Tag Archives: single-payer health care

The race for governor will offer a stark contrast

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This year’s election will trigger a turnover at the top perhaps unprecedented in Vermont history. A new governor, lieutenant governor, attorney general, and new heads of the House and Senate will all be in place by next January. And heading into the campaign, Vermont’s two major parties are offering completely different visions of the state of our state and the mood of its people.

Republicans see Vermonters as tired of high taxes, government intrusion, and the restless reformism (as they see it) of the Shumlin administration.

You’d expect Democrats to be treading cautiously. They are in the tightrope position of simultaneously defending their tenure in power, and crafting a distinctive profile going forward. Not to mention its persistently strong incrementalist tendencies.

However. Driven by Bernie Sanders’ overwhelming success in our primary, the party is moving leftward. There is a sense that Vermonters are ready for even more decisive change, even more government, a more aggressive push to lift up the downtrodden and blunt the sharp edges of capitalism.

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The Progs demur

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The Progressive Party’s State Committee met on Saturday, and decided to stay out of the race for governor. Which strikes me as a small but measurable setback for Peter Galbraith, the self-described progressive choice.

As reported by Seven Days’ Terri Hallenbeck, the Committee did endorse Sen. David Zuckerman for lieutenant governor and the re-election bid of Auditor Doug Hoffer. No surprises there.

But the Committee opted not to endorse any of the three Dems running for governor, even though Galbraith, Sue Minter, and Matt Dunne each addressed the gathering in hopes of earning the nod. There were two major factors in the non-decision, party chair Emma Mulvaney-Stanak told me.

First, the Progs’ 2010 decision to stay out of the gubernatorial race in hopes that Peter Shumlin would deliver on single-payer health care and other key issues. “That left a very bad taste in Progressives’ mouths,” she said, and little enthusiasm for supporting a Democrat.

And second, the Democratic candidates failed to inspire the Committee. “None brought a Progressive ‘wow factor,’” she explained.

Their presentations were pretty similar. They didn’t exactly make a strong case for why the Progressive Party should endorse them. They seemed unwilling to go beyond what the Democratic establishment supports

All three have tried to wrap themselves in the Bernie Sanders mantle. But Galbraith more insistently than the other two. Was Mulvaney-Stanak surprised that Galbraith didn’t impress?

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The Governor prepares a soft landing

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Is Peter Shumlin starting to act like a lame duck? It would seem so. To judge by this week’s paltry trinkle of news, he looks to have one eye fixed on the past and the other on his post-gubernatorial future. And he’s already given up on fixing one major debit in his administrative ledger.

As VPR’s Bob Kinzel reports, Shumlin opposes any tax increases to pay for Vermont’s burgeoning Medicaid bill, but he doesn’t want to cut eligibility or benefits either. In fact, he’s washing his hands of the whole mess.

“I don’t know which governor is going to get to solve this problem,” he added. “But I hope a governor gets to solve it soon.”

“…once I’m safely ensconced in the private sector with my lissome new bride,” he might have added under his breath.

Yeah, screw the 2016 session. The Governor, you see, proposed a Medicaid fix last year and the Legislature ungratefully rejected it. So he’s done his duty, and hereby washes his hands of the matter.

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Bizarro Dave

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I’m writing an awful lot about David Sunderland lately, but then he’s been doing a lot of dumb stuff lately. And this tidbit is the cherry on his hacktastic sundae.

The Vermont Press Bureau’s Josh O’Gorman did a writeup of the VTGOP chair’s latest stunt — the anti-carbon tax website, which seeks to blame Democrats for something that’s not going to happen.

And deep within the article, I discovered the source of Sunderland’s difficulty with facts.

David Sunderland (not exactly as illustrated)

David Sunderland (not exactly as illustrated)

He appears to live in an alternate dimension, with a parallel but very different set of events. Look:

Sunderland said he believes a carbon tax could be in the cards come January.

“It’s possible this will happen,” Sunderland said. “If you look to the past, nobody in million years would have ever thought we would enact state-run, single-payer health care, but it happened.”

Whaaaaaat?

