Failed Empire

Chronicling the collapse of a failed society

First in the Nation: Vermont Enacts Single-Payer Universal Health Care

Vermont single-payer

The state of Vermont has taken the first step towards bringing the United States back on par with the rest of the developed world:

 “We gather here today to launch the first single-payer health care system in America,” began Shumlin, a Democrat who has been governor barely four months. “To do in Vermont what has taken too long: have a health care system, the best in the world, that treats health care as a right, and not a privilege.”

Moments later, the governor made history, signing a law that sets Vermont on a course to provide health care for all of its 620,000 citizens through a European-style single payer system called Green Mountain Care. Key components include containing costs by setting reimbursement rates for health care providers and streamlining administration into a single, state-managed system.

The necessity and practicality of creating a single-payer universal health care system is a common theme here, and it is wonderful to see the people of Vermont taking the initiative here.  It may seem a small step, but it is an important and historic one; after all, we must begin somewhere.

The issue of universal health care is relatively straightforward, but a person’s stance on it speaks volumes about one’s character.  The fact that, in our society, it is considered acceptable to obtain profit from the illness and suffering of another human being says perhaps all one needs to know about American-style capitalism:  no matter what the consequences, if I can make a dollar everything is a-okay.

This past summer I was visiting my family after several years of being away.  We had rented a small house in the beautiful White Mountains of New Hampshire, and were playing a game which involved asking each other how we would respond to different morally complex situations.  One such situation involved the creation of the cure for a notoriously lethal disease, and the question posited was thus:  If you had created a medicine which provided the cure for, say, pancreatic cancer, would you distribute it at minimum cost to save as many people as possible, or would you set an artificially inflated price in order to maximize profits?

Now, think for a moment what this question actually entails.  It asks more or less explicitly if you believe it is acceptable to make money at the cost of human lives.  Under other circumstances, most people would likely say  no.  For instance, if I offered you $1,000 to look away while I shot someone in the face, most people would likely decline.  But for some unfathomable reason, many – perhaps even most – Americans think it is perfectly acceptable to horde life-saving medicines in order to realize a profit of little scraps of paper that carry no real inherent value.  What does that say about us as a nation?  What kind of a society are we?

Something is absolutely wrong with America when such a state of affairs is not only acceptable, but openly encouraged.  It is an open secret that the insurance and pharmaceutical industries invest millions – billions – of dollars in lobbying in Washington, in an overt attempt to influence the legislative process to ensure maximum profits.  Those profits come at the very real cost of actual human lives, but no one seems to care.  Practically everyone I know complains of extortionate insurance premiums and inconsistent coverage, yet very little people actually begrudge the industry for exercising their sacred “right” to earn a dollar.  After all, if there were no financial reward to be had in healing the sick, why would anyone bother in the first place?

It seems Vermont alone has the right answer to this question.


One response to “First in the Nation: Vermont Enacts Single-Payer Universal Health Care

  1. willbt May 31, 2011 at 12:54 pm

    After all the bitter fighting in America over “Obamacare,” and the resultant watered-down quasi-public health care plan passed into law, the State of Vermont with its Green Mountain Care is a BRIGHT LIGHT, Americans! You other 49 states: Sit up and take notice!

    But speaking from Canada, where we’ve had a national universal, single-payer (government) health care system since 1965, I would caution Vermont to watch out for one particular kvetch : Green Mountain’s stated program includes: “containing costs by setting reimbursement rates for health care providers.”

    Capping doctors’ incomes has been one really tetchy issue all across Canada, for many years.

    Yes, our universal health care plan in toto is a not-for-profit program, but the DOCTORS themselves ARE entrepreneurs, in it for their private profit. Always have been. For generations, Canada’s national fees schedule allowed plenty of room for a GP to have a private practice, do his/her work to the best of his/her abilities, and earn a handsome income requisite to a doctor’s place in society.

    But in the 90s governments across Canada (federal & provincial) began to develop serious fiscal issues – running deficit budgets, accumulating unprecedented debt levels. And come budget time, since health care is by far the biggest chunk of government spending, it has been the first program to chopped: fees for service were capped, even in some areas, cut-back. Docs didn’t like that. It became increasingly difficult for docs to generate the incomes they expected. Afterall, their office overhead continued to rise with inflation, but their incomes were shrinking. It began to look to family medical practices like Death by One Thousand Tiny Cuts. Private medical practice slowly eventually became unprofitable.

    “Salaried” doctors was never an option in public health care in the Canada plan. The idea was to allow doctors their entrepreneurial independence, but within a firm, fairly-mandated structure.

    Thus came the evil bloom of corporate-owned “Walk-in Medical Clinics”: Big MedCorp. puts up the bricks and mortar, hires salaried support staff, the docs just move in, paying “rent” only – no more burgeoning office overhead.

    But the “walk-ins” have proven to be less-than-ideal.

    Walk-ins are impersonal facilities: since docs accept no appointments, they lose personal touch with patients. “One time only” patients, (who walk in one day and never return), mix with “regular patients,” all waiting peevishly in line. Eventually they all tend to “shop,” or “bounce” around town, frustrated, trying out other walk-in clinics in pursuit of the shortest lineup. The result: docs who don’t know their patients, and patients whose maladies may be mis-managed because of the discontinuity lacking inherent the walk-in model.

    Worst of all, walk-in clinics tend to spawn a mentality amongst doctors that says: “Pay-the-rent, the rest is ALL MINE.” So they ramp up for faster patient turnover. Patients become a blur of unknown faces. Not a desirable model for good health care.

    As the Canadian health care system stands today, yes, all citizens are getting “free” health care, including the most sophisticated, expensive surgeries. That’s a very good thing. No Canadian citizen need go without health care. There are certain items that do attract fees: an ambulance ride will cost you around $45; routine dental care is not covered (emergency dentistry is free); physiotherapy and chiropractic treatment may incur a $5 or $10 service fee. And for persons gainfully employed and otherwise not collecting any other social benefits, prescription drugs are theirs [and usually their employers’] to pay for. Persons collecting social assistance and disability income pay almost nothing, ever, for any kind of care. Retired persons get attractive discounts on prescription drugs, via their Canada Pension Plan coverage.

    STILL..there is this persistent sore spot with doctors: they feel they’re being gypped unfairly by “containing costs [by] setting reimbursement rates for health care providers,” and they feel their incomes are not keeping up with their expectations. Canada loses most of its new medical school grads to other jurisdictions where they are assured high incomes – the USA being the prime landing spot.

    So, Vermont: “if you’re tempted one fine budget day to tighten your purse strings on doctors fees, think again. You could find yourself in the same boat with Canada’s malcontent doctors. Pay your doctors well. You NEED their happy cooperation.”

    In a universal public health care system, nobody wins by chopping away at fee-for-service schedules. Chop other programs, not health care.

    Be cool, Vermont. Keep your doctors happy. And congratulations!

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