against it almost cost Shumlin the governor’s job.

Asked about this on Sunday, Sanders took a swipe at Shumlin (who has endorsed Clinton).

“Let me just say that you might want to ask the governor of the state of Vermont why he could not do it,” Sanders responded. “I’m not the governor. I’m the senator from the state of Vermont.”
Yes, and as senator from Vermont, Sanders introduced several single-payer bills that went nowhere. The most recent one, the 2013 American Health Security Act, attracted not a single co-sponsor.

The plan Sanders released two hours before the debate remains too sketchy for a reliable independent analysis, according to McDonough. But lack of detail isn’t his biggest concern. It’s opening a new front in the battle to defend Obamacare.

“Republicans sent a bill to the President’s desk last week that would eliminate health insurance for 22 million Americans by 2018,” McDonough wrote me. “This is not beanbag. It’s the real deal, and we have to focus where it matters the most.”

“Bernie wants to lead us on a distraction tour while Republicans want to kill the progress we have made.”

How far have we come? Thanks to Obamacare, almost 18 million formerly uninsured Americans now have health coverage. A report just out of Georgetown University has the rate of uninsured Hispanic children falling to a historic low.

Insurers can no longer turn down people with pre-existing conditions. And important politically, Obamacare has demonstrated that universal coverage is doable without creating mass unemployment or “exploding” deficits. On the contrary.

Making Obamacare more Medicare-like through incremental steps may not feed the romantic urge to reinvent health-care reform from scratch, but there’s no other road, not in the America of 2016. Finally, let’s not forget that vanguard of reform is still on the beaches and taking fire.

Correction: The health policy expert at Harvard is John E. McDonough, not Thomas. We regret the error. This article has been updated to reflect that change.

 

By: Froma Harrop, Featured Post, The National Memo, January 19, 2016

January 20, 2016 Posted by | Bernie Sanders, Health Reform, Hillary Clinton, Single Payer | , , , , , , , | 2 Comments

   

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