Vermont has a state-run, single-payer health care system?

How did I miss that?

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The Progressives are kinda screwed

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Whiter the Progressive Party? I don’t know; there isn’t a clear path forward, and obstacles litter the landscape. They’ve gained strength in the legislature, mainly by running candidates on the P/D or D/P tickets; but they’ve just about reached the limits of that tactic, and may have hit a glass ceiling.

The Progs are anxious to make a splash in 2016, having sat out the last three gubernatorial elections in order to give Peter Shumlin a better shot at creating a single-payer health care system, hahaha. His abandonment of that goal, barely a month after his third re-election victory, plus the Dems’ habit of triangulating to the center on a host of issues, has left the Progs in a bitter mood. They’re itchin’ for a fight, and would especially like to field a credible candidate for governor.

That’s looking increasingly unrealistic. For starters, nobody seems to want to run.

This is an unintended side-effect of the Prog/Dem strategy, which has put several Progs in positions of legislative influence. Examples: Tim Ashe chairs the Senate Finance Committee; Anthony Pollina has a bully pulpit in the Senate; organic farmer David Zuckerman is vice chair of the Senate Agriculture Committee; and Chris Pearson is vice chair of the House Health Care Committee. One could argue that the Progs have been granted more influence than their sheer numbers would warrant. Or, in the words of Lyndon Johnson, the Democrats saw it’s better to have the Progs inside the tent pissing out, than outside the tent pissing in.

And indeed, it’d be hard to give up that level of influence to make a long-odds, short-funded bid for higher office.

Compounding the difficulty is that any high-profile Progressive would likely depend on public financing. That was a difficult enough pursuit in previous years (just ask Dean Corren or John Bauer). Now, it seems to have become completely untenable.

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Okay, so that happened.

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Surprise, surprise: Peter Shumlin won’t run for re-election next year.

Many more thoughts to come, but here’s the instant reaction.

— It’s the right move, but I wasn’t sure he was capable of making it. He would have had a very, very tough time winning back the voters next year. If he’d managed to right the ship on Vermont Health Connect, and if this year’s legislation had begun to make a difference, he would have had a shot at winning a fourth term. Even so, it’d be an uphill battle.

I say “I wasn’t sure he was capable of making it” because it’s awfully hard for a politician to leave the game, and it’s hard for a politician as accomplished as Shumlin to leave with the Scott Milne embarrassment as his last electoral act. In stepping aside, Peter Shumlin shows a wisdom and perspective that many didn’t think he had.

— His image was worse than the actual person. This decision shows that there’s an authentic Peter Shumlin that doesn’t measure life by political wins and losses. He has no interest in a political future; he plans to leave his East Montpelier manse and return to Putney. I expect he will do that. And though he’ll certainly continue to have a public life, I think he’ll be true to his word: no more campaigns, no more full-time public service.

— He’s waved the white flag on single payer health care. In his speech, he mentioned health care reform as the one area of failure for his administration. If he thought he could resurrect single payer between now and 2018, he might well have run for re-election.

— This gives the Democratic Party a clean slate. Without Shumlin on the ticket, it could be a very good year for the Democrats; it’s a Presidential year with either Hillary Clinton or (haha) Bernie Sanders atop the ballot, and Pat Leahy presumably running for re-election. We should have a substantial and very Democratic turnout. Sad to say, but Shumlin would have been a net negative.

— This is bad news for the VTGOP. They won’t face a wounded incumbent with a long track record and personal unpopularity; they’ll face a candidate with substantial experience (see below) and with a full 18 months to fundraise and put together a top-notch campaign. And even if there’s a spirited Democratic primary, 2010 has shown that that isn’t a bad thing.

— The Republicans really blew it in 2014. If they’d run a real candidate, they would have won the corner office. If Phil Scott has any real ambitions to be Governor, he’s gotta be kicking himself right now.

— The Democrats have an incredibly deep talent pool. I could name you half a dozen eminently qualified candidates without any trouble. There’s been a logjam at the top for quite a while, what with our extremely senior Congressional delegation and our very capable statewide officeholders (well, Pearce, Hoffer, and Condos anyway — three out of four ain’t bad) and our sclerotic state senate. By contrast, of course, the Republicans’ talent pool is more of a puddle, aside from Phil Scott.

