Vermont Healthcare Justice
— Traven Leyson
AFTER A SUSTAINED grassroots campaign, Vermont passed a law in 2011 which commits the state to a universal, publicly-financed healthcare system.
Act 48 laid out plans for implementing the Affordable Care Act in the short term, and provided the roadmap for the creation of Green Mountain Care, a universal, publicly and equitably financed healthcare system by 2017.
The victory in Vermont served as a model for organizers in dozens of states and a rallying point to rebuild national momentum for healthcare for all.
But the bill did not include a plan for funding it. The Governor was supposed to present a financing proposal, informed by public participation, in January 2013, but he delayed for nearly two years explaining that we wanted to “get it right.”
For years, the Governor’s advocacy for universal healthcare, which included raising the specter of future healthcare taxes, allowed him to get away with harmful policies that cut programs and services needed by Vermont’s most vulnerable citizens.
“Single payer” was a carrot he waved in front of progressives to distract from policies that clearly prioritized the interests of corporations and the wealthy.
Meanwhile he blocked earned paid sick leave legislation, undermined a substantial raise in the minimum wage, refused to make higher education affordable for working-class students, and supported a major fracked gas pipeline project.
The legislature was scheduled to pass a public financing plan for Green Mountain Care in 2015. However, in December the governor announced that he considered universal healthcare unaffordable. “In my judgment, now is not the right time to ask our Legislature to take the step of passing a financial plan for Green Mountain Care.”
That cynical betrayal has opened a new stage in our struggle. While some labor and single payer advocates are accommodating to the redefined limits of political possibility, the Healthcare Is a Human Right campaign’s response was two-fold.
First, the campaign stated that we “will show the way forward for publicly financing health care based on ability to pay, for equitably funded education, and for a state budget and economy that puts people and the planet first. Universal, publicly financed health care is about economic change — it’s about making our economy work for all people, not the few; it’s about an economy with sustainable businesses that serve the people, not just profit interests, an economy that creates good, livable wage jobs and protects our environment.”
Second, healthcare justice activists immediately began mobilizing. On January 8th, hundreds converged on the statehouse to demand that the legislature hold public hearings to determine an equitable financing mechanism for universal healthcare. Twenty-nine were arrested during a civil disobedience action on the floor of the State Capitol, following the Governor’s inauguration ceremony.
As expected, politicians and media pundits were scandalized that the campaign, which used the tactics and strategies of other human rights movements, including sit-ins, and disrupted the decorum of the political process.
Faith leaders followed with a press conference to affirm their support for the right to healthcare. Rev. William Barber, a leader in the Moral Monday movement, stated, “As the Rev. Dr. Martin Luther King noted toward the end of his life, there is a ‘fierce urgency of now.’ This is the time to continue to seek justice through the equitable and universal provision of healthcare. The lives and well being of thousands of Vermonters depend upon it.”
Recognizing the importance of the fight in Vermont to the national healthcare justice movement, over 60 national advocates for universal, publicly financed healthcare submitted an Open Letter to Governor Shumlin and the Vermont Legislature that declared that “Now is the time for Green Mountain Care!”(1)
Long March for Health Care
For decades prior to 2011, Vermont single payer advocates had won the policy debates, but still failed to change what was politically possible. They had run up against neoliberalism as the baseline of the thinkable in American politics. However, in 2008 the Vermont Workers Center’s Healthcare Is a Human Right Campaign set out to build a movement led by people impoverished and excluded by the market insurance and economic system, with a view to changing what is politically possible.
The campaign combines a human rights framework with working class people telling their stories, tenacious community organizing, and cultivating strong labor support to build a grassroots, statewide base of people committed to healthcare as a human right.
The Healthcare is a Human Right organizing campaign involved a conscious paradigm shift, from advocating single payer to adopting a transformative human rights framework that sees all of our economic and social rights as interconnected, i.e. a strategy aimed at challenging the bipartisan neoliberal austerity regime.
Anja Rudiger of the National Economic and Social Rights Initiative, which provides strategic advice, provocatively argues:
“Advocating for a 'single payer' insurance mechanism that cannot be executed in a “pure” form at state level is a rather narrow, and possibly self-defeating approach to social change (that) limits universal health care and the human right to health care to a specific technical policy solution called single payer — which by definition has to be national, since there is no legal way a state can take over all federal programs. But a state-based people’s campaign demanding equitable public financing for health care as a public good can open up a new way of thinking about how to fund the services that are essential for meeting everyone’s fundamental needs.”(2)
The campaign has applied the principles of human rights advocacy to health policy by focusing primarily on the hardship of individuals, rather than the details of policy debates. By reframing access to health care as a human rights issue, VWC and others are able to highlight the injustices of the high cost of medical services and a for-profit health insurance system.
