Master politician Governor Peter Shumlin has set the stage for the great health care debate of 2014 by uttering something that most politicians consider a suicide chant. He said that he would support a payroll tax to fund Vermont's single payer health care system, a plan that has a good chance of being launched in 2017.
Vermonters are barely getting introduced to the new health care exchange, yet Shumlin has made a pre-emptive strike for the next level of system change. Why do such a thing so early, considering that the general public will not be weighing in on this issue for a long time?
Shumlin's announcement was primarily intended for the ears of politicians, policymakers and those Vermonters who have been engaged in the great health care debate for years. It was timed perfectly because now is the time when the Legislature prepares for the issues that it will concentrate on in the coming session.
As the weather gets colder the legislative agenda gets hotter and it makes good political sense to be one of the first players to put your cards on the table. Operatives on the left and the right have been waiting for the time to talk about how a single payer system will be funded. Those on the right have been especially critical of Shumlin's single payer push, constantly asking for a financing plan.
Finally, legislative efforts may lead to an answer to the question of how to pay for a single payer system. There will be public posturing and a lot of arrows will be shot but, hopefully, the spectacle will create more light than heat.
That is the political side of things. There is also a debate of substance that will take place. It will be critical for both sides to have detailed plans that use realistic revenue and cost projections. Studies have been done and the up to date numbers are available.
Agreeing on the costs of a single payer system will not be too difficult. The essence of the health care debate will come down to funding. Shumlin has begun to pound home the most important public message of the coming debate. It is a point that cannot be made too many times.
Yes, the state of Vermont will need a tax source to fund a single payer health care system but creating new taxes does not mean that people will be paying out any more money overall than they now pay for health care.
Opponents of single payer will harp on the tax issue and use big numbers and say that Vermonters cannot afford any new taxes. When you hear that kind of rhetoric ask the people espousing that line if they think it is worth it to pay $100 in new taxes so that you can save $200 in health care costs.
That is what will happen (not in that exact proportion) for most people under a single payer system financed by a new payroll tax. Every study and model I have seen over the past three decades indicates that single payer saves people money. There has to be a new form of financing for such a system and because it is a publicly run program that means new taxes. It also means that people's health care costs will decrease.
Some argue that a payroll tax is not fair to business owners, especially those who have been unable to provide health insurance for their employees. They would have to pay more under a single payer system financed by a payroll tax but provisions could be implemented so that their taxes could be slowly graduated to ease their burden. Some believe the best way to finance a single payer system is through an income tax, taking some of the financial burden off the backs of business owners while uncoupling insurance from employment.
As the great single payer financing debate of 2014 unfolds, a number of tax options will be examined and there is a good possibility that there will be multiple financing proposals. The final plan will be the result of some degree of political compromise and we all know that political solutions are almost never simple.
Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at firstname.lastname@example.org.