Vermont's single-payer dream died

Twelve years ago, Vermont Democrats tried to create the nation's first single-payer government-financed healthcare system. The plan failed, and Republicans won the governorship for a decade.

Janoo challenges Scott in tight race

Amanda Janoo, a progressive political newcomer, is running as the Democratic nominee against Republican Governor Phil Scott in what polls show is a tight governor's race.

A narrower healthcare experiment

If Janoo wins, Vermont could try a new experiment: the state would pay the full tab for primary and preventive care, while leaving the rest to the existing system.

Learning from past failures

Janoo's plan shows how progressive policy idealists are learning from past single-payer failures and focusing on what they think can actually be achieved in practice.

What Janoo's plan covers

Under universal primary and preventive care, the state government would pay for Vermonters seeing primary care providers such as doctors and nurse practitioners. Insurance companies would be cut out.

What stays in the old system

Hospitals, specialists, and prescription drug companies would remain under the existing insurance system for now. Tests such as MRIs would likely still require existing insurance.

Why primary care is more achievable

Single-payer for primary care seems more achievable because primary care is a relatively less expensive part of the healthcare system compared to hospitals and specialists.

Janoo's economic philosophy

Janoo graduated in twenty ten after the financial crisis and became skeptical of neoliberalism. She studied development economics under Ha-Joon Chang at Cambridge and worked in international development.

The well-being economy movement

Janoo became involved with the well-being economy movement, which criticizes modern capitalism's obsession with economic growth and says human and environmental well-being should be prioritized instead.

Janoo's campaign message

In the Democratic primary, Janoo ran as a progressive outsider promising a more economically populist vision instead of corporate neoliberal bullshit. She won the primary by two point five percentage points.

“corporate neoliberal bullshit”

Primary care is in crisis

Primary care providers are overwhelmed and underfunded. There aren't enough doctors, patients struggle to find care, and insurance companies add administrative burdens and bureaucratic hassle.

How Janoo would pay providers

Janoo wants to phase out fee-for-service payments and instead pay primary care providers either government-paid annual salaries or per-patient per-month payments.

Attracting more doctors to Vermont

Janoo proposes relocation incentives of maybe one hundred thousand dollars, student loan repayment programs, and welcoming foreign-trained medical professionals to bring cultural diversity.

Funding through wealth taxes

Janoo proposes an income tax increase on the wealthiest Vermonters comparable to the tax break they got in President Trump's One Big Beautiful Bill Act last year.She hopes to raise hundreds of millions of dollars.

Experts question the savings claim

Janoo said the state could save as much as three hundred million dollars a year through better preventive care. But experts say prevention likely costs money while keeping people healthier, not saving it.

The real challenge: money

If the government sets provider salaries too low, the shortage of primary care doctors will worsen.If salaries are high enough to attract doctors, taxes must rise to pay them.

A stepping stone to full single-payer

Janoo views primary care reform as a starting point. She hopes to work with neighboring states to create a New England-wide system and move to universal healthcare more quickly.