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No Pivot
Vermont Slays Single-Payer

When Vox profiled Vermont’s attempt to create a single-payer system this past April, Sarah Kliff noted that “about half of countries [that] attempt to build single-payer systems fail.” According to Politico, we can now add Vermont to that count: Governor Peter Shumlin’s attempt to create a single-payer-like system is dead. The culprit is the tax hikes that would be required to pay for the system:

The model called for businesses to take on a double-digit payroll tax, while individuals would face up to a 9.5 percent premium assessment. Big businesses, in particular, didn’t want to pay for Shumlin’s plan while maintaining their own employee health plans. […]

“These are simply not tax rates that I can responsibly support or urge the Legislature to pass,” the governor said. “In my judgment, the potential economic disruption and risks would be too great to small businesses, working families and the state’s economy.”

This development will put a chill on the single-payer pivot for the foreseeable future: If it can’t be done in Vermont, it’s not likely to be done elsewhere (though New York will still try). Of course, the proposal could always get taken up again later in Vermont or elsewhere, but when it does, it will run up against the same problem: high costs. Instead of pursuing expensive and unsustainable top down reorganizations of health care, it would perhaps be better for states to bring down costs by picking the low-hanging fruit right in front of their faces.

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  • ojfl

    Single payer will never work. Even in the US the problem has always been costs and the enormous taxes they would require. It is the same everywhere.

    • Andrew Allison
      • f1b0nacc1

        I wouldn’t count upon that list as an endorsement if I were you. Most (not all) of those countries fall into two categories: 1) Resource-rich states that can fund pretty much anything (i.e. petrostates, including Norway), and 2) Demographically fortunate states with relatively healthy, homogenous populations (i.e. Scandinavian countries) there are obviously some exceptions, but even there, most of them are not single-payer, but rather two-tier states. Even those exceptions are facing severe financial pressure, in varying degrees due to their social welfare expenditures (which include health costs). In modern societies, the demand for healthcare is extremely high (who wants to be sick or die?) and without price feedback it rapidly becomes unaffordable.
        I realize that we have agreed to disagree here, it was only after finishing my paragraph that I thought about that. I apologize for restarting a closed discussion, and defer to you for the last word.

        • Andrew Allison

          It wasn’t intended as an endorsement of universal health insurance, but simply as evidence that the comment is ridiculous on its face. But, just for the record, the US is both resource-rich and (at least for now) demographically fortunate [/grin]. On a different. but related subject, I’m curious as to your understanding of two-tier: if it means allowing both public and private insurance for those who want and can afford it most, if not all, countries providing universal coverage are two-tier. I think it would be more useful to think of two-tier as system which separates insurance from the delivery of healthcare services. Regards, Andrew

  • Andrew Allison

    “When Vox profiled
    Vermont’s attempt to create a single-payer system this past April,
    Sarah Kliff noted, “about half of countries who attempt to build
    single-payer systems fail.” is grossly misleading, and unworthy of TAI. Ms. Kliff was quoting an estimate, based on 10 countries, of the number of counties in which single-payer LEGISLATION failed or passed but was not implemented. The statement was, “Sadly to say, half of them were never able to pass legislation or once
    they passed legislation, like Cyprus, the president changes and the new
    president never really implements the plan,”

    • ojfl

      And the US will still be a country with no universal healthcare Mr Allison. Even the CBO acknowledges that.

      • Andrew Allison

        Agreed, but my comment related to the mendacity of the TAI post, not universal health care.

    • Fat_Man

      The USA provides health care to everyone. Its just not in the form of the neat socialist system you want. Although the US cannot be considered to have a free market health care system.

      • Andrew Allison

        My comment had nothing to do with my so-called “socialist” views, and everything to do with TAI gross misresentation.

  • FriendlyGoat

    This article would be better if it did not give only by-reference coverage to what is meant by low-hanging fruit.

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