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Most rational people have high hopes for it succeeding in Vermont and then in the Nation. There aren't many, if any, legitimate alternatives, we must get profit out of care delivery and put innovation in, just to keep the costs a low as possible. Beyond that, we need to aggressively work on reducing the need for care and meds, a huge percentage is avoidable.
Fifty "sovereign states"? (the states rights arguments)
What I'm saying (perhaps too obliquely) is that just like with the civil union/marriage squabbles over the legal standing the push back will be too great. Not only collectively... but also that it will be shaped differently in each of those 50 separate fights. And there will be fights.
Anyway... the real point is about the all or nothing approach to the issue.
That sort of thing never really works.
The most it might do... is like the several packages of illegal immigrant legislation being passed i the several states is FORCE the issue up the line. Want to take any bets on how that might turn out?
By that definition, all people are sovereign, all local governments are and all states are. However, they exist under the federal authority as prescribed within the US constitution. King George III is long dead, who accepted the US only as a collection of thirteen sovereign nations. States are only as free within the nation as a city is within a state. Ultimately, it isn't about states rights, but people's rights.
Health care reform (advertised as Obama care by the right wingers) outlined a minimum standard for all states to meet. The states are free to devise their own plan to meet or exceed those standards. Vermont is one of many states that pushed for a single payer system for its people, to that effect.
Coincidentally, it is the conservative idea that wants to push for a federal tort reform (whether a state wants to participate or not) and open up states' borders by deregulating the health insurance companies (whether a state wants it or not). Shouldn't Vermont be able to decide whether it sees tort reform as a solution, single payer system to its people and how it wants to regulate health insurance companies within the state?
Shouldn't Vermont be able to decide whether it sees tort reform as a solution, single payer system to its people and how it wants to regulate health insurance companies within the state?
Is someone saying that they shouldn't be able to?
I know that I'm not doing so.
As regards Vermont alone... the only point I've made is agreeing with another poster that the relatively small and homogenous population will make that easier to accomplish. I wish them well in their effort.
The points I opened up extend from the idea that Vermont doesn't exist in a vacuum and that the other 49 states have a very different outlook on this (and just about every other) matter than Vermont does.
Being a good idea seems to have damned little to do with gaining broad political support.
Is someone saying that they shouldn't be able to?
I know that I'm not doing so.
As regards Vermont alone... the only point I've made is agreeing with another poster that the relatively small and homogenous population will make that easier to accomplish. I wish them well in their effort.
The points I opened up extend from the idea that Vermont doesn't exist in a vacuum and that the other 49 states have a very different outlook on this (and just about every other) matter than Vermont does.
Being a good idea has damned little to do with gaining broad political support.
When I start seeing people preach "states rights", "states sovereignty", I see... here we go again. Now, on that issue of homogenous population... what, in your opinion, gets in the way of such accomplishments in a heterogeneous population? For that matter, what exactly is a homogenous population? Is it based on skin color? Or is it more than that?
For that matter, what exactly is a homogenous population? Is it based on skin color? Or is it more than that?
Race, heritage, demographics... sure, all of those things.
But it's more than that.
You're in Texas... all 268,000 square miles of it.
Have you ever been to Vermont and experienced it's 9,000 sq miles?
wrt to politics...
It's the difference between having 25,000,000 or just 625,000 people to be responsible to...
or to have 51% of vote one way or another.
I agree with the OP that this will eventually fail. Cost being the chief reason for that failure. However, at least Vermont (as with any State) has the constitutional authority to establish a single-payer health care system. Whereas the federal government does not.
Race, heritage, demographics... sure, all of those things. But it's more than that.
I want to hear about this "more than that". Because it should be easier to discuss than the immense diversity within the demographics that exists based on heritage/ethnicity in VT.
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You're in Texas... all 268,000 square miles of it.
Have you ever been to Vermont and experienced it's 9,000 sq miles?
It's the difference between having 25,000,000 or just 625,000 people to be responsible to...or to have 51% of vote one way or another.
51% is 51%, regardless of the population, or the area the population is spread over.
