Vermont May be First State to Adopt Single-Payer Healthcare System
In January, 2011, Dr. William Hsiao—professor of economics at Harvard School of Public Health Program—introduced a proposal before the US House of Representatives that could make Vermont the first state in the union to elect a single-payer healthcare system, if they can get lawmakers committed to untangling the web of federal restrictions and barriers. This scenario would mean every resident of Vermont would have healthcare coverage, including vision and dental care.
Dr. Hsiao’s report on the single-payer healthcare system was very highly anticipated, and fairly well-received by the House. Appropriately so, representatives had many difficult questions. It appears that approaching single-payer healthcare at the state-level is a very ambitious undertaking. If you are interested in helping our state and federal governments sort through the nation’s healthcare crisis, consider a Masters in Public Health.
Single-payer healthcare is a method used by many other countries—including Canada, the UK, Taiwan and Australia—to provide reasonable and affordable treatment options for their residents. All health-related care is paid into and paid out of one single entity, usually a government-created insurance pool. The pool can have many entities paying into it. The Veteran’s Administration in the US is one example of a single-payer, socialized medicine, because not only are the hospitals set up, funded and run by the US government, but all Veterans (and only Veterans) can receive treatment at VA hospitals.
However, the US is not currently designed to support a system like the public/private single-payer proposed in Vermont. Questions were raised about out-of-state residents who work in Vermont. How would they be treated? Another concern was voiced about teachers and other unionized employees who have rallied long and hard for affordable and high-quality health care coverage—would they end up paying the same, or possibly even more, for a lesser quality of care? Would the care be instituted as a payroll tax? What about the people who don’t take a paycheck or pay payroll taxes—do they get care for free, or do they not get care? In what ways does the plan interfere with federally-funded healthcare assistance programs, such as Medicare for the elderly and Medicaid for those with few resources? Would there be ways to work around these programs? What about people who require specialized hospitals or doctors in other states?
{ 6 comments… read them below or add one }
As a student enrolled in a Masters in Public Health course, I think that you have raised some very complex and very difficult issues here. But remember that public health officials are very much responsible for ironing out the kinks even for something as new and as untested as a single payer healthcare system.
I would be very interested to see how they deal with this, we all could learn something from Vermont’s experience and mistakes!
When it comes to adopting a new healthcare system, public health officials should find out first if the system is viable for everyone concerned. It would seem that a single payer healthcare system would limit the pay for doctors and other providers, which would in turn limit their capability to invest in new technologies. This would, in turn, give rise to lower quality when it comes to patient care. On the other hand, it makes healthcare more affordable and accessible to everyone. So which is the lesser evil? That is the question that public health people should address.
With Vermont trying out the new single-payer healthcare system, it would be instructive to the rest of the country to find out what problems they encounter and how to solve it when and if the time comes that other states would adopt it. I think that accessible healthcare is a challenge of public health professionals, and we rely on these professional to make sure that this is the most appropriate system and it will be effective.
It would be nice if a single payer healthcare system would be implemented well enough to give every American ample healthcare coverage that is based on need and not on one’s ability to pay. But I do agree with your concerns here, specifically for those who need specialized care from hospitals or doctors. It would be great to have these kinks ironed out, but it will take time.
I really don’t know why we don’t just adopt a nationwide single payer healthcare system. I know that there’s a level of difficulty in implementing it and I’m pretty sure that public health officials are looking into it. Looking at the current objections you have, it seems most of it would be eliminated if every state in the country adopts the system all at the same time.
I think that there should be a rather lengthy debate on this issue first before we change anything. As a public health official, I am very familiar with the shortcomings of a single payer healthcare system. Doctors are very apprehensive about what such a system could do for their practices, particularly their fees. For them, they think that it’s like what they do now: haggle with insurance companies about how they treat their patients and how they charge for it. Only that they have a more formidable adversary in the Federal government.