• Health care delay
    October 14,2012
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    Prospects for a single-payer system in Vermont appear to be receding, though the state continues to move ahead with its plans to establish a health care exchange where Vermonters will be able to obtain insurance.

    Jeb Spaulding, secretary of administration, said last week that the Shumlin administration would not present financing plans for a single-payer system until 2015. The state has commissioned a study by the University of Massachusetts Medical School laying out some options for financing a new system, and that study is due in January. It would have provided a foundation for a proposal from the Shumlin administration about how to pay for a single-payer system.

    But Spaulding said the state will not be able to move as quickly as anticipated because state officials do not expect to obtain the federal waiver necessary for establishing a single-payer system as soon as hoped. The state’s health care reform law calls on the Shumlin administration to spell out the financing options for a new system in January, but it appears the administration will let the university study sit without offering recommendations for the Legislature.

    This delay provoked criticism from Randy Brock, the Republican candidate for governor. One of the main Republican lines of attack on Gov. Peter Shumlin’s health care program has been that Shumlin had arranged to delay release of details about the cost of his plan until after the election. Now the release of those details is being pushed back even further.

    The fear of those who oppose single-payer health care is that the Shumlin administration would spring a surprise on the people of Vermont, revealing a costly and unworkable system and forcing it through soon after the election when the voters won’t be able to have a say for another two years.

    But the delay in pursuing the single-payer system shows the opposite to be true. The single-payer system was never going to work until the numbers added up. It makes no difference if the numbers are revealed now or after the election. The plan will not go forward unless there is a payment plan and a coverage package that work together and that Shumlin can sell to the Legislature and the people.

    A premature discussion of the payment plan would suck all the oxygen out of the health care discussion — that’s the way one health care official put it. State health care officials are busy putting in place many elements of a reformed system, including the new health care exchange, plus payment reform and information technology.

    If Brock and Republicans are worried that a single-payer system will be costly and unworkable, they ought to welcome the decision to delay implementation until more information is available on the federal waiver and the federal money the state might be able to rely on.

    Vermont is engaged in a two-part process. First, we are putting together a health care exchange in accord with the federal Affordable Care Act. Then Shumlin had his sights set on establishing a first-in-the-nation single-payer system using the exchange as a foundation.

    The single-payer advocates are the ones who ought to be disappointed by the decision to delay the single-payer system. Now it is evident that a single-payer system is still years away. The possibility that Mitt Romney might be elected president casts additional doubt on the prospects for success in carrying out Shumlin’s plans.

    One wonders if the Shumlin administration has had an early glance at the findings of the university study and has realized that for the moment the options for financing single-payer in Vermont seem to be too far a reach. If so, then it makes sense that the administration would not want to push a premature plan on the Legislature, even if delay is a disappointment for those hoping for the creation of single-payer.

    At this point, the Shumlin administration appears to have decided that taking concrete steps on single-payer would be a distraction from the other reform efforts in progress. But if Brock wants Shumlin to announce immediately that single-payer is dead, that is not an announcement he is likely to hear. Rather, single-payer is a work in progress that would be the capstone of a comprehensive array of reforms that are already in the works.
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