Ten Miles Square


September 13, 2012 7:00 AM Single Payer in Vermont?

By Don Taylor

Here is a video (~1 hour) from a Politico health reform policy panel I was on at the DNC last Thursday. Two things from this panel stood out for me, both related to the comments of Gov. Peter Shumlin from Vermont, who wants to create a universal, “single payer” health system in his state.

  • All Governors say they want flexibility, and in the South they mostly talk about being pushed too far, too fast by the ACA in terms of coverage expansions. Gov. Shumlin also wants flexibility, but in order to go further, faster. He wants flexibility to move to a single payer approach before 2017 (the ACA does not allow this prior to then according to the Governor, and he says that insurance companies didn’t want this option to be available). He doesn’t want the ACA to hold Vermont back and wants both a Medicaid and some sort of ACA waiver to move toward a single source/payer approach that will cover all Vermonters as soon as possible.
  • The Governor played down the role of ideology* in making his single payer approach possible, and said that the size of the state will be the biggest predictor of big innovations in health reform going forward. He thinks that small states that have fewer/smaller/less powerful corporate interests involved in the delivery of health care will be the ones that be most innovative in insurance innovations. Sarah Kliff has also talked about Montana’s efforts in this “single payer” direction….a small (in population) state.

In any event, it is a very different context in Vermont than it is in the South, where some states are talking (I suspect mostly talk) of not even taking the Medicaid expansion in the ACA that is now optional.

*I don’t really think single payer is technically the correct term for what they are talking about because the most likely option would leave Medicare, Medicaid and private insurance, but would create a predictable way that everyone in the state would be covered. However, that is mostly just nit picky professor talk….but hey, I am a professor.

[Cross-posted at The Reality-based Community]

Don Taylor is an associate professor of public policy at Duke University, where his teaching and research focuses on health policy.


  • Cassandra Gekas on September 17, 2012 10:00 PM:

    As a policy advocate in Vermont, I am proud of Governor Peter Shumlin for his commitment and leadership on health care reform. The passage of the ACA in 2010 was a big victory and it is already making a difference in the lives of millions of Americans. But in Vermont, we are also keenly aware of the failures of the private insurance system and the ways in which it continues to fail thousands of Vermonters, even while the price tag rises. The most important thing to remember about our reform model is that we are not re-creating the wheel. We want to build a publicly financed health coverage model based on the successful systems in place. both in the United States (Medicare, VA), and in other parts of the world. It's true that we may never achieve a pure 'single-payer' system, but we are committed to getting as close as possible. This includes efforts to bring Medicare, Medicaid, and the self-insured into a single, streamlined 'funnel'. If we are successful, I believe it will have ripple effects across the country. As we move forward with this policy project, we must ensure that the flexibility we seek does not open the door for the states want to use 'flexibility' as a vehicle for rolling back critical safety net programs for their people.

  • Medicare on December 01, 2012 1:09 AM:

    I simply say before and after the elections the norms and rules have changed completely!!They are changing the rules regularly!!