Opponents of Vermont's new single-payer health law are fear-mongering about the supposed consequences of lack of "robust choice" in the health insurance marketplace. What they ignore is that health care doesn't work like other "products". It is better seen as a public good, like electricity. A publicly-financed, single-payer system will actually give us more choice.

-Right now, employers have little choice of affordable options that offer good coverage. Many cannot afford to offer it at all.

-Employees have no choice as to which policy or policies their employer offers.

-Uninsured people have no choice. They often suffer without care until they are desperately ill, or it is too late.

-People with high deductible, catastrophic coverage have no choice. These policies are becoming increasingly common. Insurers love them because they are very profitable. Families may have to pay for the first $5000 -$10,000 of care per family or per individual every year, plus unaffordable premiums, leaving them functionally uninsured.

-People who have "good" insurance have little choice. They often have to fight insurance companies to get care and medicines. They pay more to see "out-of-network" practitioners.

-Doctors and hospitals have no choice. Managed care requires them to waste hours on administrative games of "Mother, may I?" or leave patients untreated.

The federal Patient Protection and Affordable Care Act mandates health insurance exchanges. (It was written by the insurance industry.) The State of Vermont has to follow the law, and hopes to get waivers in a few years.

We've tried the "marketplace" health insurance model for fifty years in America. It gave us increasing consolidation in the industry, fewer people covered, more high-deductible plans, massive corporate profits, exorbitant executive salaries, overwhelming administrative burdens, and thousands of tragic denials of necessary care. More than 45,000 Americans per year die due to lack of health insurance, and millions suffer. This is morally wrong. Health manpower shortages are made worse because clinicians must spend so much time fighting for payment. No wonder virtually all other industrialized countries use single-payer variants!

Under Vermont's single payer plan, we will have more choice.

-A massive decrease in paperwork will leave practitioners more time to enjoy seeing patients. This should increase access, especially in primary care and psychiatry. (Several hundred new doctors have already said they would choose to come to Vermont if we get single-payer.)

-Patients will choose to get care wherever they want, not where their insurance company tells them to go.

-Employers will have a fighting chance to compete internationally because they will probably pay less under the new system than they pay for premiums now, and costs will be controlled better with everyone covered. Studies show that the more insurance companies there are in a system, the higher the costs. Multinationals like IBM and Unilever have been quite content to do business in countries with single-payer systems.

All of us--employers, clinicians, hospitals, and citizens--have input into the Green Mountain Care Board, which is designing the new system. The Board answers to us--the people of Vermont--not to shareholders or executives. Board members listen, and are actively seeking our input!

Opponents of Vermont's new law say that businesses are paralyzed by the uncertainty about costs. But not doing single-payer will be much more costly. Dr. Hsiao, an internationally-recognized health system economist, tells us that single payer can be done in Vermont, and businesses will pay less than under the present system.

Best of all, EVERYONE will be covered. Patients will be able to focus on getting better, rather than on the financial stress of being ill.

The purpose of health care, after all, is caring for people.

Susan Leigh Deppe, MD, DFAPA, practices psychiatry in Colchester.


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