Vermont in 2013 tried to develop a single-payer system as a solution to the problems of cost and access to care. Due to high-cost estimates, the approach was considered to be too expensive. Unless you have ignored the news, there is a huge problem with costs that is healthcare corporate system and insurance company driven, affecting the individual and small business marketplace for insurance coverage. Insurance networks are shrinking, doctors are being kept out of networks that are being tiered and the consumer loses. Many doctors are joining hospital systems and selling their practices to get access to their tiered networks which is also driving costs. Consumers are paying ridiculous costs for coverage that often comes with high out of pocket costs and tiered networks that help large corporate medicine thrive while harming competition from smaller groups of providers. Drug prices also continue to rise and congress is more interested in making money from their interests and watering down reform than making the hard but necessary choices that offer price competition. Corporations that self insure this past year saw their costs stay stable yet, those who are in the private insurance market saw their premiums go up 25% or more due to government uncertainty. How can self-insured companies who use large insurers and their networks keep costs steady while those of us on the private market continue to get slammed? The truth is, half of this countries insured are working for a company that self insures. Another truth is that in an excellent NY Times article, those who purchased plans through brokers or through exchanges continue to see increases in their premiums even though costs are stable with companies who are self-insured. Part of the problem is that far fewer people buy insurance through the market place than they do through their employer, resulting in smaller groups and unfortunately, higher costs because there are fewer people in those buying group. When members of the smaller group are sick, there is less sharing in a small group, resulting in higher premiums. Also, since there has been no true reform of the practice of medicine that is increasingly fragmented, once a group member is ill, costs go out of control. For Obamacare to work better, the individual and small company groups must get larger. They cannot if we insure on a state by state basis. The state to state healthcare exchanges is duplicative and wasteful when compared to a single national exchange with national plans we should be able to buy into. National plans do exist, and they cover people from the post office as well as a congress with reasonable co-payments and low deductibles. Medicare is cost-effective, has bargaining power, is easily scalable and can help keep some costs in line. Why don't we roll it out to people over 50 and allow them to buy in? What would the premiums be and would they be much lower for this age group? What about all of those self-insured plans? Allow companies to continue to offer these plans if companies are happy with how things work. On the other hand, if the costs of Medicare are lower, what do you think companies would consider doing? It is quite likely that if Medicare is much lower, companies can choose to pay premiums to Medicare to insure their workers. Reform of this type does not have to totally upend our current situation, but it can be a good step forward even though this will not fix our system, but will add pricing stability and improve access. The system, as we know it much be overhauled. There is a better way forward than to have those of us who are insured paying to much for insurance that only covers us after a high deductible. People are likely to wait, become more ill and long term, caring for them will come with higher costs, exactly not what the doctor ordered. This brings me to Vermont, who according to the Washington Post has a creative idea for reform. Their idea is a well care system that rewards doctors and hospitals financially when patients are healthy, not just when they come in sick. Medicare is pioneering a similar model. How we keep people healthy is the question? Vermont's lofty goal is the have 70% of the people in the state insured in this type of plan, which is a wonderful goal. It can totally change the idea of primary care and what their responsibilities are to their patients however, the 10-minute office visit model we currently have where doctors are starved for revenue needs to change. Also, the way procedures are paid for will likely change as well with bulk payments for everything done surgically, to reduce costs and make them more predictable. Medicare did this years ago using DRG, or diagnostic related group. Can this work or will there be too much resistance from the status quo? If this works, it may be a model for the rest of the country. Read more about it here After single payer failed, Vermont embarks on a big health care experiment By Carolyn Y. Johnson September 17 ENOSBURG FALLS, Vt. — Doug Greenwood lifted his shirt to let his doctor probe his belly, scarred from past surgeries, for tender spots. Searing abdominal pain had landed Greenwood in the emergency room a few weeks earlier, and he’d come for a follow-up visit to Cold Hollow Family Practice, a big red barnlike building perched on the edge of town. After the appointment was over and his blood was drawn, Greenwood stayed for an entirely different exam: of his life. Anne-Marie Lajoie, a nurse care coordinator, began to map out Greenwood’s financial resources, responsibilities, transportation options, food resources and social supports on a sheet of paper. A different picture began to emerge of the 58-year-old male patient recovering from diverticulitis: Greenwood had moved back home, without a car or steady work, to care for his mother, who suffered from dementia. He slept in a fishing shanty in the yard, with a baby monitor to keep tabs on his mother. Read more