While Vermont has generally been ahead of the curve with regard to health care coverage and quality, the most recent developments are cause for a great deal of concern. Vermont's all-in bet on a single-payer heatlh care system is, simply put, dangerous.

Obviously, like most Vermonters, I also have serious concerns about our current health care system and believe we must address the skyrocketing costs of health care services and insurance. I also believe, however, that those increases in costs have resulted in large part from government itself: 1) the state and federal government reimbursing providers for services provided Medicaid and Medicare patients at far less than the actual cost of services; and 2) the various services and requirements mandated over the years by government.

These costs have, therefore, been shifted to the privately insured, resulting in higher rates for Vermonters. We have also neglected for too long addressing the actual costs, but instead have created more and more programs to insure the uninsured (who are uninsured because the cost of insurance is too high).

My most significant concerns, however, about creating a single-payer health care system are two: 1) my skepticism of the claims made by the ardent supporters, and 2) the funding mechanism as outlined in the Hsiao Report that proposed to pay for the program - a payroll tax of 3.6% on employees and 10.9 % on employers.

Simply put, these arguments being made for creating this single-payer system - that the system will lower costs and improve quality - are eerily reminiscent of the arguments made in the 90's regarding education, and what resulted in the single-payer education system we now have. Not only did costs, and therefore taxes, skyrocket, but quality has not improved as a result either. The same or similar results in our health care system would be extremely detrimental to our state.

While the payroll tax has not been proposed by the Green Mountain Care Board (the five-member board that will determine the plan's benefits and the funding mechanisms), the proposal continues to concern many, including me.

With regard to the possible ramifications of a payroll tax, Cairn Cross, Managing Director of Fresh Tracks Capital, illustrated the concerns best in a Vermont Tiger blog piece entitled: Single-Payer; Many Sweatshops: "Single payer financed by a payroll tax will encourage the formation of lower paying jobs in Vermont and the migration of higher paying jobs out of Vermont."

I recommend that anybody interested in the health care reform discussions taking place in Montpelier right now read Mr. Cairns initial analysis and keep their eye on the Green Mountain Care Board's discussions.