Rutland Herald/Times Argus Editorial on HCHR: "An early test"

From the Pulitzer Prize Winning editorial writing of the Rutland Herald and Times Argus

Article published Jan 2, 2011
An early test

As Peter Shumlin prepares to take office this week, a sampling of the challenges facing him will already have gathered at the Statehouse in Montpelier.

The Health Care Is a Human Right campaign is planning to stage a rally Wednesday, bringing together people from around the state to demand a single-payer health care system, the kind that Shumlin has said he supports.

Shumlin will be inaugurated as our next governor Thursday, and how he responds to the expectations of single-payer health care advocates will be an early test of his leadership.

Already he has accepted the premises of a single-payer system, and he has argued that cost savings achieved through single-payer would help solve Vermont’s budget dilemma.

The Health Care Is a Human Right campaign has done a good job of mobilizing Vermonters on behalf of health care reform and establishing the moral and practical imperatives of providing health care to all Americans as a public good, the way we provide education, roads or fire protection.

But getting there from here has always been the challenge for health care reform, and Shumlin is not unaware of the difficulties anyone would face in moving toward a single-payer system. That’s why he supported a measure in the Legislature last year initiating a study of Vermont’s health care system by one of the world’s leading health economists, William Hsiao of Harvard.

And comments from Hsiao already suggest that those expecting immediate action to create a single-payer system may be disappointed. Hsiao’s comments also give Shumlin a way out as he staves off pressure to move quickly in a radical direction.

Hsiao’s mission was to design at least three possible reforms, including a single-payer system, and to lay out the costs and the steps involved in achieving those reforms. He is well prepared for doing so: He helped design a single-payer system for Taiwan and has worked with governments around the world to bring order and efficiency to health care.

Gov. James Douglas did not support the bill appropriating money to support Hsiao’s study. We don’t need another study, Douglas said. But giving the state a blueprint — or a choice of blueprints — recognizing the full complexity of the health care challenge is essential if we are to do anything but make piecemeal changes.

To say Hsiao’s study is not important is to suggest that everything is fine with Vermont’s health care system.

But everything is not fine. Health insurance premiums saw enormous leaps during the past year, and when premiums go up, companies experience health care costs as a drag, hurting business and persuading some to drop coverage altogether.

It is the familiar health care death spiral, which, to this point, has not been arrested.

Hsiao’s comments suggest one of his options will be a step-by-step process that could take up to 12 years. That sort of plan is likely to disappoint those many single-payer advocates who see a comprehensive universal system as something like a perfect, rationally designed machine and who believe it can be instituted with minimal fuss if we have the political will.

What Hsiao’s study can do is shed light on whether establishment of a single-payer system in short order is a real possibility and, if not, where the difficulties lie. Addressing difficulties squarely ought to be good for the political debate and for the ultimate outcome. It may well happen that his 12-year plan is the one that best takes into account the political and economic challenges.

It would also give Shumlin cover if he feels the need to go slow on his promise of a single-payer system. The state’s economic distress would be eased if the health care system were managed better — or if it could, in truth, even be called a system. But paying up front for the reforms needed to get from here to there is the hard part when the state is facing a precipitous deficit.

The Health Care Is a Human Right campaign has been one of the most effective grass-roots campaigns Vermont has experienced in recent years, grounded as it is in principles of economic and social justice. Organizers recognize that much must be done to redress the many economic inequities that are plaguing the nation.

In pushing their cause they are serving an important purpose, but Shumlin has a different challenge. He must address the state’s multiple challenges while balancing the budget, balancing political expectations and fulfilling his many promises.

Hsiao’s study must be met with an open mind on all sides for what it says we can do and what is not so easy to do. He was hired for his expertise. One hopes the state can make good use of it.