The failure of single-payer in Vermont

[NobleSavage]

If it wasn't already obvious, dreams of single-payer in the US are officially dead.

Last week, Vermont Governor Peter Shumlin (D.) announced that he was pulling the plug on his four-year quest to impose single-payer, government-run health care on the residents of his state. “In my judgment,” said Shumlin at a press conference, “the potential economic disruption and risks would be too great to small businesses, working families, and the state’s economy.” The key reasons for Shumlin’s reversal are important to understand. They explain why the dream of single-payer health care in the U.S. is dead for the foreseeable future—but also why Obamacare will be difficult to repeal.

http://www.forbes.com/sites/theapot...-payer-health-plan-was-doomed-from-the-start/

"You'd think that, if there was any state where this could fly politically, it should have been Vermont," said Matthew Dickinson, a political science professor at Middlebury College. "But in this case, the price was so big that even a state as solidly blue as Vermont wasn't able to swallow it."

When I interviewed Shumlin in March, he said that whether or not Vermont succeeded at its single-payer push would have huge national ramifications. Back then, his state had the potential to serve as a model. It could be what Romneycare was in Massachusetts: a template for national reform. But if single-payer couldn't succeed in deep-blue Vermont, Shumlin and others mused, how could it possibly move forward anywhere else?

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

 

[Jolly_Penguin]

We have had single payer in much of the modern world for quite some time now, and we have not gone under. Apparently you Americans are doing it wrong.

 

[Davka]

Only in Veront.

 

[NobleSavage]

We have had single payer in much of the modern world for quite some time now, and we have not gone under. Apparently you Americans are doing it wrong.

I'll have to look for a link, but about 1/2 the countries that have tried single-payer have failed.

 

[laughing dog]

We have had single payer in much of the modern world for quite some time now, and we have not gone under. Apparently you Americans are doing it wrong.

I don't see how we could be doing it wrong when we really haven't done it all.

 

[NobleSavage]

About half of countries who attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he is in Taiwan, Cyprus, or Vermont, the process is roughly the same: meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

 

[Jolly_Penguin]

About half of countries who attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he is in Taiwan, Cyprus, or Vermont, the process is roughly the same: meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

I suppose you have to be ready for it and really want it as a populace. For it work, it does mean higher taxes. From everything I have read though, it actually also means less spent on health care. It saves money overall, even though it does mean a higher tax rate. Maybe the US isn't ready for it. Maybe the US isn't wealthy enough as a nation. Perhaps there is too much of wealth disparity in the US, and perhaps those who can pay have the political power to pay only for themselves, and don't see the wisdom in a healthy society at large.

 

[SimpleDon]

We have had single payer in much of the modern world for quite some time now, and we have not gone under. Apparently you Americans are doing it wrong.

I don't see how we could be doing it wrong when we really haven't done it all.

What a ridiculous thing to say. About one half of the medical care in the US is paid for by single payer. Medicare, Medicaid, VA and TriCare.

 

[Jolly_Penguin]

I don't see how we could be doing it wrong when we really haven't done it all.

What a ridiculous thing to say. About one half of the medical care in the US is paid for by single payer. Medicare, Medicaid, VA and TriCare.

You have yet to try Universal Single Payer though, as much of the modern world has moved to. It carries not only cost savings, but also shifts some attention to preventative care.

Having worked in automobile insurance law, and seen all that goes on with insurers who have profit motives to pay for as little as possible, and all the red tape involved, I consider myself incredibly lucky to live where I don't have to go through that sort of thing every time I visit a hospital.

 

[SimpleDon]

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

I suppose you have to be ready for it and really want it as a populace. For it work, it does mean higher taxes. From everything I have read though, it actually also means less spent on health care. It saves money overall, even though it does mean a higher tax rate. Maybe the US isn't ready for it. Maybe the US isn't wealthy enough as a nation. Perhaps there is too much of wealth disparity in the US, and perhaps those who can pay have the political power to pay only for themselves, and don't see the wisdom in a healthy society at large.

The US is the wealthiest country in the world and one of the only countries in the in the world that can pay for the massive inefficiency of providing a large portion of our health care as a for profit business.

 

[SimpleDon]

What a ridiculous thing to say. About one half of the medical care in the US is paid for by single payer. Medicare, Medicaid, VA and TriCare.

