As Americans who pay attention to politics learned last year, the US spends (lots) more per person on health care but doesn't get spectacular results out of its system, half of all of bankruptcies are caused by medical expenses, and almost 50 million Americans go without any health care at all while tens of millions more have inadequate health care, whether they know it or not.
The Patient Protection and Affordable Care Act would make a dent in these problems, but that's if it doesn't get picked apart in the next few years by Republicans and Democrats who demagogue about deficits and their corporate masters who are salivating at the money the act sends to poor and working class people and looking for a way to get it for themselves.
Vermont's doing something different - they're going single-payer:
The Vermont House of Representatives passed the final version of a health reform bill that creates Green Mountain Care, a universal, publicly funded health care system. The state Senate passed the same bill on Tuesday. Gov. Peter Shumlin is expected to sign the bill into law within the next two weeks.
Rep. William Hsiao explains how this form of universal health care actually cuts the cost of health care:
One of the goals was to cut costs. How does this plan cut costs?
By introducing a single-payer system you remove the administrative expense, so you can get a one-time savings. Over the long run, the savings come from changing the payment system to providers. Right now we pay on a fee-for service basis -- in other words, the more you do, the more you get paid. That encouraged doctors to do more -- including more tests, more examinations, so forth. We could change the economic incentives for physicians to reward them for healing patients rather than how many services they provide. Second, the savings come from vertical integration of healthcare delivery. That would remove the duplication of tests, reduce drug complications, improve the continuity of care for patients. That would simplify administration, such as recordkeeping. You could share the same records. This is where the savings come from.
Reducing the cost of health care is not the goal of private health care providers. They dumped over $600 million into Congress just in 2009 during the health care debates because this gravy train isn't something they're going to part with easily.
The corporate health care system's goal is to charge as much as possible for health care, since the corporate model is based on increasing profit at any cost. And since people would rather pay exorbitant prices than die, they win against individuals every time. This is why people have to work together and put together an alternative to the corporate health care system or regulate that system much more stringently than we're doing now.
State-level single-payer systems aren't the best solution. For one thing, states can't pay their bills through fiat like the federal government can, so these programs would be sitting ducks for spending/tax cutters (which is probably why more aren't being proposed).
Secondly, they have less collective power. The more people that are covered together, the better terms they can negotiate for themselves. This is why people who work for big companies and firms (and the government and military) in the status quo get a better deal on health care than freelancers, independent contractors, and the unemployed do.
Last, some major, unneeded medical expenses are controlled at the federal level. As economist Dean Baker pointed out in 2009, the average American pays $800 a year over what they would if the US allowed for cheap drug importation. That's not $800 a year for drugs, but $800 too much per year, more than what Europeans who live in countries (like France) that allow for more generics end up paying for the same thing.
Some say this will show America that single-payer health care works, but I doubt that. We know it works because it works in several other countries, and other systems for universal, government-controlled health care have been producing great results for decades. Study after study shows that single-payer would mean better, cheaper health care in the US, with almost no legitimate academic work showing the contrary.
The issue in America is that the people who profit from our substandard system don't want change since they might have to buy a smaller yacht next year so some peasant can get her chemo paid for.
While a federal solution would be better, a state solution is still good. More states need to opt out of the corporate health care model to give people an alternative to it.