# 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:** 7
**Author:** ![Spoons](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spoons/32/3141_2.png) [@Spoons](https://boards.straightdope.com/u/Spoons)\ **Post date:** [November 26, 2013, 10:28am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/121 "2013-11-26T10:28:08Z")
> [@Terr](#): > > In fact, I don’t think there can be any legal “patient flow” from US to Canada, since AFAIU Canadian doctors are not allowed to accept private patients or perform private services. Incorrect. If an American with private insurance (Aetna, Cigna, Kaiser, etc.) presents at a Canadian physician’s office with a medical problem, the Canadian physician will treat the problem and either bill back to the American insurer (less common), or ask for payment from the American patient at point-of-sale (more common; and Visa and MasterCard are accepted). Insurance forms are downloadable; the American patient will be provided with the correct forms to be submitted to his or her insurer, and the patient should eventually be repaid. Assuming the treatment is covered under the policy, of course. Canadian physicians are privately employed; which means that if they wish to accept only patients with private insurance, they can do so. However, most don’t, as Canadian patients don’t have private insurance, and foreigners with private insurance are not as common as Canadians with provincial plans. Still, if a Canadian physician is willing to accept private insurance from a foreigner, there is nothing stopping him or her from doing so. I used to work for the Ontario Ministry of Health, and I’m citing my experience here. ---
**Author:** ![Farin](https://avatars.discourse-cdn.com/v4/letter/f/e79b87/32.png) [@Farin](https://boards.straightdope.com/u/Farin)\ **Post date:** [November 26, 2013, 1:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/122 "2013-11-26T13:03:14Z")
> [@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? Put up a poll asking only if they’d move to take a pay increase, keeping all other indicators the same? Why, yes, that makes sense. Despite me telling you explicitly that it wasn’t about the money. How about you put up a poll and ask people how much job satisfaction matters to them. Ask them if they’d prefer to work at WalMart or Microsoft when the wage is the same. > [@Terr](#): > > There was no comparable case. As I said, moving inside a country is a lot easier than emigrating from a country. > [@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”. > 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. :dubious: There is no mention of the 1990s in your cite. Perhaps you are right: > [@Terr](#): > > What is it with people not caring enough to read the cites they post? There is not one mention of Canada in that article. > Yes. They buy American drugs from Canada. Because Canada forces pharma companies to sell drugs at low prices. Try that in the US and you will kill pharma companies. > [@Terr](#): > > The guy I was responding to talked about the patient flow from US to Canada. I asked for a cite. You jump in with a cite that has no mention of Canada whatsoever. Why did you respond to me with that cite? Was that relevant to my question? > It probably makes them money but on the thinnest of margins. They make it up by jacking up prices in the US. If there was no US to jack up prices in, those prices in Canada would not be supportable. So, the United States should subsidize the pharmaceutical pricing in the rest of the world? We currently pay roughly an average of [400% more](http://www.ncbi.nlm.nih.gov/pubmed/22392823) for our drugs than any other European or North American country. Why on earth would or should we continue this? > [@Terr](#): > > It may be Canadians’ choice to have 5-month average wait times for any specialist procedures, but I bet you if you put the question of whether they wanted something like that here to most US health care consumers, they’d laugh at you. And yes, I know, you don’t have to tell me, you personally would be all for it. Talking about wait times for certain surgeries is misleading. It’s focusing on a single point about a system instead of looking at the system in whole. When was the last time the US had 86% approval of anything our government does? Now, **Terr** , what would you suggest we do to both bring down costs for everyone in the US while at the same time providing care for the people who currently lack it (in the 15-45 million range, depending who’s numbers you like)? American’s desire to be exceptional is bankrupting us. Not just the US, but the people within the US, as well. We need solutions and not just complaining about minor facets of things that are different. ---
**Author:** ![cmkeller](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cmkeller/32/118_2.png) [@cmkeller](https://boards.straightdope.com/u/cmkeller)\ **Post date:** [November 26, 2013, 1:21pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/123 "2013-11-26T13:21:18Z")
Farin: > [@](#): > > When was the last time the US had 86% approval of anything our government does? The attack on Afghanistan, post-9/11/2011, maybe? If not, I’d guess the first Gulf War. ---
**Author:** ![davida03801](https://avatars.discourse-cdn.com/v4/letter/d/b5e925/32.png) [@davida03801](https://boards.straightdope.com/u/davida03801)\ **Post date:** [November 26, 2013, 3:10pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/124 "2013-11-26T15:10:05Z")
Isn’t this exactly the way the original concept of the Union was set up ? Each state gets to conduct it’s own affairs as it sees fit. What may, or may not, work in Vermont is their affair. People can move there if they like and Physicians can leave if they like. Be interesting to see how it pans out. btw…Grew up in the Green Mountain State ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 26, 2013, 4:32pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/125 "2013-11-26T16:32:02Z")
