JakeStarkey
Diamond Member
- Aug 10, 2009
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Glad you came around to state level health care for the people.
Good for you. And the people have ACA who can't or won't do through the state.
Vermont governor abandons single-payer health care plan
- Thread starter DigitalDrifter
- Start date
Glad you came around to state level health care for the people.
Good for you. And the people have ACA who can't or won't do through the state.
Listening
Gold Member
- Aug 27, 2011
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Shut up Jake....
I've always been for states having that conversation. That does not mean they have to do it....it's up to them.
F**k that ACA.
Got that trip to Omaha rescheduled ?
I said four years ago when they passed this shit it would never get implemented. If Vermont can't afford it how the hell are we supposed to do it nationwide?
Vermont is the most rural state we have. In that sense it would have been more a challenge for them than a more urbanized and populated state, and certainly for the nation as a whole.
In other words if Vermont could find a way to do it, anybody could.
The Canadian system grew out of a provincial plan. Saskatchewan IIRC.
More than North Dakota? Or Montana? Vermont? I seriously doubt that for some reason.
You left out Wyoming and Alaska, but yes. Something I learned living there. It means as a percentage of population living in an urban versus a rural area. Vermont has one "city" (Burlington) and as cities go it's tiny.
Montpelier is also the smallest state capital in the nation, smaller than Pierre etc. And it's a lovely charming little town of (IIRC) about 10,000.
Montana, 4th in size. 48th in Population density. Vermont, 45th in size. 30th in population density.
Vermont is the most rural state we have. In that sense it would have been more a challenge for them than a more urbanized and populated state, and certainly for the nation as a whole.
In other words if Vermont could find a way to do it, anybody could.
The Canadian system grew out of a provincial plan. Saskatchewan IIRC.
More than North Dakota? Or Montana? Vermont? I seriously doubt that for some reason.
You left out Wyoming and Alaska, but yes. Something I learned living there. It means as a percentage of population living in an urban versus a rural area. Vermont has one "city" (Burlington) and as cities go it's tiny.
Montpelier is also the smallest state capital in the nation, smaller than Pierre etc. And it's a lovely charming little town of (IIRC) about 10,000.
Montana, 4th in size. 48th in Population density. Vermont, 45th in size. 30th in population density.
I said nothing about "population density" in geographical terms.
Here they are:
>> Nearly three out of ten Americans live in a rural area or a very small city, according to the latest figures released by the U.S. Census Bureau.
That’s the national average — 28.8 percent of Americans can be found either in an unincorporated area or in a city of between 2,500 and 50,000 residents.
But the national average is dominated by large populations in a handful of very large metropolitan areas in Texas, California, New York, Florida and Illinois. Most states, like the children in Lake Woebegone, are well above average when it comes to the size of their rural populations.
Seven out of ten states (34 of 50) have more than 28.8 percent of their people living in rural settings — either in small cities or in unincorporated areas. Fifteen states have more than half their populations living in rural areas or in towns under 50,000 population.
The most rural state is Vermont, with 82.6 percent of its population living in either rural areas or small cities. <<
That’s the national average — 28.8 percent of Americans can be found either in an unincorporated area or in a city of between 2,500 and 50,000 residents.
But the national average is dominated by large populations in a handful of very large metropolitan areas in Texas, California, New York, Florida and Illinois. Most states, like the children in Lake Woebegone, are well above average when it comes to the size of their rural populations.
Seven out of ten states (34 of 50) have more than 28.8 percent of their people living in rural settings — either in small cities or in unincorporated areas. Fifteen states have more than half their populations living in rural areas or in towns under 50,000 population.
The most rural state is Vermont, with 82.6 percent of its population living in either rural areas or small cities. <<
Well? You think I make this stuff up?
Vermont is the most rural state we have. In that sense it would have been more a challenge for them than a more urbanized and populated state, and certainly for the nation as a whole.
In other words if Vermont could find a way to do it, anybody could.
The Canadian system grew out of a provincial plan. Saskatchewan IIRC.
More than North Dakota? Or Montana? Vermont? I seriously doubt that for some reason.
You left out Wyoming and Alaska, but yes. Something I learned living there. It means as a percentage of population living in an urban versus a rural area. Vermont has one "city" (Burlington) and as cities go it's tiny.
Montpelier is also the smallest state capital in the nation, smaller than Pierre etc. And it's a lovely charming little town of (IIRC) about 10,000.
Montana, 4th in size. 48th in Population density. Vermont, 45th in size. 30th in population density.
I said nothing about "population density" in geographical terms.
Here they are:
From here, which goes on:
>> Nearly three out of ten Americans live in a rural area or a very small city, according to the latest figures released by the U.S. Census Bureau.
That’s the national average — 28.8 percent of Americans can be found either in an unincorporated area or in a city of between 2,500 and 50,000 residents.
