# 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:** 5
**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, 9:45pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/81 "2013-11-25T21:45:04Z")
> [@Terr](#): > > [Now a mere 37% of NHS doctors are white British | UK | News | Express.co.uk](http://www.express.co.uk/news/uk/226820/Now-a-mere-37-of-NHS-doctors-are-white-British) > > They do conflate foreign-trained with foreign-born as opposed to “White British”. That is nice, but is not not what I replied to. In any case the training takes place in the UK with all the costs and training involved. ---
**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, 9:45pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/82 "2013-11-25T21:45:15Z")
> [@GIGObuster](#): > > Previous does not mean last. None of the “previous” links you posted gave any numbers from Hawaii. ---
**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 25, 2013, 9:46pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/83 "2013-11-25T21:46:58Z")
> [@Terr](#): > > Expect an exodus of physicians from Vermont. That was predicted in the UK at the establisment of the NHS. It failed to materialize. It was predicted in Canada, when UHC was established. It failed to materialize. It was, as far as I know, prediced in all the countries that transitioned to UHC at the time it was introduced, and it never materialized in any of them. But honestly, if it didn’t happen in Canada which has a huge border with the US, a country where doctors are paid far better and the climate is more pleasant, the drain isn’t going to be worse elsewhere. Canada is about as bad as I expect it gets. > [@Terr](#): > > How does “doctors per capita” correlate to the quality of the health system, exactly? It is a minor Public Health measure used when comparing countries health care systems. Basically, while having more doctors than you need does not significantly affect a systems performance, having fewer than needed causes performance to drop sharply. > [@Terr](#): > > I’d rather have 10 good doctors than 20 crappy ones in the system. In Vermont, the quality of the doctors won’t change (except maybe to the worse, since the good one will be the ones leaving, because it’s easier for them to find employment elsewhere). The quantity will. Probably not. First off, the better doctors will be the more experienced ones, who are more established. Money is less of a motivator than you think at this level. You are in general well into diminishing returns for more oney at this point. Your kids having a good environment, your spouse a good job, happiness with what you do etc, are going to count for more at this level. Doctors that move location on the average tend to be young, inexperienced and footloose. In addition, observe that the average quality of physicians is probably higher in single payer countries. > [@Tom\_Tildrum](#): > > 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. And that is a bit of a problem. Single payer is more economically efficient and costs less money that the current US mishmash of public systems. But single payer as an additional layer on top of those systems will be more expensive. > [@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. Actually, [it is 30 % of current graduates.](http://www.bmj.com/content/329/7466/597) And its hardly because native born are unwilling to become doctors! Which is, bluntly put, a ridiculous idea. I assure you that no university place in medicine is left open at the end of clearing! In recent history, the UK government has paid for university, and physicans spend many years being educated, and require labs and practice placements. They are expensive. When the demand for physicans rise, it is far cheaper to just hire readily educated medical staff from the thrid world. (An option I have browsed a couple of times myself.) > [@Ibn\_Warraq](#): > > 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. That is an actual reason. However, you seem to assume there will be a significant pay cut and that it will affect interns. ---
**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, 9:49pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/84 "2013-11-25T21:49:43Z")
> [@Terr](#): > > None of the “previous” links you posted gave any numbers from Hawaii. :rolleyes: Post #26 > [@](#): > > Are doctors so fed up with Medicare’s stagnant pay and bureaucratic rules that they’re bailing out of the program? > > Short answer: Yes, some are. Long answer: Not as many as you might have thought. > [@](#): > > The number of doctors who split was 9,539 in 2012, compared with 3,700 who dropped out in 2009. Sounds bad for Medicare beneficiaries looking for care. > > Still, there were about 685,000 doctors participating in Medicare in 2012. And the number of caregivers goes over 1 million, if you add in nurse practitioners and other nondoctors. > > And some analysts at the Department of Health and Human Services just ran the numbers on doctors and whether or not they’re taking new patients. The findings are reassuring. > > They found that the proportion of docs taking new patients has held pretty steady for Medicare in recent years — rising about 3 percentage points, actually, to 90.7 percent in 2012 from 87.9 percent in 2005. In recent years, the proportion of doctors taking on new Medicare patients was higher than it was for those with private insurance. (See the chart.) ---
