# Vermont uses ACA to launch single-payer health care **URL:** \ **Category:** Great Debates\ **Created:** [November 25, 2013, 4:46pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762 "2013-11-25T16:46:00Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [November 25, 2013, 4:46pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/1 "2013-11-25T16:46:00Z")
Story [here](http://www.minnpost.com/community-voices/2013/11/health-insurance-problems-keep-arising-vermont-offers-ray-hope). > [@](#): > > All but ignored in the multitude of media coverage about the ACA and its problems, Vermont has become the first state in the union to pass a single-payer universal health care law for its residents. It has a snappy slogan: **Everybody in, nobody out.** > > The system will be fully operational by 2017, funded by Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes. Everyone will be able to go to any doctor or hospital in the state free of charge. No plans to figure out, no insurance forms to sweat over, no gotchas. > > Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings. Employers will suddenly be free to give raises to their employees instead of paying for increasingly expensive health benefits. All hospitals and health-care providers in Vermont will be nonprofit. Medicare recipients will no longer need to wade through an inch-thick book to choose supplemental plans and sort out other complex options in their Medicare enrollment. So, that’s Vermont, Hawaii . . . Just 48 to go! 🙂 The debate is: Will other states follow suit? ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [November 25, 2013, 4:52pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/2 "2013-11-25T16:52:01Z")
And how soon will the GOP point to the single payer states as proof of the failure of Obamacare and take credit for it? ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 25, 2013, 4:52pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/3 "2013-11-25T16:52:15Z")
Let’s hope it catches on. Sounds like a huge improvement over what we have now. ---
**Author:** ![Human\_Action](https://avatars.discourse-cdn.com/v4/letter/h/ac91a4/32.png) [@Human\_Action](https://boards.straightdope.com/u/Human_Action)\ **Post date:** [November 25, 2013, 5:02pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/4 "2013-11-25T17:02:14Z")
It’s not a done deal yet, Vermont requires federal permission to use federal funds for this state program. [Here’s the Vermont law](http://www.leg.state.vt.us/docs/2012/Acts/ACT048.pdf), see page 85: > [@](#): > > (e) The agency shall seek permission from the Centers for Medicare and > Medicaid Services to be the administrator for the Medicare program in > Vermont. If the agency is unsuccessful in obtaining such permission, Green > Mountain Care shall be the secondary payer with respect to any health service > that may be covered in whole or in part by Title XVIII of the Social Security > Act (Medicare). > [@](#): > > The agency may seek a waiver under Section 1115 of the Social > Security Act to include Medicaid and under Section 2107(e)(2)(A) of the > Social Security Act to include CHIP in Green Mountain Care. If the agency is > unsuccessful in obtaining one or both of these waivers, Green Mountain Care > shall be the secondary payer with respect to any health service that may be > covered in whole or in part by Title XIX of the Social Security Act (Medicaid) > or Title XXI of the Social Security Act (CHIP), as applicable. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 25, 2013, 5:04pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/5 "2013-11-25T17:04:57Z")
Expect an exodus of physicians from Vermont. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 25, 2013, 5:13pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/6 "2013-11-25T17:13:10Z")
> [@Terr](#): > > Expect an exodus of physicians from Vermont. It depends on how the SP program works. If it’s pay for performance, you are probably right. If it’s actually based on a sane payment schedule, they they will probably keep their physicians and be very much better off for switching to Single Payer. ---
**Author:** ![Buck\_Godot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/buck_godot/32/6573_2.png) [@Buck\_Godot](https://boards.straightdope.com/u/Buck_Godot)\ **Post date:** [November 25, 2013, 5:13pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/7 "2013-11-25T17:13:45Z")
> [@Human\_Action](#): > > It’s not a done deal yet, Vermont requires federal permission to use federal funds for this state program. [Here’s the Vermont law](http://www.leg.state.vt.us/docs/2012/Acts/ACT048.pdf), see page 85: It sounds like they would be asking the executive branch for the permission. The Obama administration would probably welcome single payer if there was any chance of getting it passed. Also if they try to block it than it will another example of a failure for the ACA, which the Obama administration really doesn’t need right now. So I doubt that this will be a problem. ---
**Author:** ![Crotalus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/crotalus/32/41_2.png) [@Crotalus](https://boards.straightdope.com/u/Crotalus)\ **Post date:** [November 25, 2013, 5:16pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/8 "2013-11-25T17:16:24Z")
> [@Terr](#): > > Expect an exodus of physicians from Vermont. If the paperwork simplification that is expected from a single payer system happens, I believe that your expected exodus won’t happen. What is your basis for expecting an exodus? Lower payments for doctors? Or just something you pulled out of your ass? ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 25, 2013, 5:17pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/9 "2013-11-25T17:17:50Z")
