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.