**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, 9:51pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/85 "2013-11-25T21:51:10Z")
If the topic is going to shift to foreign-educated physicians, the US has its fair share as well. The latest number I saw was over 25% of residency slots are filled by FMGs (which I guess compares to the 40% number for the UK mentioned above). One study’s results showed that foreign-born doctors do not have worse outcomes than US-born ones, although US-born but foreign-educated doctors do. (2010 study linked here: [http://content.healthaffairs.org/content/29/8/1461.abstract](http://content.healthaffairs.org/content/29/8/1461.abstract)) ---
**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, 9:57pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/86 "2013-11-25T21:57:36Z")
> [@Grim\_Render](#): > > That was predicted in the UK at the establisment of the NHS. It failed to materialize. [It happened.](http://www.ncbi.nlm.nih.gov/pubmed/20363767) As in “major demographic exodus of British-trained doctors in the late 1950s and early 1960s”. > [@](#): > > It was predicted in Canada, when UHC was established. It failed to materialize. In the 90s about 1% of doctors every year left for the US. And you underestimate the difficulty of moving from country to country vs. moving from state to state. There is a huge difference. ---
**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, 9:58pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/87 "2013-11-25T21:58:46Z")
> [@GIGObuster](#): > > :rolleyes: > > Post #26 The link is not about Hawaii. About the whole US. You really don’t read the links you give, do you? ---
**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, 10:05pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/88 "2013-11-25T22:05:40Z")
> [@Terr](#): > > The link is not about Hawaii. About the whole US. You really don’t read the links you give, do you? I actually do, but on this case: :smack: I had a link to another report on the Hawaii costs in mind. Still, unless you can show that Hawaii is not part of the USA we will have to assume that the numbers for Hawaii **are fewer**. ---
**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, 10:05pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/89 "2013-11-25T22:05:44Z")
> [@Terr](#): > > I’d rather have 10 good doctors than 20 crappy ones in the system. Don’t you think any who fulfills his state’s licensing requirements would be perfectly adequate? And most of the time adequate is all you need. This isn’t the 19th Century, when the country was full of half-schooled quacks doing more harm than good and well-schooled doctors were not much better. ---
**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, 10:10pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/90 "2013-11-25T22:10:36Z")
> [@WillFarnaby](#): > > The ACA \*was written \*by the special interests. That pretty much blows up this nonsense. > [@ElvisL1ves](#): > > 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. Michael Moore said it best: In discussions of health-care reform, “The health insurance companies are the enemy and should not have a seat at the table.” ---
**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 25, 2013, 10:12pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/91 "2013-11-25T22:12:25Z")
> [@Terr](#): > > [It happened.](http://www.ncbi.nlm.nih.gov/pubmed/20363767) As in “major demographic exodus of British-trained doctors in the late 1950s and early 1960s”. From the war-ravaged UK to **Canada** , which was just setting up UHC. If single payer was the reason, it seems peculiar that doctors would wait 7-13 yeand then go to another single payer country. > [@Terr](#): > > In the 90s about 1% of doctors every year left for the US. And you underestimate the difficulty of moving from country to country vs. moving from state to state. There is a huge difference. Cite please? In any case, we can assume that Canada is a worst-case. It seems coverable by graduating more doctors than in the US, something that is neccessary anyway, given the large patient-flow from the US to Canada. ---
**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, 10:18pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/92 "2013-11-25T22:18:53Z")
> [@Grim\_Render](#): > > Cite please? [http://www.cfhi-fcass.ca/sf-images/default-source/images/mythbuster\_migration\_chart.jpg?sfvrsn=0](http://www.cfhi-fcass.ca/sf-images/default-source/images/mythbuster_migration_chart.jpg?sfvrsn=0) Shows 500-700 physicians leaving a year in the 90s. That’s about 1%. Note that this is a “mythbuster” site so they wouldn’t exaggerate the numbers. ---
**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, 10:20pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/93 "2013-11-25T22:20:19Z")
> [@Grim\_Render](#): > > given the large patient-flow from the US to Canada. Cite? ---
**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 25, 2013, 10:31pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/94 "2013-11-25T22:31:37Z")
> [@Terr](#): > > [http://www.cfhi-fcass.ca/sf-images/default-source/images/mythbuster\_migration\_chart.jpg?sfvrsn=0](http://www.cfhi-fcass.ca/sf-images/default-source/images/mythbuster_migration_chart.jpg?sfvrsn=0) > > Shows 500-700 physicians leaving a year in the 90s. That’s about 1%. Note that this is a “mythbuster” site so they wouldn’t exaggerate the numbers. Thank you. > [@Terr](#): > > Cite? [Phantoms in the Snow, Health Affairs,](http://content.healthaffairs.org/content/21/3/19.full) is the best work I am aware of on Canada-US patient flow. Less work has been done on the other direction but a report for Ontario’s Health Minister on the subject is pretty good. I don’t think the report is online, but [reports on it is.](http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all&src=pm) I feel this forlong hope of a Canadain medical official speaking of the system being clogged up by Americans bear mentioning: _“Anyway, we hope it’s a temporary phenomenon, until President Clinton gets his health plan through.”_ ---
