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Guest editorial: Questions on single-payer

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Posted on January 13, 2014 |
By Emerson Lynn



Gov. Peter Shumlin recently took the unusual step of addressing both the Senate and house health care committees to talk about Vermont Health Connect and how the state needs to prepare itself for Green Mountain Care, the state’s single-payer health care plan.

He made the trip because the issue dominates all others. How it is managed will affect the careers of many of those who spend their time under the dome in Montpelier.

It’s time to pay attention.

This isn’t inconsequential stuff. Done poorly, it could rob the country of a good example. Done poorly, it could threaten the state’s economic base.

It’s understood that no one begins a task with the purpose of doing something poorly. But it happens when the questions aren’t asked, and when leaders assume things they shouldn’t assume. It happens when the public is not properly informed.

That’s Vermont’s circumstance as we speak. Almost no one understands what it is that is being proposed with the single-payer system, and who pays, and how much, and for what service.

What we have is a concept: that somehow we can rebuild what we have, pay for it and manage it through a single-payer system, and provide better care for all. All this for less money than we spend now.

Meanwhile, we couldn’t manage the technology required to allow people to register on the state’s Vermont Health Connect website. Even today, the system can’t process payments.

That doesn’t instill a lot of faith in the state’s plan to take over and run a $6 billion a year health care system.

To get the public to buy in will require a quantum leap in the information presently available. And it will require the sort of robust political debate uncomfortable to this Legislature. Most already have their minds made up. That’s a mistake. Expressed doubts can’t be summarily dismissed, they need to be plumbed until the points of contention are narrowed.

For example, there have been two cost-analyses of the cost of the single-payer plan. One puts the cost a $1.6 billion, the other closer to $2 billion-$2.2 billion. We need to know which is correct. A half billion dollars a year isn’t petty cash.

Proposals are already in the offing in terms of raising the necessary money to fund the single-payer system. Sen. Peter Galbraith states it plainly in his proposed legislation: The only means by which this sort of money can be raised is through the property tax, the income tax or a combination of the two. He also proposes the need to impose a 1.5-percent tax on wages beginning in 2015, just to provide the necessary funding to start things in 2017.

The governor has asked for such a discussion this legislative session. It’s not something he expects to be signed into law, but he wants legislators to “take a bullet or two” in the hopes that the discussion will broaden to the larger Vermont community.

A bullet or two is one thing, being shelled is another.

The last thing the Legislature will do, or should do, is impose a tax on wages in advance of something that, today , has no definable shape. And the conversation should include far more than simply who pays for what. As the only state in the nation doing this, how will it affect our health care providers and how will it affect our employers? We need to ask, not assume we know the answers.

Legislators should also be open to other opportunities. As the health insurance market evolves, what was true yesterday may not be true tomorrow.

An example: We have two insurers in Vermont, Blue Cross Blue Shield, and MVP. Both are in the process of accepting new clients until March. Blue Cross has long been the dominant provider in the state with roughly 75 percent of the market. If it manages to increase that percentage it may be that MVP calls it a day and leaves. We would have one insurer left.

Or, as the terminology goes, a single-payer.

Vermont could then look at Blue Cross Blue Shield the same way it does Green Mountain Power. It’s a utility the state could set up as something to be regulated. The company would be guaranteed — like Green Mountain Power — a certain level of profitability.

There would be no need to assess a payroll tax on either businesses or the employee. And considering the fact that Blue Cross says it operates at a lower cost than what would be proposed under the single-payer system, legislators should be honor bound to explore why this would not work, or what would need to happen to make it work.

It’s an option with its own complications. But it’s an option nonetheless. It’s but one example of the thoroughness required before the Legislature and the governor can move forward with the backing of most Vermonters.

Emerson Lynn

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