# 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:** 13
**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, 9:19pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/241 "2013-11-27T21:19:10Z")
> [@Grim\_Render](#): > > And there is nothing that excludes a patient flow from being medical fraud. Patient flow is about patients going elsewhere for treatment. Fraud or not is about how (and if) they pay for it. It can be both. Including medical fraud in “patient flow” is like including shoplifting in the store’s sales. ---
**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, 9:31pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/242 "2013-11-27T21:31:54Z")
> [@Terr](#): > > No, it becomes infrastructure if you call it that. And it stops being infrastructure if you stop calling it that. > Because you choose to call it that way. Actually, because that’s what the definition of the word says. > [@Terr](#): > > You can’t build anything on top of clothes? The society is built on top of clothes. Take all clothes away and it will collapse (well at least in the northern countries). **Really.** I sincerely hope you live in the southern states, because most people can make it from house to car without freezing to death, even without clothing. And then from car to final destination in the same manner. Even with clothes, most places that have a winter environment aren’t open-air. They close most public places off from the elements. Schools aren’t open-air. Malls don’t have a tree/plant area with open roofs. Businesses that want an arboretum create an outside area for it, or at least seal it from the rest of the building. Canada and Norway, Sweden, and Finland would all survive. So would the northern US. Especially if they had a forewarning that clothes were being removed from everyone. But even if they got their knickers magicked off in the middle of the night, they’d still survive, even if life would suck for a couple of months. I can see, though, that you don’t wish serious debate. I’ll drop this here. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 27, 2013, 9:32pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/243 "2013-11-27T21:32:53Z")
> [@Terr](#): > > Including medical fraud in “patient flow” is like including shoplifting in the store’s sales. I think we may be hitting the root of the problem here. A shop exists to sell stuff. A hospital exists to provide healthcare. This is a rather fundamental difference. I believe thinking about healthcare as primarily a business is where you’re going wrong here. So that analogy doesn’t work. A better one would be to think of workers doing a job, like constructing a railway line. If someone absconds with their wages at the end, they may have been defrauded, but the job was still completed. “Patient flow” is when someone goes from one place to another for health care. How it is paid for, and if it is paid normally happens later, and does not retroactivly change the nature of the flow. If a patient goes from a hospital in Honduras to a hospital in Switzerland for an operation, and stiffs them on the bill, that does not at all change the facts retrospectivly: He was a patient and he went elsewhere for treatment. ---
**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, 9:34pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/244 "2013-11-27T21:34:39Z")
> [@Farin](#): > > Canada and Norway, Sweden, and Finland would all survive. So would the northern US. Especially if they had a forewarning that clothes were being removed from everyone. But even if they got their knickers magicked off in the middle of the night, they’d still survive, even if life would suck for a couple of months. Again, because you say so. I don’t think so. ---
**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, 9:35pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/245 "2013-11-27T21:35:41Z")
> [@Grim\_Render](#): > > I think we may be hitting the root of the problem here. A shop exists to sell stuff. A hospital exists to provide healthcare. A hospital doesn’t exist to provide healthcare for free. ---
**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, 9:36pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/246 "2013-11-27T21:36:42Z")
> [@Farin](#): > > Actually, because that’s what the definition of the word says. I believe you’re misinterpreting what the definition of the word says to fit your agenda. ---
**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, 9:39pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/247 "2013-11-27T21:39:00Z")
> [@Farin](#): > > . . . Also, collusion is either bad or it isn’t. If _this_ incident of collusion is okay, then so are the collisions of business. . . . Nope. Some forms of collusion support the public good. One example is the exemption of Major League Baseball from anti-trust laws. This allows the game to be a game, and not (solely) a business. But other forms of collusion are harmful to the public good. Price-fixing is the classic example. Some of us like a public/private arrangement. For instance, the Interstate Highway System is a government project…but private construction firms bid on the job of building individual links of the big chain. The military is run by the government, but private companies sell the individual rifles to the government procurement agencies. Health care can be run this way, and run well: Canada and Australia prove it. Their systems are better than ours. Let’s just get pragmatic. Even hyper-liberal (hah) Ross Perot said this. Other countries have systems that work better than ours. Let’s learn from them! ---
