The conversation around healthcare these days is mostly focused on the Affordable Care Act, particularly its dysfunctional websites and healthcare plans ranging from "catastrophic" to "platinum." But something very different is unfolding in Vermont, where a people's movement has risen up and is leading the way to establishing the first genuinely universal healthcare system in the country.

Many people applaud Obamacare’s increased access to healthcare for a larger number of Americans. Others complain about its failings, such as increased premiums for decreased networks of doctors and a jumble of plans with high deductibles. The new system ensures the insurers billions in profits while still leaving millions of Americans uninsured. For many, Obamacare has been a positive step, but a far cry from the universal healthcare available in most industrialized countries. Study after study commissioned by the state government in Vermont over the past 10 years does the math which proves that a single-payer system, where administrative overhead and insurance company profits are eliminated, is a solution Vermont residents can’t afford to live without.

As with a number of other states around the country, Vermont has a long legacy of efforts to move toward single-payer healthcare. Vermont Citizens' Campaign for Health was started more than 30 years ago. In the early 1990s there was a serious push for single-payer. The torch was carried into the new millennium by “Vermont Healthcare for All “which was started in 1998 by Deb Richter, a former national president of Physicians for a National Health Program.

The efforts of these and other groups led to incremental healthcare reform and many state-financed studies conducted to research the viability of single-payer financing. While legislation pushing a universal health system had some traction, it was ultimately unsuccessfully as local politicians consistently felt pressure by health industry lobbyists. By 2008, efforts to create a statewide universal health system were sidelined as the ACA (also known as Obamacare) was being fought out at the federal level. If successful, resources would have to be directed to building the Vermont Exchange, the ACA-mandated marketplace for private insurance plans. But in May 2011, Act 48 was signed into law by Governor Shumlin, making Vermont the first state in the union to declare healthcare a human right and create a statewide universal health system.

What pushed it over the edge? In that time, Vermont residents began to take matters into their own hands.

Almost every Saturday for three months Mary Gerisch stood on the corner with a group of her neighbors holding signs that read “Healthcare is a Human Right“ and waved at the cars that honked their agreement. “We’ve had enough,” she explained, “Everyone who came out to the vigil has had their lives terribly affected by our health care system.”

Gerisch has Medicare, but as a retiree, she couldn’t afford the supplemental insurance needed to cover large expenses. Since dental isn’t covered at all, when she developed an abscess she couldn’t afford to go to the dentist. Within a short time, it developed into a systemic infection. She was forced to enter the hospital, via the emergency room, which resulted in bills totaling over $30,000.

“I have a judgment against me and am constantly harassed by collectors,” Gerisch said. “Since I have no car, house or salary they have nothing to garnish and have to settle for the few dollars I can come up with here and there.” Even now with the ACA in effect, nothing would be different for someone in her situation today.

In 2008, the Vermont Workers Center (VWC), which is dedicated to a broad range of economic and social rights, launched its “Healthcare is a Human Right” Campaign that brought together many groups and activated thousands of individuals to fight for their right to healthcare.

“We started with a door-to-door survey to get the pulse of the population,” says Matt McGrath, a community organizer with the Vermont Workers’ Center. McGrath had been recently laid off from his job at the Parks Department, when he stopped into the Workers’ Center Office in his neighborhood out of curiosity. They handed him a survey to fill in. While filling it in, he began to realize that his family had been divided as a result of our healthcare system. His father was forced to move to another state to take a job where he could get benefits.

After that, McGrath began to volunteer with the VWC where he helped administer the healthcare survey to others. The survey’s results showed that 95 percent of the respondents agreed healthcare is a human right. They began to invite people from different regions of the state to discuss what a health system based on people’s needs, rather than profit, should be guided by. From those discussions arose a consensus that healthcare must be provided as a public good, much like fire departments or schools. They agreed upon an organizing platform that incorporated five fundamental principles: Universality, Equity, Accountability, Transparency, and Participation. These principles act as a yardstick by which they can measure the various proposals that come up in the process of building the new system.

Just before Act 48 was passed, an amendment was introduced that said the new system would include everyone, except immigrants. “By having universality as one of our guiding principles,” Matt McGrath recalled, “we were not divided against one another. People of all races and economic backgrounds came out and defeated this amendment.”

“Many of my friends and family did not have health insurance and were forced to make decisions that no one should ever have to make,” recounted Megan Sheehan. When a friend introduced her to the Vermont Workers’ Center, she quickly joined as a member. She was impressed by their multipronged media strategy and since she had radio experience, she volunteered with their media committee.

In addition to having a weekly cable TV show and radio program, volunteers joined together to videotape residents telling their healthcare stories. From the tapes, they identified community spokespeople whose experiences showed the human tragedies suffered when healthcare is a commodity. Campaign volunteers invited politicians from regions across the state to meetings in their communities where neighbors came out to tell their stories publicly.

