POLITICO: Why single payer died in Vermont (Dec 20, 2014)

Vermont was supposed to be the beacon for a single-payer health care system in America. But now its plans are in ruins, and its onetime champion Gov. Peter Shumlin may have set back the cause.

Advocates of a “Medicare for all” approach were largely sidelined during the national Obamacare debate. The health law left a private insurance system in place and didn’t even include a weaker “public option” government plan to run alongside more traditional commercial ones.

So single-payer advocates looked instead to make a breakthrough in the states. Bills have been introduced from Hawaii to New York; former Medicare chief Don Berwick made it a key plank of his unsuccessful primary race for Massachusetts governor.

Vermont under Shumlin became the most visible trailblazer. Until Wednesday, when the governor admitted what critics had said all along: He couldn’t pay for it....

Single-payer advocates in Hawaii have seen halting progress: The legislature created a board to put together a universal health care plan in 2009, even overriding Republican Gov. Linda Lingle’s veto. But she refused to appoint anyone, and Obamacare implementation ultimately took precedence in Democratic Gov. Neil Abercrombie’s administration. Gov. David Ige was a key supporter of the universal coverage plan in 2009, but whether he’ll pick up the cause again is unclear....

read ... Why single payer died in Vermont

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VOX: How Vermont's single-payer health care dream fell apart (Dec 22, 2014)

It was Friday, December 12, when Robin Lunge began worrying that Vermont's single-payer plan was doomed.

Lunge, Gov. Peter Shumlin's director of health reform, had spent weeks trying to make the math work for a public health insurance plan that would cover all Vermonters. Since Thanksgiving, she had been sending numbers off to M.I.T. economist Jonathan Gruber (yes, that Jonathan Gruber) and Wakely Consulting, an actuarial firm.

The models Gruber was running were meant to project the cost of Vermont's plan under different scenarios. What if the health plan covered 80 percent of the typical Vermonter's health care costs? What about 94 percent? But as the numbers got more concrete — as they closed in on the plan the governor actually wanted — the financial foundation began to crack. Lunge knew by that Friday that the single-payer system Vermont wanted to build would require about $2.5 billion in additional revenue in its first year.

In Vermont, this is massive: the state only raises $2.7 billion in taxes a year for every program it funds. Early estimates said that Vermont's single-payer plan might need $1.6 billion in additional funds — a huge lift. But $2.5 billion was impossible.

"It was disappointing to me and my team that we weren’t able to make the numbers work the way that we had hoped," Lunge said.

Lunge and her team worked through the weekend. Saturday and Sunday fell into a sort of rhythm: she would change their assumptions slightly and send the new figures off to Gruber. It took him about 24 hours to run the new figures in that model, which would produce projections for how much the single-payer system would cost.

"I kept running into them at the coffee shop," said Deb Richter, a long-time single-payer advocate in Montpelier. "They looked very tired. They were working their butts off."

Each new packet of Gruber data was essentially the same as the old Gruber data. It kept showing that a single-payer system would be more costly than initially expected. "It was really over the weekend that we started to realize this might be too big an obstacle to surmount," said Lunge.

After the non-stop weekend, Lunge met on Monday, December 15, with Governor Shumlin. He reviewed the weekend's work and delivered his final verdict: he would no longer pursue single-payer.

Shumlin's office kept the decision secret until a Wednesday press conference. The audience was shocked — many had turned up thinking that Shumlin would announce his plan to pay for universal coverage, not that he was calling the effort off.

"It was dramatic being in that room," Richter said. "You just saw reporters standing there with their mouths open."

read ... How Vermont's single-payer health care dream fell apart

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LI: Vermont: Where Single Payer Went to Die

WSJ: The left’s health-care ideal implodes over punishing tax rates.

B: If Single Payer Can't Work in Vermont...

R: Vermont's Single Payer Health Care Plan Failed For One Big Reason: It Cost Too Much

F: Six Reasons Why Vermont's Single-Payer Health Plan Was Doomed From The Start

BFP: In the end, Shumlin could find no way to make the numbers work.

Physicians for a National Health Program: "We pledge to redouble our efforts to press for national legislation – such as H.R. 676, the Expanded and Improved Medicare for All Act – to achieve the goal of universal access to high-quality, affordable care. We invite Gov. Shumlin to rededicate himself to the cause of a public national health program."