Vermont Governor Lays Out Details for Single Payer Pathway

single-payerBy Nancy Remsen for Burlington Free Press

The Shumlin administration released the legislative details of how to move the state to a single payer health care system, with the first steps beginning this summer.

“We are committing to reforms that get us as many of the benefits of a single payer as possible under current federal law, and to asking for a waiver from federal law so that we can gain the full benefits of a single payer when that option is available,” Anya Rader Wallack, special assistant to Gov. Peter Shumlin for health care, told members of House and Senate panels

“I know you have been anxious to receive this proposal and get to work on the details. I also know you will find flaws in it,” Wallack said. “We don’t think we have all the answers, but we think we are putting in front of you a solid proposal for moving forward with major, meaningful health reform.”

The plan would move the state through three stages in four years to reach the target of a single-payer system.

The Shumlin administration proposes the state take two steps effective July 1: Create a health benefit exchange or marketplace called for under the federal health care law and set up a Vermont Health Reform Board to “develop payment reform and cost containment methodologies that will result in sustainable rates of growth in health care spending,” Wallack.

The next phase would begin in 2014 when the health benefit exchange begins operating. “We propose that we include in the exchange, at that time, employer groups with fewer than 100 employees,” Wallack said. “We also propose that state and municipal employees become part of the exchange, and that we integrate Medicaid, Medicare and workers’ compensation with exchange policy.”

The state would move to the final stage if and when the federal government granted Vermont waivers to establish a single, publicly financed exchange.

“At that point, current premium payments by individuals and employers in Vermont would be eliminated unless an employer chose to continue providing health insurance coverage,” Wallack said. “All Vermonters would receive coverage by virtue of their residency for a good package of health care benefits, coverage would not be linked to employment and most Vermonters would pay into an equitable system for financing this coverage.”

The bill doesn’t spell out a financing system for the third stage, but calls for continued research.


  1. GRACE A. ADAMS on February 9, 2011 at 11:31 am



    FOR US.

    • C B Stranaghan on February 10, 2011 at 3:05 pm

      See the reply to Sharon’s comment just below.
      Perhaps you do not realize that included in both the new ACA and the proposed single payer system, there is a planned affordability sliding scale with payments according to a poverty/incom. Rest assured.

  2. JT on February 10, 2011 at 11:38 am

    Grace, what makes you think Shumlin doesn’t care for you?

    Universal health-care delivered via single-payer serves everyone. From this very article:

    “All Vermonters would receive coverage by virtue of their residency”

    “coverage would not be linked to employment”

    So what exactly is the issue here? Are you just angry that he is trying to provide health care to everyone, rather than just the elderly? I hope that’s not the case, because it sounds remarkably selfish.

    • Sharon on February 10, 2011 at 1:54 pm

      Whenever there are boards about instituting universal healthcare coverage, I believe we need to be vigilant and suspicious of postings that imply that single-payer plans would be bad for the poor.

      The large insurance companies and health concerns are not above posting as if they were concerned citizens, trying to sway public opinion in any way that will preserve their profits at the expense of true healthcare.

      Before people swallow the scare tactics, they should investigate single-payer healthcare for themselves, ready everything they can, look at international models, and last but not least…vote.

      • C B Stranaghan on February 10, 2011 at 2:25 pm


        Very well said. With all the bad press fraught with outright intentional and unintentional mistruths from special interest groups, poorly informed friends and neighbors, all media, legislators, lobbyists and more, it behooves us to each do our own research about the single payer system of health care delivery. is a particularly credible source for comprehensive due diligence info.

        Also: Google Wendell Potter. View online video, “Sick Around the World”. Read the book. See Michael Moore’s movie, “SiCKO” which credible expert American scholars say, “though content is somewhat generalized, it is factual”.

        Happy trails. Help America, help yourselves, get truly informed. xo

      • whoknew42 on February 10, 2011 at 4:03 pm

        That’s true – there are groups out there – including those paid by insurance companies and certain political groups – that go onto progressive websites and post crazy stuff, just like this supposed “Grace Adams” did.

        By the way – most people don’t put their full, legal name when posting replys to articles.

