Editor’s note: This opinion piece is from the national board of Physicians for a National Health Program, a single-payer health care system advocacy group.
Health reform legislation initiated by Vermont Gov. Peter Shumlin was recently passed by the state legislature.
Many journalists and commentators have portrayed this bill as fully embracing the single-payer approach to reform. We write to clarify the views of Physicians for a National Health Program on the Vermont legislation.
We appreciate the enthusiasm for progressive health reform shown by Shumlin and the many dedicated single-payer supporters in Vermont. However, it is important to note that the bill passed by the Vermont House falls well short of the single-payer reform needed to resolve the health care crisis in that state and the nation. Indeed, as the bill moved through the House the term “single payer” was entirely removed, and restrictions on the role of private insurers were loosened.
In its present form, the legislation lays out in considerable detail a structure to implement Vermont’s version of the federal reform passed in March of 2010, which would expand coverage by private insurers and Medicaid. However, it offers only a vague outline of the additional reform promised by the governor and Legislature at such time when states will be allowed to experiment with alternatives to the federal program in 2017 (or 2014, if the effort to move up the date succeeds).
The Vermont plan promises a public program open to all residents of the state in 2017, but even then it would allow a continuing role for private insurance. This would negate many of the administrative savings that could be attained by a true single-payer program, and opens the way for the continuation of multi-tiered care.
Within the public program, the plan would continue to lump together payments for operating and capital costs, allowing hospitals and the newly established Accountable Care Organizations (ACOs) to use funds not spent on care for institutional expansion. Meanwhile, those with operating losses would shrink or close even if they were meeting vital health needs. This would perpetuate incentives for hospitals and ACOs to cherry-pick profitable patients and services, and hobble the health planning needed to assure rational investments in new facilities and high-technology care.
Under the legislation, many patients would continue to face co-payments that obstruct access to care, and the bill makes no mention of expanding coverage of long-term care. The legislation fails to proscribe the participation of for-profit hospitals and other providers (e.g. ACOs and dialysis clinics), which research has shown deliver inferior care at inflated prices.
Finally, the bill offers no concrete funding plan or structure for the public program that it promises.
We applaud the sentiments expressed by the governor and legislative leaders and remain hopeful that the legislation’s rhetorical commitment to further reform will become a reality.
Much work, including efforts to enact federal enabling legislation — and continued advocacy by single-payer supporters — will be needed in the years ahead to achieve Vermont’s goal of universal access to high quality, affordable care.
Permalink |
It is worth noting that in Canada, their National Health System – “single payer” also includes variously ‘tiered’ health plans, and leaves individuals the personal/financial choice to purchase additional health insurance in order to cover certain treatments not covered in their generic plan. NO ONE goes without basic health care coverage – NO COST, but the coverage doesn’t include all specialists,etc.
This in no way should deter Vermont from instituting “single payer”, as the current legislation provides.