Shumlin: Timing Key For Single-Payer

January 29, 2014

Hanover — The biggest challenge in moving Vermont toward a single-payer health care system is time, while the political will to achieve it still exists at the state and federal levels, Gov. Peter Shumlin said Monday.

“Governors have very short shelf-lives. We really do. And we also know that in order to get what we need to get done... we don’t want to have to work with a president that we don’t know,” Shumlin told a crowd of 120 health experts at Dartmouth College Monday evening. “In other words, we want to work with what we’ve got. We can’t gamble this plan on someone elected after 2016.”

The Affordable Care Act helped expand insurance coverage to many people who were previously shut out of the system, but it is not a solution to creating a sustainable health care system, Shumlin said. Vermont will design the template for the rest of the nation on health reform, Shumlin said, even as he acknowledged that a great deal of work — including figuring out how to pay for it — remains to be done. He implored the health professionals in the room to take up the challenge with him.

Shumlin made the remarks before students in Dartmouth’s Master of Health Care Delivery Science program, which marries the expertise of the business world with health care, and includes professionals from around the world and close to home. Indeed, Shumlin’s director of health care reform, Robin Lunge, was part of the first graduating class last year.

If successful, Vermont would be the first state in the nation to achieve single-payer health care, Shumlin said, a road that the Green Mountain State has been on since 2011. A single-payer health care system is one in which the government, rather than private insurers, pays for all health care costs.

But Shumlin acknowledged the limitations of this vision and said that true reform would require the efforts of health care leaders, including the people in the audience, to create a sustainable system.

“It doesn’t matter what payment system we come up with,” he said. “If costs keep rising as they have, there is no system that will finance the (costs)... I will not push send on a payment system if we can’t deliver on a delivery system.”

Earlier this month, Shumlin said that he was squarely focused on creating a single-payer health care system in Vermont even as he faces more immediate problems with the insurance marketplace website,, a provision of the Affordable Care Act.

As elsewhere in the nation, Vermont’s online marketplace has had technical difficulties that have prevented people from enrolling for coverage. Shumlin has acknowledged the problems and vowed that they would be fixed. But, on the first day of the legislative session earlier this month, Shumlin said that he would not be “so easily deterred” from his larger goal to implement a single-payer system by 2017.

The relative lack of special interest groups in Vermont, a network of ambitious health care providers and the state’s small size make it a good laboratory for the rest of the U.S., Shumlin said Monday, adding that there is growing interest among his peers in what Vermont is doing. Shumlin is chairman of the Democratic Governors Association and said he has spoken with California Gov. Jerry Brown, New York Gov. Andrew Cuomo and Massachusetts Gov. Deval Patrick about Vermont’s progress on health reform.

“There are a lot of folks who will come on board,” Shumlin said. “The question is who’s going to do it first.”

Still, plenty of questions remain, including how a single-payer system will be financed. Republicans have said there is little to discuss about single-payer until Shumlin’s administration can present a plan to pay for it.

In response to one audience member’s question about the financing issue, Shumlin stepped aside and let his “money man” answer for him.

Michael Costa, deputy commissioner for health care reform, said the details would be worked out this year. But whatever the system’s design, it would not cost any more than Vermonters are paying now, he said.

“As far as how to pay for it overall, I’d say you’re all paying for it today,” Costa said. “We’re not talking about new dollars at all. We’re talking about the same amount of money that you pay now (for insurance premiums) put into a publicly financed system. And for people who are concerned about what that new funding mechanism might be, they should be outraged by what they pay now.”

That conversation would happen over the coming months, Costa said, and a proposal would go before lawmakers in January 2015. Until then, he said, “I would say stay tuned.”

Chris Fleisher can be reached at 603-727-3229 or