TRANSCRIPT
JESSICA DESVARIEUX, TRNN PRODUCER: Welcome to The Real News Network. I’m Jessica Desvarieux in Baltimore.In 2017, Vermont’s health care system was to be the closest thing to a public single-payer system in the United States. But now that plan has been thrown to the wayside by Vermont Governor Peter Shumlin. He decided to bail on the plan, saying that it’d be too costly for taxpayers and small businesses. Last month, protesters demonstrated in front of the statehouse to voice their anger over the decision, saying Shumlin cannot cast aside the law that created the single-payer public system without repealing it through the legislature. You can see here through these images people burning their medical bills in protest and in what they see as a system that puts profits over people.Now joining us in-studio to help unpack this health care saga and what’s really going on in Vermont is our guest, Dr. Margaret Flowers. Dr. Margaret Flowers is a pediatrician and codirector of PopularResistance.org.Thanks so much for joining us in-studio, Margaret.
MARGARET FLOWERS, CODIRECTOR, IT’S OUR ECONOMY: Thank you for having me, Jessica.
DESVARIEUX: So, Margaret, I’m trying to get a sense of the history of this law. So we went from 2011, Act 48 being passed. And that essentially created what, exactly?
FLOWERS: So–and it actually started before that. In 2009, when most of us were focused on the federal health reform process, Vermonters were already forming a big grassroots base, educating themselves around the framework of health care as a human right. And they pushed for a piece of legislation in 2010 that actually mandated that the state bring in a health expert, a consultant, develop three choices of plans that would meet the human rights principles of universality (everybody in), equity (that everybody can get what they need), accountability, transparency, and participation.That whole process, that was how Peter Shumlin actually got elected. He ran on a single-payer platform, and he was elected because of that. And then in 2000–so they brought in that consultant, Dr. William Hsiao, and some others, and they put together three options. And Act 48 in 2011 was when they picked the one option that they were going to go for and implement. And so that’s been put into place so far. They’ve created their health insurance exchange in the way that they wanted to do that under that act.And the missing piece was the piece was the financing. That piece was supposed to be completed in 2013, but the governor delayed and delayed until after the 2014 election and announced then that the whole process was going to be too expensive.
DESVARIEUX: Okay. And let’s talk about his arguments as to why it’s going to be too expensive. When–what they looked at, was it actually even a single-payer system? What were they really evaluating?
FLOWERS: No, and that’s the thing is that so many people have called this a single payer. But that wouldn’t make sense, because a single-payer system, hands down–we know it. It’s been proven at every level that it’s the most cost-effective type of health system that you can have.
DESVARIEUX: And why is that?
FLOWERS: Well, because it has the–it has three kind of main features, huge cost-saving features. One is very simplified administration. You have one plan, one set of benefits. Everybody’s in it. Makes it very simple to use. We have a hugely burdensome administrative system here in the United States. And that’s one of the prime reasons why we’re the most expensive.They also use something called global operating budgets. So hospitals don’t have to have a whole floor of administrative staff trying to work out the billing. The hospital gets a check every month. And that’s how they pay for the things that they do. So that is also a much better way to manage your finances.And then a third thing is bulk purchasing, being able to purchase the pharmaceuticals and medical devices and other things. You have–as a single system, you have a lot of negotiating power to get the best price for that.So the Vermont system really had none of those. It was designed to be the closest to a universal health care system and to be, ultimately, a universal health care system for the state of Vermont. But they were not using a single payer. They were having some public insurances, some private insurances, and then a publicly funded kind of Green Mountain Care insurance option for everybody else.
DESVARIEUX: Okay. And the governor was saying, essentially, that this program would be getting less federal money. So we would–I mean, if I was from Vermont, they wouldn’t be able to raise enough revenue either, because taxpayers would have to be putting in more money, their income taxes, and so on and so forth would be going up, and small businesses were going to be affected. So is there some truth to that, based on that Vermont plan, which is not single-payer but universal?
