Vermont – the nation’s second smallest state with a population of just 625,741, according to the 2010 Census — is moving toward adopting a single-payer healthcare system. The House in the Green Mountain State recently passed a bill by a 92 – 49 vote that would set up a five-member board to design a benefits package that would be available to all Vermonters through a state insurance exchange.  According to the legislation, “All Vermont residents shall be eligible for Green Mountain Care, a universal healthcare program that will provide health benefits through a single-payment system.”

The Senate is expected to approve the legislation and send it to Governor Peter Shumlin, who campaigned to reform the state’s healthcare system. At that point, Vermont would need a federal waiver to implement the plan, something that cannot be provided until 2017 under provisions of the Patient Protection and Affordable Care Act (ACA).  Nationally, single-payer healthcare, also known as Medicare for All, has proven popular in polls, but was rejected during the healthcare reform debate.

“This bill takes our state one step closer to a system that ensures that all Vermonters have access to the care they deserve and contains costs,” House Speaker Shap Smith said. According to Shumlin, passing a state-funded healthcare system would make Vermont “the first state in the country to make the first substantive step to deliver a system where healthcare will be a right and not a privilege, where healthcare will follow the individual, not be a requirement of the employer, and where we’ll have an affordable system that contains costs.”  The so-called RomneyCare system in Massachusetts is the framework for the Affordable Care Act.

“We have a historic opportunity to fix a broken health care system,” said Representative Mark Larson (D-Burlington) and chairman of the House Health Care Committee.  He said the goal is to “provide healthcare security to Vermonters” and decelerate the growth of healthcare costs.  Supporters say the bill is designed to provide health insurance to the 47,000 Vermonters who don’t have coverage, provide better insurance to the more than 160,000 underinsured residents and cut costs.  Opponents say that the state is moving too fast into uncharted territory.  They say the proposed health system’s ultimate cost and how it would be funded aren’t made clear in the legislation.

One of Vermont’s leading opponents to Green Mountain Care is the Ethan Allen Institute, which describes itself as a free-market think tank.  John McClaughry, the institute’s president, argues that public option supporters rely on three arguments — that healthcare is a human right and that there is significant unhappiness with the operation and financing of the current system.  The third reason, he said, “is political and rarely stated.  It will put the government in control of all employers, medical providers, insurers (if any), and patients.  That will mean many more jobs for (unionized) government bureaucrats.  It will require unionization of doctors and other professionals who will have to bargain with the public body over their compensation and working conditions.  It will mean more campaign contributions and votes for politicians who will work to rig the system in favor of their particular group of ‘stakeholders.”

The Connecticut Coalition for Universal Health Care disagrees.  “Healthcare providers would be in a fee for service practice, and would not be employees of the government, which would be socialized medicine,” according to the Coalition.  One model of socialized medicine is the Veterans Administration’s (VA) network of hospitals, paid for by the government and managed by federal employees.  Many veterans feel they receive better healthcare outcomes through the VA than at for-profit hospitals.  Another model is TriCare, which administers the worldwide healthcare plan for 9.6 million eligible beneficiaries of the uniformed services, retirees and their families, also a superior system.