— Early favorite for the Democratic gubernatorial nomination? House Speaker Shap Smith. If he can get the Democratic caucus behind him, he’d have a big advantage at the grassroots level and he’d be very, very tough to beat. And he did a great job during this year’s legislative session of threading a very narrow needle, being an honest broker, and subtly creating a political persona of his own.

More thoughts to come, I’m sure. I welcome your comments below.

Single-payer price tag: the dollars matter less than what they bought

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Another fine “Fair Game” column by Seven Days politimeister Paul Heintz, most of which is an attempt to put a price tag on Gov. Shumlin’s failed pursuit of single-payer health care.

The takeaway number: $2 million. But that comes with some major cutouts; if you changed the ground rules, you could come up with a much higher number.

Heintz sought that number for ten weeks before the administration finally came up with it. And after all that time, all they did was add up two numbers: $597,000 to ten consultants, and $1.33 million spent on the governor’s Office of Health Care Reform.

However… the consultants and the OHCR weren’t the only people who put in time on single-payer. Work was also done by staffers in “10 offices, departments and agencies.” There was lobbying and flackery on behalf of single-payer. And many millions were spent on the Green Mountain Care Board and other entities that might not have existed, or been nearly so expensive, if not for their work on single-payer.

So, $2 million. Or a lot more, your choice.

The big question, though: was that too much? And the answer is, it depends.

If it was spent well and wisely, then $2 million or even $20 million would be a perfectly reasonable investment in research on a huge policy initiative. If it was spent poorly, then $2 million or $2,000 would be a waste.

So it depends. If you oppose single-payer, it’s an outrage. If you favor single-payer and believe the governor did his best, it’s reasonable.

And if, like me and many other single-payer supporters, you have your doubts regarding the administration’s performance, then that $2 million figure will make you a bit more queasy about the whole enterprise.

Urp.

Grüberdämmerung

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Ah, Jonathan Gruber, the gift that keeps on taking.

The latest twist in this uncomic opera: Auditor Doug Hoffer has examined Gruber’s invoices for consulting work on behalf of the Shumlin adminstration, and found them seriously wanting.

In Hoffer’s words, his review of documents “raised questions about Dr. Gruber’s billing practices and the State’s monitoring and enforcement of particular contract provisions.” More:

Dr. Gruber’s invoices referred only to “consulting and modeling” and offered no details about specific tasks. In the broadest sense, those three words describe the work performed, but such generalities do not appear to satisfy the intent of the contract.

It’s like taking a math test where you’re asked to show your work, and you turn in a sheet with “WORK” in big letters on an otherwise blank page.

Hoffer further states that top Shumlin officials Robin Lunge and Michael Costa “were aware of the need for more details in the invoices, but approved them nonetheless. … [they] had an obligation to request additional detail from Dr. Gruber, and they failed to do so.”

Gruber’s first and second invoices raise suspicion because each showed the same round number of hours worked (100 for Gruber and 500 for research assistants). Hoffer judges the round figures, and the fact that two invoices totaled exactly the same, “implausible.” He concludes that the administration “ignored the obvious signs that something was amiss.”

To me, this is the real Gruber scandal. The conservative shitfit over a handful of intemperate remarks — made during a period of years in which Gruber must have spoken on the record hundreds of times — was nothing more than political opportunism by the opponents of health care reform. But this?

Even if Gruber was invoicing to the best of his ability, it certainly reveals shoddy management by the Shumlin administration. Which is, unfortunately, of a piece with the administration’s general performance on health care reform. Did they take a relaxed approach to spending money because so much of it came from the federal coffers? Perhaps.

Here’s another fact that reinforces my interpretation. Late last year, Gruber submitted two more invoices. In an email to Hoffer earlier this month, according to VTDigger’s Morgan True, Lunge wrote that the administration was “no longer satisfied with the level of detail provided” in those later invoices.

