When considering ways to reform the U.S. health care system, the U.S. Congress did not give adequate consideration to a single-payer, state-based like the one being considered by the Vermont State Legislature, Harvard School of Public Health Professor William Hsiao writes in the March 16 issue of the New England Journal of Medicine.

While the Patient Protection and Affordable Care Act (ACA) makes great strides in providing for the rising number of uninsured Americans, it offers only “modest pilot efforts” for the U.S. health care system’s other major problem—rising costs, writes Hsiao, KT Li Professor of Economics at HSPH and a consultant on health reform to the Vermont State Legislature.

“Because of strong political opposition, however, the U.S. Congress never seriously considered a single-payer approach during the recent reform debate. Now Vermont, wishing to solve the intertwined problems of costs and access through systemic reform, is turning in that direction. Vermont Governor Peter Shumlin campaigned on a platform of single-payer health care, and Democratic legislative leaders are committed to this approach,” Hsiao wrote.