The people intent on killing “Medicare for All” have found a convenient weapon—the fact that Vermont, Bernie Sanders’s own state, passed a law creating a single-payer system in 2011, then killed the idea in 2014 before it was ever implemented.
Vermont’s single-payer plan did not fail in operation. Then-Governor Peter Shumlin, a Democrat, killed it unilaterally in December 2014 before it was ever implemented. So how can Vermont serve as an example of what to expect if Medicare for All is implemented?
Conservatives and the for-profit health care industry portray this as a “failure” and a clear sign that a single-payer system like Medicare for All is simply foolish. They push the idea that Vermont’s plan, Green Mountain Care (GMC), failed because single-payer health care is unworkable, expensive, even dangerous.
The supposed failure of single payer in Vermont was even used to attack the proposed single-payer plan in Colorado that was voted down in 2016.
In 2019, The Washington Post’s national health care policy writer, Amy Goldstein, wrote the article “Why Vermont’s single-payer effort failed and what Democrats can learn from it,” in which she quotes an anonymous “analyst” who says many advocates shared “a belief that borders on the theological” that the system would save money.
Since every reasonably objective analysis has found that an American single-payer system would cost less than the current system, that is hardly a “theological belief.” In fact, way back in 1991, the Government Accounting Office reported to Congress that if the United States adopted a Canadian-style system, “the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are currently uninsured. There would be enough left over to permit a reduction, or possibly even the elimination, of copayments and deductibles.”
The Goldstein article and others like it are quickly added to the collection of scare pieces that the health care industry’s designated single-payer attack group, the Partnership for America’s Health Care Future, uses to terrify anyone who even thinks about single-payer health care.
Vermont’s single-payer plan did not fail in operation. Then-Governor Peter Shumlin, a Democrat, killed it unilaterally in December 2014 before it was ever implemented. So how can Vermont serve as an example of what to expect if Medicare for All is implemented?
Enter the Magic Mirror: single-payer opponents hold the “Vermont experience” up to it and see only the aspects that can be spun to support the conclusions they wish to reach.
Enter the Magic Mirror: single-payer opponents hold the “Vermont experience” up to it and see only the aspects that can be spun to support the conclusions they wish to reach.
Shumlin’s ambiguous and contradictory announcement that he was pulling the plug on GMC set the stage for this phenomenon. In it he said the “risk of economic shock is too high;” a “more equitable system” must wait until “the time is right;” and that “GMC would yield savings of $378 million over the first five years of the program relative to current predicted trends.”
Between GMC’s enactment and its untimely death, opponents hammered the public with fear and misinformation. A nonprofit called “Vermonters for Health Care Freedom” devoted all of its energies to that effort. Vermont’s significant Libertarian community did the same.
I lived through the incessant barrage of op-eds, letters to the editor, online ads, and free video showings across the state, all designed to terrify Vermonters that implementation of GMC was the apocalypse.
Vermonters were told over and over that GMC would require “the biggest tax increase in history.” That was absolutely true, but it would also have produced the biggest reduction in premiums and copays and deductibles in history. In fact, almost everybody would have paid less under GMC than they were paying under the current system.
Most scares were based on sheer speculation. Doctors and businesses would flee the state. Poor people would flood in for free care. Medicare recipients would lose benefits (even though the law required benefits at least equal to Medicare). And so on.
Shumlin and the state made no effort to counteract the misinformation or explain how GMC benefited everybody, not even after a 2014 poll showed many Vermonters understood little about it. Rumors that Shumlin’s commitment to GMC was wavering began circulating near the time of that poll. But at a public forum a month or so later, Shumlin publicly reassured me that his commitment to GMC was as strong as it had ever been.
Another major factor in GMC’s demise was Vermont’s introduction of “Vermont Health Connect,” its own online insurance exchange to implement Obamacare. That was an unmitigated disaster, causing major problems for a large number of Vermonters, including me. It was such a disaster that it gave the whole idea of government involvement in health care a bad name.
Given all this, it’s not surprising that Shumlin was barely reelected in November 2014. He failed to get a majority of the popular vote, requiring that he be elected by the legislature. By the time he pulled the plug on GMC the next month, he was in a very weak political position.
Whether to implement GMC was a comparative choice: are we better off with GMC or with the current commercial insurance system? Looking only at the potential consequences of GMC, as its opponents did, totally ignored the very real flaws of the current system.
What has the actual “Vermont experience” with our commercial insurance system been in the four-plus years since the demise of GMC? Things have gotten progressively worse and far more expensive. Some examples:
- Commercial insurance rates have risen so much that the regulatory agency’s chairman publicly said, “We acknowledge they are not affordable. But at the same time we can’t put a company out of business.”
- Average employee contributions to the premiums on their employer-provided health insurance rose from $3,451 in 2014 to $4,311 in 2018; average deductibles on those policies rose from $2,679 to $3,292.
- Total health care spending in Vermont topped $6 billion in 2017, up from $5.54 billion in 2014, the year that GMC died.
- The most recent annual state survey found 3 percent of Vermonters under age sixty-five were uninsured, with another 36 percent underinsured (unable to afford their deductibles and copays).
Compare these metrics with saving $378 million with GMC while covering all Vermonters. Which system “failed?”
While the people of Vermont are paying a heavy health care price for being left to the vagaries of commercial health insurance, two of the most prominent and vocal opponents of GMC have fared quite well.
Wendy Wilton, former treasurer for the City of Rutland made claim after claim that her financial analysis predicted disaster from single payer. She now works for the Trump Administration as the Vermont state director of the Agriculture Department’s Farm Service Agency.
Darcie Johnston headed “Vermonters for Health Care Freedom” during that group’s extensive efforts to scare Vermonters away from GMC. She now works in the Department of Health and Human Services.
Peter Shumlin is also doing pretty well. This past fall, he was made a senior leadership fellow at Harvard’s T.H. Chan School of Public Health. The course he taught was called “Health Policy and Leadership: Reforming America’s Broken Health Care System from Within.”