Why “no longer”? Because Hoffer was examining the invoices and they knew they’d be embarrassed? If there’s another explanation, I’d like to hear it.

There are other problems, as reported by True: Tax documents appear to show that Gruber actually paid his research assistant far less than the amount received from Vermont for the RA’s work. DId he pocket the rest? Did the state’s lax oversight let him get away with it?

I’m a liberal, and I’m strongly in favor of universal access to health care. Our current system is an expensive stinkin’ mess, and no amount of wrongdoing by Gruber or others will convince me that reform is a mistake. But in my book, my fandom only feeds my desire for sound management by those we’ve empowered to enact reform on our behalf, and with our dollars.

The Gruber fiasco makes me wonder about the administration’s oversight of all the other consultancies associated with the reform effort. And, for that matter, its handling of the entire process.

Hoffer has referred his findings to Attorney General Bill Sorrell, who says Gruber’s invoicing raises “major questions.” He says he will meet with administration officials to see “what evidence and records are available to justify the billing amount.”

On behalf of health care reform supporters, and those who backed Peter Shumlin because of his promises to institute unversal coverage, all I can say is I hope there are no more shoes to drop. I fear that we’re only just getting our first peek inside the closet.

The moral imperative for health care reform, revealed in a handful of statistics

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At the January 27 meeting of the House Ways and Means Committee, Sara Teachout of the Joint Fiscal Office distributed three fairly simple charts that tell the story of our unfair state income tax system in bold relief. I’ll be examining those charts in an upcoming post, but right now I want to focus on a small slice: the deduction for medical expenses.

The first chart lists the most frequently claimed tax deductions across the top, and income classes down the left side. It tells a fascinating story about who benefits from which deductions, and how much. But today I’m concentrating on the first two columns, shown below:

Medical deduction chart 1

A couple of explanatory points. First, this data is from 2011, predating Vermont Health Connect and the Affordable Care Act. Second, I should explain the rules for deducting medial expenses. You can’t deduct health insurance premiums, just actual medical and dental expenses. You can only deduct medical expenses if they total more than 10% of your gross income, and only the portion above 10% is deductible. It’s a very high standard; you’ve gotta have some serious medical bills and no insurance (or really bad insurance) to qualify.

As you might expect, “Total Medical” is the outlier among deductions; it’s the only one claimed more often by the poor and working poor than by the wealthy. There are two simple reasons for this. The first is that the poorer you are, the less likely you are to have health insurance. The second, obviously, is the lower your income, the fewer bills it takes to qualify.

It’s no giveaway, though; if you’re making $25,000 a year, then medical bills over $2500 are enough to throw you into severe financial difficulties. A tax break on a portion of those bills won’t make you whole.

These columns reveal the hidden cost of our old health care system — the human and social cost, and the actual financial cost. Vermont is foregoing a large amount of potential tax revenue because so many people incur medical bills that eat up a significant portion of their earning power.

I don’t know if these numbers were factored into Gov. Shumlin’s calculations on single-payer. I sure as Hell hope so, because it’s a cost that’s every bit as real as a payroll tax.

As for the human and social costs, the top three lines indicate that more than half the total value of medical deductions was taken by those with incomes under $50,000. These are people who cannot afford a significant unplanned expense, because they’re barely making ends meet in good times.

Here’s the same slice from a second chart that shows the total number of filers in each income class, and the number who took a medical deduction. This shows that more than 50% of those claiming a medical deduction earned less than $50,000, while virtually no wealthy people claimed one.

Medical deduction chart 2

Now look at that top line. More than half the low-income filers qualified for medical expense deductions. That’s nearly 5,000 individual stories of illness and deprivation, of life-changing financial crises, most likely including thousands of bankruptcies. How many people lost their jobs and their homes, and saw their lives go into a tailspin, because of an uncovered illness or injury in 2011 alone?

So far, health care reform has dramatically reduced the ranks of the uninsured in Vermont. These figures show how crucial that progress is, for the stability of our society and the very lives of our most vulnerable.