But the national average is dominated by large populations in a handful of very large metropolitan areas in Texas, California, New York, Florida and Illinois. Most states, like the children in Lake Woebegone, are well above average when it comes to the size of their rural populations.
Seven out of ten states (34 of 50) have more than 28.8 percent of their people living in rural settings — either in small cities or in unincorporated areas. Fifteen states have more than half their populations living in rural areas or in towns under 50,000 population.
The most rural state is Vermont, with 82.6 percent of its population living in either rural areas or small cities. <<
Well? You think I make this stuff up?
The link isn't active. I did find this one though which shows Montana having about 7 percent more living in non core areas than Vermont.
http://www.rupri.org/Forms/Vermont.pdf
It's not active! I'm not making it up! If that is the site you are using then that's great but looking between the two states shows that Montana has more urban but less micro urban population. Between the two Montana is slightly more rural.
Greenbeard
Gold Member
What's interesting (and not really being noted here) is what changed in the last year or two.
Vermont was counting on re-purposing Medicaid funding to support that new system and it was also counting on getting the value of its ACA exchange subsidies from the federal government (since under the ACA's state innovation waivers, states are given the equivalent of their ACA funding to put toward whatever their alternative model is).
But both of those of those things have dropped substantially from what they were anticipating. In other words, falling per beneficiary Medicaid costs and lower-than-expected ACA exchange subsidies have taken the wind out of their sails.
The premise of Vermont's experiment is that it would be significantly cheaper than the status quo--the more the existing system (under the ACA) comes in under budget expectations the more the financial argument for switching to their pseudo-single payer concept withers.
Record low premium growth (in both the employer space and in the individual commercial markets) and record low spending growth are good news for most people but bad news for Vermont's ambitions. They've taken a huge hit from the financial over-performance of the ACA. Something that's ultimately going to be true for the single-payer movement outside of Vermont.
This is from their explanation of what went "wrong" (though these are actually good indicators of what's going right with the health care system):
What's interesting (and not really being noted here) is what changed in the last year or two.
Vermont was counting on re-purposing Medicaid funding to support that new system and it was also counting on getting the value of its ACA exchange subsidies from the federal government (since under the ACA's state innovation waivers, states are given the equivalent of their ACA funding to put toward whatever their alternative model is).
But both of those of those things have dropped substantially from what they were anticipating. In other words, falling per beneficiary Medicaid costs and lower-than-expected ACA exchange subsidies have taken the wind out of their sails.
The premise of Vermont's experiment is that it would be significantly cheaper than the status quo--the more the existing system (under the ACA) comes in under budget expectations the more the financial argument for switching to their pseudo-single payer concept withers.
Record low premium growth (in both the employer space and in the individual commercial markets) and record low spending growth are good news for most people but bad news for Vermont's ambitions. They've taken a huge hit from the financial over-performance of the ACA. Something that's ultimately going to be true for the single-payer movement outside of Vermont.
This is from their explanation of what went "wrong" (though these are actually good indicators of what's going right with the health care system):
Oh, so the only way that Vermont could hope to support a single payer system was by outside support. There was no way they could fund it with wholly internal revenue? Interesting.
Greenbeard
Gold Member
Re-purposing state Medicaid funding is internal revenue. ACA exchange subsidies are not.
The fact that health care is cheaper than expected reduces the bite of both funding sources.
JakeStarkey
Diamond Member
- Aug 10, 2009
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It's good to see that you are moderating.
So is Antares. That is smart of him. And you, too.
Listening
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Listening
Gold Member
- Aug 27, 2011
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So, it should have moved forward...right ?
Greenbeard
Gold Member
...no. Health care spending growth just reached lowest levels ever recorded last year. That means the argument that single-payer is needed to control health spending growth is diminished significantly.
Single-payer is supposed to be the white knight that saves us from what's going on now. But under what's going on now we're getting the best results we've ever seen in this country (the lowest-ever health spending growth, highest-ever insurance rates, the safest and highest quality care we've ever seen, the greatest state-level investment in health system change we've ever known).
It would've been a fine experiment, particularly for a small state, but most of the arguments for it have evaporated. They made the most sense in a pre-ACA world. But we're now in a post-ACA world. Which means most of the wind has been taken out of their sails because we're already seeing much of what they aspire to achieve.
Single-payer is largely predicated on the hope that the ACA underperforms hopes/projections. So far it's overperforming. So single-payer goes kaput (see: Vermont).
JakeStarkey
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- #35
JakeStarkey
Diamond Member
- Aug 10, 2009
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- #36
You have no idea. Study the Governor's report of the delay not the "abandonment."
JakeStarkey
Diamond Member
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- #37
If the cost savings and benefits of ACA is greater than we hoped, then we have no need for single payer.
- Thread starter
- #38
Uh, yeah, I posted this thread, yesterday. Hitting the egg nog a little early ?
CrusaderFrank
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- May 20, 2009
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Jake, need a hankie?
CrusaderFrank
Diamond Member
- May 20, 2009
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who is "we"?
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