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As health-insurance problems keep arising, Vermont offers a ray of hope

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Vermont has become the first state in the union to pass a single-payer universal health-care law for its residents.

I am a cancer survivor.

After being diagnosed with breast cancer last year, I chose to undergo medical treatment in the country of Colombia in South America. I received first-class treatment – surgery, chemotherapy and radiation – at a fraction of what it would cost in the United States. Since I have been uninsurable in the U.S. because of pre-existing conditions, I went to another country for treatment rather than paying the shamefully high costs of care in this one. 

axness
Debra Axness

I have been following the implementation of the Affordable Care Act with great personal interest. I am extremely grateful that I will be able to get health-care coverage next year. While the system is not perfect, millions of people in situations similar to mine will be able to go to a doctor next year. Getting up in the morning and praying for good health and no car crashes is no way to insure your health.

All but ignored in the multitude of media coverage about the ACA and its problems, Vermont has become the first state in the union to pass a single-payer universal health care law for its residents. It has a snappy slogan: Everybody in, nobody out.

The system will be fully operational by 2017, funded by Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes. Everyone will be able to go to any doctor or hospital in the state free of charge. No plans to figure out, no insurance forms to sweat over, no gotchas.

Estimated to save 25%

Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings. Employers will suddenly be free to give raises to their employees instead of paying for increasingly expensive health benefits. All hospitals and health-care providers in Vermont will be nonprofit. Medicare recipients will no longer need to wade through an inch-thick book to choose supplemental plans and sort out other complex options in their Medicare enrollment.

Since Oct. 1, when the ACA was rolled out, for hours on end I have been trying to find out the information I need to browse plans and sign up for insurance under the Affordable Care Act. This is not yet another rant on how bad the system is. I just wanted to relate my experience. I spent days at the computer, made many phone calls, and had an appointment with an ACA navigator.  The system makes it next to impossible to comparison shop for plans.

Then I started calling the different insurance providers to ask information about their plans and how they work. I thought of as many "gotchas" as I could and asked each one about different scenarios, from a routine visit for a sore throat to a car crash with injuries, requiring being taken unconscious to the hospital. In the case of some providers, I never found a real live person to talk to.

ACA still relies on private insurance

I am getting a better idea about how this all works. The Affordable Care Act, for all the good it will be doing next year, still functions under the rules the insurance companies have established. I learned all the lingo — deductibles, out-of-pocket, out-of-network, balanced billed charges (these are charges the insurance company denies, and that you are responsible to pay for), and all of the other complicated morass that health coverage has become. In even some of the really good platinum and gold plans, the out-of-pocket amount can be $10,000 for the year! For that kind of money, I can fly to another country, have surgery, be hospitalized for weeks, and include a vacation too.

So, the real answer for the U.S. is still a single-payer system. Costs have to be held down — there is no reason why the U.S. has to pay twice the amount per capita as the next most costly system in the world (Norway's), and still not cover millions of its citizens. A Harvard Medical School study states that 45,000 Americans die each year from treatable diseases because they cannot afford to get treatment. That’s 15 times the number that perished in the 9/11 attacks, or one American dying every 20 minutes. It continues to happen every year and is a shameful statistic.

So, what’s the weather like in Burlington or Montpelier, Vermont?

Debra Axness is a computer professional from St. Paul, and has traveled extensively.

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Comments (30)

Our health care system could be viewed as a disease...

...that all of us have contracted, and which kills 45,000 of us each year.

Yet there is no active program to find a cure. The ACA, a step in the right direction, and despite its significant benefits, is not really the answer.

Back when the health care overhaul was launched, the Democrats were too timid and fearful to simply go with single payer. Medicare works. It is highly popular. But the profits in this industry are so huge, a switch to single payer will have to overcome enormous head winds. It's easier to protect your profits in a fragmented system than if you had to deal with a single payer.

The Vermont system seems different than a simple change to single payer, however, if all providers and hospitals are required to be non-profit.

There is a good deal of chicanery in the use of the term "non-profit" when it comes to health care. You can be a "non-profit" on paper and make TONS of money to spend and invest, pay whopping salaries, etc.

Yet it seems it would be extremely difficult to persuade all providers and hospitals to change their charters to non-profit status.

