# 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:** 11
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 27, 2013, 4:01pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/201 "2013-11-27T16:01:42Z")
> [@Terr](#): > > You can’t protect people from themselves. Or at least, IMO, you shouldn’t. … This is dogma, faith-based politics. Take for instance depression. There are clearly forms of depression that are not subject to the will and self-reliance of the victim, it can be a disease of the brain and is therefore best approached with treatment. No doubt there is a point of diminishing return, where micro-managing someone’s life is both impractical and ill-advised. But your simplistic duality of right/wrong, yes/no, is not an answer so much as a refusal to answer. It is not impossible to shrug off our moral responsibility to each other, it happens all the time. In America, it is usually done in obedience to the Dollar Almighty. A man would not offer you a goblet of poison because God says he shouldn’t, but that same man will pour toxic crap into your river in obedience to a spreadsheet. ---
**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 27, 2013, 4:15pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/202 "2013-11-27T16:15:33Z")
Anyhoo, back the Vermont law, it seems they already have one [of the waivers they need in hand](http://vtdigger.org/2013/10/03/states-medicaid-waiver-extended/), the Social Security 1115 waiver: > [@](#): > > The federal government granted the state of Vermont a new waiver Wednesday to use Medicaid dollars flexibly for another three years. > > Mark Larson, commissioner of Vermont Health Access, told legislators Wednesday that the state was given a new federal 1115 waiver, which allows the state to run its Global Commitment program for another three years, or until the end of 2016. That program caps the total amount of Medicaid dollars the state can use, but gives the state leeway in how they can use them. There is a cap involved, though, and other waivers remain to be sought. One, the ACA waiver, isn’t available until 2017. I hope all the waivers are granted. If the program is hobbled by federal dictates, it loses all value as an experiment that, if successful, other states might emulate. Let it succeed or fail on its own merits, I say (as a non-Vermonter). ---
**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, 4:32pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/203 "2013-11-27T16:32:32Z")
> [@tomndebb](#): > > 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] Acknowledged. But I’m afraid it’s really **hard** to separate this issue from partisanship. It, like, goes to the heart of what (ever since the constituency-exchange and ideological sorting-out of the two parties in the 1970s) distinguishes Dems from Pubs. I recall a quote in a book, I think it was [_The Republican Noise Machine_](http://www.amazon.com/The-Republican-Noise-Machine-Right-Wing/dp/B000FVQV16) but I’m not sure, from one rich RW donor, Scaife or Coors or a Koch or someone of that kind, who as long ago as the 1980s was absolutely determined to do anything by any means to block any form of health-care reform, because HCR would finally turn America once and for all into a “social democracy.” It’s silly, but there it is. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 27, 2013, 4:37pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/204 "2013-11-27T16:37:06Z")
Right. Once the facts have been sorted out, but the ignorance continues, it certainly does become appropriate to explore the reasons behind the ignorance, in the hopes of limiting further or future promulgation of it. How else can ignorance be effectively fought, if exploring the facts and the context is not sufficient? ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [November 27, 2013, 4:48pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/205 "2013-11-27T16:48:35Z")
It’s true that some health coverage systems are more free-market than others. The ACA brought us closer to a free-market system, since it enables people to choose their insurer independently from choosing their job. Obamacare, if it had been passed, would have been closer yet, since it would have provided another option to compete with the private insurance companies. But the Republican party hates the notion of competition. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [November 27, 2013, 4:53pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/206 "2013-11-27T16:53:05Z")
> [@ElvisL1ves](#): > > Right. Once the facts have been sorted out, but the ignorance continues, it certainly does become appropriate to explore the reasons behind the ignorance, in the hopes of limiting further or future promulgation of it. How else can ignorance be effectively fought, if exploring the facts and the context is not sufficient? Is it your contention that those who don’t share your opinions on this matter are ignorant? Otherwise how is this relevant? ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 27, 2013, 4:54pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/207 "2013-11-27T16:54:25Z")
The public option does still exist for those over 65 or the poor, and it’s worked beautifully for 50 years or so with much greater efficiency than the parasite-burdened private option. Yet the private option exists for everyone nonetheless. Competition is supposed to be a good thing, so we keep getting told, since it makes market participants operate more efficiently. How about we give that a try, hmm? Can the private sector work as well as Medicare/Medicaid or can’t it, and if it can’t, why should we prop it up? ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 27, 2013, 4:55pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/208 "2013-11-27T16:55:25Z")
