Vermont Moves Toward Single-Payer Health Care

Vermont is finalizing legislation to create a state run single-payer health insurance system. The bill, entitled "An act relating to a universal and unified health system," proposes to implement a strategic plan for creating a "single-payer and unified health system." This development may surprise many who thought the single-payer or public option was off the table when president Obama signed the Patient Protection and Affordable Care Act (popularly known as "Obamacare"). Here are some points to clarify the situation.

Is Vermont's action allowed under Obamacare?

Under the US law, section 1332 provides that states may apply for waivers if they enact an alternative law that can be shown to "provide coverage that is at least as comprehensive and affordable to at least a comparable number of residents, as this title would provide and that it will not increase the federal deficit." So basically the provision says to states: If you can do better then go for it!

Is there a time limit for doing this?

Most provisions of the US law go into effect in 2014, but it does not allow states to apply for a waiver until 2017. So as currently in force, states would be required to try out Obamacare first before opting out. However, legislation in the US congress (introduced by Vermont senators) would change that provision to allow waivers to be sought in 2014.

What exactly is a single payer system?

Single-payer health insurance is "a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private." It is sometimes referred to as "Medicare for all" since Medicare is a single-payer system for people over 65 years of age.

Can a single payer system really do better?

Many people think so. Some argue it is simpler, fairer, and more efficient. A large majority of doctors favor having at least a public option, according to a national poll. A recent article in the New England Journal of Medicine studied approaches for Vermont to consider, and concluded that "the system capable of producing the greatest potential savings and achieving universal coverage was a single-payer system."

Will other states follow Vermont's lead?

There are efforts to enact single-payer plans in other states, most notably Oregon's House Bill 3510 "The Establishment of The Affordable Health Care for All Oregon Plan" and California's Senate Bill 810 "The California Universal Healthcare Act." The California bill twice passed the legislature but was vetoed by the governor. It is being re-introduced this year and expected to have a good chance to become law with the recent election of Democrat Jerry Brown as governor.

Sources
Yahoo News
Vermont State Legislature
The Library of Congress THOMAS
Physicians for a National Health Program
Robert Wood Johnson Foundation
New England Journal of Medicine
Oregon State Legislature
California State Senate