Non-Profit Status Is Good...

Non-profit status is good, but the real savings will come from the power of a single payer to negotiate prices down, no matter who is doing the selling. I don't mind if the government negotiates with non-profit or for-profit healthcare providers in the private sector, as long as the purpose of the negotiation is to bid down prices. The ideal is for all healthcare providers, and all private-sector businesses generally, to be low-profit, so that their products and services will be affordable to consumers.

I agree that we should be distrustful of labels like "non-profit," which may or may not actually mean anything. But in the future, Vermonters will be able to see clearly what their healthcare system actually costs them, and with a little publicly funded research, they'll be able to see clearly how much it benefits them as well.

The Nation Will Follow Vermont, Someday.

Thank you, Debra Axness, for your plain-spoken presentation of the facts that everybody should know. I am confident that within a few years, or a few decades at most, everybody WILL know what you know. The success of Vermont will become common knowledge. Someday, we will all wonder why we couldn't have created a single-payer system much sooner.

But of course, the reason is the reason Steve Titterud has given. The for-profit health insurance industry has a big advertising budget. It has used this power very effectively, demonizing the very idea that health care is a human right and insinuating, in the face of all evidence, that private health insurance is somehow better than public insurance and that it's okay for some of us to have no health insurance at all.

Lots of taxes needed

According to this article from a VT newspaper, the state is going to need $2 BILLION dollars in new state taxes to pay for this. Vermont's 2012 population was 625K, The 2012 population of MN was 5.4 million. We will need a bit more than $2 billion to pay for it.

http://www.gmoutlook.com/news/2013/nov/18/vermont-needs-2-billion-new-ta...

You're forgetting one thing...

You're forgetting one thing... the single payer system means that I will no longer have to pay the ridiculous in insurance premiums, outrageous deductibles and crazy, overpriced hospital bills. This will leave me plenty of money to pay in higher taxes. The same is true of employers, the burden of insuring their employees will be lifted and passed on to the state, pretty much the same way it is done in every other civilized nation.

Even if the single payer system ends up costing me the same or even more than I currently pay for insurance, I more than welcome it. Just the thought of not having to deal with insurance forms, deductibles, out-pocket expenses, in-network vs. out-network doctors, makes the single payer system priceless in my opinion.

Vermont will set the standard in the US for what healthcare should be throughout the country. Hospitals will no longer be able to charge you $50 for an aspirin or $100 for a box of Kleenex.

Way to go Vermont!

One More Item

Also with a single payer universal system, should you ever lose your job you will still be covered. No more fretting about getting laid off when your spouse is in the middle of treatment for cancer. Even ignoring for a moment Joseph's excellent points above, that alone is worth going for a single payer system.

Considering two thirds of all bankruptcies are medical related, the American people stand to save a lot of time, money, and stress by implementing Vermont's program.

Here are a few more facts about the changes in Vermont.

We are going to be hearing lots and lots of NOISE about Vermont's new health care paradigm from opponents. You'll hear it stated or implied, for example, that Vermonters are going to be paying $2 billion in NEW dollars they currently don't have to spend. This is false.

“Vermont’s lawmakers have until 2017—when the reforms come in effect—to raise $1.6 billion in new taxes to replace private insurance premiums and to cover the health care costs of those who are now uninsured.” http://www.thesolutionsjournal.com/node/23903

So in truth, money currently expended by Vermonters on private insurance premiums is going to be REDIRECTED to support the single payer system. In addition, the currently uninsured will be brought into coverage for the first time, certain to be a cost-saver in the long run. This is not new expense, and the claim is not true but is propounded by right-wingers in their normal mode of spreading fallacies and confusion.

You can also see why the insurance industry is howling about how bad this is going to be for Vermonters. It's going to deprive the industry of premiums !! So of course their line is that it will be bad for everyone else.

This $2 billion figure is launched into the media without context and understanding as a scare tactic. But in fact, the VT government had estimated it would cost $1.6 billion, and this $2 billion is another (and perhaps it is a better) estimate of the transfer, but not really much in the way of news, unless all you read are the headlines.

The insurance industry and certain elements of the health care providers are opposed to it because of threats to the profits their business models portend WITHOUT single payer.

