Vermont’s Single Payer Healthcare System

On Thursday Vermont became the first state to enact a single payer healthcare system for its citizens. It’s not exactly surprising that one of the country’s most liberal states has become the first state to legislate a fundamental right to healthcare for all of its citizens. And, should the federal government allow them to proceed, it is only a few years until Vermont surpasses Massachusetts in the percentage of its population that has access to healthcare.

About a week ago, the New York Times ran a story about the campaign to pass this law. The article focused mostly on one of the main advocates for the law, though it did briefly quote one of the main opponents, a former Republican state senator. For once we weren’t subjected to the same tired old excuses, that government has no place in the healthcare market, meant to protect the healthcare industry.

The argument, also used during the fight over national healthcare reform, was that the new healthcare law, specifically the new taxes that would be necessary to enact it, would drive businesses from Vermont. This is an argument that of course makes little sense; Vermont will be replacing its current healthcare system with a cheaper one. Businesses that currently provide healthcare to their employees will almost certainly see a fall in their expenditures on healthcare. Yes, businesses that do not provide healthcare to their employees will be negatively impacted, but are these the type of businesses one wants in their state?

With that being said, the practical arguments are all rather beside the point. The question of healthcare policy is a question of ethics: our citizens’ lives and livelihoods are at stake. It is a moral failure to ignore that fact, yet we so often do so.

In response to the former state senator’s claim that the healthcare law would drive businesses from Vermont, I have one very simple question, one that has never been answered by opponents of increasing access to healthcare: how many jobs is one human life worth?

We know without a doubt that tens of thousands of Americans die every year for lack of access to adequate healthcare. We also know that untold numbers more are far sicker than they need to be due to a healthcare system designed with little interest in actually improving health. So when an argument is presented in opposition to increasing access to healthcare, it must be weighed against the lives lost and ruined under the current system. In this case, the opponents of reform have placed the potential loss of jobs on the scale. So a rephrasing of my question: what number of dead and sickly citizens of Vermont balances the scale against the jobs that might be lost due to this law?

This debate should remind us that the opponents of healthcare reform, both on the state and national levels, in their crusade to protect the liberty of corporations, have engaged in an endless assault on individual liberty. The two do not have to be mutually exclusive; unfortunately, the defenders of corporations have forced our nation to decide between the two. I for one am glad to see that at least one state has decided that the two are compatible and has enacted a law that both respects human dignity and improves the financial condition of businesses.

19 Responses to Vermont’s Single Payer Healthcare System

  1. Joe S says:

    I think it would be better to unburden US labor from the cost of health care. Instead of taxing work and jobs, a progressive tax on consumption would be a better way to fund health care. In that way the goods we import from China would carry the same health care penalty that goods made in the US have.

    But to limit whatever taxes are necessary to provide universal health care, the primary challenge will be to reform the health care process to be much more cost effective. Too litlle discussion on that subject because we are always trying to redistribute the cost instead of reducing it.

  2. Righty Bulger says:

    Yes Andrew, those are the types of businesses one wants in their state. They are the small businesses. The mom and pops shops which employ the vast majority of residents. Vermont just put a great number of them out of business. Good luck finding a job in the Green Mountain state from here on in.

    Joe, you are so right. So much time is spent worrying about who is going to pay for health care and how much of the burden unions, government and residents should bear. Yet we still have not seen a single action take at the state or federal level to keep costs from bankrupting all of us, government, business and private citizens.

  3. Righty Bulger says:

    As for the “cost of a human life” angle of this discussion, look to the failed European models now bankrupting the continent. And not only is it bankrupting them, they’re still receiving inferior health care. The wealthy “pad the envolope” to receive the best care, while those without enough to bribe their way out of the waiting rooms suffer.

    Of course, we should also examine why anyone with a penny in their pocket comes across the Atlantic for health care, to this horrible land of health care injustice which the Andrews of this country rail against. Ironic, isn’t it?

    Do me a favor Andrew. Next time you’re in need of medical care, hop a flight and spend some time in Europe getting care. Then you can come back and lecture us about the horrors of America’s system vs. the wonders of socialized medicine.

  4. Joe S says:

    Just to clarify, I am not against single-payer health care, but rather the source of the funds to make those payments. However, a caution with single-payer is that we could put too much power into the hands of one entity, whether it be private of government responsibility. But there should also be many benefits, such as reduced overhead, consistent services and possibly the elimination of profit and some of the adverse decisions that goes along with it.

