But this is Vermont, a state in the vanguard of offering health benefits to its residents. Under the Vermont Health Access Plan, a program for people who are earning just enough to make ends meet, Mrs. Lacaillade only pays $3 a month for her medicine.

“Medicine is awfully expensive today,” she said. “The old people need some help.”

That is the prevailing philosophy here, embraced by the Democratic governor, state legislators from both parties, doctors and, clearly, the public.

The array of health benefits that Vermont provides its residents — not just the elderly but also children and low-income adults — is unmatched by any other state.

And while many of Vermont’s programs would not work in larger and more urban states, other aspects could serve as models. Today, 93.5 percent of all Vermont residents have health insurance, including essentially all children. By contrast, only 63 percent of low-income children in Texas and 60 percent in Arizona are insured.

“It is my view that health insurance ought to be universal, the right of every citizen in Vermont,” Gov. Howard Dean said in an interview.

Under a program called Dr. Dynasaur (some marketing wizard thought up the odd spelling), the state has guaranteed free medical and dental care to every resident age 18 and younger from a family with income below about $50,000 a year.

Adults with income below 150 percent of the federal poverty line are entitled to medical coverage for a nominal fee. The poverty line, for instance, is $8,350 this year for a single person and $17,050 for a family of four. That means a single adult earning less than $12,500 is eligible, as is a family of four with less than $25,500.

In addition, health insurance companies are required to sell policies to residents who request one, and must provide them at the same cost to all customers, regardless of their age or medical history.

Here is what this can mean for a family: Gary and Sheila Clayton live in Burlington, barely making ends meet. He is a glazier for a company that does commercial and residential glass work. She works part time as a clerk in a doctor’s office. They have three children, 12, 10 and 5. If they took family health insurance through Mr. Clayton’s employer, it would cost $89 a week.

But the Clayton children are covered by the Dr. Dynasaur program. And under the Vermont program for families with incomes only slightly above the poverty line, Mr. and Mrs. Clayton pay only $40 every six months for their own coverage.

When Bradley, the 5-year-old, was born, he spent a week in the hospital in the neonatal care unit. The hospital bill was almost $10,000; Dr. Dynasaur paid all of it.

Mr. Dean, a Democrat, and his wife, Judy Steinberg, are physicians, and the generous health benefits are largely his doing.

He took office in 1991 determined to pass legislation that in one fell swoop would provide health coverage to everyone in Vermont. His bill was similar to the one offered by the Clinton administration in 1993, and it was defeated in the State Legislature in 1994, just months before the Clinton plan died in Congress.

So Mr. Dean began implementing the plan gradually — extending coverage to low-income adults one year, providing drug coverage to the elderly another, expanding coverage for children another. This year, 28,600 elderly and disabled Vermont residents, about one-third of those on Medicare, are receiving drug coverage under the state program. The Dr. Dynasaur program covers 55,000 of the state’s 145,000 children.

“I now realize that the only way you can do this is incrementally,” he said. “You do it piece by piece and bit by bit because you can’t take on every special interest all at once.”