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Dr. Marvin Malek has been yearning and advocating for a publicly financed, single-payer health care system for at least two decades. Now, as Vermont stands on the threshold of being the first state to launch such a plan, he's confessing to trepidation.


"I am pretty damn nervous," he confided before bounding off for rounds at the Vermont Central Medical Center, still clutching the bicycle helmet he wore on his ride to work.


It's not that Malek has reservations about the desirability of a single-payer system. He and other supporters in Vermont point out that it is already in place in many developed countries that produce better health outcomes at lower cost than the U.S.


It's that getting there seems so fraught with complexity. "The problem is that the tentacles of our completely dysfunctional U.S. health system reach so deeply into every state," he said. "How do you disentangle from that abysmal structure to create single-payer?"


That explains why Malek and many others here believe the Vermont legislature's landmark vote in 2011 to move the state to a single-payer system by 2017 was the easy part of the process. Devising how to actually do it, a process the state is enmeshed in now, will be much more grueling.


The outcome couldn't be more consequential, not only for Democratic Gov. Peter Shumlin, who put single-payer health care at the center of his first gubernatorial campaign in 2010, but for many others who have long cherished the idea of universal health care built on the foundation of a single-payer system.


Some believe that if the Vermont experiment is successful, other states could follow. In Canada, they note, single-payer started in one province and then spread across the country.


"We could be the Saskatchewan of America," said Bram Kleppner, CEO of Danforth, a pewter manufacturer in Middlebury with roots tracing back to colonial America. He is among a group of business executives in Vermont Businesses for Social Responsibility (external - login to view), which actively promotes single-payer. He also sits on a board advising the governor on the financing of the plan.




Vermont is 'single-payer' trailblazer (external - login to view)