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Here in good old 'Murica, the debate over single-payer health care has largely been relegated to the sidelines. Much as conservatives decry Obamacare as the worst thing since sliced Hitler, it's pretty much cemented the presence of insurance companies and confirmed that the U.S. will not have a health care system similar to Canada's anytime soon. Well...in 49 out of 50 states, anyways. http://www.nytimes.com/2014/04/06/o...&pgtype=article Vermont signed into law a single-payer health care bill in 2011, but because of Obamacare they have to set up the (private) insurance exchanges just like everyone else. Now, here's the kicker: in 2017, the "waiver for state innovation" takes effect, allowing individual states to opt of the Obamacare requirements if they've got their own plan to cover their citizens. Vermont plans on using this to establish Green Mountain Care, taking those sweet federal subsidies to pay for the roughly $1.7 billion needed to cover their citizens. So, is this a good idea and a natural step forward in American progress, or a sign of the apocalypse and big government run mad? Let's debate! 
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Apr 22, 2014 16:59
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It is the best thing ever and I'm just sad it has taken 70+ years since the Second Bill of Rights was proposed to actually do something to move in that direction. Maybe a GMI is soon to follow?
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Apr 22, 2014 17:47
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I hope this can be a model for other states. Sure, Vermont has a tiny population, and scaling it up will inevitably involve difficulties, but there's no reason it can't eventually be done.
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Apr 22, 2014 18:31
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I wonder, has there been much backlash from the opposition? Given just how hard the GOP railed against the PPACA, I'd imagine this would send them into complete fits. Or does the Vermont branch happen to be actually reasonable?
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Apr 22, 2014 18:36
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Perestroika posted:I wonder, has there been much backlash from the opposition? Given just how hard the GOP railed against the PPACA, I'd imagine this would send them into complete fits. Or does the Vermont branch happen to be actually reasonable? I'm not as tuned into state politics as I used to be, but from what I hear back home the state GOP isn't throwing quite the shitfit you'd expect from the national party. In part I credit this to vestigial reasonableness as VT Republicans were one of the last holdouts of the Rockefeller wing of the party, as well as tea party types often being seen as flatlanders what we don't want 'round these parts. Also, keep in mind that VT has been moving towards UHC since well before the proposal and passage of PPACA, so a lot of the ideological battles have already been fought.
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Apr 22, 2014 18:50
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Unfortunately Vermont is still dragging its feet on actually implementing single-payer; the law was signed four years ago and the state still has not produced a budget proposal for paying for it. I just hope they can get their act together soon enough, the single-payer movement in the US is probably going to depend a lot on Vermont's success.
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Apr 23, 2014 18:26
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The Maroon Hawk posted:Unfortunately Vermont is still dragging its feet on actually implementing single-payer; the law was signed four years ago and the state still has not produced a budget proposal for paying for it. I just hope they can get their act together soon enough, the single-payer movement in the US is probably going to depend a lot on Vermont's success. I don't know if I'd call it foot-dragging; they can't actually implement anything until 2017, so it's not like they're losing time that the law could be active and protecting people. Though, given the speed of bureaucracy, I do agree that they should really try to get something together soon--it's going to take plenty of time to get everything in order.
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Apr 23, 2014 19:46
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Keep in mind: that waiver in 2017 also has to be approved by HHS, which I'm sure will be right at the top of President Cruz's priorities.
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Apr 23, 2014 21:08
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Joementum posted:Keep in mind: that waiver in 2017 also has to be approved by HHS, which I'm sure will be right at the top of President Cruz's priorities. We'll have much bigger problems if we get a President Cruz. If this works out well in VT, I can see a few other deep-blue states taking a punt. Maybe MA. Or CA if we ever get this corruption under control.
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Apr 23, 2014 21:32
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redscare posted:We'll have much bigger problems if we get a President Cruz. California's legislature passed single-payer twice while Schwarzenegger was governor, only to have him veto it. So it's not out of the realm of possibility, although they haven't even tried since Brown took office so single-payer could very well just be red meat to throw to their base to drum up votes.