**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, 9:44pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/248 "2013-11-27T21:44:41Z")
> [@Terr](#): > > A hospital doesn’t exist to provide healthcare for free. Neither, in any ontological or definitional sense, does it exist to make a profit. But it does, in an ontological and definitional sense, exist to provide health care. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 27, 2013, 9:44pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/249 "2013-11-27T21:44:42Z")
> [@Terr](#): > > Again, because you say so. I don’t think so. As a resident of Northern Norway, who is looking forwards to sunrise in later january 2014, I rather feel I must support him. No, civilization would not collapse without clothes. I really don’t see what would induce it to do so. > [@Terr](#): > > A hospital doesn’t exist to provide healthcare for free. Well, the vast majority of hospitals in the developed world certainly doesn’t exist to provide it for profit!! As for “_free_”, that is more a question of definition. “_Free_” as in “_Free at the point of delivery_”. Certainly many do. Perhaps most. "_Free"_ as in “costs less than what US citizens pay for government healthcare, without recieving healthcare in return”? Also, the vast majority does that. Taking in less for government healthcare than the US does, per person, and delivering a product over 70 % of US citizens simply don’t get. ---
**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, 9:50pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/250 "2013-11-27T21:50:33Z")
> [@BrainGlutton](#): > > Neither, in any ontological or definitional sense, does it exist to make a profit. But it does, in an ontological and definitional sense, exist to provide health care. A for-profit hospital exists to make a profit, by definition and by its fiduciary duty. A non-profit hospital doesn’t. But in neither case does the hospital exist to provide health care to fraudulent patients. ---
**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, 9:53pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/251 "2013-11-27T21:53:04Z")
> [@Grim\_Render](#): > > As a resident of Northern Norway, who is looking forwards to sunrise in later january 2014, I rather feel I must support him. No, civilization would not collapse without clothes. I really don’t see what would induce it to do so. Take a walk outside for 15 minutes in January naked. Tell me how it went. > [@](#): > > Taking in less for government healthcare than the US does, per person, and delivering a product over 70 % of US citizens simply don’t get. Wow. They really brainwashed you over that didn’t they? You think 70% of US citizens do not get health care? ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 27, 2013, 10:02pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/252 "2013-11-27T22:02:34Z")
> [@Trinopus](#): > > The military is run by the government, but private companies sell the individual rifles to the government procurement agencies. > > Health care can be run this way, and run well: Canada and Australia prove it. Their systems are better than ours. Or for a healthcare example: In Norway, the patient picks the hospital, private or public, and the governement pays the bill and the transport. If some kind of procedure seems to be developing an unacceptable wainting list, the government calls for tender a batch of operations, and hospitals bid on the contract. Public and private. > [@Terr](#): > > A for-profit hospital exists to make a profit, by definition and by its fiduciary duty. A non-profit hospital doesn’t. But in neither case does the hospital exist to provide health care to fraudulent patients. Actually, it may do. In the sense that the distinction between fraudulent and entitled patient is irrelevant to the hospital. The hopsital is built, it has a staff that in on a salary, and the marginal costs for a patient of this sort are often neglible. Expensive procedures are normally a long in-patient time, and is not a favorite of people relying on false papers. The costs show up at a much higher level than the hospital, which is just there to -provide health care. ---
**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, 10:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/253 "2013-11-27T22:03:30Z")
> [@Trinopus](#): > > Nope. Some forms of collusion support the public good. One example is the exemption of Major League Baseball from anti-trust laws. This allows the game to be a game, and not (solely) a business. > > But other forms of collusion are harmful to the public good. Price-fixing is the classic example. > > Some of us like a public/private arrangement. For instance, the Interstate Highway System is a government project…but private construction firms bid on the job of building individual links of the big chain. The military is run by the government, but private companies sell the individual rifles to the government procurement agencies. > > Health care can be run this way, and run well: Canada and Australia prove it. Their systems are better than ours. > > Let’s just get pragmatic. Even hyper-liberal (hah) Ross Perot said this. Other countries have systems that work better than ours. Let’s learn from them! Those private/public arrangements aren’t collusion, though. The US went “We want highways _here_.” and then gave companies money to go do so under contract. Same