WEST BRATTLEBORO — Insurance offered through Vermont's Health Benefit Exchange is not part of Vermont's future single-payer system.
Required by the federal Patient Protection and Affordable Care Act of 2010 (“Obamacare”), the exchange sells private plans for those needing insurance. Also, Catamount Health and Vermont Health Access Program (VHAP) will cease and Medicaid will be offered in their place to cover those needing insurance in 2014, three years before a single-payer system begins.
The exchange will not save money. It perpetuates America's profitable private insurance model.
Insurance is mandatory, and the cost could be a hardship for the neediest, with insufficient subsidies, until single-payer begins. Private insurers, as “middlemen,” are in business to make profits for themselves and stockholders. They handle the money and billing. They do not provide health care.
Cost control is built into single payer's design. It will happen only if we rein in the profligacy of our wasteful mix of multiple insurers, equipment, drug companies, and other profiteers. Costs are helping to bankrupt our depressed economy, where many remain uninsured.
For now, however, the exchange can cover most of the uninsured. It can also move means-tested, low-income beneficiaries in and out of insurance plans, and it might even delay their re-insurance as their incomes fluctuate.
Single payer will provide uninterrupted coverage 24/7, independent of employment, for all citizens who lack insurance, for lower cost. This is the plan that serves many countries, and its effectiveness has been verified by expert analyses. America's Medicare and Veterans Affairs system are variations of single payer, though they need improvement.
In designing Vermont's single-payer system, the Green Mountain Care Board recognizes the need for more primary-care providers and fewer specialists. It is restructuring health-care organization and delivery and payment systems, and its very nature should also support medical professionalism, which has been strained in today's business model that values profits over patients.
Our talented health-care providers in Vermont, who value patients above profits, need the support of a system that honors their ethics as health professionals.