Panic may be too strong a word, but advocates of single-payer health care experienced a shock to their confidence last week when Gov. Peter Shumlin came close to defeat at the polls.
Opponents of single payer, mainly Republicans, took heart, as if the vote represented a repudiation of Shumlin’s health care reforms. It is more accurate to say that voters’ confidence in Shumlin’s leadership has weakened, even if a majority remains supportive of the health care overhaul that Shumlin has been promoting.
The likeliest consequence of the election in relation to health care is that Shumlin will have a harder time putting together the coalition he will need if he is going to win approval of a single-payer plan. Dangers for Shumlin will take several forms.
Legislators who are doubtful of single payer may have been inclined to be supportive if they saw a wave of support was sweeping the plan along. They also might have felt protected from the wrath of critical voters if Shumlin’s popularity had remained high. Lack of a clear mandate might cause doubters to peel off from the coalition of support.
The election results might also reinforce the suspicion of legislators that the failures of Vermont Health Connect, the state’s health care exchange, have soured the public on major new health care reforms. With public skepticism on the rise, legislators are more likely to give voice to their own skepticism. Advocates have stressed the point that single payer will simplify the system, eliminating difficulties that have torpedoed the exchange. But that case will have to be made again and again.
It is clear that Shumlin’s decision to develop his single-payer program in secret has backfired on him. For more than two years, his staff has been working on a plan without informing or consulting with the public, even defying language in the law requiring the administration to reveal elements of the plan. As time has passed without information on what he plans to spring on the public, misgivings have been allowed to grow. The problems of the exchange have magnified those misgivings.
These are not just misgivings of opponents on the right, who believe the government should more or less stay out of health care. Misgivings are growing on the left. Who knows what backroom deals Shumlin has been making with major economic players in order to win their backing? Sen. Peter Galbraith of Windham County has suggested that Shumlin’s plan may end up putting an excessive burden on individuals and small businesses while giving a break to large corporations. It would be a way for Shumlin to negate opposition from major players, but it could dash the hopes of those who believe the burden of paying for health care must be shared fairly.
Earlier missteps by Shumlin have aroused worries that he is less sensitive to the needs of low-income and working Vermonters than he might be. If voters and legislators conclude that Shumlin’s plan reflects excessive coziness with the corporate sector, they may abandon single payer altogether.
Everything hinges on details of what is to be revealed in the next two months. What could have been a process involving the public and widespread, ongoing, open debate has been in the hands of Shumlin staff exclusively for years. Republicans have hammered on that point.
It is likely, however, that instead of evading the public process, Shumlin’s decisions mean that the public process will begin in January, except with more vehemence and more skepticism than might otherwise have been the case. The case for single payer remains strong. There would be a raft of new taxes, but these would be offset by the elimination of health care premiums. Many workers probably don’t think all that often of how much money is taken out of their paychecks each week, but it is a significant sum. If they end up getting a pay raise because the new plan has established a more rational and efficient health care system, then Shumlin may get the coalition he needs. But much persuasion remains to be done.