An op-ed by A. W. Gaffney on the failure of Vermont’s proposed single-payer plan made a point I hadn’t thought of before. Here’s the kernel of the point:
The Shumlin plan, for instance, didn’t integrate either Medicare or TRICARE into its “Green Mountain Care†plan, and was set to allow “ERISA employers†(big businesses that self-employ their workers) to continue providing private health insurance (albeit while still having to pay taxes for the public system, which they didn’t seem to like).
As a result, Vermont would have still had multiple insurers, or “payers,†and hence, it wouldn’t have “single-payerâ€; the plan would have additionally accommodated other private plans, like Medicare Advantage and “Part D†drug plans.
Unfortunately, this is a profound problem, for the administrative simplicity of single-payer plans is the crucial source of the large savings these systems can achieve. The Harvard School of Public Health study that put forth the original “public-private single-payer†reform proposal for Vermont, for instance, estimated some $580 million in savings from a Vermont single-payer-like system for 2015, savings which the Shumlin administration now asserts are not “practical to achieve.â€
There are three problems being highlighted here. One is economic, one is administrative and legal, and the third is political.
The administrative and legal problem is that state moves towards single-payer can’t proceed without the permission and cooperation of the federal government. The federal government has a multiplicity of plans: Medicare, Medicaid, TRICARE, and now the PPACA. Reconciling the requirements of these plans is a daunting and perhaps impossible task.
The political problem is that the beneficiaries of these various plans will oppose any aspect of a prospective plan that isn’t as good or better than the plan they already have.
The economic problem is how in the heck do you pay for a plan that’s better (read: more expensive) in every way than Medicare, Medicaid, TRICARE, the PPACA, and private insurance?
The article outlines the varying paths that countries have taken to national healthcare systems. This seems like a good point at which to repeat something I’ve mentioned before: no country as large and diverse as we are with healthcare costs as high as we pay has ever adopted a national healthcare system. Might we? Who knows? I strongly suspect it will be much more difficult than its supporters think.
So Vermont’s single payer system failed, at least in part, because it wasn’t single payer. So it was called a single payer system why? Republican false flag operation to discredit single payer? The government of Vermont called it that to make all them green mountain hippies happy with the ssmell of their own farts? A lack of dictionaries?