I wanted to respond to Mr. Emerson Lynn’s editorial “Auditor’s ego threatens progress on state’s all-payer model health care experiment” (February 5, 2021), concerning the lawsuit by our state auditor against OneCare over its salary problems. First, and for the record, I am on the advisory committee of the Green Mountain Care Board and have been since its inception.
I do agree with our state auditor. OneCare’s salary levels are insane. They have instituted another bloated bureaucracy with a budget of $1.4 billion. Some $16 million of this, of our money, goes to salaries and other administrative expenses. Yet our runaway costs keep rising just like before OneCare entered the fray, with little measurable difference in our health care.
My focus here, however, is not the lawsuit, but Mr. Lynn’s statement “The irony is that OneCare is as close to a single-payer system as one can get.” That is not even remotely true. OneCare does nothing for the uninsured or the underinsured–those burdened by what we term as “cost-sharing,” a handy euphemism for insurers foisting costs onto us to preserve acceptable medical loss ratios. It adds complexity to an already complex system, and imposes yet more administrative costs on a system already overburdened with them.
Single-payer, on the other hand, provides health care for all the currently uninsured and greatly reduces the burden of “cost-sharing” for the underinsured. It simplifies the Byzantine structure of our current health care system, which would greatly reduce administrative costs. It pulls everyone in and leaves no one out. It does not treat our lives as a condition of employment, of age or income eligibility, or of metal plans. Under single-payer, health care is not a commodity; it is a right of all citizens, a public good. While some single-payer systems operate on a per capita basis like OneCare, many work with the ancient fee-for-service and still produce far lower costs with everyone covered from cradle-to-grave, which is more than OneCare will ever do with its value-based structure.
It was tragic that former governor Shumlin ditched single-payer for OneCare to save his political life after his near defeat in 2014. Vermont is still paying an awful price for that surrender.