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Vermont Health Care for All
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Montpelier, VT 05601

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At the Crossroads: The Future of Health Care in Vermont

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Myths & Realities:

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 Beliefs about "Why we can't"

Myth 1: The claim: Vermont is hamstrung by Medicare, Medicaid, self-insurance programs, federal laws and federal mandates and cannot possibly enact anything like a universal health care system on its own.

This is a large, sweeping claim. In the final analysis it implies that Vermont cannot control its own destiny as to health care costs and the fate of its health care services. Is it true? Taken as a whole it is not true. For easier understanding we will break up its constituent claims into Myths A, B, C, D, E and F.


A - A universal health care system is equivalent to a single-payer system...

B - Where there is more than one payer in health care there cannot be a global budget.

C - Medicare stands outside state control.

D - Medicaid stands outside of state control.

E - Almost 75% of health care spending stands outside state control and regulation.

F - The claim is that ERISA law - which prevents tampering with employer self-insurance plans - stands as a barrier to any publicly financed universal health care system as long as employers pay anything into it.

 Beliefs about "Why we shouldn't"

Myth 2: The claim: Health care would be government-run

Myth 3: The claim: We have the best health care in the world, so let's not tinker with it.

Myth 4: The claim: Administrative savings in a Vermont universal health care system would be far less than imagined.

This is a large claim. One of the attractions of a universal health care system is that it holds the potential of very large administrative cost savings. The claim contains several parts and we will divide them for easier grasp into Myths A, B, C, D, and E.

First, some background. America's health care consumes vast sums in administrative expenses. This is not in dispute. Nearly one fourth to one third of every health care dollar goes to administrative expenses. By and large these are necessary expenses as things stand, because of the complexities of medical care charges, payment schedules and collection bureaucracies in the U.S.

Second, other nations' health care systems all have lower administrative costs. This is not in dispute. Even complex systems with many payers are 10 to 15 percentage points less costly than the U.S.


A - Vermont's administrative costs are low, therefore savings will not amount to much.

B - Vermont's administrative expenses look high because they include extraneous items like laundry costs.

C - A universal health care system in Vermont will necessarily operate with more than one payer, e.g., Medicare, and therefore administrative savings will not amount to much.

D - Cross-border issues with New Hampshire and New York State will undermine administrative cost savings.

E - A government-created agency of whatever kind is incapable of administrative efficiency.

Myth 5: The claim: Taxes will soar.

Myth 6: The claim: Rationing will ensue from a universal health care system.

Myth 7: The claim: In other nations' health care systems the medical care is inferior.

Myth 8: The claim: If we implement a system like theirs we will experience waiting lists.

 Beliefs about "What We Need"

Myth 9: The claim: Enhancing the private insurance market will reduce premium costs.

For clearer understanding we will divide this claim up into Myths A, B and C.


A - The claim: Increasing the number of private insurers will bring down costs.

B - The claim: More private insurers would mean more competition, which would mean lower costs.

C - The claim: If we got rid community rating, if we made Vermont a private insurer-friendly market, insurers would flock here and premiums would cost less.

Myth 10: The claim: Cost-conscious patients will save money because they will use less.

Myth 11: The claim: If Americans had better health habits costs would be lower.

Myth 12: The claim: Health care costs are high because people demand too much health care