Editor’s Note: When Vermont’s House of Representatives passed its single payer healthcare legislation on Mar. 24, it was seen by many – including this blog – as important news in the health reform movement. But as Physicians for a National Health Program points out, the Vermont legislation doesn’t quite live up to a true single payer plan. Could California’s SB 810 come up against the same obstacles as Dr. McCanne describes below? If we are persistent in demanding that our legislators resist any attempts to water down the bill and pass it as is, we can overcome any roadblocks.

Vermont health bill mislabeled ‘single payer’: doctors’ group

Physicians for a National Health Program says draft legislation gives wide berth to private insurers, falls far short of single-payer reform

Physicians for a National Health Program
April 7, 2011

The following statement was released today by the national board of Physicians for a National Health Program.

Health reform legislation initiated by Vermont Governor Peter Shumlin was recently passed by that state’s House of Representatives and awaits action in the Senate.

Many journalists and commentators have portrayed this bill as fully embracing the single-payer approach to reform. We write to clarify the views of Physicians for a National Health Program on the Vermont legislation.

We appreciate the enthusiasm for progressive health reform shown by Gov. Shumlin and the many dedicated single-payer supporters in Vermont. However, it is important to note that the bill passed by the Vermont House falls well short of the single-payer reform needed to resolve the health care crisis in that state and the nation. Indeed, as the bill moved through the House the term “single payer” was entirely removed, and restrictions on the role of private insurers were loosened.

In its present form, the legislation lays out in considerable detail a structure to implement Vermont’s version of the federal reform passed in March of 2010, which would expand coverage by private insurers and Medicaid. However, it offers only a vague outline of the additional reform promised by the governor and Legislature at such time when states will be allowed to experiment with alternatives to the federal program in 2017 (or 2014, if the effort to move up the date succeeds).

The Vermont plan promises a public program open to all residents of the state in 2017, but even then it would allow a continuing role for private insurance. This would negate many of the administrative savings that could be attained by a true single-payer program, and opens the way for the continuation of multi-tiered care.

Within the public program, the plan would continue to lump together payments for operating and capital costs, allowing hospitals and the newly established Accountable Care Organizations (ACOs) to use funds not spent on care for institutional expansion. Meanwhile, those with operating losses would shrink or close even if they were meeting vital health needs. This would perpetuate incentives for hospitals and ACOs to cherry-pick profitable patients and services, and hobble the health planning needed to assure rational investments in new facilities and high-technology care.

Under the legislation, many patients would continue to face co-payments that obstruct access to care, and the bill makes no mention of expanding coverage of long-term care. The legislation fails to proscribe the participation of for-profit hospitals and other providers (e.g. ACOs and dialysis clinics), which research has shown deliver inferior care at inflated prices.

Finally, the bill offers no concrete funding plan or structure for the public program that it promises.

We applaud the sentiments expressed by the governor and legislative leaders and remain hopeful that the legislation’s rhetorical commitment to further reform will become a reality. We urge the Vermont Senate to address the shortcomings in the House bill.

Much work, including efforts to enact federal enabling legislation – and continued advocacy by single-payer supporters – will be needed in the years ahead to achieve Vermont’s goal of universal access to high quality, affordable care.


Physicians for a National Health Program (www.pnhp.org) is an organization of 18,000 doctors who support single-payer national health insurance, an improved Medicare for all. A March 26 rally at the Vermont Statehouse organized by medical and other health-professional students from PNHP and the American Medical Student Association drew over 200 attendees in support of single-payer health reform.



By Don McCanne, MD

Vermont is experiencing some of the problems that all state-level single payer efforts face. They are hindered by a complex quagmire of federal and state programs, laws and regulations, plus pressure from vested interests who would prefer other options, if not the status quo.

There is an understandable tendency to want to adopt simplistic strategies that hopefully eventually would lead to single payer. If we only included a public option in the insurance exchanges authorized by the Affordable Care Act (ACA), then we could expand that to become the single payer. If we only moved up the date for ACA waivers which would authorize state innovations in reform, then we could enact single payer systems on a state-by-state basis.

As much as we wish they would work, these simplistic measures don’t. Vermont is finding that out now. To comply especially with federal laws and regulations, Vermont has had to make so many changes in their bill that it is no longer a single payer model. Recognizing that, they even removed “Single Payer” from the title of the bill.

Health policy is now a relatively advanced science. You can predict with a great degree of certainty what the results of various policy decisions would be. In fact at PNHP we have done just that and have a batting average of 1000. We also have predicted the results of enacting a national single payer program. For those who complain that PNHP is too negative, look at our predictions for a bona fide single payer system. You could not find a more positive expression anywhere else.

We support Vermont’s effort to bring relief from physical and financial suffering for its residents. We encourage Vermont to move forward with policies that would bring them as close as possible to a single payer system. We encourage the people of Vermont and of the entire nation to elect individuals who will enact the federal legislation that would ensure health care justice for all – a single payer national health program.

Why did the PNHP board believe that we had to make a statement on the deficiencies of the Vermont effort? It is simply because the citizens of our nation are not keeping their eyes on the ball. Supporters of reform have been distracted by efforts to try to made ACA work, and by state-level efforts to try to get us closer to single payer. The ball we need to watch is comprehensive affordable care for everyone through true single payer reform. All of us must direct our attention and efforts to that above all else, even though we should continue to support state efforts in the interim that would provide some temporary relief before we can get to the national health program that we need.

Re-posted with permission from pnhp.org.