Sen. Bernie Sanders: 'Vermont stands a chance to be the first state in the nation to pass single-payer'

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Sen. Bernie Sanders (I-Vt.) has long supported state waivers in the health-care bill, and for a very specific reason: He'd like to see Vermont create the first single-payer system in the nation, as he believes it'll demonstrate enough cost and quality advantages that other states will want to follow suit. We spoke by phone last night, and a lightly edited transcript of our conversation follows.

Ezra Klein: You worked hard on getting the original version of the state waiver into the legislation. Why? Liberals aren’t usually associated with federalist approaches.

Bernie Sanders: As a single-payer advocate, I believe that at the end of the day, if a state goes forward and passed an effective single-payer program, it will demonstrate that you can provide quality health care to every man, woman and child in a more cost-effective way. So we wanted to make sure that states have that option, we wanted it to be available when the bill gets implemented in 2014. But we ran into the most insane objections from the Congressional Budget Office.

Is that why it got pushed back to 2017?

Our argument was we don’t want any more money from the federal government. When the bill is implemented, let the states use the money the federal government would already be paying to implement single-payer. The CBO came up with one of the weirder counterarguments we’ve ever heard. The CBO said we think the states are smarter than the federal government and they’ll outmaneuver the feds to get more money. So we were forced by the CBO -- not by anybody in the Congress -- to push it back to 2017. And I agreed to that very reluctantly.

So what happens if Scott Brown and Ron Wyden get their way and the waiver moves up to 2014? Will Vermont use it?

We believe Vermont stands a chance to be the first state in the nation to pass single-payer. The governor-elect campaigned on it, and we have support in the House and Senate. We’re not asking for one nickel more than we’d otherwise get. The other thing we think we have an opportunity to do is reach out to our conservative friends and say, hey, Vermont wants to go forward with a single-payer system, and Mississippi and Alabama don’t, but maybe they have other ideas. Now, we’re conscious of the need to make sure that the health-care reform bill’s standards aren’t diminished. So everyone needs to provide the same quality of health care as the bill provides and at the same, or lower, price. But if they can do that, then they should be able to go for it.

And then the various models can compete with one another and, presumably, spread to other states if successful?

Absolutely. And that’s what we wanted from it. In my state, it’ll be single-payer. In California, I think there’s a chance it could be single-payer. In other states, it will be something else. This makes the states laboratories for the system, and then other states can copy them. Now, you need a minimum level for coverage and quality. You can’t go lower than health-care reform.

http://voices.washingtonpost.com/ezra-klein/2010/11/sen_bernie_sanders_vermont_sta.html

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Have Scott Brown and Ron Wyden figured out the way forward on health care?

The GOP’s slogan on health-care reform has, till now, been “repeal and replace.” But they don’t have the votes for either. What they might have the votes for is reform that, maybe, one day, if all goes well, could lead to replacement. And, believe it or not, liberals might be able to get on board with this strategy, too.

This morning, Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) introduced the “Empowering States to Innovate Act.” The legislation would allow states to develop their own health-care reform proposals that would preempt the federal government’s effort. If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill.

Wyden, with the help of Sen. Bernie Sanders (I-Vt.), was able to build a version of this exemption into the original health-care reform bill, but for various reasons, was forced to accept a starting date of 2017 -- three years after the Patient Protection and Affordable Care Act goes into effect. The Wyden/Brown legislation would allow states to propose their alternatives now and start implementing them in 2014, rather than wasting time and money setting up a federal structure that they don’t plan to use.

In general, giving the states a freer hand is an approach associated with conservatives. On Wednesday, Sen. Orrin Hatch (R-Utah) sent a letter to the Republican Governors Association advocating exactly that. “The most effective path to sustainable health care reform runs through the states, not Washington,” he wrote. If it’s really the case that the states can do health reform better, Wyden and Brown are giving them a chance to prove it.

One state that wants to prove it is Sanders’s Vermont. “As a single-payer advocate,” he says, “I believe that at the end of the day, if a state goes forward and passes an effective single-payer program, it will demonstrate that you can provide quality health care to every man, woman and child in a more cost effective way. So I wanted to make sure that states have that option.” Vermont’s governor-elect, Peter Shumlin, is on the same page. “Vermont needs a single-payer system,” he said during the campaign.

Single-payer, of course, is even more objectionable to conservatives than the existing health-care law. But that’s the beauty of this option: It allows the liberal states to go their way, the conservative states to go their way, and then lets the country judge the results. If Vermont’s single-payer system provides universal care at a low, low cost, then maybe that nudges California -- which is facing massive budget deficits -- off the fence. After all, if the state spends less than the government sends it, it gets to keep the remainder. It’s a nice incentive for cost control. And if it works, how long will more conservative states wait before they decide to take part in the savings, too?

