Letters to the editor

Don’t confuse exchange with single payer

One of most disingenuous ways some would try to derail Act 48’s Green Mountain Care’s single payer universal health care plan is to link it to the Vermont Health Connect insurance plans.

In spite of a couple of needed reforms, there is no way, shape or form that these heath plans are comparable or similar. Far from it. Green Mountain Care, due in 2017, resembles Medicare, which is for the most part a single payer plan. Vermont Heath Connect is a convoluted, federally mandated insurance-company-based exchange program with various degrees of coverage, premiums, deductibles, eligibilities and subsidies that perpetually needs updating depending on a number of factors on a yearly basis. Green Mountain Care’s only requirement is being a Vermont resident. Like Medicare, no yearly renewals needed.

One soon to be ex-politician guilty of the above grossly inaccurate comparison is Paul Ralston in his recent letter “Single payer is key campaign issue” (Aug. 28). Not only are the two health plans miles apart in every conceivable way, Vermont Health Connect wouldn’t even exist if it wasn’t federally mandated by the Affordable Care Act and Vermont didn’t have to wait for the necessary waivers in 2017 for Green Mountain Care to become a reality.

His professed support for single payer (Green Mountain Care) becomes questionable by choosing fellow House member Heidi Scheuermann as his co-founder for  “Vision to Action Vermont.” Scheuermann, as her record and commentaries show, is no friend of single payer. His motive is further questioned by a number of “what ifs”, with no factual basis, such as “what if single payer doesn’t provide universal access heath care?”  Sowing the seeds of fear and uncertainty is a classic tactic in attempting to manipulate public opinion for political or other reasons.

Jerry Kilcourse
Montpelier

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A defined path to single payer

In a recent letter (“Single payer is the only campaign issue” Aug. 28), Middlebury’s outgoing State Rep. Paul Ralston raises some questions about the state’s roadmap to single payer. However, his conclusions are based on assumptions that need more probing. Here are a few of the issues raised that need more careful examination: No. 1, the letter asserts that the state has performed poorly in its “first attempt at health care reform” and that therefore people must now be cautious. However, it is important to make clear that the health care exchanges were federally mandated and not a state idea. Furthermore, single payer is a simpler concept than the health care exchange, as it does not involve different levels of coverage for different people, changing subsidies as your life situation changes, restricted enrollment periods that can leave you in the lurch, and all the rest of the exchange complexity, including a long and less than dependable application process.

Rather, with single payer we are all enrolled automatically by virtue of our Vermont residence, and then our coverage is guaranteed. As Act 48 states, Green Mountain Care will cover all Vermonters regardless of any other coverage they may also hold (such as Medicare for which it will act as a wraparound).

No. 2, single payer detaches payment from coverage. We are covered regardless of whether we lose a job, get a job, get a divorce, or undergo any other change in our life circumstance, so long as we are a Vermont resident. As far as payment, we have figured out how to pay for other state services equitably, and we can do so for single payer as well.

No. 3, the letter states that the program for Green Mountain Care, the proposed single payer plan, has no “clear definition.” That is incorrect. Act 48 specifies the minimum cost sharing and coverage for Green Mountain Care, the state’s future single payer plan. The benefit package, by law, must include primary and specialty care, mental health and substance abuse, hospitals and prescription drugs. Under Green Mountain Care, everyone will be eligible for these broad benefits, and out of pockets must be kept to a minimum because the “actuarial value,” or the amount that the plan pays, must be kept high. What is still undecided are the categories of adult dental and vision, and this is something on which citizens will need to weigh in as the Legislature considers the financing package in the next session.

No. 4, What about the financing parameters? We already know them. Every professional study has estimated a cost of between $1.6 billion and $2.1 billion for the tax package to fund single payer. That is less than Vermonters already pay in private premiums and out of pockets ($2.6 billion in 2012), and most importantly, it will replace them. Of course, how the tax package is crafted, how progressive it is, what portion will be payroll and what portion income, etc. are important questions. They will be carefully thought about and debated once the administration presents its proposal, the Legislature considers and weighs it, and revisions are suggested based on citizen input.

Ellen Oxfeld
Middlebury