> [@Farin](#): > > It depends on how the SP program works. If it’s pay for performance, you are probably right. If it’s actually based on a sane payment schedule, they they will probably keep their physicians and be very much better off for switching to Single Payer. It’s Single Payer. One payer. The only game in town. The physician only gets paid from one source. No competition. So when costs need to be cut, and that source lowers its payments, the physician can either accept the cut in his income or leave. Basically - show me one “Single Payer” place where physicians get paid as much as they do in the US. Here is a helpful chart from 2009: [http://graphics8.nytimes.com/images/2009/07/15/business/economy/GPpay.jpg](http://graphics8.nytimes.com/images/2009/07/15/business/economy/GPpay.jpg) ---
**Author:** ![Rachellelogram](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rachellelogram/32/8689_2.png) [@Rachellelogram](https://boards.straightdope.com/u/Rachellelogram)\ **Post date:** [November 25, 2013, 5:22pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/10 "2013-11-25T17:22:20Z")
Good for them. Just another reason to live in Vermont (their drug testing laws are very employee-friendly). ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 25, 2013, 5:25pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/11 "2013-11-25T17:25:57Z")
> [@Terr](#): > > It’s Single Payer. One payer. The only game in town. The physician only gets paid from one source. No competition. So when costs need to be cut, and that source lowers its payments, the physician can either accept the cut in his income or leave. > > Basically - show me one “Single Payer” place where physicians get paid as much as they do in the US. > > Here is a helpful chart from 2009: [http://graphics8.nytimes.com/images/2009/07/15/business/economy/GPpay.jpg](http://graphics8.nytimes.com/images/2009/07/15/business/economy/GPpay.jpg) I know what “single payer is” and my point was that a **sane** payment schedule that didn’t try to pay doctors less than they pay out would mean their physicians would stay. Additionally, why does it matter how much a doctor is paid per patient? Can the doctor make a respectable living after paying for his/her nurses, building, utilities and such? If so, it’s an adequate payment system. Paying them more than that is nothing but a bonus for the doctors. ---
**Author:** ![Human\_Action](https://avatars.discourse-cdn.com/v4/letter/h/ac91a4/32.png) [@Human\_Action](https://boards.straightdope.com/u/Human_Action)\ **Post date:** [November 25, 2013, 5:29pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/12 "2013-11-25T17:29:00Z")
> [@Buck\_Godot](#): > > It sounds like they would be asking the executive branch for the permission. The Obama administration would probably welcome single payer if there was any chance of getting it passed. Also if they try to block it than it will another example of a failure for the ACA, which the Obama administration really doesn’t need right now. So I doubt that this will be a problem. You’re probably right, but it is worth noting that there remain hurdles to cross before Green Mountain Care goes into effect. > [@Farin](#): > > It depends on how the SP program works. If it’s pay for performance, you are probably right. If it’s actually based on a sane payment schedule, they they will probably keep their physicians and be very much better off for switching to Single Payer. It seems to be pretty broad. Page 44: > [@](#): > > “Payment reform” means modifying the method of payment from a fee for-service basis to one or more alternative methods for compensating health care professionals, health care provider bargaining groups created pursuant to section 9409 of this title, integrated delivery systems and other health care professional arrangements, manufacturers of prescribed products, medical supply companies, and other companies providing health services or health supplies, for the provision of high-quality and efficient health services, products, and supplies while measuring quality and efficiency. The term may include shared savings agreements, bundled payments, episode-based payments, and global payments. The details are delegated to the Green Mountain Care board to work out programs and schedules. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 25, 2013, 5:29pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/13 "2013-11-25T17:29:35Z")
> [@Farin](#): > > Additionally, why does it matter how much a doctor is paid per patient? Can the doctor make a respectable living after paying for his/her nurses, building, utilities and such? If so, it’s an adequate payment system. Paying them more than that is nothing but a bonus for the doctors. Seriously? You want the state to decide what is “adequate” compensation for you? Let’s say as a doctor you can make “respectable” living in Vermont. But in a neighboring state you can make twice as much, working as much. Don’t you think you would move? ---
