Yeah, I saw this yesterday & I’ve been resolutely devastated about it ever since. The death of SP in VT is really, truly sad & depressing news, given that so much was ostensibly riding on it. Funding was always going to be a challenge for a state like VT to enact SP, but I’m surprised to see Gov. Shumlin abandon the effort so soon instead of plowing through for a few more years & trying to make it work.
Perhaps it really does need to happen first in a big, sweeping state like CA or NY. My best guess is that SP will now arise out of a CA ballot initiative, whether in 2016 or later.
But still, this is terrible, no good news any way you slice it & a cutting blow to SP advocates.
California is almost broke. Partially due to the government expecting the taxpayers to pay for things like healthcare for people who don’t intend to pay for it themselves.
And it probably will due to the fact that we are awash in liberals. Then even more businesses, rich people and seniors will leave the state and the percentage of those working to those not will be even lower.
We pay 100% of our employees health insurance. If we had a single payer plan in our state, we could stop tomorrow and give every employee a huge raise. And we would. I really don’t understand why companies like Ford or Microsoft are not lobbying hard to de-couple health care from employment.
Problem is, it wasn’t just 11%. It was also a 9.5% income tax and they would still have needed the federal funding Vermont taxpayers pay their share of.
On the bright side, it looks like they were prioritizing making the single payer plan equivalent to what people already had rather than going for the cost savings. But if you do that, what’s the advantage of single payer? It’s only real advantage over multi-payer is the savings.
Microsoft I could see being in favor, but Ford? THe UAW is already having a cow over the cadillac tax, imagine how they’d react to losing their awesome plans and settling for what everyone else has.
From what I understand, unions like single payer, as long as they are exempt from it. Which means they don’t actually support true single payer. Which means Democrats will never support true single payer.
Oregon rejected single payer in the last decade. Switzerland rejected it just this year. In the 21st century, there are just too many stakeholders in the private insurance industry, leaving aside the insurance companies themselves, to make going single payer viable for any state or nation. Unions have got their cadillac plans, government employees have great insurance, there are trade associations with great insurance. As Ezra Klein noted in a Netroots speech, there’s just no way to say, “We’re going to take your insurance away from you and give you something better.” that will fly politically. Especially since I doubt anyone outside of single payer fans would think that single payer would be better insurance. It might be better for other reasons, but as pure insurance it’s not going to beat employer insurance.
I think a public option is a pretty good “foot in the door” strategy for single payer. I’d rather take a gradualist approach than an all or nothing approach. I hope Vermont doesn’t give up on health care reform because off this setback.
Good question. If I were them, I’d put a provision saying that a person has to be a resident for a certain amount of time before they’re eligible. If a retiree has to wait 2 years before they can get on the single payer plan, that could put a damper on the immigration problem.
Not being sarcastic here, but most people who need any kind of health care can’t afford to pay for it on their own. So what does it mean “people who don’t intend to pay for it themselves”?
The whole system is set up (pre- and post-ACA) so that contributors subsidize each other, and hopefully at any given moment enough birds are flying so the ship doesn’t sink.
Most people can’t pay for health care when they get seriously hurt or seriously sick. Most people can pay for routine care, otherwise society wouldn’t be able to pay for it through taxes.
From a realpolitik perspective, employer based health insurance results in job lock. People can’t leave their jobs so retention goes up. Maybe that is part of why large companies do not embrace single payer.
Single payer is nice, but to me the real problem is that our health care is so much more expensive than anywhere else.
Vermont’s plan was supposed to reduce spending by 25% by 2027, so now that is gone.
I wish a large state like NY or CA would pass some kind of bill giving the state the power to negotiate and set prices for medical supplies and equipment. In many ways that would be more revolutionary than single payer. The fact that we do not have that is a big part of why our health care is 2x more expensive than other wealthy nations. Of course if prices were set too low, medical personnel might relocate. So that could be a problem.
