Shots fired!
In response to revenue cuts ordered by the Green Mountain Care Board, the University of Vermont Health Network is slashing services at multiple locations. Most egregious, to me, is the closure of Central Vermont Medical Center’s inpatient psychiatric unit.
Reminder that we’ve had a chronic shortage of inpatient psychiatric space more or less continuously since 2011, when Tropical Storm Irene put the final nail in the old Waterbury state hospital’s coffin. And now we’re cutting eight beds?
A cynical observer might infer that UVMHN disagrees with the Board’s mandate, and is forcing the issue with unpopular and/or unworkable reductions. Seven Days’ Derek Brouwer wrote that the Network’s announcement “ratchets up a long-simmering tension” between the Health Network and the Board.
The Board was in a ratcheting mood itself. It issued a huffy statement Thursday afternoon expressing deep concern with the cuts and asserting that it “was not consulted on, and did not approve, these reductions.”
Well, boo frickin’ hoo.
Last month, the Board mandated cuts in hospital revenue across the state. Not cuts in profits or net revenue, but total revenue. Heck of a way to run a railroad. I mean, an organization usually has two choices when facing a financial pinch: grow revenues or cut operations. And the Board not only ruled out revenue growth, but actually ordered revenue reductions. What did they think the hospitals would do?
These latest developments may have ratcheted up the tension, but it’s been simmering for quite a long time. Back in 2021, VTDigger published a piece (by my former Seven Days colleague Katie Jickling) asking the musical question, “10 years after it was created, has the Green Mountain Care Board worked?” It quotes a health policy expert as saying “Everyone’s mad at the Green Mountain Care Board” (which would make a lovely sampler) and cites a letter to the GMCB from John Brumsted, then CEO of UVMHN, that accused the board of becoming “untethered” from its guiding principles and making decisions that “will harm Vermont’s patients and hospitals.”
Hmm. If tensions have gotten worse since everyone was mad at the Board and our top health care exec deemed it “untethered” and harmful, we’re in some serious trouble. And this, at a time when a consultant reported that our health care system is “badly broken” and on the verge of an existential crisis. So, things are bad and they’re going to get much worse. Strikes me as a time when the big boys ought to be pulling in the same direction, no?
Now, I’m not an expert in health care policy or finance, nor do I pretend to be. But I do know this: The GMCB is something of a kludge. It was originally proposed by then-governor Peter Shumlin as part of the single-payer health care system he hoped to implement. He scuppered his signature policy initiative after the 2014 election, but somehow the Board survived and became the state’s health care regulator with a mandate to control costs.
And its work seems much more focused on our hospitals than on, say, Big Pharma or Big Insurance or any of the other Bigs that might be too big for the Board to handle. Again, no expert here, but that’s how it looks.
The GMCB’s six* members include three* attorneys, two academics, only one doctor**, and no one from the world of health care administration. (You could maybe count Board member Robin Lunge, who was Shumlin’s Director of Health Care Reform, as having administrative expertise, but running a policy shop is not the same thing as managing a medical institution. And I’m not sure if being Shumlin’s health care point person is really a credential given how that project ended up crashing and burning.)
**Clarification: The Board has five members, not six. Its website led me to believe otherwise; the Executive Director is included in the list of “Members” alongside the five actual, um, members. Apologies for being misled by a poorly laid-out webpage. Further clarification: The three attorneys include the Executive Director, so there are only two attorneys on the actual GMCB.
**I don’t think there’s ever been more than one health care practitioner on the Board since it was founded, and sometimes there have been none at all.
Not that I have tremendous faith in health care administrators, but they do offer relevant expertise and deserve a seat at the table. And if I have to choose sides in a pissing contest between the Board and UVMHN, I’m opting for the latter. Three years ago it was perfectly valid to ask if the Board had accomplished anything since its creation. It’s an even more relevant question now, as the Board has alienated pretty much the entire health care system with what seems to be an impractical and punitive mandate. Not to mention that [checks notes] it has failed to rein in health care costs.
And now we’re entering a systemic crisis.
This doesn’t seem ideal.
The Vermont Political Observer. 
The VPO is my hero.
My first issue is that the contest between the UVM network and the Board leaves some patients behind the eight ball today not tomorrow. The UVM network said “Today’s a hard day for our organization and for our leaders.” He did not mention patients in his lead statement. That is in my way of thinking quite unfortunate. Leadership of both groups need to get real before someone dies because of this sharp disconnect.
