Ezra Klein’s “explain the news” site Vox has just gone live, and it’s already calling attention to the case for a single-payer health care system. Sarah Kliff, who formerly worked with Klein atWaPo’s Wonkblog, profiles Vermont governor Peter Shumlin and his plan to bring single payer to his state. In 2011, at his urging, the Vermont legislature passed a law requiring the state to transition to a single-payer system by 2017:
Vermont’s case for single-payer health care can be summarized in one number: $82,975.That’s the amount a 2011 study in the journal Health Affairs found the average American doctor spends on dealing with insurance companies. Across the border in Ontario, doctors spend about a quarter of that amount — $22,205 per physician — interacting with the province’s single-payer agency.American doctors spend lots of money dealing with insurers because there are thousands of them, each negotiating their own rate with every hospital and doctor […] That doesn’t happen in single-payer systems. When the government owns and operates one health insurance plan for all residents, it sets a single price for each medical procedure.
The piece mentions some of the arguments against single payer, and provides a fair-minded assessment of where ACA supporters want to take the health care fight. While critics of the ACA are still working on repealing and replacing Obamacare, progressives are already testing out the next stage of their preferred health reforms. The shift in focus from Obamacare to single-payer is coming faster than many realize, and sites like Vox will do what they can for the new cause.In the meantime, we hope conservative state legislatures will also tinker in this area. One possible reading of the Obamacare sturm und drang is that federal-level health reform is just too difficult and controversial to get anywhere. More state-level experimentation like this Vermont plan is a good idea.Still, Obamacare supporters and detractors alike are still prone to the same mistake: framing the health-care debate in terms of the problems involved in how we pay for care. Rather we need to focus on improving the ways in which we deliver care. U.S. health care delivery is too expensive, period. Until that changes, it won’t much matter whether the government or private insurers shoulders the burden.