Single payer remains the goal
Insurance offered through Vermont’s health benefit exchange is not part of Vermont’s future single payer. Required by the 2010 federal Affordable Care Act (“Obamacare”), the exchange sells private plans for those needing insurance. Also, Catamount and VHAP will cease, and Medicaid will be offered there, to cover those needing insurance in 2014, three years before single payer begins. The exchange will not save money. It perpetuates America’s profitable private insurance model. Insurance is mandatory, and the cost could be a hardship for the neediest, with insufficient subsidies, until single payer begins. Private insurers as middlemen are in business to make profits for themselves and stockholders. They handle the money and billing. They do not provide health care.
Cost control is built into single payer’s design. It will happen only if we reign in the profligacy of our wasteful mix of multiple insurers, equipment and drug companies and other profiteers. Costs are helping to bankrupt our depressed economy where many remain uninsured. However, for now the exchange can cover most of the uninsured. It can also move means-tested low-income beneficiaries in and out of insurance plans and may even can delay their re-insurance as their incomes fluctuate.
Single payer will provide uninterrupted coverage 24/7 independent of employment, for all citizens who lack insurance, for lower cost. Single payer serves many countries and is verified by expert analyses. America’s Medicare and Veterans Affairs are variations of single payer, though they need improvement. The Green Mountain Care Board in designing Vermont’s single payer recognizes the need for more primary care providers and fewer specialists. It is restructuring health care organization and delivery, payment systems, etc. Single payer’s very nature should also support medical professionalism, which has been strained in today’s business model that values profits over patients. Our talented professionals value patients above profits and need the support of a system that honors their ethics as health professionals.
MARGARET NEWTON, M.D.