But conservatives don’t believe that will happen. They think a consumer-directed system will offer higher-quality health care at a lower price, and with more choice. If Tennessee takes that route and outperforms Vermont, it’ll be their system that spreads across the land.

The funny thing about the health-care reform debate is that for all the arguing, everyone says they’re in favor of it. The GOP’s "Pledge to America," for instance, promises that the Republicans will repeal Obama’s health-care law “and put in place real reform.” Shumlin, too, promises Vermonters that he’ll produce “real reform.” The problem is that no one seems able to agree on what real reform is. The beauty of Wyden and Brown’s approach is that the country doesn’t have to choose.

“Real reform,” in their world, is whatever works best to cover everyone at the lowest cost. Utah and California can go their separate ways, and the other states can judge the victor based on results, not ideology.

That an Oregonian and a Bay Stater are behind this legislation is perhaps no surprise: Wyden’s home state of Oregon just reelected John Kitzhaber, a former emergency-room doctor who pioneered a radical set of Medicaid reforms when he served as governor in the late '90s and early Aughts. Brown’s constituents in Massachusetts still overwhelmingly support the system that then-Gov. Mitt Romney signed into law in 2005 -- and that then-state Sen. Scott Brown voted for. “There’ve been a handful of states that’ve tried for some time to break out from the cookie-cutter molds,” says Wyden, and their senators want to protect their innovations.

The Obama administration is cautiously supportive. "The cliche about states as the laboratories of democracy is not just a cliche," CMS director Don Berwick told Wyden at a Finance Committee hearing. "It’s true." The question is whether the rest of Congress will agree. Liberal Democrats might shiver at the thought of conservative reform plans, while conservative Democrats might worry about the possibilities of public options and single payer. Republicans may worry that attempts to reform the health-care law will read to their base as if they’re making peace with it rather than working to repeal it. And both sides will face pressure from various industries involved in the provision of medical services that fear -- and will likely fight -- the prospect of reforms they can’t anticipate, and may not benefit from.

But those who hide from this proposal are fundamentally signaling a lack of faith in their own ideas. What Wyden and Brown are offering is the chance for the various sides to prove that they’re right. If the industry players make the system work better, then the states that prize their involvement will prosper. If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?

[Mr. Big Dog 10,747]

If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?

That works for me.

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That works for me.

It does sound good. Devil, details, and all that though.

[Mr. Big Dog 10,747]

It does sound good. Devil, details, and all that though.

Sure, can't wait to read about stories of folks in Vermont waiting a couple of weeks for a non-emergency MRI and not reading about stories of folks in AZ actually dying because the state just cut them off from the care they actually need to have a chance to live. The profiteers of the fcuked up health care system will surely spend big to leave things the way they work for them. It's a $2.5 trillion+ a year industry. They've got deep pockets and will sure invest what it takes to make them deeper.

[DEDixon 39]

first single payer state might attract a low of sick people to the state.

i hope illegals qualify.

good business... turn hotels into elder homes for the poor, americans are mobile, people can move for such a great benefit.

Edited November 22, 2010 by DEDixon

[mawilson 2,133]

i hope illegals qualify.

Why? You want to see Vermont fail? If so, why do you think their failure would be a good thing?

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Why? You want to see Vermont fail? If so, why do you think their failure would be a good thing?

This is why we can't have nice things.

[DEDixon 39]

Why? You want to see Vermont fail? If so, why do you think their failure would be a good thing?

so it keeps them out of the emergency rooms.

there is no question that they'll fail. i think it is an irresistable attraction the same as san francisco is for the homeless. san francisco has deep pockets and a lot of liberals so san francisco survives for the most part, but not sure the same is true in vermont.

health care is so expensive while at the same time relocating into a rental is so cheap. i just don't think they can go it alone without being abused.... could be wrong.

[DEDixon 39]

This is why we can't have nice things.

who is we?

[Danno 1,228]

This is why we can't have nice things.

Wouldn't coverage for "everyone".... (or all of Gods children, as McCain describes them) be a good thing?

[Danno 1,228]

This is truly the way to go about it if enough people wanted it...

state by state where the best models will surface and competition can play a roll.

One huge federal program will be a major disaster both in cost and service...... state run programs will be bad enough.

[spookyturtle 9,465]

They still have Gary to contend with.

[Pooky 3,355]

The GOP’s slogan on health-care reform has, till now, been “repeal and replace.” But they don’t have the votes for either. What they might have the votes for is reform that, maybe, one day, if all goes well, could lead to replacement. And, believe it or not, liberals might be able to get on board with this strategy, too.

