A Doctor’s Push for Single-Payer Health Care for All Finds Traction in Vermont

MONTPELIER, Vt. — Many people move to Vermont in search of a slower pace; Dr. Deb Richter came in 1999 to work obsessively toward a far-fetched goal.

She wanted Vermont to become the first state to adopt a single-payer health care system, run and paid for by the government, with every resident eligible for a uniform benefit package. So Dr. Richter, a buoyant primary care doctor from Buffalo who had given up on New York’s embracing such a system, started lining up speaking engagements and meeting with lawmakers, whom she found more accessible than their New York counterparts.

“I wrote a letter to the editor, and the speaker of the House called me up to talk about it,” Dr. Richter, 56, recalled recently. “It was astounding. In New York, I couldn’t even get an appointment with my legislator.”

Twelve years later, Dr. Richter will watch Gov. Peter Shumlin, a Democrat, sign a bill on Thursday that sets Vermont on a path toward a single-payer system — the nation’s first such experiment — thanks in no small part to her persistence. Though scores of people pushed for the bill, she was the most actively involved doctor — “the backbone,” Mr. Shumlin has said, of a grass-roots effort that helped sway the Democratic Legislature to pass it this spring even as other states were suing to block the less ambitious federal health care law.

“We wouldn’t be where we are without Deb,” Mr. Shumlin said in an interview. “She’s made this her passion. And like anyone that’s making significant social change, she has qualities of persuasiveness and leadership and good judgment that are hard to find.”

As in all states, the cost of health care has increased sharply in Vermont in recent years. It has doubled here over the last decade to roughly $5 billion a year, taking a particular toll on small businesses and the middle class. All 620,000 of the state’s residents would be eligible for coverage under the new system, which proponents say would be cheaper over all than the current patchwork of insurers. A five-member board appointed by the governor is to determine payment rates for doctors, what benefits to cover and other details.

But much remains to be worked out — so much that even under the most optimistic projections the plan might not take effect until 2017. Most significantly, Mr. Shumlin still has to figure out how much it will cost and how to pay for it, possibly through a new payroll tax. Whether he will still be in charge by 2017 is among the complicating factors.

“If we had the exact same Legislature and the same governor we could get it done,” Dr. Richter said. “It’s a big if, because the opposition has a ton more money to convince people that the governor is evil and this is socialized medicine and all kinds of other scary stuff.”

The opposition will probably include insurance companies, drug makers and some employers who say there are too many unknowns. Many doctors, too, are wary of the change and what it might mean for their income. Dr. Richter said she believed a “slim majority” of the state’s 1,700 licensed physicians were supportive.

“One of the bigger worries I have is we’ve had all this hoopla and nothing’s going to happen,” she said at a coffee shop here recently on a rare quiet afternoon. “But it might also be helpful to us, because it’s going to be hard for any opposition to be steadily pushing for seven years.”

The federal health care law has complicated Vermont’s plans, requiring the state to first create a health insurance exchange to help residents shop for coverage by 2014. The state would then need a federal waiver to trade its exchange for a government-run system.

Dr. Richter said she embraced the idea of a single-payer system as a young doctor in Buffalo, where many of her patients put off crucial treatments because they were uninsured. As a medical student, she saw a patient with a life-threatening heart infection caused by an infected tooth that had gone untreated because he lacked dental insurance.

“He was in the hospital for six weeks, and I was like, ‘This makes no sense,’ ” she said.

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Scientists: Iceland's Grimsvotn Volcano Erupting

REYKJAVIK, Iceland (AP) — Iceland's most active volcano has started erupting, scientists said Saturday — just over a year after another eruption on the North Atlantic island shut down European air traffic for days.

Iceland's Meteorological Office confirmed that an eruption had begun at the Grimsvotn volcano, accompanied by a series of small earthquakes. Smoke could be seen rising from the volcano, which lies under the uninhabited Vatnajokull glacier in southeast Iceland.

A no fly zone has been designated for 120 nautical miles (220 kilometers) in all directions from the eruption. Isavia, the company that operates and develops all airport facilities and air navigation services in Iceland, described this as standard procedure around eruptions.

"The plume of smoke has reached jet flying altitude and plans have been made for planes flying through Icelandic air control space to fly southwardly tonight," said Hjordis Gudmundsdottir, the spokeswoman for Isavia.

Grimsvotn last erupted in 2004. Scientists have been expecting a new eruption and have said previously that this volcano's eruption will likely be small and should not lead to the air travel chaos caused in April 2010 by ash from the Eyjafjallajokull volcano.

History shows that previous eruptions in Grimsvotn have not had much influence on flight traffic — unlike the massive disruption caused last year.

Pall Einarsson, geophysicist at the University of Iceland, said last year's eruption was a rare event.

