Healthcare issues

What does Universal Mean to You?

When I made my pitch to the Speaker, hoping to secure a seat on the House Health Care committee, I promised to vote for the bill if it covered everyone and saved Vermonters money. H. 202, when it passed the House, set Vermont on a path to do just that.

When the Senate passed the bill they tacked on two amendments that are particularly troubling, and clearly violate the "universal" in universal health care. Keep in mind the title of the bill is "An Act Relating to a Universal and Unified Health System."

The first floor amendment, offered by Sen. Galbraith, takes a big step to carve a few people out. With broad support, he excluded anyone enrolled in TRICARE (the VA system). The logic is simple, these people already paid for health care through their service to the country. What he fails to understand is that Green Mountain Care, our hoped-for single-payer system, may well want to enroll eligible people into TRICARE. For some Vermonters that would be the cheapest way to get health care. This is part of what Hsiao meant when he said a hybrid single-payer system.

We ought to figure out a fair way to finance Green Mountain Care without asking folks who've already paid their health care bill to pay again. But that can be done without excluding this population from the outset. They are Vermonters and part of guaranteeing that they have coverage means being able to work with TRICARE, not prohibiting it.

A more troubling moral change coming from the senate is the Brock-Sears amendment to exclude undocumented workers from care. Charming! It's unclear what happens when an undocumented farm-worker shows up at the emergency room after his arm was half ripped off in an accident. We know Vermont doctors will care for this person. The Brock-Sears amendment leaves us wondering how that care will get paid for. One of the beauties of a universal system is that the cost shift is eliminated. Carving out this or any population reinstates the cost-shift and is a bad idea.

H. 202 is a long-term plan to get significant health care reform into reality for our state. We shouldn't start out of the gate by excluding certain populations. And if we do, we should have the integrity to remove the word "universal" from the title. Many in the legislature are fighting to undo these last-minute changes. We should have an update by late Tuesday.

Sugar Sweetened Beverages

Houston, we have a problem. In the mid-nineties Americans' consumption of sugar-sweetened beverages (soda, sports drinks etc) eclipsed milk for the first time. Since then the trends have continued in the unhealthy direction.

Last week, House Health Care heard from Yale's Dr. Kelly Brownell. He directs the Rudd Center for Food Policy and Obesity and explained that part of the problem arises because our bodies aren't good at recognizing calories from fluids. If half of you reading this drank 200 calories at the end of your meal and half of you ate 200 calories worth of cheesecake those of you who drank the calories would be eating again sooner.

When you consider that up to 10% of American's calories now come from drinks it's not hard to believe the link to obesity and therefore to type II diabetes.

So what do we do? H. 151 before the House Ways & Means committee asks for a $0.01 tax per ounce of sugared-sweetened beverages (not juices but anything where sugar is added). Economists believe this is a significant enough rate to curb consumption by as much as 20%. While this concept has been proposed in states and cities around the country it hasn't been enacted anywhere yet.

The Philadelphia city council came within one vote of imposing a 2 cent per ounce tax. Since then Coca-Cola has donated $10 million to the local children's hospital for studying childhood obesity. Professor Brownell compares the debate to the public discussion around taxing cigarettes.

For Progressives, part of the challenge is that a consumption tax is, by nature, regressive. And since a lot of marketing for soda, etc. is targeted to low-income consumers, the concern is exacerbated. Meanwhile, costs of healthy foods have climbed while soda prices have remained fairly stable. Obviously public health suggests we need to drink less soda. But is it fair to target a population whose incomes have declined in the last decade and who already feels left behind by policy makers and government?

H. 151 isn't moving this session but the issue isn't going to go away. We need solutions to slow our consumption of sugar-sweetened beverages or else we will continue to face significant health-related expenses both as taxpayers and as a community.

Leading with retreat

In an amendement offeredby Health Care Committee Chair Mark Larson (D-Burlington), the term "single payer health care" was excised from the H.202, the single payer health care bill, in part (according to vt Digger) to make it "more palatable to Republicans."

How did that work out? Was it successful, despite the long track record of Democrats watering down health care reform in order to get Republican buy in? Well, the streak remains unbroken, as no Republican voted for the bill as it passed third reading in the house early this morning.

