The Affordable Care Act gives states a lot of flexibility to experiment, if they can show that they’ll achieve greater cost savings than the market design laid out in the ACA.
Don Taylor says Vermont Governor Peter Shumlin wants to use this flexibility to establish single-payer insurance for Vermont:
- All Governors say they want flexibility, and in the South they mostly talk about being pushed too far, too fast by the ACA in terms of coverage expansions. Gov. Shumlin also wants flexibility, but in order to go further, faster. He wants flexibility to move to a single payer approach before 2017 (the ACA does not allow this prior to then according to the Governor, and he says that insurance companies didn’t want this option to be available). He doesn’t want the ACA to hold Vermont back and wants both a Medicaid and some sort of ACA waiver to move toward a single source/payer approach that will cover all Vermonters as soon as possible.
- The Governor played down the role of ideology* in making his single payer approach possible, and said that the size of the state will be the biggest predictor of big innovations in health reform going forward. He thinks that small states that have fewer/smaller/less powerful corporate interests involved in the delivery of health care will be the ones that be most innovative in insurance innovations. Sarah Kliff has also talked about Montana’s efforts in this “single payer” direction….a small (in population) state.
Single-payer is definitely better at controlling costs than a system where market power is divided across a bunch of different private insurers. Lots of smaller payers don’t have as much bargaining power against an increasingly-concentrated hospital market as a single payer would. The single government insurer would have more power to dictate the price of services to providers, and pass the savings along to the state’s health care consumers. There’s no question that this would work. It is how every other rich country pays so much less for health care than the US.
We could do this in PA if we can get Democratic candidates to sign on. But before we can get Democratic candidates to state government to sign on, we need to get it into the party platform. We need to persuade members of the *state committee* to put it in the Democratic platform, and then after that, we can get candidates to pledge to support the party platform once in office. Getting candidates on the record with specific policy positions is how the Tea Party has been so successful at holding Republican legislators accountable on the policy issues they care about. It can also work for Democrats who want a single-payer system for Pennsylvania.