# 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:** 10
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [November 27, 2013, 4:07am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/181 "2013-11-27T04:07:59Z")
> [@Terr](#): > > There is an awful lot of “doctoring” that happens that can easily be handled by a technician being paid 25% of the money if not less. Expect an exodus of physicians (from markets where their services are rendered more economically by the lesser educated)… ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 27, 2013, 4:13am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/182 "2013-11-27T04:13:36Z")
> [@Terr](#): > > Everything is a specialist field. Gourmet cooking is a specialist field, yet you have no problem picking a good restaurant. Fixing cars is definitely a specialist field, but people manage to pick mechanics. There is word of mouth, or, in the age of Internet, specialized web sites. You pick a good restaurant by trial and error. Your friend tells you a place is good, you go and you get a hockey puck instead of a steak and murdered vegetables. Do you go back? No. The same with a mechanic. Word of mouth is poor here, also. What if he fixed up my friend’s 69 Mustang just perfectly? Does he have the skills to repair my 2009 Audi? As a lay person, you don’t know. You use trial and error. > [@Terr](#): > > I mean, how do you pick your doctor today? Do you just stick your finger into the directory and go “that one”? Then guess what, you are just as likely to get a crappy one now. This is how a lot of people pick a GP, today. How often is(are) your friend(s) on the same insurance plan as you? Most people when they get a policy will pull out the big list o’ DoctorBs from their insurer and pick one. Each person uses a different metric. And while trial and error is how you pick now, surely you can see that’s a poor way to do it? > [@Terr](#): > > You don’t micromanage your doctor’s decisions. You pick a good one, based on all the information available to you (and on the price) and you trust him to treat you. Kinda like today except today the price does not enter into the picture. Except that people have no real good information on a doctor. Outside of instances where they were prosecuted for something relevant to medicine, you don’t have a lot of information on them. Sure, you can hit a “doctor review” site, but at best you’ll get 5-10 anecdotes. That’s not useful. > [@Terr](#): > > You would be surprised just how fast prices will come down when people will actually have to PAY (wow) for services instead of having it being invisibly paid for them. You’d be surprised how untrue that is. The same thing that was true pre-ACA would be true with your plan in place: People would simply never get health care and use an emergency room for services when it was critically required. And then, for the poor, their financial lives would be over because, as I touched on earlier, there’s nothing stopping the hospitals from continuing to collect $2,000 per visit to the ER. By the way, the HDHP where you pay the first $2,000 - $10,000 pre-ACA hasn’t significantly slowed medical inflation since it’s inception. That was the way that people were supposed to drive down costs for employers and insurers, using the “Free market” approach. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 27, 2013, 4:13am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/183 "2013-11-27T04:13:47Z")
> [@Lobohan](#): > > Not all people are stupid. That’s right. Liberals always exclude themselves. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 27, 2013, 4:17am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/184 "2013-11-27T04:17:24Z")
> [@Farin](#): > > You’d be surprised how untrue that is. The same thing that was true pre-ACA would be true with your plan in place: People would simply never get health care and use an emergency room for services when it was critically required. And then, for the poor, their financial lives would be over because, as I touched on earlier, there’s nothing stopping the hospitals from continuing to collect $2,000 per visit to the ER. You can’t protect people from themselves. Or at least, IMO, you shouldn’t. > [@](#): > > By the way, the HDHP where you pay the first $2,000 - $10,000 pre-ACA hasn’t significantly slowed medical inflation since it’s inception. That was the way that people were supposed to drive down costs for employers and insurers, using the “Free market” approach. Because the overwhelming majority of consumers use the policies where their costs are miniscule or zero so the impact of the high-deductible plans is very small. Ban comprehensive insurance and you will see an impact. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [November 27, 2013, 6:00am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/185 "2013-11-27T06:00:22Z")
> [@Terr](#): > > What is it with people not caring enough to read the cites they post? There is not one mention of Canada in that article. > Yes. They buy American drugs from Canada. Because Canada forces pharma companies to sell drugs at low prices. Try that in the US and you will kill pharma companies. Better them than me. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 27, 2013, 6:21am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/186 "2013-11-27T06:21:22Z")