You have yet to try Universal Single Payer though, as much of the modern world has moved to. It carries not only cost savings, but also shifts some attention to preventative care.

Having worked in automobile insurance law, and seen all that goes on with insurers who have profit motives to pay for as little as possible, and all the red tape involved, I consider myself incredibly lucky to live where I don't have to go through that sort of thing every time I visit a hospital.

A large part of why we have such expensive health care is that we have been turning it into a for profit business over the last forty years or so. There is a widespread delusion in the US that private, for profit business is always more cost efficient than government. It is in fact almost never true.

 

[Valjean]

Was Vermont single payer or 'government run'? Government run is socialized medicine, like the VA or UK. Single payer is private. Totally different systems.

 

[Jolly_Penguin]

That is an excellent point. And so long as health care is looked at as a for profit business, and centred around for profit insurance companies, I really don't see how you can expect things to improve. This is why I was sorely disapointed in Obamacare. Correct me if I am wrong, but from what I understand (not living in the US), they actually now FORCE you to put money into the pockets of the health insurance companies?

I often hear people from the USA concerned about a government beurocrat making health decisions for them.... but apparently not worried about a for profit insurance adjuster doing the same. The government at least has a fiduciary duty to you and your health. And in my experience under the Canadian health care system, the government never actually makes these decisions anyway. It is your doctor who decides, and they do it based on need and not cost.

I also hear a lot of "horror stories" from people from the USA afraid of universal single payer health care, and as a Canadian it is just funny to hear, because they are so shocking, even to people who live under the system. In reality I can go to my family doctor tomorrow if I call and make an appointment today. I can go right now if I want to wait an hour or so in a hospital or walk in clinic. What is with these horror stories about insanely long lines? To get a critical life saving procedure, that happens immediately, at the hospital. To get something optional or less time pressing, yes you could wait a lot longer, but so what? It is optional and not time pressing. Others get triaged ahead of you. I have no problem with that.

 

[Juma]

About half of countries who attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he is in Taiwan, Cyprus, or Vermont, the process is roughly the same: meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

Thus there is nothing wrong with the system in it self, just that the rich dont want to contribute their share.

 

[RavenSky]

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

I suppose you have to be ready for it and really want it as a populace. For it work, it does mean higher taxes. From everything I have read though, it actually also means less spent on health care. It saves money overall, even though it does mean a higher tax rate. Maybe the US isn't ready for it. Maybe the US isn't wealthy enough as a nation. Perhaps there is too much of wealth disparity in the US, and perhaps those who can pay have the political power to pay only for themselves, and don't see the wisdom in a healthy society at large.

yep, especially to the bolded.

 

[RavenSky]

That is an excellent point. And so long as health care is looked at as a for profit business, and centred around for profit insurance companies, I really don't see how you can expect things to improve. This is why I was sorely disapointed in Obamacare. Correct me if I am wrong, but from what I understand (not living in the US), they actually now FORCE you to put money into the pockets of the health insurance companies?

I often hear people from the USA concerned about a government beurocrat making health decisions for them.... but apparently not worried about a for profit insurance adjuster doing the same. The government at least has a fiduciary duty to you and your health. And in my experience under the Canadian health care system, the government never actually makes these decisions anyway. It is your doctor who decides, and they do it based on need and not cost.

I also hear a lot of "horror stories" from people from the USA afraid of universal single payer health care, and as a Canadian it is just funny to hear, because they are so shocking, even to people who live under the system. In reality I can go to my family doctor tomorrow if I call and make an appointment today. I can go right now if I want to wait an hour or so in a hospital or walk in clinic. What is with these horror stories about insanely long lines? To get a critical life saving procedure, that happens immediately, at the hospital. To get something optional or less time pressing, yes you could wait a lot longer, but so what? It is optional and not time pressing. Others get triaged ahead of you. I have no problem with that.

You are correct on all points, and your last paragraph especially boogles me, too. I live under this supposedly superior US mess, and I can attest that we have to wait for a lot of medical treatment too. Sadly, it is not just optional less-pressing treatments for those who have to wait the longest. Except for critical emergency care, if you are poor and without health insurance, you may have to wait for many months to get a doctor's appointment even for serious life-threatening chronic conditions. Even when you are not poor, and do have health insurance, sometimes the wait for appointments is 3 or more months. I ran into this all the time with my daughter's Type 1 Diabetes. Pediatric endocrinologists in my area typically have a 3+ month waiting time to get an appointment. If, of course, the child goes into ketoacidosis as a result of non-treatment, there is always the emergency room - a far more expensive option for everyone.

