A pioneering grassroots campaign for the human right to health care has made Vermont the first state mandated by law to establish a universal, equitable health care system based on human rights principles. Since the federal reform effort failed to guarantee equal access to health care for all regardless of a person's ability to pay, Vermont's legislators stepped up and responded to the growing grassroots pressure by agreeing an ambitious planning initiative to secure health care for all. On May 27, 2010, the Universal Access to Health Care Act (S.88) passed into law, after Governor Jim Douglas (R) refrained from vetoing the bill, which had commanded a large majority in the legislature. The new law requires the state to commission an independent consultant to design three options for a universal health care system, including a single payer model. The final design must be selected during the 2011 legislative session, with implementation beginning no later than July 2012.
Vermont's new law constitutes a first decisive step in the direction of universal health care. If pressure from human rights activists continues, the implementation process could offer a model for other states on how to sidestep the market-based federal health reform, which primarily expands the subsidized customer base of the insurance industry. The unique achievement of the Healthcare is a Human Right campaign, run by the Vermont Workers' Center, is reflected in the human rights principles enshrined in Vermont's new law. All three health system designs are required to meet these principles: universality, equity, accountability, transparency, and participation. The new law explicitly states that Vermont's future health care system must ensure that every resident has access to comprehensive, quality care, free of systemic barriers. This access must be financed in an equitable and sustainable way. The system must operate efficiently, transparently, and accountable to the people it serves. The state must also ensure public participation in the system's design, implementation, and evaluation.
This basic normative framework, which has now been enshrined in law, was developed collectively by the many activists of the Healthcare is a Human Right campaign, based on international human rights law. In 2008, the campaign held human rights hearings across Vermont, with hundreds of people testifying about their lack of access to appropriate care. The following year, accountability sessions were held in numerous legislative districts, with over 70 legislators participating. In these public events, legislators were asked to consider the role of human rights principles for health care reform in Vermont. The majority recognized the human right to health care and committed to supporting a single payer bill as an important step toward building a universal, equitable health system in Vermont.
Throughout the 2010 legislative session, which ended in early May, campaign activists kept the focus on a principled approach to reform, in a marked difference to the federal efforts. In particular, they highlighted that health care must be provided as a public good shared by all, not a commodity bought and sold on the market. This is now reflected in the law, which recognizes health care as a public good for all Vermonters.The formidable task now awaiting both activists and policymakers is to translate the principles into practice, a significant challenge in the face of obstructive efforts by the insurance industry and by cheerleaders of market-based reform. Fortunately, the state has wasted no time and already issued a request for proposals (RFP) from health systems consultants. The name of one potential candidate has emerged repeatedly in the public debate: William Hsiao, the Harvard professor who designed the Taiwanese single payer system. Whichever consultant is selected, the RFP confirms that all design options must ensure that access to health care is universal, equitable, comprehensive, and continuous throughout peoples' lives. And if there is any doubt about what this might entail in practice, activists of the Healthcare is a Human Right campaign are ready to show that only a publicly funded and publicly administered health system can satisfy these basic human rights principles.