10-20-15 – All Payer “Reforms”      

by John McClaughry

My column of October 1 on the merits, if any, of All Payer health care (available HERE) produced a rejoinder from Mr. Lee Russ of Bennington.

Mr. Russ says that “all payer systems tend to raise the amounts that doctors and hospitals receive for providing services to Medicare recipients.”

However there is only one “all payer system” – Maryland, since 1975. The Federal government has showered around a billion dollars a year on Maryland to increase Medicare provider reimbursements. Last October Washington informed Maryland that their forty-year joy ride is over, and any future state alternative system involving Medicare must now be revenue neutral.

Where exactly will Vermont get the annual hundred million dollars needed to pay its Medicare providers at the uniform “all payer” rate? Not from Washington.

Mr. Russ noted that I charged Quebec Medicare with relying on lower-level providers, but that I favored Minute Clinics and other arrangements staffed by Nurse Practitioners. I do support nurse practitioners providing a wide range of low-level medical services. The problem comes when the “all payer” system, like Quebec’s “single payer” system, starts running out of money, and has to rely on NPs to perform services that really require MDs.

I agree with Mr. Russ that there are a lot of serious problems with our present health care system (although I’m not clear about what “unsustainable” means).

Reversing dumb or special interest venal government interventions ought to be the starting point for genuine health care reform. But alas, the most vocal critics of our present “unsustainable” system invariably believe that there can be no “reform” other than turning all of health care over to the tender mercies of perennially cash-strapped governments.  Groan.

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