Vermont Legislature Tackles Single-Payer Health Bill

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The Vermont Senate has given preliminary approval to a health care initiative that puts the state on a path to become the first in the country to adopt a single-payer system. Critics say the legislation could drive physicians out of state, limit patient choice and raise taxes. Once the Senate's action is complete, the measure goes back to the House.

STEVE INSKEEP, host:

And we have more this morning on the way that Vermont is dealing with health care. Right now, many states are cutting back on health care programs, but not Vermont. The legislature is working out final details of a bill that puts the state on a path to become the first in the country to adopt a publically financed, single-payer health care system.

John Dillon of Vermont Public Radio has more.

JOHN DILLON: In town meetings and legislative hearing rooms, hundreds of Vermonters have been telling their health care stories. Many spoke about being part of a health system that's tied to employment, yet doesn't always pay for the care they need.

Ms. HEATHER LOUGHLIN: My insurance carrier has denied, denied, denied prescribed treatment at every turn.

DILLON: Heather Loughlin of Ludlow testified in favor of the Vermont health overhaul bill, which she says could take the profit motive out of health care.

Peter Shumlin, Vermont's new Democratic governor, campaigned on a promise to deliver a single-payer, health care-for-all system. But the bill doesn't go that far. Instead, it defers the big questions to a five-member board that would actually design the system, including what benefits are covered and how they're paid for.

Total health care costs in Vermont are rising about $350 million a year. And Governor Shumlin says the state could become a national model for cost containment and universal coverage.

Governor PETER SHUMLIN (Democrat, Vermont): So our challenge in Vermont is to figure out the first system in the country where we get rid of waste and use our health care dollars to make Vermonters healthier, getting the insurance companies and profits off our providers' backs, and that's the goal.

DILLON: Shumlin and his legislative allies say the state can cover more people with less money by eliminating administrative expenses associated with processing claims for private insurance companies.

Professor NANCY TURNBULL (Harvard School of Public Health): It's a very big and bold and ambitious proposal of a kind that's never been tried in the United States before.

DILLON: Nancy Turnbull of the Harvard School of Public Health says the bill could lead to fundamental changes in health care financing and delivery.

Prof. TURNBULL: The biggest one to me would actually be to essentially cut the connection between employment and health insurance for people.

DILLON: But employers might be allowed to offer additional insurance coverage, much like the supplemental policies that are available for Medicare recipients. The governor says a single-payer system could save about half-a-billion dollars a year in Vermont. But some of those who actually deliver the care aren't convinced.

Unidentified Man: Fletcher Allen on side one.

DILLON: Fletcher Allen Health Care in Burlington is the state's largest hospital. It serves patients throughout Vermont and Upstate New York.

Dr. Melinda Estes is the CEO, and she says the legislature has overestimated the savings her institution could achieve under single-payer. And she's also worried about how the coverage would be paid for. Lawmakers have talked about a payroll tax, but the governor has not committed to a funding source.

Dr. MELINDA ESTES (CEO, Fletcher Allen Health Care): And that concerns us both as a provider, but also as a very large employer. We don't know what the program will look like, what that basic set of benefits will be.

(Soundbite of bus engine)

DILLON: At the hospital's main entrance, Tina McGrath is waiting for a commuter bus. She's open to the single-payer concept, but, like the hospital CEO, she's also got questions.

Ms. TINA MCGRATH: Is it going to give me the same coverage? Is it going to give me less coverage? Is it going to, you know, is my deductible going to be a lot more than it is now? We don't know.

DILLON: Governor Shumlin expects the new health care board will have the answers to those and other questions sometime next year. He wants the single-payer system in place in 2014, but to meet that schedule, he needs a waiver from the Obama administration.

For NPR News, I'm John Dillon in Montpelier, Vermont.

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INSKEEP: It's MORNING EDITION, from NPR News.

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