Vermont to Design a Single Payer Health Care System

By Jon Walker

In Vermont, a bill that could possibly lead to a government-run single payer health care system is now state law. Republican Gov. Jim Douglas chose not to veto the bill, letting it become law without his signature.

At issue, Senate Bill 88 (PDF), creates a commission to design and create an implementation plan for three different health care systems. One of the options that the commission will design is a single payer health care system and one will be a health care system that includes the choice of a state-run public option along side private health insurance.

(2)(A) One option shall design a government-administered and publicly financed “single-payer” health benefits system decoupled from employment which prohibits insurance coverage for the health services provided by this system and allows for private insurance coverage only of supplemental health services.

(B) One option shall design a public health benefit option administered by state government, which allows individuals to choose between the public option and private insurance coverage and allows for fair and robust competition among public and private plans.

There is no guarantee that Vermont will implement either the single payer plan or the system with a public option, but it is a small step toward making that happen.

It is possible, if not likely, that federal law will be used to prevent the state from implementing a single payer system.

Reinventing Primary Care: Lessons From Canada For The United States

By Barbara Starfield in HealthAffairs.org

Barbara Starfield (bstarfie@jhsph.edu) is a professor of health policy in the Departments of Health Policy and Management and of Pediatrics at the Johns Hopkins University in Baltimore, Maryland.

Canada is, in many respects, culturally and economically similar to the United States, and until relatively recently, the two countries had similar health systems. However, since passage of the Canada Health Act in the 1970s, that nation’s health statistics have become increasingly superior. Although the costs of Canada’s health system are high by international standards, they are much lower than U.S. costs. This paper describes several factors likely to be responsible for Canada’s better health at lower cost: universal financial coverage through a so-called single payer; features conducive to a strong primary care infrastructure; and provincial autonomy under general principles set by national law.