Amanda Janoo, the Democratic nominee for governor of Vermont, is campaigning on a proposal to establish a state-funded system for primary and preventive healthcare, a move that could represent a new approach to single-payer healthcare in the United States. This initiative seeks to build on past attempts in Vermont and elsewhere that aimed for broader single-payer systems but ultimately failed due to political and financial challenges.
Janoo's plan, which she refers to as "universal primary and preventive care" rather than explicitly "single-payer," would involve the state government paying healthcare providers directly for these services, making them free for patients and excluding private insurers from this segment of care. However, other healthcare services, including hospital care, specialist visits, and prescription drugs, would continue to operate under the existing insurance framework.
This approach contrasts with earlier, more comprehensive single-payer proposals, such as Vermont's failed 2014 attempt or Bernie Sanders's national "Medicare-for-All" concept. Those efforts faced significant public and political opposition, largely due to concerns about the high costs and necessary tax increases to fund such a system. Janoo's strategy is to target a less expensive, yet crucial, segment of the healthcare system first, hoping it can serve as a foundational step toward broader reforms.
"I think it’s clear at this point that a profit-oriented healthcare system is a terrible idea," Janoo stated in an interview. "But after assessing that the state budget made it ‘unrealistic’ to do single-payer immediately, she concluded, ‘we could do universal primary and preventive care,’ financed by a tax on the wealthiest."
Advocates for this approach argue that primary care providers are currently overwhelmed and underfunded, leading to shortages and difficulties for patients in accessing timely preventive services. Janoo's plan includes measures to address this, such as offering relocation incentives and student loan repayment programs for primary care providers, and potentially creating pathways for foreign-trained medical professionals. She proposes shifting from a fee-for-service model to either government-paid annual salaries or per-patient monthly payments for providers.
Funding for the initiative would come from an income tax increase on the wealthiest Vermonters, which Janoo estimates could generate hundreds of millions of dollars annually. She believes this could be comparable to tax benefits provided by federal legislation in recent years.
Despite the potential benefits, the plan faces scrutiny. Health policy experts have raised questions about its practical implementation and potential impact. Some experts suggest that while improved access to primary care can enhance overall health, it may not necessarily lead to significant cost savings in the short term, and could even increase spending by identifying more conditions requiring treatment. There are also concerns about how providers would be incentivized under a salaried system and whether the state could effectively hold them accountable.
Janoo's political background is rooted in progressive economic thought, including skepticism of unchecked economic growth and a focus on "well-being economy" principles. Her campaign emphasizes a populist vision, contrasting with what she describes as "corporate neoliberal bullshit." She won the Democratic primary by a narrow margin and is now facing incumbent Republican Governor Phil Scott, whose past electoral victories have been substantial, though current polls indicate a tighter race.
Neighboring states, including Minnesota and Washington, have also seen discussions around universal primary care programs, indicating a broader trend of states exploring such reforms. Governor Scott himself has supported a study on universal primary care, though he has expressed reservations about any plan that might be a precursor to full single-payer.
Janoo hopes her primary care initiative will be a stepping stone, eventually leading to a more comprehensive, single-payer system for the entire state, and potentially a multi-state New England system. "My hope is, when I’m governor, that I can start to work with some of our neighboring states. Because if we could create a New England-wide system, we could move to universal healthcare really quickly," Janoo said.