Richter: Single payer’s last chance

Editor’s note: This op-ed is by Dr. Deb Richter who practices medicine in Cambridge, Vt.

Is this our last best chance to get single payer in Vermont? If it is, then look upon it as a political and health policy emergency.

Outside my hours as a physician, I’ve worked for 20 years on health care reform. In all that time I’ve never seen better conditions for real and sensible reform than right now here in Vermont.

The conditions won’t last long. In my view it is now or almost never. Our window of opportunity is not even a year’s time. More like 10 months.

By 2010 the window will have started closing. That’s when important provisions of the federal health reform kick in. By 2014 the window will be all but shut. It will stay shut until at least 2017.

The federal bill does some good things for Vermont. But the rest of the good provisions will only bring the rest of the nation up to Vermont’s standards. The bad stuff is what the federal bill doesn’t do: it doesn’t have any way to manage or control health care costs and it does not do enough to help many of those struggling to pay for their health care.

Since rising health care costs is Vermont’s biggest problem now, the federal bill isn’t going to help us much.

What it will do in less than a few years is end Vermont’s opportunity to call its own shots at controlling and managing out-of-control health care costs.

There is a way, though, and that brings us back to the conditions that might allow real reform. The first condition is, of course, broad based public support for a publicly funded system that creates universal access and controls costs. In Vermont, this condition has already been met. But there are three more conditions that must be met to allow for real reform.

These conditions are wrapped up in Senator Bernie Sanders, Dr. William Hsiao and Peter Shumlin.

Let’s take a closer look starting with this. Five years ago we had a process bill that would have led to the design of a fiscally responsible health care system when the legislature passed a single payer health care bill. Gov. James Douglas vetoed it. As a result we veered down the side road of incremental (think tiny) changes. Costs have risen more than $1.5 billion since then ($2600/Vermonter).

Fiscally responsible means there is some kind of sensible management of overall costs and fairness in the way we pay for health care. And system means all the health care facilities are tied together and coordinated to the benefit of everyone.

The 2005 bill, a fatality of politics not policy, might have eventuated in a single-payer system. Single payer health care systems are proven to be the most cost-efficient.

This year legislation was passed that asks next year’s legislature to consider one of three systems currently under design, one of them being single payer.

Sen. Sanders favors single payer and has worked for years on the issue. Dr. Hsiao has stated that in order to cover everyone for less money, you need a single-payer system. And Peter Shumlin has never wavered in his support for single payer.

Dr. Hsiao is well known to everyone in the health care policy field. He is a world renowned health economist from Harvard who designed Taiwan’s spectacularly successful health care system in the 1990s.

Peter Shumlin is known to some Vermonters as president pro tem of our Senate but to most Vermonters for having faced down strong opposition to same-sex marriage and for taking down Vermont Yankee’s corporate powers for publicly lying to the Vermont public.

Why is this important?

Shumlin is a candidate for governor in the Democratic primary (Aug. 24 this year). He has been unequivocal in his support for a single-payer health care system. Sen. Sanders has been unequivocal in his support and has said he will go right to President Obama to get any necessary federal waivers. Dr. Hsiao is the man designing the three systems (emphasis on systems) for next year’s legislators to consider. His wide knowledge, practical experience and gentle sophistication is just what the doctor ordered for our legislature.

Hsiao is at work as we write. Sen. Sanders has pledged his part. That leaves
the governor’s chair. As we learned five years ago, you can have the right legislation but you need the right governor.

There are a lot of reasons for electing someone governor. Reasons that applied two years ago, six years ago, ten years ago may not apply today. Fiscal reform of Vermont’s health care will have the single most beneficial impact on our economy. That’s big. It demands someone smart and tough. Peter Shumlin is smart and tough.

He was smart to seize on Dr. Hsiao’s expertise and to introduce him to our legislature. He took on same-sex marriage, a tough issue, and Vermont Yankee’s shutting down on schedule, a tough issue. He navigated both and won.

After 20 years of disappointment I can’t help but think this is our best chance to do the right thing. Shumlin, Hsiao and Sanders make the best combination anyone could hope for to get the right thing done. We don’t have much time. We can’t wait.