Issue XLVII: Healthcare Reform goes Local

21 Jan

The House of Representatives has passed its two page repeal of Obama’s Affordable Care Act.  It’s a pointless stunt, and the Republicans will fight tooth and nail to undermine Obama’s very mild and actually quite Republican (for 1994) health care plan. I’m not a lawyer, but I suspect the court cases challenging health care reform will not go anywhere either.

But if you want to be a member of the fast class and not part of the ponderous “conventional wisdom” train of thought, I am going to scoop you on the big news in health care reform in 2011 before it even happens.  The most exciting places to watch for real health care reform will be Sacramento, California and Montpelier, Vermont.  Why?

When Arnold Schwarzenegger was governor of California, the California legislature twice passed single payer health care bills.  This would have created a single insurance system like Medicare in Canada and have done away with the private health insurance companies.  With a new Democratic governor, there is a much higher chance that this bill will be signed by Governor Jerry Brown.  In his 1992 run for president, he supported single payer health care unlike his more conservative opponent, Bill Clinton.

Given California’s budget crisis and Jerry Brown’s rightward turn, perhaps the better contender for healthcare reform will be the tiny state of Vermont.  The Green Mountain state is not very impressed with Obama’s milquetoast health care reform because it doesn’t have any real cost controls.  Vermont also has a real third party, the Progressive Party, which unabashedly supports single payer health care and has won elections to the statehouse.  Locally, they can push the Democrats to the left.

Vermont’s Governor Shumlin won his primary and election as a staunch advocate of single payer health care.  The state already has universal health care for children because of Howard Dean.  It’s main insurance company is Blue Cross (75% of the market share) and is nonprofit.  A small state like Vermont may not have powerful special interests and has an insurance industry that is apathetic to the bill.  But does Shumlin and the Legislature really mean it?

William Hsiao, a Harvard health economist, designed Taiwan’s single payer system in the 1990s.  Right now he is drafting a proposal to create a single payer solution in Vermont.  Because this a state project, it will be hard to integrate Medicare and Medicaid into the plan.  However he has come up with some different plans for the state to enact.  Shumlin is on board and means it.

It’s not unreasonable to think that California or Vermont’s experience will lead to the rest of the country to single payer health care.  If insurance mandates are unconstitutional, government insurance is the only solution.  Canada’s Medicare system began in a single rural province, Saskatchewan, by a democratic socialist government.  It then spread to the rest of the nation.

So whenever you watch the theatrics in Washington, remember that the real health care reforms will not come from anywhere close to Capitol Hill.


Stateline – “In Vermont, Single Payer in a single state

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