Category Archives: Health care

We’re Not Retreating. We’re Advancing to the Rear.

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What is an institution to do when it makes a decision that kinda blows up in their face? Well, one option is to stick with the decision but modify it just enough to quiet the critics. Or to put it metaphorically, apply enough lipstick to a pig and make people stop noticing it’s a pig.

As it happens, two august Vermont organizations are currently engaged in the messy business of searching for the minimum acceptable capitulation. Vermont State University is trying to figure out how many books it will have to preserve, not because it wants the damn things, but because it desperately needs to quiet the howls of criticism; and the Green Mountain Care Board is looking for a way to give away $18 million while convincing us that they’re not giving away $18 million.

VSU’s nascent leadership continues to fumble its plan to close the campus library system… sorry, create something better than libraries… no wait, they’ll still be libraries but unencumbered by books… oops, now we’ve got a “refined plan” that will select the most academically important volumes while disposing of the rest. (You can tell they’re proud of their plan because they posted it online last Thursday with no formal announcement or public event of any sort.)

Gee, it’s almost as if the original plan was thrown together in haste with minimal forethought. Which inspires no confidence in the ability of this administration to lead a troubled system out of its current straits and into a better tomorrow. The future of VSU’s library system is way down on the list of critical issues to be addressed. If they can’t handle this without it blowing up in their faces, how will they address a massive structural deficit when they’ve already squandered their credibility dicking around with the library plan?

And all the while, they insist they’ll implement this vaguely defined thing by the end of June, come Hell or high water.

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Housing the Homeless as Economic Development Strategy

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We could view homelessness as a moral failure… or a failure of capitalism… or a failure of individuals to live productive lives… or a problem in need of resources we can’t afford to commit…

Or… just spitballin’ here… a waste of potential and precious human capital.

For this discussion, we’re leaving out the moral and ethical dimensions of the issue. We’re not declaring an obligation to protect our most vulnerable. We’re putting on our green eyeshades and considering homelessness from a purely bottom-line point of view.

To hear the Scott administration tell it, extending the emergency motel voucher program is kind of like taking a pile of money and setting it on fire. It produces a bit of transient warmth, but it’s otherwise a waste of resources. Legislative Democrats and even some housing advocates often fall for this: They tacitly accept the premise instead of making the economic case for (a) giving everyone a roof to sleep under in the short term and (b) ending homelessness in the longer term.

When you look at it that way, you find that we can’t afford not to end homelessness. There is abundant evidence that addressing homelessness is an economic winner — not just in the long term, but almost immediately. So let’s stop talking about whether we can afford $72 million for another year of motel vouchers or $31 million for a stripped-down version of the program or a few hundred million to provide enough housing for all. Instead, let’s talk about the economic positives of a humane policy choice.

(I don’t pretend that any of this is my idea, but it ought to be more of a factor in our policy debates.)

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Green Mountain Care Board Prepares to Punt Away an Investment in Inpatient Mental Health Care

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Our health care guardians at the Green Mountain Care Board are trying to sneak through a bit of business that combines bad policy with questionable procedure.

Well, I guess that explains the “sneak through” part. They can’t be proud of this.

Six years ago, the GMCB ordered the University of Vermont Medical Center to take $21 million in surplus revenue and spend it on developing a plan to boost inpatient mental health care, which has been abysmally lacking since Tropical Storm Irene wiped out the old state hospital in 2011. We’re now in our twelfth year of inadequate inpatient care that has left severely mentally ill patients languishing in emergency rooms and frontline providers dealing with the consequences.

The failure to address this situation ought to be a source of embarrassment if not shame to Our Political Leaders.

Anyway, it seemed like a decent idea: Let UVMMC use the surplus to tackle a challenge that nobody else would.

Well, now the GMCB is about to let UVMMC off the hook, further delaying any meaningful response to the shortage of inpatient care. And the Board trying to rush it through with the least possible fanfare.

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Phil Scott’s Charmless Offensive

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Since the beginning of his fourth term, Gov. Phil Scott has been busily drawing lines in the sand and daring the Legislature to cross them. It’s a strategy that seems to borrow much more from his years at Thunder Road than from his allegedly collaborative approach to governing.

But he’s not stopping with public defiance of the Democratic majority. He’s also putting out a series of aggressive policy stances that threaten to further inflame relations with majority Democrats. First there was the proposal to shift state retirees’ health insurance from Medicare to Medicare Advantage, the Potemkin Village of senior coverage. That proposal was cheekily unveiled during campaign season, when you might think he’d at least pretend to be friendly to the state employees’ union. Second, his proposal to spend $900,000 to study an issue that’s already being studied by the state’s Climate Council.

And third, the Department of Public Safety’s transparently political plan to publish a politically motivated (and dismally stupid) crime “heat map” that won’t help the public understand crime trends but will give the administration another cudgel for its attacks on criminal justice reform.

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The Dangerous Drift of Vermont’s Health Care System

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When he was governor, Peter Shumlin made a big push on health care reform. It didn’t end well for reform or for Shumlin. Since then, the system has become less functional and more expensive but there’s been no appetite for another push.

With one major exception, and that’s OneCare Vermont. It has soldiered on in its effort to rein in health care costs by paying providers for outcomes rather than treatment. It has spent a tremendous amount of money, but so far there’s not much evidence of impact.

That’s troubling, and it’s more so when you read VTDigger’s piece about the latest Green Mountain Care Board meeting. Beyond that, there’s a broader critique of our health care system in a recent series of essays by journalist and health care policy analyst Hamilton Davis. Taken together, it looks like a huge sector of our economy (upon which our physical and financial well-being depends) is drifting along with a bunch of people who call themselves “Captain” staying as far away from the helm as they can.

The Digger article makes the leaders of OneCare look like The Gang That Couldn’t Shoot Straight. The GMCB, especially its new members, were asking questions that shouldn’t have been tough to answer. For instance, do you have any evidence that your system is working? Can you point to measurable results in terms of cost savings or improved outcomes?

OneCare leaders seemed to be taken aback by this line of questioning.

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The Health Care Crisis is Already Here

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Did you know that the Scott administration Covid policy isn’t aimed at reducing illness? Nope, they don’t care about that. The governor himself has said, over and over, that his goal is to prevent Vermont’s health care system from being overwhelmed. As long as the caseload is manageable, he’s fine.

Well, yeah, he’s fine.

But there’s a problem with that “set the bar low and jump over it” policy goal. It’s already failing. The health care system is already in crisis. It just hasn’t completely blown up yet.

And that’s only because of heroic and unsustainable efforts by health care workers and staff. The administration is desperately trying to patch things together and prevent a total blowup, and that’s all it cares about. Human Services Secretary Mike Smith has taken to giving weekly updates on efforts to add more subacute inpatient beds (to hustle patients out of the hospital as quickly as possible) and ICU beds — and the state is paying God knows how much to staff those extra beds.

I’ve also heard that the University of Vermont Medical Center is relying heavily on temporary nurses because it’s so short-staffed. If that’s the case at our crown jewel, imagine what’s happening in smaller facilities. Temporary nurses are in such high demand that they can almost write their own tickets, and the temp-staff agencies are making out like bandits. (Those agencies charge up to 100% of the staffer’s salary.)

The administration is willing to do anything, at any cost, because they don’t want to see Covid patients parked in emergency rooms or triaged for lack of resources. It’s not about quality of care of public health, it’s about avoiding a PR nightmare.

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