Rutland Herald

Gov. Peter Shumlin has said he will reveal details of the financing for his new single-payer health care proposal at the end of the month. His announcement will touch off a historic exercise in lawmaking, requiring his administration and the Legislature to negotiate the treacherous currents of policy and politics.

Much hangs in the balance. The health of Vermonters is the primary concern. Shumlin is launching the state on a quest to create a system that will provide care fairly, comprehensively and affordably, and it won’t be easy.

The state’s economy is also a concern. Health care constitutes about one-sixth of the state’s economy, absorbing a healthy portion of many people’s paychecks and also employing many thousands of Vermonters. If a single-payer system can be made to work, it could provide a huge boost to the state’s economy by relieving people of the cost burden created by escalating insurance costs and by freeing people of the worry that they might lose their insurance. A well-run system could serve as a magnet for new companies and residents who are happy to free themselves of the entanglements of the present dysfunctional system.

Conversely, a single-payer system that fails to deliver on its promises could create cost burdens that stand in the way of good health care. If health care were to become snarled in bureaucracy, Vermonters could quickly become disenchanted. Then again, the present system is already a tangle of insurance company bureaucracy from which many Vermonters are yearning to free themselves.

Shumlin’s severest political challenge may come from the left. Single-payer advocates ranging from the League of Women Voters to the Vermont Workers Center have been working for years to establish a single-payer system. They have made great strides in advancing the idea that health care is a human right, not a privilege reserved for those lucky enough to have the right kind of job. In this sense, they are following in the line of thinking put forward by President Franklin Roosevelt, who argued that health care ought to be part of a what he called a Second Bill of Rights, along with other requirements of a civilized life, such as good education and adequate food and shelter.

Single-payer supporters will be watching closely to make sure Shumlin’s proposal delivers on the question of fairness, both in how it provides health care and how it raises money to pay for it. In this connection, Vermont’s experience with Vermont Health Connect, the state health care exchange, is a cautionary tale.

Thousands of Vermonters have gained health care through the website, but for many the choices have proven costly. Plans with high deductibles may be affordable, but health care reform was meant to avoid the trap whereby the only affordable policies are ones that do little good.

Single-payer advocates counter that Vermont Health Connect is a poor predictor of what single-payer will be. Single-payer is meant to solve many of the insurance-related problems that are perpetuated on Vermont Health Connect.

Nevertheless, raising $2 billion in new taxes will inevitably ignite a wrenching political fight over the fairness of the taxes levied and their effect on the economy and on individual pocketbooks. Everyone will be starting out from their individual situations — looking at their paychecks to see how much is being deducted each week and trying to determine if the new taxes will exceed or fall short of what they are paying already.

Some low-income Vermonters may already have been hit with new costs in getting coverage on the exchange, but at least they may have coverage for the first time. Apportioning costs among low-income and high-income taxpayers will be a crucial test for Shumlin at a time when the economy and tax system are already creating major advantages for the wealthy and fostering economic inequality. If it is designed right, any new health care system ought to alleviate inequality, not worsen it.

The Republicans will have an important role in the discussion, bringing a critical eye to Shumlin’s proposal. Sen. Kevin Mullin and Lt. Gov. Phil Scott have already shown that they can act as constructive participants from their positions in opposition. It is likely that out-and-out naysayers will find themselves on the margin of the debate.

Shumlin won only narrowly over his inexperienced Republican opponent, Scott Milne, and some Republicans view the closeness of the race as a rejection of Shumlin’s health care plans. That is a misreading of the electorate. If Shumlin were to back away from his plans now, he would be backing away from the voters who have elected him three times. Shumlin has spoken of the difficult challenge represented by single-payer. The time is approaching for the state to take up that challenge.