Vermont Signs Single-Payer Health Care into Law:

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BRATTLEBORO, Vermont — Vermont became the first state to lay the groundwork for single-payer health care on Thursday when its governor signed an ambitious bill aimed at establishing universal insurance coverage for all residents.

"This law recognizes an economic and fiscal imperative," Democratic Governor Peter Shumlin said as he signed the bill into law at the State House.

"We must control the growth in health care costs that are putting families at economic risk and making it harder for small employers to do business."

Legislators say the plan, approved by the Democratic controlled House and Senate this spring, aims to extend coverage to all 620,000 residents while containing soaring health care costs.

A key component establishes a state health benefits exchange, as mandated by new federal health care laws, that will offer coverage from private insurers, state-sponsored and multi-state plans. It also will include tax credits to make premiums affordable for uninsured Vermonters.

The exchange, called Green Mountain Care and managed by a five-member board, will set reimbursement rates for health care providers and streamline administration into a single, unified system.

Residents and small employers will be able to compare rates from the various plans and enroll for coverage of their choosing.

As designed, the goal is an eventual state-funded and operated single-payer system.

But its sponsors say that outcome is far from certain. The plan will be phased in over several years, with an evolving financial structure that mandates a number of conditions.

Among the criteria are adoption of a financing plan by 2014; ensuring the new system costs less than the current fee-for-service one; and obtaining federal permission via a waiver to allow Vermont to proceed with the single-payer option, in around 2017.

Advocates of change say the existing fee-for-service care has a financial incentive to deliver more care, such as tests, with little attention to quality or better outcomes.

The single-payer concept was omitted from the federal health care overhaul championed by President Barack Obama, in part due to Republican criticism it meant excessive government control.

Progressives in Vermont, including Shumlin and U.S. Senator Bernie Sanders, an independent, have worked for years to modify the state's health care system.

Shumlin said he recognized "people have legitimate questions" about how a single-payer plan would be financed and operated.

"We will answer those questions before the legislature takes the next step ... We'll be getting input from all Vermonters moving forward, which is essential."

If the state secures one key federal waiver related to exchanges, Green Mountain Care could begin as early as 2014. Another waiver needed to implement the single-payer component under federal law would not be available until 2017.

Vermont's plan calls for the board to consider the likely costs of coverage, factor in potential savings from reforms and recommended sources of revenue. It is charged with delivering a financing plan to legislators by 2013.

If that plan's single-payer component is adopted, lawmakers would approve a budget annually.

Single-payer proponents say the present system is too expensive and excludes too many residents. Vermont has around 47,000 uninsured and 150,000 underinsured residents.

But critics are wary of what a new program will cost and which taxes would help finance it. It is not yet clear whether it would involve increases such as a higher payroll tax.

The state's health care spending runs about $5 billion annually, with costs rising between 6.5 percent and 8.5 percent in recent years.

Some experts say a revised system would save an estimated $580 million annually, and $1.9 billion by 2019, while creating several thousand jobs.

(Reporting by Zach Howard; Editing by Chris Michaud and Jerry Norton)
Sounds like a step-up from insurance, which is awesome for Vermont :D
3 Enkufka27th May 2011 10:54:20 AM from Bay of White fish
Wandering Student ಠ_ಠ
The only thing keeping me from living in vermont is the weather now. I seriously love vermont for this. <3grin
Very big Daydream Believer.

"That's not knowledge, that's a crapshoot!" -Al Murray

"Welcome to QI" -Stephen Fry
Yeah, there's a whole month where you can't ski.
Charlie Tunoku is a lover and a fighter.
Call me in 2 years when it doesn't pay for anything, your state is in massive debt, taxes are bending you over and tell me you wouldn't rather live in a state with no income tax.
There are states without income tax?
Charlie Tunoku is a lover and a fighter.
7 Enkufka27th May 2011 11:09:40 AM from Bay of White fish
Wandering Student ಠ_ಠ
Way to grab that strawman and run with it, Deux. >Applauds<
Very big Daydream Believer.

"That's not knowledge, that's a crapshoot!" -Al Murray

"Welcome to QI" -Stephen Fry
8 MajorTom27th May 2011 11:09:43 AM , Relationship Status: Barbecuing
Eye'm the cutest!
^^ Several actually.

^ Not a strawman. There was a program not too dissimilar to Obamacare put up in Massachusetts a few years ago (which is also the reason why Mitt Romney will never be elected President) and guess what, your average health care insurance costs alone in that state are 900 dollars higher than any of its neighbors, then it has long wait lines, the state has just about gone bankrupt from subsidizing so many people and the program has become unsustainable.

Vermont will fare no better in the long run.

edited 27th May '11 11:12:17 AM by MajorTom

"Allah may guide their bullets, but Jesus helps those who aim down the sights."
I couldn't speak for any other state, but Florida has no state income tax. We use sales and property taxes instead, so we can still get revenue from tourists and snowbirds (who, not actually living here, wouldn't pay state income tax).
10 HungryJoe27th May 2011 11:13:53 AM from Under the Tree
Although to use strictly correct comperative politics terms no American lives in a state without income tax.