This morning, Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) introduced the “Empowering States to Innovate Act.” The legislation would allow states to develop their own health-care reform proposals that would preempt the federal government’s effort. If a state can think of a plan that covers as many people, with as comprehensive insurance, at as low a cost, without adding to the deficit, the state can get the money the federal government would’ve given it for health-care reform but be freed from the individual mandate, the exchanges, the insurance requirements, the subsidy scheme and pretty much everything else in the bill.

Wyden, with the help of Sen. Bernie Sanders (I-Vt.), was able to build a version of this exemption into the original health-care reform bill, but for various reasons, was forced to accept a starting date of 2017 -- three years after the Patient Protection and Affordable Care Act goes into effect. The Wyden/Brown legislation would allow states to propose their alternatives now and start implementing them in 2014, rather than wasting time and money setting up a federal structure that they don’t plan to use.

In general, giving the states a freer hand is an approach associated with conservatives. On Wednesday, Sen. Orrin Hatch (R-Utah) sent a letter to the Republican Governors Association advocating exactly that. “The most effective path to sustainable health care reform runs through the states, not Washington,” he wrote. If it’s really the case that the states can do health reform better, Wyden and Brown are giving them a chance to prove it.

One state that wants to prove it is Sanders’s Vermont. “As a single-payer advocate,” he says, “I believe that at the end of the day, if a state goes forward and passes an effective single-payer program, it will demonstrate that you can provide quality health care to every man, woman and child in a more cost effective way. So I wanted to make sure that states have that option.” Vermont’s governor-elect, Peter Shumlin, is on the same page. “Vermont needs a single-payer system,” he said during the campaign.

Single-payer, of course, is even more objectionable to conservatives than the existing health-care law. But that’s the beauty of this option: It allows the liberal states to go their way, the conservative states to go their way, and then lets the country judge the results. If Vermont’s single-payer system provides universal care at a low, low cost, then maybe that nudges California -- which is facing massive budget deficits -- off the fence. After all, if the state spends less than the government sends it, it gets to keep the remainder. It’s a nice incentive for cost control. And if it works, how long will more conservative states wait before they decide to take part in the savings, too?

But conservatives don’t believe that will happen. They think a consumer-directed system will offer higher-quality health care at a lower price, and with more choice. If Tennessee takes that route and outperforms Vermont, it’ll be their system that spreads across the land.

The funny thing about the health-care reform debate is that for all the arguing, everyone says they’re in favor of it. The GOP’s "Pledge to America," for instance, promises that the Republicans will repeal Obama’s health-care law “and put in place real reform.” Shumlin, too, promises Vermonters that he’ll produce “real reform.” The problem is that no one seems able to agree on what real reform is. The beauty of Wyden and Brown’s approach is that the country doesn’t have to choose.

“Real reform,” in their world, is whatever works best to cover everyone at the lowest cost. Utah and California can go their separate ways, and the other states can judge the victor based on results, not ideology.

That an Oregonian and a Bay Stater are behind this legislation is perhaps no surprise: Wyden’s home state of Oregon just reelected John Kitzhaber, a former emergency-room doctor who pioneered a radical set of Medicaid reforms when he served as governor in the late '90s and early Aughts. Brown’s constituents in Massachusetts still overwhelmingly support the system that then-Gov. Mitt Romney signed into law in 2005 -- and that then-state Sen. Scott Brown voted for. “There’ve been a handful of states that’ve tried for some time to break out from the cookie-cutter molds,” says Wyden, and their senators want to protect their innovations.

The Obama administration is cautiously supportive. "The cliche about states as the laboratories of democracy is not just a cliche," CMS director Don Berwick told Wyden at a Finance Committee hearing. "It’s true." The question is whether the rest of Congress will agree. Liberal Democrats might shiver at the thought of conservative reform plans, while conservative Democrats might worry about the possibilities of public options and single payer. Republicans may worry that attempts to reform the health-care law will read to their base as if they’re making peace with it rather than working to repeal it. And both sides will face pressure from various industries involved in the provision of medical services that fear -- and will likely fight -- the prospect of reforms they can’t anticipate, and may not benefit from.

But those who hide from this proposal are fundamentally signaling a lack of faith in their own ideas. What Wyden and Brown are offering is the chance for the various sides to prove that they’re right. If the industry players make the system work better, then the states that prize their involvement will prosper. If conservative solutions are more efficient, that will be clear when their beneficiaries save money. If liberal ideas really work better, it’s time we found out. Forget repeal and replace, or even reform and replace. How about compete and succeed?

I hope Vermont, empowered by this bipartisan effort, gets the chance to show just how much better a single-payer system is than the what we have now, or what we will have foisted on us by 2014.

[Gary and Alla 3,694]

Vermont had a health care program long before the US did and it actually covers people and offers low cost insurance.

Sanders whether you disagree with him or not states his opinion and beliefs and stays with them. He is a genuine Socialist ans says so. Obama is a Solialist and lies about it.