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View Full Version : Anybody watching VT's move to single payer health care?



JMAC
05-07-2011, 10:03 AM
I know their new Governor proposed it and the house and senate have approved it and that the Gov said he will sign it into law in the next two weeks....googling VT single payer came up with opposition sites.

Anybody have opinions? The easy target seems to be pointing out that Canadians have to wait a loooong time to get care. Is this true?

George Jung
05-07-2011, 10:10 AM
Have you ever noticed how successfully 'truth' can be shouted down in these sorts of instances?

You would think 'the facts' would float to the top.

Instead, somebodies holding their heads underwater.

perldog007
05-07-2011, 10:44 AM
Anything can be done well or done poorly IMO. A well done single payer system with a robust private option is what I'd like to see. "We got Healthcare" was the hue and cry nationally. I can't dispute that, the current system was got and is headed off a cliff under mandates. If Vermont is moving honestly and openly towards single payer I call that much more honest policy and wish them well.

I don't consider "free" Healthcare a right. I do think using the resources we have to serve as many people as possible is the right thing to do. YMMV

Shang
05-07-2011, 10:45 AM
I know their new Governor proposed it and the house and senate have approved it and that the Gov said he will sign it into law in the next two weeks....googling VT single payer came up with opposition sites.

Anybody have opinions? The easy target seems to be pointing out that Canadians have to wait a loooong time to get care. Is this true?

All I know about the Canadian system is what I have read here. Most seem well cared for and satisfied.

You might want to go back and look up my comments on our recent experience with the Belgian health care system.
In a foreign country, on a Sunday, we were directed to a doctor on duty, waited only a few minutes, and were professionally treated at less expense than the co-pay would have been in the U.S.

Our U.S. system of for-profit health insurance companies is awkward, expensive, and does not serve the people.

Flying Orca
05-07-2011, 10:49 AM
Way to spin, "Judge". Without exception, the Canadian members of this forum prefer our system to yours. While you might not have to wait, others under your system can't get coverage. A system that leaves a significant portion of the population without coverage is something we view as inhumane.

Once again, it's "I'm alright, Jack".

Shang
05-07-2011, 10:56 AM
perldog007 "...I don't consider "free" Healthcare a right. I do think using the resources we have to serve as many people as possible is the right thing to do. YMMV "

You don't?
Is it that you don't believe that everyone is entitled to health care?
Or that health care should only be available to those who can pay for it?
Or should the richest country in the world allocate its resources in such a way that people fall through the cracks?

Bruce Taylor
05-07-2011, 11:10 AM
I've never had to wait an unreasonable amount of time for care. I don't doubt that it happens, but I've never run into it.

Prompt care saved my son's life twice, this year (a few months before his cerebral hemorrhages, we had a little run-in with a perforated appendix).

A couple of weeks ago, he was having small headaches again. We presented ourselves to the emergency in late morning; he was in and out of the MRI within the hour, and neurosurgery gave us the (very reassuring) results before lunch.

wardd
05-07-2011, 11:26 AM
Anything can be done well or done poorly IMO. A well done single payer system with a robust private option is what I'd like to see. "We got Healthcare" was the hue and cry nationally. I can't dispute that, the current system was got and is headed off a cliff under mandates. If Vermont is moving honestly and openly towards single payer I call that much more honest policy and wish them well.

I don't consider "free" Healthcare a right. I do think using the resources we have to serve as many people as possible is the right thing to do. YMMV

no such thing as free health care, that's why we pay taxes

the thing about single payer once you remove the profit motive is that it is more efficient and cheaper and covers everybody and that should be a right

take your head out of the insurance industry hole

wardd
05-07-2011, 11:28 AM
it serves some of the people

wardd
05-07-2011, 11:33 AM
for the most part we offer fire and police protection to all

should that be by subscription only?

if your neighbors house catches fire you want it put out, what if your neighbor has a highly contagious disease?

perldog007
05-07-2011, 11:34 AM
no such thing as free health care, that's why we pay taxes

the thing about single payer once you remove the profit motive is that it is more efficient and cheaper and covers everybody and that should be a right

take your head out of the insurance industry hole Ummm, I said I support single payer. Take your head out of whatever hole it's in and we can have a conversation about that :D

Bruce Taylor
05-07-2011, 11:34 AM
It would be unlikely for that to happen so smoothly in the US... and, without health insurance, even less likely.

