Last week the Governor of Vermont, Peter Shumlin, and Representative Mark Larson introduced H.202 (pdf):
This bill proposes to set forth a strategic plan for creating a single-payer and unified health system... to provide coverage for all Vermonters after receipt of federal waivers...
According to Kaiser Health News
Former Vermont governor Howard Dean, who unsuccessfully sought to institute a single-payer system in 1994, praised the effort. "It makes a lot of sense and it'll save them a ton of money,"
There have been other single-payer bills introduced at various times in state leglislatures, including Minnesota, California, Illinois and Pennsylvania, but none has become law. At this point Vermont's bill, with the strong support of its governor and an overwhelmingly Democratic legislature, would seem to have the best chance.
The bill is 80 pages long (a far cry from the PPACA's 1000+ pages, but still impressively complicated). Its principles, however, are exquisite:
(1) to ensure universal access to and coverage for essential health services for all Vermonters... Vermonters must receive affordable and appropriate health care at the appropriate time in the appropriate setting, and health care costs must be contained over time.
...
(3) The health care system must be transparent in design, efficient in operation, and accountable to the people it serves.
(4) Primary care must be preserved and enhanced so that Vermonters have care available to them, preferably within their own communities.
(5) Every Vermonter should be able to choose 1 his or her primary care provider.
...
(9) A system must be implemented for containing all system costs and eliminating unnecessary expenditures, including by reducing administrative costs; reducing costs that do not contribute to efficient, high-quality health services; and reducing care that does not improve health outcomes.
(10) The financing of health care in Vermont must be sufficient, fair, sustainable, and shared equitably.
Possibly the biggest hurdle in establishing single-payer in Vermont relatively quickly will be getting a waivers bill through Congress. It will have to allow the Department of Health and Human Services to begin issuing waivers in 2014 instead of starting in 2017 as the PPACA currently specifies. With a Republican House which is committed to "States' Rights" until it comes time to actually vote on letting states implement more liberal policies than the Federal Government, and a Senate which has to have sixty votes to wipe its ass, no betting man would take even odds on such a proposition. Still, stranger things have been known to happen.
If the waivers are granted, the bill specifies that a single-payer system called "Green Mountain Care" shall be created:
all Vermont residents shall be eligible for Green Mountain Care, a universal health care program that will provide health benefits through a single payment system. To the maximum extent allowable under federal law and waivers from federal law, Green Mountain Care shall include health coverage provided under the health benefit exchange established under chapter 18, subchapter 1 of Title 33; under Medicaid; under Medicare; by employers that choose to participate; and to state employees and municipal employees...
(a) Upon implementation, all Vermont residents shall be eligible for Green Mountain Care. The agency shall establish standards for the verification of residency.
(b) An individual may enroll in Green Mountain Care regardless of whether the individual’s employer offers health insurance for which the individual is eligible.
A serious concern with this bill is that there is currently no funding mechanism, and one is not due to be created until sometime in 2013.
The secretary of administration or designee shall recommend two financing plans to the house committees on health care and on ways and means and the senate committees on health and welfare and on finance no later than January 15, 2013.
One funding proposal is for a scenario where waivers are not granted, and the other for waivers being granted, allowing the program to begin in 2014. But there is no guarantee that the 2013 legislature (of unknown party composition) will approve the funding mechanisms proposed, or any funding mechanism at all. After all, it's never a good time to vote for tax increases, even if they are just taking the place of health insurance bills.
There are many other provisions of the bill, including provisions for medical records technology, increasing the number of doctors and nurses practicing in Vermont, a study to investigate setting up a no-fault medical malpractice system, setting up an evidence-based drug formulary, negotiations with drug companies regarding pricing, and a lot more stuff that I probably don't understand.
This seems like an excellent first step towards making Vermont the first single-payer heatlh care state in the United States. (I'd love to see California, my state, be the first. But the fact is California's government is so SNAFU'd that wishing just isn't going to make it so. Nothing seems to be happening with AB 810, California's single-payer legislation, and nothing may happen until the budget is taken care of, which could be decades...)
So let's hope (and support, as possible) that this bill passes the Vermont Legislature and is signed into law
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On a completely off-topic topic, please help some others out:
Go here, and click for Rhode Island. No signups, no hassle, just a click or two.
For an explanation of why this is important