Looks like Don Berwick’s plan to implement single-payer healthcare in our state if he is elected as our next Governor is starting to get some national media attention. Two great articles were posted today on the websites of The Washington Post and Vox.com
Check them out if you haven’t already!
Please share widely!
A Warren-Berwick 1-2 punch would put us where we should be: leading the national conversation for progressive values and good government.
Single Payer sounds nice, but there is one major problem: Don Berwick doesn’t say anything about how he intends to pay for the Massachusetts Single Payer System. It will be expensive, and it will require new taxes.
About 15% of our state’s population is covered by Medicare (federal program). Medicaid, currently takes about 35% of the state’s budget and covers about 20% of the state’s population. So, to cover the remaining 65% of the state, without projecting any savings, the budget (and state income taxes) would need to more than double. Even if a single payer plan reduced healthcare costs by 50%, there would be a pretty dramatic increase in taxes.
So, until Don Berwick describes his plan to pay for Single Payer, he really doesn’t have a plan.
Incidentally, I like single payer, but I believe it is only practical on a federal level.
Likely, though, health insurance premiums would go down or perhaps disappear. So while I think you’re certainly right that taxes might go up, it has a good chance of turning into a net savings.
I’m not sure how important a legislative plan is yet, but it could certainly be good to have a governor pushing for Single Payer.
Sure, under Single Payer, health insurance premiums would decline dramatically. But, the large increase in taxes will not be politically possible, especially since we don’t have a progressive income tax.
Basically, Don Berwick needs to explain how he will pay for single payer.
You can read more about that here. In addition, according to Mass Care, increased taxes would be politically possible because everyone would have more money in their pockets at the end of the day with a single payer system. Everyone I guess, except for those at the high end of the income ladder that would have to pay more with a progressive income tax, but they can afford to take the hit I think!
So, is that the plan???? First pass a constitutional amendment for a progressive income tax, and then dramatically individual personal income taxes? That plan doesn’t work when you consider that approximately 20% of the population pays for their health insurance directly, while the remainder have their premiums paid by their employer or by the government.
I still would like to see Berwick describe how he will pay for single-payer on a state basis.
That is what VT is considering. For most people, the increase in Payroll Taxes will be offset by the significant savings in healthcare costs that the switch can accrue. Unfortunately, VT won’t be in a vaccumn. It’s hospitals treat as many as 25% of patients from neighboring states so they will still need to deal with admin and overhead costs for those patients on private insurers. The funds needed to be raised will account for 40% of the budget for the years of implementation, and probably require short term sacrifices until the cost savings come online and the program starts saving money. They may also be able to get grants from the federal government under ACA.
To me, $2 billion is a small price to pay for covering the health care of an entire state. That’s about 1 B-2 bomber or F-35 joint strike fighter or carrier. And there is no escaping the fact that this is rationed care. But in many ways that is what private insurance is as well, care rationed and costs pooled together, but the scale of it is much smaller and the insurance company is attempting to make a profit so there is little incentive to reduce consumer costs. Removing the need to make a profit while expanding the pool to include everyone in a state would go a long way to reducing costs, as Medicare already does due to the government being a bulk consumer.
This Vox article, and the embedded video in it, explain a lot about the system. . Shumlin also wants to switch from the fee for service model, so this should be more efficient than Canada’s.
But there will be tradeoffs. It’s a moral question more than an economic one, what are we willing to pay to ensure everyone in society has their health care needs covered?
Vermont may have an easier time with the progressivity problems, no?