# 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:** 9
**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, 9:28pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/161 "2013-11-26T21:28:17Z")
> [@Spoons](#): > > Let’s see. You said, at post 106: The context does not start at 106. It talks about “patient flow from US to Canada”. Tourists getting a sprained ankle are not “patient flow”. And yes, you showed that an American with insurance, if he wants to go and get treated in Canada, can do so. Why he would do so outside of an emergency situation while on a trip to Canada, I have no idea. ---
**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, 9:30pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/162 "2013-11-26T21:30:10Z")
> [@jasg](#): > > OK. Is there a freer health care market than the pre-ACA US? No. US is (well, used to be) the beacon of freedom in the world. Slowly but surely getting dimmer and dimmer. ---
**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, 9:33pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/163 "2013-11-26T21:33:16Z")
> [@Werekoala](#): > > No, sir, I’m fully aware what “total compensation” means - but I’m also aware that when you sign an offer letter for $40,000/year (for example) you’re agreeing to TAKE HOME that much (less taxes and your share of insurance, of course). The company doesn’t sign you on for $50,000/year then only pay you $40k because of insurance costs etc. , that’s figured in to their payroll expense for hiring you, but you never see a statement of how much that costs is to your employeer - it’s all behind the screen. > > So - without having to pay insurance for the employee, what is the more realistic outsome? All of a sudden the employee gets a $10k/year raise, or the company cuts their payroll costs by around 20% and sends all the upper management on a coke-and-strippers cruise to Tahiti? And all without having to cut the employee’s pay by a dime - you still get your $40k/year. It’s all subject to agreement, negotiation, etc. And it’s pure speculation how any insurance cost savings would be handled. Wasn’t there an earlier post that indicated that Vermont planned to impose both an income tax (on employees) and a business tax (on employers) to pay for the single-payer health care? So how much savings would there really be for a company? But I can tell you for a fact that companies absolutely consider employment costs when setting and negotiating salaries. And insurance is part of that equation. People bemoan the fact that salaries aren’t rising as much as they “should” be, but part of the problem is that pension and health care costs (along with unemployment insurance and other costs) are rising rapidly, increasing the total payroll expense even if take-home pay isn’t going up as fast. ---
**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, 9:37pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/164 "2013-11-26T21:37:24Z")
> [@Orwell](#): > > It’s all subject to agreement, negotiation, etc. And it’s pure speculation how any insurance cost savings would be handled. Wasn’t there an earlier post that indicated that Vermont planned to impose both an income tax (on employees) and a business tax (on employers) to pay for the single-payer health care? So how much savings would there really be for a company? > > But I can tell you for a fact that companies absolutely consider employment costs when setting and negotiating salaries. And insurance is part of that equation. > > People bemoan the fact that salaries aren’t rising as much as they “should” be, but part of the problem is that pension and health care costs (along with unemployment insurance and other costs) are rising rapidly, increasing the total payroll expense even if take-home pay isn’t going up as fast. You are correct long-term. Short-term changes do not work that way. If a company has some kind of expense that suddenly becomes less (whatever expense it is, whether it is health care for workers or price of raw materials suddenly drops) it certainly does not translate into higher salaries for workers. It does translate into higher profits for the company. Long term, higher profits will allow the company to pay higher salaries _if it needs to_ in order to attract better employees. ---
