Everyone wins when all pay in
Editorial
Rutland Herald, VT
September 3, 2006
A single-payer health care system would save the state $51 million a year, according to a new study carried out for the Legislature and released last week. It would achieve these savings by reducing the wasteful administrative costs that burden the present system.
The Legislature’s study provides welcome information, but it ran into immediate criticism from the business community and from the office of Gov. James Douglas. The hostile response by officials ready to denounce the idea of a single-payer system is an indication of the difficulties facing any proposal to put such a plan into effect.
Democratic proponents of health care reform are not ready to embrace a single-payer system. They understand the political difficulties and the economic uncertainties that remain. But at least, they are not closed-minded. The principles underlying a single-payer system are important to understand because they help set a direction toward the goal of universal access and cost-containment.
One of the important principles is shared risk. That is the principle behind all insurance, and it applies to health coverage that might be provided by the state. Shared risk means that the cost of health care is shared because we recognize that for most individuals the high costs incurred by most medical procedures are not affordable.
It is the same principle behind auto insurance. The high cost of an auto accident is likely to be unaffordable to an individual driver, so through a system of insurance we share the risk, knowing the driver having the accident may some day be any one of us.
At present the risk pool is limited to those with insurance, who pay high costs because their insurance premiums must incorporate the costs of care provided, often in haphazard fashion, to those without insurance. In a single-payer system, everyone would pitch in, and everyone would be covered.
Another advantage of a single-payer system would be its efficiency. As much as a third of medical costs at present go to the complex, wasteful process of tracking down insurance payments and fighting insurance companies who make their money by finding reasons not to pay.
Sharing the risk broadly would mean that those now enjoying a free ride would have to begin paying for health care. Many small businesses in Vermont do not offer health insurance, and paying the payroll tax needed to fund a single-payer system would be a significant new cost for them and their employees. On the other hand, employers who now offer insurance and their employees would see their costs fall when their present health insurance plans were replaced by a new payroll tax.
The study conducted by the Legislature by consultant Kenneth Thorpe describes this system, but legislative leaders know the state is far from adopting it. It would have its complications. It could not supplant Medicare and Medicaid, the federal programs for the elderly and the needy, and it would have to recognize the private plans of people from out of state receiving care in Vermont.
And there is the political resistance. As soon as the Thorpe plan was released, the Vermont Chamber of Commerce jumped on it, saying that it would “drown” the state in new taxes. Not mentioned was the elimination of the cost of health care premiums, which would actually save money for many businesses and individuals. A spokesman for Douglas also took a potshot at the Legislature, accusing it of looking for ways to raise the payroll tax.
It is apparent to Democratic legislators that paranoia about raising taxes, even if costs to businesses and individuals are lowered, is a political fact of life. Resistance to a single-payer system from the insurance industry and from businesses seeking to prolong their free ride will continue to be tenacious.
But it is useful to remind ourselves of the principles underlying a single-payer system as we move ahead with the reforms associated with the new Catamount Health plan. One question that emerged last week was whether people who leave jobs voluntarily would be eligible for the state-backed Catamount plan without a year’s wait. The state is arguing that barring them for a year was necessary to protect the solvency of the system. Legislators countered that covering them was essential to provide the seamless coverage that is the goal of Catamount Health.
Broad, seamless coverage is what a single-payer system is all about, and it ought to be a goal of less sweeping reforms as well. Locking people in unproductive jobs because they fear to go without health insurance is damaging to individual enterprise and to the state’s economy. Let’s cover everyone. Let’s eliminate unnecessary barriers to the health care that everyone deserves.