Dr William Hsaio, perhaps the world's foremost expert in the implementation of new health care systems, has delivered a report to the Vermont General Assembly recommending that the state adopt single payer health care based on a hybrid means of financing. Financing would stem from an employer-employee payroll deduction; benefits would be comprehensive and come with a low co-pay. It leaves Vermont Medicare and Medicaid intact, apparently because eliminating them would greatly complicate implementation. The General Assembly is expected to pass some version of Hsiao's proposal. The state would then request a waiver from the Affordable Care Act, which the Obama administration would almost certainly grant.
Implementation of a single payer program would be a health care reform development on the scale of Medicare and the Affordable Care Act. Hsiao estimates (conservatively, he says) that Vermont will save 25% of expected health care costs between 2015 and 2024. If the plan delivers as promised, pressure will grow on other states to reduce costs by expanding coverage and benefits. HealthMatters details the proposal here.
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Meanwhile, TN legislators just passed a law allowing people to opt out of the federal HC reform law altogether.
The crying shame of this is that it is truly fiddling while Rome burns. Vermont acts to save costs and extend comprehensive benefits to all while Tennessee wastes time passing a law that can't possibly survive a legal challenge even to this Supreme Court.
Massachusetts is looking into this, too. In fact, there have been public information meetings held around the state within the last month. As you know, Bill Hsiao is at HSPH, and is responsible for designing health care models for remote sections of China and other parts of Asia. I've attended a few of his classes and can tell you, they're fascinating.
States like Vermont and Massachusetts (and Maine and New Hampshire) are small and fairly homogeneous. They may have a better chance at pulling off something like single payer than states with multiple large cities (IL, TX)and established contrary factions (CA), or many transients (Florida, SC). My 2 cents...
Hopefully this is the start of a national movement.
Paula, you're right: Vermont is an ideal place to test single payer. Hsiao's design has a great chance of success, IMHO. In that case, voters in Maine and New Hampshire will start asking why their state can't have health care that costs less and delivers more.
Single payer would get harder to implement with greater population and diversity, but we could say that about any approach. This could get interesting.
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