> [@Spoons](#): > > Incorrect. If an American with private insurance (Aetna, Cigna, Kaiser, etc.) presents at a Canadian physician’s office with a medical problem, the Canadian physician will treat the problem and either bill back to the American insurer (less common), or ask for payment from the American patient at point-of-sale (more common; and Visa and MasterCard are accepted). So - why in the world would the American patient do that? He likes to wait for his doctor’s appointment for five months instead of getting immediate service? ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [November 26, 2013, 4:35pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/126 "2013-11-26T16:35:20Z")
> [@Terr](#): > > Yes. They buy American drugs from Canada. Because Canada forces pharma companies to sell drugs at low prices. Try that in the US and you will kill pharma companies. Nobody’s **forcin’** nuttin’. The pharma companies have the option of not selling in Canada at all. That they do shows they still find the trade profitable under those imposed conditions; why would it not be the same in the U.S.? ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 26, 2013, 4:36pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/127 "2013-11-26T16:36:52Z")
> [@Terr](#): > > So - why in the world would the American patient do that? He likes to wait for his doctor’s appointment for five months instead of getting immediate service? I’m thinking vacation. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 26, 2013, 4:38pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/128 "2013-11-26T16:38:29Z")
> [@Farin](#): > > Put up a poll asking only if they’d move to take a pay increase, keeping all other indicators the same? Why, yes, that makes sense. Despite me telling you explicitly that it wasn’t about the money. This was your post: If your job lets you get job satisfaction, but paid half of what is paid in another state, you’d probably stay there, despite the pay increase you could get by moving. This was mine: 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. How is my question not the same as you described? > [@](#): > > :dubious: There is no mention of the 1990s in your cite. Two different situations. One is in Britain - that’s the one with the cite. The other is Canada - in 1990s - I gave the cite later. > [@](#): > > So, the United States should subsidize the pharmaceutical pricing in the rest of the world? We currently pay roughly an average of [400% more](http://www.ncbi.nlm.nih.gov/pubmed/22392823) for our drugs than any other European or North American country. Why on earth would or should we continue this? Do you think companies always charge the same price for the same product in different countries? Go ahead and pass a law that says pharma company cannot charge less abroad for the drug than it charges in the US. While you’re at it, pass a law like that for any company. Watch US industry become uncompetitive abroad. > [@](#): > > Talking about wait times for certain surgeries is misleading. It is not “certain surgeries”. Did you see the article? It is EVERY freaking specialist. Across the board. ---
**Author:** ![Orwell](https://avatars.discourse-cdn.com/v4/letter/o/dfb087/32.png) [@Orwell](https://boards.straightdope.com/u/Orwell)\ **Post date:** [November 26, 2013, 4:42pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/129 "2013-11-26T16:42:21Z")
> [@BrainGlutton](#): > > Nobody’s **forcin’** nuttin’. The pharma companies have the option of not selling in Canada at all. That they do shows they still find the trade profitable under those imposed conditions; why would it not be the same in the U.S.? “Profitable” to sell the millionth dose is not the same as profitable to sell the first dose. Drug prices are high in the US, supporting the R&D to develop new drugs. Once a drug is being manufactured, the per-unit cost to manufacture additional pills is very low. So, it’s not surprising drug manufacturers are willing to sell “additional” doses at low prices that cover the cost of manufacture and distribution, but perhaps (likely?) not high enough to pay for R&D. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [November 26, 2013, 4:45pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/130 "2013-11-26T16:45:25Z")
> [@Orwell](#): > > Drug prices are high in the US, supporting the R&D to develop new drugs. And drug prices are low in Cuba, which happens to be the only place in the region where original pharmaceutical R&D is done. Clearly the profit motive is not indispensable here. ---
**Author:** ![elninost0rm](https://avatars.discourse-cdn.com/v4/letter/e/ed655f/32.png) [@elninost0rm](https://boards.straightdope.com/u/elninost0rm)\ **Post date:** [November 26, 2013, 5:02pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/131 "2013-11-26T17:02:50Z")
> [@Farin](#): > > Now, **Terr** , what would you suggest we do to both bring down costs for everyone in the US while at the same time providing care for the people who currently lack it (in the 15-45 million range, depending who’s numbers you like)? I’ll note that this went unanswered. We all can interpret what that means. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 26, 2013, 5:11pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/132 "2013-11-26T17:11:46Z")
> [@elninost0rm](#): > > I’ll note that this went unanswered. > > We all can interpret what that means. “We gotta do something.” “This is something”. “This means we gotta do this.” ---
**Author:** ![elninost0rm](https://avatars.discourse-cdn.com/v4/letter/e/ed655f/32.png) [@elninost0rm](https://boards.straightdope.com/u/elninost0rm)\ **Post date:** [November 26, 2013, 5:16pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/133 "2013-11-26T17:16:17Z")
> [@Terr](#): > > “We gotta do something.” > “This is something”. > “This means we gotta do this.” He asked for you to suggest an alternative. Nowhere does his message suggest that the ACA or single-payer are the only options. If you deny that any change needs to happen, fine, but there are millions who (rightfully) disagree with that. ---
