April 11th, 2011

A Friendly Word Of Advice From VDB To Governor Shumlin: Beware The Deal

by Philip Baruth

Now look, Governor Shumlin has done yeoman’s work on single-payer: he ran on it, made it a staple of mainstream political discourse, and now his administration is moving that legislation forward every single day in Montpelier. Shumlin has major cred on the issue. Still, certain things make VDB nervous — and they happen to be the two things that nearly killed health care reform at the Federal level.

First, a prolonged period where there is no specific legislation to defend, a period in which every feverish bit of misinformation takes on a durable life of its own.

And second, the tendency — in the bleak hours of the end-game — to start cutting deals that ultimately become not merely counter-productive, but ruinous to the reform’s public image as reform. Think “Cornhusker Kickback,” the insanely sweet deal that Ben Nelson demanded in return for allowing legislation to come to a Senate floor vote.

The first of these threats has been institutionalized by this point: the House and Senate have agreed to move the Administration’s single-payer plan in a two-stage process, with the empty structure and the resulting questions on the front end, and all of the details, figures and final answers on the back end. That leaves pro-reform elected officials defending against anything and everything for a period of 18 months, minimum.

And during those 18 months attack ads playing on the unanswered questions will almost certainly drive down support for single-payer dramatically.

But that die is cast, and that strategy is still supportable, assuming that the second worrisome trend doesn’t take hold: the individualized deal-making. To wit:

“IBM officials said Friday they came away from a meeting with Gov. Peter Shumlin reassured they could agree on a way the state could move forward with planning for a more consolidated health care system while respecting IBM’s desire to manage its own health benefit program.”

Why is it troubling to see IBM muscling its way into an arrangement that will allow IBM to control its own costs, and by logical extension, to determine whether those costs have in fact been controlled? Because it begins at the state level what came to be called “opt-out” at the federal level: individual entities, in this case companies, bargaining to be left out of the grand bargain.

As John O’Kane put it for IBM: “We want to be able to manage our own health-care program, and we have a track record of good success holding down health-care costs.” To which Shumlin responded: “IBM is one of the companies that has figured out how to control costs.”

Not too hard to imagine, from that exchange, a provision that would allow IBM to carve itself a place outside whatever system results from the next two years of reform. And that would be a dangerous precedent, to allow one large employer to set its own terms, to be treated in effect as a stand-alone entity.

Because the whole point of single-payer, the philosophy that has brought it to prominence and to the verge of passage, is that no one stands alone, and that we’re better off both morally and financially when we recognize that central truth, and organize a reformed system accordingly.

Which is to say to the Democratic Governor that VDB helped elect: beware the deal. Remember, Ben Nelson was eventually shamed into voting to rescind his own sweet carve-out, but only after being publicly humiliated and becoming a national poster-child for all that is unsavory in Washington.

And as Sinclair Lewis was known to maintain, it can happen here, too.