Single Payer in Vermont

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Welcome to Politics Bites, where every afternoon at It's A Free Country, we bring you the unmissable quotes from the morning's political conversations on WNYC. Today on the Brian Lehrer Show, Kevin Outterson, associate professor of Law and associate professor of Health Law, Bioethics and Human Rights at Boston University School of Law, discusses Vermont's efforts to introduce a single payer healthcare system.

The Green Mountain state is experimenting with a new single-payer health care system.

The new system will provide every Vermont resident with health care. Governor Peter Shumlin said the publicly-funded plan would address three major themes: health care as a human right; removing the burden of insurance from employers; and spending less on insurance companies and more on care.

Things won’t change overnight. Outterson said what Vermont has done by passing the plan is to lay out a framework, the details of which will be designed over the coming two years. Next year a financing plan will be submitted to the legislature, and implementation will not start until 2014. Still, Outterson said today was a big step.

Financing the plan is likely to be through payroll taxes, and the key to success will be the ability to control costs.

If Vermont is able to control costs better than neighboring states, then they will be a magnet for employment. People won’t mind exactly how they pay for it as long as the total cost is lower.

Currently about 75% of Vermonters get their health care through BlueCross, and BlueCross Vermont will likely be the contractor the state hires to handle implementation. A state board will determine what procedures will be covered, and Outterson said that board will be extremely accountable to Vermont’s residents.

Vermont’s a small state, and if the board of Green Mountain Healthcare doesn’t remain responsive to the needs of Vermont citizens, they really know how to raise a ruckus. So I don’t fear that somehow there is going to be a faceless board in Vermont. It’s a state where a lot of people know everyone.

Ultimately, while the board could rule against a doctor’s recommendation for a procedure, Outterson thinks that might be a good thing for patients currently being sold unnecessary treatments. He points to studies finding that doctors who offer a certain procedure in their office are far more likely to recommend that particular procedure.

There are a lot of conflicts of interest in medicine today. There was a study last year in Health Affairs that doctors who own MRI machines are much more likely to send you to the MRI… The radiation levels from an MRI are much greater than what you would get from living in Tokyo throughout this [current nuclear] disaster. [Addendum -- Outterson corrected this statement in a later comment on the story, see below.]

One potential hitch to the new plan may be in its ability to comply with the unfolding federal legislation. The federal Affordable Health Care Act requires all states to set up private health care exchanges for the uninsured with no public option. Outterson said Vermont is moving forward on setting up those private exchanges. 

They would prefer to get permission from the federal government to skip that step and go directly to Green Mountain Health Care, and several other states have asked for that as well. Scott Brown, the Republican Senator in Massachusetts, has put a bill in to allow states to do just that, to implement a waiver before 2014.

Outterson said another for Vermont will be Medicare. Vermont would like Medicaid and Medicare to be a part of the Green Mountain Health Care system, but that will also require some flexibility on the part of the federal government.

I think it’s in the best interest of the administration to try. If Vermont is able to make it work, other states will like it. If Vermont doesn’t make it work then we can avoid trying this in the other forty-nine.

The doctor who spearheaded this effort, Dr. Deb Richter, originally tried to bring this legislation in New York. When she was unable to get traction in Albany, she moved to try instead in Vermont.

Outterson said the key to the plan catching on elsewhere will be its success or failure to control costs. Massachusetts is another possible model, with near-universal coverage there on a private model, much closer to the current federal plan. In the next five years, other states will be watching closely both Vermont and Massachusetts to see how these plans do.

If at the end of five years we can say Vermont care is cheaper, they have the lowest health insurance premiums in the country and their people are quite healthy and everyone is happy with it, that’s going to be a powerful argument for the state.