Argumentative Essay: Saskatchewan's Single Payer System

Saskatchewan, the vast and rural Canadian province above Montana and North Dakota, is a place farther even than Vermont from centers of power. Barely a million people live in Saskatchewan and its largest city, Saskatoon, would not even be one of the fifteen biggest in California. In 1947, Saskatchewan began paying the hospital bills of everyone who lived there. No province had ever done anything like it. But people loved it and word spread. Three years later Alberta, the larger province next door, began doing the same thing. By the early 1960s, every Canadian province was doing it. In 1966, Canada passed a bill that made the Saskatchewan model national law. Canada had a single payer system.

The United States just needed its Saskatchewan.

There had been several close calls. California’s legislature passed single payer bills in both 2006 and 2008, but both were vetoed by Governor Arnold Schwarzenegger. Hawaii’s legislature approved single payer in 2009, but it was again vetoed by a Republican Governor. Illinois, Minnesota, Montana, Pennsylvania, New York, Massachusetts, Oregon, Colorado, had all also seen pushing for single payer in the previous thirty years. But none of those had even put a bill on the Governor’s desk. In Vermont, single payer was signed into law in 2011, to be launched in 2017. We had our Saskatchewan. Now they just needed to design and implement the program.

This, of course, was easier said than done.

Governor Shumlin had admitted that the stakes were high, observing, "If Vermont gets single-payer health care right, which I believe we will, other states will follow. If we screw it up, it will set back this effort for a long time.”

As Shumlin approached the podium, he laced his fingers and looked down at his hands and then out at the waiting crowd before beginning to speak. After a short preamble, he made his big announcement: he was pulling the plug on Green Mountain Care. There would be no single payer system in Vermont. The crowd listened, some literally with mouths open, as Peter Shumlin, the first American ever to win a gubernatorial race by campaigning on single payer, the first man to successfully shepherd a single payer bill into law, was announcing the death of what would have been his signature achievement in office. Yet again, the dream of single payer was out of reach. What happened? How did Vermont’s single payer effort

collapse?
The short answer, the one Shumlin gave that day, was that his team could not figure out how to make the economics work. Single payer programs are expensive, but even the most pessimistic projections showed the program saving Vermont’s health system money. The more likely explanation is that Green Mountain Care had lost the public support necessary to implement such an ambitious reform, due in part to a handful of mistakes that Shumlin and his team made.
Vermont’s single payer effort was a reaction to the Affordable Care Act.

Within a month of taking office in early 2009, Barack Obama announced that he was focusing on health reform. Healthcare consumed Washington and cable news for much of the next year. The plan that emerged was based on Mitt Romney’s reforms in Massachusetts, which incorporated Republican ideas endorsed by former House Speaker Newt Gingrich and the conservative Heritage Foundation. The ACA made changes to America’s existing health insurance system, though some progressives wanted to see Obama blow it up and create something new, like a Canadian-style single payer

system.
The cautious incrementalism of the ACA was a choice made in the hope of swaying moderate Republicans to support the bill. It didn’t work. Obamacare became law without a single Republican vote in either the House or the Senate. The law was liberal enough to be despised by most Republicans but still too moderate for many Democrats. By the time the Affordable Care Act became law in March 2010, 59 percent of Americans opposed it and only 39 percent supported it. In the 2010 midterm elections, this created a toxic political environment for Democrats that led to a Republican romp.
Democratic candidates faced a lose-lose decision on how to position themselves relative to Obamacare: either support an unpopular new law or oppose the signature achievement of your party’s new president. This calculus was complicated in a blue state like Vermont, where most voters liked Obama but there was enough opposition to the ACA to make full-throated support dangerous. A few months before the midterms in reliably liberal Massachusetts, Republican Scott Brown won a special election for Ted Kennedy’s old Senate seat, a shocking upset that put pretty much every Democrat in the country on notice.