Medicare

Vermont to Pursue a Single-Payer Health Care System?

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Remember when Vermont Senator and self-described democratic socialist Bernie Sanders introduced a 700-page amendment to the health care overhaul bill that would have transformed it into a national single-payer program? And then Sen. Tom Coburn responded by making the Senate clerk spend a couple of hours reading the amendment's text on the Senate floor? Good times!

And they may not be over, either—or at least not in Sanders's home state of Vermont. From The Boston Globe:

While Massachusetts grapples with its own health costs, the nation's eyes will be on Vermont as it tries to do ObamaCare one better and switch to a single-payer health insurance system. The newly elected governor, Peter Shumlin, made single-payer a main campaign pledge. Now he has assembled a team of health officials grounded both in the realities of Vermont medical care and the pros and cons of comprehensive health reform. Shumlin's special assistant for reform will be Anya Rader-Wallack, once an aide to former Vermont Governor Howard Dean and more recently deeply involved with the Massachusetts universal-coverage system.

This isn't the first time a state has toyed with the idea of setting up a single payer program. In the 1990s, for example, California pursued a similar idea through a ballot initiative. But although the process may differ from state to state, the single-payer pitch over the last few decades has typically come down to some variation on the idea that it's Medicare-for-all. Medicare is popular, the thinking goes, and pitching single payer as Medicare-for-all will make it an easy sell.

But Shumlin, the state's new governor, is reportedly also selling the idea as a cost-control measure. There's a tension between those two ideas, though—namely that Medicare doesn't control costs very well, and never has. In the first year of its operation, the program cost more than three times what the highest cost estimates had projected, and spending on the program has continued to grow from there. Even the program's defenders concede that a lot of the money spent on the program goes nowhere: Prior to the passage of the new health care law, the Obama administration pointed to data suggesting that as much as 30 percent of all Medicare spending was wasteful. Indeed, the new health care law is set to create an independent board of federal overseers tasked with limiting the growth of Medicare spending. Liberals have expressed a lot of hope that the board will turn Medicare into a manageable, sustainable program. Right now, though, it isn't.

So sure: Medicare-for-all might be a politically effective slogan. But it's not very convincing as a cost-control plan.