Vermont governor proposes single-payer health plan
At a time when several newly-elected governors are railing against health reform's governmental intrusion, new Vermont Gov. Peter Shumlin is taking a different path – a proposal released this week to create a single-payer health plan for his state.
The proposed bill leaves as many questions as answers, including the specifics of how the system would be funded. Further, there are no provisions in the Affordable Care Act that allow for the creation of single-payer systems in states, which ultimately would require that Vermont to get a waiver from the Department of Health and Human services.
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"Healthcare costs are climbing at a rate of more than 12 times the growth of the Vermont economy, and we're not getting the best value for our money," said Shumlin in a statement announcing the plan. "Too many Vermonters are uninsured or underinsured, and the hundreds of millions of dollars we're spending on our inefficient healthcare system could be used to meet other important priorities."
Healthcare costs in Vermont, which had lagged behind U.S. averages in terms of gross domestic product earlier this decade, reached 18.5 percent in 2009, higher than the 17.6 percent of the country as a whole. Further, Vermont's spending on healthcare has tripled since 1992 to more than $4.7 billion annually.
To begin moving toward a single-payer system, the state would establish the Vermont Health Reform Board, whose first mission would be to control costs. The board would also set up payment fee schedules for doctors and other providers, with the intention of moving away from the current fee-for-service model of payment toward one that provides bundled payments to manage the health of a defined population.
While working to establish the single-payer system, the state would also set up a state health insurance exchange, as required under health reform. The groundwork would be laid this year, with a transition sometime after 2014 to a single-payer system that "includes all Vermonters, is publicly financed and is decoupled from employment," according to a summary of the proposal from Anya Rader Wallack, PhD, special assistant to the governor for healthcare.
Wallack said the road to a potential single-payer system would be difficult.
"Our proposal also may scare some people who have defined roles in the current system and may see those roles change or disappear. Change and dislocation are scary, and we will be mindful of that as we move forward," she said. "But the prospect of continuing on our current path of an unaffordable, fragmented system that does not treat all Vermonters fairly is far worse."
