Single payer or universal? Semantics struggle continues for health care

March 21, 2011

By Peter Hirschfeld
Vermont Press Bureau
MONTPELIER — Plenty of legislative proposals this year will engender opposition. None will instill the fear that Gov. Peter Shumlin’s health-care bill has wrought on opponents of his single-payer concept.

Late last Wednesday evening, in a cramped Statehouse meeting room, a crowd of more than 50 single-payer opponents listened to an invited speaker talk in grave terms about the plan.

Delivering universal coverage through a publicly financed system, according to St. Albans anesthesiologist Dr. Edward Pomicter, amounts to an authoritarian takeover of the free health-care market.

“We’re going down the path of Hitler, Mao, Pol Pot,” Pomicter said at a rally sponsored by the newly formed group, Vermonters for Health Care Freedom.

In a split vote that reflects the partisan divide in Montpelier, the House Committee on Health Care late Thursday night approved the bill known as H.202. And while the measure has cleared its first legislative hurdle, the battle for hearts and minds has only begun. The Senate Committee on Health Care has already scheduled three public hearings on the reform bill. House lawmakers were criticized for convening only one.

As administration officials, Democratic lawmakers and single-payer advocates cement a multiyear path toward universal coverage, they will try to win over, or at least neutralize, intensifying opposition.

Steve Kimbell, commissioner of the Department of Banking, Insurance, Securities and Health Care Administration, has sought to frame the health-care narrative in economic terms. With system-wide costs rising at two to three times the rate of inflation, Kimbell says, the health-care sector, which already accounts for nearly 20 percent of the state’s gross domestic product, risks imminent financial collapse.

“Under private-sector guidance, we’ve been unable to control costs,” Kimbell says.

He’s also appealed to people’s humanitarian ideals.

“Here’s the threshold question, and on this people are going to differ: Is access to health-care a public good? Or is it something only a select few should have access to?” Kimbell says. “If you subscribe to the latter, then you don’t want government involvement.”

Those arguments though have failed to win over large segments of critical interest groups, doctors and businesses among them.

Dr. Melbourne Boynton, head of the department of surgery at Rutland Regional Medical Center, has warned lawmakers of an exodus of medical providers should the bill pass into law.

In an email to Rep. Jim Eckhardt, a Chittenden Republican who sits on the House health-care committee, Boynton said he’s already “recommended to all the surgical specialists under the age of 55 (years old) at RRMC to get active medical licenses in other states.”

“I have an active license in Florida and am looking at Michigan and New Hampshire,” wrote Boynton. “We don’t want to leave, but we need to be ready to depart promptly to a state that values our services.”

Rep. George Till, a Jericho Democrat and practicing obstetrician, says fear among medical providers is widespread. He’s surveyed more than one-quarter of the state’s approximately 1,700 licensed physicians.

Asked whether they would be “likely to stop practicing in Vermont” under a government-run, single-payer system, 28 percent answered “yes.”

But doctors and businesses aren’t universally opposed to the administration plan. Dozens of primary-care physicians have spoken in favor of the idea. At a press conference in the Statehouse Thursday, several members of Vermont Businesses for Social Responsibility, which represents about 1,200 companies, called single-payer reform the most important jobs bill the state has ever seen.

“H.202 is basically an economic-development bill disguised as health-care reform,” said Don Mayer, founder of Small Dog Electronics in Warren.

But the term “single-payer” itself has been struck entirely from lawmakers’ version of the Shumlin bill. What was formerly known as “An Act Relating to a Single-Payer and Unified Health System” has become a “Roadmap to a Universal and Unified Health System.” Sections of the bill that used to refer to “single-payer” have been replaced with terms such as “single payment,” “single administrative” and “single source.”

The new verbiage doesn’t reflect any change in the administration’s intent, Kimbell says.

At last Wednesday rally, Sen. Randy Brock, a Franklin County Republican, said the medical industry would benefit from less oversight by the state, not more.

“When we started Medicare and Medicaid, these were great programs. The theory behind them is unassailable. But government didn’t keep its promises,” Brock said, and meager reimbursement rates have shifted costs to privately insured consumers.

“And we want to know why health is so expensive right now,” Brock said. “I don’t blame providers. I don’t blame pharmaceutical companies. I blame government.”

Vermonters, he said, should be afraid.

“I’m concerned we’re very much like cattle in the chute going toward the executioner,” Brock said. “And as we go down that chute, we’ll reach a point where we won’t be able to turn around.”

Cassandra Gekas, a health-care advocate for the Vermont Public Interest Research Group, said it’s far easier for opponents to tear the reform framework down than it is for supporters to build it up. “Campaigns of fear,” she said, have been effective killers of past efforts at system-wide health-care reform.

“All they have to do is insert questions into people’s minds. It’s all about fear and uncertainty,” Gekas says. “The pattern is that the most ambitious reforms get stalled or scaled back, so we’re not dealing with the system as a whole.”

As the reform effort progresses, Gekas says, opposition will only strengthen.

“It doesn’t matter if what they’re saying isn’t true,” she says. “It sticks with people if they’re affected by the message, or trust the messenger.”

Shumlin too says Vermonters have reason to fear. In his version of the story, single-payer is the savior.

“This system we have now is destined to fail,” Shumlin said recently. “To folks who are skeptical of change, I ask them this: What if we do nothing?”