So why did Vermont decide to take this action ? In 2011, Vermont did an analysis of projected costs:

From http://www.leg.state.vt.us/jfo/healthcare/November%20Report%20-%20Final....

“The analysis indicates that without reform, Vermont health care spending will more than double from 2009 to 2019, from $4.7 billion to $10 billion.“ and…

“If action is taken in each area of potential savings discussed in this report, savings will begin in 2014 and rise rapidly for the next several years. In 2020, savings are estimated to range from $553 million (5.5 %) to $1.8 billion (18.3 % of total spending)” and…

“The Hsiao report, delivered in February 2011, projected that by 2024, the state could reduce its health care spending by up to 25 percent from what would have been spent in the absence of state health care reform (but counting the impacts of federal reform). “

Another fascinating aside: apparently, proponents of ObamaCare became OPPONENTS of Vermon'ts single-payer system !! (http://www.thesolutionsjournal.com/node/23903)

One wonders if they fear Vermont's single-payer system would make the ACA look like crap.

ACA

Of course certain supporters of the ACA view Vermont's plan as a threat to the ACA.
The ACA is all about insurance company profits.
Vermont's single payer system is about healthcare at reasonable costs.
Businesses and corporations will always seek to protect their profits....even to the point of telling lies.

UHC

So how soon can we get universal health care here in Minnesota? The health care industry's objections should be completely ignored as they're just going to protect the system as it is, which is simply failing our citizens. If they had a viable solution to the ever-rising costs they would have implemented it already. They've had no less than 70 years to come up with a plan and despite all that time we've seen nothing from them.

It's time to stop pandering to the industry, cut the ties, and implement a plan like Vermont's that's good for all people, not just the select few who have a job with a benefits package.

As others have pointed out, the problem with ACA is it pandered to the health care industry, which has lead us to the disaster we have now. The industry doesn't have a vested interest in changing the system; they want it to stay the way it is so they can make boatloads of money. Go with single payer though and they'll lose out. Many will still be in the business of offering supplemental health insurance, but their business model will have to change accordingly. They won't like that, but health care isn't in the business of providing jobs for overpaid executives.

I'm writing my legislators and telling them I'd like to see this as a top priority when they resume in February next year. You can find contact information for your legislators here:

http://www.leg.state.mn.us/leg/faq/faqtoc.aspx?id=47

Vermont Laws

Vermont passed a law restricting campaign contributions.
The U.S. Supreme Court ruled that law unconstitutional and refused to allow Vermont to implement it.
I suspect the Supreme Court will do the same with this Vermont law.
Vermont does not control the U.S. Supreme Court.
Insurance companies and other corporations do.

Adventuring made it hard to get health care coverage

Starting in about 2006, the writer of this article traveled and sight saw from a small boat and ended up more or less living in South America. This was quite an adventure but, I am sure, would prevent her from securing, for example, employer sponsored insurance. It's too bad that she didn't have employer sponsored insurance. Or, if she had stayed in Minnesota she could have purchased Minnesota Comprehensive insurance which, of course, was available to residents with pre-existing conditions. Given all of this, I am wondering if she would even be eligible for Vermont's system. Would Vermont allow folks to spend years traveling and then move in for low-cost health care when the need arises?

As the writer suggests, the ACA is lousy for folks her age (in her 50's) and policies in Minnesota under ACA will be expensive for someone her age. It seems quite easy, however, to compare different plans on the MnSure site.

Problems with current system

I do not know who Karen Anderson is, but she did bring up one of the main problems with the current health insurance system: forcing most of us to get insurance through our employers. Most of the people I know and worked with in the computer industry suffered from layoffs through the 2000s, leaving them with no insurance once COBRA runs out. None of my employers ever offered car or home insurance to their employees; why should they be forced to offer health insurance? With single-payer, we can use the buying clout of the entire American public to offer the best health care for the dollar to everyone, not just those who are fortunate enough to have jobs at big companies offering good health insurance. I do not intend to move to Vermont; obviously Karen Anderson cannot appreciate a light-hearted bon mot. As a previous commenter pointed out, Canada's history shows them switching to single-payer province by province, starting with a low-population province (Saskatchewan) in 1947. My hope is that Vermont is only the first of our United States to go with single-payer.

