As health-insurance problems keep arising, Vermont offers a ray of hope

I am a cancer survivor.

After being diagnosed with breast cancer last year, I chose to undergo medical treatment in the country of Colombia in South America. I received first-class treatment – surgery, chemotherapy and radiation – at a fraction of what it would cost in the United States. Since I have been uninsurable in the U.S. because of pre-existing conditions, I went to another country for treatment rather than paying the shamefully high costs of care in this one.

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Debra Axness
I have been following the implementation of the Affordable Care Act with great personal interest. I am extremely grateful that I will be able to get health-care coverage next year. While the system is not perfect, millions of people in situations similar to mine will be able to go to a doctor next year. Getting up in the morning and praying for good health and no car crashes is no way to insure your health.

All but ignored in the multitude of media coverage about the ACA and its problems, Vermont has become the first state in the union to pass a single-payer universal health care law for its residents. It has a snappy slogan: Everybody in, nobody out.

The system will be fully operational by 2017, funded by Medicare, Medicaid, federal money for the ACA given to Vermont, and a slight increase in taxes. Everyone will be able to go to any doctor or hospital in the state free of charge. No plans to figure out, no insurance forms to sweat over, no gotchas.

Estimated to save 25%
Dr. William Hsaio, the Harvard health care economist who helped craft health systems in seven countries, was Vermont’s adviser. He estimates that Vermont will save 25 percent per capita over the current system in administrative costs and other savings. Employers will suddenly be free to give raises to their employees instead of paying for increasingly expensive health benefits. All hospitals and health-care providers in Vermont will be nonprofit. Medicare recipients will no longer need to wade through an inch-thick book to choose supplemental plans and sort out other complex options in their Medicare enrollment.

Since Oct. 1, when the ACA was rolled out, for hours on end I have been trying to find out the information I need to browse plans and sign up for insurance under the Affordable Care Act. This is not yet another rant on how bad the system is. I just wanted to relate my experience. I spent days at the computer, made many phone calls, and had an appointment with an ACA navigator. The system makes it next to impossible to comparison shop for plans.

Then I started calling the different insurance providers to ask information about their plans and how they work. I thought of as many “gotchas” as I could and asked each one about different scenarios, from a routine visit for a sore throat to a car crash with injuries, requiring being taken unconscious to the hospital. In the case of some providers, I never found a real live person to talk to.

ACA still relies on private insurance
I am getting a better idea about how this all works. The Affordable Care Act, for all the good it will be doing next year, still functions under the rules the insurance companies have established. I learned all the lingo — deductibles, out-of-pocket, out-of-network, balanced billed charges (these are charges the insurance company denies, and that you are responsible to pay for), and all of the other complicated morass that health coverage has become. In even some of the really good platinum and gold plans, the out-of-pocket amount can be $10,000 for the year! For that kind of money, I can fly to another country, have surgery, be hospitalized for weeks, and include a vacation too.

So, the real answer for the U.S. is still a single-payer system. Costs have to be held down — there is no reason why the U.S. has to pay twice the amount per capita as the next most costly system in the world (Norway’s), and still not cover millions of its citizens. A Harvard Medical School study states that 45,000 Americans die each year from treatable diseases because they cannot afford to get treatment. That’s 15 times the number that perished in the 9/11 attacks, or one American dying every 20 minutes. It continues to happen every year and is a shameful statistic.

So, what’s the weather like in Burlington or Montpelier, Vermont?

Debra Axness is a computer professional from St. Paul, and has traveled extensively.

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