Quote:
Originally Posted by Glitch
I agree with the OP that this will eventually fail. Cost being the chief reason for that failure. However, at least Vermont (as with any State) has the constitutional authority to establish a single-payer health care system. Whereas the federal government does not.
If federal government imposes a national tort reform on all states, then all is fine?
There are already single payer systems IN THIS COUNTRY. Other countries have already had them for a long, long time. Somehow I get the feeling you've never been anywhere else.
Please don't write about things you don't understand. Less emotion, less Rush and more library for you.
And then there is the geographical and internecine political aspects of having 50 separate sovereign states to impose that upon.
The issue isn't whether the US could make it work or even whether the US should make it work... the issue (in my view) is about what can actually get through Congress and how close that might be to what we actually need and be accepted by the largest majority and in fact be better than what we have now and before these latest changes.
IOW... the realpolitik as opposed to the pipe dream.
---
But this continuing argument over the notion that the problem can somehow be resolved as an either/or proposition is a large part of why this problem hasn't been resolved.
The US needs a mixture of the several approaches to PAYING FOR care.
It's also a fair statement that the UHS countries need a mixture of approaches as well.
FIRST: A tax supported plan for the catastrophic and traumatic care, major disease, and other universal underlying systems that individuals can't ever afford on their own but which they also can't ever afford to even insure against.
Just getting the worry and expense of this entire range of care and expenses off the backs of individuals will completely change the dynamic. Even as an incremental step toward eventual UHC this concept will have the most general appeal and likely needs to be done regardless of whatever else we might do beyond this.
SECOND: A whole lot more personal responsibility for the day to day care we may use... the costs of which are most affected by the other day to day choices we make... and will be most impacted by competition and market forces.
With the big worries off our shoulders and no more need for that 'OH MY GOD!" insurance policy... most people will be quite happy to do everything else on their own tyvm.
THIRD: And some small degree of private insurance on an individual basis for the services and costs that will occasionally come up that lie between those two ends.
But what we DON'T need are the Humongous Private Insurance Companies in every corner of our lives to do any of this..
nor do we (the largest majority of us) need an overly large government program to replace that model.
So far, the policies that have the most traction in DC are the ones that work against changing anything at all...
policies designed to actually support those big HI Companies.
THIS is the largest problem we have. That political influence of the HI companies.
-------- The middle ground approach:
I believe in keeping our employers and employment status out of the discussion entirely.
I believe in a tax supported network that keeps 911 and ER's and Trauma Centers operating.
This is the best part of Medicine in the US and we do it VERY well.
I believe in tax supported basic medicine for the poor, the elderly and for children.
I believe in tax supported advanced medicine (Cancer, Traumatic Injury, etc) for EVERYONE.
I believe in NOT distinguishing the peripheral services (dental, optical etc) from "medicine".
I believe in everything else that we might need of a medical nature on a year to year basis being a personal responsibility;
one that we can plan for and budget for and should pay for privately.
I believe we have NO NEED for Big Insurance as a part of that scheme in any way whatsoever
or for those companies to be even remotely involved in the servicer choices we may make.
I believe everyone should have a basic insurance policy to backstop us for the occasional hiccup in those year to year expenses
we otherwise pay for privately and that it should function very simply... very much like how a homeowner or auto policy functions.
(Some, with more involved medical conditions or other claim patterns will necessarily pay more for this than others)
I believe this covers it all.
Good post. The one thing I would add to this is there should be an "opt out" option for those die hard conservatives who refuse to even acknowledge that our current system is broken.
That way, government isn't forcing "socialism" (sarcasm) on them. They don't have to pay in, BUT, they don't get to use it either. If they want to be "independent", let them be on their own.......
Good post. The one thing I would add to this is there should be an "opt out" option for those die hard conservatives who refuse to even acknowledge that our current system is broken.
And that's the rub...
The expensive things need that 100% actuarial base for the whole shebang to work.
Like housing and maintaining that helicopter (and pilot and medic) you'll probably never need.
Do you REALLY want to be put on THAT "no fly" list?
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They don't have to pay in, BUT, they don't get to use it either. If they want to be "independent", let them be on their own.......
nice in theory... not practical in reality.
But you can still not do the biennial colonoscopy if you don't want to pay for it.
Your choice.
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