Single-payer has built-in safeguards
Rep. Paul Ralston’s recent commentary, “Single-payer is the only campaign issue,” raises some understandable concerns about Vermont’s move to create a publicly funded, universal health care system. Fortunately, in 2011 the Legislature foresaw the need to have these questions answered as it had its debate over passing legislation to create Green Mountain Care.
The Legislature installed “triggers” that would prevent Green Mountain Care from being implemented if the concerns Representative Ralston cited were to occur: What if single payer doesn’t provide universal access? What if single payer rations care? What if it’s more expensive than our current system? Here are the relevant “triggers,” verbatim:
A determination by the Green Mountain Care Board, as the result of a detailed and transparent analysis, that each of the following conditions will be met:
— Each Vermont resident covered by Green Mountain Care will receive benefits with an actuarial value of 80 percent or greater.
— When implemented, Green Mountain Care will not have a negative aggregate impact on Vermont’s economy. This determination shall include an analysis of the impact of implementation on economic growth.
— The financing for Green Mountain Care is sustainable. In this analysis, the board shall consider at least a five-year revenue forecast using the consensus process established in 32 V.S.A. § 305a, projections of federal and other funds available to support Green Mountain Care, and estimated expenses for Green Mountain Care for an equivalent time period.
— Cost-containment efforts will result in a reduction in the rate of growth in Vermont’s per-capita health care spending without reducing access to necessary care or resulting in excessive wait times for services.
— Health care professionals will be reimbursed at levels sufficient to allow Vermont to recruit and retain high-quality health care professionals.
So to reiterate, no matter what plan the Shumlin administration eventually proposes and no matter how eager the Vermont Legislature may be to pass such a proposal, it cannot be enacted unless it meets the above criteria — that it provides a basic level of coverage to all Vermonters with no reduction in necessary care, it saves money compared to the current system, it won’t drive Vermont’s economy into the ground and doesn’t put health care providers out of business.
As someone who also consulted with the state of Vermont to help launch the exchange, comparisons of its IT and administrative functioning to Green Mountain Care are wildly off base. In fact, the processes needed to implement Green Mountain Care are a much closer cousin to those the state has already successfully put in place through Dr. Dynasaur: a Vermont-created, Vermont-run, single-payer solution providing publicly funded, affordable and comprehensive health care to pregnant women and children. And I would encourage any doubters to go and talk to any one of the tens of thousands of Vermonters who have been on Dr. Dynasaur and ask if they ever experienced administrative nightmares or found it too complex. I am confident that as many as 98 percent would answer with a resounding no.
By comparison, the exchange is a federally mandated administrative nightmare with multiple private insurance carriers forced to communicate complex and ever-changing data with multiple public institutions such as the U.S. Treasury Department and the Department of Vermont Health Access. And then consumers have to negotiate 18 different plans with varying premiums, co-insurance, co-pays, deductibles and out-of-pocket limits along with federally mandated regulations such as open enrollment periods. Green Mountain Care is the antithesis of this: a single plan that every Vermonter has access to by right of living in Vermont paid for by taxes. It’s as simple as that.
Rep. Ralston is absolutely correct in stating that Vermonters should ask candidates who are running for office hard questions about whether moving to a universal, publicly funded health care system is the right decision. Fortunately, the answer is readily available: “yes.”
Peter Sterling is director of Vermont Leads, a nonprofit organization working to educate the public about the advantages of implementing a publicly funded, universal access health care system in Vermont.