# 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:** 2
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 25, 2013, 6:17pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/21 "2013-11-25T18:17:50Z")
Wouldn’t be all that surprised. For some, being an MD is their calling, for others, merely their profession. For some, the patient is a human being to be helped, for others, a problem to solve and a check to cash. And so it goes. This is a bold and gutsy step, there are no guarantees. The whole single payer approach depends on the broadest possible demographic base to gain enough efficiency to make it viable. Vermont may be too small, or sick people may move in and burden the system. A lot of people are invested in seeing it fail, so this is not a slam dunk by any means. ---
**Author:** ![Simplicio](https://avatars.discourse-cdn.com/v4/letter/s/c37758/32.png) [@Simplicio](https://boards.straightdope.com/u/Simplicio)\ **Post date:** [November 25, 2013, 6:27pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/22 "2013-11-25T18:27:54Z")
> [@Human\_Action](#): > > 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. My father owns a practice in VT (he’s for the law, FWIW) and I think people underestimate how much time, effort and money go towards dealing with patients that can’t afford to pay, haggling with all the different insurance companies over what gets paid for, trying to figure out the codes and such for all the different plans, etc. Assuming the State sets up a relatively simple system, I think the potential savings are fairly large. I suspect some specialists will see a pay-cut, and a few might leave, but that most hospitals and practices in general will make out pretty well. Also, most people that live in VT really like living in VT. So even if their bottom lines suffer, I doubt you’ll see that many specialists leave. After all, what’s the point in being rich (and specialists are rich) if you can’t live where you want. ---
**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, 6:38pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/23 "2013-11-25T18:38:55Z")
> [@Farin](#): > > 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? Did I say Vermont would become “completely defunct”? A lot of doctors will move. Mostly the better ones. ---
**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, 6:40pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/24 "2013-11-25T18:40:18Z")
> [@Jas09](#): > > It could make a wonderful case study. I’m all for it. That’s what “state’s rights” were supposed to be - 50 social laboratories. ---
**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, 6:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/25 "2013-11-25T18:42:59Z")
> [@Simplicio](#): > > My father owns a practice in VT (he’s for the law, FWIW) and I think people underestimate how much time, effort and money go towards dealing with patients that can’t afford to pay, haggling with all the different insurance companies over what gets paid for, trying to figure out the codes and such for all the different plans, etc. Assuming the State sets up a relatively simple system, I think the potential savings are fairly large. Exactly. Just about anyone involved in the medical profession has to know the large percentage that goes into billing and receiving. If VT can truly reduce these costs then the reduction in compensation for anything but the highest-paid specialists should be small enough to be completely swamped by the benefits of living where you want. We shall hopefully get some meaningful results in the next few years. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [November 25, 2013, 6:47pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/26 "2013-11-25T18:47:04Z")
> [@Jas09](#): > > It could make a wonderful case study. > > If the exodus does not occur will you reconsider your position on single-payer? We already have Hawaii, it demonstrates that the right wing predicted high numbers of doctors that would “flee” an already expanded medicare did not materialize. The FUD numbers that the right wing sources like the Wall Street Journal predicted were indeed just Chicken little musings. [http://hpr2.org/post/doctors-fleeing-medicare-not-so-fast-feds-say](http://hpr2.org/post/doctors-fleeing-medicare-not-so-fast-feds-say) ---
**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, 6:47pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/27 "2013-11-25T18:47:58Z")
> [@Terr](#): > > That’s what “state’s rights” were supposed to be - 50 social laboratories. History shows that “states’ rights” were supposed to be about keeping slavery. Then about keeping Jim Crow. Then about keeping segregation. Today, about keeping blacks’ access to voting, among other things, limited. But you won’t find this “social laboratories” stuff seriously presented as a central justification outside of recent revisionist screeds. ---
**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\ **Post date:** [November 25, 2013, 6:49pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/28 "2013-11-25T18:49:16Z")
Terr’s probably right. There probably will be doctors who leave Vermont to seek more profitable practices elsewhere. That’s pretty much the fundamental divide on this issue. Do we want a health care system that serves the best interests of special interests like doctors and insurers or do we want a health care system that serves the best interests of the general public? Conveniently, our two major political parties have taken the two different sides on this issue. The Republicans generally favor the special interests and the Democrats generally favor the general public. So people can decide which position they support and vote accordingly. It would be nice if all political issues offered such a clear choice. ---
**Author:** ![Deeg](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deeg/32/2955_2.png) [@Deeg](https://boards.straightdope.com/u/Deeg)\ **Post date:** [November 25, 2013, 6:49pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/29 "2013-11-25T18:49:39Z")
I’m hopeful that they’ll get a meaningful trial out of this to see if it works (or doesn’t). ---
**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, 6:50pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/30 "2013-11-25T18:50:47Z")
> [@Jas09](#): > > Exactly. Just about anyone involved in the medical profession has to know the large percentage that goes into billing and receiving. [Is 8% “large percentage”](http://www.physiciansnews.com/2010/06/17/should-your-practice-outsource-medical-billing/)? ---
**Author:** ![Deeg](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deeg/32/2955_2.png) [@Deeg](https://boards.straightdope.com/u/Deeg)\ **Post date:** [November 25, 2013, 6:53pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/31 "2013-11-25T18:53:50Z")
> [@ElvisL1ves](#): > > History shows that “states’ rights” were supposed to be about keeping slavery. Then about keeping Jim Crow. Then about keeping segregation. Today, about keeping blacks’ access to voting, among other things, limited. The history of states rights also has legalized SSM, liberal drug laws, and the abolishing of the death penalty. We could also mention that slaves were first freed by states rights. States Rights is by itself neither a great evil or an undoubted good. ---