"The ash in Eyjafjallajokull was persistent or unremitting and fine-grained," Einarsson said. "The ash in Grimsvotn is more coarse and not as likely to cause danger as it falls to the ground faster and doesn't stay as long in the air as in the Eyjafjallajokull eruption."

A plane from the Icelandic Coast Guard carrying experts from the University of Iceland will fly over the volcano and evaluate the situation.

One eyewitness, Bolli Valgardsson, said the plume rose quickly several thousand feet (meters) into the air.

Sparsely populated Iceland is one of the world's most volcanically active countries and eruptions are frequent.

Eruptions often cause local flooding from melting glacier ice, but rarely cause deaths.

Last year's Eyjafjallajokul eruption left some 10 million air travelers stranded worldwide after winds pushed the ash cloud toward some of the world's busiest airspace and led most northern European countries to ground all planes for five days.

Whether widespread disruption occurs again will depend on how long the eruption lasts, how high the ash plume rises and which way the wind blows.

In November, melted glacial ice began pouring from Grimsvotn, signaling a possible eruption. That was a false alarm but scientists have been monitoring the volcano closely ever since.

The volcano also erupted in 1998, 1996 and 1993. The eruptions have lasted between a day and several weeks.

___

Jill Lawless and Danica Kirka in London contributed to this report.

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Promise of Arab Uprisings Is Threatened by Divisions

BEIRUT, Lebanon — The revolutions and revolts in the Arab world, playing out over just a few months across two continents, have proved so inspirational to so many because they offer a new sense of national identity built on the idea of citizenship.
 Video interviews with more than two dozen people under 30, from Libya to the West Bank, talking about their generation’s moment in history and prospects for the future. Riot police clashed with protesters in Tunis on May 6.
But in the past weeks, the specter of divisions — religion in Egypt, fundamentalism in Tunisia, sect in Syria and Bahrain, clan in Libya — has threatened uprisings that once seemed to promise to resolve questions that have vexed the Arab world since the colonialism era.
From the fetid alleys of Imbaba, the Cairo neighborhood where Muslims and Christians have fought street battles, to the Syrian countryside, where a particularly deadly crackdown has raised fears of sectarian score-settling, the question of identity may help determine whether the Arab Spring flowers or withers. Can the revolts forge alternative ways to cope with the Arab world’s variety of clans, sects, ethnicities and religions?
The old examples have been largely of failure: the rule of strongmen in Egypt, Syria, Libya and Yemen; a fragile equilibrium of fractious communities in Lebanon and Iraq; the repressive paternalism of the Persian Gulf, where oil revenues are used to buy loyalty.
“I think the revolutions in a way, in a distant way, are hoping to retrieve” this sense of national identity, said Sadiq al-Azm, a prominent Syrian intellectual living in Beirut.
“The costs otherwise would be disintegration, strife and civil war,” Mr. Azm said. “And this was very clear in Iraq.”
In an arc of revolts and revolution, that idea of a broader citizenship is being tested as the enforced silence of repression gives way to the cacophony of diversity. Security and stability were the justification that strongmen in the Arab world offered for repression, often with the sanction of the United States; the essence of the protests in the Arab Spring is that people can imagine an alternative.
But even activists admit that the region so far has no model that enshrines diversity and tolerance without breaking down along more divisive identities.
In Tunisia, a relatively homogenous country with a well-educated population, fault lines have emerged between the secular-minded coasts and the more religious and traditional inland.
The tensions shook the nascent revolution there this month when a former interim interior minister, Farhat Rajhi, suggested in an online interview that the coastal elite, long dominant in the government, would never accept an electoral victory by Tunisia’s Islamist party, Ennahda, which draws most of its support inland.
“Politics was in the hands of the people of the coast since the start of Tunisia,” Mr. Rajhi said. “If the situation is reversed now, they are not ready to give up ruling.” He warned that Tunisian officials from the old government were preparing a military coup if the Islamists won elections in July. “If Ennahda rules, there will be a military regime.”
In response, protesters poured back out into the streets of Tunis for four days of demonstrations calling for a new revolution. The police beat them back with batons and tear gas, arrested more than 200 protesters and imposed a curfew on the city.
In Cairo, the sense of national identity that surged at the moment of revolution — when hundreds of thousands of people of all faiths celebrated in Tahrir Square with chants of “Hold your head high, you are an Egyptian”— has given way to a week of religious violence pitting the Coptic Christian minority against their Muslim neighbors, reflecting long-smoldering tensions that an authoritarian state may have muted, or let fester.
At a rally this month in Tahrir Square to call for unity, Coptic Christians were conspicuously absent, thousands of them gathering nearby for a rally of their own. And even among some Muslims at the unity rally, suspicions were pronounced.
Anthony Shadid reported from Beirut, and David D. Kirkpatrick from Cairo. Heba Afify contributed reporting from Cairo, and an employee of The New York Times from Damascus, Syria.
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