On the other hand, because of our worries, a member of the neuro team scheduled him for an MRA & MRV, which (given Ben's inability to keep still) would have to be done under general anesthetic. Because it's not urgently needed -- and the results of it are, in any case, unlikely to change the treatment plan, in the short term -- the wait for that procedure would be several months (it requires the attendance of a surgical team). The neurosurgeon called me a couple of days ago to tell me about the long waiting time, and told us he'd fit us into his schedule for an early followup appointment to discuss our concerns. I'm quite satisfied with this, but I can imagine some people might not be.

wardd
05-07-2011, 11:37 AM
Ummm, I said I support single payer. Take your head out of whatever hole it's in and we can have a conversation about that :D

but then you say health care is not a right, can't have it both ways

perldog007
05-07-2011, 11:37 AM
for the most part we offer fire and police protection to all

should the be by subscription only?

There is no right to be protected by the police for any individual (http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=No+right+in+America+to+Police+Protection), look it up. Yes, in many areas fire department response is by subscription. Look that up too.

Again, I'm in favor of Universal single payer with the option to buy private insurance. Buy a clue.

perldog007
05-07-2011, 11:38 AM
but then you say health care is not a right, can't have it both ways

It's not. Having a right and doing right aren't always the same.

wardd
05-07-2011, 11:39 AM
There is no right to be protected by the police for any individual (http://www.google.com/search?sourceid=chrome&ie=UTF-8&q=No+right+in+America+to+Police+Protection), look it up. Yes, in many areas fire department response is by subscription. Look that up too.

Again, I'm in favor of Universal single payer with the option to buy private insurance. Buy a clue.

if there were single payer, i bet you couldn't afford private insurance

perldog007
05-07-2011, 11:46 AM
if there were single payer, i bet you couldn't afford private insurance

Then I wouldn't buy it. If I wanted it I would have to earn it. That's wrong because? I know you want to harass me, but really you're not the right tool for the job. First and last warning my friend.

wardd
05-07-2011, 11:50 AM
warning?

oh, i take warnings on the net most seriously

i bet if some of the things you say you're against were offered to you as a right, you'd change your tune and jump for them

people seem to be against things the can't get anyway

JMAC
05-07-2011, 11:50 AM
I was driving in VT the day of their Governor's inaugural speech in January which I heard on VPR. He said, as near as I can remember- "We are going to take the burden of health insurance off the backs of businesses and enact a single payer health system." I'm no expert on this, but I really like the idea that VT is taking this bold initiative.

wardd
05-07-2011, 11:52 AM
I was driving in VT the day of their Governor's inaugural speech in January which I heard on VPR. He said, as near as I can remember- "We are going to take the burden of health insurance off the backs of businesses and enact a single payer health system." I'm no expert on this, but I really like the idea that VT is taking this bold initiative.

business loves the idea of single payer

JMAC
05-07-2011, 11:57 AM
I'm hoping we'll get a Vermonter to chime in. I've been wondering how they will address worksite injuries. I run a woodworking business and am safe, but there is a bit of danger here.

Flying Orca
05-07-2011, 04:11 PM
Middle class Canadians pay infinitely more in income tax than do lower to middle class Americans who have grown accustomed to paying none since the "tax cuts for the rich" were put in place a decade ago.

If we're going to compare tax rates, how about we compare class to class (however you choose to define such) rather than middle-class to lower- and middle-class? Better yet, how about you provide some numbers? Here's something to chew on in the meantime: compared to the USA, socialized health care provides better overall outcomes for less per capita spending in pretty much every other first-world country.

Keith Wilson
05-07-2011, 05:08 PM
I wonder if the 48% that currently pays no Federal income tax would continue to enjoy that free ride . . . Oh God, here we go again. http://www.kailashnadh.name/gb/files/smileys/smiley-rolleyes.gif "The Judge" certainly seems intelligent enough to understand that federal income taxes are only one kind of tax among many, and that tax dollars are interchangeable. A serious distortion at best, a lie at worst.