**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, 6:55pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/32 "2013-11-25T18:55:49Z")
> [@Terr](#): > > Expect an exodus of physicians from Vermont. There was none from Canada, AFAIK, or even from the UK. ---
**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, 7:01pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/33 "2013-11-25T19:01:34Z")
> [@BrainGlutton](#): > > There was none from Canada, AFAIK, or even from the UK. My GP is a refugee from NHS. But in general, it is a lot harder to leave a country than it is to leave a state. ---
**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, 7:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/34 "2013-11-25T19:03:14Z")
> [@Deeg](#): > > The history of states rights also has legalized SSM, liberal drug laws, and the abolishing of the death penalty. Fair points, but the states that have done so have still failed in getting those things established nationwide. The “experiments” have proven successful, but the other states have generally not used the results of the “laboratories”. > [@](#): > > We could also mention that slaves were first freed by states rights. Not really. There was no abolition of slavery in any state after the Constitution was ratified, until the Civil War did it by force. The “free” states had abolished it beforehand, or as part of the constitutions they submitted to Congress as part of their statehood applications. > [@](#): > > States Rights is by itself neither a great evil or an undoubted good. The problem is when its alleged goodness is used as an argument _itself_, as a cover for simple obstinacy - especially when accompanied by a demonstrated ignorance of the Constitution’s supremacy clause, as it so often is. Not only is the US not a confederation of states under the Constitution, as we are so often tiresomely told, _it never was._ ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [November 25, 2013, 7:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/35 "2013-11-25T19:03:17Z")
> [@Little\_Nemo](#): > > Terr’s probably right. There probably will be doctors who leave Vermont to seek more profitable practices elsewhere. > > That’s pretty much the fundamental divide on this issue. Do we want a health care system that serves the best interests of special interests like doctors and insurers or do we want a health care system that serves the best interests of the general public? > > Conveniently, our two major political parties have taken the two different sides on this issue. The Republicans generally favor the special interests and the Democrats generally favor the general public. So people can decide which position they support and vote accordingly. > > It would be nice if all political issues offered such a clear choice. I will would also make the point also that many doctors in the long run will benefit, and as the case of Hawaii shows “Yes, some are [leaving]. Long answer: Not as many as you might have thought”. As I have seen on discussions like this one, an important cost item that many miss is that savings for the doctors do happen when there is less private bureaucratic red tape to deal compared with the current system we have, doctors would actually benefit for having less overhead costs. > **[FAQs - PNHP](https://pnhp.org/what-is-single-payer/faqs/)** > > To view a two-page handout containing a selection of these Q&As that is suitable for reproduction, click here. > [@](#): > > In fact, insurance overhead accounts for only one-quarter of total health care administrative costs in the U.S. The complexity of our current reimbursement schemes requires providers to fight with insurers for payment for every aspirin and bandaid. This requires a huge administrative staff, billing computers etc. > > In contrast, a single payer system could greatly streamline providers’ paperwork. Paying hospitals on a lump sum budget basis — e.g. as a fire department is currently paid — could cut hospital administration costs in half. Similar savings could be realized by simplifying doctors’ billing. ---
**Author:** ![blindboyard](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/blindboyard/32/2833_2.png) [@blindboyard](https://boards.straightdope.com/u/blindboyard)\ **Post date:** [November 25, 2013, 7:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/36 "2013-11-25T19:03:47Z")
> [@BrainGlutton](#): > > There was none from Canada, AFAIK, or even from the UK. It’s true that nowhere it the world pays doctors anywhere near as much as the USA. Yet most countries in the West have more doctors per capita than America. ---
**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, 7:04pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/37 "2013-11-25T19:04:05Z")
> [@Little\_Nemo](#): > > Terr’s probably right. There probably will be doctors who leave Vermont to seek more profitable practices elsewhere. > > That’s pretty much the fundamental divide on this issue. Do we want a health care system that serves the best interests of special interests like doctors and insurers or do we want a health care system that serves the best interests of the general public? It is a fundamental divide - between people who think that if you reduce a doctor to a civil servant with a “reasonable” salary, you will get the same quality as you would in a high-income-for-doctors market system. ---
**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, 7:04pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/38 "2013-11-25T19:04:31Z")
> [@Deeg](#): > > The history of states rights also has legalized SSM, liberal drug laws, and the abolishing of the death penalty. We could also mention that slaves were first freed by states rights. States Rights is by itself neither a great evil or an undoubted good. There’s also legal abortion, protection from involuntary commitment, environmental regulations, and other areas. > [@ElvisL1ves](#): > > But you won’t find this “social laboratories” stuff seriously presented as a central justification outside of recent revisionist screeds. That doesn’t make it a bad idea, though. ---
**Author:** ![QuickSilver](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quicksilver/32/7832_2.png) [@QuickSilver](https://boards.straightdope.com/u/QuickSilver)\ **Post date:** [November 25, 2013, 7:05pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/39 "2013-11-25T19:05:19Z")
> [@BrainGlutton](#): > > There was none from Canada, AFAIK, or even from the UK. It’s slightly easier to leave a state or province than an entire country. Though I imagine a doctor would be a welcome addition in any country. I do wonder if **Terr** would pack his bags and leave Vermont on principal alone, given his objections to the single payer system. ---
**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, 7:08pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/40 "2013-11-25T19:08:01Z")
> [@Human\_Action](#): > > That doesn’t make it a bad idea, though. It isn’t. I agree we should try it sometime. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=1) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=3)