“We asked the politicians point blank if they believed healthcare was a human right,” Sheehan said. “Their answers told us everything we needed to know about which side of the fence they were on.” Winning universal healthcare is not an end for the movement the VWC has built. In many ways, it is only a beginning. “When you use human rights as a framework, you begin to understand how health care relates to many other issues, such as housing, education, and work with dignity,” Sheehan added.

Burlington resident Keith Brunner was volunteering with local environmental justice groups when he started to understand the connection between the various issues that people in his community were fighting for. He joined with the VWC on their livable wage campaign. Because he showed interest in helping to organize in his neighborhood, the VWC invited him to attend one of their “solidarity schools.” Now, he is working with the VWC’s Education Committee and helps organize two-day solidarity schools around the state. The VWC sees education as a crucial component to building local leaders who lift up others to organize in their communities.

“We reach out to people who are active with many different kinds of organizations and offer them free leadership training,” Brunner explains. In the Solidarity School’s workshops, they examine various issues faced by people in their communities and try to examine their root causes. “By using a human rights framework and our five principles as a jumping off point, we don’t get bogged down in the details of specific cases, but can see the bigger picture of how these issues fit in. A lot of other organizations are just action oriented and don’t make time for reflection. The struggle and each campaign is a school in itself and we need to learn, collectively, from our experiences,” Brunner said.

“I went through a bad healthcare situation in 2006 and almost died,” recalls Walter Carpenter. He was working at the time and had insurance. But when he got liver disease, most of his claims were denied because he went to the doctor without getting “prior authorizations.” He was extremely sick by the time he was able to get the first of three operations. At first, the hospital estimated it would cost $20,000, but after extensive pleading, the hospital was willing to charge him $8,000 instead.

“It came down to how much are you willing to pay to save your life,” Carpenter said. “I went to a meeting at a church near my home to tell my story. From that I began to volunteer with the VWC and worked on an enormously successful letters-to-the-editors effort.” In 2008, Carpenter also helped with a campaign in which the VWC got thousands of postcards signed by people demanding universal healthcare, and poured them out on the statehouse floor.

This has become a yearly ritual in which Vermont residents reaffirm their continued support for universal healthcare. In 2009?, Walter Carpenter joined the “People’s Team,” a group of red-T-shirt-clad community members who collectively act as a lobby group for collective universal healthcare regularly attending public hearings at the statehouse. Carpenter has sat in on over 1,000 statehouse meetings, wearing the group’s signature red T-shirt. He audio records each meeting to help the group stay on top of developments as they occur in the various committees. “We have been able to move the debate from an economic one to a moral one and I have no doubt we will win,” Carpenter said.

Representative Paul Poirier has been involved in Vermont politics since the 1980's and has seen single-payer efforts come and go. As a member of the State's Health Committee, who feels Obamacare doesn't go far enough, he has been happy to see the Healthcare as a Human Right movement pick up steam, in spite of the many business interests that have been pushing against it. "The only reason I keep getting re-elected is because I do what my constituents want," he said, "and they have been telling me very clearly that they want universal healtcare."

Act 48, won by these grassroots efforts, commits to setting up a publicly financed system by 2017. Using a waiver provision in the ACA, states can opt out of Obamacare and administer their own statewide health program, if they can demonstrate that the state’s access to healthcare will be at least as good as under the ACA. The “Healthcare Is a Human Right” campaign is working toward an innovative new system where insurance premiums are done away with and all state residents become automatically eligible for publicly financed healthcare that covers the care they need, when they need it. While Act 48 puts Vermont on a path to a universal healthcare system, the state must accomplish several steps to realize that goal. Most importantly, the details of which revenue streams Vermont will use to pay for the new system and how it will be administered must still be worked out.

In a concession to the insurance industry, Obama took a single-payer option off the table at an early stage of negotiating the ACA. Now, the people of Vermont have shown that lots of people in this country will not stop organizing until they get the universal healthcare they feel we all deserve. Pressure on Vermont’s politicians who have embraced the new system is mounting. Elections are this November. With insurance and pharmaceutical companies mobilizing to prevent universal healthcare from moving forward and the Koch brothers heavily financing pro-Republican campaign spots that seize the opportunity created by the failings of Obamacare, the battle in Vermont is set to intensify. As people continue to occupy political spaces, reach out to their neighbors and take action, it remains to be seen if people power in Vermont will triumph over the traditional healthcare industry victors.

As the first state to create a universal health care system for its residents, the eyes of the country will be focused squarely on Vermont as it goes forward. Much like gay marriage and medical marijuana, universal healthcare could be won on a state-by-state basis. With the limitations of Obamacare becoming ever clearer, people in other states are looking to Vermont to learn how they can make their elected officials institute universal healthcare. Grassroots groups in Maine, Maryland and Pennsylvania have picked up the VWC’s “Healthcare is a Human Right” banner and are borrowing some of their organizing tactics to build their own movements.