Guest opinion: Vermont’s failed single-payer health plan
In November, Colorado voters will decide the fate of Amendment 69. It proposes to create ColoradoCare, a bureaucracy to control all health care in the state. It would initially be funded by a 10 percent tax increase on all forms of income.
Coloradans trying to decide how to vote on Amendment 69 can learn from Vermont’s experience.
Vermont’s governor and legislature set the stage for a very similar “single-payer” proposal in 2011. Act 48 established the Green Mountain Care Board, and directed the governor to produce a plan to pay for its universal benefits. Like the ColoradoCare Board created in Amendment 69, Act 48 gave the new Green Mountain Care Board sweeping powers to regulate Vermont’s entire health care industry.
Like ColoradoCare, Green Mountain Care was not required to provide any specific health care to any specific person. Instead, it declared that every Vermont resident would be entitled to “appropriate care at the appropriate time in the appropriate setting.”
Left unsaid was that “appropriate” really meant “appropriate in light of available resources.”
Vermont, like Colorado, already had administrative control over Medicaid and the State Children’s Health Insurance Program. The Obama administration said it would entertain granting an ObamaCare section 1332 waiver to the state. This would have made every resident covered by Green Mountain Care automatically in compliance with the Obamacare individual mandate. It also would have transferred the millions of dollars in health insurance premium subsidies flowing through the state’s Obamacare health exchange to help pay for Green Mountain Care starting in 2017.
But in order to make Green Mountain Care work, the governor still had to raise at least $2 billion in new taxes to pay for the increased demand for services. This is a huge amount in a state with a 2016 general fund budget of $1.5 billion.
It also became clear that the Green Mountain Care Board would not be able to exert the complete control needed to realize the promised savings unless it could control the Medicare payment stream. But the politicians soon learned that Medicare beneficiaries did not want to be forced into an experiment that would allow state bureaucrats to change the place, time, manner and providers delivering their health care.
After a near-death experience at the polls in 2014, Act 48’s chief cheerleader, Gov. Peter Shumlin, recognized that Vermonters simply couldn’t bear the enormous taxes required to fund the Green Mountain Care experiment. He sorrowfully pulled the plug.
Critics of Green Mountain Care repeatedly pointed out the experience of Quebec’s single-payer plan, just across the northern border. Since 1984 Quebec has operated a plan that deals with the fundamental problem of single-payer – infinite demand and limited resources – by shrinking the provider universe. It has a serious shortage of physicians, long waiting lists, and long wait times, and often refers critically ill patients to U.S. states for treatment.
Green Mountain Care advocates understandably maintained a calculated silence on Quebec’s health care outcomes. When in a debate a visiting Canadian doctor confronted the leading Vermont single-payer advocate, also a doctor, about Canada’s unhappy results, she could only blurt out “But we’re Vermonters! We can make it work.”
Putting state government in charge of an all-inclusive, taxpayer-financed, price-fixing, one-size-fits-all, bureaucrat-intensive monopoly health care system will excite some voters, but their yearning for someone else to pay their health care expenses doesn’t solve unavoidable real-world problems.
A single-payer plan will never have enough tax money to go around, and patients will suffer some annoying inconveniences, like rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care and, of course, much higher taxation.
Vermont’s residents came to understand that there was little reason to believe that Green Mountain Care would work better than what they had. They knew that “Don’t worry. Your Government can work those things out” was not a serious answer to the very real health-care problems Vermonters faced.
ColoradoCare appears to be Green Mountain Care on a larger scale. It promises crippling taxes and all the problems produced when a bureaucracy is tasked with rationing limited resources to meet unlimited demands.
Colorado voters should learn from Vermont’s example and demand health-care reform that is more than unfulfillable promises and wishful thinking.
John McClaughry is vice president of Vermont’s Ethan Allen Institute, and a former state senator. He wrote this for the Independence Institute, a free market think tank in Denver.
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