Vermont Is Not Like Anywhere Else

(ahem) This is a very...very... *small* ray of hope.

As someone who lived there for nearly 10 years and who worked in State Government for 5+ of those years, I am a HUGE fan of the state, but I'm also enough of a realist to understand that there are things that work there that are not necessarily going to translate well in other states, never mind at the Federal level...

REALITY CHECK:
1) Vermont is a VERY SMALL state -- the entire population of the state is about equal to the population of Baltimore, MD ... 600,000 people. It's much easier to manage health care for 600,000 than it is for 6 million.

2) Vermont is a very homogeneous state -- probably one of the least diverse states in the union. Because there are fewer language and cultural barriers, people who need help are better able to serve themselves without a lot of government assistance required to get their needs met.

3) Vermont is full of...Vermonters! And Vermonters are different from most other folks (though they're somewhat similar to New Hampshirites and Mainites in some ways... they're very much their own unique sort of people). They're flinty and fiercely independent New Englanders (that's the Green Mountain Boys/Independent Vermont Republic influence) who are also very community-minded (that's the Quaker influence). These people sometimes don't even want to accept help they're *required by law* to accept, never mind ask for help if they don't feel they need it. I remember doing a ride-around with DOC Probation & Parole one time where we visited a guy who was a repeat DUI offender who'd lost his car and license to drive. He was living in the central-VT boonies b/c that was all he could afford, but he was still required to report in to his probation officer, attend AA meetings, and look for work. This man RODE HIS BICYCLE to do all these things. IN VERMONT. IN WINTER. Even though, by law, the state is required to provide him with transportation to get where he needs to go -- all he had to do was make a few phone calls to arrange it. He didn't seem to mind at all, though -- said it kept him health and kept his mind occupied. These people are *that* independent.

4) They've been doing this already for YEARS (Thank you, Governor Howard Dean, MD!)... so they're well versed in the pitfalls and have already navigated some of the danger zones, and have done so on a much smaller scale, so they've got a lot of the kinks already worked out that aren't even on the radar of the other states (never mind the Feds).

5) Their government is probably more efficiently run than most state governments, not only because it is such a small state, but because people there *know one another*... so they feel accountable to one another -- and hold their gov't officials to a very high standard because of that. For example, the Director of the Agency of Human Services isn't some remote dude in a far away capital city. He's someone who likely fishes out of the same lake you do, or who shops at the same grocery store your sister uses, or who attends the same church as your Aunt Alma. Not so in larger cities and states. Definitely not so at the Federal level where faceless anonymity is the rule rather than the exception.

So... it's all well and good to say "If Vermont can do it, we ALL can do it." In theory that may be true. I'm just not sure how realistic it will be in actual practice. If we were a nation of little Vermonts, populated by Vermonters, with a pervasive "Vermonter" mindset and culture... maybe. But unfortunately that is not the case, so expect things to be a lot messier in states like California, New York, Florida, Texas, and Michigan...

Vermont

Excellent! Vermont has already done the heavy lifting and has become our pilot program. I can hardly wait to get it implemented here at home.

Vermont should illustrate MINIMUM economies of scale...

...to be possible when implemented across larger populations. So Vermont's small population makes it a perfect pilot project.

I'm not sure about your other warnings: the word "probably" jumped out at me in both points #2 and #5.

California, New York, Texas and Florida are messier in every other aspect, so I'm sure you're correct things will be messier in those places upon implementing single payer. This is not an argument against improving the health care system.

Come to think of it, #3 and #4 are not arguments against improving the health care system, either.

Sure, there will be problems. But the problems in the current system outweigh any risks. We'll deal with them.

The biggest problem of all is that the centers of capital in the insurance industry and their allies will mount a TREMENDOUS campaign against universal single-payer, as they have so much money to lose. The value of that money is ours to gain, as a people.

