Here's a radically simple idea: What if, on Town Meeting Day, Vermonters were allowed to vote on how much money they spend each year for health care, the same way they vote on public school budgets? Would it affect how and where health-care dollars are spent and who gets coverage?

Advocates for universal health care in Vermont believe so, and floated the idea at a panel discussion last week about containing the state's skyrocketing health-care costs. With Vermont facing a $70 million Medicaid shortfall, the largest in the state's history, representatives from two groups -- Vermont Citizens' Campaign for Health and the Vermont Public Interest Research Group -- pitched an initiative that will appear on ballots next week. On March 1, voters in 18 communities, including Burlington, will be asked if they support the creation of a universal and comprehensive health-insurance system that is publicly financed and covers all Vermonters from cradle to grave.

The goal of these nonbinding measures is to "light a fire" under lawmakers and the governor and to show broad citizen support for universal coverage, says Richard Davis, executive director of the Vermont Citizens' Campaign for Health and one of the three panelists.

"People say we have the best health-care system in the world," says Davis, who has also been a nurse in Vermont for 28 years. "But we pay a lot for what we don't get."

In fact, nearly twice as much as the rest of the industrialized world, he contends. Although Vermonters spend more than $5000 per person each year on health care, more than 63,000 -- one in 10 Vermonters -- went without coverage in 2002. Of those, about 90 percent were employed full- or part-time. Health-care expenditures are now the leading cause of personal bankruptcy nationwide, even among those with health insurance.

Part of the problem, Davis explains, is that as insurance premiums rise -- from an average of $7054 for an employee-sponsored family plan in 2001 to a projected $14,565 in 2006 -- fewer small businesses can afford health insurance for their employees. As a result, employers are forced to cut benefits, which in turn leads to more uninsured or underinsured patients showing up in hospital emergency rooms. The net effect: The costs of those visits are passed along to everyone else, which drives insurance rates even higher.

The crux of the issue, Davis contends, is the current system's "absurdly inefficient" level of overhead and paperwork. Since the early 1970s, the number of nurses and physicians has remained largely static, while the number of administrators has grown by more than 2000 percent. Overhead and profits now comprise as much as one-quarter of our insurance premiums.

Opponents of a single-payer system have long argued that overhauling the current system would be far too expensive and complicated. But Burlington attorney John Franco, one of last week's discussion panelists, argues just the opposite. Franco, who helped draft a universal health-care bill in 1991 based on the Canada Health Act, contends that a unified health system in Vermont would be modest in size -- comparable, he says, to the number of participants in Blue Cross/Blue Shield of North Dakota.

"This is not pie-in-the-sky," says Franco. "It's small potatoes."

Vermont Citizens' Campaign for Health and VPIRG are hoping these ballot measures will "begin the dialogue for a roadmap towards universal health care," says Theresa Cassiack, VPIRG's public-health advocate. "It's time to stop playing Russian roulette with people's lives." Both groups are planning a daylong demonstration on universal health care at the Statehouse on April 5.