Dunne Embraces Universal Primary Care As Step to Single Payer
July 01, 2016
Matt Dunne outlined a three-point plan on Thursday for moving Vermont to a universal health care system.
Dunne, who is running against Sue Minter and Peter Galbraith for the Democratic nomination, said he would fix Vermont Health Connect, embrace payment reform under the all-payer model, and then implement a universal primary care system.
All three initiatives would support his vision for shifting the state from commercial insurance plans paid for by employers and individuals to a single-payer health care system supported by taxpayers.
Dunne announced the plan at the Statehouse flanked by family members and community supporters who said he has been personally committed to the issue for years. His brother, Josh Dunne, started the press conference with a story about how, at the age of 40, he was uninsured, with no primary care physician to coordinate his care.
Josh Dunne said he had a medical event and went to the emergency room, where he was diagnosed with a blood clot in his brain and was given blood thinners. He said the specialists didn’t know he had an aneurism in his brain, and the blood thinners caused him to have a stroke. He was rushed to Dartmouth-Hitchcock Medical Center in New Hampshire.
“There’s no reason someone should face the kind of perfect storm health scenario as I did,” Josh Dunne said. “Matt has a policy vision to put us back on track to high-quality health care for all Vermonters.”
Matt Dunne said the biggest challenge for state officials and advocates who want to shift Vermont to a single-payer health care system is public distrust of government initiatives because of ongoing problems with Vermont Health Connect. He said the website should be taken care of first, and he would not put a time frame on when a universal primary care would be implemented.
Gov. Peter Shumlin supported single-payer health care when he was elected in 2010 but abandoned his ambitious plans in December 2014 when he decided the burden on taxpayers would be too high. The governor incurred the wrath of activists who interrupted his 2015 inauguration with a demonstration by the Vermont Workers Center.
That protest was led by James Haslam, who is now the executive director of the activist group Rights and Democracy, and a longtime single payer activist.
Haslam supports Dunne.
“This is a guy that actually cares about the issues,” Haslam said. “He’s not just an ego who will tell everyone what they want to hear just to get into power.”
Universal primary care is the brainchild of Dr. Deb Richter, a family doctor and a long-time advocate for single-payer health care. She said primary care is about 5 percent of the nearly $6 billion Vermont will spend on health care this year.
Richter said people with chronic illnesses face high out-of-pocket costs to see family doctors, and as a result ration their own care. “I’ve seen many, many people die as a result of untreated or under-treated diabetes, some as young as 22, 25,” she said. “I’ve seen babies die.”
In addition to supporting universal primary care, Dunne said he would consider the expansion of Dr. Dynasaur, a Medicaid program for kids and pregnant women, to everyone up to age 26. He said the two ideas are not mutually exclusive.
Dunne said he would lay out a timeline for his three-point plan, including implementing universal primary care, in his first year as governor because Vermonters wouldn’t have “a lot of patience beyond a second term” and the state has “lost so much ground because of the failed implementation of the website.”
At the press conference, Dunne was reluctant to disclose a plan to pay for his health care proposals. After prodding by reporters, he said universal primary care could cost about $174 million, but said that number does not include any potential savings from Vermonters who benefit from prevention.
A December study from the Joint Fiscal Office on the cost universal primary care put the figure between $221.7 million and $281.9 million. If Medicaid paid a portion of the partial cost, the study said the net costs of the insurance claims would be between $112.9 million and $174.6 million.
However, budget analysts at the Joint Fiscal Office said more analysis was needed because the study “says nothing about costs of providing universal primary care beyond 2017,” and “some discussion of expected cost growth rates beyond 2017 will be important for policy makers as they contemplate future costs.”
Dunne said the following about financing: “I believe that the way that you pay for it is the same way you pay for your premiums now, which would be through a payroll deduction. I think that’s the most obvious. I’ll look at any options that are out there, but I think we’ve got to get our way to universal primary care.”
Dunne said of the Joint Fiscal Office study underestimated the cost savings “because it didn’t account for anything around the fact that people would be getting the right care at the right time, and not showing up at the worst possible time in emergency room, getting the most expensive care.”
With regard to what he called a “payroll deduction” to finance universal primary care, Dunne said: “It would be just in the same kind of partnership (between employers and employees), and then we would just make sure that we were doing it in a way that is fair, equitable, and progressive.”
Dunne did not use the word “tax” to describe his proposal.
Shumlin’s proposal would have used taxes to fund the health care system, which in the end he decided was too costly for Vermonters. The financing plan would have imposed an 11.5 percent payroll tax on employers and an income tax with a sliding scale from 0 percent to 9.5 percent, depending on income and family size.
The maximum income tax a family would have paid under the Shumlin proposal was capped at $27,500 per household. Previous news reports had pegged the payroll tax percentage at 5 percent and 8 percent for employees and employers, respectively.
POSITIONS OF DEMOCRATIC OPPONENTS
Peter Galbraith said he supports universal primary care as “one of the options that we must go in the path toward universal, publicly-financed health care.” He also said all-payer is “a sensible way to go” because “the fee-for-service system is very time-consuming and inefficient.”
Galbraith said he would pay for universal primary care with a 2-percent payroll tax on employers, not workers. He said employers would be able to deduct the money spent on the payroll tax from their federal income taxes, meaning that the federal government would essentially be paying for part of his health care plan.
“I think (Governor) Peter Shumlin demonstrated that when you put forward a plan without a plan to pay for it, it’s just politicking, and so I didn’t see in Matt Dunne’s plan (how) he’s going to pay for it, and if the answer is with these magical inefficiencies that are going to be discovered, that’s not realistic. That’s not a real plan,” Galbraith said.
Sue Minter, who is also vying for the Democratic nomination, has said health care a human right that is “breaking our family budgets, school budgets, and our state budget.” She said her administration would fix Vermont Health Connect and embrace payment reform under the all-payer model.
“We will work to ensure that Vermonters receive care where they needs it most, through home and community based services, to keep them out of the hospital—the most expensive form of care,” Minter said.
“As we reform our payment system and reduce cost I will also work to put us back on track to universal health care as through either Dr. Dynasaur 2.0 or universal primary care as a first step to universal health care,” she said.
All five candidates for governor talked about health care at a forum Monday. The video is available here.