By Ezra Klein
The Washington Post, Nov. 18, 2010
Sen. Bernie Sanders (I-Vt.) has long supported state waivers in the health-care bill, and for a very specific reason: He’d like to see Vermont create the first single-payer system in the nation, as he believes it’ll demonstrate enough cost and quality advantages that other states will want to follow suit. We spoke by phone last night, and a lightly edited transcript of our conversation follows.
Ezra Klein: You worked hard on getting the original version of the state waiver into the legislation. Why? Liberals aren’t usually associated with federalist approaches.
Bernie Sanders: As a single-payer advocate, I believe that at the end of the day, if a state goes forward and passed an effective single-payer program, it will demonstrate that you can provide quality health care to every man, woman and child in a more cost-effective way. So we wanted to make sure that states have that option, we wanted it to be available when the bill gets implemented in 2014. But we ran into the most insane objections from the Congressional Budget Office.
Is that why it got pushed back to 2017?
Our argument was we don’t want any more money from the federal government. When the bill is implemented, let the states use the money the federal government would already be paying to implement single-payer. The CBO came up with one of the weirder counterarguments we’ve ever heard. The CBO said we think the states are smarter than the federal government and they’ll outmaneuver the feds to get more money. So we were forced by the CBO — not by anybody in the Congress — to push it back to 2017. And I agreed to that very reluctantly.
So what happens if Scott Brown and Ron Wyden get their way and the waiver moves up to 2014? Will Vermont use it?
We believe Vermont stands a chance to be the first state in the nation to pass single-payer. The governor-elect campaigned on it, and we have support in the House and Senate. We’re not asking for one nickel more than we’d otherwise get. The other thing we think we have an opportunity to do is reach out to our conservative friends and say, hey, Vermont wants to go forward with a single-payer system, and Mississippi and Alabama don’t, but maybe they have other ideas. Now, we’re conscious of the need to make sure that the health-care reform bill’s standards aren’t diminished. So everyone needs to provide the same quality of health care as the bill provides and at the same, or lower, price. But if they can do that, then they should be able to go for it.
And then the various models can compete with one another and, presumably, spread to other states if successful?
Absolutely. And that’s what we wanted from it. In my state, it’ll be single-payer. In California, I think there’s a chance it could be single-payer. In other states, it will be something else. This makes the states laboratories for the system, and then other states can copy them. Now, you need a minimum level for coverage and quality. You can’t go lower than health-care reform.