Former Vermont Governor: Small States Can't Pull Off Single Payer Alone

Sep 19, 2017

Former Vermont Gov. Peter Shumlin told the Harvard School of Public Health on Tuesday that he miscalculated the political and policy challenges associated with the single payer approach.

For most of his political career as a legislator and governor, Peter Shumlin strongly supported the creation of a single payer health care system in Vermont.

That's why it came as a shock to many people when Shumlin announced, just a month after the 2014 election, that he was abandoning his efforts to implement a government financed health care system.

"The lesson is — I was wrong,” said Shumlin Tuesday. “I don't think small states can go it alone, at least little states like Vermont with an unstable federal partnership." 

Under the single payer plan that Shumlin was looking at, all employers and employees would pay for health care — primarily by using a new payroll tax.

Shumlin says there was no assurance that these tax rates wouldn't increase substantially in the future if health care costs continued to go up.

"It's very tough to make the sale to legislators and to constituents: 'Hey, this is a great thing you're finally going to have health care as a right and not a privilege,” said Shumlin. “'But you're going to have tax rates that are quite high replacing premiums so it's not money you're not spending now but there's winners and losers, so that was the biggest problem - money." 

Shumlin says the final blow to his single payer approach was the disastrous roll out of Vermont Health Connect, the state's health care exchange.

"We all had exchanges that blew up and as you can imagine I lost tremendous credibility as a leader on health care when I couldn't deliver something as simple theoretically as expanding uninsured on Medicaid." — Former Gov. Peter Shumlin

It encountered huge technical problems and cost overruns. Thousands of Vermonters were unable to sign up for coverage for months.

"We all had exchanges that blew up and as you can imagine I lost tremendous credibility as a leader on health care when I couldn't deliver something as simple theoretically as expanding uninsured on Medicaid," said Shumlin.     

Progressive Lt. Gov. David Zuckerman was a state senator when Shumlin threw in the towel on single payer. Despite facing some strong obstacles, Zuckerman thinks Shumlin should have continued to fight for the plan.

"Based on the mismanagement of Health Connect I think he may have been right that some in Vermont were not ready,” said Zuckerman. “But I still believe the majority of Vermonters want a wholesale fix to the system and would like to have seen us move forward." 

Zuckerman also disagrees with Shumlin that it's too difficult for a small state like Vermont to implement a single payer system.

"Based on the mismanagement of Health Connect I think he may have been right that some in Vermont were not ready, but I still believe the majority of Vermonters want a wholesale fix to the system and would like to have seen us move forward." — Lt. Gov. David Zuckerman

Zuckerman thinks that Vermont can make incremental progress starting with legislation that provides universal primary care to all Vermonters.

"I certainly think we can but maybe it needs to be done in steps,” said Zuckerman. “It's one of the reasons I think an idea like universal primary care and doing it in steps is probably a more logical way to go about it.”

Legislation setting up a comprehensive study of a universal primary care system has 13 cosponsors in the Vermont Senate and it will be the top priority for the Senate Health and Welfare committee in 2018.