# 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:** 4
**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, 7:47pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/61 "2013-11-25T19:47:09Z")
> [@Ravenman](#): > > Sigh. Still no response as to why overpaid doctors aren’t as happy as others. I don’t really know (or care) why. It is not a controlled study - there are literally hundreds of variables not controlled for when you compare country to country. As I pointed out with the Belarus to Belgium thing. ---
**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, 7:48pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/62 "2013-11-25T19:48:30Z")
> [@Procrustus](#): > > Another thing Vermont doctors will like is not having to pay health insurance premiums for their employees… That will save them many thousands of dollars. I am sure Vermont doctors will also be very happy to pay that “slight increase” (LOL, yeah, that’s the ticket) in taxes that the “single payer” will rely on. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [November 25, 2013, 7:52pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/63 "2013-11-25T19:52:20Z")
> [@Terr](#): > > I don’t really know (or care) why. It is not a controlled study - there are literally hundreds of variables not controlled for when you compare country to country. As I pointed out with the Belarus to Belgium thing. I guess the answer is denial, then. ---
**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, 7:54pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/64 "2013-11-25T19:54:40Z")
> [@Terr](#): > > I am sure Vermont doctors will also be very happy to pay that “slight increase” (LOL, yeah, that’s the ticket) in taxes that the “single payer” will rely on. Based on the link by **Ravenman** , I have to say that many doctors will not agree with you, the item that causes the most complains for the doctors is the delays and lack of access their patients have. IOW, the current system we have. ---
**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, 7:59pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/65 "2013-11-25T19:59:39Z")
> [@GIGObuster](#): > > Based on the link by **Ravenman** , I have to say that many doctors will not agree with you, the item that causes the most complains for the doctors is the delays and lack of access their patients have. IOW, the current system we have. Yup. Show me a study that asked the doctors whether they would be happy with a system that would eliminate the “delays and lack of access” in return for a 50% cut in their income. Without it, the link by Ravenman is meaningless. “Would you like a pony?”. “Yes, I would”. ---
**Author:** ![Tom\_Tildrum](https://avatars.discourse-cdn.com/v4/letter/t/e95f7d/32.png) [@Tom\_Tildrum](https://boards.straightdope.com/u/Tom_Tildrum)\ **Post date:** [November 25, 2013, 8:00pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/66 "2013-11-25T20:00:12Z")
A clarification: Vermont has not yet worked out how the system will be [funded](http://digital.vpr.net/post/analysis-can-man-figure-out-how-fund-single-payer). An earlier iteration called for a 10% tax on businesses and a 4% tax on individuals, but that was deemed to steep even for Vermont. From the sound of it, they are largely back to the drawing board on the financing side of this reform. ---
**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, 8:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/67 "2013-11-25T20:03:32Z")
> [@Farin](#): > > Please cite references to when this was true in previous instances of switching from nonSP to SP. I’m actually interested. There was no comparable case. As I said, moving inside a country is a lot easier than emigrating from a country. ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 25, 2013, 8:05pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/68 "2013-11-25T20:05:40Z")
I think it’s great for Vermont to try this experiment. I’m anxious to see how it works. And, no, I’m not being sarcastic. Frankly, the ACA is so cumbersome, complex, incomplete and costly I’m not sure I wouldn’t rather have seen implementation of a single payer system instead. For those that mentioned Hawaii, it’s just too remote and different to offer up much evidence one way or the other, so Vermont will (hopefully) provide some real-world results. And, yes, I’m aware other countries have single payer systems, but they also have many other differences from US health care, so you can’t tally up just the positives without also considering the negatives and general social and economic factors. ---
