title: Prospective political analysis for policy design: enhancing the political viability of single-payer health reform in Vermont.
abstract: BACKGROUND
  In 2011 the state of Vermont adopted legislation that aims to create the nation's first state-level single-payer health care system, a system that would go well beyond national reform efforts.
  
  
  OBJECTIVE
  To conduct a prospective, institutional stakeholder analysis to guide development of a politically viable, universal health care reform proposal, as commissioned by Vermont's legislature in July 2010.
  
  
  METHODS
  A total of 64 semi-structured stakeholder interviews with nearly 120 individuals, representing 60 different groups/institutions, were conducted between July and December 2010. Interviews probed stakeholders regarding five major design components: financing options, decoupling insurance from employment, organization/governance, comprehensiveness of benefits, and payment reform.
  
  
  RESULTS
  There was a range of opposition and support across stakeholder groups and components, and more remarkably a diversity of views within groups often believed to be unwavering supporters or detractors of comprehensive health reform. Given the balance of conflicting views, relative power, and acceptable trade-offs, the research team proposed a single-payer health care system financed through payroll taxes, decoupled from employment, with a generous benefit package, governed by a public-private intermediary.
  
  
  CONCLUSIONS
  Prospective political analysis can assist in choosing among a range of technically sound policy options to create a more politically viable health reform package.
authors.affiliation: Harvard School of Public Health, Department of Global Health and Population, 677 Huntington Avenue, Boston, MA 02115, USA. njblanchet@mail.harvard.edu
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Blanchet
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Fox
mesh_terms: D004651:Employment; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006291:Health Policy / Q000331:legislation & jurisprudence; D061889:Healthcare Financing; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence / Q000458:organization & administration; D011050:Policy Making; D011057:Politics; D018855:Single-Payer System / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D019472:Universal Health Insurance / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014707:Vermont