• Time crunch
    April 20,2014
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    Discontent continues to simmer in the Legislature about the work underway by the Shumlin administration to develop a single-payer health care system by the year 2017. At his press conference last week Gov. Peter Shumlin rebuffed the idea pursued by some legislators for developing a Plan B to take effect if the single-payer proposal did not work out.

    The idea that a Plan B might be necessary received a jolt of life several weeks ago when a Shumlin ally, Sen. John Campbell, mentioned that he thought it might be useful to develop an alternative in case single-payer falters. It was a surprising case of quaking knees by someone Shumlin might have expected would be in his corner.

    Last month the House rejected a demand from Republicans, with the help of the Democratic member from Arlington, Cynthia Browning, that Shumlin produce a financing plan for the single-payer program. Shumlin’s response has been what it has been all along — when the financing plan for Green Mountain Care is ready, he will be happy to make it public.

    It is likely, however, that interest in some sort of Plan B will persist as long as details of the financing for Green Mountain Care remain undetermined or under wraps. There are several reasons.

    All along Republicans have believed that Shumlin was playing politics with the details of his single-payer proposal, holding back on his announcement of a funding mechanism until after the past election, and then after the coming election, so as not to saddle Democrats with the need to defend a major tax increase.

    In addition to the political suspicions aroused by the delay, doubts may grow about whether the administration is able to develop a workable plan. Creating a single entity with the revenue stream enabling it to cover the health care of a majority of Vermonters is an enormously complicated undertaking.

    Especially complicated is the job of identifying a taxing mechanism that will be fair, workable and not overly burdensome. The longer the state delays in hammering together a proposal the greater will be the doubts about whether it is doable.

    The fundamental change upon which the new system is to be based is easy to understand: Instead of paying exorbitant monthly premiums for health cave coverage through their employers, Vermonters would pay a new tax that, one assumes, would be less exorbitant. If it were easy to develop a plan to do that, the Green Mountain Care Board would have announced it a long time ago.

    Doubters might suspect the Shumlin administration of waiting until the last minute before springing the new plan on voters and legislators, hoping to shrink the window of opportunity for debate and delay. But given the lessons learned from the rushed implementation of Vermont Health Connect, the state’s new health coverage website, it is unlikely that state officials believe that rushing single-payer would be a good idea.

    Supporters of Plan B argue that the state ought to be ready with an alternative in case Shumlin’s proposal is found to be wanting. But that alternative already exists. It is Vermont Health Connect, the program put together under the auspices of the Affordable Care Act, which enrolled thousands of Vermonters through its new website, which was launched with creaking inefficiency last October. Since then the operation of the state website, like the national one, has improved, and it has helped extend and improve coverage to a whole range of Vermonters.

    Shumlin is correct to remind legislators that they are on record in support of the development of a single-payer plan. Skeptics are justified in saying they need to be convinced. But as numerous supporters of single-payer health care made clear following Campbell’s expression of doubt, jumping off the boat midstream is not likely to prove helpful.

    In fact, the Green Mountain Care Board has had the luxury of several years to work out the details of its plan, which is what the state lacked as it, and its contractors, rushed to put in place the problem-plagued Vermont Health Connect website. It would be foolish for the board to feel compelled to hurry a plan into existence when it still had time to work out as many potential problems as possible.

    And yet the people of Vermont will still require sufficient time to debate the plan. And the Legislature will not want to rush its approval any more than Shumlin wants to rush the plan’s creation. Thus, Shumlin and his administration are facing a time crunch — taking as much time as necessary to create a workable plan, while leaving enough time for the Legislature and the people to understand, consider and approve it with confidence.
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