Push Renews for Vermont Health Reform

Advocates for universal health care will descend on the Statehouse on Wednesday as they look to forge legislative support for broad reforms to the way Vermonters receive medical coverage.

A rally being staged by the Healthcare is a Human Right Campaign aims to draw hundreds of citizens into the state capital on the first day of the 2011 legislative session. James Haslam, director of the Vermont Workers Center, which oversees the campaign, said this “people’s movement” will cement the political will needed to overhaul a health-care system that cost Vermonters $4.9 billion in 2010.

The rally begins at 12:30 p.m. in the Cedar Creek Room on Wednesday.

“We wanted to get started on day one of this new legislative session by showing legislators that Vermonters are really excited about moving forward boldly this year toward a universal health care system in this state,” Haslam said. “We understand it’s not going to be easy, and that doing something as big as establishing a universal health-care system is a big challenge. We think it’s important to show legislators they have support for this from the get-go.”

Haslam and other proponents of a universal-care system — which would accord every citizen of the state equal access to health care services — say this year’s legislative session presents a watershed moment in the reform movement.

The unveiling later this month of three health care reform proposals, commissioned by the Legislature from a Harvard economist, coincides with the inauguration of a Democratic governor whose campaign centered largely on a promise to make Vermont the first state in the nation to adopt a single-payer health-care system.

“We’ve never had the stars line up like that,” said Dr. Deb Richter, head of Vermont Healthcare for All, a nonprofit organization that has lobbied for more than a decade for a single-payer system. “Add to that the fact that we have a strong congressional delegation which is in support of universal care and can help us overcome some of the obstacles we may encounter at the federal level, and we’ve never had all those things line up at the same time.”

Both Haslam and Richter, whose organizations have galvanized several thousand residents behind the movement, say any reform package must include a publicly funded system that delivers universal access in an equitable and transparent manner.

Though her organization’s advocacy campaign is called “Vermont For Single Payer,” Richter said she’s concerned more with the substance of the reforms than the funding mechanism.

William Hsiao, the Harvard economist commissioned by lawmakers to devise new health-care models, will present three options in a report due out Jan. 19. The options will include a single-payer model, a public-option model and a model of Hsiao’s choosing that he believes is the most viable for Vermont, both economically and politically.

“I wouldn’t even begin to judge which option will most clearly align (with our goals) until we see that report,” Richter said. “I want to see details before I make any statements about it, and our role will be to show what the different options represent and how closely they align with our overall goals for health-care reform.”

Haslam said that while his organization won’t dismiss a nonsingle-payer proposal out of hand, he believes single-payer offers the most obvious path to universal coverage.

“It’s certainly an equitable way to do it and in addition to being equitable, it’s an efficient way of doing it,” Haslam said. “It can save money and eliminate a lot of waste that’s now going to unneeded paperwork, and it can stop sending health-care dollars to people who aren’t actually providing health-care services.”

Richter said the for-profit insurance and pharmaceutical industries will spend big to stymie reform efforts in Vermont.

“There are a lot of forces that are doing quite well under the status quo,” Richter said. “A lot of people profit off this chaotic system, or nonsystem, and profit off of other people’s ill health. I’m sure they will hire every lobbyist in sight.”

Bill Driscoll, vice president of Associated Industries of Vermont, said opposition isn’t limited to out-of-state corporations. Home-grown businesses suffering in the worst economy since World War II, Driscoll said, have good reason to fear a single-payer or other publicly funded system.

“The primary concern for employers when it comes to health care is the cost,” Driscoll said. “And if the current premium-based system, which is very expensive for employers, is simply replaced by an even more expensive, tax-based system, then that is not necessarily better for employers.”

Under the current system, Driscoll said, employers have wide latitude when it comes to determining what level of coverage, if any, they want to extend to employees.

“In some cases, even though it’s never the first choice, employers have the option not to offer insurance if they simply cannot afford it,” he said. “Companies that cannot currently afford insurance may be required to pay taxes they can’t afford either.”

Driscoll said AIV is also unconvinced that a single-payer system will actually save money on the whole. He said to lower the cost of policies and drive down health-care costs overall, the state needs to increase competition among private insurers and create incentives for behavioral choices that lead to good health.

“The push toward a single-payer system is sometimes portrayed as a panacea for health care when in fact we should be focused more on the root cost drivers rather than looking at shifting away from the market-based system we have,” he said.

Daniel Barlow, public policy director for Vermont Businesses for Social Responsibility, said his organization’s research indicates the business community would, in fact, support a publicly funded, universal health-care system. According to a business survey conducted in the spring of 2010, nearly half of VBSR’s 1,300 members cited “the rising cost of health insurance as a major obstacle to the success of their business,” Barlow said.

“It far outweighed any other obstacles they identified,” Barlow said. “And 84 percent said they favor a publicly financed system.”

For moral as well as financial reasons, according to Barlow, many businesses support a reform package that decouples health care from employment, which would free employers from the onus of providing health care.

“VBSR doesn’t specifically support a single-payer system. Call it whatever you want, so long as it ensures everyone in Vermont is covered and it’s coverage they can afford and it’s decoupled from employment,” he said.

Gov.-elect Peter Shumlin, who is to be inaugurated later this week, has cited the positive impact on businesses as one of the more compelling arguments for universal coverage. Shumlin’s support for a single-payer system during the gubernatorial campaign won him the votes of many health-care reform advocates, and expectations for his administration are extraordinarily lofty. A Boston Globe editorial that appeared on Sunday said “the nation’s eyes will be on Vermont as it tries to do ObamaCare one better and switch to a single-payer health insurance system. The newly elected governor, Peter Shumlin, made single-payer a main campaign pledge.”

Anya Rader Wallack, who, as a special assistant to Shumlin, will spearhead the incoming administration’s health-care reform efforts, said advocates are being heard.

“Are we listening? Are we watching? Absolutely,” she said Monday. “I think the governor has very clearly said he’s committed to both those concepts — single payer and universal coverage, and that’s what we’re working toward.”

At the same time, Rader Wallack said the administration will first have to “deal with some real constraints on what we can do.”

In order to achieve a single-payer system, Vermont would need waivers from the federal government to bypass some of the provisions outlined in the federal health-care bill. And it would take an act of Congress to exempt Vermont from a federal law that prevents the imposition of state health-care regulations on companies that insure their own employees.

“We’re working to understand all that and craft a strategy,” Rader Wallack said.