How big a majority is needed before abandoning the idea that you lead with retreat? If the Republicans were down to one member in the house, would we still be watering down legislation to try (and fail) to get that one vote?

Health Care, Taxes, Budget

The week ahead will be a busy one on the House floor and Progressives will be right in the middle of things since the bills up for debate include the miscellaneous tax bill, the health care bill, and the budget.

House Health Care voted H. 202 out of committee late Thursday night with my support. The vote was 8-3. I assembled a short video to explain the vision for Green Mountain Care, Vermont's single payer system. Watch it here.

Last week Progressives were at the forefront of a discussion about raising revenue. H. 401, my bill to increase income taxes on the wealthiest Vermonters, has been the subject of lots of discussion in Montpelier. While it seems unlikely H. 401 will pass it's worth mentioning that we've been able to prevent our system from getting more regressive.

Following the advice of the Blue Ribbon Tax Commission House Ways & Means was poised to switch Vermont to using "Adjusted Gross Income" (AGI) rather than "taxable income" as we have today. This change makes sense because it makes our system simpler and is already used by most other states. Plus, it eliminates the 40% capital gains tax exemption Progressives have been fighting for years.

In the proposal to switch to AGI, there were some troubling details. To begin with, 2/3 of the folks earning $1 million plus would have actually seen a tax break! You read that right. I quoted Sen. Sanders during his testimony in front of Ways & Means calling the change "Unconscionable."

The next day the shift to AGI was scrapped and will not be part of the Miscellaneous Tax bill debated this week. While that is good, the bill still doesn't do much to increase revenues so we can protect important state programs. Watch for an amendment along the lines of H. 401 to be brought forward by me and Rep. Poirier (I- Barre).

We will also be watching the budget bill closely. End of the week rumors suggested up to $30 million of Shumlin's proposed cuts had been restored but we will tell you more as details emerge. Obviously a successful amendment to the tax bill would go a long way to easing the pain handed down in the state budget. While many members agree this should be our direction it remains to be seen how many will be willing to buck their leadership.

The Other Health Care Bill

House Human Services has continued its focus on Hospice and palliative care services. The problem is that too few patients receive timely referral to either service. Informed patient choice of care requires that patients be advised of all their options. Treating physicians tend to offer only the most invasive and aggressive medical interventions. One cannot receive Hospice services without a referral. In Vermont those referrals, if made at all, often come just days before death is probable.

Hospice is a great service, and Vermont has excellent providers. But doctors see any referral as “giving up” so patients are denied access to services that can make them much more comfortable, physically, emotionally and spiritually. An insurance company study found that increasing access to hospice services not only improved quality of life for its patients, it increased their longevity and it saved money.

Among the current obstacles to increasing access are the funding limitations of Medicare, Medicaid and most insurers. Currently one who requests hospice services must agree to give up further curative care. Payers also require that a physician certify a life expectancy of less than six months. By broadening eligibility to expand services to one year and allow the continuation of curative treatment, we could improve the quality of life for many Vermonters. And research shows that we would also reduce health care costs.

H.201 will increase access by assuring that physicians recognize the role of palliative care and hospice in treating their patients. Vermont is one of only six states that do not require continuing medical education as a condition of license renewal. As a result many physicians do not fully understand the advances in palliative care and hospice and their place in the range of available medical services.

Vermont's Struggle for Single-Payer Healthcare

March 10, 2011, the Nation, Steve Early

After years of political frustration, Earl Mongeon had to see it to believe it. Often, when he finishes his twelve-hour night shift at IBM in Essex Junction, Mongeon heads home for breakfast and a few hours of brush clearing on his sixty-acre lot in Westford. In mid-January, the 55-year-old microprocessor assembler and workers’ rights advocate hopped into his car and drove in the opposite direction, to Montpelier. There, at the state Capitol, Mongeon and other supporters of single-payer healthcare gathered to hear Senators Bernie Sanders and Patrick Leahy, Congressman Peter Welch and new Democratic Governor Peter Shumlin explain that last year’s national healthcare bill—a costly mix of subsidies to private medical plans, some insurance market reforms, Medicaid expansion and a mandate that people buy coverage if they don’t already have it—isn’t good enough for the Green Mountain State. The top state and federal officeholders pledged to work together for something better. “We firmly believe we can be the state that passes the first single-payer system in the country,” Shumlin declared.

