Vermont's push to single-payer has been getting a lot of attention in the national media. From filmmaker Michael Moore's op-ed in The New York Times to the Atlantic Magazine article exploring the road ahead to 2017. But in the state, the feeling is there's not even quite a map of that road yet.
"Single-payer is used by lots of different people to mean lots of different things," said Steve Kappel, a health policy professor at the University of Vermont.
In fact, Kappel says Vermont doesn't even have a single definition for single-payer.
"I think a lot of people think they have it, but I'm not sure everyone has agreed on what it means quite yet," Kappel said.
That is the next step for the state as Al Gobielle sees it. He chairs the Green Mountain Care Board, which will vet the single-payer plan.
"There's a lot of flavors of single-payer in the world," Gobielle said. "We in Vermont have to get really focused on what flavor it is we're describing and what we as Vermonters want in our ice cream."
Whether Vermonters want a Canadian-style single-payer flavor, which is totally state-run; a German-style, which is somewhere in the middle; or something totally new; they say almost everyone agrees that any single-payer plan in the state needs to have three main parts: universal access, affordability and streamlined administration.
After lawmakers decide what single-payer means, they then have to find the money for it, anywhere from 1.6 billion-$2.2 billion in new revenues. Read: new taxes.
"Will be the largest tax increase in Vermont history," said Darcie Johnston of Vermonters for Health Care Freedom.
That's the part that worries Vermonters for Health Care Freedom most. They say they fear single-payer will drive doctors, businesses and families across the border.
"We are not an island, we are not a country; we are 600,000 people who have the freedom to move very easily," Johnston said.
For their part, supporters of single-payer say any tax increases will be offset by cost-savings, but the two sides are setting the stage for the legislative session.
"People don't like the current system very much. It's ineffective; it's inefficient," Kappel said. "But I think people have this skepticism of large government, so the question is how do you weigh those two things against each other?"
The answer looks to be coming to Vermont by way of what's shaping up to be a blockbuster debate that the nation is watching.
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