By Ethan Parke

March 10, 2011

John Walsh, writing in Dissident Voice, a radical blog based in Santa Rosa, California, has delivered a scathing criticism of Governor Shumlin’s health care bill, claiming that its passage would not result in a single payer system in Vermont, and that therefore supporters are being hoodwinked.

Walsh is right that the bill is heavy on interim steps, such as the health care exchanges called for in the recent federal health care legislation. He is also right that many components of single payer (the financing mechanism being the most obvious) are left out of Shumlin’s bill. He’s also right that the bill gives a nod to “payment reform,” which could be interpreted to mean ACOs—a nebulous concept suspiciously like HMOs, which are currently all the rage among establishment health policy analysts.

But hoodwinked? No. Single payer activists in Vermont are fully aware that H.202 could be improved, and some advocates have been testifying to the very points made in Walsh’s commentary.

David Himmelstein’s pessimistic analysis, cited repeatedly by Walsh, is also not news to the leaders of Vermont’s single payer movement. Himmelstein’s indefatigable work for single payer at the national level has been extraordinarily helpful over the years. However, the Vermont single payer proponents have chosen to look at the Shumlin bill as a glass half full rather than half empty. In this light, the fact that not everything is spelled out in H.202 is an asset, not a liability.

Consider: If a financing package had been proposed this year, there is a good chance that the entire bill would be defeated. That’s because financing will inevitably stir a huge debate. And remember that Peter Shumlin was elected governor by a very slim margin. Better to have a framework in statute to begin with, and pass a financing package in a later year when more details of the system have been filled in and when Governor Shumlin has had more time to solidify a political base.

Consider: It’s a good thing that the benefit package, cost-sharing provisions, the health care budget, and many other details would be left to the new health care reform board. For anyone who has watched the Vermont legislature over the years ignore, obfuscate, water down, compromise, and/or destroy perfectly good health care legislation, a five-member board appointed by a governor who is a friend of single payer sounds like a breath of fresh air.

Finally, Walsh asserts that a less-than-perfect bill is a bad organizing tool. It would be if everyone was content to let it pass as is and go home. But the fight for single payer is a long haul, a very long haul. We are perhaps closer in Vermont than ever, but no one is breaking out the champagne. There are many issues remaining to be discussed and fought for. There are many strategic decisions still to be made and there will be plenty of criticism along the way, from the right and the left and everywhere in between. And so Walsh’s blog is no surprise.

Vermonters in favor of single payer are no dummies. We want H. 202 passed, and in the years to come we will fight for the other measures—the financing, the federal waivers, the global budgets—that will someday make single payer a reality.