Pulling back on single-payer is best for now

It’s football playoff season, and pregame shows are full of grown men screaming at one another, hopping up and down, banging on shoulder pads and generally getting hysterical. Then they charge onto the field and spend several hours running into one another at full speed.

Imagine if, when all the screaming and hopping was over, the coach said, um, well, we’re not going to play today. You wouldn’t want to be that guy, facing down thousands of pounds of football beef.

That’s the situation Gov. Peter Shumlin is in now. The fervor among Vermont advocates of health care reform has been building for several years, pointing toward a single-payer system that recognizes health care as a human right.

Then Shumlin presented the numbers and said Vermont just can’t afford it, at least not right now.

The single-payer price looked pretty steep — an 11.5 percent tax on company payrolls, a state income tax rate of up to 9.5 percent, and still an uncertain handle on costs. A lot of Vermont businesses have not fully recovered from the Great Recession and the state’s economy is sort of bumping along, with personal income lower than expected. Middle-class families are feeling squeezed, and so is the state government, which faces a $100 million deficit in the coming year because tax collections are considerably slower than predicted.

Given all that, Shumlin decided now is not the time to push hard for single-payer.

Then the shrieking began.

Predictably, reactions broke into two camps — one that feels betrayed, the other that feels relieved. The health system surely needs reform. Vermonters now spend about $2.2 billion a year on health care, costs of procedures vary widely, and businesses squeezed by the cost of providing employee health insurance can have trouble staying competitive in a global economy.

The trick is how to capture that $2.2 billion and redirect it in a fair, efficient way that allows reconstructing the insurance system so everyone benefits. Shumlin’s retreat shows just how difficult that process will be.

Turning the gigantic health-care ship in a new direction is fraught with potential missteps, and cost is one of the biggest. At the same time, the current health insurance system isn’t fair, and it’s not financially sustainable.

Without reforms, “people will pay pretty dramatically different prices for the same health care,” says House Speaker Shap Smith, D-Morrisville.

As Shumlin noted in pulling back from single-payer now, Vermont can still accomplish a lot on the health-reform front —reducing the number of uninsured Vermonters, improving access to primary care, reducing cost-shifts to private insurers, and strengthening the Green Mountain Care Board to give the state a better shot at long-term cost containment.

This fight is for the long haul. As with slavery, civil rights, the Vietnam War and now U.S.-Cuba relations, it took years and years for the nation to reach any kind of consensus.

As Shumlin said, his decision is hugely disappointing — but it’s the right decision for right now.

After 42 years, no nukes

 The Vermont Yankee nuclear power plant went out of business with a sigh on Monday. No protests, no mass arrests, no grandmothers being carted off to paddy wagons.

The plant, which operated for 42 years on the banks of the Connecticut River in Vermont, had lots of problems — collapsed cooling towers, steam-dryer cracks, absurd evacuation plans — but it ended its electricity-producing life without the catastrophe that could have turned parts of Vermont, New Hampshire and Massachusetts uninhabitable for hundreds of years.

On the plus side, Vermont Yankee was a good corporate citizen, generous with charities, a solid and well-thought-of employer.

But we’ll breathe a little easier now, knowing that the reactor is down for good.