> [@Bone](#): > > Is it your contention that those who don’t share your opinions on this matter are ignorant? Facts are not matters of opinion. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [November 27, 2013, 5:14pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/209 "2013-11-27T17:14:17Z")
> [@ElvisL1ves](#): > > Facts are not matters of opinion. Is it your contention that all your statements are factual? I can rephrase the question if that will cause you to not dodge it: Is it your contention that those who don’t agree with your assessment of the facts on this matter are ignorant? Otherwise how is this relevant? ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 27, 2013, 5:16pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/210 "2013-11-27T17:16:16Z")
If there were real competition, would health insurance providers make all that much money? Enough money to build huge headquarters buildings with a wide open plaza and an abstract sculpture by the famous artist Whatshisface? Actuarial tables are known, applied science, yes? Given a wide enough pool, it is possible to define your intake and output ratios to a very fine point, because of maths. In that environment, the only place to compete is in the profit margin, since the costs are pretty much the same for all the competitors, there is no raw material to buy more cheaply, there are no factories to build and maintain. If they were in competition, the only advantage Blue Cross might have over Health Partners is by having a three percent profit margin compared to a five percent. The theology of capitalism claims that competition is the driving force for efficiency, and thus the source of benefit for the consumer. But the truth of the matter is that collusion is more profitable and reliable than competition. Make a deal, divide up the territory and the pie, shake hands and hire lobbyists to enshrine your deal into law. And oh! how the money rolls in, rolls in… ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 27, 2013, 5:24pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/211 "2013-11-27T17:24:50Z")
> [@Bone](#): > > Is it your contention that all your statements are factual? If no contravention of a statement of mine deeper than “Obama suxx!” is presented, then what else am I to think? > [@](#): > > Is it your contention that those who don’t agree with your assessment of the facts on this matter are ignorant? Give us an actual example and we can go over it. That’s what we’re here for. But if, for example, a particular “assessment of the facts” is derived from nothing more than “Obama suxx!”, then yes, that’s ignorance, of course. So whaddaya got? ---
**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, 5:33pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/212 "2013-11-27T17:33:14Z")
> [@elucidator](#): > > If there were real competition, would health insurance providers make all that much money? Enough money to build huge headquarters buildings with a wide open plaza and an abstract sculpture by the famous artist Whatshisface? > > Actuarial tables are known, applied science, yes? Given a wide enough pool, it is possible to define your intake and output ratios to a very fine point, because of maths. In that environment, the only place to compete is in the profit margin, since the costs are pretty much the same for all the competitors, there is no raw material to buy more cheaply, there are no factories to build and maintain. If they were in competition, the only advantage Blue Cross might have over Health Partners is by having a three percent profit margin compared to a five percent. > > The theology of capitalism claims that competition is the driving force for efficiency, and thus the source of benefit for the consumer. But the truth of the matter is that collusion is more profitable and reliable than competition. Make a deal, divide up the territory and the pie, shake hands and hire lobbyists to enshrine your deal into law. And oh! how the money rolls in, rolls in… Yes. Collusion short circuits competition. But the government colludes with business on money deals (both projects and laws) all the time. So how is the government dictating rules to private business that only enhances private business at the expense of citizens a good thing? The ACA went “Well, you have to cover pre-existing conditions and a few other things. To offset that _horrible burden_ we will give you all of the people as customers.” How is that any different than the collusion of public/private companies that you seem to detest? Every time I see a government help business in any way, I get a bitter taste in my mouth. Bail outs? Bad. Policy decisions that “help local businesses”? Bad. Tax breaks to entice companies to move to your area? Bad. But it’s all collusion. The citizen public is getting deprived of something (even if it’s simply “taxes”) for the sake of business. That’s outside of what the government should be doing, and they did it in spades with the ACA. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [November 27, 2013, 5:39pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/213 "2013-11-27T17:39:10Z")
> [@ElvisL1ves](#): > > If no contravention of a statement of mine deeper than “Obama suxx!” is presented, then what else am I to think? Can you answer the question in the form of a statement, rather than another question that doesn’t actually address the question presented? Some people consider that weaseling. ---
**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, 5:39pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/214 "2013-11-27T17:39:58Z")
> [@Farin](#): > > How is that any different than the collusion of public/private companies that you seem to detest? In this instance of collusion millions of people have access to health care? ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 27, 2013, 5:41pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/215 "2013-11-27T17:41:38Z")