What is both horrific and ironic to me is that people like GW Bush and John Goodman (a McCain health advisor) insist that the US really does have universal health care because we have the Emergency Medical Treatment and Active Labor Act (EMTALA). This law was only passed in 1986, is far less than comprehensive, and is unfunded which means that it causes extreme financial impossibilities for both the hospitals and the people trying to access health care via the emergency room.

I mean, people have access to health care in America. After all, you just go to an emergency room.

The Emergency Medical Treatment and Active Labor Act (EMTALA)

 

[NobleSavage]

Was Vermont single payer or 'government run'? Government run is socialized medicine, like the VA or UK. Single payer is private. Totally different systems.

Vermont's proposed system wasn't government run. Making a public vs private distinction is an oversimplification. No two countries are alike and the NHS contracts out an increasing amount to private companies. http://www.bbc.com/news/health-25660555

 

[NobleSavage]

http://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

Thus there is nothing wrong with the system in it self, just that the rich dont want to contribute their share.

I never said there was, just that it ain't gonna happen in the US.

 

[SimpleDon]

Was Vermont single payer or 'government run'? Government run is socialized medicine, like the VA or UK. Single payer is private. Totally different systems.

No, the UK and the VA are examples of the government providing most all of the health care. They employ the medical personal. They run the hospitals. The lowest cost solution, paid for with taxes largely by the wealthy.

Single payer is a description of how medical care insurance is provided. It can be by the government like Medicare. Or it can be private, non-profit insurance companies. The most widespread and arguably most successful health care providing system is the Bismark pattern based on private non-profit insurance companies and government negotiated medical costs. When the US had reasonable over all medical it was because most people had their insurance through the Blue Cross-Blue Shield in non-profits. The Blue Cross-Blue Shield had so much of the business that they could control medical costs rather well.

We broke up the Blue Cross-Blue Shield and turned most of them into for profit companies. Not only are the for profits too small to control costs they have no reason to control costs. The higher costs are the higher their profits because they depend on a cost plus model.

 

[SimpleDon]

That is an excellent point. And so long as health care is looked at as a for profit business, and centred around for profit insurance companies, I really don't see how you can expect things to improve. This is why I was sorely disapointed in Obamacare. Correct me if I am wrong, but from what I understand (not living in the US), they actually now FORCE you to put money into the pockets of the health insurance companies?

I often hear people from the USA concerned about a government beurocrat making health decisions for them.... but apparently not worried about a for profit insurance adjuster doing the same. The government at least has a fiduciary duty to you and your health. And in my experience under the Canadian health care system, the government never actually makes these decisions anyway. It is your doctor who decides, and they do it based on need and not cost.

I also hear a lot of "horror stories" from people from the USA afraid of universal single payer health care, and as a Canadian it is just funny to hear, because they are so shocking, even to people who live under the system. In reality I can go to my family doctor tomorrow if I call and make an appointment today. I can go right now if I want to wait an hour or so in a hospital or walk in clinic. What is with these horror stories about insanely long lines? To get a critical life saving procedure, that happens immediately, at the hospital. To get something optional or less time pressing, yes you could wait a lot longer, but so what? It is optional and not time pressing. Others get triaged ahead of you. I have no problem with that.

I lived more than three years in Canada and more than four years in Germany. There was really no difference in the medical care in those countries and the US. Waiting times for major procedures in the US are in the middle of the developed economies.

The advantages of private enterprise is in consumer choice and innovation, not in cost. These factors don't come into play in health care. Innovation in health care is driven by the desire for better health outcomes, not better profits. Consumer choice doesn't enter into the question either, the product is pretty much the same across the board, intentionally. It doesn't increase profits, information is freely shared, there are no patents on medical procedures. Consumers don't have the training and the knowledge to really make choices.

Yes, drug companies and device suppliers do follow innovation, consumer choice and advantages from the for profit model more than other aspects of the for profit model. But not to the degree that the free market enthusiasts think.

Yes, the government subsidies for purchasing health care insurance pretty much go to pay for the inefficiencies of the for profit insurance companies. The ACA depends on the world's most expensive health care delivery method, by insurance purchased from for profit insurance companies in the US.