After years of political frustration, Earl Mongeon had to see it to believe it. Often, when he finishes his twelve-hour night shift at IBM in Essex Junction, Mongeon heads home for breakfast and a few hours of brush clearing on his sixty-acre lot in Westford. In mid-January, the 55-year-old microprocessor assembler and workers’ rights advocate hopped into his car and drove in the opposite direction, to Montpelier. There, at the state Capitol, Mongeon and other supporters of single-payer healthcare gathered to hear Senators Bernie Sanders and Patrick Leahy, Congressman Peter Welch and new Democratic Governor Peter Shumlin explain that last year’s national healthcare bill—a costly mix of subsidies to private medical plans, some insurance market reforms, Medicaid expansion and a mandate that people buy coverage if they don’t already have it—isn’t good enough for the Green Mountain State. The top state and federal officeholders pledged to work together for something better. “We firmly believe we can be the state that passes the first single-payer system in the country,” Shumlin declared.
Mongeon and other supporters of single-payer have marched and lobbied for years, most recently under the banner of the Vermont Workers’ Center and its “Healthcare Is a Human Right” campaign. Their tireless activism had a lot to do with spurring Vermont’s singular display of independence and political unity. Two weeks earlier, several hundred VWC supporters descended on the legislature on its opening day. State House and Senate leaders, including some recent converts to the single-payer cause, paid fealty to the grassroots movement. Before a boisterous crowd of union members and community activists, 71-year-old Peg Franzen, a VWC leader and disability rights advocate, hailed the “people power” that had persuaded legislators to commission a detailed study of options for universal healthcare last year. In late January a joint session of the Democrat-dominated legislature received a 203-page report from Dr. William Hsiao, the Harvard healthcare economist hired to develop a road map for reform. Hsiao’s research team identified fifteen hurdles to creating the system they recommended: universal coverage with equal access and a common benefit package that includes community-based preventive and primary care, as well as control in the escalation of health costs.
Undaunted by the roadblocks ahead, Shumlin’s special assistant for healthcare, Anya Rader Wallack, went before a joint legislative committee on February 8 to unveil H. 202, “An act relating to a single-payer and unified health system.” Wallack spelled out a three-stage reform process, spanning at least four years but beginning with the creation of a Vermont Health Reform Board to control costs and streamline payment methods. Wallack described Vermont’s current system of multiple private and public payers as “too complex and misguided,” noting that it leaves “more than a quarter of the state’s population potentially facing healthcare bills that send them to bankruptcy.” On behalf of the governor, she insisted that “this craziness must stop. We have to get insurers out of managing medicine and allow providers to use technology and appropriate quality oversight to get waste out of the system.”
The perfect storm for fundamental reform seems to have arrived in America’s second-smallest state, but the wind is blowing rightward elsewhere in the country, with the new Republican majority in the House voting to repeal the Patient Protection and Affordable Care Act, which they brand “Obamacare.” Red-state attorneys general and their GOP governors are challenging the constitutionality of PPACA by focusing on its controversial individual mandate. Healthcare reformers in Vermont aren’t happy with President Obama’s scheme either. That’s why they’re trying to create a social insurance system that would sever the connection between coverage and employment and make access to medical care a “human right” for the state’s more than 625,000 citizens. Marketplace competition and profiteering—given a renewed lease on life nationally by PPACA—would be phased out locally as soon as possible. If single-payer works in Vermont, its backers envision the state becoming the Saskatchewan of America, just as Canada’s thinly populated but left-led prairie province paved the way for Medicare-for-all north of our border fifty years ago.