**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, 10:35pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/95 "2013-11-25T22:35:32Z")
> [@Grim\_Render](#): > > [Phantoms in the Snow, Health Affairs,](http://content.healthaffairs.org/content/21/3/19.full) is the best work I am aware of on Canada-US patient flow. Your post said “large patient-flow from the US to Canada.” Why would you give me the link for the flow from Canada to the US? > [@](#): > > Less work has been done on the other direction but a report for Ontario’s Health Minister on the subject is pretty good. I don’t think the report is online, but [reports on it is.](http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all&src=pm) So it is not patient flow. It is medical fraud. There is a lot of it, but it has nothing to do with “patient flow from the US to Canada”. That presupposes non-fraudulently-obtained medical care. ---
**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, 10:43pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/96 "2013-11-25T22:43:41Z")
> [@BrainGlutton](#): > > Don’t you think any who fulfills his state’s licensing requirements would be perfectly adequate? And most of the time adequate is all you need. This isn’t the 19th Century, when the country was full of half-schooled quacks doing more harm than good and well-schooled doctors were not much better. I have had a lot of experience (unfortunately) with doctors. All of them “fulfilled their state’s licensing requirements”. Some of those experiences were good. Some were horrendous. So - maybe “most of the time adequate is all you need”. But it’s those times when adequate won’t do that are life-defining. And you never know, when you go to your doctor, if it’s one of those times. ---
**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, 10:56pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/97 "2013-11-25T22:56:11Z")
> [@Terr](#): > > I have had a lot of experience (unfortunately) with doctors. All of them “fulfilled their state’s licensing requirements”. Some of those experiences were good. Some were horrendous. So - maybe “most of the time adequate is all you need”. But it’s those times when adequate won’t do that are life-defining. And you never know, when you go to your doctor, if it’s one of those times. Sounds better than not having a doctor at all. As me and some family members do. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [November 26, 2013, 1:47am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/98 "2013-11-26T01:47:26Z")
> [@Terr](#): > > Cite? [2 million americans a year.](http://www.law.harvard.edu/news/bulletin/2013/summer/feature_1.php) [1-10 americans buys drugs from Canada.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936287/) Doctors list paperwork and bureaucracy as major reasons they are burned out. If Vermonts single payer system creates a system that streamlines administration it will hopefully reduce that motive. Also (I have no idea if this is true) if saving time on paperwork allows doctors to spend more time with patients then they may get a better work/life balance, another major burnout factor for doctors. Plus a lot of people have ideological or moral reasons for supporting single payer. So there could be a move towards Vermont for some doctors who find their system more moral, streamlined and ideologically sound. People will have to wait and see what happens. ---
**Author:** ![kanicbird](https://avatars.discourse-cdn.com/v4/letter/k/5f8ce5/32.png) [@kanicbird](https://boards.straightdope.com/u/kanicbird)\ **Post date:** [November 26, 2013, 2:33am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/99 "2013-11-26T02:33:41Z")
> [@Terr](#): > > Seriously? You want the state to decide what is “adequate” compensation for you? > > Let’s say as a doctor you can make “respectable” living in Vermont. But in a neighboring state you can make twice as much, working as much. Don’t you think you would move? State jobs seem pretty highly desired, so state compensation seems fairly good in the eyes of many. And for those who love the profession I can see no better happening then getting rid of the nightmare of insurance paperwork and overhead and just be able to practice medicine. Now doctors who are just in it for the money may move, but those are in it for the money. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [November 26, 2013, 2:44am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/100 "2013-11-26T02:44:34Z")
Plenty of rich folks for them to work for. Maybe not _that_ many, but hey, it’s healthy competition! Be good for them, competing for that fairly limited population. Who knows, might even revive the custom of the “house call”! Assuming they are willing to present themselves at the tradesman’s entrance, of course. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=4) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=6)