In CT we picked it up to replace our toolbooths.

It did do that, but now they're climbing up.

Anyway, it's not a given that the whole system will come crashing down. The UK's NHS survived for about six decades, and Thatcher's policies did a lot to hasten its downfall.
Charlie Tunoku is a lover and a fighter.
11 Deboss27th May 2011 11:15:41 AM from Awesomeville Texas
I see the Awesomeness.

Damn ninjas.

Yes, there are several states that don't have an income tax. Alaska being the craziest with neither income, nor property tax.

edited 27th May '11 11:16:42 AM by Deboss

Talk about state income taxes, independent of health care, is off topic.
13 Enkufka27th May 2011 12:29:51 PM from Bay of White fish
Wandering Student ಠ_ಠ
Call me in 2 years when it doesn't pay for anything, your state is in massive debt, taxes are bending you over and tell me you wouldn't rather live in a state with no income tax.

Sorry, this seems strawman-ish to me, as it makes several assumptions I haven't seen evidence for, first being "doesn't pay for anything." What follows seems to be confounding to me since DH states that VT will be in massive debt because of it. What? if it fails to pay for anything, then why would the state be in debt? Third is "taxes are bending you over" which implies that a massive tax hike would follow, which seems like an overly dramatic view. I fail to know the specifics, but a marginal increase in taxes would seem to solve the problem of funding the single payer system. finally, the last point is immaterial.

Also, Obamacare fails to provide single payer (and I am deeply against it because it fails to provide said coverage) so I wonder why it is pertinent to bring in a national system requiring coverage from private insurance companies requiring funding and control orders of magnitude greater than a state of 640,000 people in a discussion regarding a single payer system for said 640,000 people plus various corporations/businesses/companies. I would find it much more pertinent to not bring obamacare in at all and instead directly compare Romneycare to Green-Mountaincare.
Very big Daydream Believer.

"That's not knowledge, that's a crapshoot!" -Al Murray

"Welcome to QI" -Stephen Fry
14 Deboss27th May 2011 12:40:54 PM from Awesomeville Texas
I see the Awesomeness.
Yes. That too.

I'm not sure how to see this, on one hand, I really don't trust elected officials not to fuck it up somehow. On the other, it's supposed to be cheaper.
Health insurance mandates are entirely different beasts from single-payer.
16 Karkadinn27th May 2011 12:46:35 PM from New Orleans, Louisiana

Figured this'd be a good enough source for anyone involved, if anyone besides me was wondering why Massachusetts is having such problems. Long story short, you can't just copy the solution while leaving the underlying funding engine unchanged. In particular, American healthcare costs seem to be centered around a payment system that encourages doctors to perform unnecessary but highly expensive operations on their patients. There's also some administrative cost differences, and while that's an incredibly easy target, it's a relatively small factor of about a ten percent difference.

edited 27th May '11 12:48:43 PM by Karkadinn

Furthermore, I think Guantanamo must be destroyed.
17 Deboss27th May 2011 12:46:38 PM from Awesomeville Texas
I see the Awesomeness.
That too was addressed to you, English Ivy, however since I seem to be getting ninja'd all over the place, I'll head off and do something else.
[up] Deboss

Alaska taxes the other states. True story.

We'll see if Single-Payer works, it'll be interesting to see them get a waiver.

Pretending to be human
I guess Vermont is officially socialist now.

Seriously though, good luck to them, see how it goes...
20 HungryJoe27th May 2011 01:36:01 PM from Under the Tree
What's wrong with being socialist? I mean, I understand that a lot of people say it doesn't work well, but what's so wrong with it?

I've never seen anybody get mad at Germany for having a parlimentary democracy, so why does anybody care what a state's economic stance is?

Besides, for real socialism you need a lot more than state-run healthcare.

Charlie Tunoku is a lover and a fighter.
Socialism is Evil. Haven't you gotten the memo? It's like the spawn of Satan combined with a man-eating dinosaur that is also an arsonist.

22 Enkufka27th May 2011 02:08:24 PM from Bay of White fish
Wandering Student ಠ_ಠ
But mainly it takes money away from those poor, working class rich people and gives it to those snooty elitist poor people who don't do an ounce of work ever in their lives.

But in all seriousness, the main argument against welfare and healthcare is that it is taking money from the upper classes and giving it to the poor. Many middleclass americans see it as personal theft since they don't automatically consent to the use of their tax money for other people's use.

I would be interested to see a comparison between how much of the median tax-paying family's money goes to the support of a single person on welfare, instead of how much one family's tax money goes to welfare as a whole.
Very big Daydream Believer.

"That's not knowledge, that's a crapshoot!" -Al Murray

"Welcome to QI" -Stephen Fry
"Health insurance mandates are entirely different beasts from single-payer. "

Exactly. It is another beast. The raw feral beast of government force. To force a man to engage in commerce is still force.
Forcing the rest of us to cover your health bills is also force.


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