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At this stage, no one knows whether state-level universal health care will succeed, and it’s an open question as to whether Vermont can work as a model for other states.

“Developing a single-payer system for Vermont is a lot easier than in California or Texas or New York state,” said U.S. Sen. Bernie Sanders. The independent, frequently described as the only socialist in the Senate, has been pushing for some form of socialized medicine since he was mayor of Burlington 30 years ago.

The nation is focused on the rollout of the state-based health insurance marketplaces and the disastrous unveiling of healthcare.gov. In the meantime, Vermont’s efforts have largely gone unnoticed, said Chapin White, a researcher with the Washington-based Center for Studying Health System Change.

“Vermont’s thinking about 2017, and the rest of the country is just struggling with 2014 right now,” White said.

Even with years to go before Vermont’s single-payer plan will be in place, several obstacles remain.

The largest national health insurance industry lobbying group, America’s Health Insurance Plans, has warned that the law could limit options for consumers and might not be sustainable.

“The plan could disrupt coverage consumers and employers like and rely on today, limit patients’ access to the vital support and assistance health plans provide, and put Vermont taxpayers on the hook for the costs of an unsustainable health care system,” said AHIP spokesman Robert Zirkelbach.

And questions have also arisen about the expected cost savings of eliminating multiple insurance companies and their different coverage levels and billing styles.

Much of a hospital’s billing process is coding to ensure that the right patient is billed the right amount for the right procedure, said Jill Olson, vice president of the Vermont Association of Hospitals and Health Systems. That would continue in a single-payer system.

Vermont also has yet to answer how it will cover everyone. The post-2017 system is not envisioned to include federal employees or those with self-insured employers that assume the risk of their own coverage and are governed by federal law, including IBM, one of the state’s largest private employers. It also may not include residents who work for and get insurance through companies headquartered out of state, Olson said.

At least one resident, 73-year-old Gerry Kilcourse, has little patience for the naysayers.

Kilcourse said that when he and wife Kathy bought a hardware store in Plainfield in the early 1980s, they struggled for years to find good, affordable health insurance coverage.

In retirement, Kilcourse has schooled himself on health policy and advocates for universal coverage. He sees health care as a public good and likens the current campaign to the 19th-century push in the United States for public schools.

“It should be similar to education, which is publicly funded,” Kilcourse said of health care. “If we did the same thing for education (as in health care), you’d have a number of people being excluded” from public schools.

Shumlin has made it clear the status quo can’t hold. As a part owner himself of a small business — a student travel service based in Putney — he has spoken often of the burden that employee health coverage is to such business owners.

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