    It appears there are efforts ongoing in Massachusetts to reduce the cost of health care. One exhibit is the ranking that Lowell General Hospital has as a low-cost provider in the State. There may be many reasons for that ranking, but surely one has to be the arrangement the hospital has with BCBS to transition to global care instead of fee-for-service. Since the rankings emanate from a State-sponsored study on reducing health care costs, it is a sign that Massachusetts may be ready to take that next big step on the affordability of near-universal health care.

  5. Renee Aste says:

    We can wait and see if it works. If it works, it works. I think my concern is Vermont isn’t as diverse as other states, differing factors.

  6. Andrew says:

    Joe and Righty, you both have a very good point about reducing costs, which is the point of a single payer healthcare system. It’s very difficult to reduce costs for a few reasons. On the prescription side of things, European countries have imposed cost controls, meaning that the US pays for most of R&D. I’m not quite sure how we would reach a more equitable arrangement.

    As for the small businesses, the individuals at those small businesses already have to pay for healthcare as it is, just individual plans, which are more expensive than plans gained through some form of collective bargaining. Ergo, single payer should reduce their healthcare costs. I was referring to the large businesses that do not provide healthcare for their employees, such as WalMart, that could actually leave the state.

    Righty, there are some flaws in the argument in your second comment. I’m not really sure which countries you’re referring to; can you please provide some examples? The Europeans all spend far less per person on healthcare than we do, have universal coverage, and by basically every measure are healthier than we are. So which countries are being bankrupted by healthcare costs and are providing inferior care?

    It’s more than a penny in their pocket. Yes, if you have money, the US is a great place to come for healthcare. We have the best medical schools in the world and most of the best hospitals. The problem is access. A rather large number of Americans don’t have healthcare period and how many more do not have access to the best care available? The fact that rich foreigners come here for healthcare is no argument for how good our system is; it’s an argument for how good our system is for the wealthy at the expense of everyone else.

    As for being in need of medical care, it was only three years ago that I was in desperate need of medical care, so there’s no need to lecture me. I had to wait quite a while from when I was referred by my primary case physician to see a specialist; in fact, I had to wait the maximum amount of time legally allowed in the UK under the NHS. Based on wait times, I would have been better off in most other European countries. But we need not look to Europe. I have a very good friend from school who has the same condition I do. The difference is Canadian. Our experiences with the healthcare system were quite different. I would have preferred hers. And I, unlike many Americans, not only have healthcare, but have a fairly decent plan.

  7. Michael Luciano says:

    Done right, a single-payer system in America would be a boon to business because it would greatly reduce the amount of money employers and employees spend on health care. Would taxes have to be raised? Sure. But the amount of private capital freed up for productive commerce would increase several fold. Instead of making Vermont less competitive, as some have claimed, once their system is fully implemented, it should make them a more attractive place to start a business since it will no longer be up to employers to contribute exhorbitant sums of money for health care.

    In this country we spend double the amount per capita on health care than the rest of the industrialized West. Righty may trash “Europe,” which no doubt has its problems, but in terms of exports it is beating us. Germany has a single-payer system and it alone exports more than the United States.

    It is true that many foreign nationals come to the US to receive various health treatments, but no Australian or Frenchman for example, would come to the US for the health INSURANCE. For that would constitute a decrease in his standard of living.

  8. Righty Bulger says:

    “Righty, there are some flaws in the argument in your second comment. I’m not really sure which countries you’re referring to; can you please provide some examples? The Europeans all spend far less per person on healthcare than we do, have universal coverage, and by basically every measure are healthier than we are. So which countries are being bankrupted by healthcare costs and are providing inferior care?”

    The simple answer is ALL OF THEM.

    Comments like “they’re much healthier than we are” is a total crock of you-know-what. It has nothing to do with health care and everything to do with thousands of mitigating factors, not the least of which is the United States continues to take on the poorest of the poor from the rest of the world and our hospitals treat them as royalty is treated overseas.

    What you and Michael Luciano keep ignoring is the fact that lower insurance and health care costs overseas comes from inferior health care. Of course and Australian or Frenchman wouldn’t come here for health insurance. They come here WITHOUT it to save their lives. And we give it to them, just as we give it to the millions of illegals who seek it day in and day out.

    Again, I ask you Andrew, and you Michael, to spend a couple of years in another country and seek life saving health care, or basic health care for that matter. Short of that, seek out immigrants in our country, shouldn’t be difficult here in Lowell especially, and ask them about the wonders of medicine in their homeland and why they came here.

    Then you can tell me if you’d put your life, or the lives of your loved ones, in the hands of another system of health care.

  9. joe from Lowell says:

    In point of fact, a single payer health care system provides a level playing field between mom-n-pops and big businesses, by eliminating the advantage the latter enjoy in the effort to attract workers.

    In point of fact, the Affordable Care Act includes numerous provisions intended to bend the curve on health care costs.