**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, 10:16pm UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/165 "2013-11-26T22:16:08Z")
> [@Trinopus](#): > > Are there companies in Canada selling “supplemental” private insurance, to augment coverage, and perhaps to help pay for additional care, better care, faster care, etc.? > > This idea seems to work in Australia, where everyone who has a few dollars in their budget buys a supplemental plan, to make the public plan a little nicer in case of a health issue. > > The taxes on the private plans help to fund the public plan. It benefits everyone, and preserves both free-market ideals and universal (ooh, socialist!) ideals. Yes, there are supplemental plans. While many employers provide these plans to their employees as a benefit, some don’t; but individuals can purchase such plans on their own. Yes, they provide additional care, but not faster care. Let me explain. There are core services that are covered by each province’s public insurance plan. This group comprises a wide range of services: everything from annual physicals to broken bones to heart transplants; and it includes everything required to provide those services: x-rays, anaesthesia, etc. There is no limit to the provision of these services–if it takes ten x-rays, well, it takes ten x-rays. Additionally, if you are covered under the provincial plan, you will never pay out-of-pocket for the provision of core services; there are no co-pays or deductibles. You cannot buy private insurance that covers core services. But those core services do not cover absolutely everything that one might need or want. They do not cover such things as private rooms during hospital stays, nor do they totally cover such things as vision (eye exams and glasses), dental (unless required during a medical procedure), or prescription medications (again, unless required during a medical procedure or hospital stay). Note that provincial plans might cover a portion of the above, or they might not; but at any rate, for these situations, one can purchase supplementary insurance from a private provider. Additional care, yes. But they will not provide faster care. There is no overlap between what the public plan covers (and as I mentioned, there is no private insurance that covers core services), and what is covered by private supplementary plans. This removes the incentive for physicians to take the patient with the gold-plated private insurance plan over the patient who is only covered by the public plan. There is a queue for some things; and nothing you can purchase will get you to the head of the line faster. ---
**Author:** ![PhillyGuy](https://avatars.discourse-cdn.com/v4/letter/p/ed655f/32.png) [@PhillyGuy](https://boards.straightdope.com/u/PhillyGuy)\ **Post date:** [November 27, 2013, 12:22am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/166 "2013-11-27T00:22:11Z")
> [@jasg](#): > > OK. Is there a freer health care market than the pre-ACA US? First to come to mind should be the People’s Republic of China. Silly me, thinking that Taiwan is a free country and the PRC is not. I suppose I should see little to choose from in comparing the two, since although the Taiwanese have freedom of speech, they don’t have freedom to remain uninsured. > [@Terr](#): > > No. US is (well, used to be) the beacon of freedom in the world. Slowly but surely getting dimmer and dimmer. If we ever were such a beacon, it was not because of our freedom to die of cancer due to being uninsured. This is the one part of our beacon that no democratic nation seeks to emulate. ---
**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, 12:23am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/167 "2013-11-27T00:23:49Z")
> [@PhillyGuy](#): > > If we ever were such a beacon, it was not because of our freedom to die of cancer due to being uninsured. This is the one part of our beacon that no democratic nation seeks to emulate. Why would anyone want to emulate US when the obvious desire of the government of the US is to emulate others? ---
**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, 12:33am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/168 "2013-11-27T00:33:38Z")
> [@Terr](#): > > Why would anyone want to emulate US . . . Why indeed? You need to drop that delusional American-exceptionalist “beacon” bullshit, once and for all and the sooner the better. The **Soviet Union** was about being a beacon. We’re a \*\*country,\*\*that’s all. We’re not a city on a hill and we never were. Any value democratic-republican government has, it has independently of the American example. ---
**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, 12:41am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/169 "2013-11-27T00:41:48Z")
> [@BrainGlutton](#): > > Why indeed? You need to drop that delusional American-exceptionalist “beacon” bullshit, once and for all and the sooner the better. The plaintive cry of the modern US liberal. “Being exceptional is bad, mkay?” ---
**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, 12:45am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/170 "2013-11-27T00:45:51Z")
> [@Terr](#): > > The plaintive cry of the modern US liberal. “Being exceptional is bad, mkay?” Being exceptional is **irrelevant.** ---
**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, 12:51am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/171 "2013-11-27T00:51:11Z")
> [@Spoons](#): > > . . . such things as private rooms during hospital stays . . . This was exactly the example my Australian source mentioned, and a reason many people get supplemental private insurance. A private room is not a medical necessity…but it is nice. > [@](#): > > But they will not provide faster care. . . . nothing you can purchase will get you to the head of the line faster. Cool. And also good! That’s the way it should be. Thank you for the clarification! ---
