Vermont governor signs single-payer health law

dp1200 · May 28, 2011

hmm, ok, let's look at the parts of this that the op didn't mention:

the legislation, when fully enacted, will guarantee every vermont resident the right to enroll in a state-sponsored insurance plan, green mountain care.
the law is set to become operational in 2014. in the meantime, the legislation establishes a five-member board that will develop the health care system and ready it for implementation.

the entire state's health care system is going to be in the hands of five people? are these five incredibly powerful positions elected public offices? i bet they aren't. no, these are going to be political crony positions outside the reach of the average person who has to live with the system these five people decide on. welcome to centralized, socialized health care.

the board will also be charged with figuring out how to pay for the plan, and must submit an outline for doing so to the legislature for approval by jan. 15, 2013.

wait, what? they are guaranteeing everyone in the state health insurance, but they haven't even figured out how they're going to pay for it? how can you promise to give someone something when you don't have it to give, and don't know how you're going to get it? this is what passes for "government" these days?

in order to implement the new law, vermont will need to secure a waiver from the affordable care act, the federal health care overhaul congress passed in march of 2010. under that law, states are not permitted to launch alternative plans until 2017. however, in february, president obama expressed his support for the idea of moving that date up to 2014.

now this is pretty funny. vermont needs to get a waiver from obamacare in order to implement its plan. no big deal i suppose, since literally thousands of corporations and unions have already been given waivers.

something else i want to know about the vermont plan: when implemented, will it be totally self-sufficient? i.e., will vermont residents still receive any federal money at all from, say, medicare, medicaid, or schip? if so, their little experiment with "single payer" socialized medicine will be completely irrelevant because the rest of us in the other 49 states will be subsidizing it.

WIN007 · Jun 6, 2011

I can tell you that these five people you mock are experts in healthcare administration. And YOUR OWN credentials would be??

They've crunched the numbers and no doubt concluded it would save money. States already pick up the brunt of uninsured via medicaid so they're not insuring extra people (as if that would be a bad thing). Using a single payer system will save them a fortune on bureacracy and Vermont already has one of the best health exchanges in the nation. In otherwords, holistic/complete medical records are viewable by all major medical institutions in the state and I believe, in adjoining states since Vermont is small. Worth noting too, Vermont has a smaller population and one of more educated/affluent population. There's probably not a heck of a lot of uninsured in Vermont as it were compared to say, Tennessee, which has among the highest percentages of people on medicaid in the nation.

Also this has nothing to do with the Affordable Care Act which in no way mandates state or municipal payment systems. Though something tells me that won't deter you.

WIN007 · Jun 6, 2011

PS - by definition a state-run single payer system inherently implies that medicaid is gone, see. As the states largely fund medicaid themselves this is entirely their business. Other states such as Texas and Florida are making deep cuts into Medicaid budgets where there are enormous populations dependent upon it and with effectively no access outside of an ED visit. I guess the hospitals just get to eat it again and pass it on to the rest of us becasuse after all , per the stalwart constitutional interpretations of the hard right and it's affiliates it would be "unconstitutional" for people to have to buy health insurance (but presumably not so for already mandated auto insurance). I mean they will just pass the cost onto the rest of us , yes? I think that's the hard right's argument when it comes to never taxing corporate conglomerates and other times that argument is convenient.

One wonders how many people could keep their insurance if states dedicated themselves to streamlining their processes and to efficiency instead of just slashing and burning. This is the reason the Meaningful Use Act of CMS/ONC which saves billions via holistic records, health exchanges, eliminating redundant orders and fraud and standardizes care, is very much preferable to the Republican solution of leaving an inefficient broken system as is (or eliminating it altogether) while ever more persons don't have access to it. Especially as it also focuses on clinical decision support, inter-institutional and state and eventually national access to full records and standarized care. THIS is what's going to save money AND improve outcomes.

WIN007 · Jun 6, 2011

>

:uhoh3:

people from hard red states which receives more in federal tax dollars than they contribute, year after year, decade after decade, are disqualified from lecturing other states on socialism and handouts!

dp1200 · Jun 10, 2011

people from hard red states which receives more in federal tax dollars than they contribute, year after year, decade after decade, are disqualified from lecturing other states on socialism and handouts!

You know the old saw about making assumptions, right? FYI, I've lived my entire life in a BLUE state, which is bankrupt thanks to its own experiment with "universal health care" (MA).

Just answer the question: are VT and its residents going to continue receiving any federal money at all to make its "single payer" system work? It's a yes or no question.

I also think it's laughably naive for people to put unquestioned trust in 5 as yet unnamed political appointees, bestowing what can only be described as religion-like faith that these unknown, unelected, all-powerful 5 have " crunched the numbers and no doubt concluded it would save money". Really? How on earth can anyone draw this conclusion when (A) the health care system hasn't even been defined yet, and (b) They haven't figured out how they are going to pay for it! (straight from the original cited article, not me).

WIN007 · Jun 10, 2011

dp100;

My take:

Don't fret. Mass is in better shape than most states! Near all state and local governments are in a devastatingly bad spot now contending with high unemployment, and reduced revenues. I can't really comment on Romney's governorship as he was strategiecally careful to quit before the going got rough. Pity the governors of the heartland states for the past 8 years. Romney care didn't work as well financially as expected because the economy tanked reducing revenue and increasing demand for services, and at the same time he exempted employers with deep pockets from having to pay into it even as they unloaded droves of formerly provided employees onto it. Also, outside of the economies of scale (administration) which take time to realize, there was not much to address rising healthcare costs.

