Last night here in Vermont I took part in an interesting state-wide conference call. Democracy for America organized house parties and we listened on speaker phones while the head of the House and the head of the Senate discussed the different versions of health care reform that they were offering and which will soon be in the hands of a conference committee.
It broad terms the House version states a general policy of moving the state toward single payer sets up a planning mechanism to get there. The Senate, also under the control of Democrats, is advocating a more gradual policy that would focus on first getting a little bit of insurance for those currently uninsured and do so with a 3% payroll tax on payrolls payable to uninsured workers (excluding the first $25,000 in total payroll).
Critics of the Senate plan said that the gradual approach would just pump more money into a failing system and that unless everyone were brought into the system it would not be able to control medical costs or realize the savings involved in single payer.
At one point Peter Welsh, head of the Senate explained that the lawyers the Senate has spoken to said that because of ERISA and federal preemption it would be virtually impossible simply incorporate existing employee plans into a state-wide single payer. He was challenged on this by a participant who said that the labor lawyers he had spoken to said that this was not really a problem. Welsh stood firm and said that he had heard otherwise from several very well qualified labors who worked in the area and said that if anyone knew a lawyer who thought different to please send him their name.
After the call broke up there was discussion in the Brattleboro group and I found myself one of the few who thought that while a quick transition to single payer would have all sorts of advantages perhaps it was just not legally possible to do so in a politically acceptable way. Others objected that since ERISA does not apply to state run plans it couldn't stop the state from putting together any sort of plan that it wanted. But it seems to me that unless a plan could somehow capture at least a large part of the payments being made to existing employer run plans the new taxes required to implement single payer would be a deal breaker.
Already in fact Vermont's Governor Douglas (who BTW intends to stay put and not challenge Rep. Berni Sanders (I-VT) for Jim Jeffords US Senate seat) is putting an astronomical price take on the cost of following through on the goals advanced in the Vermont House version of health care reform.
When I filled my wife in on the ERISA argument she asked "What about Hawaii? Don't they already have a single payer plan?"
I just am sort of stuck. It looks to me like ERISA might present big obstacle to a move to single payer. Even if there is a way in which the Dept. of Labor could grant special permission let the state incorporate existing plans into a state-run one, in a situation where an incumbent Republican Governor was in a fight with a Democratic controlled legislature I don't think it would be reasonable to expect much help from that direction.
I know nothing about EIRSA, but my instincts tell me that the State Senate's view of the problems of reaching those currently insured with plans that come under ERISA is probably correct and not just an excuse for wimpling out. It also seems to me that in the absence of the perhaps unattainable goal of House plan the Senate plan would look like a large and bold first step. I fear that the large and active group of independents on the left may scuttle the Senate plan by painting it as a cop-out which will accomplish nothing and that this opposition, combined with the attacks from the Republicans, will undermine any chance to reform healthcare in significant way in Vermont.