While several states are suing the federal government to block health care reform and dragging their feet on implementing any part of it, Vermont this week will be taking a giant leap in the other direction -- toward universal coverage and greater cost control -- when Gov. Peter Shumlin signs legislation putting the state on the path toward a single-payer health care system.
The Vermont House last week voted 94-49 to approve legislation that has been years in the making. The Senate approved the measure a few days earlier. While it will not establish a government-run system right away, work will begin almost immediately to lay the groundwork to create a state health plan -- called Green Mountain Care -- that could be up and running as early as 2014.
Ironically, one of the reasons the state could not move any faster is because the federal health care reform law enacted last year will not allow it. In fact, the Affordable Care Act doesn't permit states to do anything as far-reaching as what Vermonters want to do until 2017 -- although legislation has been introduced in Congress to move that date up by three years. So Vermont lawmakers -- with a lot of help from Shumlin's office -- had to craft a bill that wouldn't run afoul of the feds but that would put the Green Mountain State on course for single-payer sooner rather than later.
Many hurdles remain -- not the least of which is overcoming intense opposition from the health insurance industry and its corporate and political allies in the years ahead. For now, though, Vermont has done something no other state has been able to do.
To some extent, the stars simply aligned to make it happen. Democrats control both chambers of the Legislature, and Shumlin -- himself a Democrat -- was a vocal supporter of single payer during his campaign last year.
But while there is plenty of credit to go around (or blame, depending on your point of view), Shumlin undoubtedly would not have a bill to sign -- and might not even be in the governor's office -- were it not for the tireless work of a couple of determined women, Dr. Deborah Richter and Dr. Ellen Oxfeld.
I met both of these 50-something women when I was in Vermont earlier this year just as the legislature was beginning to hold hearings on the bill. It didn't take me long to see why Vermont was getting so close to making history.
Richter, a medical doctor, has spent years not only seeing patients but studying and writing about health care issues. Oxfeld, a professor of anthropology at Middlebury College, is more of an organizer and activist. They're both good storytellers and single-payer missionaries.
Richter told me about how angry and helpless she had often felt seeing the health of many of her patients deteriorate because they couldn't afford health insurance. In many cases her patients were considered uninsurable -- they couldn't buy coverage at any price because of preexisting conditions. Several of her patients died because they simply could no longer afford the level of care she knew they needed.
She had many sleepless nights because of what happened -- or didn't happen -- to even some of her youngest patients. Two of her patients were siblings who had juvenile diabetes, a manageable disease if treated early. This brother and sister were not so fortunate, however, because they did not have health insurance. The young man went blind and died soon after his 21 st birthday because of an infection. His sister died at 25 of a heart attack not long after giving birth to a premature baby; the baby also died.
This brother and sister were patients of Richter's when she worked at a clinic in Buffalo, New York. She decided while there to join Physicians for a National Health Program (PNHP), an organization that has long advocated for a single-payer system. She ultimately would serve a term as president of the group.
It soon became clear to her, however, that advancing the cause of reform in New York would be far more difficult than it might be in a smaller state, so she moved her family and practice to Vermont 12 years ago. Since then she has made hundreds of presentations at all kinds of forums, from town halls to Chambers of Commerce to House and Senate hearings.
Oxfeld got involved in the single-payer movement from a sense of social justice. She has traveled the world with her husband, Frank Nicosa, a professor at the University of Vermont. She has seen how other countries with single-payer systems do a much better job than the United States in making sure their citizens get the care they need.
Richter and Oxfeld teamed up a few years ago in an effort to spread the gospel of single payer health care and convince political candidates to embrace it. One of their converts was candidate Peter Shumlin. When Shumlin promised to work with the legislature on enacting a single payer bill, Richter and Oxfeld began working night and day to help get him elected.
The women wish their dream could come true much earlier. They were not happy with some of the amendments that were attached to the bill. And they know the insurance industry will do all it can next year to replace the Democrats who voted for the measure with Republicans who will seek to repeal it. But they'll take this victory and continue to fight until every Vermonter is enrolled in Green Mountain Care. I'm confident they will be standing near the governor when he signs the bill into law this week.