Vermont apparently tried to setup a single-payer healthcare system, only to have various healthcare and pharmaceutical companies threaten to ruin them if they did so, at which point Vermont, a state not large enough to take them on, backed down.

Despite this, countries like Iceland have single-payer systems, and don't have to deal with things like nonsense pharmaceutical price gouging despite having only around half the population of Vermont, and six billion dollars less in GDP.

Why is it that Iceland can setup a single-payer system, but Vermont couldn't? What does Iceland have that Vermont doesn't? And how can these differences be generalized such to explain what the requirements are for a state, or country, or healthcare providing NGO to be able to run a single-payer system?


From what Wikipedia tells me on the Vermont case, the Vermont government feared increases in costs and taxes from such a reform. In the end, it boils down to what people/voters/decision-makers are willing to pay for a health care system they believe to be good for the people. Scandinavian countries provide lots of top-class public services (health care, child care, education) but also collect the highest tax rates in the world. Apparently, political will and public opinion in Iceland were willing to accept the price attached, which was not the case in Vermont. Beyond, it is possible that the move from the previous system was less drastic in Iceland, requiring fewer things to change.

  • $\begingroup$ Thx, I understand now. That said, I'd argue that given the US's vary ... lets say, "overly trusting" campaign financing rules, the distaste for taxes may be coming from a different group. ;D $\endgroup$ – Tirous Oct 25 '18 at 4:32

Single payer systems are primarily an interest group policy. Giving and taking money from the same person is never rational. All major social security systems are PAYGO.

So vermont is simply too small to have the necessary political infrastructure for a funded system to be viable.

  • 1
    $\begingroup$ Care to elaborate? I don't quite follow what your saying. $\endgroup$ – Tirous Oct 17 '18 at 3:52
  • $\begingroup$ Vermont is almost twice the size of Iceland by population and has a bigger GDP. Presumably that is part of why the two are being compared here. $\endgroup$ – Brythan Oct 18 '18 at 0:17

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.