Man without a plan
Governor Shumlin has said that the financing plan for Green Mountain Care, Vermont's new single payer system, is not ready to be presented. It is a complex matter to figure out how to finance a new health care system for a state, but one has to wonder if the delay in presenting the financing plan will not become too much of a political issue.
The governor was required to present the plan in January of 2013 and that never happened. Most of the public outcry about a lack of information came from Republicans when Shumlin failed to meet that deadline. He also made public statements that he would reveal the plan this month, but later said he will not do so until January of 2017. He now has critics from all political camps.
In a March 10 VtDigger story, "Shumlin was adamant Monday that he didn't believe waiting to lay out the financing options would set back plans to launch Green Mountain Care. "We're going to take the time we need to get it right without slowing down, I hope, the goal of having this done on January 1st, 2017," he said. The Legislature has a number of committees looking at all aspects of the transition to Green Mountain Care, and that's been the case throughout the session, Shumlin said."
"But Janet Ancel, D-Calais, who leads one of those committees, said Shumlin's decision to put off the financing plan might change how she allocates her committee time.
"We've spent two to three hours a week on health care all session, and my thinking has been that the more knowledge my committee members have the better," said the Ways and Means chair. "I think the only thing I need to reassess is if we should keep doing that this session."
Shumlin has taken on a health care financing expert, Michael Costa, to help the administration work on the financing plan and on February 27 Costa said the plan would be presented this spring. Yet, it is clear that deadline will pass because the boss has said the plan is simply not ready.
The issue may be exactly as stated by the governor. Developing the plan is so complex that deadlines cannot be met. But it seems like there has been quite a bit of time to develop at least the essential elements of a financing plan. There are not a whole lot of financing options.
To finance a health care system requires generating new taxes and there are only so many options. A state looking to finance a health care plan will have to dedicate taxes to the new system and that means using payroll or income taxes or some combination of both or perhaps creating an entirely new type of health care tax.
It is still important to note that even though about $2 billion in new taxes will need to be generated, that most Vermonters will be paying less for health care under the new system and the new tax will be a wash for some and a savings for others.
So why the delay by Shumlin? Is it simply because the plan is not ready or is he trying to create the most political advantage when it is finally introduced? Vermonters of all political stripes respect transparency and they also do not like it when a politician does not make good on a deadline and then starts making excuses.
I fear that Shumlin may lose some of his political support for single payer by stalling as long as he proposes. Why not present an outline or even a tentative proposal so that the public debate can begin? By holding all of the cards and not acquiescing to the public desire for information he may run the risk of losing too much public support.
It is hard enough to be the first state to make an effort at implementing some sort of single payer health plan. We don't need the distraction of a public battle over the delay of presenting details of a financing plan.
Richard Davis is a registered nurse and long-time health care advocate. He writes from Guilford and welcomes comments at firstname.lastname@example.org.
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