These figures are also a powerful argument that we need to keep it up. We shouldn’t have thousands of poor and working-class Vermonters qualifying for this deduction. There should be none, or very few at most. That’s the goal of, and the moral imperative for, universal health care.

The Shummy Shimmy

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Before the November election, I’d planned to write a post-election piece offering my services to the Shumlin administration for the newly-created position of Shitkicker-In-Chief. The duties would include pointing out the flaws in administration reasoning, deflating egos when necessary, and the occasional loud guffaw.

The idea was based on my belief (hahahaha) that the election wouldn’t be close. When Shumlin won by a shoestring, I thought my idea was irrelevant. The election was a more effective shitkicker than I could ever be.

Seems I was wrong, because the Governor has quickly fallen back into to some bad habits. One of his worst is his almost-complete inability to admit that he was wrong about something — even if it’s something trivial. It makes him appear small-minded, overly defensive, duplicitous, and condescending.

This habit is again on display in the foofaraw over releasing documents related to single-payer health care.

For those just joining us, when the governor announced in December that he was ditching single-payer, WCAX’s Kyle Midura asked a provocative question. Here’s the exchange, as reported by Seven Days’ Paul Heintz:

“Will you waive executive privilege for all backdated documents at this point related to this question so we can see what you knew when?” Midura said.

“There is nothing to hide on what we knew when, so we’d be happy to show you any documents you wish to look at,” the governor responded.

Emphasis: “any documents you wish to look at.” And Midura’s use of “this question” is generally seen as referring to Shumlin’s decision on single-payer.

Naturally, multiple media outlets made public-records requests for any related documents. And that’s when Shumlin backtracked: the administration withheld “hundreds of pages of documents related to single-payer,” reports VPR’s Peter Hirschfeld.

Shumlin never wrongShumlin says he never intended for him comments on Dec. 17 to mean that he’d release all internal communications related to single-payer.

“Now no governor ever divulges inter-staff conversations, but what we did divulge was all the data that led us to the conclusions that we came to,” Shumlin said.

Okay, I can see that point of view. But why did he promise, on Dec. 17, to release everything?

Evasive maneuvers, Mr. Sulu!

So far, we’ve heard two different explanations.

In an email to Heintz, the Governor’s legal counsel Sarah London asserted that Midura’s question referred narrowly to “the specific question of Medicaid reimbursement rates.”

On the other hand, Shumlin told Hirschfeld that he thought the question referred only to documents involved in a lawsuit by Rep. Cynthia Browning.

“Well as you know we had a fairly well-publicized court case … where we were asked to divulge all the data, studies and information about every detail that led us to the disappointing conclusions that we came to about public financing,” Shumlin said. “I assumed that his question was simply, are you going to continue to withhold that data? Or are you going to share it?”

It got even worse when Shumlin tried to clarify his position at a news conference yesterday:

“If you listen to the entire question, I answered it very clearly. And what I said was, the question I understood — I had it played back to me, so I think I got it — was, ‘Are you going to release the documents that, frankly, hadn’t been released before?’ You may recall Cynthia Browning requested them and we went to court and the court ruled in our favor. ‘Are you now going to release those documents? The documents that give us the data, all the dates, what you’ve done, all the studies?’ And I said, ‘Of course, we are. We want Vermonters to have that information.’ If you took the question as something else, you should’ve asked it that way. You didn’t.”

The Shummy Shimmy.

It’s one of his worst features: ducking and diving in a transparent effort to avoid admitting he was wrong.

I guess they could still use a Shitkicker-In-Chief.

Here’s a little free advice. Or consider it part of my S-I-C job application. Here’s what he should have said — and it’s not much different from what he did say.

“I apologize for misspeaking on Dec. 17. I should not have promised to release ‘all documents,’ because every administration needs some measure of privacy in its internal policy discussions. Any chief executive would agree with that.

“We have provided as much documentation as we can. The information we have released should be more than adequate to understanding how we arrived at our decision. I hope you, and the people of Vermont, can appreciate our position.”

There. Was that so hard?

The occasional apology would go a long way toward changing Shumlin’s image for the better. The long-term benefit would far outweigh the immediate discomfort.