In the writing of the bill, the 2006 health care overhaul in Massachusetts, which also did not include a single-payer system, served as a model. Now, advocates for a single-payer system hope that Vermont can serve as a model during future efforts to reform the health care system on either the state or federal level. If so, Hsiao’s work will be on center stage.

Given the amount of gridlock and partisan rancor on Capitol Hill, Hsiao says that the only hope at widespread reform may be on the state level. Though reform in Vermont is still early in the implementation process, experts predict that if it succeeds, the state would likely become an example for other larger states to follow. California, Oregon, Pennsylvania, Minnesota, and Colorado have all approached Hsiao in recent months to solicit his help in possible reform efforts in their states.

“If Vermont is up and running and seems successful in the next five years, it could affect presidential agendas in 2016 and beyond,” Blendon said.

According to Hsiao, the problem is that while the Affordable Care act extended coverage to nearly all Americans, the inefficiencies latent in the system were left unchanged, allowing health care costs to continue to soar. The problem, he says, is a systemic one related to how Americans approach health services.

“Right now our whole structure is if you get sick I treat you and I get income. If you do not get sick, I don’t get paid. It’s not rocket science to see that is unsustainable,” Hsiao says.

In other words, doctors have an incentive to treat sick patients after the fact, rather than prevent sickness beforehand, a much less expensive approach.

“The mistake the United States made is that we poured so much money into health care and we postponed our reforms for so long, we’ve created very powerful stakeholders,” says Hsiao. “They are so invested, they make it so difficult, if not impossible, to reform the system.”

But if the health care overhaul in Vermont can show that it maintains the quality of care while at the same time reducing costs, advocates for a single-payer system hope that the state’s system can be implemented in other states or used like as a model for a federal overhaul akin to the way the Massachusetts system featured in the 2010 health care debate.

After it enters full operation in 2015, the Vermont law is estimated to save the state 25.3 percent annually compared to current health spending.

Critics of the law assert that the new system is likely to decrease the quality of care, lead to increased wait times, and reduce salaries in the health care industry, decreasing incentive for potential health care workers to enter the field.

But if Hsiao and his colleagues are able to present data after the law’s implementation that contradict these claims, the Vermont law could become a powerful counterargument to conservative claims against a single-payer system.

—Staff writer Nicholas P. Fandos can be reached at nicholasfandos@college.harvard.edu.