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agate
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 Posted: Sat Sep 08, 2012 11:58 am Post subject: (Lancet) VT attempts single-payer health care |
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A UK perspective on US health care.
From The Lancet, September 8, 2012:
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Vermont attempts single-payer health care
Carrie Arnold
While the passing of the Affordable Care Act was met with a backlash in many US states, Vermont took a different approach, with a push for a more public health-care system. Carrie Arnold reports.
Besides the mudslinging and finger pointing, one of the constants of the American presidential campaign is the issue of health care. In 2008, President Barack Obama campaigned on the promise of health care reform. A year after taking office, he signed the Affordable Care Act (ACA) into law, which prohibits insurance companies from denying coverage because of a pre-existing condition, expands access of the government-funded Medicaid to low-income Americans, and provides tax subsidies to help people purchase private insurance.
Unlike many areas of the USA, which experienced a backlash against more government involvement in health care, the state of Vermont took a different tactic. With the passage of legislation in May, 2011, Vermont paved the way for the state to establish a single-payer health-care system. Since then, a handful of other states around the USA have begun to research the creation of similar systems. “We don't really have a health-care system in the United States”, said Deb Richter, a Vermont physician who has been active in encouraging the single-payer system. “We want to show the rest of the country that a single-payer system is more efficient and will cost us less.”
Currently, the USA has a multipayer system. Doctors and hospitals submit their bills to one of thousands of different insurance companies around the nation, each with their own Byzantine array of copays and regulations. This situation has created enormous overheads for physicians, who often have to hire separate billing clerks just to handle insurance claims. Advocates of the multipayer system say that competition between insurance companies helps with cost containment and the provision of the best services.
The facts, says Harvard University economist William Hsiao, tell a different story. Large swaths of the country have no health insurance. Costs have been increasing significantly faster than the inflation rate. Americans spend 18% of gross domestic product (GDP) on health care, compared with countries like France and the UK, which spend 11·8% and 9·4% of GDP on health care, respectively. “We have a broken system”, Hsiao said.
Alarmed at the rising costs and large numbers of uninsured individuals, Vermont called for an independent commission of health economists to suggest ways of fixing the problem. Hsiao's work, as one of the leaders of this commission, advocated moving to a single-payer system that ensured everyone in the state would have access to “comprehensive, quality health care”, regardless of income or job status.
As stipulated by the ACA, Vermont will create an insurance exchange known as Green Mountain Care, headed by an independent, five-member board. Vermonters can select insurance from any company on the exchange, but the state-funded Green Mountain Care will set all rules and regulations, as well as reimbursement rates for doctors and hospitals. By 2017, if all goes to plan, Vermont will transition into a true single-payer system.
A single-payer system has several advantages over the current system, Hsiao says. Large insurance companies frequently spend a large chunk of their profits on advertising and administrative overheads—much more than government-run programmes like Medicare and Medicaid. Physicians and hospitals must submit different forms to different insurance companies, all of whom have different rules about billing and reimbursement. Fraud is much harder to detect, and Hsiao said that roughly 10% of health spending is based on fraudulent charges.
David Himmelstein, president of Physicians for a National Health Program, says that it is a mistake to equate Vermont's move towards a single-payer system with “socialised medicine”. In true socialised medicine, doctors and hospitals are employed directly by the government, as is the case in the UK's National Health Service. Whereas doctors bill the government for patients with Medicare and Medicaid in the USA, they are independent providers and do not work for the government. These are examples of a single-payer system that are not socialised medicine. A single-payer system could also involve a private insurance company that covers the entire state.
The Vermont legislature has “left open the possibility that an insurance company will administer [the plan], which I think would be a mistake”, Himmelstein said. Regardless of who administers the plan, he noted, the alternatives are simply not working.
Still, single-payer health care faces many hurdles before it becomes reality in Vermont. The state must figure out how to finance the plan by 2014, and receive a waiver from the federal government to allow Vermont to move to a single-payer system by 2017. “If you don't have money to pay for something, it's not reality yet”, Hsiao concluded.
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The article can be seen here. |
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