**Author:** ![PhillyGuy](https://avatars.discourse-cdn.com/v4/letter/p/ed655f/32.png) [@PhillyGuy](https://boards.straightdope.com/u/PhillyGuy)\ **Post date:** [November 27, 2013, 1:12am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/172 "2013-11-27T01:12:06Z")
> [@BrainGlutton](#): > > You need to drop that delusional American-exceptionalist “beacon” bullshit, once and for all and the sooner the better. In every country, a large portion of the populous thinks that, in important ways, their country is the best. So long as not taken to an extreme, it is a harmless aspect of human nature. I see no problem with being proud to be an American as a general proposition, and, if I did, it was been purest tilting at windmills to express it. I do have a problem with being proud of allowing people with heart disease and cancer to be cut out of the individual insurance market due to pre-existing conditions. It’s all theoretical now. Just wait until next year when newly insured people are going on TV announcing that their cancer was caught just in time. We’ve got way better arguments for the ACA than to attack boilerplate nationalism. A right wing nightmare is that in a couple years, when people are asked what makes them proud to be an American. millions will say: Obamacare. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 27, 2013, 2:01am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/173 "2013-11-27T02:01:25Z")
> [@Terr](#): > > The plaintive cry of the modern US liberal. “Being exceptional is bad, mkay?” Wrong. \*Claiming \*to be exceptional without or even in spite of the evidence is bad. Jingoism is not a virtue. The evidence is that single-payer is the most cost-effective and most comprehensive approach to health care available. Refusing to implement it simply because the rest of the world does it already is, well, let’s just call it silly and leave it at that. ---
**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, 3:26am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/174 "2013-11-27T03:26:46Z")
> [@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. > > 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. I agree that the ACA is bad law. I think it should be completely rescinded. But something needs to be done once it’s out the window. I am open to discussing all plans, not just the ACA. However, your plan will leave a significant number of people without access to health care on the basis of cost. There are no cost controls. While you do leave the insurance companies more or less out of it which would yield some savings, the hospitals will have all the control instead of insurance companies. That sort of power transition wouldn’t do much for the consumer. It would not be hard to have HealthONE or some other health provision company come in and maintain current rates or, possibly, even jack up rates. Especially for emergency or urgent services (you are less choosy when it’s an urgent situation.) I do not believe your plan would control costs and would deny a significant number of people proper health care. Health Care, like freeways or telecommunications, are a vital infrastructure in my opinion and should be co-ordinated by at least the state governments. ---
**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, 3:29am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/175 "2013-11-27T03:29:20Z")
> [@Farin](#): > > However, your plan will leave a significant number of people without access to health care on the basis of cost. That is what charity- and community-run clinics are for. And expanded role for nurse-practitioners. There is an awful lot of “doctoring” that happens that can easily be handled by a technician being paid 25% of the money if not less. > [@](#): > > There are no cost controls. The consumer is the cost control. Just like the consumer is the cost control everywhere else. As in “there’s no way in hell I am paying that much for this procedure. I will find someone else, thank you very much.” ---
**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, 3:54am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/176 "2013-11-27T03:54:29Z")
> [@Terr](#): > > That is what charity- and community-run clinics are for. And expanded role for nurse-practitioners. There is an awful lot of “doctoring” that happens that can easily be handled by a technician being paid 25% of the money if not less. > > The consumer is the cost control. Just like the consumer is the cost control everywhere else. As in “there’s no way in hell I am paying that much for this procedure. I will find someone else, thank you very much.” This is a specialist field. How, as a consumer, do you tell the reliability between Doctor A and Doctor B? Most malpractice claims are settled before court and leave no record. So, is your doctor going to prescribe you acetaminophen