It was as fitting a contrast as you could get between politics in Vermont, and Washington, D.C.
On the same day that the new Republican majority in the U.S. House voted to repeal last year's health care reform bill, Dr. William Hsaio unveiled a proposal that, if adopted, could bring a single-payer health care system to Vermont by 2015.
The timing was coincidental, but it was another example of the disconnect between the broken politics in Washington and the possibility of change in Montpelier.
While the Republican majority in the House engaged in empty symbolism with its repeal vote, the Democratic majority in the Vermont Legislature is poised to enact a bold plan that could reduce health care costs, cover more Vermonters, and create up to 5,000 new jobs.
The plan, as outlined by Hsaio last week, would have most employers and employees pay for health care through a new 11-percent payroll tax, which Hsiao said would be split between the employer and employee and would not increase current costs.
In return, everyone would receive an “essential” benefits package that would cover 87 percent of medical care and 77 percent of drug expenses. There would be small co-pays for doctors' visits, but no deductibles.
Hsaio said this plan would be better than the coverage that most Vermonters have today. It would give access to health care to the 47,000 Vermonters currently uninsured, as well as the tens of thousands of underinsured Vermonters who are paying large amounts of money for inadequate, mediocre coverage.
The state wouldn't actually administer this single-payer system. Instead, administration of the plan would be put out to bid to private insurance companies.
At the same time, as many as 30 percent of Vermont workers who are either employed at big companies that self insure, or at businesses with fewer than 10 employees, would be exempt from the proposal. Nor would the Hsaio plan affect Medicare coverage.
Hsaio said that moving to a single-payer system will help create the new jobs over a number of years by lifting the burden of providing and administering insurance off the shoulders of businesses, giving these firms incentive to expand and hire more workers.
The three major health insurance companies still doing business in Vermont - Blue Cross Blue Shield of Vermont, MVP Health Care, and Cigna - are already angling for a piece of the new health care pie.
“Given Vermont's history with reforms such as guaranteed-issue, community-rating, and the Blueprint program, it must be noted that the remaining health insurers in Vermont - especially those run as nonprofits - are likely more accustomed and potentially more open than insurers elsewhere to working with state-led regulations,” wrote Hsaio in his report.
If any of the three insurance providers will ultimately go along, it will likely be Vermont's largest insurer, Blue Cross Blue Shield, which has 75 percent of the state's health insurance business.
That company's chief lobbyist, Leigh Tofferi, told VTDigger.org that “if there's a single-payer system, we'd like to be the single payer,”
There is talk that the three companies might also offer supplemental policies, similar to the “gap” policies sold to those enrolled in Medicare, for those who can afford to pay for a higher level of coverage.
The biggest threat to public/private version of single-payer health care is not in Vermont. It's the insurance industry in the other 49 states, which sees Vermont's plan as a threat. If our state somehow comes up with a workable alternative to the broken and dysfunctional system that we now have, other states may follow.
“It is reasonably safe to assume that health insurance companies would oppose any major health system reform that reduces their autonomy in financing and paying for health care, increases government's role, and/or introduces new competitors to their market,” Hsaio wrote.
The process will not be quick or easy, and the many obstacles are considerable. But compared to past attempts at health-care reform at the Statehouse, there appears to be broad support for this plan. That is a reflection of the truly messed-up state of our nation's health-care system and the realization that nothing is going to happen on the federal level to change it.
Once again, it's up to Vermont to lead the way.