Keller: It’s too soon to know specifics of paying for single payer

Editor’s note: This op-ed is Betty Keller, MD, of St. Johnsbury.

Regarding the Vermont Public Radio news report on Oct. 10 about how we will pay for single payer:

It is great to provide potential options for financing a single-payer health care system and a recommendation in January 2013, because it gives time to look them over and vet them publicly, aside from the fact that the state law requires reporting the financing recommendation, for transparency, accountability and an opportunity for public participation.

This is what all Vermonters throughout the state have been asking for: People who already support single payer, which is the majority of Vermonters, want to be ready if proceeding becomes possible; people who are reluctant about single payer have been clamoring to know how it would/could be financed, but have also complained about other bills that were passed in the same session in which they were introduced, as being ramrodded through the Legislature and forced down their throats. So opponents have wanted the information to know how it could be financed, but don’t want the decision forced on them too quickly.

It wouldn’t make sense to vote for a financing plan yet, given that it appears likely to not be possible to proceed until more than two years from now, when different lawmakers will be in place. In addition, we don’t know how much money we would get from the federal government until the exchange has been working for a full year, since they will use the federal subsidies provided to families on the exchange to compute how much money to send us. We won’t have that information until 2015. By that time, there may be additional money for pilots, as well. Both of these factors would totally change whatever budget we had and therefore how much money we needed for the financing. In a state that values lawmakers not wasting time and costing taxpayers extra money, the majority of voters would not support wasting time like that if they understood those details.

Bringing up the money spent on the exchanges is only confusing the issue. Federal law requires the exchanges. And the exchanges are NOT single payer. If we didn’t have to build an exchange, designing the infrastructure for single payer would be far easier and cheaper, but we do get grants from the federal government to help with the expenses of setting up the exchange.

If Randy Brock believes that options identified in 2013 may well be out of date by 2015, why would he push for a vote in 2013? It seems disingenuous to complain about bothering to make a recommendation in January 2013 that won’t be acted on immediately when he has been complaining all along about not getting the recommendation for a financing plan sooner, and when he expresses concern that people might not like it. You can’t try to change something you don’t yet know.

I would be so happy to no longer have premiums, copays and deductibles, and to no longer have to navigate our “insurance system” when we must change plans, when we are confused about what providers we can see “in network” and what we will have to pay for the difference for out-of-network providers, and when we have trouble with denials, that I am totally excited to hear the recommendations and will keep an open mind.

Vermonters know there is no such thing as a free lunch. We know taxes will have to go up if we aren’t paying premiums and out-of-pocket expenses. But like so many other Vermonters, I will be happy to know that my taxes will be ensuring care is available to all Vermonters, instead of paying for staff to deny claims, for marketing, for overpriced medications, and for exorbitant CEO salaries for insurance and pharmaceutical companies.