October 27, 2013

Vermont thinks big on health care

The state looks ahead to a universal health care system.

By Dave Gram
The Associated Press

(Continued from page 1)

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Workers at the Vermont Health Connect call center in Burlington, Vt., talk to customers on Oct. 1. Gov. Peter Shumlin said recently that the Vermont Health Connect health insurance marketplace’s performance is improving.

The Associated Press

just the facts

While states implement health insurance marketplaces this fall, Vermont is considering a bigger goal that more fully embraces government-funded health care.

The state plans a 2017 launch of the nation’s first universal health care system. It’s a sort of a modified Medicare-for-all.

The plan is seen as especially ambitious in the current atmosphere surrounding health care in the United States, with some states and some in Congress balking at the federal health overhaul.

National experts say Vermont’s plan has gone unnoticed amid the national debate over the federal law.

Democratic Gov. Peter Shumlin is continuing to vow to make Vermont a place where “health care is a right and not a privilege.”

“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, using an industry term to describe a system in which health care is paid for by a single entity.

Sanders, 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.

The nation is focused on the rollout of the state-based health insurance marketplaces and the disastrous unveiling of healthcare.gov. In the meantime, Vermont’s efforts have largely gone unnoticed, said Chapin White, a researcher with the Washington-based Center for Studying Health System Change.

“Vermont’s thinking about 2017, and the rest of the country is just struggling with 2014 right now,” White said.

Even with years to go before Vermont’s single-payer plan will be in place, several obstacles remain.

The largest national health insurance industry lobbying group, America’s Health Insurance Plans, has warned that the law could limit options for consumers and might not be sustainable.

And questions have arisen about the expected cost savings of eliminating multiple insurance companies and their different coverage levels and billing styles.

Much of a hospital’s billing process is coded to ensure that the right patient is billed the right amount for the right procedure, said Jill Olson, vice president of the Vermont Association of Hospitals and Health Systems. That would continue in a single-payer system.

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 state’s largest private employers. It also may not include residents who work for and get insurance through companies headquartered out of state, Olson said.

At least one resident, 73-year-old Gerry Kilcourse, has little patience for the naysayers.

In retirement, Kilcourse has schooled himself on health policy and advocates for universal coverage. He sees health care as a public good and likens the current campaign to the 19th-century push in the United States for public schools.

Shumlin has made it clear the status quo can’t hold. As a part owner himself of a small business – a student travel service based in Putney – 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.

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