Doing that plus a medicare buy in would be as revolutionary as single payer, plus be more politically feasible. If even Vermont can’t get single payer I don’t know what another state could do. Vermont is the most progressive state in the union.
There’s no reason we can’t have single payer in the 21st century – there are many, many things that can be done to reduce costs within the health-care industry that have nothing to do with advanced technology. Even Medicare covers “pretty advanced stuff”, so it certainly can be done.
Things that can be tried include:
[ul]
[li]One price per procedure per area – no more agreeing to pay hospital A in Boston $3000 for a c-section, but agreeing hospital B $5000 for the same c-section;[/li][li]Price controls on medications: why are Americans charged 10x what other countries are charged for the same medication? [/li][li]Educate people about when to use the ER vs calling your doctor vs going to an urgent care center. [/li][/ul]
And that’s off the top of my head pre-caffeine. There are dozens more.
There is no reason this country can’t have Medicare for All. There are just too many people who hear “socialism!” and run away, not realizing that grandma and grandpa have socialized medicine and are doing better than their kids, who risk bankruptcy or losing their homes over an unpaid hospital bill.
I used to say the same thing until I listened to a great NPR story on this. They tried to nail down pricing to reasonable amounts and demonstrate the absurdity of massive deviations between facilities located just miles away. But their investigative reporters learned a lot and one of those things is that healthcare providing infrastructure is not like SimCity. You don’t plant down a hospital or med center for a fixed cost in a city, region, or even a state. Each source of health care infrastructure has it’s own unique history. Some have endowments, some have charitable organization behind them, some are for profit, some are in massive debt for expansion, some a government funded, etc…
Thus, each one of them has a different background that effects their operating costs and, therefore, their pricing.
Then, after all that, we get into philosophy. Some are teaching orientated, some care orientated, others are service orientated and others are excellence/prestige orientated. Therefore, they hire and compensate employees and create staffing Tables of Organization to reflect their philosophy, thus changing their costs and thereby pricing.
Until we have a Simcity healthcare infrastructure system, trying to regulate an exact pricing is next to impossible.
Of course, there are egregious examples and I think education on this subject is a good approach to identify some of these and reign them in when they get too far off the mark. But, nonetheless, the first problem still remains.
Oh and I also forgot the part about location and costs associated.
Urban versus rural, land cost, taxes (or availability of tax abatements), even things like the availability of parking all had an impact, even when one hospital was built just 3 miles away from another in the same city.
It really was very interested and make me understand a bit more about why our system is so complex and difficult to just fix easily.
We can’t have Medicare for all in its current form. Too expensive. Single payer systems are cheap through a combination of price controls, rationing, and “educating” doctors about what they can and can’t prescribe. Whereas in the US doctors will often go straight for the most expensive options, and if your insurance doesn’t cover it, then they’ll try something cheaper.
To have universal health care does mean you need to normalize acceptable levels of health care provided. This even includes things as simple as infrastructure and timeliness of response to healthcare needs.
You cannot create the best healthcare for option for everyone. Not everyone can have a “presidential work-up” every year.
You have to set a certain level and provide that to all. In a country where people have become used to a Pay to Treat Better system, it is very controversial to normalize healthcare, even among those who support extending healthcare to all members of the society.
The ominous “death panels” debate is a good example of this. I found it disconcerting when supporters of health care reform rejected the notion we would ever have groups of people who would make life and death decisions based on costs vs. general societal benefit. Taking the individual out, as many people who did support health care reform pointed out, is inherent in our system already. We already have “death panels”, they are insurance companies and personal bank accounts.
This does not mean I do not support a single-payer system. I think there are some positives to this, but we have to have a rational discussion about it. Sadly, given the reality of so many special interests and the general ignorance of the american public who lap up talking points on major issues, I am just not sure this is possible. It does not mean we should not try though. I do believe over time, the public can overcome Wizard’s First Rule.