Vermont health bill mislabeled ‘single payer’: doctors’ group

Vermont health bill mislabeled ‘single payer’: doctors’ group:
http://pnhp.org/blog/2011/04/07/pnhp-on-vermonts-single-payer-legislation/

Vermont health bill mislabeled ‘single payer’: doctors’ group

Vermont health bill mislabeled ‘single payer’: doctors’ group:
http://pnhp.org/blog/2011/04/07/pnhp-on-vermonts-single-payer-legislation/

debra axness

Typical democrat .,,, Debra ignorantly fear mongers for her cause. "...Getting up in the morning and praying for good health and no car crashes is no way to insure good health,"

Many states require "personal injury protection " or PIP as a minimum requirement for mandatory auto insurance. I personally have $100,000.00 of PIP in addition to my personal health insurance.

Almost every community has health care clinics for the poor or uninsured staffed by competent doctors charging on a sliding scale, Illness beyond their scope is forwarded on to appropriate specialists, And there is the "Health Department". I know someone without money ,a job, or insurance that is being treated for diabetes and heart disease -now, for free.

And you complain about wanting health insurance that I am expected to subsidize with my taxes when you went for treatment in Columbia .South America and paid cash.

You must be a democrat.

You must be a Democrat

Deedee, who on earth do you think pays for that "free" healthcare? If you're paying insurance premiums, you are.., If you're paying taxes, you are... nothing is free. The point is, negotiating for everyone will lower the costs of healthcare, and whatever form of paynment, such as taxes instead of premiums, will keep those costs down.

And don't even get me started about auto insurance... How is it that the federal government can force all the states to require everyone who drives an automobile to buy insurance, but not healthcare? It has been said over and over, becuase there's too many profits to lose going to a single payer system. Until this country does, health care costs will continue to rise every year, with or without the ACA; just less with the ACA.

Insurance Companies not the only issue ...

Read this thread with interest and will be watching whether this works in VT (small homogenous state or not). Just felt a need to chime in that folks often comment about the status quo and that insurance companies drive that discussion. I work for an insurance company and, yes, they are an important party at the table of any serious discussions about health reform and have a lot at stake. But folks underestimate the power of the AHA and the AMA and other provider organizations who have just as much - maybe more - at stake when it comes to group purchasing power to drive down provider reimbursement. Hospitals have much to lose if they can no longer choose their price at the negotiating table with hundreds of different insurance companies and physicians have much to lose if their incomes are restricted because they can no longer skim off the patients with high reimbursing insurance companies, but ignore those with lower reimbursement. Powerful lobbies both ... and powerful incentives exist to keep the status quo.

PS ~ It Costs Less in VT Because Vermonters Are Healthier

I want to add to my earlier comment that health care in Vermont will be more affordable all around for everyone than it likely would be in many other states because Vermont is consistently one of the healthiest states in the US.

To wit -- according to the United Health Foundation's report from 2012, in Vermont:

Only 11.8 percent of adults smoke
10 percent of adults binge drink
20.7 percent of adults are obese
16.5 percent of adults live a sedentary lifestyle
90.7 of incoming ninth graders will graduate high school

Compare this with the unhealthiest state, Mississippi:
25.7 percent of adults smoke
16.1 percent of adults binge drink
33.4 percent of adults are obese
33.8 percent of adults live a sedentary lifestyle
67.3 of incoming ninth graders will graduate high school

More poor health indicators = Higher health expenditures

We have to accept some responsibility for creating a "health culture" by how we each choose to live our own lives, by how we feed and educate our children, and by how much carrot (incentive) we provide to our fellow citizens to stay healthy (discounts for non-smokers/non-drinkers) vs. how much stick (disincentive) we provide (such as higher taxes on alcohol and tobacco products) to discourage unhealthy choices.

Leave everything up to the government and ... well, "Brawndo -- it's what plants crave."

Healthy States

While it is certainly true that healthier residents in a state will make for less expense in health care, what is most interesting to me is the statistic given by Dr. William Hsaio, the Harvard health care economist. He analyzed and helped craft the new system, and estimates that Vermont will save 25% over current health care costs per capita, in Vermont. Not 25% compared to Mississippi, but compared to their own current expenditures.

I heartily agree that a culture of healthier lifestyles is much needed across our country as well.

Single payer health care

If you want to see how well single-payer health insurance works, glance up this way. We've had it for decades in Canada, and we see exactly what Vermont expects: far better care for far fewer bucks. Funny how the anti folks never look up our way....

Not a single Canadian I've known criticizes their health...