Here's what people really pay in taxes, once again. I'm going to keep posting the damn thing until the nonsense about a "free ride" goes away forever. And to put the icing on it, Canada spends about $3300 per capita per year on heath care, (PPP US dollars) The US spends about twice that for no better average results. I would sign up for Canada's system in a millisecond.

http://graphics8.nytimes.com/images/2009/04/13/business/economy/taxrates2.jpg


http://graphics8.nytimes.com/images/2009/04/13/business/economy/shares.jpg

(Source) (http://economix.blogs.nytimes.com/2009/04/13/just-how-progressive-is-the-tax-system/)

CWSmith
05-07-2011, 05:36 PM
While in Montreal for a meeting, a Chinese graduate student working with our group was feeling ill. We took him to a French hospital where he had a Vietnamese doctor. I was joking that with all the languages involved, he could be pregnant for all we knew. He was admitted to see the doctor immediately, was diagnosed within the hour, and learned that he had experienced a small stroke. With little to do, he was released, we stayed not many blocks from the hospital that week, and he recovered without further treatment. Excellent, prompt care for someone who was not even a payer in the system. Could we do as well in the US?

JMAC
05-07-2011, 08:09 PM
I never hear mentioned whether a single payer plan would be cheaper in taxes than the premiums for a plan from a for-profit insurance agency. Bring out the charts! I have a bogus catastrophic plan with a $15,000 deductible.That I can afford it is the only thing positive about it. ..for the car crash or cancer scenario.

wardd
05-07-2011, 08:10 PM
I never hear mentioned whether a single payer plan would be cheaper in taxes than the premiums for a plan from a for-profit insurance agency. Bring out the charts! I have a bogus catastrophic plan with a $15,000 deductible.That I can afford it is the only thing positive about it. ..for the car crash or cancer scenario.

it's cheaper per capita in most other countries

Keith Wilson
05-07-2011, 09:58 PM
ROFL! Tax dollars are interchangeable?You can get up off the floor now. You misunderstood me completely. To the one paying, all tax dollars are alike. One dollar for taxes out of your pocket or mine means we have one dollar less, whatever it goes to.

The charts were not at all irrelevant. You claimed that those who don't pay federal income tax were somehow getting a "free ride". This is false. I showed that there is no free ride, that almost everybody pays taxes, and that people at various income levels pay taxes in surprisingly close proportion to their share of the total income. Considering progressive income tax only while ignoring other taxes, some quite regressive, is very deceptive.


You are lying to yourself if you think there can be single payer health care in this country without MASSIVE income tax increases on the lower and middle classes.If single payer health care were instituted, it would almost certainly require tax increases. So what? Pay for insurance, pay out of pocket for medical care, pay taxes for insurance, it's all one. The relevant question is not tax rates, but how much do we spend for health care and what do we get for the money. All the evidence shows that tax-financed systems, whether in the US or other countries, can deliver health care for less money than the current US system. About half of all health care in the US is now paid for out of taxes. These programs, while far from perfect, are far, far more efficient at providing care per dollar spent than private insurance.

The US is not alone in providing health care to its citizens. Every other developed country does so, in general fairly successfully. US results are about average; better in some areas, worse in others. Systems vary a lot, but the US is an extreme outlier in three respects:
1. Costs. We spend about double the average of everybody else, whether figured as a percentage of GDP or dollars per capita (and it's not due to research, that's only 0.5% or GDP in the US).
2. People without insurance: We have 50 million. No other country has a significant number.
3. Degree of government involvement. Almost every other country pays for a far greater percentage of health care out of tax revenue than the US.

You think this might give us a freakin' clue that there's a better way to do things? Nope. The theology on the right in the US says that the free market must always be superior, even when the evidence shows it isn't. The Canadian system costs half as much as the US one for essentially the same results, and any politician who seriously tried to get rid of it would be out of office in milliseconds..

Another "irrelevant chart".

http://graphics8.nytimes.com/images/2009/07/08/business/economy/08economix.chart.2.jpg

George Ray
05-08-2011, 06:15 AM
Thanks Keith !

Garret
05-08-2011, 06:58 AM
I see all the usual suspects here arguing about how we can or can't afford it, but if I may, I'd like to point out a few things I've gleaned on this from local news, some doctors & talking to state Senators & Reps.

First: Judge, if you have to pay $100/month in bills - does it matter whether you pay $50 to 2 companies or $100 to one or $25 to 4? You are still paying $100. That's what Keith was trying to say.