**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 26, 2013, 5:28pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/134 "2013-11-26T17:28:47Z")
**Terr** ’s health care reform proposal consists of criticizing everyone else’s health care plan. I call it the Boehner- **Terr** plan. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 26, 2013, 5:53pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/135 "2013-11-26T17:53:30Z")
> [@Ravenman](#): > > **Terr** ’s health care reform proposal consists of criticizing everyone else’s health care plan. I call it the Boehner- **Terr** plan. It is a stupid contention that in order to point out how bad Obamacare is, you have to give your own plan. Obamacare is a bad law, all on its own. My policy would include banning all “comprehensive” health insurance plans, leaving only catastrophic ones, thus allowing the marketplace to dictate the prices and encouraging price-shopping among consumers. Hugely expand the role of nurse-practitioners. Have localities institute public clinics where you make it easy for doctors to volunteer for pro-bono work on as part-time a basis as they want. If my auto insurance covered oil changes, I am sure they would cost $1000 a pop. ---
**Author:** ![Cyros](https://avatars.discourse-cdn.com/v4/letter/c/a698b9/32.png) [@Cyros](https://boards.straightdope.com/u/Cyros)\ **Post date:** [November 26, 2013, 5:53pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/136 "2013-11-26T17:53:34Z")
> [@Terr](#): > > So - why in the world would the American patient do that? He likes to wait for his doctor’s appointment for five months instead of getting immediate service? You do realize that there is not a five month wait for every aspect of the Canadian health system, right? I can usually make an appointment for my family doctor and be seen within 24-48 hours. When I went to the hospital and needed my gall bladder removed I showed up at 10am and was waking up after the operation at 7pm. After hours clinics allow me to make an appointment at 430pm to be seen at 6pm. ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [November 26, 2013, 6:03pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/137 "2013-11-26T18:03:12Z")
> [@Cyros](#): > > You do realize that there is not a five month wait for every aspect of the Canadian health system, right? I can usually make an appointment for my family doctor and be seen within 24-48 hours. When I went to the hospital and needed my gall bladder removed I showed up at 10am and was waking up after the operation at 7pm. After hours clinics allow me to make an appointment at 430pm to be seen at 6pm. [http://news.nationalpost.com/2013/10/28/canada-must-offer-private-options-along-with-universal-health-care-to-combat-long-wait-times-report/](http://news.nationalpost.com/2013/10/28/canada-must-offer-private-options-along-with-universal-health-care-to-combat-long-wait-times-report/) Gallbladder surgery falls under “general surgery” I believe. The median wait time in Canada for that is 7 weeks. Add to that the median wait from visiting your family doctor to seeing the specialist of 8-9 weeks and you have 3-4 months for gallbladder surgery. Just because you happened to luck out does not negate these numbers. Unless you want to tell me they are lying in this article? ---
**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, 6:10pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/138 "2013-11-26T18:10:23Z")
This probably explains the massive and overwhelming movement among Canadians to repeal this horrific system. I don’t have any cites for that, kinda depending on you to provide them. They _do_ let people vote in Canada, right? Pretty sure I heard that. ---
**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 26, 2013, 6:40pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/139 "2013-11-26T18:40:48Z")
> [@](#): > > Quoth **Terr** : > > I’d rather have 10 good doctors than 20 crappy ones in the system. Therefore, it’s a good thing when a state does something like Vermont is doing, which will encourage the crappy doctors to leave, but the good doctors to stay. See, the way I figure it, people become doctors for one of two reasons. Some people become doctors because they want to help people, and some people become doctors because it pays well. And I also figure that those in the first category are going to be much better doctors than those in the second category. So if you make it easier to help people, you’re going to get more of the good doctors, and if you lower the pay, you’ll get less of the bad ones. Sounds like a win-win to me. ---
**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 26, 2013, 6:57pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/140 "2013-11-26T18:57:43Z")
> [@Terr](#): > > It is a stupid contention that in order to point out how bad Obamacare is, you have to give your own plan. Obamacare is a bad law, all on its own. No, it is a brilliant, insightful, and morally justified contention to point out that if someone isn’t part of the solution, they are part of the problem. > [@](#): > > My policy would include banning all “comprehensive” health insurance plans, leaving only catastrophic ones, thus allowing the marketplace to dictate the prices and encouraging price-shopping among consumers. Hugely expand the role of nurse-practitioners. Have localities institute public clinics where you make it easy for doctors to volunteer for pro-bono work on as part-time a basis as they want. That’s a fucked up system. For example, I find it contradictory to decry waiting times when those waits are based on medical necessity, and then favor waiting times based on one’s ability to pay, compare prices, clip coupons, or whatever. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=6) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=8)