**Author:** ![elninost0rm](https://avatars.discourse-cdn.com/v4/letter/e/ed655f/32.png) [@elninost0rm](https://boards.straightdope.com/u/elninost0rm)\ **Post date:** [November 25, 2013, 8:05pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/69 "2013-11-25T20:05:55Z")
> [@Terr](#): > > You know what - put up a poll. Give the theoretical situation - you’re getting job satisfaction, but you are offered 100% more money in another state. For the sake of argument, make the standard-of-living levels the same in both states. What do you think will be the percentage of people that would move? Not me. There’s 1, and I’m assuming 2 given the person you were replying to. The Almighty Dollar has limited importance for some of us. Sorry to disappoint. Time to return to being a “cog in the machine”. Woe is me. ---
**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, 8:06pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/70 "2013-11-25T20:06:17Z")
> [@Terr](#): > > Yup. Show me a study that asked the doctors whether they would be happy with a system that would eliminate the “delays and lack of access” in return for a 50% cut in their income. Without it, the link by Ravenman is meaningless. “Would you like a pony?”. “Yes, I would”. As the numbers from Hawaii show, it is not really 50%, and stop with the FUD already. For sure there will be unhappy doctors, but not as much as you assume when many do care about their patients. ---
**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, 8:10pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/71 "2013-11-25T20:10:18Z")
> [@GIGObuster](#): > > As the numbers from Hawaii show, it is not really 50%, and stop with the FUD already. For sure there will be unhappy doctors, but not as much as you assume when many do care about their patients. Of course they do. And they will care about their new patients as well, in whatever place they move to. And what numbers from Hawaii? Can you show me what the compensation for doctors under Hawaii’s “single-payer” will be? ---
**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, 8:20pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/72 "2013-11-25T20:20:04Z")
> [@Orwell](#): > > I think it’s great for Vermont to try this experiment. I’m anxious to see how it works. And, no, I’m not being sarcastic. Frankly, the ACA is so cumbersome, complex, incomplete and costly I’m not sure I wouldn’t rather have seen implementation of a single payer system instead. For those that mentioned Hawaii, it’s just too remote and different to offer up much evidence one way or the other, so Vermont will (hopefully) provide some real-world results. I still do not think this is a good point, it is an expanded kind of Medicare what we are talking about, and Doctors that are leaving medicare there just become private doctors, they are not leaving Hawaii. Remoteness is not much of a factor. > [@Orwell](#): > > And, yes, I’m aware other countries have single payer systems, but they also have many other differences from US health care, so you can’t tally up just the positives without also considering the negatives and general social and economic factors. In reality many of the health care systems in Europe are not just single payer, the closest one to the mix that we are attempting to make in the USA happened in Switzerland and while it is the most expensive by GDP after the USA, it is still almost half of what the USA [del]wastes[/del] is expending. ---
**Author:** ![WillFarnaby](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/willfarnaby/32/514_2.png) [@WillFarnaby](https://boards.straightdope.com/u/WillFarnaby)\ **Post date:** [November 25, 2013, 8:26pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/73 "2013-11-25T20:26:57Z")
> [@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. The ACA \*was written \*by the special interests. That pretty much blows up this nonsense. ---
**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, 8:38pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/74 "2013-11-25T20:38:17Z")
> [@Terr](#): > > Of course they do. And they will care about their new patients as well, in whatever place they move to. > > And what numbers from Hawaii? Can you show me what the compensation for doctors under Hawaii’s “single-payer” will be? The numbers I mentioned came from the previous link I made, In Hawaii the progress is going towards single payer and Hawaii was ahead of other states on offering UHC. In any case I do think that a lot of Doctors in Hawaii are in favor of single payer thanks to the endorsement by the Hawaii Medical Association: > **[About Single Payer - PNHP](https://pnhp.org/what-is-single-payer/)** > > Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer... > [@](#): > > Doctors > > Doctors’ incomes would change little, though the disparity in income between specialties would shrink. The need for a “wallet biopsy” before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy. > > Medical endorsements include PNHP (18,000), the American Public Health Association (30,000), American Association of Community Psychiatrists, Massachusetts Academy of Family Practice, American Medical Women’s Association (13,500), Alameda-Contra Costa Medical Society, American Medical Student’s Association, D.C. Medical Society, National Medical Association (6,500), American College of Physicians (Illinois Chapter), Long Island Dermatological Society, Islamic Medical Association, National Nurses United (160,000), American Nurses Association, the D.C. chapter of the American Medical Association, and the Hawaii Medical Association. ---
