“You’d think that, if there was any state where this could fly politically, it should have been Vermont,” said Matthew Dickinson, a political science professor at Middlebury College. “But in this case, the price was so big that even a state as solidly blue as Vermont wasn’t able to swallow it.” […]“If Vermont gets single-payer health care right, which I believe we will, other states will follow,” he [VT Gov.Peter Shumlin] predicted. “If we screw it up, it will set back this effort for a long time.”
In other words, Vermont’s failure to enact single-payer may be one of the most important policy flops in recent memory. Health care in America remains a problem unsolved. After the passage of the Affordable Care Act, the argument over health care was channeled into a debate about the specifics of the ACA and its political future. But as the intensity of that debate has eased, with the law having done nothing extraordinarily good or extraordinarily bad and the GOP now looking to marginal reforms instead of full repeal, the conversation has expanded again to include the dysfunction of our medical system in general and not just the ACA’s failures to address it.If single-payer had pushed forward in Vermont just as pundits and policy makers cooled on the ACA debate, it would have dominated the new conversation. The pivot from the ACA to a single-payer system has long been favored by liberal health care wonks, and a real live state-level example of that happening would add huge momentum to it. Single-payer, which so far has seemed a political impossibility in America, would suddenly be a possibility. But the failure in Vermont means that, for now at least, the single-payer pivot has become far less viable, leaving the field more open for other approaches.But if we cannot bring down costs in the coming years via reforms that are less top-heavy , single-payer will return as a favored policy—and that would be a reasonable, if flawed, response to persisting high costs. Nothing could be more important this time around than having a better debate about heath care policy than we did last time. Let’s hope we get it.