Burlington, Vermont - February 16, 2011
"Today the way the economy is, I think everybody should have health insurance," said Jean Baker of Burlington. "Or the poor people and the middle class should at least get a break."
"It would be less stress for everybody if everyone was on an equal playing field and everybody got the same health care benefits," said Amanda Robbins of Burlington.
"In general, there's a lot of flaws that need repairing," said Ray Devoid of Burlington.
Which is why Governor Peter Shumlin wants to reform health care in the state of Vermont. His solution is a single-payer health care plan. But how does that compare with what we have today?
Over 90 percent of Vermonters have some kind of health insurance coverage. About two-thirds of those have private insurance and one-third are covered by government programs; Medicaid which covers low-income and disabled people, and Medicare which covers people over 65.
Our health care system is complex, but here's a general idea of how it works:
People with private insurance go to a doctor for treatment. The doctor then bills one of the few insurance companies operating in Vermont. The patient might also pay part of that cost in a copay or deductible.
The premiums for the insurance are paid by the patient's employer, though with most plans the employees also pick up a portion of that tab.
For the one-third of the population in Medicaid and Medicare, they go to the doctor and the doctor bills the government for the services. The government only pays about 60 percent of the cost, so doctors pass on the difference by raising rates for people with private insurance.
The coverage is not free for patients, who also pay deductibles and copays.
Advocates for a single-payer system hope to streamline the system by having everyone covered by a single insurance company, contracted with the state. And the state government, not employers would pay for the coverage. However, employers and citizens would still fund the system, but through taxes instead of premiums.
"It would look like Medicare. You'd have security. You'd know if you changed jobs, you've got the same plan. If your kids grow up and move out of the house, they are going to be covered somehow. There's a security," health care consultant Jeanne Keller explained.
Keller says single-payer plans can streamline coverage and simplify benefits for Vermonters.
"Predictability. You know exactly what your coverage is, as a consumer, you know what will be paid for," she said.
And no matter where you are in your life, Keller claims a single-payer plan will always be there.
"That guarantee that no matter how your living situation changes, your circumstances change, your kids circumstances change; you know your health care is paid for," she said.
"I already have health insurance. I pay for my own," said Mark Bouchette of Homeport. "And I like it just fine."
Some Vermonters like Bouchette would rather keep things the way they are. He believes health care coverage is a choice not a right.
"I like to be the one making the decision of whether to pay the price, versus having that decision taken away from me," Bouchette said.
Bouchette runs a family business-- Homeport-- on Church Street in Burlington. Having lived in Canada and the U.S., he's seen his health insurance costs go down now that he's in the U.S.
"They took more out of my paycheck there than they took out of my paycheck when I came here. So I was able to get myself pretty much the same coverage here for less money than I was able to get there," Bouchette said.
Dr. Bob Emmons is also against a single-payer plan.
"Big complex systems tend to result in medical care that's bureaucratic, impersonal and inconvenient," the psychiatrist said.
Emmons believes the doctor-patient relationship will suffer by adding more government involvement in health care decisions.
"Single-payer would have lots of rules and regulations to follow and patients would be on the receiving end of that," Emmons said.
This is only the framing the debate. There are many other pros and cons, and plenty of questions, such as how a single-payer system would be funded, the impact on employers and the impact on health care providers.
We're going to "check up" on those aspects of the health care debate in the weeks to come.
Melinda Davenport - WCAX News
