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

“Instead of someone paying a $1.50 for a dollar’s work and another person paying nothing for a dollar’s work, we will have a fair, equitable payment plan,” he adds. “Most importantly we will spend less money on health care for better outcomes. Financing is the easiest part. We won’t push ‘send’ on the public financing until we’ve designed a system that costs less than they otherwise would have paid for better outcomes.”

But while lawmakers and regulators hammer out the details of the new system, the uncertainty over the outcome could make Vermont a less desirable destination for young doctors.

“What makes physicians nervous is uncertainty, and who wants to, you know, take their family and start their career someplace where you aren’t going to be in a stable environment,” says John R. Brumsted, CEO of Fletcher Allen Health Care in Burlington, the state’s largest medical provider. “To the extent that there’s uncertainty about what will happen in Vermont or anywhere else, that makes physicians nervous.”

The uncertainty has kept the Vermont Medical Society, which represents about two-thirds of all practicing physicians in the state, from taking a position. It’s not a sure thing that Vermont will be able to get the necessary waivers from the federal government, says Executive Vice President Paul Harrington. Coming up with new taxes to fund the system might also be a hard sell in a different political climate.

“If I were to state with a high degree of confidence that something would happen, something contingent on Congress passing necessary legislation, well, let’s just say that I’d like to have the other side of that bet,” Mr. Harrington says.

Under the Affordable Care Act, a state-run health insurance exchange is supposed to be up and running by 2014, letting Vermonters shop for policies. Federal subsidies are supposed to help middle-income families afford policies, but people will be barred from buying policies privately, outside of the health exchange, which will dramatically affect the state’s three main insurers.  

“This legislation would reduce patients’ access to health plans’ innovative programs and services that they rely on today, and will put Vermont taxpayers on the hook for the soaring cost of medical care,” says Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, an industry trade group.

As with many things in Vermont, it seems unlikely that the single-payer experiment, if it even goes through, will be replicated elsewhere. The size and homogeneity of its population, its left-leaning politics and the general confidence most Vermonters have of local and state governments differs markedly from many other states.

Even Dr. Binnick, despite his failure to pass off his practice, says he supports the Vermont program. And he’d go even further.

“Ideally, what we’d have is single-payer universal care for the entire country,” he says, “a national health-care system.”

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