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Vermont's Single Payer System: Coming to State Near You?

The plan already has progressives buzzing, but is Vermont's new health-care system a model that can work in other states?

Liberals finally have the health care system they’ve been hoping for—in one state at least. Last week, Vermont’s governor Peter Shumlin signed a law that puts the state on the path to providing single-payer health care. The plan will first create a statewide exchange where residents can pick from private or state insurance plans, but eventually there will just be one state-operated system called Green Mountain Care.


Before you pack your bags, though, be advised: the federal health care reform law won’t allow Vermont's plans to go forward until 2017. The state is asking for a waiver to speed up the process, but that still has them waiting until 2014. And there’s at least one critical component missing from the 141-page plan—namely, a way to fund it.

The plan already has progressives buzzing, and wondering if their state (or the country) could be next. Still, we’re talking Vermont here—the home of gay marriage and Ben & Jerry’s, Howard Dean and Bernie Sanders. It’s not your run-of-the-mill state of the union. There are a few things to consider:

1) Vermont is tiny. The state only has 620,000 residents, which makes it the second smallest state after Wyoming. That’s about 1/30 of the size of the New York City area. This small size may make it far easier to change the tide. On the other hand, if places like California and New York implemented the law, the monetary burden of a new system would be lower per capita. California, particularly, must be eyeing the Vermont plan: A single-payer health care system has twice passed the legislature and may have another chance with a new Democratic governor.

2) Vermont locks insurance companies down. The state has a highly regulated insurance industry, where insurers can only vary insurance premiums by 20 percent. This is a far cry from the way it’s done in places like Alabama or Maine, where the policies are much more laissez-faire. As a result, only 10 percent of Vermonters are uninsured—which gives them a running start next to the rest of the country. Still, these regulations could change after the federal health care law takes effect.

3) Vermonters are cool with a little socialism. After all is said and done, what really matters are the people electing their state representatives. They elected Bernie, after all, the only Socialist currently sitting in the Senate. A Gallup poll found Vermont to be the most liberal state in the country. This might bode well for Oregon, New York, or Rhode Island. Places like Mississippi, Idaho, Texas? Not so much.

With the Obamacare hoopla going strong for years now, it seems unlikely that the federal government will touch this kind of thing any time soon. But if Vermont saves a few dollars with Green Mountain Care, the discussion may take off.

Photo (cc) from Flickr user Public Citizen

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