Vermont-- First Out Of The Gate In The Race For Medicare For All

Yesterday Gov. Peter Shumlin of Vermont signed a single-payer health care bill into law, the first of it's kind in the U.S.

Legislators say the plan, approved by the Democratic controlled House and Senate this spring, aims to extend coverage to all 620,000 residents while containing soaring health care costs.

A key component establishes a state health benefits exchange, as mandated by new federal health care laws, that will offer coverage from private insurers, state-sponsored and multi-state plans. It also will include tax credits to make premiums affordable for uninsured Vermonters.

The exchange, called Green Mountain Care and managed by a five-member board, will set reimbursement rates for health care providers and streamline administration into a single, unified system.

Residents and small employers will be able to compare rates from the various plans and enroll for coverage of their choosing.

As designed, the goal is an eventual state-funded and operated single-payer system. ... Advocates of change say the existing fee-for-service care has a financial incentive to deliver more care, such as tests, with little attention to quality or better outcomes.

The single-payer concept was omitted from the federal health care overhaul championed by President Barack Obama, in part due to Republican criticism it meant excessive government control.

Progressives in Vermont, including Shumlin and U.S. Senator Bernie Sanders, an independent, have worked for years to modify the state's health care system.

...If the state secures one key federal waiver related to exchanges, Green Mountain Care could begin as early as 2014. Another waiver needed to implement the single-payer component under federal law would not be available until 2017.

Vermont's plan calls for the board to consider the likely costs of coverage, factor in potential savings from reforms and recommended sources of revenue. It is charged with delivering a financing plan to legislators by 2013.

If that plan's single-payer component is adopted, lawmakers would approve a budget annually.

Single-payer proponents say the present system is too expensive and excludes too many residents. Vermont has around 47,000 uninsured and 150,000 underinsured residents.

Even Mitt Romney likes it and says he supports Vermont's single payer plan. As Vermont's state government moves to aggressively better the lives of the people there, it stands in the starkest of contrasts to the governor and legislature of Wisconsin, virtually a fascist-controled government inside our national borders. As we've seen over the last few weeks, Wisconsin has taken a leading role on behalf of American oligarchs in every scheme there is to deal body blows to working families and immobilize democracy itself. Wednesday the editorial board of the New York Times suggested to Democrats that to beat the GOP in 2012 there is a lot of work to do beyond just pointing to Paul Ryan and yelling that the Republicans want to kill Medicare, which, of course, they always have. "It’s a useful reminder of the vast differences between the parties," they opined, "but defines only the Republicans, not the Democrats."

Sooner or later, Democrats will have to admit that Medicare cannot keep running as it is-- its medical costs are out of control, and a recent report showed its trust fund running out of money in 2024, five years earlier than expected. Bill Clinton was right on Wednesday to warn his party that it must bring down those costs if it is to have any credibility on the deficit and the economy.

Many Republicans are ruefully admitting that the House went much too far in passing the Ryan plan last month. Hypnotized by their own rhetoric, firmly believing that the 2010 elections gave them a mandate to dismantle essential programs rather than raise taxes on the rich, House Republicans approved a budget that went far beyond the comfort level of the nation’s center. On Wednesday, five Republicans refused to support the Ryan plan in a symbolic vote in the Senate.

But not all Medicare cuts are the same. Democrats don’t like to admit this, but President Obama’s health care law reduces Medicare spending by more than $500 billion through 2019. This is done mostly by reducing the increases in payments to providers and cutting Medicare Advantage plans. After the law was passed, Mr. Obama proposed reducing health costs even more sharply. The subject is so confusing to voters that Republicans have used these cuts to suggest that everyone wants to cut Medicare. That’s why Nancy Pelosi prefers a more simplistic pitch: “We have a plan. It’s called Medicare.”

At some point in the next year, Democrats will have to do better than that. They can start by defending their cuts and clearly differentiating them from Mr. Ryan’s extreme plan, which makes the program unrecognizable. It might require, as Mr. Clinton put it, giving up some short-term political gain, but voters might also appreciate a dose of honesty and realism in their political diet.

Or, they can do the inevitable and the only real answer... start moving towards single-payer the way Vermont has. That's what the Democrats should campaign on in 2012: Single Payer For All. I spoke with New Mexico state Senator Eric Griego last night. He had just come home from meeting with a group of Albuquerque physicians to discuss a more sensible health care system. "Rather than targeting Medicare for cuts," he told me, "we should be building on it and making it available to more if not all Americans. 'Medicare 2.0' as some call it, would reduce administrative costs, increase access and affordability and put patients before profits. More Members of Congress should sign on to legislation like H.R. 676-- the Medicare for All bill that I plan to co-sponsor if elected to Congress." Blue America is targeting this race as one of the best chances anywhere in America to elect a real-deal progressive leader-- on health care and across the board. If the Memorial Day Weekend is a good time for you to contribute, you can find Eric's campaign here.

