A peek down the road?

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Vermont is putting into effect a single-payer health care system and everyone seems to be pretty damned pleased with themselves but much like the health care reform law that is in process of being rolled out nationally, there appear to be just a few minor details that have yet to work themselves out.

But first, the human interest angle because any good social change starts with the people, right?

Many people move to Vermont in search of a slower pace; Dr. Deb Richter came in 1999 to work obsessively toward a far-fetched goal.

She wanted Vermont to become the first state to adopt a single-payer health care system, run and paid for by the government, with every resident eligible for a uniform benefit package. So Richter, a buoyant primary care doctor from Buffalo who had given up on New York's embracing such a system, started lining up speaking engagements and meeting with lawmakers, whom she found more accessible than their New York counterparts.

"I wrote a letter to the editor, and the speaker of the House called me up to talk about it," Richter, 56, recalled recently. "It was astounding. In New York, I couldn't even get an appointment with my legislator."

Twelve years later, Richter will watch Gov. Peter Shumlin, a Democrat, sign a bill on Thursday that sets Vermont on a path toward a single-payer system - the nation's first such experiment - thanks in no small part to her persistence. Though scores of people pushed for the bill, she was the most actively involved doctor - "the backbone," Shumlin has said, of a grass-roots effort that helped sway the Democratic Legislature to pass it this spring even as other states were suing to block the less ambitious federal health care law.

"We wouldn't be where we are without Deb," Shumlin said in an interview. "She's made this her passion. And like anyone that's making significant social change, she has qualities of persuasiveness and leadership and good judgment that are hard to find."

As in all states, the cost of health care has increased sharply in Vermont in recent years. It has doubled here over the last decade to roughly $5 billion a year, taking a particular toll on small businesses and the middle class. All 620,000 of the state's residents would be eligible for coverage under the new system, which proponents say would be cheaper over all than the current patchwork of insurers. A five-member board appointed by the governor is to determine payment rates for doctors, what benefits to cover and other details.

But much remains to be worked out - so much that even under the most optimistic projections the plan might not take effect until 2017. Most significantly, Shumlin still has to figure out how much it will cost and how to pay for it, possibly through a new payroll tax. Whether he will still be in charge by 2017 is among the complicating factors.

"If we had the exact same Legislature and the same governor we could get it done," Richter said. "It's a big if, because the opposition has a ton more money to convince people that the governor is evil and this is socialized medicine and all kinds of other scary stuff."

(italics, ours)

Now, ain't that a shame? 6 paragraphs of rainbows and unicorns before reality barges in through the door uninvited.

Please note the angst expressed by Richter regarding how the democratic process is getting in the way of true progress and how some have the temerity to openly question just how it is they are all going to pay for this.

In this respect, Richter is channeling her inner Thomas Friedman who continually looks wistfully to the East and sees China as the model for top-down, command-and-control economic and social change absent the checks and balances of a constitutional Republic. It's this damn two party system that continually gums up the works.

But in order to implement this plan, you know what they're going to need, right?

The federal health care law has complicated Vermont's plans, requiring the state to first create a health insurance exchange to help residents shop for coverage by 2014. The state would then need a federal waiver to trade its exchange for a government-run system.

Or course, you did.


But like any good democracy, not everyone is happy with the New Hampshire plan.

Some supporters of single-payer health care say Vermont's law does not go far enough, mostly because it would allow at least a handful of private insurers to stay in the market indefinitely. Self-insured businesses like IBM, the state's largest employer, could continue providing health coverage to workers under the law, though they would have to help finance the new system, possibly through a payroll tax.

Those supporters won't have to worry about that as this problem would appear to be self-correcting as we don't see IBM being played for chumps in paying for health care for their employees and paying into the single-payer system. Since they're mandated to help chip in for the state-run system, what is the likelihood that companies like IBM will continue to provide health care coverage for their employees? As Pops would say, "slim and none and slim just left town."

This is similar to the perverse incentives built into ObamaCare where companies will simply drop coverage for their employees and pay the nominal fine rather than have to pay for the addtional mandates and regulatory features of ObamaCare.

Perhaps Vermont's single-payer system will give us a look at what we can expect from ObamaCare.







* Definetely not Vermont. This is I-70 westbound in central Utah heading for the San Rafael Swell in the heart of the country explored and documented by John Wesley Powell in the 1870s and 1880s.