Growing the Campaign for
Universal Primary Care
A Network-Based Playbook for
Creating Contagious Change in Vermont
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The Challenge: Overcoming Past Failures and Political Inertia
Vermont's current healthcare system is economically and morally unsustainable, characterized by a crisis of the underinsured, crushing costs for small businesses, and massive administrative waste. Previous efforts to achieve universal coverage, notably the Vermont’s 2011 Single-Payer Health Insurance Legislation, failed not because of a flawed policy but due to a collapse in political will. This has created a legacy of skepticism and inertia that stands as the primary obstacle to reform. A new approach is required—one that moves beyond traditional lobbying and instead builds an undeniable, grassroots social consensus for change
The Core Strategy: Change as a “Complex Contagion”
This playbook presents a new strategy grounded in the science of social change. It posits that adopting a universal healthcare system is a “complex contagion”—a high-risk, controversial idea that people resist until they receive social reinforcement from multiple, trusted sources. Therefore, the campaign's central objective is not to broadcast a message but to become “social architects,” intentionally weaving a new, dense network of trust and mutual support across Vermont's diverse communities.
Strategic Implementation: The “Snowball Strategy”
The strategy is executed through a patient, methodical process of network weaving:
Map the Network and Target the Periphery: The first step is to map Vermont's civic landscape (business groups, faith communities, education leaders, etc.). Change is initiated not at the center with established influencers, but on the periphery, by cultivating small, protected “incubator” groups of innovators who are open to new ideas.
The Endgame: From Social Will to Political Action
The ultimate goal is to create a new social norm where UPC is seen as a mainstream, legitimate, and necessary solution. Success is measured by the organic adoption of the campaign's language, spontaneous actions from partner groups, and a shift in the opposition's tactics. This broad-based social will creates an environment where legislative action becomes a political inevitability rather than a fight. The final passage of legislation will be the formal recognition of a change that has already been methodically built from the ground up.
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Why Universal Primary Care Is a Democracy Issue
The Challenge We Face
Since 2016, we've been fighting to protect democratic institutions from authoritarian assault. We've organized, rallied, and resisted. We've had important wins—7 million people at No Kings 2, Democratic victories on November 4th.
But we face a deeper problem: millions of Americans are losing faith in democracy itself because it's not delivering basic security for their families.
When people can't afford to see a doctor, when medical debt crushes them, when small businesses fail under insurance costs—they learn from lived experience that "the system" doesn't work for ordinary people. That's when they stop voting. Or worse—they vote for authoritarians who promise to burn it all down.
Vermont's healthcare crisis is a democracy crisis.
And we have a concrete opportunity to prove that democracy can still deliver: H.433, the Universal Primary Care bill.
What Is Primary Health Care?
Primary health care is your healthcare home—your first point of contact for any health concern, delivered by a trusted physician or nurse practitioner who knows you, coordinates all your care, and helps keep you healthy over time.
Under H.433's plan for Universal Primary Health Care, every Vermonter would have:
A personal primary care provider (family physician or nurse practitioner) who serves as your healthcare quarterback—someone who knows your history, your challenges, and your goals
Integrated mental health and substance use treatment as part of routine primary care, not as a separate, stigmatized service you have to seek out on your own
A care team approach that coordinates specialists, hospitals, and community resources so nothing falls through the cracks when you need more complex care
Prevention-focused care including screenings, vaccines, chronic disease management, and the testing needed to diagnose communicable diseases
Critically, this means no co-pays, no deductibles, no surprise bills for these essential services. It means you can see your doctor when something's wrong—not when it's already a crisis. It means early detection instead of emergency rooms. It means managing diabetes before it costs a leg and catching depression before it costs a life.
Good primary care also strengthens communities by addressing the social conditions that affect health and working toward health equity so everyone has a fair chance at wellbeing.
This is what H.433 would guarantee: not just insurance, but an actual healthcare home where you're known, cared for, and never turned away because of cost.
Why and How This Campaign Protects Democracy
1. Democracy dies in isolation; it thrives in connection
The authoritarian playbook depends on division, exhaustion, and tribal warfare. The UPC campaign does the opposite.