    In point of fact, most European countries, as well as Japan, see better health care outcomes than the United States, as every comparative study ever done has shown.

    In point of fact, universal-health-care countries like Germany, France, and England are facing less of a fiscal problem than the United States.

  10. joe from Lowell says:

    “Do me a favor Andrew. Next time you’re in need of medical care, hop a flight and spend some time in Europe getting care. Then you can come back and lecture us about the horrors of America’s system vs. the wonders of socialized medicine.”

    You mean like when Sarah Palin wrote in her book about how her family used to sneak across the border to Canada to get health care?

  11. Joe S says:

    Maybe we should look at this as an economic problem, not just a social problem.

    Health care spending in the US in 2009 was $2.5T, which was 17.6% of GDP. That was an increase from 16.6% of GDP in 2008, and about $8,100 per capita.

    That $2.5T comes from a variety of sources – if it were all to come from a single source it would be the elephant in the room. In the case of a national single-payer, the majority of that money would be funneled through it, although there still may be multiple sources of the revenue.

    From an economic point-of-view (and jobs), it would seem that we should unburden work from that expense. Rather than tax jobs to create the revenue, or ask that the employer funds it, I would rather see it come from consumption. However, a consumption tax is generally very regressive, so a more complicated system of tax would be required to generate the revenue “fairly”. The benefit of this shift in source of health care revenue would be that goods made in China (and other) and sold in the US would contribute equally to the health care system as goods and services produced in the US.

    And rather than stop there, I would unburden employers (and the self-employed) of the matching 6.2% of social security tax, along with the total 2.9% Medicare tax.

    Then where would the money come from?

    a 17.5% national sales tax with a rebate for a given amount of that tax, with an effect similar to the standard deduction on the income tax. That would be one small step to make the tax less regressive. Combined with that in a hybrid tax system, the income tax would drastically change to eliminate most deductions and complications, but to drastically increase the standard deduction (to about $100K for married couple with no dependents), and with progressive tax rates at higher incomes than that. The sales tax component of this would provide sufficient revenue to fund the majority of health care costs administered by a single-payer, as well as provide the Social Security revenue that would otherwise be lost with the removal of the employer portion of that tax. We could also reduce the SS tax rate on individuals slightly, but should extend the tax to all levels of income.

    The individual responsibility for revenue would come from a combination of a nominal premium and co-pays. The premium would be about $100/month/person and the co-pay about $20/visit, with each reduced on a sliding scale for incomes below a certain threshold.

    But $2.5T increasing at 6% per year is not sustainable, so action to reduce health care costs are also needed. Maybe single-payer will help, but more extensive reform is necessary. The suggested approach to funding noted above would provide about $2T for health care, and fully fund Social Security. So we would need about 20% savings compared to the way we do business today.

  12. Andrew says:

    Righty, you still haven’t answered my question. Provide evidence please. I know of no European country that is facing a fiscal crisis because of their healthcare system. I also know of no western/northern European country that has worse health outcomes than the US, even if you ignore immigrant populations. Again, please provide evidence, even just one or two countries as an example.

  13. Michael Luciano says:

    Righty, your points are nothing more than right-wing rhetoric and babble. Congrats. You can repeat the talking points spoon fed to you by Fox News and WTKK. But let’s get serious for a moment. Explain to me, and the other inquisitive commenters here, where Germany and its single-payer system go wrong. What of Sweden or Norway? Their national balance sheets are in far better shape than ours, whilst they provide universal coverage for their populations. No one in Europe ever files for bankruptcy due to medical-related costs, unlike here where a majority of such filings are owed to health-related expenses. I doubt you have any substantive understanding of the Eurozone economy, but if I am wrong please let me know. I would be happy to hear your opinions on which European states are suffering the most from such a system.

  14. Righty Bulger says:

    No Fox News talking points necessary. Real life experience in European hospitals is all that’s necessary for me to share my opinios. I’ve lived there. Have you? I doubt it. Again, next time you or Andrew have the need for health care, fly overseas and see for yourself how wonderful it is.

    Now I could sit here and provide a series of links showing how U.S. Health Care is the best in the world, same as the two of you could provide and equal number of links to statistics showing otherwise. We all know what you can do with statistics to prove a point. (Just ask the FBI criminologists)

    Instead, I’ll simply ask you to point me in the direction of one American you know who went somewhere else for health care because it was better there. Not to save money, mind you, but to get better health care.

    Take a stroll into any American hospital, especially the ones in Boston and count the number of foreignors here to save their lives.

    P.S. Michael the Europeans are bailing each other out left and right because of their entitlement programs, which include health care.