> [@Terr](#): > > You can’t protect people from themselves. Or at least, IMO, you shouldn’t. Then we also need none of the government spending or mandates on roads, phone service, water service, or electrical service. People should be able to provide these to themselves without concern for the needs of the others in the nation, right? There is a basic requirement level that a government should meet in infrastructure. And health care is infrastructure. If our populace is in the middle of anything like an “obesity epidemic”, then we as a country become weaker. We have seen 25 years of waning power because people beat their chest about individual responsibility and never stop and realize that there’s a personal responsibility _to the state_ as well as _to themselves_. As in all things, there is a balance between the state and individual that must be maintained. But we, as a nation, cannot stop and pretend that a basic tenet of our economic process is a cure-all. The laissez-faire free market is already destroying us as a nation. The ever widening wealth gap will push us into civil war in the next century if we don’t stop staring at our navel and coo-cooing ourselves about how good we are. We have problems. They need solutions. The longer we wait to have honest discourse, the more likely we get solutions like the ACA. Or the PATRIOT Act. or the DMCA. > [@Terr](#): > > Because the overwhelming majority of consumers use the policies where their costs are miniscule or zero so the impact of the high-deductible plans is very small. Ban comprehensive insurance and you will see an impact. HDHPs were roughly 15% of the insurance market pre-ACA. If you don’t feel an impact at 450 Billion in spend (we hit $3 T in medical care costs in 2012) then when will you feel it? 50%? 75%? If the free market is so powerful on it’s own, then it should have had at least some impact by now. And, since you are paying $X out of pocket for your bills before your insurance kicks in, you should have an incentive for cheaper care. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [November 27, 2013, 6:26am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/187 "2013-11-27T06:26:09Z")
> [@Terr](#): > > That’s right. Liberals always exclude themselves. If you weren’t so viscerally angry because of the misinformation you believe, you’d probably have a different viewpoint. I don’t think you’re stupid. I think you’re mislead into thinking you should be outraged. And outrage doesn’t drive good decision making. ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [November 27, 2013, 6:31am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/188 "2013-11-27T06:31:51Z")
> [@Werekoala](#): > > Or they could keep the money, post record profits, drive up stock prices and cash in nice dividends for the CEO etc. > > After all, it’s not like the employees will be taking a pay cut - insurance premiums paid by a company are never part of take-home pay anyway, so why would they just give the money to their employees? > > So cute when they’re naive. Naive is one way to phrase it. I’m sure there are other ways to characterize such statements. ---
**Author:** ![Spoons](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spoons/32/3141_2.png) [@Spoons](https://boards.straightdope.com/u/Spoons)\ **Post date:** [November 27, 2013, 6:33am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/189 "2013-11-27T06:33:49Z")
> [@Trinopus](#): > > This was exactly the example my Australian source mentioned, and a reason many people get supplemental private insurance. A private room is not a medical necessity…but it is nice. It is indeed. > [@](#): > > Cool. And also good! That’s the way it should be. Thank you for the clarification! Glad to help! 🙂 ---
**Author:** ![Evil\_Captor](https://avatars.discourse-cdn.com/v4/letter/e/f17d59/32.png) [@Evil\_Captor](https://boards.straightdope.com/u/Evil_Captor)\ **Post date:** [November 27, 2013, 6:37am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/190 "2013-11-27T06:37:22Z")
> [@Terr](#): > > Slowly but surely getting dimmer and dimmer. Funny, that’s how I’d describe conservatism in the US. ---
**Author:** ![Trinopus](https://avatars.discourse-cdn.com/v4/letter/t/2bfe46/32.png) [@Trinopus](https://boards.straightdope.com/u/Trinopus)\ **Post date:** [November 27, 2013, 7:08am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/191 "2013-11-27T07:08:53Z")
> [@Terr](#): > > . . . You would be surprised just how fast prices will come down when people will actually have to PAY (wow) for services instead of having it being invisibly paid for them. This, however, discourages preventive medicine. Paying a whole bunch for a blood test, for instance, when I happen to feel perfectly fine, seems a waste of money. So I don’t…and miss catching something in the early stages. Oops. “Invisibly” paying for preventive care reduces costs. ---
**Author:** ![Trinopus](https://avatars.discourse-cdn.com/v4/letter/t/2bfe46/32.png) [@Trinopus](https://boards.straightdope.com/u/Trinopus)\ **Post date:** [November 27, 2013, 7:11am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/192 "2013-11-27T07:11:21Z")
> [@Evil\_Captor](#): > > Funny, that’s how I’d describe conservatism in the US. Conservatives always exclude themselves. 😉 ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 27, 2013, 7:36am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/193 "2013-11-27T07:36:17Z")
> [@Farin](#): > > Then we also need none of the government spending or mandates on roads, phone service, water service, or electrical service. People should be able to provide these to themselves without concern for the needs of the others in the nation, right? > > There is a basic requirement level that a government should meet in infrastructure. And health care is infrastructure. Yeah, right. Hell, why don’t you provide clothing as “infrastructure” too? Housing - that’s definitely “infrastructure”. Food - you definitely can live longer without health care than you can without food - that’s “infrastructure”. Just build big housing tracts, house people in them, feed them, clothe them and entertain them. It’s all “infrastructure” - and people are way too stupid to provide all that stuff to themselves. ---