What Does America Have To Learn From Vermont?

Vermonters have a lot to be very proud of; their state government serves as a kind of beacon of hope in the savage darkness that is Wisconsin, Ohio, Michigan, Florida... even nearby Maine. The other day Ezra Klein explained in the Washington Post how the state is closing in on single player and the state's most ardent advocate of working families, Bernie Sanders, took to the page of the Guardian to explain why single payer is the only way to go. Bernie shatters some truisms that the Medical Industrial Complex and their conservative political shills keep pounding into the heads of the public through a weak, complacent-- if not complicit-- media.

The United States is the only major nation in the industrialised world that does not guarantee healthcare as a right to its people. Meanwhile, we spend about twice as much per capita on healthcare and, in a wide number of instances, our outcomes are not as good as others that spend far less.

It is time that we bring about a fundamental transformation of the American healthcare system. It is time for us to end private, for-profit participation in delivering basic coverage. It is time for the United States to provide a Medicare-for-all, single payer health coverage programme.

Under our dysfunctional system, 45,000 Americans a year die because they delay seeking care they cannot afford. We spent 17.6% of our GDP on healthcare in 2009, which is projected to go up to 20% by 2020, yet we still rank 26th among major, developed nations on life expectancy, and 31st on infant mortality. We must demand a better model of health coverage that emphasises preventive and primary care for every single person without regard for their ability to pay.

It is certainly a step forward that the new health reform law is projected to cover 32 million additional Americans, out of the more than 50 million uninsured today. Yet projections suggest that roughly 23 million will still be without insurance in 2019, while healthcare costs will continue to skyrocket.

Twenty-three million Americans still without health insurance after health reform is implemented? This is unacceptable. And that is why, this week, Representative Jim McDermott and I are announcing the re-introduction of the American Health Security Act, recognising healthcare as a human right and providing every US citizen and permanent resident with healthcare coverage and services through a state-administered, single payer programme.

Let's face it: until we put patients over profits, our system will not work for ordinary Americans.
It is incomprehensible that drug companies still get away with charging Americans twice as much, or more, than citizens of Canada or Europe for the exact same drugs manufactured by the exact same companies. It is an outrage that insurers still often hike premiums 20%, 40% and 60% a year on individual policy holders; and some insurers still spend 40 cents of every premium dollar on administration and profits while lavishing multimillion-dollar payouts on their CEOs.

It boggles the mind that approximately 30% of every healthcare dollar spent in the United States goes to administrative costs, rather than to delivering care. We must do better. Taiwan, for example, spends only a little over 6% of GDP on healthcare, while achieving better health outcomes on some key indicators than we do; yet they spend a relative pittance on administrative costs.

I am very proud that my home state of Vermont is now taking big steps to lead the nation in healthcare by moving forward on a plan to establish a single payer healthcare system that puts the interests of patients over chasing profits. The American Health Security Act would make sure every state does the same-- taking profits out of the equation by implementing a single payer system, but letting each state administer its own programme, according to strict standards, in a way best suited to its needs.

The goal of real healthcare reform must be high-quality, universal coverage in a cost-effective way. We must ensure, to as great a degree as possible, that the money we put into health coverage goes to the delivery of healthcare, not to paper-pushing, astronomical profits and lining CEOs' pockets.

Don't you wish you had a senator like Bernie representing your state? And, believe me, just because someone has a "D" next to their name, it doesn't mean their enlightened or courageous or even on the side of working families. Just look at how Claire McCaskill and Mark Udall are working with Republicans to penalize working families on behalf of their wealthy patrons. And they're not even as bad as some of the corporate shills the DSCC is trying to foist on the American people in 2012-- like arch-conservatives Ed Case in Hawaii, Joe Donnelly in Indiana and Jim Matheson in Utah, to name three of the worst.

When Blue America launched our Bernie Sanders page the day after the 2010 midterms, we hoped he would run for president. But we doubted he would and we were happy to be contributing money to his Senate reelection campaign. His is the single most crucial voice in that body... by far. Tuesday he-- along with Seattle Congressman Jim McDermott in the House-- introduced single-payer, Medicare-for-all legislation, the antidote to the backward-looking Paul Ryan/John Boehner approach based on a vision that government is there to help make society a better and safer place for everyone, not just a tool to protect economic predators and social parasites. Sander's and McDermott's bill, the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs. It will take the election of a progressive Congress to pass it, not just replacing corporate Republicans with corporate Democrats, but, for example, making sure we replace reactionary Blue Dogs and Democratic corporate shills like Dan Lipinski in Illinois with healthcare advocates like John Atkinson. All of the candidates endorsed by Blue America support the Medicare-for-all vision being pushed by Bernie and the Congressional Progressive Caucus. That's why you're not going to see us asking for contributions for endangered middle-of-the-road Democrats like Claire McCaskill, let alone anti-healthcare Trojan horses like Joe Donnelly.