To the Editor:
In his editorial, “Looming questions for Vt. Legislators” (1/7/2014), Emerson Lynn raises questions about the feasibility of Vermont implementing a single payer system in 2017. Several of his concerns need to be addressed.
First Lynn raises the issue of cost. He points out that some studies have estimated that Vermont would have to raise $1.6 billion in taxes to fund a single payer system while others assert it would be closer to $2 billion, and he says the discrepancy is not without consequence. However, he neglects to mention that both of these numbers are less than Vermonters now pay in premiums and out of pockets (over $3 billion per year). And, we need to keep in mind that taxes to fund a single payer system will replace premiums (which are really a hidden tax).
Second, the editorial points out that there were many problems with the implementation of the exchange and asks why we should think a single payer system would work better. But, this confuses apples and oranges. What did not work in the exchange was the web-based sign-up system – one that was exceedingly complex because it was an amalgam of many different private insurance plans and policies and different levels of coverage; these further had to be matched to individuals’ different economic circumstances to see if they qualified for a subsidy.
It is exactly this patchwork of private plans, different levels of coverage, and many 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. Instead of individual and varying plans, these funds would support our health care infrastructure as a public good, so that the care will be there for all of us when we need it. .
Of course, the Shumlin administration will have to present a series of financing proposals to the legislature. Public financing needs to be equitable, progressive and sufficient to guarantee the continued vitality of our health care services. But, keep in mind that Vermonters are already paying for the entire bill. It is simply that our way of paying now, through many different private insurance plans, 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. The problem is not the quality of our health care providers, but our patchwork system of payment. It is not only administratively costly, but also leaves too many Vermonters without access, or with high medical debts.
Since the year 2000, Vermont has commissioned five separate studies (Lewin, Hsiao, Thorpe, BISHCA, and UMASS). Each one 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 that can accomplish the twin goals of cost containment and universality,
Ellen Oxfeld
Middlebury, Vermont