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Single Payer

Almost exactly a year ago, the Governor of Vermont said, you know? We're not going to do single payer after all.

https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-single-payer-health-plan/VTAEZFGpWvTen0QFahW0pO/story.html

Why? Well, that's a little tricky to decipher. Vermont has a lot of small businesses that do not supply health care to their workers, so this was straight up added cost -- a big hike in the employer payroll tax (exactly what Senator Sanders proposes for the US as a whole) and a big hike in income taxes for the worker. Obvs, if you were already paying for health insurance, and it was taking a _bigger_ percentage of your income, this would be an improvement. Apparently, this worked out to a good deal if your household makes less than $150K or thereabouts, and a bad deal otherwise.

In the ensuing year, a variety of people have weighed in on _why_ the economics and politics of single payer in Vermont did not work out. But they're so blue! And it's such a small state! It clearly would be cheaper overall! Etc. Well, there were some issues. People who didn't _live_ in Vermont who _worked_ in Vermont were sort of an interesting case. People who worked for the federal government while in Vermont were an interesting case. Etc.

Here's a postmortem:

http://www.nejm.org/doi/full/10.1056/NEJMp1501050

This is the quote that I think a lot more people should be paying attention to.

"At some point, perhaps 5 to 15 years from now, as the size and scope of Medicare, Medicaid, and the ACA subsidy structure balloon far beyond today's larger-than-life levels, our political leaders may discover the inanity of running multiple complex systems to insure different classes of Americans."

Inanity is a tricky concept: some synonyms include vapid, fatuous, shallowness, pointlessness.

This author thinks it is crazy/stupid/laughably nuts that different classes of Americans might want different kinds of health care.

I guess I don't need to worry about this ever happening, then. Because if that's the perspective backing this horse, it ain't never gonna win any race it runs in.

I think you can make a ton of solid, valid arguments for single payer -- and I say that recognizing that precisely what constitutes single payer is undefined. What I _don't_ think you get to do is to just dismiss out of hand all the counter arguments, wishes, preferences, etc. embedded in the status quo as crazy. You actually _do_ have to deal with all of that. That is how politics works. I am sorry. I wish it was not so. And yet, there it is.

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