Witness the odd creature that is H.304, the newest bill intended to make movements towards single-payer health care, and its very existence brings up many interesting questions and points.
First of all, the simple fact that the House still has a Health Care committee post-Catamount is a great thing, in that it invites continued action and creative thinking on this issue. H.304 is a perfect example. But the atmosphere around this bill is especially interesting. Championed by Deb Richter and Con Hogan, the bill is sponsored by a Republican and two Democrats, but no Progressives. On the other hand, it is quite the topic of organization at the Progs’ official site, including on the Prog Blog.
The bill itself has gotten as much attention for its organizing slogan as its content (“Take Back Vermont Healthcare,” which has only served to piss people off by evoking “Take Back Vermont” – Richter has since announced a change in its advertising gimmick – and hopefully a reconsideration of career choice for whatever communications person thought such a name was a good idea).
Although large crowds have come to a couple rallies, the outreach has seemed fairly limited in scope – almost perfunctory at times. The result is a lot of confusion about the issue, the bill and its relative merits. In fact, I’ve had a hard time finding a proponent who can tell me what the bill actually does. Even the advocacy website set up for the bill makes it painfully hard to find out anything at all (not a strategy that inspires confidence, which adds to the general sense of chaos around the “grasstops” effort)
An attempt to get an idea what’s going on after the fold…
304 would set up the State of Vermont to become the functional single insurance payer for Hospital care. The idea is that, once implemented, regular premiums will come down 40%, paperwork will be dramatically streamlined and reduced, which could bring down rates even further, and it ultimately becomes a cheaper and more cost-efficient way for the State to meet its Medicare and Medicaid matching burdens. In fact, the bill depends on Vermont being able to pool its Medicare and Medicaid federal monies to cover the system.
And the result is that everybody can go to the ER and be paid for.
I think the reason you dont see Progressive and Liberal Democrats lining up to get behind this bill is that it would seem to make so many assumptions as to be a virtual leap of faith. A 40% premium decrease is not only a dangerously murky figure, the idea that premiums would drop just because it’s “the law” is deceptively simplistic. There is no mechanism by which they have to drop that much under those circumstances.
Also painfully murky is the $115 million figure thrown out as the amount of administrative overhead that will be reduced. Maybe, maybe not. There are not $115 million worth of medical, budgetary line-items cleanly segregated under the “waste and abuse” column. This is not unlike the rhetoric used by Republicans to attack social programs – rhetoric that creates a self-servingly simplistic picture that – among other things – completely ignores the quantum effects of implementing radical change.
There’s also the Hospital Association’s argument: that this will simply further encourage people to use Hospital ERs as the medical care of first resort, rather than seeking preventative care. The proponents response is basically “no they won’t”.
As an underinsured person who lives paycheck to paycheck and supports a family, let me just say: yes we will.
Finally, there’s the issue of paying for it. The website offers this on their faq:
4. How will we pay for H.304?
a. We have some numbers derived from work by the Joint Fiscal Office.
b. One example would be a 5.5% payroll tax plus a $200 fee for each Vermonter under age 65.
c. The Legislative committees that deal with revenue can figure it out.
a: Well, that’s nice.
b: Great. More regressive taxes.
c: Punt.
Although the website is pretty, in terms of content, in a lot of ways the website seems to have had as much thought put into it as the unfortunate slogan.
In fact, the message from the site and the rally posters seems to be: Its about single payer. You are in favor of single payer, right? Then forget the details, just show up and support this thing.
The slap-dash, lickety-splittery of this bill and the push for it, in my opinion, do a disservice to the cause and are a bit patronizing to its supporters. As a supporter of single-payer, I have to say that the common theme behind the crude sloganeering, the half-baked bill and the condescendingly incomplete advocacy seems to be that organizers think I’m stupid.
Premiums will come down x amount because we say they will. X amount will be saved from paperwork because we said so. People wont lean on ERs for primary care because they just won’t. It’ll get paid for because ways and means will fix it, no problem.
And perhaps most extreme of all, the federal government will let us do whatever we want with medicare and medicaid money because they will.
Added together, the rhetoric underplays so dramatically the fundamental changes and the fiscal impacts of what it would wreak as to seem almost deceptive, and it does so in a kind of patrician, leave-it-to-the-experts style that only feeds the worst stereotypes about liberals.
It may be that many proponents don’t understand what’s in the bill. It may be that proponents have been talking to the same old people (e.g.each other) about health care for so long, they no longer feel the need to make a comprehensive case for single-payer, assuming everyone is on their side. It may be that they’ve decided some “radical creep” is called for by sneaking up on people with a dramatic change in the system to show them, despite themselves, that its not so bad once they’re steeped in it.
Whatever the reason(s), proponents seem to have fallen back on vague sleight-of-hand with a touch of snake oil to bypass what really needs to happen to create such fundamental change.
What needs to happen is exactly what happened with the Great Society laws, and even the New Deal; a broadly, clearly, honestly stated commitment to fundamental change. An understanding that its not going to be easy or cheap, so we must be committed to make it happen, come what may.
So far, that consensus is not in play around this bill. I have some sympathy, as to make such a case, you need someone in a leadership position to stand up and advocate aggressively. Rep. McFaun is trying to play that role, but his platform isn’t broad enough.
Nor is he getting the right kind of support from advocates who have him speaking at the same forums to the same people who are always at these things. The use of “Take Back Vermont” suggests that advocates have some intellectual understanding that they need to look beyond this crowd, but the crude offensive sloganeering demonstrates either how little they bothered to really consider the best way to do that, or how ill-equipped they are to understand those people.
In any event, the half-hearted “just do it” quality of the bill and the support for it aren’t doing the cause a lot of favors.
…but… wanna hear the punchline?
I’m still glad to see it.
The bill will fail. Miserably, and for a variety of reasons. The whole thing is a leap of faith on many, many levels.
But it’s simple existence does three things:
One, it furthers the single-payer argument in a more concrete way than we’ve yet seen.
Two, it sets the bar for real health care reform closer to where it should be, and hopefully will inform whatever new bill actually emerges from the legislature this year.
Three, it puts a spotlight on the need for flexibility on federal money and points out the real necessity for federal support to move towards single-payer, or something really resembling single-payer.
These are all good things. Necessary and important things. If I were a legislator, I couldn’t in good conscience vote for it in this form, but that same conscience would demand I not abandon it – rather that I get involved and really take it on to make sure I was part of the solution. I hope other legislators and advocates see it that way.
Richter and Hogan are doing a service by promoting this. Representatives McFaun, Obuchowski and Ojibway may not be doing themselves any favors among their peers putting forward such a flawed bill, but this conversation is in desperate need of a push to the next step, and this is one way to do that.
It could be argued that a screwed-up bill is worse than no bill, as it delegitimizes the overall approach, but don’t think so. Single-payer is the direction the argument is headed, and there’s no changing that
