Between the Lines: Taking a hard look at single-payer health

There are plenty of reasons to be worried about Vermont’s march toward single-payer health care.
Federal health care reform may allow states to cover virtually all health care costs within their borders. But of course there’s no guarantee such a system would work. It’s never been tried in the U.S.
Proponents of single-payer can rightfully point to single-payer successes in many other countries. But places like Canada aren’t countries that cling to the present-day amalgamation of health coverage from government, businesses and individuals.
A massive transformation will be required for single-payer to work in Vermont. We would save the costs of private health insurance, but single-payer would entail new taxes on businesses and individuals. The Legislature would have to substantially expand its role in apportioning health care dollars. It would take years to make the dream a reality, including a waiver from the federal government.
At best it will take at least six years to make Green Mountain Care (GMC) a full reality — affordable, universal health care for all Vermonters. It’s hoped that would include prescriptions drugs, medical supplies, hospital coverage, and primary, specialty and mental-health care. (Vision and dental, too? Well, as with so much of this process, no one knows for sure.)
Single-payer proponents are correct in pointing out that we could reapportion how health care dollars are collected — perhaps streamlining the confusing mix of federal programs, employers who cover their workers, individuals who pay (partly or completely) out of pocket, and unreimbursed care.
Everyone is counting on potentially huge cost savings through the efficiencies of electronic medical records and other digital wonders.
But in health care as in so many other human endeavors, rational efficiency does not always prevail.
In North Carolina, for example, a plan to improve the processing of Medicaid claims is now more than $200 million over budget. And even though the company assisting the state has also been implicated in egregious cost overruns in the British system, the state isn’t blaming the company.
The culprit, according to North Carolina? The federal government, which has changed Medicaid specifications several times and thereby required the state to rejigger its own program.
Another potential hurdle: If Obamacare is significantly altered by Republican legislation or court defeats, the process to achieve Green Mountain Care becomes even more torturous.
Of course it won’t be smooth sailing politically for Gov. Peter Shumlin and the Democratic leadership, either.
Last week’s pro-single-payer gathering in Middlebury featured the admirably dedicated Shumlin and House Speaker Shap Smith, among others. There, two Addison County doctors served notice that while some Vermont physicians favor single-payer, even they are watching with a suspect eye as the state tries to pull off a medical miracle.
MDs aren’t the only one ready to pounce. The health of Vermont’s community hospitals, so vital to the quality of life in this rural state, could be at stake, too.
Medical device companies, which have already been hit with a new tax under federal reform, might oppose new reforms here in Vermont. (Disclosure: I consult for device companies.)
Even more significantly, insurance companies would be among the big losers under single-payer. And the insurance industry is not exactly known for its political timidity or lack of spending power to bend government to its will.
And yet.
And yet we all have a huge stake in seeing Green Mountain Care succeed.
I support it, and I think you should, too. Universal health care is possible for Vermont, and it’s the right thing to do.
Our present system is grossly inequitable, and it poses a threat to a strong America. One in three Americans under age 65 went without health insurance at some point in 2007-08, according to a Lewin Group study from Families USA.
Even the conservative estimates from the U.S. Census Bureau show that more than 15 percent of us have no health coverage. That means at least 46 million Americans are one serious illness, one accident, away from overwhelming debt and potential bankruptcy.
We expect our businesses to pay an enormous share of the health care burden — through direct taxes (e.g. Social Security) and through the expensive coverage they provide employees. Businesses also bear the cost of sorting through the confounding insurance maze.
Individuals who are self-employed or unemployed have to dig into their bank accounts to afford measly coverage. Or worse yet, they just go without. They hope for good health, and when they are sick, they fall back on our overwhelmed emergency rooms for cheap or unreimbursed care.
In short, our expensive, convoluted, sometimes corrupt health care system puts a tremendous strain on individuals, families and businesses.
We have the resources to provide affordable care to everyone. And yet, hamstrung by history, ideology and corporate greed, we endure an increasingly inefficient and unfair system.
Worse yet — and this may be the most ironically un-American thing about the whole mess — we don’t even get good value for what we pay. American health care may lead the world in spectacular, lifesaving new technology. But we lag behind many other nations in critical measures such as infant mortality and the average cost of common care and medications.
Yes, there are many reasons to worry about single-payer care in Vermont. But there are even more reasons to be worried if we fail to achieve universal care.
Vermont has many advantages in working toward that goal — a committed, intelligent political leadership in the Legislature and governor’s seat; a state small enough to be a laboratory of democracy without attracting the soul-crushing power of greedy insurance companies; civically minded physicians; and a resilient populace.
Few states have those advantages, and these pluses are largely absent at the federal level.
Vermont has already led the way on democratically establishing marriage equality. It’s time we did the same with affordable health care for all.
To point the way forward — and to do the right thing by better providing for the common good — we should all hope that Vermont can achieve universal, affordable and equitable care.
Gregory Dennis’s column appears here every other Thursday. In his day job, he provides public relations and marketing support for health care nonprofits and technology companies. The opinions expressed here are his own. Past columns at; email: [email protected].

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