Mongeon and other supporters of single-payer have marched and lobbied for years, most recently under the banner of the Vermont Workers’ Center and its “Healthcare Is a Human Right” campaign. Their tireless activism had a lot to do with spurring Vermont’s singular display of independence and political unity. Two weeks earlier, several hundred VWC supporters descended on the legislature on its opening day. State House and Senate leaders, including some recent converts to the single-payer cause, paid fealty to the grassroots movement. Before a boisterous crowd of union members and community activists, 71-year-old Peg Franzen, a VWC leader and disability rights advocate, hailed the “people power” that had persuaded legislators to commission a detailed study of options for universal healthcare last year. In late January a joint session of the Democrat-dominated legislature received a 203-page report from Dr. William Hsiao, the Harvard healthcare economist hired to develop a road map for reform. Hsiao’s research team identified fifteen hurdles to creating the system they recommended: universal coverage with equal access and a common benefit package that includes community-based preventive and primary care, as well as control in the escalation of health costs.

Undaunted by the roadblocks ahead, Shumlin’s special assistant for healthcare, Anya Rader Wallack, went before a joint legislative committee on February 8 to unveil H. 202, “An act relating to a single-payer and unified health system.” Wallack spelled out a three-stage reform process, spanning at least four years but beginning with the creation of a Vermont Health Reform Board to control costs and streamline payment methods. Wallack described Vermont’s current system of multiple private and public payers as “too complex and misguided,” noting that it leaves “more than a quarter of the state’s population potentially facing healthcare bills that send them to bankruptcy.” On behalf of the governor, she insisted that “this craziness must stop. We have to get insurers out of managing medicine and allow providers to use technology and appropriate quality oversight to get waste out of the system.”

The perfect storm for fundamental reform seems to have arrived in America’s second-smallest state, but the wind is blowing rightward elsewhere in the country, with the new Republican majority in the House voting to repeal the Patient Protection and Affordable Care Act, which they brand “Obamacare.” Red-state attorneys general and their GOP governors are challenging the constitutionality of PPACA by focusing on its controversial individual mandate. Healthcare reformers in Vermont aren’t happy with President Obama’s scheme either. That’s why they’re trying to create a social insurance system that would sever the connection between coverage and employment and make access to medical care a “human right” for the state’s more than 625,000 citizens. Marketplace competition and profiteering—given a renewed lease on life nationally by PPACA—would be phased out locally as soon as possible. If single-payer works in Vermont, its backers envision the state becoming the Saskatchewan of America, just as Canada’s thinly populated but left-led prairie province paved the way for Medicare-for-all north of our border fifty years ago.

Getting from here to there will not be easy. The Green Mountain State’s single-payer initiative could be delayed unnecessarily by the implementation timeline of PPACA. Under that law, every state must have health insurance exchanges in order to get the hundreds of millions in new federal dollars to subsidize private benefits. Unless PPACA is amended—as President Obama recommended on February 28—any pilot projects headed in a single-payer direction would be delayed until 2017. In the now GOP-dominated House, Representative Welch has introduced a bill authorizing the federal waivers needed for Vermont to become “a laboratory for innovation and excellence” in three years, rather than six. As the New York Times reported on March 1, Welch’s bill has “no Republican co-sponsors, making its prospects for passage uncertain at best.”

Single-payer also faces resistance from big business, inside and outside the state. (A taste of that was provided six years ago by antiunion IBM, which held in-plant meetings for 6,000 workers to warn them that a single-payer bill, then pending before the legislature, would require $1 billion in new taxes and force businesses to leave.) A former state legislator from Putney, Governor Shumlin is also part owner of a family business that made him a multi-millionaire. In the face of blunt opposition from his fellow employers, he has pitched single-payer as a way to make Vermont more “business friendly” by curbing healthcare costs, which have doubled in the past decade. Many of the entrepreneurs affiliated with Vermont Businesses for Social Responsibility do seem to favor decoupling health insurance from employment, although not necessarily via a single-payer system. The more mainstream and politically influential Associated Industries of Vermont displays little enthusiasm for moving to a publicly funded plan financed by payroll taxes.

