While America as a whole experiments with its clunky Affordable Care Act, the state of Vermont is on track to implement a state-run single-payer system, starting in 2017. Sean McElwee writing in The Atlantic explains in detail what the plan will do and how it came about.
Governor Peter Shumlin signed a revolutionary single-payer plan, Green Mountain Healthcare—the culmination of decades of work by progressive politicians in the state—into law in May 2011. The new system aims to guarantee universal insurance coverage, improve benefits for those who are currently underinsured, include universal dental care and vision care, and increase the Medicaid reimbursement rate to doctors in order to avoid cost-shifting.
The program was designed by Harvard economist William Hsiao, who detailed the plain in a 2011 Health Affairs article. Hsiao projected the state would save 25.3 percent annually in total healthcare spending, lower household and employer healthcare spending, job growth, and higher economic output for the state. The savings would come from lower administrative expenses, reduced fraud and abuse, eliminating middlemen, malpractice reform, and governance improvements. These savings, about $4.6 billion over the first five years, would be plowed back into paying to cover the uninsured and expanding benefits and services leaving $2.3 billion in residual savings. The law also created the Green Mountain Care Board, an independent group charged with overseeing the law and ensuring quality. What the plan didn’t do is lay out how the state government would pay for its increased spending.
The article goes on to say what the challenges are and why Vermost may be peculiarly suited to meeting them.
Vermont’s plan is a bold experiment in whether the government can convince humans, naturally risk-averse, to drop their wariness about changes that might affect their access to healthcare.
Arthur Woolf, an associate professor of economics at the University of Vermont, says the state “is very much like a Social Democratic Western European country,” both economically (because of its equality and prosperity) and demographically (because of its homogeneous population). So perhaps it’s not surprising that the state is also the first to explore a Canadian-style single-payer system.
Supporters of single payer hope that Vermont will be like Saskatchewan which was the Canadian province that first instituted a single payer system that later became the model for the whole nation. You can be sure that opponents will make every effort to sabotage the Vermont initiative, just like they are doing with the ACA.