Vermont Considers Single-Payer System

Published April 1, 2011

The Vermont legislature, which has considered imposing a single-payer health care system in the past, is discussing the step once again in the current legislative session.

William Hsiao, the K. T. Li Professor of Economics at the Harvard University School of Public Health, was commissioned by the legislature to conduct an examination of Vermont’s health care system. Hsiao, who was directly involved in developing single-payer systems in Taiwan and eight other countries, testified in favor of such a system for Vermont before the legislature on January 19.

“Despite its valiant efforts, Vermont has not been able to provide high-quality, affordable health care for all of its residents. It is fair to say that the system is broken,” Hsiao said in his testimony, expressing doubts that President Obama’s law would solve the state’s long-term problems.

Three Options Offered

Hsiao was tasked with developing three options for reform to present to the legislature in the report, which he coauthored with Jonathan Gruber of the Massachusetts Institute of Technology. He compared a state government-administered and publicly financed single-payer health benefits system, to a state government-administered, public option that “would allow Vermonters to choose between public and private insurance coverage,” and proposed as a third option a “public/private single-payer system.”

Hsiao endorsed this third option, claiming it was designed to provide an “essential” benefits package, which would be administered by an independent board and run by a third party after a competitive bidding process.

“Beyond yielding greater cost savings, we believe Option 3 is most feasible because it is likely to be accepted by the broadest cross-section of Vermont stakeholders,” Hsiao testified, calling the approach “economically responsible and politically palatable.”

Complete Government Control

Yet Hsiao’s plan is not moving forward without criticism. John McClaughry, president of the Vermont-based Ethan Allen Institute, observes several problems with a single-payer system.

“From 1990 to the present, liberal legislators have voted millions of dollars for study and design projects to bring the wonders of single payer health care to the people of Vermont,” said McClaughry. “Under a single payer system, health insurers and premiums become history. The government determines the type and location of medical facilities to ensure that all benefits are equal and available to everybody. The government levies progressive income and payroll taxation to pay for all health care. No one can be allowed to use their own money to purchase health care covered by the single payer plan, because that would introduce another payer and inequality.”

Despite these critiques, Vermont Governor Peter Shumlin (D) is moving forward. He announced plans in February to create a health reform board to make recommendations for the single-payer plan.

Sarah McIntosh, esq. ([email protected]) is a constitutional scholar writing from Lawrence, Kansas.