Monday, May 09, 2005

Fifty Laboratories....
From The Wall Street Journal on Friday:Canada South: Will Vermont pass the most radical health-care "reform" in American history? Looks like Vermont is on the verge of having a single-payer health plan. A look at the history:
In its early days in the Union--after 14 years as an independent republic--Vermont was a bastion of 18th-century radicalism dedicated to principles of "liberty and property." But shaped by the state's traditional town-meeting democracy, succeeding generations of Vermonters tempered this radical individualism. Until recently, however, Vermonters had steadfastly resisted big-government collectivism.

This great leap forward into socialized medicine can be traced to the governorship of Madeleine M. Kunin (1985-90). She was committed to a Canada-style single-payer system. But her plan faded as revenues declined, and she ultimately settled for providing health services to needy children age 6 and under. But the single-payer concept would rise again.

In August 1991, when Gov. Kunin's Republican successor Richard Snelling died in office, part-time lieutenant governor and physician Howard Dean suddenly found himself Vermont's chief executive. Gov. Dean quickly distanced himself from the single-payer idea he had supported, favoring instead something called "regulated multipayer." Translation: Hillarycare.

Gov. Dean convinced the 1992 legislature to create a Health Care Authority to come up with two proposals: a single-payer plan and a regulated multipayer plan. But when it came time for a House vote in 1994, political support for a big-government solution had evaporated. Health care "reform" died ignominiously after a 7-0 vote in the Senate Finance Committee, and the Health Care Authority was abolished in 1996.

From 1995 until late 2004, health care "reform" in Vermont consisted of Gov. Dean's constant expansion of Medicaid to higher income workers, known as the Vermont Health Access Plan. Since the plan's costs rose much faster than the revenues assigned to pay for it, Gov. Dean financed the expansion by progressively underpaying doctors, dentists, hospitals and nursing homes. His successor, moderate Republican Jim Douglas, ruefully announced in his 2005 inaugural address that the state was headed for a $270 million Medicaid shortfall by 2007.
But the Vermont house has approved a program which would:
The proposed solution was universal coverage for "essential" services as defined by legislative committee. The state's 12 hospitals would be subjected to a binding "global budget." Doctors and other providers would be compensated on a "reasonable" and "sufficient" basis, in light of bureaucratically established "cost containment targets." Private health insurance for essential services would be abolished. The new system would be paid for by $2 billion in new payroll and income taxes
Sounds much like the proposal rejected in Oregon back in 2002.
No indication if this would go before the voters in a referendum or not. The final paragraph:
All of this would seem to be a tempest in a very small teapot, but for one thing: Over the past 30 years, Vermont, with a liberal majority, a hive of activist left-wing organizations, and a press corps largely hostile to anything smacking of conservatism, has become the nation's premier blue-state testing ground for virtually every imaginable liberal proposal. Putting single-payer health care in place in Vermont would be an enormous breakthrough for the left. This year its advocates are closer to victory than ever before. If they ultimately succeed, the reverberations will be felt from coast to coast.
To which I say, go ahead, let them do it. It's easy for me to say it since I don't live in Vermont. The beauty of the federalist system is that the states can serve as trial group. Let Vermonters live a few years under a single-payer system. If it works, great. If it does literally turn Vermont into "Canada South" with waiting lists, rationing, and provider emigration then maybe the Kool-Aid won't taste so good. We're all for evidence-based medicine aren't we?
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