**Author:** ![Human\_Action](https://avatars.discourse-cdn.com/v4/letter/h/ac91a4/32.png) [@Human\_Action](https://boards.straightdope.com/u/Human_Action)\ **Post date:** [November 25, 2013, 5:33pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/14 "2013-11-25T17:33:46Z")
> [@Terr](#): > > Seriously? You want the state to decide what is “adequate” compensation for you? > > Let’s say as a doctor you can make “respectable” living in Vermont. But in a neighboring state you can make twice as much, working as much. Don’t you think you would move? One thing that might offset lower payment schedules than what private insurance offers, is no longer serving patients for whom the doctor receives no payment at all, [which is a large number](http://www.forbes.com/sites/brucejapsen/2013/01/07/unpaid-hospital-bills-rise-to-41-billion-annually/), though I’m sure it falls more on hospitals than GPs. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 25, 2013, 5:39pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/15 "2013-11-25T17:39:06Z")
> [@Human\_Action](#): > > The details are delegated to the Green Mountain Care board to work out programs and schedules. I am high with hope that they go to a system where the doctors are paid a salary and the number of doctors to employ are set at a threshold (x doctors at y people). But I’m sure that the “experts” will get in there and require fees that are beneficial to their bottom lines. > [@Terr](#): > > Seriously? You want the state to decide what is “adequate” compensation for you? > > Let’s say as a doctor you can make “respectable” living in Vermont. But in a neighboring state you can make twice as much, working as much. Don’t you think you would move? First, these disparities already exist. How come no state is completely defunct of doctors just because the doctors make less than they would in the surrounding states? Second, the government and insurance companies (and health care companies, if you work in a hospital) already dictate to you how much you get for various services, down to the service level. There are hundreds (or maybe thousands?) of codes for electronic record keeping that insurance companies before the ACA were forcing doctors to start using. Each of those codes comes with it’s own price tag in many insurance companies. The difference will, hopefully, be that they won’t try to cut costs in Vermont by requiring that doctors take less in than they pay out. ---
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [November 25, 2013, 5:40pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/16 "2013-11-25T17:40:01Z")
> [@Terr](#): > > Seriously? You want the state to decide what is “adequate” compensation for you? > > Let’s say as a doctor you can make “respectable” living in Vermont. But in a neighboring state you can make twice as much, working as much. Don’t you think you would move? I might move _ **to** _ Vermont to live in a sane health care system. ---
**Author:** ![Subterraneanus](https://avatars.discourse-cdn.com/v4/letter/s/a183cd/32.png) [@Subterraneanus](https://boards.straightdope.com/u/Subterraneanus)\ **Post date:** [November 25, 2013, 5:41pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/17 "2013-11-25T17:41:32Z")
> [@Crotalus](#): > > If the paperwork simplification that is expected from a single payer system happens, I believe that your expected exodus won’t happen. > > What is your basis for expecting an exodus? Lower payments for doctors? Or just something you pulled out of your ass? I’d go with the ass-extraction theory. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 25, 2013, 5:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/18 "2013-11-25T17:42:26Z")
> [@Terr](#): > > It’s Single Payer. One payer. The only game in town. The physician only gets paid from one source. No competition. So when costs need to be cut, and that source lowers its payments, the physician can either accept the cut in his income or leave. Sounds like a good argument for implementing it nationally, then. > [@](#): > > Basically - show me one “Single Payer” place where physicians get paid as much as they do in the US. Is the point of the system to maximize physician income as well as insurance company income? Not to provide care? Show us one single payer place where there is a real shortage of physicians, where young people are dissuaded from entering medicine as a profession due to the levels of income available to them, and where mid-career physicians tend to leave the field in significant numbers for financial reasons. ---
**Author:** ![Subterraneanus](https://avatars.discourse-cdn.com/v4/letter/s/a183cd/32.png) [@Subterraneanus](https://boards.straightdope.com/u/Subterraneanus)\ **Post date:** [November 25, 2013, 5:44pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/19 "2013-11-25T17:44:07Z")
> [@ElvisL1ves](#): > > Sounds like a good argument for implementing it nationally, then. > > Is the point of the system to maximize physician income as well as insurance company income? Not to provide care? Why do you hate America? ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [November 25, 2013, 5:57pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/20 "2013-11-25T17:57:41Z")
> [@Terr](#): > > Expect an exodus of physicians from Vermont. It could make a wonderful case study. If the exodus does not occur will you reconsider your position on single-payer? [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=2)