Vermont's two major party candidates for governor — Republican incumbent Gov. Phil Scott and Democratic nominee Christine Hallquist — have sharp disagreements on the path Vermont should take to make health care more affordable in the short term. Yet the two candidates view the long-term solution in a similar way.
Hallquist views access to health care as a "right for all Vermonters."
And that's one of the reasons she thinks the state should move to a government-financed system, often called single payer, where all people would have health care coverage. It would be financed by imposing a new tax that would replace the current premiums paid to private insurance companies.
Hallquist isn't sure Vermont can go it alone with its own single-payer system, but she believes it would be feasible if several states joined together.
"What I'm going to tell voters is they should never accept no for an answer until we get there,” said Hallquist. “I will work hard to get us there, and I think it's going to have to happen through a coalition with other states."
But Scott said it's a big mistake for Vermont to set up its own single-payer system or form a coalition with nearby states.
He's concerned that the taxes needed to finance such a system will hurt the state's ability to bring new businesses into Vermont.
"We would be uncompetitive with other states, with other regions," said Scott. "We're already suffering from an affordability crisis here in Vermont where we're not competitive with other regions of our country."
In the short term, Scott is optimistic that a new payment reform plan will help contain health care costs and result in healthier outcomes for many people.
The idea is to move away from the current "fee for service" system where many health care providers are reimbursed for each medical procedure. Instead, providers would be reimbursed on a per-patient basis and they would be encouraged to expand preventative care services.
Scott said the initial results of a yearlong study of this approach, involving 30,000 Medicaid patients, are promising.
"The results were positive," Scott said. "We want to grow that. And eventually if it all proves out, and we prove ourselves along the way, then this could be part of the solution for the future."
Hallquist thinks there's a better way to provide expanded preventative care to all Vermonters and it represents a step towards a full government-financed health care model.
She supports legislation that would make primary care services available to all Vermonters.
Under this approach individuals would still need to have a private policy for all non-primary care, but their premiums would be lower.
Hallquist said this "primary care for all" system could be put into place by imposing a 1.5 percent payroll tax, and she said there would be sizeable savings from using this approach.
"I've already looked at that and that would — with a payroll tax — that would pay for itself by the savings that result from people going to the doctor right away,” said Hallquist.
While they may disagree on short-term approaches, surprisingly Hallquist and Scott are in agreement on a long-term approach to provide universal access to health care.
They would both support a "Medicare For All" system like the one Sen. Bernie Sanders has introduced in Congress. Hallquist thinks this approach makes a lot of sense.
"It's a much more efficient system,” said Hallquist. “That's one thing our government knows how to do is run a health care system. And Medicare is one of those systems that ... most people are pretty happy with."
Scott said the Medicare for All plan has a lot of merit. He says he has no problem with the implementation of a government-financed health care system as long as it is done at the national level.
"That would be fine with me because we're then on an even keel with other states," said Scott. "We're not competing with them. And we're not causing Vermonters to pay more than other states and other residents in other surrounding states and other parts of the country."
And Scott said the state needs to decide its health care priorities in the near future so that the business community can better understand what its role is expected to be.