The bill to put Vermont on the irreversible path toward a single payer health care system is now well on its way to the governor's desk. The ceremonial signing may well be the governor's answer to the pageantry of a United Kingdom royal wedding.
Perhaps the most startling aspect of this four month legislative saga has been the enormous contrast between the daunting requirements of organizing the new $3 billion government program, and the limited competence of its advocates.
The 2010 legislature launched the process, for at least the third time, by voting $300,000 to Dr. William Hsiao of the Harvard School of Public Health to explain how to gather all Vermonters into the grandsingle payer system. The Hsaio team recommended a level of health benefits thought to be suitable for Vermont's under- 65 population. It specified the payroll tax rates required to bring in enough tax dollars to pay for the program. It claimed an astounding $590 million a year would be saved (starting in 2015) by abolishing health insurance companies.
So the House Health Care Reform Committee brought out a bill that gave the Hsaio-recommended Green Mountain Care Board the power to set benefit levels and decide how much to underpay health care providers but neglected to include any provision for raising the necessary $2 billion of new taxes. Instead, the new Board was told to take another year and another million dollars to grapple with the same questions that Hsaio had already studied.
Once the eligible population is identified, the Board's view of the "appropriate health care at the appropriate time in the appropriate setting spelled out, the costs of that care estimated, and the Federal subsidies added in, the Board can tell the legislature how much it will have to raise in new taxes to keep this ship above water.
In the Senate, the majority Democrats won the vote of Sen. Kevin Mullin (R-Rutland ) by agreeing to require the Board at some unspecified point to announce to the world that it believes that Green Mountain Care would reduce administrative costs (whose?), contain the growth in health care costs, improve the quality of care, attract providers, and not damage the state's economy. There is no appeal process or enforcement mechanism for these declarations.
Gov. Shumlin has made it clear that he wants the new ObamaCare-mandated Exchange to be the only place anyone can obtain health insurance. In addition, liberals have long ago taken to viewing Health Savings Account plans as a conservative plot to thwart their collectivist ambitions. Sen. Vince Illuzzi (R-Essex-Orleans) offered a carefully crafted amendment that would have prevented the Exchange from exterminating the popular HSA plans. The Democrats voted it down 11-19.
The Democrats also voted down an amendment from Sen. Randy Brock (R-Franklin) to advance the date for the administration's health care tax request from January 2013 to September 2012. That would allow the voters to learn what's in store for them if the governor is reelected. Only eight senators were willing to support that eminently sensible provision.
It was patently apparent during the legislative debate that the backers of single payer, now relabeled "universal and unified health system", have little grasp of the complexities involved in completely disassembling and repackaging Vermont's $5 billion health care sector to satisfy the Sanderistas shouting that health care is a human right.
The Democratic legislators are marching to orders from the Shumlin health care high command. They are almost mystically convinced that the native genius of Vermonters can somehow make Green Mountain Care work. This is so even though forty years of the almost identical Canadian single payer model have produced rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and of course much higher taxation.
Typical of this widely held attitude is the remark of Sen. Anthony Pollina (I-Washington): "We're from Vermont. We're one of the smartest states in the country, and we can figure this [single payer thing] out." This is the same Sanderista activist whose venture to pay farmers premium prices for milk and sell it at competitive prices predictably collapsed into insolvency.
As the saying goes, politics ain't beanbag. Neither is health care reform, but the beanbaggers are in the driver's seat.
John McClaughry is vice president of the Ethan Allen Institute (www.ethanallen.org).