Political Health
But first, some correction and amplification:
Until about 1:15 PM Friday, readers of Friday’s post may have understood that the State Senate was toying with the idea of diverting $6.89, otherwise known as six dollars and eighty-nine cents, from one fund to another.
Presumably most readers of this web site are alert, more alert in this case than is, at least sometimes, the writer of this web site, and understood that what the meant was $6.89 million.
But what’s few zeros among friends? And thanks to the readers who noted the omission.
Also, Sen. Ann Cummings is chair of the Senate Finance committee, not, as Friday’s post said (again, until corrected), the Appropriations Committee. Susan Bartlett is Appropes chair.
Something else was absent from Friday’s post because it was not clear on Thursday, at least not to the News Guy, and apparently not to many legislators. That $10 million to be raised by considering some capital assets – expensive houses, stocks and bonds, etc. – when applying the “income sensitivity” provision on the statewide school property tax is not slated to go into the Education Fund.
Instead, for the first time, money from the school property tax would go into the General Fund.
Like any policy change, this one might be defensible, or even wise. But it does stretch if not violate the understanding that the school property tax would be used to support the schools, not the rest of state government. It’s only $10 million, but when it comes to taxes, experience shows that the first exception is rarely the last.
Now, to today’s main order of business, also inspired by readers who have communicated by email, old-fashioned phone calls, and even older-fashioned personal conversations (you may remember them; the kind where the conversers are actually in the same place at the same time).
The question: why, right after the entire United State Government adopts a comprehensive change in the health care financing system, is the Vermont Legislature passing a bill to study comprehensive change in the state’s health care system?
Good question, because it can be answered with one word: politics.
That’s a description, not a condemnation. Politics, the method by which free people govern themselves, is not a pejorative. It’s a reality.
The political reality against which lawmakers have based their political decision to pass S.88 http://www.leg.state.vt.us/docs/2010/bills/Senate/S-088.pdf (in separate House and Senate versions that have yet to be resolved) is that Vermont is home to a politically significant minority of voters who are convinced of the superiority of a ‘single-payer’ health care financing system—basically Medicare for everyone.
No, that was an understatement. These folks are not merely convinced of the superiority of a single payer system; they are committed to such a system with a fervor approaching that of a religious zealot’s devotion to his faith, with comparable intolerance toward dissent.
This too is description not (except for the intolerance part) condemnation. Clearly, there is a case to be made for a single-payer system. It is how most civilized (prosperous, democratic) countries finance health care. In those countries, everyone is covered, they live longer, healthier lives than Americans, and it’s all done for a lot less money per person.
The focus here today. Though, is not on the policy, but on the politics, the first requirement of which is, in the words of Richard J. Daley to “know how to count,” raising the question of how big is this constituency of single-payer enthusiasts.
Not very. Nobody has polled on the matter, but we are almost surely talking about less than 10 percent of the adult Vermont population, though probably more than five percent. For purposes of discussion, then, let’s say seven percent, or about 20,000 voters.
Ah, but it’s a strategically positioned seven percent. Just about every one of them identifies with either the Democratic or the Progressive Parties. Furthermore, just about every man (and woman)-jack of them will vote. Unless the Progressive Party puts up its own candidate for governor, most of them will vote in the Democratic primary in August. In what is likely to be a low-turnout election, this faction will make far more than seven percent. It could come close to a majority.
Obviously, then, two outcomes Democrats – and especially Democratic candidates for governor — want to avoid are: (1) Displeasing these primary voters and (2) Annoying the Progressives so much that they decide to find a gubernatorial candidate of their own, who would siphon off more votes from the Democratic contender than from Republican, Lt. Gov. Brian Dubie. Months ago the Progs declared that Democratic support for a single-payer health care system was among their sina qua nons for staying out of the race.
So it should be no surprise that Sen. Doug Racine, one of the five Democrats running for governor, introduced the bill to engage a consultant to study health care reform, with specific directions to look into the single-payer option. No surprise either that few Democrats opposed it.
There is no suggestion here of insincerity or cynicism on the part of Racine or the other Democrats. Racine has long been a single-payer proponent. He no doubt thinks it would benefit Vermont, and he could be right.
(Or not. If there is a strong case for the entire nation to adopt a single-payer system, there is an equally strong case for a single state to avoid it, for reasons to be discussed in another post soon).
Nor is the earnestness of other Democrats and Progressives in the Legislature open to doubt. Judging from a couple of overheard conversations outside the second floor cafeteria in the Statehouse the other day, some of them are so solemn and intense about the subject that they may have lost touch with reality.
But sincerity and political self-interest are not mutually exclusive, and there seems little doubt that whatever else they may be doing, the Democrats are pandering to one of their core constituencies. Absent that intense minority of single-payer enthusiasts, this bill might never have come before the Legislature.
Again, this is observation, not condemnation. All political factions pander to constituencies. Gov. Jim Douglas, for instance,, has of late been pandering to the home builders and the all-terrain vehicle riders. Politicians not only have to pander, but up to a point they should. It’s part of democracy.
The point at which they should not pander, of course, is reached when the interest of the pandered-to constituency is actually contrary to the public interest. But that does not seem to be the case here. The worst that can be said about this consultant study is that it will spend $250,000 that may not have to be spent. As unnecessary expenditure, this is small potatoes, and for a function likely to be more productive than the comparable expenditure on the pointless pornography-detecting software the Douglas Administration is in the process of installing on state computer systems.
Besides, the process might do some good. The consulting firm is likely to look at the possibility of replacing the fee-for-service method of paying doctors. Many health care economists consider fee-for-service second only to the high price of prescription drugs as an explanation for why health care is so much more expensive in the U.S. than elsewhere.
But the consultant report will not pave the way for Vermont to adopt a single-payer health care system. That’s because Vermont, on its own, is not going to adopt such a system, not now, and possibly not ever. Federal law forbids it until at least 2017, and while Congress could theoretically grant the state a waiver from the prohibition, the prudent Vermonter would be advised neither to hold his/her breath nor to bet next month’s mortgage payment on that outcome.
The real – if not, it should be stressed, the intended — purpose of this legislation is not to change Vermont’s health care system. It is to send a signal to a small but potent constituency. It seems to have worked.
Tags: Doug Racine, health Care
