Here is a video (~1 hour) from a Politico health reform policy panel I was on at the DNC last Thursday. Two things from this panel stood out for me, both related to the comments of Gov. Peter Shumlin from Vermont, who wants to create a universal, “single payer” health system in his state.

  • All Governors say they want flexibility, and in the South they mostly talk about being pushed too far, too fast by the ACA in terms of coverage expansions. Gov. Shumlin also wants flexibility, but in order to go further, faster. He wants flexibility to move to a single payer approach before 2017 (the ACA does not allow this prior to then according to the Governor, and he says that insurance companies didn’t want this option to be available). He doesn’t want the ACA to hold Vermont back and wants both a Medicaid and some sort of ACA waiver to move toward a single source/payer approach that will cover all Vermonters as soon as possible.
  • The Governor played down the role of ideology* in making his single payer approach possible, and said that the size of the state will be the biggest predictor of big innovations in health reform going forward. He thinks that small states that have fewer/smaller/less powerful corporate interests involved in the delivery of health care will be the ones that be most innovative in insurance innovations. Sarah Kliff has also talked about Montana’s efforts in this “single payer” direction….a small (in population) state.

In any event, it is a very different context in Vermont than it is in the South, where some states are talking (I suspect mostly talk) of not even taking the Medicaid expansion in the ACA that is now optional.

*I don’t really think single payer is technically the correct term for what they are talking about because the most likely option would leave Medicare, Medicaid and private insurance, but would create a predictable way that everyone in the state would be covered. However, that is mostly just nit picky professor talk….but hey, I am a professor.

[Cross-posted at The Reality-based Community]

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Don Taylor is an associate professor of public policy at Duke University, where his teaching and research focuses on health policy.