        Nice try – but we see right through you

  3. Michael G on February 10, 2011 at 1:26 pm

    Of course not knowing how the details would play out on the ground causes justifiable concern. What does current federal law allow given the health insurance lobby’s influence in healthcare legislation? It’s a work in progress and, while we hope and pray this plan will do what early statements claim, it’s too soon to celebrate.

    I’m in Texas, a state likely to resist such a plan, but Vermont’s initiative has the potential to be a model for other states, and ultimately the nation, something the Massachusetts plan apparently will not do.

    Vermont has my appreciation and respect for accepting the challenge of using it’s resources to bring quality, affordable healthcare to it’s citizens in our current economic reality, by which I mean the capture, sequestering, and redirection (overseas) of the nation’s wealth by dominant corporations, not least of which are the health insurance companies.

    I’m not a Socialist, I am an American who believes healthcare is a right, not a privelege, in a nation such as ours where we pay taxes for essential services. Low taxes are great but there are good uses for tax dollars, one of which is healthcare. Medicare and Social Security have shown with 3-5% overhead that the government can efficiently administer social programs with good results, in direct contrast to corporate health insurance, which profits from denying care and excluding the sick, while consuming 20-30% of premium dollars in overhead.

    • Saoirse on February 10, 2011 at 2:25 pm

      And for what it’s worth, Michael, Massachusetts has it’s own strong single-payer movement (see as we recognize that the Massachusetts reform is a failure.

    • C B Stranaghan on February 10, 2011 at 3:42 pm


      I, too reside in Texas, for the last number of years. Though I was born an American citizen, I was raised & raised my family on the Canadian single payer system in British Columbia and am a practicing health care professional and a consumer.
      I can tell you that our current system in America is incredibly expensive, unnecessarily complicated and more. Simply: a genuine consumer and practitioner nightmare of inefficiencies and inhumanities.

      It is also a genuine national financial ripopff in obvious and hidden multilayered ways to which I have been a witness far too many times.

      Solution: a single payer system and Best Practice utilization.
      Once “best practice” is fully utilized, Torte Reform will be unnecessary. To do otherwise or in reverse, would be an injustice to the consumer and just more health care reform smoke & mirrors.

  4. Arnold on February 10, 2011 at 1:50 pm

    It sounds like a really valuable experiment. The nation will be watching. The Canadian Single Payer system started in one province-they have provinces not states and was so successful it spread.This could be similarly a precursor of future systems.
    The big problem in all these plans is cost control.
    If we don’t realize that what the patient calls an expense, is somebody else’s income and livelihood we will be lost forever.
    The Medical/Pharmaceutical industry is so profitable because they can control what INFORMATION a patient gets and try to discredit and ay least downplay safer more natural and cost-effective solutions to medical problems. A good source of Alternative Medical Doctors is The American College for Advancement in Medicine
    or the American Academy of Environmental Medicine

  5. Saoirse on February 10, 2011 at 2:36 pm

    Quoting Arnold, below: “The big problem in all these plans is cost control.” Or, maybe, perspective. The federal government and for-profit insurance companies want to turn this into a discussion where the primary focus is how much we spend on healthcare. We should watch our public spending as vigilantly as we watch our personal spending, get value for what we spend and use the best evidence-based treatments, including alternative treatments. That said, cost is NOT the most important factor in healthcare reform: health is! It is up to us as single-payer advocates to insist that human life and health are valuable beyond a dollars-and-cents equation, and that we are all worthy of care to preserve these. I would love to see a public conversation about, oh let’s say war, where Senators were shaking their heads and clucking on about how we couldn’t possibly spend that much, how we had to be careful not to give away the store… I don’t think we’ll ever sell single payer, or any reform, to the public on an accounting basis, no matter how good the numbers look. It’s just not that compelling to most people. But as a moral issue, as a question of caring for those we love and being able to stay healthy for them, it is a shoo-in.

    • C B Stranaghan on February 10, 2011 at 5:57 pm

      Well said! Three cheers, Saorise.
      Though cost is among the many statistics proving the credibility of a single payer system found at and elsewhere, the morality is undeniable.

  6. Ned Yellig on February 10, 2011 at 8:58 pm

    Keep on truckin’. We’ll get to single payer eventually. I’m disappointed that vermont is not moving to that sooner.