Vermont Considers Single-Payer Health System

The concept of a single-payer health system remains somewhat controversial among some legislators, yet Vermont continues to embrace the transition despite the challenges.

In 2011, Vermont state officials voted to shift the state’s healthcare model to a single-payer system by 2017 in what is known as Act 48. To be successful in its endeavors, it will require a variety of measures including the development of a unified data and claims system, and a unified method for measuring the quality of care. It also must consider reimbursement models such as pay-for-performance, which focus on paying doctors for providing value-based care.

“Even for states that are keeping it ‘old school,’ watching a state create a unified health budget and seeing how it benefits them and the process they use, that will be enlightening to everybody,” said Hilary Heishman, a program analyst at the Robert Wood Johnson Foundation.

In place of paying premiums to private insurers, state residents and employers would pay for their healthcare through taxes. Health plan benefits would include prescription drug coverage, and other government programs including Medicaid and Medicare would continue to operate alongside Act 48. However, increased taxes are likely and changing resistant attitudes may not come easy.

“The problem is that the tentacles of our completely dysfunctional US health system reach so deeply into every state,” said Marvin Malek, MD, MPH, a practitioner from Central Vermont Medical Center. “How do you disentangle from that abysmal structure to create single-payer?”

A 2011 Health Affairs study estimated that the single-payer would save an estimated 25% over current state health spending, cut employer and household healthcare spending by $200 million, create 3,800 jobs, and raise the state’s economic output by $100 million. With a same set of universal benefits and protocols, it can also make care easier for physicians.

“All my patients will have the same insurance and the same benefits,” said Deb Richter, a doctor practicing addiction medicine and a leader in Vermont Health Care for All. “There will be one set of rules, one set of regulations, one set rate of reimbursement and one formulary.”

Around the Web

All Eyes on Vermont as it Blazes a Single-Payer Trail [MedCity News]