It brings together:
Farmers and nurses
Small business owners and teachers
Faith leaders and union members
Conservatives and progressives
When a dairy farmer and a mental health counselor both testify at the State House about why they need universal primary care, that's democracy working. That's the pluralistic coalition-building that authoritarianism cannot survive.
This campaign creates a thousand moments where Vermonters discover common ground across difference. That connection—across class, geography, and political identity—is the antidote to everything Trump represents.
3. Economic security is community security
Why are so many Americans vulnerable to authoritarian promises?
Part of the answer: They're drowning in medical debt, avoiding care because of deductibles, watching their businesses fail under insurance premiums.
When people experience economic insecurity as a permanent condition—when they're always one emergency away from ruin—they become desperate. And desperate people make desperate political choices.
Universal Primary Care is preventive medicine for democracy itself. By delivering tangible economic security, we rebuild faith that democratic institutions can improve people's lives.
The question is simple: What happens when 200,000 Vermonters learn from experience that their government can't (or won't) deliver affordable healthcare? They stop trusting democracy.
We can't let that happen. Not here. Not on our watch.
2. Civic muscle atrophies when we only react; it grows when we build
Since 2016, we've been in perpetual defense mode. But defense alone doesn't rebuild democratic institutions.
The UPC campaign is a multi-year organizing laboratory where we practice democracy by:
Organizing town halls and cross-sector convenings
Training volunteers in facilitation and storytelling
Mapping community needs and building coalitions
Holding elected officials accountable to deliver
These are exactly the organizing muscles we'll need for every fight ahead—including the fight to protect democracy itself.
We don't build democratic capacity by resisting alone. We build it by organizing to win concrete victories that prove the system can work.
4. State-level victories create the template for national resistance
Trump's assault on federal institutions makes state-level organizing more critical than ever.
If Vermont becomes the first state to implement universal primary care, we:
Help 645,000 Vermonters immediately
Prove it can be done (creating a replicable model)
Demonstrate that states can lead when the federal government fails
Show that democracy delivers when we organize for it
Remember: Marriage equality didn't start in Congress. It started in states like Vermont and Massachusetts.
State victories become proof of concept. They show other states what's possible. They demonstrate that organized people can still win against organized money.
The Bill: H. 433
What it does:
Provides universal primary care to all Vermont residents (Year 1)
Adds preventive dental and vision care (Year 2)
Phases in additional services over 10 years
Eliminates co-pays and deductibles for primary care
Uses a public financing model (payroll tax + income surcharge)
Current status:
28 legislative sponsors
Sitting on the committee wall
Needs grassroots push to move forward
Why it's winnable:
Primary care = only 6% of total healthcare costs (manageable start)
Phased implementation reduces risk
Delivers immediate, tangible benefits
Builds momentum for broader reform
Strong policy foundation from 2011 Act 48
What You and Others Can Do
Immediate actions:
Host educational sessions on H.433 for members
Organize letter-writing campaigns to House Health Care Committee
Coordinate testimony during legislative session
Train "Story Ambassadors" to share healthcare experiences
Network-building actions:
Recruit members to join cross-sector convenings
Build coalition relationships with:
Local business associations
Healthcare worker unions
Faith communities
Education groups
Service clubs (Rotary, Lions, etc.)
The Key Takeaway
Democracy isn't just voting and institutions. It's the daily practice of working across difference to solve shared problems.
If we want to protect democracy, we have to prove it works. We have to show people—not tell them, show them—that when they organize, when they build coalitions, when they demand that representatives deliver for working families, democracy responds.
The question is:
If we can't prove that here in Vermont, then where?
If not now, when we face the greatest threat to democratic institutions in our lifetimes, then when?
Universal Primary Care is winnable. The strategy exists. The coalition is forming. What's missing is the organized grassroots push.
That's where you and the groups you’re connected to come in.
The strategy: This isn't traditional lobbying. It's network weaving—systematically building trust and common cause between diverse community groups. When business owners, nurses, teachers, and faith leaders all speak with one voice, legislators respond.