However - VT's single payer system. The original study was done by Dr. William Hsaio from Harvard. He believes that Vermont can save 500 million/year by going to single payer. My pessimistic self thinks it'll be less (if anything) - but the goal is increased coverage, not necessarily decreased overall cost.

Doctors here are almost universally in favor. Why? Because they can take people who now work full time on insurance billing & have them do medically related things. My doctor works in a group of about 10 doctors that share admin staff. They have 3 people who do nothing but insurance, as they deal with 27 different companies & therefore 27 different billing costs for every item & procedure. Single payer removes 26 of these & means that the doctor gets to charge one price for everyone. How is the price determined? As I understand it, prices will be set by a state panel, made up of state folks, doctors & if necessary (more on this in a minute) rep(s) from the insurance company. So - with one price & one place to bill, far less admin time will be necessary.

Insurance company? What? This is that commie single payer thing! Well - maybe not. As I understand it, the proposal is that the underwriting & administration of the system will be put out to bid. This will allow insurance companies to bid as well as the state itself. Additionally, it will be re-bid every X years. The details of this (& much of the system) are not fully developed yet, but it seems pretty certain that the final legislation will include a bid option like this.

How will it be paid for? That is the sticky part. As far as I know, they are looking at payroll taxes to begin with. Where this will go is hard to say, but I see employers getting taxed as a likely way. I'm not sure why this is, as the income tax seems like a fairer place for it to my little brain.

I have not studied the final bill that come out last week. I've heard that it has a # of private insurance compromises, so the simplification may not be as complete as some would hope. However, we've got all kinds of folks yelling about the end of the world over this, so maybe it is pretty good. Ooops - the cynical side of me just showed up.

Keith Wilson
05-08-2011, 07:09 AM
Private insurance pays out roughly 70 cents on average for actual medical care for every dollar paid in premiums, and that ignores the cost to providers of dealing with myriad insurance companies, each with their own forms and bureaucracy. Medicare is in the high 90s. The unanimous evidence of 20-odd other countries, as well as the US, shows pretty conclusively that treating health care as a public good, like roads and schools and the fire department, and paying for it out of taxes is much more cost-effective. Sure, taxes go up. But the total amount you actually pay goes down.

Garret
05-08-2011, 10:45 AM
Sure, taxes go up. But the total amount you actually pay goes down.

But Keith - taxes are evil & paying exorbitant prices so health insurance execs get lavish bonuses is good! ;)

Flying Orca
05-08-2011, 11:11 AM
Exactly. Let's not call it "inefficiency and profiteering", let's call it The American Way(tm)!

Garret
05-08-2011, 12:33 PM
Isn't it already? ;-)

Keith Wilson
05-08-2011, 01:41 PM
But Keith - taxes are evil & paying exorbitant prices so health insurance execs get lavish bonuses is good!Well, as far as I can tell, behind a lot of the arguments lurks the Randian idea that taxation is theft, particularly taxation that pays for anything for anyone with less money than you. Tax-financed health care would likely be paid for out of moderately progressive taxes - or at least only slightly regressive, like current Medicare taxes. This will necessarily mean that on average the rich will pay more and the poor less than they do now, for the current system (Medicaid excepted) is like any large fixed-price purchase; no problem if you have lots of money, difficult or impossible if you don't. "The law, in its majestic equality, forbids the rich and the poor alike to sleep under bridges, to beg in the streets, and to steal bread", and the current US health care system in its egalitarian splendor allows rich and poor alike to buy insurance and medical care on the open market (except that those who are better off normally have employer-provided insurance). The current arrangement is just fine if you have a lot of money, and taxes stay low. The fact that it's very inefficient is an unimportant side effect of its great virtue, that the wealthy don't have to support "free riders". In my more cynical moments, it seems that "low taxes for the rich" is absolutely the only thing the US right wing really believes in; everything else is just P.R. to get votes from those who aren't in the top 5% of income.

The problem is that we can't afford the current system for much longer. When every other industrialized country can provide good quality health care for every citizen for an average of 8% of GDP, and the US spends 16% (research is only 0.5%), we have a real problem, and it's getting worse. There are two kinds of solutions: Paul Ryan's "let 'em die in the streets if they don't have enough money" plan which is faithful to free-market theology, and the more efficient more socialized systems that have been proven to work elsewhere. Our choice.