MONTPELIER, Vt. – As states open insurance marketplaces amid uncertainty about whether theyre a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.
The state has a planned 2017 launch of the nations first universal health care system, a sort of modified Medicare-for-all that has long been a dream for many liberals.
The plan is especially ambitious in the current atmosphere surrounding health care in the United States. Republicans in Congress balk at the federal health overhaul years after it was signed into law. States are still negotiating their terms for implementing it. And some major employers have begun to drastically limit their offerings of employee health insurance, raising questions about the future of the industry altogether.
In such a setting, Vermonts plan looks more and more like an anomaly. It combines universal coverage with new cost controls in an effort to move away from a system in which the more procedures doctors and hospitals perform, the more they get paid, to one in which providers have a set budget to care for a set number of patients.
The result will be health care thats a right and not a privilege, Gov. Peter Shumlin said.
Where some governors have backed off the politically charged topic of health care, Shumlin recently surprised many by digging more deeply into it. In an interview with a newspapers editorial board, he reversed himself somewhat on earlier comments that Vermont would wait to figure out how to pay for the new system. He said he expects a payroll tax to be a main source of funding, giving for the first time a look at how he expects the plan to be paid for.
Vermonts small size is often credited with helping preserve its communitarian spirit. People in its towns know one another and are willing to help in times of need.
The key is demography, said University of Vermont political scientist Garrison Nelson. Discussions about health policy can be handled on a relative face-to-face basis, he said.
And, for better or worse, Vermont has little racial or income diversity, Nelson pointed out.
Then theres the fact that Vermont is close to universal health care already. Lavarreda noted that the state became a leader in insuring children in the 1990s. Now 96 percent of Vermont children have coverage, and 91 percent of the overall population does, second only to Massachusetts.
At this stage, no one knows whether state-level universal health care will succeed, and its an open question as to whether Vermont can work as a model for other states.
Developing a single-payer system for Vermont is a lot easier than in California or Texas or New York state, said U.S. Sen. Bernie Sanders. The independent, frequently described as the only socialist in the Senate, has been pushing for some form of socialized medicine since he was mayor of Burlington 30 years ago.
Even with years to go before Vermonts single-payer plan will be in place, several obstacles remain.
The largest national health insurance industry lobbying group, Americas Health Insurance Plans, has warned that the law could limit options for consumers and might not be sustainable.
The plan could disrupt coverage consumers and employers like and rely on today, limit patients access to the vital support and assistance health plans provide, and put Vermont taxpayers on the hook for the costs of an unsustainable health care system, AHIP spokesman Robert Zirkelbach said.
Vermont also has yet to answer how it will cover everyone. The post-2017 system is not envisioned to include federal employees or those with self-insured employers that assume the risk of their own coverage and are governed by federal law, including IBM, one of the states largest private employers.
At least one resident, 73-year-old Gerry Kilcourse, has little patience for the naysayers.
Kilcourse said that when he and wife Kathy bought a hardware store in Plainfield in the early 1980s, they struggled for years to find good, affordable health insurance coverage.
It should be similar to education, which is publicly funded, Kilcourse said of health care. If we did the same thing for education (as in health care), youd have a number of people being excluded from public schools.
Shumlin has made it clear the status quo cant hold. As a part owner himself of a small business – a student travel service – he has spoken often of the burden that employee health coverage is to such business owners.
At a Chamber of Commerce forum in September, he called the federal health overhaul a great improvement over the past but added it is not the silver bullet that will ... provide universal access and quality health care for all Vermonters.
That, he appears to hope, will come in 2017.