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Thoughts on the Vermont health care system

The bill to put Vermont on the irreversible path toward a single payer health care system is now well on its way to the governor's desk. The ceremonial signing may well be the governor's answer to the pageantry of a United Kingdom royal wedding.

Perhaps the most startling aspect of this four month legislative saga has been the enormous contrast between the daunting requirements of organizing the new $3 billion government program, and the limited competence of its advocates.

The 2010 legislature launched the process, for at least the third time, by voting $300,000 to Dr. William Hsiao of the Harvard School of Public Health to explain how to gather all Vermonters into the grandsingle payer system. The Hsaio team recommended a level of health benefits thought to be suitable for Vermont's under- 65 population. It specified the payroll tax rates required to bring in enough tax dollars to pay for the program. It claimed an astounding $590 million a year would be saved (starting in 2015) by abolishing health insurance companies.

So the House Health Care Reform Committee brought out a bill that gave the Hsaio-recommended Green Mountain Care Board the power to set benefit levels and decide how much to underpay health care providers but neglected to include any provision for raising the necessary $2 billion of new taxes. Instead, the new Board was told to take another year and another million dollars to grapple with the same questions that Hsaio had already studied.

Once the eligible population is identified, the Board's view of the "appropriate health care at the appropriate time in the appropriate setting spelled out, the costs of that care estimated, and the Federal subsidies added in, the Board can tell the legislature how much it will have to raise in new taxes to keep this ship above water.

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