Letter: Single-payer is the only way forward
Editor of the Reformer
The latest brawl around health care financing and affordability - as discussed in several recent Reformer editorials and op-ed pieces - is yet another sign that America's system doesn't work. Its dysfunction is imposing such a burden - economically, politically, socially, and of course physically - that it may have profoundly dire consequences for our future as a nation. Health care costs roughly 18 percent of US GDP. Think about that for a moment. This means that nearly one out of every five dollars generated by the US economy goes to pay for health insurance premiums, out-of-pocket costs, and other health-related purchases, and fees. This equals about $3.3 trillion dollars per year, or around $10,400 per American on average - twice the per-capita cost of health care in other rich countries. But we're not getting our money's worth, and we lag other countries in health outcomes. We are sicker than our counterparts, and more afflicted by a range of illnesses and conditions, from obesity to low infant birth weights to substance dependency and abuse.
An additional part of this burden that should not be ignored comes in the form of chronic uncertainty, stress, legal fees, and inefficiencies as people adjust to changing insurance policies, are bumped from one public program to another, and pursue lawsuits to challenge positions taken by health insurers. It is a chaotic, continually changing, and frequently demeaning, frustrating situation.
The health industry makes out very well from this arrangement. The large insurance companies in particular have attached themselves like a massive parasite to the US economy, and spend large sums to buy political favors and manipulate public opinion. They are in fact the only winners in the current system.
In 2010, Vermont hired health system expert Bill Hsiao from the Harvard School of Public Health to analyze Vermonters' health care needs and design several improved systems, including a single-payer system. His team estimated that a payroll-tax-financed single-payer system would save Vermonters as a whole about $500 million in its first year, and that savings would expand over subsequent years. Despite higher taxes to pay for universal coverage, the complete elimination of insurance premiums plus cheaper co-pays and pharmaceuticals would yield a net saving. Which is exactly what happens in the scores of countries that already have such a system.
However, after lots of hype and many promises, and in a fashion we now recognize as the politics of the corporate Democrats, Peter Shumlin backed away from actually implementing single-payer, and the whole idea has lapsed in the years since. Peter Shumlin in effect told Vermonters, "You can't afford to save a lot of money." (Between the lines, what he was really saying was, "My friends at Blue Cross/Blue Shield and MVP can't afford to have you save lots of money.")
Now we are being told that the Republicans' new health bill may lead to a $200 million hole in the state budget, presumably due to reductions in health exchange subsidies and Medicare and Medicaid reimbursements. Our Governor and legislators are in a panic about where to find $200 million (having just emerged from a battle to close a more modest $50 million deficit in the General Fund budget) and are talking about raising taxes or cutting services.
How long is this madness going to continue? The answer is right in front of our noses. Single-payer. This is the only affordable, manageable way forward now. It's time to revoke the health insurance companies' charters in Vermont; institute single-payer; decouple health insurance from employment; create a standard state-wide schedule of co-pays, reimbursements, and meds prices; and provide universal health, dental, vision, and mental health coverage. It's better, and cheaper. It's good for business. It would impel many people to relocate to Vermont (until other states did single-payer). It would put our people on the path of long-term health improvement and restored trust in the social contract. It would `just' take enormous political courage and determination by a core group of politicians - together with an awakened grassroots - to drive it through, over the fears, lobbying muscle, and ideological rigidity of its opponents. Becca, Jeanette, Tristan, Val, and Mollie: are you ready for the fight?
Brattleboro, March 13
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