Why Vermont's single-payer effort failed and what Democrats can learn from it

[Gothmog]

Good article on why Vermont's effort to adopt single payer failed

Link to tweet

Three and a half years after Vermont’s then-Gov. Peter Shumlin signed into law a vision for the nation’s first single-payer health system, his small team was still struggling to find a way to pay for it. With a deadline bearing down, they worked through a frozen, mid-December weekend, trying one computer model Friday night, another Saturday night, yet another Sunday morning.

If they kept going, the governor asked his exhausted team on Monday, could they arrive at a tax plan that would be politically palatable? No, they told him. They could not.

Two days later, on Dec. 17, 2014, Shumlin, who had swept into office promising a health care system that left no one uninsured, announced he was giving up, lamenting the decision as “the greatest disappointment of my political life so far.”

The trajectory of Green Mountain Care, as Vermont’s health system was to be known — from the euphoric spring of 2011 to its crash landing in late 2014 — offers sobering lessons for the current crop of Democrats running for president, including Vermont’s own Sen. Bernie Sanders (I), most of whom embrace Medicare-for-all or other aspirations for universal insurance coverage.

[sandensea]

1. Sure. A single-payer can only work nationwide, or something close to that.

And certainly not in any state a small as Vermont.

Can you imagine if LBJ had rolled out Medicare and Medicaid is a couple of small states as a pilot? It would have failed a in a couple of years and given the GOPee the chance to say (petulant little girl voice and all): "See? I told you so!"

[Gothmog]

2. From the article cited in the OP

If you can not get a plan adopted in Vermont, it will be hard to do this nationwide

To some who still bear the battle scars of Green Mountain Care, the state’s unrealized vision is a neon warning for Sanders and other disciples of single-payer health care.

“If you can’t do it in Vermont, with one private health plan and low uninsured rates, then the amount of disruption you would have nationally with winners and losers would be enormous,” said Kenneth Thorpe, an Emory University health-policy researcher who worked as a consultant to Vermont.

[Vinca]

3. I disagree since we already have Medicare operational. It would seem that if there was political

will to do it, it could get done. Sadly, one party in this country doesn't give a shit whether you or I or anyone else has access to medical care. As long as they've got it, there's no need to do anything. I do think the size of Vermont mattered a great deal. Just as blue states subsidize red states, a tiny state would need more funding from somewhere else.

[SunSeeker]

4. No, Vermont had a low uninsured rate, compared to nationwide. It was ideal.

Really, the only reason VT single payer failed was outright cowardice to raise the necessary taxes--even though those taxes would have been less than what people were paying for less coverage now. Bernie would not say a word to justify the needed tax increase, after passionately championing the law -- before the tax increase legislation to fund it came up for discussion. Then he clammed up. That sent a signal that there was no political will for a tax increase. Even one that made perfect sense. So it died.

The small size of Vermont should have helped rather than hindered. Canada passed single payer province by province, not all at once nationwide.

[NewJeffCT]

7. While I'd love a sweeping Medicare for All plan

Realistically, I can see it going one of two ways to improve healthcare - Assuming a Democrat wins the White House in 2020 and Dems also get control of the Senate and we also return to where the ACA was when Obama left office.

I see it going one of these ways:
1) Expand Medicare to let people buy in at age 50 or 55
2) Add a strong public option onto Obamacare.

Option 1 will then lead to an eventual lowering of the buy-in age, likely in stages
Option 2 leads to employers eventually steering their employees to the public option and private insurance slowly withering away.

Not as glamorous as passing it all in one fell swoop, but Social Security was expanded over time as well.

[marble falls]

5. It needs to be a Federal and nationally funded single payer.

[Hoyt]

6. California and Colorado abandoned single payer for same reason, no politician had the guts to tell

voters how much their taxes would increase. Didn't matter if the tax would offset premiums and all, or most, cost-sharing (deductibles and copays).

It's going to take a Demonstration of sorts -- Public Option -- to let people try it. It's the only way it will work without forcing people too ignorant to understand single payer is best for all us. If Medicare is as good as we think, people will gravitate to it quickly.

[Doremus]

8. I'll listen to the naysayers about (Medicare for all/Social Security/Medicaid/Free college/etc....

...when they explain how we were able to afford $1 trillion in tax cuts and a $700B military budget.

Until then, shove it where the sun don't shine. And take your deep concerns about our fiscal health elsewhere cause I ain't buyin'.