In a memo to members, Conor Casey, the government affairs liaison for the Vermont State Employees Association, said the union won’t endorse H.202 for the time being.
The lingo used by the union in reference to the shift to single-payer is remarkably similar to that used by critics in the business world. The union’s invocation of the word “unknown,” for example, could be easily swapped out with the business community’s catchword for economic anxiety — “uncertainty.” The idea that the single-payer system might be financially “unsustainable,” on the other hand, is a worry both the union and private sector critics have expressed.
VSEA director Jes Kraus said the union has taken a “neutral position” on H.202.
“The board has endorsed principles of the health care as a human right campaign (pushed by the Vermont Workers Center),” Kraus said. “When it comes down to the nitty gritty though, we haven’t taken a position — there are too many unknowns.”
H.202 sets in motion a timeline for gradual implementation of a state-managed, universal health care system for every Vermont resident.
The bill includes a series of studies that will be used by the Green Mountain Care board to answer the big questions — what the benefits package will be, how medical providers will be reimbursed, how much the system will cost and who will pay for it. The financing details will not be available until 2013, well after the outcome of the next gubernatorial election has been determined. Gov. Peter Shumlin, a Democrat, aggressively campaigned on a single-payer health care system in Vermont. He is scheduled to sign the bill on Thursday.
No other state in the country has attempted a single-payer system.
Until the key questions about benefits and costs are answered, VSEA officials don’t know what to tell their members. Over the summer, the union plans to poll members, Kraus said, “to take the pulse of our membership and find out where people come down on it.”
Kraus said some members are concerned that the new health care system could affect collective bargaining; others are adamant supporters of the legislation. “It’s not oh gosh they’re coming for us; it’s let’s be careful before we jump in with both feet either way,” Kraus said. “I’ve got to be honest, no matter how much we support it in principle, we don’t know what design, what funding mechanism is going to be. There’s too much up in the air to make a credible decision as to what position to take.”
One of the biggest items in play is the benefits package. In a memo to members, Casey said some “worry about creating an unsustainable system that will result in some paying more and receiving less in benefits.”
The other big question for union members is whether a single-payer system will affect the collective bargaining process.
Casey says there would have to be a tradeoff. The state may have to make concessions on wages if health care is no longer on the bargaining table.
“The groups that have to worry are the ones that don’t have an organized workforce,” Casey said. “We could go into negotiations and the fact finder could say the state is saving money and redirect that savings to higher wages.”
Private companies with non-union employees might shift those savings toward profits, Casey said. “That’s a big risk.”
Single-payer in the limelight
Vermont’s single-payer bill may be fodder for nitty gritty criticism in the Green Mountains, but elsewhere it’s the subject of much ballyhooed speculation.
Slate reporter David Weigel dubbed the H.202 phenom “Green Mountian Dreams.”
Ezra Klein, a Washington Post columnist, interviewed Kevin Outterson, an associate professor of health law, bioethics and human rights at Boston University, who gives H.202, and especially the Shumlin administration’s cost containment strategy, a big thumbs up.
Outterson said: “The first thing I posted on was the incredible power of Vermont’s version of the Independent Payment Advisory Board to control costs. If they do this and they’re successful, there are a number of other states that will want to try it. It’s a 20-year time horizon, but if you think national single-payer is a political nonstarter, this is where the action is. But that’s the question: whether they can control costs. That’ll be everything.”
Former CIGNA-executive-turned-activist Wendell Potter, who came to Vermont several months ago, wrote a glowing report about “two 50-something women” — Dr. Deb Richter and Dr. Ellen Oxfeld — who became tireless advocates for a single-payer system in Vermont.
Editor’s note: A write-thru of this story was posted at 8:30 a.m. May 21, 2011.
