Alex Blaze

Vermont Goes to Single-Payer Health Care

Filed By Alex Blaze | May 07, 2011 4:00 PM | comments

Filed in: Politics
Tags: health care reform, insurance, medical expenses, single payer, Vermont

As Americans who pay attention to politics learned last year, the US spends (lots) more per person on health care but doesn't get vermont-single-payer.jpgspectacular 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.

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There is way that it could work other New England States and outside states could join with Vermont.Massachusetts can't get any Bluer all it has to do is dump Romney care which sucks and team up with Vermont.New York is also a next door neighbor. Get more States involved and it would help move the federal government towards single payer. Throw in California and the pool would be huge.

Rick Sutton | May 8, 2011 7:16 AM

I don't know why we continue to call it "Health Care." In fact, it's really geared exclusively for the powerful and the wealthy. Our current patchwork design is lousy, costs too much and has loopholes like Swiss cheese---all designed to favor those who bought the loopholes.

"Wealth Care" is more like it.

Bravo for Vermont.

Jay Kallio | May 8, 2011 8:10 AM

Vermont's plan is not really single payer, and they even removed the phrase "single payer" from the title of the bill. This bill does take several steps toward a possible single payer system, but they are still keeping the private and employer based health insurances intact, so most of the savings that you obtain in a true single payer system will not happen.

True single payer achieves so much savings by streamlining the system, eliminating the horrendous monstrosity of complex billing of multiple insurers, and by economies of scale ("buying in bulk") it saves enough on health care costs that we could cover ALL our uninsured and provide health care access for all, cradle to grave. Many other countries have adopted single payer systems, most recently Taiwan, where they were shocked to see how their health care expenditures went down, even though they were covering everyone, instead of leaving a huge number of their citizens without any care at all before under their previous system of private health insurance. We can do it here, as well. All we need is the political will.

If you want to know more about what a real single payer system looks like, and can accomplish, go to pnhp.org (Physicians for a National Health Program) where you will find a tremendous amount of documentation and background on this type of truly humanitarian, egalitarian health care system. Our motto: "Everyone in, nobody out".

PS: You do not have to be a physician to join PNHP, all health care advocates are welcome. And another great activist single payer group is Health Care Now.

Kathy Padilla | May 8, 2011 9:32 AM

This is a very welcome step forward.

I don't think the economy of scale is such a concern at the state level. Even a very small state such as Vermont has more residents than all but the six largest companies. And my city has three times the residents Vermont. So - perhaps some of the large cities could be empowered to look at the issue if their states are reluctant.

It will be interesting to see if this attracts business to Vermont as corps will have lower employee costs - and if out of state people can buy in.

Jay Kallio | May 8, 2011 10:19 AM

The Vermont plan basically expands the role of private insurance and Medicaid, but additionally offers a public plan by 2017. With health care costs rising well beyond the rate of inflation the co pays forced on patients will continue to block access for many in dire need. Without the substantial savings that a real single payer plan would provide the cost of health care will continue to be well out of reach for so many people. It's a tragedy.

With the quagmire of federal regulations that are imposed on states the difficulties of enacting a true single payer plan statewide are immense.

As a first responder who has spent my life treating primarily the terrible emergencies that the poor and uninsured face daily, when their long unmet need for healthcare bears it's terrible fruit of early morbidity and mortality, I bear witness to immense suffering that we should be preventing now.

No one in this rich country should be dying of simply treatable diseases and injuries, just because they don't have money, as so many of the chronically ill find themselves becoming destitute from the inflated cost of care. It's a crime. That the profits of the few should outweigh the many lives lost in this immoral system is an ongoing catastrophe. It's like another Katrina every day, but faced silently, and alone.

Now if only the rest of us could get that!