1-13-15 – Single Payer Zombie Attack?

posted by Wendy Wilton

I agree with Rep. Oxfeld in her recent Op-Ed that single payer is not dead. It will be resurrected, this session, through the All Payer Waiver.

How? Global Budgeting.

The All Payer Waiver, which will be sought by the Shumlin Administration, will allow Vermont to incorporate all sources of healthcare funding into one stream and pay for care under ‘Global Budgets’ set by the Green Mountain Care Board. All sources will include Medicare, Medicaid, Tricare and federal employees insurance as well as those covered by BCBS, and other insurers. This will create the “single payer” mechanism. Candidates and organizations who claimed that the Shumlin Administration’s goal is to control Medicare were right. The Green Mountain Care Board, unelected, will call all the shots.

The real danger here is the Global Budget mechanism, where the state will determine the budget for each hospital or provider. Once a global budget is exhausted there will be no more money until the next fiscal year’s funding is available. This is how the Canadian health care system controls costs and results in delays or rationing of care. The VA operates in a similar way. The worst of the world’s health care systems in developed countries (Canada, UK) use global budgets to control costs.

Proponents of achieving single payer through the All Payer Waiver will point to the state of Maryland as a success story. For many years Maryland has been granted an all payer waiver which allowed Maryland to boost reimbursement rates with additional federal funding subsidies. Compared to VT, Maryland has a more robust insurance market and a younger state demographic, so this worked out very well until the Feds could no longer fund the subsidy at high levels.

Maryland has recently been forced to go to Global Budgeting in order to continue to receive the subsidy. Until we know how this turns out for Maryland, VT should be cautious, especially since we have a greater percentage of our population on Medicaid and Medicare and a lower percentage of our population covered by private insurance. For these reasons it will be very tough for VT to increase reimbursements and not increase the cost shift at the same time, as suggested by Speaker Shap Smith, even with federal subsidies.

The legislature should not go down this path blindly without doing some really in depth analysis, including demographics, about the impact of the waiver and global budgets on reimbursement rates and tax burden. A repeat of the Act 48 waiting game on the financial plan is not likely to be tolerated by the voters.

– Wendy Wilton is the Rutland City Treasurer and a board member of the Ethan Allen Institute. 

{ 3 comments… read them below or add one }

Katherine Silta January 13, 2015 at 11:20 pm

Completely agree. They continue to be ip to no good.


jim bulmer January 16, 2015 at 6:52 pm

Wendy, add your argument the fact that in addition to a younger population, Maryland has a mucher higher percentage of well paying jobs and a much larger absolute number of individuals participating. Comparing Vermont to Maryland is like comparing lemons to wondweful tasting Bartlet pears.


Doug Richmond, Underhill January 16, 2015 at 9:33 pm

If we must a “HEALTH CAR CZAR” let it be Wendy Wilton !!

She could.would quickly bring us back to freedom and competition, and give up the crony bureaucracies and monopolies which socialism has established.


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