The friends of single payer health care are hard at work to persuade the 2003 legislature and new governor that a government controlled health care system will better serve the health needs all Vermonters, and save money to boot. It’s worth looking closely at just what is being proposed.
Single payer advocates believe that every person has a right to enjoy all “necessary medical care.” The government does not own or employ the doctor or hospital, but all providers are compensated according to a schedule set by the government. Every provider must operate within a government fixed budget. Single payer offers rigorous control of the total cost of health care because when the budgeted amount of tax dollars is used up, there is no more money and no more health care.
Under single payer, the government levies progressive income and payroll taxation to pay for all health care. No one can be allowed to use their own money to purchase health care covered by the single payer plan, because that would introduce another payer and inequality.
Leaving aside the interesting question of whether anyone has a right to force others to pay for his or her health care, the single payer proposal boggles the mind. Who decides how much care is “medically necessary”? The government. Who decides how much each doctor, dentist, chiropractor, psychiatrist, hospital, laboratory and clinic will be paid for each of the many thousands of services, tests, and procedures? The government. How much will a hospital be allowed to spend in a year? The government sets the budget numbers.
There will be no more health insurance premiums. That’s a saving. But there will be higher taxes. One study favored by the single payer advocates projects an increase in the payroll tax from 7.65% to 16.35%. The same study says that the state would have achieved a net savings of $118 million if single payer had been in place in 2001. The main reason for the savings is said to be the efficiency of having only one payer, a smart, lean, efficient government health care bureaucracy. Think about that one for a moment.
It shouldn’t take a reasonable person long to see that an all-inclusive, taxpayer-financed, one-size-fits-all, government-rationed, price-fixing, bureaucrat-intensive health care monopoly is not very attractive. Such a system features politicized decision making, crushing tax burdens, vast bureaucracies, long waiting lines, dispirited doctors and nurses, shabby facilities, obsolete technology, and poor quality care beyond the scratch, scrape, sniffle and immunization level.
The single payer people deserve some credit for idealism, but Vermont’s patients, taxpayers and economy deserve better than the afflictions of their proposed “reform.”
This is John McClaughry – thanks for listening.
John McClaughery is president of the Ethan Allen Institute, a Vermont policy research and education organization.