Tag Archives: Mark Larson

Shumlin Administration Dumps Ballast

Frontrunner for Least Surprising Personnel Move of the Year:

Department of Vermont Health Access Commissioner Mark Larson is stepping down from his post in March and will be replaced by Deputy Commissioner Lori Collins on an interim basis, the Shumlin administration announced Tuesday.

First of all, I don’t know how much blame Larson deserves for the disastrous rollout of Vermont Health Connect, or in the fundamentally flawed oversight of its development. What I do know is that last September, when the VHC website was finally taken offline so it could be patched together, Larson was the only administration official to pay a price. He was benched from any involvement in VHC, but allowed to keep his job and perform other, undefined duties.

And as you may recall, when Gov. Shumlin announced his abandonment of single-payer in December, Larson was relegated to a seat across the room from the phalanx of officials backstopping the governor. Didn’t want him appearing in any press photos, I guess.

Either he was a scapegoat, or he failed. In any case, he got to keep his job and his salary, even though one of DVHA’s chief operations was no longer in his control. Nice work if you can get it.

Shumlin issued a statement on Larson’s departure, praising the soon-to-be-former Coffee Boy.

“Mark has worked as hard as anyone on my team over the last four years,” Shumlin said. “Mark led the Department through some challenging times, but no one cared more or tried harder to overcome those challenges so Vermonters could access affordable health care than Mark.”

I don’t doubt that he cared deeply or tried hard. The question isn’t how dedicated he was — it’s how effective he was. From all outside appearances, the answer is “not very.”

And yet, by the time he leaves, he will have occupied his position and drawn paychecks for a full six months after one of his primary responsibilities was removed.

One of Governor Shumlin’s best qualities is his loyalty. He builds a team, relies on them, and rewards them for their service. It’s also one of his worst qualities: he sticks by his people whether they objectively deserve it or not. Failure rarely results in punishment or removal; at most, there’s a mutually agreed upon parting of the ways. Shumlin’s been in office for four years now, and I believe the only high-profile person he’s ever fired is Doug Racine — his longtime #1 political rival, and definitely not a Shumlin insider.

In announcing Larson’s departure, both he and the governor noted that, during his tenure, the number of uninsured Vermonters has dropped by half. Which is true; but is that a matter of causation or correlation?

Available evidence suggests the latter.

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Here’s something Governor Shumlin should stop saying

Ever since last Thursday’s inaugural ceremonies, Gov. Shumlin has been telling anyone who will listen that he was “saddened” by the presence of protesters. Like other Democrats, he singles out the one protester who crossed the line by singing during the benediction.

He has to highlight that one moron because otherwise, the demonstrators were not disruptive or offensive. They followed the rules of civil protest. The inauguration proceeded as scheduled until the very end.

Of course, what really offends the governor is that they dared to crash his coronation. The Vermont Press Bureau:

“The inauguration is an opportunity where we all say, ‘Let’s roll up our sleeves, cut out all this party stuff and get to work,’” the governor said. “And I just don’t think that they did their cause… much good by the kind of tactics they employed…”

Or in Brill Building terms: “It’s My Party and I’ll Cry if I Want To.”

The whingeing is excessive and self-centered. But I’d like to focus on one thing the Governor is saying, over and over again, that hurts his credibility. It goes something like this:

“I was really saddened by what happened yesterday, because I’m as frustrated as anyone with our health care system, and there’s no one that wants to see the goal of universal access as much as I do,” he said.

That’s from Saturday’s Burlington Free Press, but he’s been spouting variations on that theme in other outlets.

And he needs to stop. Now.

For one thing, it’s false. For another, it’s a two-sided statement: Shumlin is trying to emphasize his own political pain and loss — but at the same time, he’s downgrading everyone else’s.

Is there really no one who is more frustrated by Shumlin’s abandonment of single-payer? Is there really no one who more ardently wants to see universal access?

Of course there is.

Start within the administration itself. Are Robin Lunge or Mark Larson less disappointed than Shumlin? How about Anya Rader Wallack? Or Jonathan Gruber, who’s become a national laughingstock and has now lost his best chance to enact single-payer? There must be, at minimum, dozens of staffers and contractors who’ve put their heart and soul into Vermont’s single-payer initiative. That’s not to mention the single-payer advocates like Deb Richter and Peter Sterling, who served on the Governor’s Consumer Advisory Council and had the rug pulled out from under them.

Widening our scope, how about the entire Progressive Party, which put its own gubernatorial ambitions on hold for three straight election cycles in order to give Shumlin a free hand on single-payer? Might they be more frustrated than the Governor?

Which is not to overlook Democrats who’ve fought for single-payer. Maybe ex-Rep. Mike Fisher feels a bit of disappointment after losing his bid for re-election and then the cause he’d worked so hard for.

Finally, let’s not forget the tens of thousands of Vermonters who still don’t have health insurance, and the additional tens of thousands who still struggle to pay their premiums, in spite of the Affordable Care Act’s advancements. They are directly impacted by Shumlin’s decision in ways that he will never, ever be. He’s a millionaire who can afford any kind of health coverage he wants, up to and including concierge medicine from the Mayo Clinic.

That’s a partial list, but a substantial one. I think it’s safe to say that there is at least one person more frustrated and more disappointed than Governor Shumlin.

Whether he intends it or not, the Governor slights the feelings and experiences of all those people  when he claims special status as the number-one victim of single-payer’s demise.