FLOWERS: Right. But even in a single-payer system, your taxes, you’re going to have to pay for it somehow. And what’s been determined is that the best way to pay for health care is through your taxes. You pay into a system. The system is there. And then you don’t have to pay when you use it. So you don’t have co-pays or deductibles or other out-of-pocket costs that actually keep people from going to the doctor. So you would pay through your taxes, but everybody would be insured, and most people would be paying less through taxes than they pay right now between insurance premiums and out-of-pocket costs. So, yeah, there were some taxes.I think it’s–what’s important to do is go back and look at the whole process, because the Vermonters who really drove this piece of legislation, the grassroots, was very heavily involved throughout the process. And then, once Vermont created this Green Mountain board, which was tasked with helping with the financing, I think a lot of the activists stepped back. They thought, okay, our job is done; now this board is going to implement this law that requires them to do these things. And my understanding is that a lot of the single-payer health financing experts were not invited to be part of that discussion of how they determine the financing, that a lot of it was really done by kind of the same people who are part of the whole establishment that’s been organizing the current system that we have right now.
DESVARIEUX: Who exactly are we talking about?
FLOWERS: Some people like /ɑːnjəreɪdərˈwɑːlək/, who was a big part of developing the Affordable Care Act at the national level, Jonathan Gruber. You know, these are people that were consulting that. And business. Shumlin went to a lot of businesses instead of, really, to the health policy, you know, health finance policy experts.
DESVARIEUX: And do you know what’s behind that? You would think Vermont being more of a liberal state–and like you said, he ran on that platform of a single-payer system. He was the most progressive on that issue. And he ended up winning. And we should note that in Vermont it’s every two years, the terms are only two years, of governorships. So why have such a strong influence? Why does business still have this grasp over the political process?
FLOWERS: Well, I think, you know, Shumlin–and we knew this going in, that he’s just like a lot of other Democrats. He’s very connected with business and that any way–the way that Vermont got to the stage they got to was through, really, grassroots pressure and grassroots organizing. And I think that’s the lesson is that you just can’t let back on that. If you want to get these types of progressive pieces of legislation passed, you have a huge opposition that you’re up against. I mean, the health industry is one of our top industries in this country in terms of the amount of money that they make. And so they’re in there fighting to get what they need or what they want, and you have to balance that out with the people. I think of what just happened in Vermont with Governor Cuomo banning fracking. That happened because for six years the grassroots pressure hounded him. Literally everywhere that he went, they put pressure on and they didn’t give him a break until he just had no choice. And I think that’s what our takeaway lesson is is that you do, you have to be in there constantly fighting and making sure that your interests are being represented.
DESVARIEUX: So it sounds like for you you’re definitely not going to give up this fight. What sort of strategies going forward should people be keeping in mind?
FLOWERS: Well, I think that things that–like the Vermont Workers’ Center and a lot of their grassroots activists reacted right away to Shumlin’s decision with a very creative protest, where the delivered a tray of toast to him and said, Shumlin, you’re toast. And I think that’s actually the accurate strategy that they should follow.Governor Shumlin has not been–he has not won the election yet. In Vermont they have an interesting system where you have to win at least 50 percent of the votes to be elected governor. And there were three candidates. So none of them got 50 percent. So it’s actually up to the legislature to decide who the governor is on January 8. And I think the smartest thing to do would be to not give Governor Shumlin that position. He ran on single-payer. He committed to it–or not single-payer, but the publicly financed universal system they are going for. He committed to that, and then he didn’t deliver. And he didn’t deliver because he went through kind of a secretive process, exclusionary process towards the end when it came to the financing.So I think the Vermonters are going to continue their direct pressure on him. I think they’re going to build that pressure. They say they’re going to get this system. Whether he’s there or not, they’re going to fight for it. And I think that’s what we have to do. Any real gain that we’ve made in this country has always happened because of committed direct pressure on the legislators and the people not giving up even when it seems like it’s tough.
DESVARIEUX: Alright. Dr. Margaret Flowers, joining us in-studio.Thank you so much for being with us.
FLOWERS: Thank you.
DESVARIEUX: And thank you for joining us on The Real News Network.