...care system. Every single one has expressed a high level of satisfaction, and this is dozens of people.

They feel sorry for Americans. They regard our health care system as "cruel" - and exact quote.

It is right-wingers down here in the States that complain about the Canadian system, not Canadians.

Canada

Years ago when this debate was in its infancy some conservatives did indeed point to the Canadian system and exclaim that people have to wait months for critical surgery. They fell silent though when our friends to the north pointed out that this was for non-critical and elective surgery. For the important operations, people got in right away.

I'm curious though Molly if we can get your take on the advantages of the Canadian system. What do you really like about it? How does it function for you? Just as importantly, what don't you like about your system? If we're going to implement something comparable here it would behoove us to learn from other people's systems and craft a program that's even better.

The right-wingers claim that Canadians "flock" to the U.S. for

medical care.

I wonder what people in border cities would say about this. Do Canadians in Fort Frances flock to International Falls for medical care? Do people in Windsor flock to Detroit?

I wonder how much of that "flocking" is retired Canadians who, for understandable reasons, spend the coldest months of the year in Florida or other parts of the southern U.S.

AARP ran an article on research into this point

http://www.aarp.org/politics-society/government-elections/info-03-2012/m...

The claim that Canadians flood across the border for health care in the U.S. is shown by the studies cited to be completely false.

But then, have you ever seen responsible research in support of this bogus claim ? I haven't, which is natural when there is none.

This follows the pattern of so many campaigns by the right-wingers on behalf of their political clients: make a lot of hysterical noise, obfuscate, exaggerate, falsify, send forth an army of straw men, and a wide front of fallacies.

Then repeat, repeat, repeat a la Karl Rove, who taught that it doesn't really matter if your main message is total hogwash, as the people aren't smart enough to see through it. This is how you control political dialogue, he insisted.

Now, Karl Rove is a smart guy, and he never really believed any of the crap his minions were promoting, knowing it for mere chicanery. But this current wave of right-wingers are just as empty-headed as the masses whom Karl Rove held in such contempt. Some of these folks have actually come to believe this garbage.

single payer healthcare

Unfortunately, fear mongering in the states is a sport (both sides of the political isle...). All we ever hear is that people can't get service because too many in line, doctors are leaving because they can't make any money, Canadians come to the US for procedures they can't get in Canada... it's all BS, but the cable news sound bites are enough for the ignorant Americans to swallow without knowing the facts. After all, look at the bozo's this country elects!

One correction

One correction, pointed out by Sen. John Marty, the Minnesota Senate's tireless advocate for universal coverage. The Vermont bill does not require non-profit status of its health care providers. All hospitals in Vermont are already non-profit, however. In my opinion, an ideal bill for universal coverage should require at least a cap on profits. We also need to close the loopholes that exist currently for providers and hospitals with a non-profit and not-for-profit status; many still reward middle and upper management with egregious salaries and big dividends to their shareholders, at the expense of the American patients they care for. We need to put a stop to these practices to stem the rising costs of service.

United Socialists States of America

I am not commenting as an affront to the author of this article. Cancer is a HORRIBLE disease. My aunt suffered from cancer while living in the Dom Rep. Where did she go for her therapy? She hopped on a plane and came to the states where she was given full care and wonderful treatment. She had been here since the early fifties and retired in the Dom. Rep. I asked her why didn't she get care in the DR, and she said the care was not very good. I am an immigrant myself and am just atonished by those in this country who advocate a plunge into Sociailsm. Many of my friends also have come here to this country escaping the stranghold of Socialism. I am also surprised at how many comment on the "sin" of making profits. What's next? The gubmint regulating how much a company can make? Also how is the government going to tax everyone on a single payer system? Those who make less will still be given quality care, while those who make more, will pay more, and get the same care as those who are poor? IS THAT FAIR? I guess if you are a Socialist it would be. Single payer system has been around for more than 100 years and still has many problems to confront. If a single-payer system is implented this this country, how long will it take to be even 90% efficient? Many think the miracle will be immediate. Not so. When bureaucrats handle a dilemma as huge as healthcare, the results will not be to many people's liking. There are better ways to bring sound healthcare to all, not down the path of Socialism where all are equal in misery.