Yeah, ’cause state-level plans never go national

Andrew Sullivan quotes Kate Pickert arguing that Vermont’s single-payer system isn’t really a big deal:

Vermont is not like the rest of the country. First, the state is home to only about 600,000 people. It’s not clear that the scale is large enough to test out a single-payer system and see if it could be instituted in larger states or nationwide. Vermont’s existing private insurance market is also unlike most other places. The state has very strict insurance regulation that has whittled down the number of private insurers selling policies on the individual market. Turning Vermont’s existing system into single-payer would be a huge change, but it’s not the same as a big state like California making the jump or a far less regulated state like Alabama.

At first I thought this might be a joke. But it’s not.

Let’s imagine I’d written this five years ago:

Massachusetts is not like the rest of the country. First, it’s only home to about 6,500,000 people. It’s not clear that the scope is large enough to test out a mandate coupled with exchanges and subsidies and see if it could be instituted in larger states or nationwide. Massachusetts’ existing network of hospitals and insurers is also unlike most other places. The state already has a very low uninsurance rate, due to previous reforms, and a concentration of medical centers almost unparalleled anywhere else. Turning Massachusetts’ existing system into a universal one would be a huge change, but it’s not the same as a big state like California making the jump or a far less regulated state like Alabama.

I’m not saying that as Vermont goes, so goes the nation. But, really, how silly would I look now, if I’d written this so declaratively just a short time ago?

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