The Nation: Vermont’s Struggle for Single-Payer Healthcare

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.


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.