Single-payer system is the best roadmap

February 07, 2014

By: Ellen Oxfeld, Middlebury

In his guest editorial, “Single-payer questions” (Jan. 23), Emerson Lynn questions the feasibility of a single-payer system in Vermont. Several of his concerns must be addressed.
Dr. Bauman

Lynn points out that studies have estimated Vermont would have to raise between $1.6 billion and $2 billion in taxes to fund a single-payer system. However, both of these numbers are less than Vermonters now pay in premiums and out of pocket (over $3 billion per year). Taxes to fund a single-payer system will replace premiums.

Second, he points out there were problems implementing the exchange. But, this confuses apples and oranges. What did not work in the exchange was the web-based sign-up system, which was an amalgam of different private insurance plans and policies and different levels of coverage, which had to be matched to individuals’ economic circumstances to see if they qualified for subsidies.

It is exactly this patchwork of private plans, different levels of coverage, and different sources of financing that a single-payer system avoids. Instead of bronze, silver, gold and platinum plans, and instead of providers billing multiple payers, single payer replaces this with publicly raised funds. These funds would support our health care infrastructure, so the care will be there for all of us when we need it.

Of course, the Shumlin administration will have to present several financing proposals. But, keep in mind that Vermonters are already paying for the entire bill. Our way of paying now is not only complex, but also falls more heavily on those with less ability to pay.

When it comes to the quality of health care services, Vermont has always scored extremely high. But our patchwork system of payment is administratively costly and leaves too many Vermonters without access, or with high medical debt.

Since 2000, Vermont has commissioned five separate studies, and each has come to the same conclusion — we can provide health care to all Vermonters and contain costs with a single-payer system. There is no better roadmap to accomplish the twin goals of cost containment and universality.