**Author:** ![not\_what\_you\_d\_expect](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/not_what_you_d_expect/32/3246_2.png) [@not\_what\_you\_d\_expect](https://boards.straightdope.com/u/not_what_you_d_expect)\ **Post date:** [November 27, 2013, 12:32pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/194 "2013-11-27T12:32:20Z")
Some people _are_ too stupid to provide for themselves. What should we do with them? ---
**Author:** ![crucible](https://avatars.discourse-cdn.com/v4/letter/c/5f8ce5/32.png) [@crucible](https://boards.straightdope.com/u/crucible)\ **Post date:** [November 27, 2013, 12:39pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/195 "2013-11-27T12:39:56Z")
Vermont seems perfectly capable of working out what is best for Vermonters. One of the problems regarding physician compensation (addressing the question of whether doctors will leave Vermont rather than serve the public under the new system) is the enormous debt burden most of them have when they finally finish medical training. Vermont could help themselves and the debt-burdened young doctors by offering to pay off the debt if the doctors will agree to stay in Vermont at least 10 years. In some communities the offer might extend to setting up a practice (building and equipment). ---
**Author:** ![tomndebb](https://avatars.discourse-cdn.com/v4/letter/t/b9e5f3/32.png) [@tomndebb](https://boards.straightdope.com/u/tomndebb)\ **Post date:** [November 27, 2013, 1:02pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/196 "2013-11-27T13:02:55Z")
Terr, BrainGlutton, Lobohan, ElvisL1ves, Trinopus, (and anyone else thinking of jumping into the sideline discussion): Knock it off. While everything political seems to degenerate into partisan sniping, here, it does not promote the actual debate. [/Moderating] ---
**Author:** ![crucible](https://avatars.discourse-cdn.com/v4/letter/c/5f8ce5/32.png) [@crucible](https://boards.straightdope.com/u/crucible)\ **Post date:** [November 27, 2013, 1:28pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/197 "2013-11-27T13:28:19Z")
> [@crucible](#): > > Vermont seems perfectly capable of working out what is best for Vermonters. > > One of the problems regarding physician compensation (addressing the question of whether doctors will leave Vermont rather than serve the public under the new system) is the enormous debt burden most of them have when they finally finish medical training. > > Vermont could help themselves and the debt-burdened young doctors by offering to pay off the debt if the doctors will agree to stay in Vermont at least 10 years. > > In some communities the offer might extend to setting up a practice (building and equipment). the corollary to that, of course, is that any country deciding to have some form of universal medical service should also have a way to train doctors using tax money instead of loans. Some of that happens today, I suppose you might say, when young MD’s serve in the armed services (and get their debts paid off.???) ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 27, 2013, 1:29pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/198 "2013-11-27T13:29:20Z")
> [@Terr](#): > > Yeah, right. Hell, why don’t you provide clothing as “infrastructure” too? Housing - that’s definitely “infrastructure”. Food - you definitely can live longer without health care than you can without food - that’s “infrastructure”. Just build big housing tracts, house people in them, feed them, clothe them and entertain them. It’s all “infrastructure” - and people are way too stupid to provide all that stuff to themselves. We actually provide infrastructure for all of that, except clothes. We subsidize housing purchases. We subsidize farms. We subsidize roads. We subsidize electrical generation and some portions of the electrical grid. We subsidize water treatment and the major transport pipes. We even still subsidize telephone grids in rural areas. All of those things are used every single day by almost every American. Even the housing subsidies. Why? Not because Americans are “stupid” or that “they can’t provide all that stuff to themselves” but because it is cheaper, more reliable, and overall more efficient for government to do so. It lets Americans build from those (hence “infrastructure”) and make a successful go at life. There are things our government sucks at. But basic infrastructure has been one of it’s long term shining successes. War on Drugs? Laughable failure. Interstate Highway System? Fairly damn good. War on Crime? Yeah…No. Farm management subsidies? Very good. Adding health care to that is a good idea. It, too, gives Americans the ability to build toward success without having to worry about some random cough turning into Ebola-SARS and costing them $2 million in treatment. Or, with your catastrophic plan, $25,000. Both of those hits are crippling financially. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [November 27, 2013, 2:51pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/199 "2013-11-27T14:51:17Z")
> [@PhillyGuy](#): > > In every country, a large portion of the populous thinks that, in important ways, their country is the best. So long as not taken to an extreme, it is a harmless aspect of human nature. True. But thinking your country sets an example others must follow is, quite often in history, not harmless. ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 27, 2013, 3:19pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/200 "2013-11-27T15:19:03Z")
> [@Lobohan](#): > > Sorry you don’t agree. I don’t like the shitty wars the folks you vote for start. I guess we’re even. Ah, I see. THAT’S the level of argument we get. I got it. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=9) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=11)