In The Atlantic, Sean McElwee asks, “Can Vermont’s Single-Payer System Fix What Ails American Healthcare?” I certainly hope so, because we haven’t been doing too well.
A 2012 Institute of Medicine report finds that the U.S. healthcare system wastes $750 billion each year. A study published in the Journal of the American Medical Association found, “Among 34 OECD countries between 1990 and 2010, the U.S. rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL [Years of Potential Life Lost] rate from 23rd to 28th, for the age-standardized years lived with disability rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for healthy life expectancy from 14th to 26th.” OECD countries pay half of what the U.S. does, in per capita terms, for better outcomes and universal coverage.
The implementation of ObamaCare should help by making health care more affordable and accessible, and by encouraging people to get more preventative care. But we’re still going to be paying much more than other comparable nations and getting subpar results.
The wait is frustrating, but I am hoping that Vermont will succeed and shine like a beacon showing the rest of the country the way forward.
It used to be that Americans didn’t settle for being second-best. We certainly didn’t settle for being 27th out of the 34.
If it was designed by Hsiao, I’d say that if it doesn’t work then we’re well and screwed, and need something even more revolutionary. You aren’t going to get a better expert on how to get health care systems to work than Hsiao…especially if they actually follow his advice and plans rather than picking and choosing.
The state hired him to develop 3 complete systems, then the legislature voted for the one that provided the best outcomes with the least cost (turns out it’s the one that’s entirely single-payer, go figure).
The irony is that the ACA tossed a monkey wrench into the works. Since we couldn’t get an early waiver on setting up an exchange, we had to go through that whole process (at an extra $15 million) to set one up, instead of moving directly into implementing single-payer, which the state had voted for the year before ACA went into effect.
The exact funding details (how much from employers, how much from property tax, etc.) are being worked on right now. The goal is a program where you go to the doctor, get the care you need. Period. No deductibles, no out-of-pocket, nothing. Though there might be a token co-pay, just to get people to buy into the care plan created by their doctor – sort of like the way charging a token amount ahead of time for event attendance results in better attendance.
Very difficult to accomplish through health insurance when the supply has been allowed to develop into a high cost product. Single-payer would further aggravate the situation seen in the mid-1990s in Los Angeles when Medicaid beneficiaries were allowed to choose between public health clinics and hospitals and private ones. They chose private which significantly reduced the revenues for public health facilities and that in turn eroded the ability of the public facilities to provide care. The private facilities ramped up by building new large complexes. And the cost of health care rose dramatically.
Perhaps it’s different in Vermont and the supply is adequate to care for all residents and there isn’t a two or three tiered supply based on wealth. However, given Bernie Sanders push to include additional funding for community health centers in the PPACA, doubt it.
However, given Bernie Sanders push to include additional funding for community health centers in the PPACA, doubt it.
I don’t. Bernie was just doing what any good politician does. He saw the writing on the wall and made sure he got something for his state out of it. He wasn’t a grandstanding asshole about it like, say, Ben Nelson.
Was pointing to Sanders efforts as evidence that the supply of primary health care in Vermont is inadequate and under-serves those of limited means. Giving that population health insurance doesn’t increase the supply and the co-pays or co-insurance in the pre-existing supply remain unaffordable.
I don’t mean to be a contrarian but, I think we-Americans-always settle for second best by being incapable of imagining we could get the best…true democracy and justice for all…we settle for a compromised result of a “little more”.
It depends on whether or not it is something that we want to compete in – we didn’t care about being an also-ran in soccer but now that we’ve discovered futbol we have elevated expectations.
Nothing against Vermont, but I want to see single payer in California
An interesting ray of light in the JAMA report: mean lifespans in ALL countries have increased. Mean lifespans in the US increased by about 3 years since 1990, which is not too shabby — I’ll take those three years, thanks! But they increased even more in many other countries, which is why our ranking dropped from 20th to 27th.
People are getting healthier the world over. Some good news for the new year.
WAPO 11/21/12
And we only spend $8,508/annum/capita to match the results in the Czech Rep that spends $1,996.
“Our way of life” also contributes to our poorer life expectancy and medical costs:
Trauma centers for gun violence and traffic accidents isn’t cheap.
It has also been noted that life expectancy of African-American men and women as increased the most and has decreased for low income and low education white Americans.
The only way money is going to stop being wasted on healthcare is if there is a concerted effort to educate people on how to prevent health problems in the first place. This means better education about eating habits, what’s healthy to eat and beneficial for health versus what is detrimental. But that in itself would incur massive costs and I’m also sure that food corporations aren’t ready to swap out cheap ingredients in their food stuffs for healthier alternatives. And the same goes for the public, most people wouldn’t be happy paying more for food that is healthier.
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