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Bankrupt Healthcare
Single-Payer: Dead In Vermont, Dead Everywhere

Will the death of single-payer in Vermont have important national consequences? In Vox, Sarah Kliff has a retrospective on how it happened, and she seems to think it will:

“You’d think that, if there was any state where this could fly politically, it should have been Vermont,” said Matthew Dickinson, a political science professor at Middlebury College. “But in this case, the price was so big that even a state as solidly blue as Vermont wasn’t able to swallow it.” […]

“If Vermont gets single-payer health care right, which I believe we will, other states will follow,” he [VT Gov.Peter Shumlin] predicted. “If we screw it up, it will set back this effort for a long time.”

In other words, Vermont’s failure to enact single-payer may be one of the most important policy flops in recent memory. Health care in America remains a problem unsolved. After the passage of the Affordable Care Act, the argument over health care was channeled into a debate about the specifics of the ACA and its political future. But as the intensity of that debate has eased, with the law having done nothing extraordinarily good or extraordinarily bad and the GOP now looking to marginal reforms instead of full repeal, the conversation has expanded again to include the dysfunction of our medical system in general and not just the ACA’s failures to address it.

If single-payer had pushed forward in Vermont just as pundits and policy makers cooled on the ACA debate, it would have dominated the new conversation. The pivot from the ACA to a single-payer system has long been favored by liberal health care wonks, and a real live state-level example of that happening would add huge momentum to it. Single-payer, which so far has seemed a political impossibility in America, would suddenly be a possibility. But the failure in Vermont means that, for now at least, the single-payer pivot has become far less viable, leaving the field more open for other approaches.

But if we cannot bring down costs in the coming years via reforms that are less top-heavy , single-payer will return as a favored policy—and that would be a reasonable, if flawed, response to persisting high costs. Nothing could be more important this time around than having a better debate about heath care policy than we did last time. Let’s hope we get it.

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  • Fat_Man

    “If Single Payer Can’t Work in Vermont…” By Megan McArdle Dec 23, 2014

    “The U.S. health-care system may be all kinds of screwed up. But at least at this late date, single payer is not the cure for what ails it.”

    • Suzyqpie

      When liberals and liberal policies fail, it can never be because they are liberals and liberal policies. Reasons for liberal failures:
      1) they were not liberal enough
      2) racism or if Hills is Pres, sexism
      3) bigots, homophobe, islamphobe, neocon, nativists, arsonist, terrorists, or just your garden variety conservative
      4) the Wrong Libs were in charge, the new and improved special Libs known as Spechul Snowflakes can fix everything
      5) ___________(fill-in-blank), basically any excuse will do other that Liberals are Losers

      • Venkat Rao Dasari

        Don’t forget Big Insurance, Big-Oil, Big-Nuclear, Fracking, Banks, and Coal.

        • FriendlyGoat

          It’s odd, but (probably without knowing it) you have made a good list of corporations which could have gargantuan mishaps—-either financial or environmental—–, go bankrupt, and dump most of the consequences on the public citizenry. We already had to bail out some banks and insurance companies to keep their losses from cascading to everyone. No one should even wonder who bears the risks of climate change, radiation exposure, water contamination, unnecessary earthquakes or disease.

          • Suzyqpie

            0bama’s AG Eric Holders indictments for Wall Street 2008 meltdown of the financial sector? Zero. Not one Wall Streeter was ever held to account. Quid pro quo at its finest.
            Unnecessary earthquakes….Friendly, come on, WDC autoecious bureaucrat adjudicate earthquakes….
            The True Believers, truly believe.

          • FriendlyGoat

            It’s not a stretch to imagine that high-pressure injection can cause something unstable to move in the earth’s crust.
            We are coincidentally having lots of them in fracking country. I don’t know how many of them are going to occur or how much damage may be sustained——but they are a consideration.

          • Josephbleau

            I am amazed that the “Party of Science Democrats”, being so much smarter than the “Knuckle Dragging Party of Stupid” understands science so poorly. Liberal scientific belief has become “I can think of a bad thing and have an off the cuff theory, so the bad thing must be true.” Have you considered that even if we could trigger quakes by injecting water into rock ( and by the way natural water pressure at a depth of 1000 feet is 500 PSI naturally) it would turn THE BIG ONE into many tiny small ones anyway.

          • FriendlyGoat

            My understanding is that fracking is done at depths much deeper than 1000 feet. I’m not pretending to “know” the science related to possible earthquakes. But we do hear that Oklahoma and parts of Texas are having a lot of small ones lately. The point is, we don’t necessarily know what we’re doing.

          • Josephbleau

            As a perspective, shale fracking from vertical holes has been done for gas in NY and PA since 1910. Also 2 mile deep underground mining has never been associated with earthquales. Men are small compared to nature and don’t have the ability to affect geology much.

          • Boritz

            You remember how Godzilla was wakened by a nuclear test and went on a rampage but everyone came to understand that he is actually part of the balance of nature so ultimately a good thing? That was awesome.

  • FriendlyGoat

    Well, shall we say “so much for the much-ballyhooed notion of federalism being the incubator for good ideas to be tried at state level”?

    OF COURSE a tiny little state cannot do single-payer by itself. So, having suddenly awakened to that reality, we’re ready to pronounce dead the main decent idea for cost control——-UNTIL, as TAI notes in last paragraph, we get tired of talking circles for a few more years.

    The “better debate” from the political right might involve lip service on price transparency, a thing that conservatives are unwilling to actually impose, though, because it violates the conservative “principle” of allowing corporate entities to maintain secrecy over anything they would prefer not appear in public disclosure. My guess is all you’re going to get anytime soon is incremental ideas to make ACA more and more unworkable and some noise about selling (unspecified) insurance products across state lines (FROM the least-regulated GOP state with the least-possible standards to protect policyholders—-the “detail” never mentioned in all that babbling about competition.)

    • Suzyqpie

      The recipients of 0bamaCare subsidizes perform as pack animals hauling government largesse to the campaign Donor Class of Wall Street. Join the profit bacchanalia, buy CI, WLP, HU, UNH, & AET. And THC, Tenet where Jeb Bush just resigned from the Board. Don’t worry, the Rs of WDC are not going to interfere with the profits of the campaign Donor Class. After the WDC Ds passed 0bamaCare, I speculate they all rushed to invest in these health care companies stock, including WDC Rs & Ds.

    • Suzyqpie

      Hi Friendly, I always give you an up-vote. I am aware that Democrats have fragile self esteem issues so I thought up-voting you might help you feel better about being a loser. I am an altruistic American always trying to help my fellow Americans, even Americas enemy, the democrats.

      • FriendlyGoat

        Hi Suzy. Your acerbic commentary is better for my arguments than your up-votes. It always helps when people are exposed to sweetness (?) of spirit which resides at the root of conservatism.

    • R. Howell

      Please advise as to how large a state must be to make single payer work?

      • FriendlyGoat

        I don’t believe single-payer is a realistic goal for a state any more so than we would believe that aviation or communications are proper subjects for a state to try to run and regulate. Reasons for this might include:

        1) That people travel over state lines
        2) That many medical corporations travel (do business) over state lines
        3) That we are living in an environment which now includes Medicare, Medicaid, ACA, VA and other federal programs which may be difficult for a single state to navigate around
        4) That cost control is a national problem. It’s too easy for providers to move from state to state (or threaten to) for their personal financial advantage if only one or a few states are trying to control costs. We have to remember that cost control is really about trying to get more care for less money—–as many nations actually accomplish. You can’t do it by giving all the providers the open opportunity to do end runs around the whole point.

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