Commentary: The Single Payer Healthcare Cost Nobody’s Talking About (December 2013)

by Rob RoperRob Roper

A goal of Green Mountain Care – the primary goal, according to Governor Peter Shumlin – is to control the total amount of money that Vermonters pay for health care. Back in November, an independent report by Avalere Health concluded that the official estimate of $1.6 billion in new taxes necessary to replace premiums and pay for a single payer healthcare system was too low. The real number is more likely to be in the $1.9 billion to $2.2 billion range.

This is significant because, if the Avalere numbers are correct, adopting Green Mountain Care will not save Vermonters anything. The single payer system would end up costing us even more than the current system, as messed up as the current system is. At the end of the day, the Administration and the legislature that gave us Act 48 don’t have much room for error in a project that has been, so far, plagued by serious and consistent errors of both judgment and execution.

However, nobody is discussing a line item that could blow the doors off the total cost of healthcare in Vermont under Green Mountain Care. This is the cost of the supplemental insurance policies that will be necessary to “wrap around” the benefits offered under the single payer system.

Whenever supporters of single payer are challenged about the workability of a single payer system, they invariably point to Medicare. That’s a single payer system that works brilliantly (forgetting for the moment that Medicare is facing some $35 trillion in unfunded liabilities), and single payer healthcare is really just “Medicare for All.” But in reality, most Medicare recipients require some form of supplemental insurance coverage. According to a Kaiser Family Health report released in April 2013, 88% of Medicare recipients had some form of supplemental insurance, either a privately purchased MediGap plan, some sort of employer-based retiree plan, or through Medicaid. The average cost of a MediGap plan in 2010 was $183 per month ($2196 per year).

To put this in perspective, if Green Mountain Care is truly an “everybody in” policy (excepting 107,000 Vermonters over 65 covered by Medicare), and we apply the Kaiser statistics for supplemental coverage, we’re talking  as much as another billion dollars of additional healthcare expense coming out of Vermonters’ pockets under Green Mountain Care. Even taking into account a younger, healthier demographic needing less coverage, we’re still looking hundreds of millions of dollars. So far, this very large tab appears to be off the citizens’ radar — and off the government’s books.

Who will be expected to pay? Individuals? Businesses? Taxpayers?

Under the Medicare single payer example, 14% of users receive supplements through Medicaid and 14% through Medicare Advantage. But, under Green Mountain Care, Medicaid will be part of the single payer system, not a supplement to it, and there can be no Medicare Advantage-like program in a system with no private insurance market.

25% receive supplements through an employee retirement arrangement, but Green Mountain Care beneficiaries are not retired. So, despite the goal of severing the relationship between employment and healthcare, you can expect to see serious pressure on Vermont businesses to supply “wrap around” policies for their employees, particularly if those employees are experiencing a decrease in quality of coverage under Green Mountain Care.

It’s impossible to know exactly what kind of supplemental policies Vermonters will need under Green Mountain Care or what they will ultimately cost because we don’t know exactly what Green Mountain Care will cover. This is a problem. Will dental and vision care be part of the package? Mental health? Long term care? Travel outside of Vermont? We need answers to these questions, and the sooner we get them the better.

But there are some things we do know….

Dr. William Hsiao’s 2011 report to the legislature specifically mentioned the need for “wrap around” policies. Governor Peter Shumlin and Anya Rader Wallack (then Chair of the Green Mountain Care Board) stated categorically that supplemental insurance policies would be available under Vermont’s single payer system, so these policies are expected to be a part of the landscape.

However, some single payer advocates have argued that the benefits of Green Mountain Care will be so comprehensive that supplementary policies will not be necessary. For this to be the case, the GMC benefits package  would have to be more generous than Medicare and more generous than, say, unionized teachers’ benefits. The cost of such a program would dwarf the highest estimates of the Avalere report. Hsiao himself recommended a “basic” benefits package, because anything more comprehensive would be unaffordable for Vermont.

One thing 2013 taught us is that we can’t afford to be surprised by known but unsung aspects of grand healthcare reform plans – like learning too late that we can’t, in fact, keep our plans if we like them, or that our new “affordable” policy will cost us more than the old unaffordable one. Individuals and employers have a right to know if, in addition to the billions of dollars in new taxes Green Mountain Care will cost us, we will also likely be shelling out even more dollars for supplemental health insurance policies. The only way to find out is to ask hard questions and demand clear answers.

How’s that for a New Year’s resolution?

– Rob Roper is president of the Ethan Allen Institute


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{ 2 comments… read them below or add one }

Sean Pratt January 14, 2014 at 1:59 am

Well, first and foremost, Medicare would not be facing such deficits if it were not constantly under fiscal attack.

Second, one of the key principles of Medicare, and the main reason why supplemental insurance is required is because Medicare sets prices for services.

What we need is price control, not private insurance. What we need is free universal health care-single payer system, like Medicare for all. What we need is to fight back against the rising cost of services. They do not need to be as expensive as they are and the cost does not have to be pushed back on patients.

This article inflates costs because it is based on the private health care principles of billing for all services separately at astronomical prices (ensuring profits for investors).

We are allowing professional politicians to think about this all wrong.

And if you cannot let go of this privatized paradigm, then consider rechanneling funds from defense (remember, domestic spying is considered defense and the TSA is considered defense).


bob hertz February 1, 2014 at 1:14 am

Sean you are singing my tune!

I have some articles I would like to send you. Can you give me your email address?

Bob Hertz
The Health Care Crusade


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