Oregon, Montana and Vermont want to move much faster on health care reform than President Barack Obama’s Affordable Health Care Act will allow. It’s frustrating.
Oregon Gov. John Kitshaber said, “We want to show that health reform is something real, that it actually works. Oregon is a place that can actually make it happen.”
Oregon passed its own health care act that changes how it pays doctors and eventually will enroll state employees in the Medicaid program as a big move toward a single-payer system. To do that, however, the federal government will have to grant Oregon waivers on the way Washington funds Medicaid and from other key pillars of the federal program.
But waivers can’t be granted until 2017 under the federal law. A bill that would step up that date to 2014 has been endorsed by President Obama but is stuck in a Senate committee.
Vermont has gone even further than Oregon. It has become the first state in the nation to enact a single-payer health care system. It has started discussions with Washington about the waivers it will need to convert health insurance there into a single-payer system run by a public board.
“We’ve had some very general discussions with the federal government about our single-payer plans. We’ll continue to press for earlier waivers,” Anya Rader Wallack, chair of the Green Mountain Care Board, told a New York Times reporter. “If we can’t have it, we can’t implement our reforms as fast as we’d like to. It’ll make a difference in terms of the degree of simplification in implementation and the savings associated with that.”
Montana also has started exploring single-payer options. Last month, Gov. Brian Schweitzer announced he would seek permission to open up his Medicaid program to government employees and other individuals, laying the foundation for a future universal coverage program.
The governor has spent three years working on his plan that is modeled after one in Saskatchewan, the Canadian province directly north of Montana.
THESE THREE governors are ahead of the game. They all want to create single-payer systems that will give a governing board the power to decide how health care will be administered and paid for in their states.
As Gov. Schweitzer is well aware, Canada offers his state — and the other 49 — a working model to copy.
And as all three of those governors know, the only way to bring the cost of health in line with costs in the rest of the rich world is to control the elements that make up a nation’s health care bill. That means controlling administrative costs, prescription drug costs, hospital costs and the cost of the rest of the health care providing industry.
Single-payer systems provide the most practical way to control those costs. Up to now, that is the only way health care costs have been controlled in a modern nation.
Can it be done state-by-state in the United States? That remains to be seen. Bringing costs down means reducing income to the players. In Vermont, for example, health insurance companies will be crowded out of the game. In all three states doctors, hospitals, drug companies, along with health insurance companies, will see their income drop. Some providers — those earning the most under the current system — will be hit particularly hard.
Costs can’t be reduced without reducing incomes and such reductions will continue to be resisted mightily.
WHETHER SUCH dramatic changes can be accomplished by Vermont, for example, while the industry remains unchanged in New York, Massachusetts, New Hampshire and Maine is problematic. Still, Canada has maintained and continuously improved its single-payer health system for all of these decades despite (or, perhaps, because of) the free market competition which has flourished in its dominant neighbor to the south. The fact that it spends only 11 percent of its GNP on health care for all Canadians while the U.S. spends nearly 17 percent, and leaves 50 million of its citizens without coverage, has become a matter of national pride.
So perhaps three or more states can show the rest of the U.S. the way to save enough on health care to balance the federal budget and have some left over for tax cuts. Worth a try.
