9-3-15 – What’s the Difference Between “All Payer” and “Single Payer? Not Much.

By John McClaughry

Morgan True’s long article on the continuing adventures of the Green Mountain Care Board appeared on VTDigger.org on September 3. In it he explains that:

“An all-payer model would eventually be used to put the state’s health care providers on a fixed income, and allow the board to set payment rates for all of the payers.”

Note that “fixed income” is the new euphemism for “global budget”: the GMCB will tell you how much you can spend, and also decide how much each doctor, dentist, nurse and other providers will be paid for their services.

What, again, is the difference between this “all payer” and “single payer”? Probably only that under “all payer” Blue Cross will be allowed to exist (MVP will most likely depart). This “existence” will be as an administrative contractor arm of the GMCB, under full state control.

Where does this lead? By whatever name, Vermont will have a single payer system on the fascist model: private ownership of assets, under total state control. (This will annoy socialists, who want to eliminate the private providers altogether.)

One major problem with this plan is retaining or recruiting skilled providers. The Hsaio Report allocated $50 million a year to pay providers not to leave. That evaporated. Watch for the GMCB to stamp out independent medical practice, followed by an outflow of primary care providers.

What they are creating is a Giant System – as Gov. Kunin used to say, “uniform in standards, specific in requirements, and tough on delinquents” – that will control everything related to your health. This is the Administrative State, which is not interested in anyone’s liberty.

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