Diagnosing Vermont’s Single Payer Crash

I have a commentary in this week’s New England Journal of Medicine on “the demise of Vermont’s single payer plan.” Beyond what’s in the article, here are some points of note.

First, as some of ardent single payer proponents note, the plan was never “pure” single payer because VT Gov. Peter Shumlin never envisioned including Medicare in the system.  So it would have been single payer — except for Medicare and other federal programs that would have been challenging to include.  Though including Medicare in the original plan would, quite likely, have been politically suicidal, the point is well taken.

VermontSP

Second, Vermont’s move in this direction in 2011 was the most exciting and important pro-single payer development in a generation at least.  A state chief executive with a strongly Democratic legislature in a small, progressive and compact state — one could hardly imagine a more auspicious opportunity.  Add to that the disappointment among so many Democrats in 2010 that the Affordable Care Act did not go further.  I admit to being caught up in the exuberant enthusiasm. Continue reading “Diagnosing Vermont’s Single Payer Crash”