Vermont has many very smart people working with them. They have one of the few profitable HIE's in the nation already intact which will have tremendous impact on holistic records, reduced fraud and redundancy. I bet their banking their savings there and in administration will actually reduced the current outlays on medicare. I hope they have some sort of residency minimum for eligibility though. then again perhaps they're counting upon the cost of living in vermont as sufficiently prohibiting? :-)

Should be interesting to watch anyway.

WIN007 · Jun 10, 2011

I also think it's laughably naive for people to put unquestioned trust in 5 as yet unnamed political appointees, bestowing what can only be described as religion-like faith that these unknown, unelected, all-powerful 5 have " crunched the numbers and no doubt concluded it would save money". Really? How on earth can anyone draw this conclusion when (A) the health care system hasn't even been defined yet, and (b) They haven't figured out how they are going to pay for it! (straight from the original cited article, not me).

naive religion-like faith sounds a lot like you're continued interjections on a project you clearly aren't informed about. I have more faith in Vt. to implement this successfully than I do in a misinformed commenter. Vermont has been working with the best physician-based informatics group in the nation and already had several successes. As I see it they've gotten fed up with the radical right obstructing all meaningful healthcare reform (or in Romney's case, ensuring that it isn't adequately funded) and recognizing HIT is what truly will save their budget, have moved on with the ONC project at a state level in expectation that the Republicans will defund the ONC efforts on the National Information Highway Network. Kudos to them for that.

I am not a socialist leftwinger nor a rightwinger but a pragmatist. I will embrace whatever solution seems to fit the problem irrespective to ideology and would never let an ideology interfere with the access of healthcare to people who need it. So far I haven't heard the hard right offer much other than the same ridiculously disproven assurances that some undefined market-based service will solve the many problems with our healthcare without a single proposition to address the runaway costs outside of denying access and slashing staff. In fact even passing legislature preventing competition as favor to their pharmas and insurances donors.

In Tennessee, a state with virtually no taxation no regulation, that 'free market' turned out to be a disaster with three quarters of the state without insurance , all people who would have no insurance were not TNCARE/medicaid available. TN now has an exchange that at least is holding the damn up for now in the Memphis area. many other states aren't as fortunate.

nicurn001 · Jun 10, 2011

DP1200 in the thread you decried having any faith in the 5 Political appointees overseeing VT healthcare , but at least these people will be identifiable , wheras the people who oversee private health financing will and always have made their decisions anonymously , without any public input and being influenced in their decisions by the effects of them upon the profitability of their employer . It makes me wonder who has a greater problem with blind / religous faith in people .

jmqphd · Aug 14, 2011

DP1200 in the thread you decried having any faith in the 5 Political appointees overseeing VT healthcare , but at least these people will be identifiable , wheras the people who oversee private health financing will and always have made their decisions anonymously , without any public input and being influenced in their decisions by the effects of them upon the profitability of their employer . It makes me wonder who has a greater problem with blind / religous faith in people .

yeah, well... if I don't like the decisions of my health carrier, I can leave it. May have to leave my job, or leave town... but I'm not forced to take one (as in "single", unitary, unique, without alternatives) payer. On the other hand, in my private insurance, I am paying for me, and my co-workers are paying for themselves. True, our employer pays into it, but with money that would otherwise go into my pocket directly (as in per diem employees.) So, it's money I earn, and decide to use to insure myself as much as I can. And, I get to choose from a range of benefits. Like PPO or HMO. I can use an MD in the plan or outside the plan. I can choose to take the dental and eye benefits or not. I can be part of my spouse's plan or use my own, or be covered by both.

Vis., 5 very smart people making all the decisions about how to do something incredibly complex for a huge number of people, all of whom are individuals and each of whom has individual needs that vary over time. Are you out of your mind? They would have to be God (in 5 persons, not 3) to have that much wisdom. What incredible blind faith. Abundant and overwhelming evidence from human history richly illustrates how bad an idea this is.

Now those 5 wise men were Adam Smith, Edmund Burke, Milton Friedman, Friedrich Hyek and Ronald Reagan... hmmm... nah. Not even then.

OC_An Khe · Aug 14, 2011

Health care costs are all shifted to those with the ability to pay., either directly or indirectly. Even if you have an individual health insurance policy or paying your own healthcare costs out of pocket, you are subsidizing health care provided to non payers.

It is the way our "free market" health care system works and has always worked.

jmqphd · Aug 14, 2011

Health care costs are all shifted to those with the ability to pay., either directly or indirectly. Even if you have an individual health insurance policy or paying your own healthcare costs out of pocket, you are subsidizing health care provided to non payers.
It is the way our "free market" health care system works and has always worked.

So, VT has decided that every citizen will have the same "insurance". As you point out, the care of the indigent has more or less always been supported by those with means. But for some reason, it is somehow brilliant to limit the options of those that provide for themselves while demanding they give more of their resources to those with less.

It is one thing to say to a free person... "you must pay because your neighbor is poor" and quite another thing to say "you may have nothing that you do not provide for your poor neighbor." In the first, my earnings are not my own. In the second, not only are my earnings not my own, but I am no longer free to choose how to spend the limited earnings I'm allowed to keep.

On the positive side, at least VT is inflicting this upon themselves, not imposing it upon the nation. I believe in Federalism. When it becomes plain that this is a very bad idea, there is a way out. People may vote with their feet.