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Apr 23, 2014 22:23
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The Maroon Hawk posted:California's legislature passed single-payer twice while Schwarzenegger was governor, only to have him veto it. So it's not out of the realm of possibility, although they haven't even tried since Brown took office so single-payer could very well just be red meat to throw to their base to drum up votes. It actually keeps being introduced by state senator Mark Leno. But yeah, since Brown become governor, instead of passing the legislature it mysteriously can't even get past committee now...
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Apr 23, 2014 22:53
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Shumlin is going to need to stay on as Governor until the program gets approved and implemented because most of the details are being ironed out by a board overseen and appointed by the Governor, which is not politically popular within the state. He easily won re-election in 2012 after his very narrow initial victory in 2010. Obviously, 2012 was a good year to be running as a Democrat in a blue state, but so far it looks like he'll coast to victory again in 2014. Right now his only challenger on the Republican ticket is perennial Independent candidate Emily Peyton, whose big platform idea is to grant total property tax relief to anyone willing to set up a lifetime hemp farm using loans from a new public bank. Yeah, she's not the typical Republican.
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Apr 23, 2014 22:56
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When you give white people a state to themselves, they treat each other really nicely.
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Apr 23, 2014 23:14
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Joementum posted:Shumlin is going to need to stay on as Governor until the program gets approved and implemented because most of the details are being ironed out by a board overseen and appointed by the Governor, which is not politically popular within the state. He easily won re-election in 2012 after his very narrow initial victory in 2010. Obviously, 2012 was a good year to be running as a Democrat in a blue state, but so far it looks like he'll coast to victory again in 2014. Do we really have many typical Republicans anymore? The last governor they managed was Douglas and he at best was tepidly center-right by modern GOP standards. Peven Stan posted:When you give white people a state to themselves, they treat each other really nicely. In our defense, we're equally aloof and unhelpful to flatlanders of every race and ethniticy.
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Apr 24, 2014 00:52
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Peven Stan posted:When you give white people a state to themselves, they treat each other really nicely. The state of Maine would like to have a word with you.
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Apr 25, 2014 00:09
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Acrophyte posted:The state of Maine would like to have a word with you. And New Hampshire, for that matter. Particularly the northern half of the state.
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Apr 25, 2014 00:48
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Welcome to the club, Vermont!
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Apr 25, 2014 01:51
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Would it be funny if 20 years Down the line every state offers a UHC option for its residents, and they use Obamacare monies to fund it. Would that be Kafkaesque or :usa:
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Apr 25, 2014 07:13
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AYC posted:Here in good old 'Murica, the debate over single-payer health care has largely been relegated to the sidelines. Much as conservatives decry Obamacare as the worst thing since sliced Hitler, it's pretty much cemented the presence of insurance companies and confirmed that the U.S. will not have a health care system similar to Canada's anytime soon. For what it's worth, this is essentially what Canada does. Technically the companies that run the health authorities in a region are not owned by the government. However, since the government is the only entity that pays them, they effectively are. Doctors are all private and they simply bill the government for the cost of the procedure as basically Canada just acts as a gigantic health insurance company.
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Apr 25, 2014 15:26
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Interesting.... is it possible this backdoor in Obamacare could actually end up being the health care reform we actually needed by making funding available for states to do the right thing on their own?
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Apr 25, 2014 16:41
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Jarmak posted:Interesting.... is it possible this backdoor in Obamacare could actually end up being the health care reform we actually needed by making funding available for states to do the right thing on their own? No, because the federal money in no way would be enough to cover it, states would have to raise taxes be quite a bit, and that's always unpopular. Also Vermont is white as snow with a very low and rural population, normal rules of American politics don't apply.
