by Ethan Parke, Montpelier
Partisan politics, not sound statistical analysis, underlies recent attacks on Vermont’s plan to create a single payer health care system. Rutland City Treasurer Wendy Wilton has attracted media attention with her off-the-cuff number crunching. Bruce Lisman (a retired investment banker at JPMorgan Chase) and Lieutenant Governor Phil Scott have both been warning that single payer health care is too risky in these difficult economic times. And Robert Letovsky (a business professor at St. Michael’s College) has maligned the Canadian system in an attempt to discredit Vermont’s initiative.
Wilton’s curious refrain has been that single payer revenues do not match single payer expenses. She asserts that by 2019 Vermont would be $2 billion in the red if a single payer plan is adopted. The allegation is odd because to date there has been little attempt to formulate a revenue plan for the single payer program, and estimates of costs and savings are usually given as ranges. There are simply no hard numbers to debate. However, Wilton uses the lack of a financing plan as the basis to attack the whole premise of universal health care.
I agree with Wilton that it would be nice to have a complete picture of health care reform all at once. As Rutland City treasurer she must certainly gain satisfaction from analyzing the cost of a new dump truck, calculating its return on investment, and pinpointing the effect of the purchase on the city tax rate. Unfortunately, changing the health care system of an entire state, providing coverage for all its residents, and controlling costs is a much more complex task. Since no state has yet made this move, there is no fixed price tag, no iron-clad quantification of savings and health status improvements, and no perfect comparison models.
Furthermore, as much as we would wish it, single payer in Vermont cannot happen in one fell swoop. The Legislature has taken a cautious approach, commissioning a thorough study and enacting a framework for future action. The Green Mountain Care Board has recently published a study of expected single payer savings, as required by statute. The next steps may include development of payment reform models, outlining a benefits package, and working out the ways that federal health care reform can provide a transition to single payer.
Wilton raises the specter of “the largest tax increase in the history of Vermont.” This was the same fear tactic that was used to defeat health care reform in the 1990s. Yes, if you replace private health insurance premiums with taxes, the increase in state revenue will be huge. It would be irresponsible for the Legislature to levy such taxes without also eliminating the waste, fraud, and redundancy in the current system, and creating a transparent and accountable means of administering such revenue. It would also be irresponsible to saddle businesses that currently provide excellent health benefits to their employees with taxes exceeding the projected costs of private insurance. Preliminary studies indicate that such challenges can be surmounted, but we must be patient.
Truth be told, we do not currently have a transparent and publicly accountable system. We do not now have adequate ways to control costs or to prevent personal bankruptcy from health care bills. And Vermonters die because they do not have access to affordable medical care. Ms. Wilton admits the current system is unsustainable, but if she has a better idea how to solve these problems, I have not heard it.
One final point: It is easy to pull out tiny pieces of the health care puzzle and say this or that should be changed. Ms. Wilton intimates that if people behaved in a healthier manner, health care costs would be lower. She also cites Vermont’s chronic disease management program (the Blueprint for Health) as a way to reduce costs. But if Vermont were perfect in both these areas, overall health care costs would still be too high. Institutional fixed costs would remain the same and would rise with inflation. Providers would continue the insane chase of paperwork involved in billing and insurance reimbursement. And costs would continue to shift from one area to another without any overall rationale. In the absence of unified financing, we will never be able to keep the lid on our health care spending.
If we want to give our businesses a break, if we want to rescue our economy, if we want to be a society that has the decency to make health care available to everyone, regardless of assets or income, then, despite the uncertainty involved, we must continue on our present path toward single payer. We know that a public process and legislative action will be necessary at each step along the way. We must not be distracted by those who would derail reform in order to score political points.