with military rifles. Each service branch finds a company/companies that’ll provide the specs they need and then buys from them. This sort of thing is basic business. Collusion is giving Comcast a municipal monopoly for Cable TV service. Or requiring everyone buy insurance from private companies. The pain and suffering of what’s offered doesn’t hurt the municipality or the service provider, it hurts the citizen. I also think that single payer could work very well. I advocate for it. If they had passed Law HealthCareX and given the list of prices to pay for each service and insurance companies were out of it, I would probably support it. (Obviously, I’d be interested in the costs providing a reasonable life for doctors and not, like, 28 cents per office visit or something.) As for the MLB exemption, I disagree with that as it’s showing favor to a specific business. No other sport enjoys that protection and they are working well. So why should MLB continue to enjoy this century-old protectionism? As for a game being a game, maybe so…but why does only ONE business entity of a single sport enjoy that protection? And and what income level does it become more of a business than a game? > [@Grim\_Render](#): > > Taking in less for government healthcare than the US does, per person, and delivering a product over 70 % of US citizens simply don’t get. Your number are flipped. About 20-30% of Americans don’t have insurance (or didn’t pre-ACA). ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 27, 2013, 10:09pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/254 "2013-11-27T22:09:32Z")
> [@Terr](#): > > Take a walk outside for 15 minutes in January naked. Tell me how it went. Odds are, it’d go OK if I was spotted shoes. Some types of weather excepted. This is an oceanic climate. However, it is irrelevant, because civilization does not rely on people going for walks any longer than to the car. Believe me, we are motivated to stay inside in winter! Thre are a number of tasks that we could not do, but I’m fairly sure we could improvise around those. > [@Terr](#): > > Wow. They really brainwashed you over that didn’t they? You think 70% of US citizens do not get health care? 72 % of US citizens do not get _ **government** _ health care. Yet government healthcare in the US costs 4200 $ per person per year. Which, in the end, comes from taxes. This is more per person than all other developed countries bar two pay per person to cover 100 %. And that 72 % of US citizens have to for over for insurance or out-of-pocket. ---
**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, 10:22pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/255 "2013-11-27T22:22:09Z")
> [@Grim\_Render](#): > > 72 % of US citizens do not get _ **government** _ health care. I see. Because it is horribly important that it be _ **government** _ health care, not (booga!) non-government kind. ---
**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, 10:23pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/256 "2013-11-27T22:23:17Z")
> [@Grim\_Render](#): > > Odds are, it’d go OK if I was spotted shoes. Please do. In January. I will spot you shoes and underwear. Normal underwear, not long type. 15 minutes. Do provide video as proof. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [November 27, 2013, 10:41pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/257 "2013-11-27T22:41:44Z")
> [@Terr](#): > > Please do. In January. I will spot you shoes and underwear. Normal underwear, not long type. 15 minutes. Do provide video as proof. Actually, please do not. I’m sure I’m not the only one who has no interest in seeing **GR** in his skivvies standing in the freezing cold. ---
**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, 11:25pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/258 "2013-11-27T23:25:55Z")
> [@Terr](#): > > I see. Because it is horribly important that it be _ **government** _ health care, not (booga!) non-government kind. His point is a good one: Americans are already paying quite a bit for government healthcare, and paying yet more for private healthcare. And for what? The care isn’t any better, it just costs more. If everyone could be well covered for what we already pay in taxes, meaning that the bulk of what’s spent on private care could be used for other things, where’s the harm? ---
**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, 11:35pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/259 "2013-11-27T23:35:46Z")
Because _freedom_! If they get control of our health care, they will turn our nation into a festering hell-hole like Sweden, or, God forbid, _Canada_! ---
**Author:** ![Mr.Duality](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mr.duality/32/4098_2.png) [@Mr.Duality](https://boards.straightdope.com/u/Mr.Duality)\ **Post date:** [November 28, 2013, 12:15am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/260 "2013-11-28T00:15:31Z")
> [@Terr](#): > > [Is 8% “large percentage”](http://www.physiciansnews.com/2010/06/17/should-your-practice-outsource-medical-billing/)? [Here’s a cite](http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/) saying medical administration overhead amounts to 21%. [Here’s another](http://www.businessweek.com/articles/2013-04-10/the-reason-health-care-is-so-expensive-insurance-companies) which says it’s 30%. I note that your cite is a fictional scenario. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=12) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=14)