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Apr 26, 2014 01:23
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Amused to Death posted:No, because the federal money in no way would be enough to cover it, states would have to raise taxes be quite a bit, and that's always unpopular. Also Vermont is white as snow with a very low and rural population, normal rules of American politics don't apply. Also Obamacare has a clause which states that the unique state plan can not add to the federal deficit beyond current spending: quote:Also, before Green Mountain Care is allowed to launch, state law requires Vermont to define the benefits in the program, provide a three year budget that costs less than current health care expenditures, and to acquire the federal waiver
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Apr 26, 2014 02:23
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Amused to Death posted:No, because the federal money in no way would be enough to cover it, states would have to raise taxes be quite a bit, and that's always unpopular. Also Vermont is white as snow with a very low and rural population, normal rules of American politics don't apply. In Canada, money for the government health insurance is levied as an insurance premium and totally separate from taxes. You even pay directly to the provincial health ministry. It's about $60/month, with reductions for people on (very) low income. That does make it slightly regressive (vs something like the UK's National Insurance which scales with income), but it at least makes it clear that it's not a "tax".
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Apr 26, 2014 09:20
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HBNRW posted:For what it's worth, this is essentially what Canada does. Technically the companies that run the health authorities in a region are not owned by the government. However, since the government is the only entity that pays them, they effectively are. Doctors are all private and they simply bill the government for the cost of the procedure as basically Canada just acts as a gigantic health insurance company. It's also the system that Vermont picked after evaluating different options including a NHS style government built and run healthcare system system. However after evaluating the large of amount of pre-built private medical infrastructure that state decided it would be better to do something similar to Canada. Basically the government provides insurance for everyone regardless of income but pays private doctors/hospitals for all the medical care. quote:Option 1: As laid out by the requirements of Act 128, the first option would create "a government-administered and publicly financed single-payer health benefit system decoupled from employment which prohibits insurance coverage for the health services provided by this system and allows for private insurance coverage only of supplemental health services."The proposal considered this option to be the easiest path to single-payer, but was critical of the "complex and inefficient process" of proof of residency needs.
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Apr 26, 2014 19:04
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Lead out in cuffs posted:In Canada, money for the government health insurance is levied as an insurance premium and totally separate from taxes. You even pay directly to the provincial health ministry. It's about $60/month, with reductions for people on (very) low income.
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Apr 26, 2014 19:08
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How does this keep people with horribly expensive diseases from just moving to Vermont when diagnosed and sticking the state government with the bill? Then when treatment is over you leave the state.... Or just selling postage stamp sized lots to be considered a resident of Vermont. So that you then just bill your out of state doctor to Vermont and laugh all the way to the bank?
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Apr 26, 2014 19:20
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Fat Ogre posted:How does this keep people with horribly expensive diseases from just moving to Vermont when diagnosed and sticking the state government with the bill? Because it will be linked to basic residency requirements just like being able to vote or register a car in-state.
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Apr 26, 2014 19:26
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The intersection of people uninsured in 2017, people with expensive health problems, and people able to move to Vermont is going to be almost nonexistent.
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Apr 26, 2014 19:35
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Fat Ogre posted:How does this keep people with horribly expensive diseases from just moving to Vermont when diagnosed and sticking the state government with the bill? In addition to etalian said, land development laws in VT are pretty strict and while designed more to prevent land speculating and flipping, would likely impede that last point pretty effectively.
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Apr 26, 2014 19:59
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etalian posted:Because it will be linked to basic residency requirements just like being able to vote or register a car in-state. Good luck with that. Right to travel according to SCOTUS trumps that poo poo. http://en.m.wikipedia.org/wiki/Shapiro_v._Thompson
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Apr 26, 2014 20:14
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Fat Ogre posted:Good luck with that. I suspect they have taken this into account in some manner.
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Apr 26, 2014 21:21
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Nessus posted:Well go file an amicus curae brief with the Vermont Republican Party then, I'm sure you'd be rewarded handsomely. Which is what I was asking in the first place. Does anyone know how they plan to keep it from getting abused? Or do they even care?
