I’ve been looking into Vermont’s brand new single-payer health care law.(pdf). I’ll just pick out some highlights:
As provided in Sec. 4 of this act, upon receipt by the state of necessary waivers from federal law, all Vermont residents shall be eligible for Green Mountain Care, a universal health care program that will provide health benefits through a single payment system. To the maximum extent allowable under federal law and waivers from federal law, Green Mountain Care shall include health coverage provided under the health benefit exchange established under chapter 18, subchapter 1 of Title 33; under Medicaid; under Medicare; by employers that choose to participate; and to state employees and municipal employees.
The board shall negotiate payment amounts with health care
professionals, manufacturers of prescribed products, medical supply
companies, and other companies providing health services or health supplies in order to have a consistent reimbursement amount accepted by these persons.
Read the whole thing or just the good parts. It’s like liberal policy porn.
Maybe we can do a group analysis of the law here, because we don’t hear a lot from (sitting) liberal governors. There are apparently four available lots for rent on the valuable real estate that is commercial news, and those lots are reserved for Mitch Daniels, Scott Walker, John Kasich or Chris Christie.
The state-level policy debate stretches all the way from far Right in Indiana to far Right in New Jersey. In terms of geography it’s broad, I guess. Can anyone deny that Indiana is many miles from New Jersey? There you go. The media defense rests.
Reading the Vermont law, I think of Bernie Sanders. When I think of Bernie Sanders I think of community health centers. I’ve described my great experience with a community health center before. But I relied on a county community health center for affordable, sliding-scale fee pre-natal care (a long time ago). Mine wasn’t a federally qualified community health center. At the time I knew nothing of these distinctions, but I did know this was the only primary care provider that would take me because I looked.
This is the definition of a federally qualified community health center:
non-profit, community-directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, cultural and other barriers. Also known as Federally-Qualified Health Centers (FQHCs), they: are located in high-need areas identified as having elevated poverty, higher than average infant mortality, and where few physicians practice; are open to all residents, regardless of insurance status or ability to pay; tailor services to fit the special needs and priorities of their communities, provide comprehensive primary and other health care services; provide high quality care, reducing costly emergency, hospital, and specialty care, and saving the health care system $24 billion a year nationally.
40% of the low-income uninsured in Vermont rely on a federally supported non-profit community health center for basic health care, now, today. Compare with Texas (12%), or Ohio (14%) or California (25%). Then compare with Washington. 47%. Take a look at all the states.
Is an existing non-profit or public primary care delivery system a good prerequisite to a universal single-payer payment mechanism? Or, does an existing non-profit or public primary care delivery system make a transition to a universal single-payer mechanism more likely?
I’d add the caveat I began with: federally supported community health centers are not the only non-profit or public health care provider. Looking at the percentage of uninsured who rely on this provider may be misleading. Perhaps Texas, for example, has a great network of county health department centers that aren’t (directly) established at the federal level. Of course we know that all health care delivery in the U.S., public or private, is federally supported one way or another, despite the persistent libertarian fantasies of media and conservatives.
Here’s where you can find a federally-funded community health center, if you’re looking for one.