Just a little bit more….

regret

Vermont's Single-Payer Dream Is Taxpayer Nightmare

Where are those that earn their degrees from vaunted university systems that build lucerative careers to study, project and establish outcomes in projects like this? Or, is it all a crap shoot, ideology over reason… scary, I guess all the adults are on vacation.

Vermont's Single-Payer Dream Is Taxpayer Nightmare

By Megan McArdle

Of the plans that states have hatched for the Affordable Care Act, none has been bolder than that of Vermont, which wants to implement a single-payer health-care system, along the lines of what you might find in Britain or Canada. One government-operated system will cover all 620,000 of Vermont’s citizens. The hope is that such a system will allow Vermont to get costs down closer to Canada’s, as well as improve health by coordinating care and ensuring universal coverage.

Just two small issues need to be resolved before the state gets to all systems go: First, it needs the federal government to grant waivers allowing Vermont to divert Medicaid and other health-care funding into the single-payer system. And second, Vermont needs to find some way to pay for it.

Although Act 48 required Vermont to create a single-payer system by 2017, the state hasn’t drafted a bill spelling out how to raise the additional $1.6 billion a year (based on the state's estimate) the system needs. The state collected only $2.7 billion in tax revenue in fiscal year 2012, so that's a vexingly large sum to scrape together.

Vermont is a middling-tax state, as states go. And that’s not an accident; its population consists of longtime Vermonters, some of whom vote Republican (at least for governor) and are not super-tax-friendly, and transplants from Massachusetts and New York state, who, last time I looked, had moved to Vermont partly because the taxes were lower. Paying for this program would likely make Vermont the highest-taxed state in the nation, by quite a lot.

Now, you can argue that people should be glad to make this trade-off, not just for peace of mind, but because they will trade higher taxes for lower (no) insurance premiums. You can also argue that poor people in America should be laughing and dancing and singing all day because every one of them is economically better off than starving farmers in drought-ridden regions of Africa. Neither argument will do you much good, however, because that’s not how people think.

Especially when you consider that estimates for this plan's cost are likely to err on the optimistic side, because, well, people drawing up proposed budgets for their pet ideas tend to be a little optimistic. Yes, yes, there may be fabulous cost savings from using the government’s monopoly buying power to bargain prices down with providers. But Vermont is already the beneficiary of significant monopoly buying power: One insurer has 74 percent of the state’s small-group business. It’s a Blue Cross/Blue Shield, so don’t count on fabulous savings from squeezing out profits. The large group market is even more concentrated, though on a for-profit insurer.

Nor can you get much administrative saving at the provider level, because they still have to deal with out-of-state insurers quite a bit. And the once-vaunted fabulous savings from preventative care have mostly turned out not to exist.

So this is going to be expensive. So expensive that I doubt Vermont is actually going to go forward with it.

This should be instructive for those who hope -- or fear -- that Obamacare has all been an elaborate preliminary to a nationwide single-payer system. It isn’t. The politics are impossible, and even if they weren’t, the financing would be unthinkable.

To contact the writer of this article: 
Megan McArdle at mmcardle3@bloomberg.net.

To contact the editor responsible for this article: 
James Gibney at +1-202-624-1863 or jgibney5@bloomberg.net.

Reflections on Obamacare, w/Mike Walker

Reflections on Obamacare

Mike Walker, Col. USMC (retired)

All,

Being dismayed by TV reporting is becoming a chronic condition, whether the source is NBC News or Fox News or CNN.

Political ideology has nothing to do with it and Obamacare is an excellent case in point.

The software malfunction – in and of itself – was only a passing embarrassment.

The “seven million” figure is also of limited importance.

After spending nine years on the board of directors for a non-profit health care provider, I can tell you that what is important is the make up the patient pool – not how many people are in it.

Is the pool healthy or sick and if sick then how sick? That is crucial information.

And that leads us to the source of my dismay: Why the TV media obsession about the outer edges of Obamacare while ignoring what really matters?

First, it is impossible for either detractors or supporters to declare Obamacare a success or failure.

No one in America has ever seen Obamacare in operation. NO ONE. We are like the blind guy feeling the elephant.

There are provisions originally not intended to go into effect until next year or later. Since the ugly rollout, no less than two dozen additional provisions (I lost count), some minor, some significant, have been either suspended or modified.

Here is the reality: 2014’s version of Obamacare bears little resemblance to the law passed in 2009. The jury on this one will be out for years.

Second (and far more important), the ONLY BIG STORY is determining how many previously uninsured Americans now have health care.

THAT WAS THE REASON FOR THE LAW.

That is the only thing that matters!

That is why tens of millions of us supported the idea of Obamacare.

Its Republican critics have to face the reality that when they held power they did NOTHING to get the 10% of uninsured Americans covered.

Taking care of the most vulnerable Americans is a just and noble deed and President Obama deserves a lot of credit for taking action.

But things are not so rosy for the Democrats either.

Trying doesn't cut it in America. We demand success and that is a good thing.

Aye, there’s rub!

Obamacare changed the entirety of the health care system. It now touches everyone from Washington to Wall Street to Main Street. 

It touches babies and seniors, it changed how 20-somethings get insurance to 80-somethings using Medicare Advantage. It is pervasive in its reach.

And that gets to the big fear of the Democrats.

If the Republicans are guilty of the sin of omission on this issue then the Democrats are facing the sin of commission.

One lasting lesson of the website rollout, both at the Federal and State level, was a painful demonstration of just how inefficient government can be compared to the private sector.

What will happen to the champions of “Washington-centric solutions” if, when Obamacare is in full force in a few years, we find out that the law imperfectly messed with health care of the whole 100% while failing to address the needs of the most vulnerable 10%?

One thing is for sure: It will be ugly.

A political goal of Obamacare was to gain the attention of the entire country and it succeeded.

Good luck with that in the years to come.

Mike