Can a Vermont Democrat Crack the Code on Universal Healthcare With a Smaller Plan?

A narrower healthcare proposal

Janoo’s plan would have Vermont pay for residents’ primary and preventive care, with insurers excluded from that part of the system. Other care, including hospital treatment, specialists and prescription drugs, would continue under existing insurance arrangements.

She hopes the approach could eventually lead to broader single-payer reform. The proposal is more limited than Vermont’s earlier effort and Bernie Sanders’s Medicare-for-All idea.

Lessons from Vermont’s past

Twelve years ago, Vermont Democrats pursued a government-financed, single-payer system. The plan was signed into law but later abandoned before implementation after the governor judged it unworkable. Efforts to establish state-level single-payer systems have repeatedly failed, including in blue states. High costs and the taxes needed to pay for them have been obstacles for politicians and voters.

Funding and expected effects

Janoo said the state budget made immediate, full single-payer reform unrealistic. She proposes financing universal primary and preventive care with a tax on the wealthiest. Because primary care is a smaller part of healthcare spending, Janoo’s approach may be more achievable, but she expects it to have wider effects. Better preventive care, she argues, could improve health and reduce some hospital visits.

Questions remain about delivery

Health policy experts expressed sympathy for universal primary care but raised questions about implementation. They questioned whether the plan would attract more primary care doctors to Vermont and whether it would increase their pay.

Experts also asked whether preventive care would produce the cost savings Janoo hopes for. The proposal is part of her campaign as she challenges Republican Gov. Phil Scott in a race described by polls as tight.