Speaking at a union conference in Burlington over Martin Luther King Day weekend, Mark Dudzic of the Washington, DC–based Labor Campaign for Single Payer Health Care warned about a deluge of anti-single-payer propaganda. “There will be a massive mobilization of corporate power to smash any state single-payer initiative,” he predicted. “Vermont is going to be one of the first battlefields in that fight.” In unionized workplaces—including those represented by the state’s two largest unions, the Vermont Education Association (VEA) and the Vermont State Employees Association (VSEA)—some single-payer advocates worry not enough is being done to educate and mobilize members, whose own negotiated medical benefits are currently at risk. In Vermont, as in other states, there’s growing taxpayer resentment at paying for coverage that most private-sector workers don’t have anymore, whether unionized or not.

At every teachers union bargaining table in Vermont, management is seeking bigger premium contributions, part of a larger giveback trend that has triggered several strike threats. No group of union members has a bigger stake in building a viable tax-supported system of universal coverage than public employees—because their healthcare is already publicly funded by state, county or municipal governments. Nevertheless, as VWC activist and VSEA member Leslie Matthews notes, her own union has not been leading the struggle because some workers are “apprehensive that healthcare reform could lead to erosion of hard-won benefits.” In reality, Matthews argues, “it’s the rising costs, increasing inequities and cost shifts in our current healthcare system that will ultimately bring us down. As union members, our access to affordable healthcare will only be secure when all working people have access to affordable healthcare.”

Workers’ Center director and lead organizer James Haslam does report that the American Federation of Teachers, the Communications Workers of America and the AFL-CIO have all increased their funding of VWC activity. Other national groups, like the Universal Health Care Action Network, have created a “Help Vermont Win! Campaign Fund” to channel more resources into the fight. In late March Physicians for a National Health Program will send nursing and medical students to Vermont to rally support for single-payer. And on May 1 the Jobs with Justice–affiliated VWC will sponsor its biggest May Day “March on Montpelier” ever—to adopt the strongest possible version of Shumlin’s plan.

The new governor’s commitment to the cause is a case study in how Democrats could behave elsewhere—on healthcare and other issues—if their party faced more challenges from the left. Before his run last fall, Shumlin’s only previous bid for statewide office was a failed campaign for lieutenant governor in 2002. His candidacy, as a Democrat, was undermined when 25 percent of the electorate backed Anthony Pollina, a Progressive Party member and longtime single-payer backer who now serves in the State Senate. In last year’s crowded Democratic gubernatorial primary, all the candidates played a game of healthcare reform one-upmanship that helped solidify support for single-payer. Shumlin won the free-for-all by just over 200 votes, even though he was not the preferred nominee of the VEA, VSEA or state AFL-CIO.

In the general election, Shumlin’s opponent was Brian Dubie, an affable Republican who garnered some labor support based on his membership in the Air Line Pilots Association. In the last month of the campaign, the race was very close. That’s when the state’s big-foot independent socialist stepped into the ring. Rallying his own grassroots base, Bernie Sanders held a series of GOTV events for Shumlin that helped the Democratic candidate gain favor among working-class Vermonters who might otherwise have drifted toward Dubie. Shumlin ended up winning by less than 2 percent of the vote.

At a Nation book-signing event in Boston in February, Shumlin’s white-haired, 69-year-old helper was welcomed by local activists. In his discussion with them, Sanders noted that single-payer has become “absolutely mainstream” in Vermont because “we’ve been talking about the issue for thirty years.” But he warned that further grassroots organizing was needed because “this is by no means a done deal.” Back home, the Vermont Workers’ Center and allied groups are taking nothing for granted either, as they gear up for a spring offensive in Montpelier to keep single-payer from getting bogged down in the public policy equivalent of Vermont’s fabled “mud season,” which has never been kind to new models seeking traction, much less the fast track.

Syndicate content