They probably do know what they’re doing, and it’s not what we are led to believe. The first chair of this board was Kevin Mullin, the VT legislative Rep. For ALEC–the American Legislative Exchange Council, that funnels corporate dollars into state legislators, who do not identify themselves as such in their states. Their job is to take the model legislation generated by ALEC–which reflects the desires of corporations, not the people of any state–and revise it enough to be proposed in their state as if it were written by them; Again, never identified as a nation-wide effort of corporations. People in Vermont remain oblivious to the role of ALEC in moving right-wing legislative trends into state legislatures across the country.
There are many right-wing nationwide trends that covertly move into our legislatures–including the dismantling of public systems, privatizing them into corporate hands, which is the unraveling of democratic institutions across the country. This is true of the Medical Industrial Complex which has been privatizing what were once called “hospitals” and are now called Medical Centers. It is true with the dismantling of education, which began back when Dick Scharf allowed himself to be bullied by then-commissioner (a Democrat BTW) to pressing his committee to begin the process of deregulating our schools. That our Vermont media–despite how much we love and appreciate them as people and our neighbors–fail to report outside of the mainstream VT narrative (i.e what earns them the role of “stenographers to power”) keeps us in the dark about the inner workings of public policy until it’s too late.
That lack of understanding, especially about several highly significant statewide topics, is why people were generally surprised to see the GOP flip seats. People on the ground–Vermonters, your neighbors–who have been ignored by the legislators AND Vermont media (look at how few public commentary pieces are actually published) have spoken. And still Vermont media fails to understand MANY of the core issues: The undermining of Act 250 by our governor from within, and a mainstream narrative that fails to report anything beyond lobbyist propaganda; and the expensive and unwieldy policies like Clean Heat Standard, and other mandates that represent tech industry dominance in the public communications sphere John Rogers gained many non-partisan votes on these topics.
For anyone who read Orwell’s 1984 in high school decades ago (or even recently), we should understand the importance of taking everything VPR and every other Vermont media outlet that generates the same narrative with limited discussion with a dose of skepticism. Ask yourself, “What is being omitted? Who are they relying on as experts? Do their reports and embedded views represent my interests? And then read outside of your comfort zone and think for yourself beyond the intentional right-left partisan framing.
I just read the story about the cuts I live in Barre, omg what are they doing to CVH. My practice already has merged it’s offices, maybe they should tell Randolph to stay in Randolph Gifford. My 2 cents
I think this analysis may be a little schematic.
You have: a hungry, top-heavy behemoth (UVMHN) managed by a completely compliant board; a regulatory body built as an afterthought (GMCB) by a governor who was already halfway out the door, one which, as you note, has rarely had a health care practitioner on board; an aging population in a state that can hardly house the (ever diminishing) number of health care workers who will continue to be necessary to care for that population; a fiercely protective group of regional medical centers which attempt to provide all things to all patients, and which are intensely suspicious of their services being balkanized by some ad hoc committee. And like UVMHN, have recently joined the fray, cutting selected patient services with little or no notice, evidently in response to GMCB’s recent mandate, the “…unpopular and/or unworkable reductions” you note. (See vtdigger and Randolph Herald for 11/14/24.)
The sniping at one another by the various parties strike me as foreground to a shared deeper understanding that the state simply won’t be able to bear the financial strain of this system very much longer. And overlooked in this view is the ongoing and worsening immediate problem of providing daily health care in Vermont, namely the crazy imbalance between quality of care (excellent) and the accessibility/availability of care (unacceptable.)
In case you might have missed them, I recommend giving a listen to Marc Johnson’s recent interviews with:
Bill Schubart https://podcasts.apple.com/us/podcast/vts-health-care-system-is-broken/id1708273447?i=1000666896542
Stephen Leffler (UVMMC President) https://podcasts.apple.com/us/podcast/can-vermont-afford-a-%242-billion-operation/id1708273447?i=1000669693963
Owen Foster (chair, GMCB) https://podcasts.apple.com/us/podcast/emergency/id1708273447?i=1000673295571
(By the way, given that UVMHN’s captive insurance company was based offshore in Bermuda until 2017 — where UVMHN C-level executives regularly enjoyed expensive, lavish retreats — and moved to Burlington only after an investigative report by vtdigger, Brumstead’s remark about GMCB being “untethered” passes neither the laugh nor smell test.)