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Obamacare is radical? Vermont thinks even bigger, with single-payer plan.

Vermont plans to become the first state to adopt a single-payer health-care system. Its backers say it will cut costs and create jobs, but critics say the centralized control will drive away doctors.

By Mike EckelContributor / July 19, 2012

In this May 2011 file photo, Vermonters rally at the Statehouse for health-care in Montpelier, Vt.. Vermont plans to become the first state to adopt a single-payer health-care system.

Mark Collier/Times Argus/AP/File

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When Dr. Alan Binnick decided to retire after 34 years, he tried for more than a year to find someone to take over his dermatology practice in the southwestern Vermont town of Bennington – free of charge.

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Last November, he gave up, saying his search failed in no small part because of Vermont’s health-care reform effort, perhaps the most radical in the United States.

“There’s a sense of uncertainty that made (potential doctors) choose other positions elsewhere, where they know they’re in demand,” Dr. Binnick says.

Tiny, quirky Vermont is at it again, tackling pressing social concerns with a progressive vengeance. This time, it’s health care, and if all goes well, by 2017 or even earlier, the state of 626,000 plans to become the first in the country to adopt a single-payer system. But there’s serious uncertainty about what it will look like, and how it will be paid for.

“It’s one model for solving the health-care problem, and it’s quite different from what the rest of the country is heading toward,” says Elliott S. Fisher, director of the Center for Population Health at the Dartmouth Institute in Hanover, N.H. “I think it’ll have tremendous significance.”

The Supreme Court’s June 28 decision cleared the way for President Obama’s Affordable Care Act, with some provisions kicking in as early as next year. The act drew much of its framework from the landmark 2006 Massachusetts law that for the first time mandated that all residents have health insurance.

Last year, the Green Mountain State one-upped the Bay State when its Democratic-controlled legislature passed “An Act Relating to a Universal and Unified Health System,” laying out a roadmap for a single-payer system.

Such systems have been used in other countries – Canada, notably – but in Vermont, the idea is that everyone would be insured through a state-funded pool called Green Mountain Care. A five-member agency called the Green Mountain Care Board ultimately would all but govern the health-care delivery system, including setting rates for everyone from primary-care physicians to cardiologists and for everything from broken bones to open-heart surgery. For now, employers with self-insured plans – such as IBM, a major employer in Vermont – would be able to keep their current coverage.

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