Vermont Could Surpass Mass. As Health Reform Pioneer

BOSTON — When it comes to reforming health care, Massachusetts has been the most pioneering state in the nation. But that title could be on its way to going to another state: Vermont.

On Wednesday, the Vermont legislature heard a proposal that would radically change the way Vermonters get insurance and pay for their health care. Bill Hsiao, a professor at the Harvard School of Public Health who redesigns health care systems for countries around the world, made that proposal, and he spoke with WBUR’s All Things Considered about what he has in mind for Vermont.

Sacha Pfeiffer: Before you explain the specifics of your proposal, tell us why Vermont isn’t happy with the health care system it now has in place. Because just a few years ago, the state passed a law aimed at getting more people covered, lowering costs, and improving care. Has that new law not worked?

Bill Hsiao: That new law worked to some extent, but still leaves roughly seven percent of Vermonters uninsured. But, more importantly, Vermont has experienced rapid cost escalation. The current health care system is not sustainable any more.

Today, you proposed to the Vermont legislature that the state basically adopt a single-payer system. For people who don’t understand that term, or whose eyes glaze over when they even hear that term, give us a brief definition of what you mean by that. Are you recommending a health care system entirely run by the government?

No, we’re not. It’s a system that provides insurance to everyone with a common benefit package. And then, second, channels all the payments to providers through a single pipe.

And would that single pipe be a government pipe?

The Vermont law that commissioned us required us to develop such an option, but we are not recommending a government-run, single payer system; we recommend a public and private partnership.

You recommend that this new government-run health care system in Vermont be paid for by a payroll tax. And that would be a progressive tax, so the more you make, the more you pay. Do you think that when Vermonters hear “new tax,” that alone risks killing the idea of this new proposal?

The tax is less than what they are paying in premiums now.

So instead of paying a premium, they would pay this payroll tax?

That would be a decision the employer would make, and the workers.

Massachusetts is typically viewed as the most progressive state when it comes to health care reform. Do you think Massachusetts risks losing ground on the health care front to Vermont if Vermont adopts this proposal?

Unquestionably, Vermont would be the vanguard of the nation.

And how likely do you think it is that Vermont will adopt this?

With the newly elected governor, who is fully in support of the single-payer scheme, and with the legislative leaders who seem to be also unified in support of it, Vermont has a good chance of adopting a single-payer system.

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  • greg martin


  • helenfortier

    I just heard it on the radio that “Wise Health Insurance” can offer health insurance for just $1 a day any one aware of this ? have anyone purchased insurance through them. I did search for them and found them online.

    • Wcarpent

      Be very wary of that, Helen. Look out for deductibles, who is in network and out, what premiums co-pays are, and look around for customer comments about them. They could be one of these that will sell you the insurance, take your money, then be gone when you need them and you’ll be owing tens of thousands of dollars while they are laughing at the bank.

      Dr. Hsiao is not confused. He knows exactly what he is doing.

  • Greg Scandlen

    Mr. Hsiao seems a bit confused by his own proposal. At one point he denies it is a single payer — “we are not recommending a government-run, single payer system; we recommend a public and private partnership.” But then he concludes by saying — “Vermont has a good chance of adopting a single-payer system.”

    Is he confused or is he trying to confuse us?

    • http://pulse.yahoo.com/_VDH4GYJMIUFU373W3XUQVD2V4E Patrick

      Why listen to the Harvard professor who’s spent decades on this issue… we have a commenter here on WBUR that had the answer all along! Greg, the state will choose a private insurance company and dictate the rules to it for payout ratios. The 80% payout rackets will be kicked out and Vermonters will get more health dollars out of it. It’s that simple.

  • DrSteve

    To help clarify for Greg and others about what single payer is an is not. It is Medicare for All.

    Under single payer there is a single insurance pool that is paid into via taxes. But the delivery of care, the private doctors, offices, clinics, hospitals, all remain unchanged, private and independent. They can and should compete for your business as a patient, who provides the best service for you.

    The main difference is that you will have more choice among all those private health care providers, since you will have insurance and everybody in Vermont would have the same insurance.

    So it is NOT government takeover of health care.
    It is government take over of the insurance pool.
    Is current Medicare coverage for the over 65 a takeover of private delivery of care? Of course not. This is just Medicare for everybody.

  • Phil Edmundson

    Critics of the Vermont proposal may say that this is like Venezuela’s President Chavez nationalizing certain industries in the “national interest”. How is this different? Will Vermont compensate the private insurance industry for this taking of an eminent domain interest?

    • Anonymous

      you don’t seem to know what eminent domain is. eminent domain involves the govt taking of private property. real private property. an insurance company has terminable contracts to provide a service. not close to the same thing.

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