**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, 8:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/75 "2013-11-25T20:42:46Z")
> [@WillFarnaby](#): > > The ACA \*was written \*by the special interests. Yes, without the need to placate the insurance industry by giving them a bunch of healthy new rate-payers, we might already \*have \*full single-payer. ---
**Author:** ![Ibn\_Warraq](https://avatars.discourse-cdn.com/v4/letter/i/e19b73/32.png) [@Ibn\_Warraq](https://boards.straightdope.com/u/Ibn_Warraq)\ **Post date:** [November 25, 2013, 9:05pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/76 "2013-11-25T21:05:43Z")
> [@BrainGlutton](#): > > There was none from Canada, AFAIK, or even from the UK. IIRC, something like 60-70% of all doctors in the UK were educated in Third World countries because frankly they have so few native born willing to become doctors because they don’t find the compensation worth it. In the US the average medical school graduate owes around 120,000 dollars in student loans and makes very little for the first 3-5 years as interns, so most don’t start making real money until their early 30s. It seems foolish to me to believe a significant pay cut won’t cause many to move. ---
**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, 9:21pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/77 "2013-11-25T21:21:32Z")
> [@Ibn\_Warraq](#): > > IIRC, something like 60-70% of all doctors in the UK were educated in Third World countries because frankly they have so few native born willing to become doctors because they don’t find the compensation worth it. > > In the US the average medical school graduate owes around 120,000 dollars in student loans and makes very little for the first 3-5 years as interns, so most don’t start making real money until their early 30s. > > It seems foolish to me to believe a significant pay cut won’t cause many to move. IIRC it was the Telegraph that reported that big number of 60-70%, but looking at the source where they claimed to get the info from, the numbers from the World Region of PMQ that refers to the region in which a doctor gained their initial qualification shows that 60% were trained in the UK. [http://www.gmc-uk.org/doctors/register/search\_stats.asp](http://www.gmc-uk.org/doctors/register/search_stats.asp) ---
**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, 9:29pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/78 "2013-11-25T21:29:01Z")
> [@GIGObuster](#): > > The numbers I mentioned came from the previous link I made The previous link you made was not about Hawaii. It was about US en toto. Did you not notice that? ---
**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, 9:40pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/79 "2013-11-25T21:40:13Z")
> [@GIGObuster](#): > > IIRC it was the Telegraph that reported that big number of 60-70%, but looking at the source where they claimed to get the info from, the numbers from the World Region of PMQ that refers to the region in which a doctor gained their initial qualification shows that 60% were trained in the UK. > > [http://www.gmc-uk.org/doctors/register/search\_stats.asp](http://www.gmc-uk.org/doctors/register/search_stats.asp) > **[Now a mere 37% of NHS doctors are white British](https://www.express.co.uk/news/uk/226820/Now-a-mere-37-of-NHS-doctors-are-white-British)** > > AN influx of foreign doctors means just one in three is now classed as white British, astonishing new figures revealed yesterday. They do conflate foreign-trained with foreign-born as opposed to “White British”. And there is this: [The NHS Needs More British Doctors, Senior Surgeon Warns - American Renaissance](http://www.amren.com/news/2013/08/the-nhs-needs-more-british-doctors-senior-surgeon-warns/) The GMC registers 13,000 doctors a year, 6,000 or whom come from foreign countries and start work with “little or no knowledge and experience of British culture or of our health service—and this in the most people-centric occupation of all. It really does matter,” he said. A GMC survey found that foreign-trained doctors are up to four times more likely to be suspended or struck off than their UK colleagues. ---
**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, 9:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/80 "2013-11-25T21:42:23Z")
> [@Terr](#): > > The previous link you made was not about Hawaii. It was about US en toto. Did you not notice that? Previous does not mean last. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=3) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=5)