There are now Healthcare Is a Human Right campaigns in Maryland, Pennsylvania and Maine. Groups in Oregon and Washington are also hoping to model health care advocacy work on the Vermont template.
Secret Dirty Deals
Contrary to the law’s guidelines about transparency and public participation, the Governor worked out his financing proposal behind closed doors in tandem with his Business Advisory Council on Healthcare Financing.
Internal documents suggest that all along his goal with healthcare “reform” had been to lower business costs and shift costs from companies onto working people. The extent to which business interests determined the multi-year process of internal healthcare financing discussions was revealed in the governor’s briefings despite his invoking “executive privilege” to keep some documents secret.
The Governor’s decision was political, not economic, revealing opposition to universal healthcare, even with the planned cost shifts, from his big business and wealthy allies. By no coincidence, the Governor’s newest, piecemeal healthcare measures, proposed in his budget address, echo the Chamber of Commerce’s playbook.(3)
While the Democratic Party leadership quickly circled their wagons around the Governor’s decision to abandon universal healthcare, Vermont’s Progressive Party shot back, “Shumlin’s Decision to Scrap Single Payer a Betrayal of Vermont’s Working Families.”
However, the timidity of Progressive legislators betrays their own accommodation to the redefined limits of political possibility. Despite their Party’s message — “Don’t forget about the Workers Center rally in support of single payer today at the Statehouse. I’m sure our Progressive legislators will be there” — the caucus leader complained that the protesters “ruffled a lot of feathers and not helped their immediate cause. I’d like to think we can get over it and move forward with important policy work.”
The Workers Center, however, proceeds from an understanding that “the mobilization of collective defiance and the disruption it causes have always been essential to the preservation of democracy.”(4)
It is not only economically feasible but necessary to move to a publicly financed healthcare system that provides better care for all and increases family incomes.5The question is whether there is the political will to move forward.
The Workers Center believes that the drive for universal health care must be linked with a much larger and powerful political mobilization. In 2012, their People’s Budget campaign succeeded in writing into statute that the purpose of the state budget is “to address the needs of the people of Vermont in a way that advances human dignity and equity.”
Now, yet again we are facing austerity budget proposals. The People’s Budget campaign insists that budgeting must be a participatory, transparent and accountable process that involves the public in a meaningful way, and avoids pitting different needs and rights against one another.
As Dr. King said, “Nonviolent direct action... seeks to so dramatize the issue that it can no longer be ignored.” Because of a courageous mass action, an issue that was at risk of being eclipsed has once again been thrust into the limelight of Vermont politics.
Legislators are now discussing hearings on the Governor’s financing report, but it will take a creative combination of grassroots organizing, policy work, and escalating actions to move forward.(5) Fundamentally, this is not a policy debate, but a question of building power.
For the past 17 years the Vermont Workers Center has been building organic alliances with the unions, a necessary step in the creation of new institutions far broader than the current institutional labor movement, capable of mobilizing class-wide solidarity.
As Mark Dudzic of the Labor Campaign for Single Payer argues, the fight for universal health care through the mobilization of a working-class constituency “challenge(s) the underpinnings of neoliberal social policy around a demand that is central to the well being of the working class. Building a movement powerful enough to win such a demand under the conditions of neoliberalism would be a powerful learning experience and serve as a building block for a new, transformative political movement.”
- Now Is the Time for Green Mountain Care: An Open Letter to Governor Shumlin and the Vermont Legislature signed by 60+ organizations, http://www.solidarity-us.org/site/greenmountaincare.
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- “Reviving Progressive Activism: How a Human Rights Movement Won the Country’s First Universal Health Care Law,” New Politics, November 6, 2011, http://newpol.org/content/reviving-progressive-activism-how-human-rights-movement-won-country%E2%80%99s-first-universal-health.
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- A rational approach to health care reform, http://www.essexreporter.com/news/perspective-4/.
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- Frances Fox Piven, Challenging Authority: How Ordinary People Change America.
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- Although the Governor’s tax plan was far from progressive, it was less regressive than the current pattern of health care funding. According to the report’s estimates, a universal publicly-financed healthcare system would increase net incomes for families earning less than $150,000 annually, covering nine in ten Vermont families. The campaign is developing its own rights-based proposal for equitable financing in consultation with economists with calculations for multiple revenue sources, which will include a progressive income tax on earned and unearned income that does not cap contributions by the wealthy, and a graduated payroll tax that applies to businesses based on size and the discrepancy between the wages of their lowest and highest paid workers. This would ensure that small businesses benefit from universal healthcare, and removes incentives to cut payroll costs by lowering wages.
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March/April 2015, ATC 175