    Bringing up Norway and Sweden in a debate about American health care shows your left-wing, PBS ignorance.

  15. Michael Luciano says:

    @Righty, You seem intent on keeping this discussion at a level of abstraction, and so I wonder if you can think beyond your own personal anecdotes. You even explicitly discourage the use of statistics–evidence basically–in this discussion.

    Essentially your argument is: I lived in “Europe” and I received subpar health care. Therefore, and trust me on this one, single-payer is horrible. Oh and also, because hardly any Americans spend thousands of dollars out of pocket to fly to, stay in, and receive medical care in Brussels or wherever, that means our system is better.

    I’ll also bring up my initial point, since you never addressed it, or any or substantive point I made for that matter: under single-payer, the amount of private capital freed up for productive commerce would increase several fold. Instead of making Vermont less competitive, as some have claimed, once their system is fully implemented, it should make them a more attractive place to start a business since it will no longer be up to employers to contribute exhorbitant sums of money for health care.

    By the way, if my bringing up European countries in a debate about American health care means I have an ignorant left-wing bias, then you must have one as well since it was you who first opened that door by advising us to ” look to the failed European models now bankrupting the continent.” Well I did, and brought up Germany, Norway, and Sweden just to name a few. In terms of our debt to GDP ratio, we’re worse off than a lot of European countries, and that’s without universal health care. So you can trash the PIIGS countries etc. for being in bad shape, but we’re right there with them. The only difference is, they can’t print their own money.

  16. Renee Aste says:

    I find the problem with government stepping in to control health care is the same problem with corporate run health care. Remember it was just several decades ago, when all healthcare was run by one form or another of charity and support care by family members.

    While Europe may have decent healthcare systems, they are losing the demography that supports it. When we rely on government and/or capitalism as their sole support system, we tend forget the value of charity and family. We dependent (at the mercy) on each other when we are young, old, and sick.

    I’m thankful for medicine and there is a price for it, as well professional health care aides. But our reasoning and attitude towards the well being of the sick changes when it simply becomes a focus of who should manage it, not how do we actually care for those in need.

    I guess you can say I fear government controlling health care in the same way we fear HMOs controlling our health care decisions.

  17. Righty Bulger says:

    “…hardly any Americans spend thousands of dollars out of pocket to fly to, stay in, and receive medical care in Brussels or wherever, that means our system is better. ”

    Yes, that’s my point that you continue to ignore. Hardly any Americans do that, yet there are millions who pay out of pocket to fly, stay in and receive medical care in the United States, in particular Boston.

    There’s a reason for that folks. Don’t let the “Universalists” and their doctored stats tell you otherwise.

    Also Michael, tell me again how many immigrants make their way to Norway, Sweden and Germany again? There are 30,000 Southeast Asians in Lowell alone. I doubt there are that many immigrants in Norway and Sweeden combined.

    But, that has no effect on our skyrocketing health care costs either, right?

  18. Michael Luciano says:

    Well Righty, I tried. I reiterated my initial points about freeing up capital and asked you to explain what’s so wrong with the German or Scandinavian systems, to no avail. You’d rather talk about what’s two feet in front of you. Why are there 30,000 SE Asians in Lowell? I don’t know. Ask them. I assume it’s because once upon a time their ancestors regarded America as the land of opportunity, which it then was, and generational inertia has done the rest. But that is becoming less the case, as the US ranks behind Western Europe in social mobility.


  19. Righty Bulger says:

    I told you what’s wrong with the systems. They provide an inferieor health care product, as evidenced by the millions who flock here to receive care, not insurance.

    Using numbers to say other countries are “healthier” and their health care systems are better doesn’t work because it isn’t a level playing field. Norwegians don’t have to provide health care for the 30,000 Asians in Lowell, nor for the millions throughout the entire country. Emergency room doctors and nurses in Norway aren’t called on to treat millions of refugees from other lands. They aren’t confronted with the social and economic hardships that come with a wide open immigration policy that opens the borders to countless legal and illegal immigrants. They aren’t confronted with the socio-economic challenges a nation the size of the U.S. faces. When you think about it, we actually get tremendous bang for our buck here, which again is why millions flock to us to save their lives. They don’t go to Norway.

    Imagine what would happen if the PIGS nations were allowed to go bankrupt and their citizens suddenly swarmed Norway, Sweden and Germany. Think their government sponsored health care system would crumble under the weight?

    There’s a reason the Germans et al are bailing out the Greeks. It’s cheaper to give them billions than to have their refugees flock into Germany and destroy their all their systems, including health care.

    And Michael, I tried, too. Pray you’re never in need of medical services anywhere but America. If you are, you’ll understand where I’m coming from.