> [@Bone](#): > > Can you answer the question in the form of a statement, rather than another question that doesn’t actually address the question presented? Some people consider that weaseling. Some people consider the failure to present any actual examples for discussion to be handwaving. ---
**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 27, 2013, 5:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/216 "2013-11-27T17:42:10Z")
> [@elucidator](#): > > If there were real competition, would health insurance providers make all that much money? Enough money to build huge headquarters buildings with a wide open plaza and an abstract sculpture by the famous artist Whatshisface? Why not? Retail certainly has real competition, and I’m sure retailers’ corporate HQs are fancy too. Remember the Sears Tower? > [@elucidator](#): > > Actuarial tables are known, applied science, yes? Given a wide enough pool, it is possible to define your intake and output ratios to a very fine point, because of maths. In that environment, the only place to compete is in the profit margin, since the costs are pretty much the same for all the competitors, there is no raw material to buy more cheaply, there are no factories to build and maintain. If they were in competition, the only advantage Blue Cross might have over Health Partners is by having a three percent profit margin compared to a five percent. There are other areas in which an advantage could be won: more streamlined and efficient processes for booking, billing, working claims, and so forth. Better choices of investments (a major part of insurance companies’ revenue). Innovation in products: pet insurance, term vs. whole life, cancer insurance, discounts for healthy lifestyle choices, etc, etc. Goodwill and a reputation for honest dealings. Aggression in abandoning products that are becoming less profitable, instead of clinging to business-as-usual. > [@elucidator](#): > > The theology of capitalism claims that competition is the driving force for efficiency, and thus the source of benefit for the consumer. Which is true, in markets well-suited to competition. > [@elucidator](#): > > But the truth of the matter is that collusion is more profitable and reliable than competition. Make a deal, divide up the territory and the pie, shake hands and hire lobbyists to enshrine your deal into law. And oh! how the money rolls in, rolls in… Such a cartel will always be unstable, because it’s a prisoner’s dilemma: the ideal outcome for each participant is that they cheat on the cartel agreement, while the other participants do not. The power of government to create and protect cartels is one way around this, and is part of why regulations on business should be carefully written, and judged by quality, not quantity. ---
**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, 5:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/217 "2013-11-27T17:42:13Z")
> [@Bone](#): > > Some people consider that weaseling. I see what you did there. ---
**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, 5:48pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/218 "2013-11-27T17:48:45Z")
> [@Lobohan](#): > > In this instance of collusion millions of people have access to health care? No, millions of people have access to health _insurance_. Because of the high price of premiums and prohibitively expensive out of pocket requirements, a lot of those people are in exactly the same boat they were before, only now with an extra premium or tax (at their choice) to pay. Also, collusion is either bad or it isn’t. If _this_ incident of collusion is okay, then so are the collisions of business. And remember, whatever inch you take to move your agendas forward will be taken by your opposition to move theirs a mile. ---
**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, 5:49pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/219 "2013-11-27T17:49:57Z")
It is difficult to shake partisanship from the health care debate because its very nature strikes at the heart of the values that define left and right. The left favors an inclusive approach, we should care for all citizens, rich or poor, black or white, etc., helping out through government as necessary. The right favors an exclusive approach: we should not care for one another at all, outside a tiny minimum such as “not murdering one another out of hand” saying we should all be self-reliant and not need government help at any time. We all (well most of us) grow old and get sick, so we all need health care at some point, health care that can be ruinously expensive at times. So we’re all involved in this debate. And essential to the debate are our core values. Before we can come to an agreement over how health care should work, we should talk over the values, because our values will frame our viewpoint on the solution. ---
**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, 5:53pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/220 "2013-11-27T17:53:29Z")
> [@Human\_Action](#): > > The power of government to create and protect cartels is one way around this, and is part of why regulations on business should be carefully written, and judged by quality, not quantity. If you are saying “quality of the law” I would disagree. We should measure laws based on the hard results they achieved. If you pass a law that outlaws goats to prevent the spread of goat cheese disease but it instead quadruples the incidents of goat cheese disease, that law should not be expanded. It should be repealed and an understanding of what was actually going on needs to be had before crafting it’s replacement. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=10) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=12)