Last updated on 2011.06.05
Republicans are cooing over Rep. Paul Ryan's "budget," a utterly unserious plan based on flim-flam math that doubles the national debt while hammering low-income folks and destroys Medicare and Medicaid. (As an afterthought, the Ryan plan also puts Kristi Noem and other GOP dissemblers in the awkward flip-flop of embracing exactly the PPACA Medicare cost controls that last year were fodder for their election season scare tactics.)
Meanwhile, the Vermont Legislature is showing us the path to true health care reform. Rather than destroying Medicare by voucher and throwing senior citizens to the private insurance death panels, Vermont is affirming the American commitment to community with a bill that would create a statewide single-payer health insurance program to cover all Vermonters by 2017.
The bill has passed the Vermont House; it passed the Senate Health and Welfare Committee yesterday 5&ndash0. If it makes it through two more committees and the full Senate intact, Governor Peter Shumlin will sign it. Then, in an interesting twist, it will hinge on permission from Washington to opt out of the federal health reform law. (I eagerly await the spectacle of Tea Party Republicans trying to use PPACA to prevent Vermont from one-upping ObamaCare with a single-payer system.)
Vermont is leading the way toward real health insurance reform that fulfills the American ideals of community, generosity, and human dignity. Health care isn't a matter of commerce; it's a right better provided by all of us working together through our government than through profit-seeking private insurers. Go, Vermont!
Bonus Encouragement: As Robert Reich points out, Medicare isn't the problem; it's the solution.
Update 12:20 CDT: The Ryan budget isn't serious at all. It is as Paul Krugman describes it, a "sick joke... pure fantasy." Krugman also notes that when the government uses its purchasing power properly, as it does in the Department of Veterans Affairs and as President Obama proposes for Medicare drug purchases, we can save 40% over purchases through private plans like the current system and like the further privatization Rep. Ryan proposes.
How do they plan to pay for this system?
Vermont has a pretty high tax burden already.
If this plan passes into law, what's to stop sick people from moving to Vermont and healthy entrepreneurs from fleeing Vermont lower-taxed places such as, well, South Dakota?
When I lived in Wisconsin, people talked about this same sort of idea, expanding their "BadgerCare" system to include everyone. I don't know what's happened on the medical-care front since I left Wisconsin in 2004, but I do know that one of their chief concerns was that sick people would converge on the state and overburden the system.
Really, in my opinion, a monolithic centralized single-payer system ("socialized medicine" or "Kucinich care") is the only real workable way to go about solving this huge problem, and it will cost a lot of money to do it. I suspect that if we ever get to that point, the only way to get the revenue will be through a national value-added tax (VAT).
I have mixed feelings about this whole mess. I can say this much: (1) I don't like the idea of a VAT and all its attendant paperwork one bit; but (2) I'd sure like to be able to go to the doctor when I'm 75 or 80 or 85 years old, and not fear losing everything I have to avoid dying. If it takes a VAT to do that for me, well then, I guess I can swallow it. And by the year 2028 when I'm 75, or 2033 when I'm 80, or 2038 when I'm 85, I reckon I'll have about 50 million voters right there in the same tank with me.
Stan, I'm still convinced that a single-payer health insurance system will cost less than the current private insurance system. My taxes (whichever tax the state uses) might go up $3600, but my annual private insurance premium of $3600 disappears. I get more health care per dollar, since a single unified system has less paperwork and overhead. The system covers everybody, so it enjoys the biggest risk pool possible. Big picture, a single-payer system takes a smaller slice of GDP than the current fragmented system.
Sick migration: an interesting possible phenomenon! I wonder just how many sick people would move away from their home states with the social support networks. I might ask for a comparison to Canada: how many Americans move north of the border? We certainly medical tourism, as old folks take advantage of cheaper drug prices in Canada, but how many people actually move permanently just for the health insurance? (Granted, international migration is much more complicated than interstate migration.)
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