The Governor of Vermont, Peter Shumlin, who was elected last November after the promise of reform of the State health care unveiled a bill Tuesday that abolishing most forms of private health insurance and move residents of the State funded with public funds in a secure repository.
Its expected proposal sets out a strategy that leaves a number of details key - including how to pay for the system: open debate.
Vermont Governor Peter Shumlin
Under the system of "single-payer" of the Shumlin, Vermont residents receive health benefits paid by the State, regardless of their status in employment or revenue. The plan is designed to help curb the rising costs of health, State officials say they have become unsustainable.
"Health care costs are increasing at a rate of more than 12 times the growth of the economy of Vermont, and we're not getting the best value for our money," Shumlin said in a prepared statement. "He has time for change".
Former Governor of Vermont Howard Dean, who unsuccessfully tried to institute a system of paying only in 1994, praised the effort.
"It makes sense and will save a lot of money," he said in an interview.
Some Democrats attorneys for a national plan of single-payer, when Congress was debating federal health review in March, but that plan never was considered politically feasible due to widespread opposition and concerns about the cost. Even the efforts to offer a plan of insurance of the public option that would compete against insurers private business consumers not that conservative Democratic Senators refused to support it. Instead, health law opted for stricter regulation of existing private schemes with a mandate that almost every American purchase health insurance.
Skeptics have questioned whether the Shumlin reform agenda is feasible. Lt. Governor Phil Scott, a Republican, said before the Shumlin Bill was released that had received letters from a number of State residents who have concerns.
"He had heard on the Bill and have heard the thoughts, but the devil in the details, and that they would like to see what it means to them", said Scott.
Governor plan calls for the establishment of a Board of health care reform this year to make recommendations for the plan. A single comprehensive plan payer will not be operational by 2014.
Shumlin, a Democrat, has garnered some support for a revision of health in the legislature, where Democrats overwhelmingly control of both houses. The legislature had already commissioned the Harvard Economist William Hsiao, who helped design of Taiwan single payer, along with Economist MIT Jonathan Gruber and consultant to the policy of Vermont Steve Kappel to provide recommendations on how to reform the health system of Vermont. Shumlin plan takes many of these recommendations into account.
But Republicans in the State have expressed their concern and business groups, have not yet signed. The State will also be necessary to delete a series of administrative barriers at the federal level ..
The need for exemptions
Shumlin strategy tries to take advantage of federal resources that the new health law kicks in 2014. This time, expected that each State has its own "Exchange of health", an on-line marketplace where consumers can purchase private that meet new federal standards in health plans. Shumlin proposal involves the use of federal funds to build an infrastructure of Exchange that can be later converted in support of single payer system.
But due to a single payer plan is not sanctioned in health law, Vermont would also ensure Federal waivers in order to proceed with its plans.
"Every step of the way, we can it with restrictions on the federal Act and marching forward, said Anya Rader Wallack, Special Assistant to Shumlin on health care reform."
Federal health law allows States like Vermont to apply for exemptions to opt for many of their requirements in 2017, when they submit an alternative that could achieve the same goals: increased health coverage for more people - with equal or greater success.
But legislators in Vermont, fearing it could displace support against single-payer during the next election cycle does not want to wait six years to deliver its reforms. Waiting may opt out of health care law as soon as possible.
That puts Vermont in a delicate situation: for now, at least the State will be necessary to develop a plan to comply with the federal law on health while simultaneously paving the way for its own plan. What more complicated, Vermont officials should also work with federal officials to make adjustments of critical payment within Medicare, the federal program of health for seniors and people with disabilities.
Funding is an open question
Team of the Governor has not yet devised a way to pay for the new system. They plan to return to the legislature in 2013 with proposals with Wallack.
Hsiao and colleagues had previously recommended that the State implemented a tax payroll divided between employers and employees, an idea that caused alarm bells with small business owners.
Among them is Scott, who also owns a construction company. "I understand that some of the arguments for this type of system [were] take the burden of employers and I guess I'm not seeing where he'll move that burden," said Scott.
Rick Rayfield, who owns a bookstore in Waitsfield, is tentatively in favour of a single payer - system but want to see how the legislature hammers details key.
"I think we are trying to develop a philosophy of who pays for health care without asking us exactly what we're willing to pay," said. "We are being asked if a single payer system is something we like without saying that we will send to".
Rayfield still considers that some of the advantages. "I guess that I am so overwhelmed by the stupid complexity of (current) system as it is I simply adore the simplicity of the single payer plan," he said.
Supporters of change is the need to despair. They point to the statistics showing that health spending more than doubled in Vermont between 1992-2009. The Shumlin Office has estimated that the State would save $ 500 million in the first year of a single payer plan.
That would reduce administrative costs and marketing insurance. Hospitals and doctors lose time and money to fill the information of the claims for each bill private health plan.
Shumlin plan recommends pay doctors and hospitals in a way that encourages provide higher quality care without providing unnecessary services.
"There are a lot of smart things that the Governor of her doing", said Dean. "The best part is that it is... by saying: 'will not reach funding mechanism until you change the payment system.'"
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