Wednesday night I was at a meeting of the Western Coalition for Single Payer Healthcare (a group in Western PA campaigning for a national single payer plan to be enacted). The subject of state efforts to enact single payer came up. I said that there were efforts in several states to enact it and Vermont passed it two years ago. A member objected saying that Vermont's plan is not single payer because it's administered by Blue Cross. This made me ask myself what a single payer system is.
I looked at the Vermont for Single Payer website and they do have a definition saying that "health care is financed by the public whose money is managed by the government or by a government sanctioned agency... (the full definition can be read here)." If the government of Vermont indeed has sanctioned Blue Cross to administer their plan in a nonprofit capacity then it does meet their definition of single payer. As TR Reid in the documentary Sick Around the World shows there is considerable variability in health care systems around the world. Germany, Japan, and the Netherlands have systems which are administered by private insurers but heavily regulated by the government. Does that count as single payer? According to Vermont, yes.
Watch Sick Around the World on PBS. See more from FRONTLINE.
Canada, the United Kingdom, Cuba, and Taiwan have healthcare systems which are administered directly by the government. This I believe is the type of single payer system which those at the Western PA Coalition would prefer. While there are good reasons to be suspicious of the intentions of Blue Cross or UPMC. We won't really know how it works until it is fully implemented.
We do have working models in other nations for universal non profit systems, They are all good systems with outcomes comparable to Canada's. The commonwealth fund has studies which show that their health and cost outcomes are roughly equivalent with the US for profit system trailing. If you double click on the image with some comparisons between the US and other countries below you can enlarge it.
I go to discussion groups like Drinking Liberally where many on the left do not really understand what single payer is. They ask me questions like "doesn't Massachusetts already have it?" I tell them no because it leaves the for profit nature of the current system intact which drives up the costs.