for your headache or benzodiazepine? That’s extreme, but if you die from the wrong drug or get really messed up, you settle and then the next guy doesn’t know that your doctor is a cock-up. On top of that, a specialist field is hard to get info from. And you can easily find bad information on the internet about anything above basic care. If your doctor recommends one type of chemotherapy over another that your grandmother took and it sent her into remission, who are you to know the difference as a layman? Was his explanation that the drug used on your grandmother for ovarian cancer not useful for your own kidney cancer a good statement? You can research it. But you’ll find a LOT of information that’s not ready for a lay person to digest about any drug, much less drug cocktails. What if the drug recommended by your oncologist is twice as much as the older drug used for your grandmother? Do you still complain? Do you go on the internet and start a “Cancer Diet” to help kill your cancers from someone else? Do you double your physician costs to constantly get second opinions? This is not purchasing a television. The free market does not help when the consumers are easily distracted by “alternatives” that may or may not work if they can’t easily and quickly find an answer to “Is this a good idea?” While the ACA isn’t a useful law, and brings many, many things to the table that it shouldn’t, your plan needs work. The free market won’t work and will bring up many, many items in need of regulation. It will probably continue to cost more than any other method used by other countries. ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [November 27, 2013, 3:55am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/177 "2013-11-27T03:55:39Z")
> [@Terr](#): > > As in “there’s no way in hell I am paying that much for this procedure. I will find someone else, thank you very much.” There is no way I will pay that much to not die. I will find a cheaper way to not die, thank you very much. This is the level of arguments we get. :rolleyes: ---
**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, 4:00am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/178 "2013-11-27T04:00:10Z")
> [@Farin](#): > > This is a specialist field. How, as a consumer, do you tell the reliability between Doctor A and Doctor B? Most malpractice claims are settled before court and leave no record. Everything is a specialist field. Gourmet cooking is a specialist field, yet you have no problem picking a good restaurant. Fixing cars is definitely a specialist field, but people manage to pick mechanics. There is word of mouth, or, in the age of Internet, specialized web sites. I mean, how do you pick your doctor today? Do you just stick your finger into the directory and go “that one”? Then guess what, you are just as likely to get a crappy one now. > [@](#): > > This is not purchasing a television. The free market does not help when the consumers are easily distracted by “alternatives” that may or may not work if they can’t easily and quickly find an answer to “Is this a good idea?” You don’t micromanage your doctor’s decisions. You pick a good one, based on all the information available to you (and on the price) and you trust him to treat you. Kinda like today except today the price does not enter into the picture. > [@](#): > > It will probably continue to cost more than any other method used by other countries. You would be surprised just how fast prices will come down when people will actually have to PAY (wow) for services instead of having it being invisibly paid for them. ---
**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, 4:01am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/179 "2013-11-27T04:01:17Z")
> [@Lobohan](#): > > There is no way I will pay that much to not die. I will find a cheaper way to not die, thank you very much. > > This is the level of arguments we get. :rolleyes: There’s another liberal plaintive cry. “People are stupid, we (the government) should decide for them.” ---
**Author:** ![Lobohan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lobohan/32/79_2.png) [@Lobohan](https://boards.straightdope.com/u/Lobohan)\ **Post date:** [November 27, 2013, 4:05am UTC](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762/180 "2013-11-27T04:05:51Z")
> [@Terr](#): > > There’s another liberal plaintive cry. “People are stupid, we (the government) should decide for them.” Not all people are stupid. The government, which, by the way, is _the people_, should work to fix things that can’t be fixed by the market. It is never profitable to pay for people’s medical bills. So you need laws and regulations to force insurance companies to do it to an acceptable level. Sorry you don’t agree. I don’t like the shitty wars the folks you vote for start. I guess we’re even. [Previous page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=8) [Next page](https://boards.straightdope.com/t/vermont-uses-aca-to-launch-single-payer-health-care/674762.md?page=10)