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Apr 26, 2014 21:31
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Nessus posted:Well go file an amicus curae brief with the Vermont Republican Party then, I'm sure you'd be rewarded handsomely. For example: when you're suffering from a difficult illness, quitting your job for a few months to move to Vermont is not, in fact, a realistic solution. Additionally, plenty of chronic illnesses (ulcerative colitis, rheumatoid arthritis, etc.) do not actually "go away" and require monthly treatments and constant medication, meaning you'd have to move to Vermont forever. This is the "If they don't like the bigoted homophobia of their state, why don't they just move?" argument transported to healthcare, with the bizarre twist that this time it's posited as a bad thing.
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Apr 26, 2014 21:31
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Bicyclops posted:For example: when you're suffering from a difficult illness, quitting your job for a few months to move to Vermont is not, in fact, a realistic solution. Additionally, plenty of chronic illnesses (ulcerative colitis, rheumatoid arthritis, etc.) do not actually "go away" and require monthly treatments and constant medication, meaning you'd have to move to Vermont forever.
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Apr 26, 2014 21:33
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Fat Ogre posted:Good luck with that. States are able to charge residents and nonresidents different tuition amounts and that seems pretty uncontroversial
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Apr 26, 2014 21:33
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Nessus posted:I believe Fat Ogre's inquiry is, what keeps someone from moving there briefly and applying for welfare, which they may not be lawfully denied based on their status of residency? And I think my answer is that uprooting one's entire life to temporarily obtain Vermont residency is not a realistic solution for almost anyone in a position where they're lacking adequate healthcare; it is a self-correcting "problem."
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Apr 26, 2014 21:38
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VitalSigns posted:States are able to charge residents and nonresidents different tuition amounts and that seems pretty uncontroversial Tuition isn't welfare.
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Apr 26, 2014 21:44
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Vermont is probably out of the way and tiny enough for that not to be an issue, not to mention it's about the 10th most expensive state to live in. However, it's certainly possible if a larger more accessible (cheaper, more central to lots of low income earners) left leaning state like Illinois (for example) implemented a good single payer system selection bias would be a non-trivial issue. Moving a state or two over and getting the same low paying job you would have in WI, OH, IN, and so on is hardly an insurmountable task even for low earners.Bicyclops posted:And I think my answer is that uprooting one's entire life to temporarily obtain Vermont residency is not a realistic solution for almost anyone in a position where they're lacking adequate healthcare; it is a self-correcting "problem." I agree for Vermont for the reasons above, but you really can't just wave your hands and ignore issues like that in general. Putting it as a problem in scare quotes ignores that you actually do need to pay the bills at the end of the day- and even left leaning states like Illinois and CA aren't very eager to raise taxes. Considering this Vermont thing is probably half a decade away at best it doesn't seem like a waste of the threads time to explore issues of single payer being implemented on a state by state basis. Maybe there will be no problems. Thing is, if there are and its implementation is a failure you can kiss any chance of it getting national play goodbye for a long time. Most countries that have excellent welfare and Single Payer systems get around such things by having extremely rigid immigration laws; moving from state to state is much easier relatively and there could certainly be some problems that arise from that. Bicyclops posted:This is the "If they don't like the bigoted homophobia of their state, why don't they just move?" argument transported to healthcare, with the bizarre twist that this time it's posited as a bad thing. No, it's not like that at all, what an utterly bizarre thing to bring up. enbot fucked around with this message at 22:07 on Apr 26, 2014 |
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Apr 26, 2014 22:04
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enbot posted:
It really is, though, because both of these arguments assume that people are capable of interstate moving without any real difficulty. In this instance, we'd have assume someone would be able to move as soon as they need treatment, and do it fairly swiftly.
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Apr 26, 2014 22:16
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Bicyclops posted:It really is, though, because both of these arguments assume that people are capable of interstate moving without any real difficulty. In this instance, we'd have assume someone would be able to move as soon as they need treatment, and do it fairly swiftly. That is the reason why SCOTUS overruled residency requirements because it kept poor people locked into states.
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Apr 26, 2014 22:25
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