As for what he should say instead, here’s a suggestion:

“My decision not to pursue single-payer health care has caused a lot of anger and frustration, and disappointed a lot of people, including many who have supported me politically. Our inability to move forward on single-payer has brought pain to thousands of Vermonters who are still without health insurance. 

“I apologize to each and every one of them. My commitment to universal access is as strong as ever, and as long as I am Governor, I will strive to advance the cause of universal access to the best of my ability.” 

There. That’s not too hard, is it?

The Emily Post Guide to Gubernatorial Seating Arrangements

There’s one unobserved aspect of Gov. Shumlin’s white-flag presser on single payer health care that I’d like to mention before the event is any farther in our rear-view mirrors.

Because the Governor was announcing his single payer reversal not only to the media, but also to his two big Advisory Councils on health care reform, the event was moved from his ceremonial office to Room 11, one of the larger conference rooms in the Statehouse (which is notorious for small, cramped, unphotogenic rooms). Room 11 is on the first floor, to the left of the Abe Lincoln bust that dominates the central hallway.

It’s a long rectangle; the east and west walls are the long ones. There’s a big wooden conference table along the west wall. Directly in front of this table is a rather narrow open area; along the east wall are three long rows of chairs.

The south wall (closest to the front of the building) is kind of an open area. In front of the north wall are several rows of seats.

The lectern for the news conference was set up on the south end of the room. The seating area on the east wall was filled with members of Shumlin’s Business Advisory Council and miscellaneous others. The conference table opposite was where most of the media sat. (Yeah, we grabbed the comfy chairs.)

In the open area between east and west walls, the TV cameras were set up.

The seating area near the north wall was where Shumlin’s Consumer Advisory Council sat.

Now, it’s well known in government circles (and probably the private sector as well) that proximity equals influence. Presidential staffers clamor for space in the White House instead of the Executive Office Building, for instance.

Well, in this case the Business Advisory Council got the prime seats. The Consumer Advisory Council was in the Siberia of Room 11. Their view of the lectern was blocked by all the TV tripods.

You don’t think that was an accident, do you?

Oh, and also languishing in the cheap seats was a rather forlorn looking Mark Larson, who still holds the title (and draws the salary) of Vermont Health Access Commissioner, even though he was sidelined months ago in a staff shakeup. He may still be a top Shumlin health care executive, but he was nowhere near the front of the room where all his, ahem, colleagues hovered closely behind the governor.

After remarks from Shumlin and others, he opened it up for questions. He sought to go back and forth between the media and members of his two Councils.

Who do you think dominated the Q&A period? Well, the media did, but aside from that it was all Business Advisory Council. Only one voice emerged from the back of the room: CAC chair David Reynolds made a brief and forgettable statement about how much hard work had been done. Not a peep was heard from CAC members like Peter Sterling, James Haslam, and Dr. Deb Richter — three of Vermont’s leading advocates for single payer. Maybe they were in shock, or maybe they couldn’t be seen from the lectern because of all the TV guys.

Several members of the BAC spoke. All were vociferous in their praise for everyone’s hard work, and all credited Shumlin for his hard work and his wisdom in scuppering single payer. Yeah, right: some of these guys were against single payer from day one. A couple of them were harshly critical of the media for being mean to the governor, when in fact we were only doing our jobs, and Shumlin gets worse than that in his regular news conferences.

The business community, up close and with a clear view of the Powers That Be. The consumer representatives, exiled to the back of the room where they’d have to jump and shout to be recognized.

Given the content of Shumlin’s announcement, that all seems about right.

VHC and the NFL

The National Football League, the unstoppable beast of modern sports, is having a bad time of it. Commissioner Roger Goodell, team owners, and players are under scrutiny for what appears to be an epidemic of bad behavior toward women and children, and a casual attitude toward violent offenders.

In actual fact, there are no more or fewer incidents than there have ever been. The problem is the league’s hypocrisy, backtracking, dishonesty, and double-dealing. Or, as we learned from the Watergate scandal — well, we should have learned it — it’s not the crime that gets you, it’s the cover-up. If the NFL had gotten out in front and taken plausibly strong action, its current PR crisis would never have happened.

Which brings me to Vermont Health Connect, our long-troubled and (temporarily?) sidelined health care exchange. And particularly the need for a heavy dose of the best disinfectant: sunshine.

To begin with the takeaway: Please, let there be no more surprises. If there are unrevealed problems, call a news conference ASAP and get all the bad stuff out in the open at once. No more dribs and drabs, no more Friday afternoon newsdumps; just a public accounting for everything. Take heed of the NFL’s tribulations, made worse every time new information comes out or a prominent figure sticks his foot in his mouth.

Maybe there’s no bad news left. Maybe we know it all. That would be great, if true. But the Administration’s recent track record doesn’t fill me with confidence.

Go back, first of all, to the Friday afternoon newsdump to end all Friday afternoon newsdumps: the release of the Optum report detailing serious problems with the state’s oversight of the VHC website’s construction. Not problems with the technology or software; but serious management shortcomings by Shumlin Administration officials. The report was released the Friday before Labor Day, so maybe you missed it.

At the time, the words of responsible officials were not reassuring. Health care reform chief Lawurence Miller said the Optum report would help chart “the best way forward,” which seemed to preclude any accounting for past maladministration. And Health Access Commissioner Mark Larson, who has since been sidelined from VHC oversight, allowed as to how his takeaway from the report was that “we have worked hard with our vendor partners.”

Well, yeah, hard. But not effectively.

On September 15 came the temporary VHC shutdown. It was first announced as a way to streamline repairs and upgrades in advance of the next open enrollment period. It made sense, and I praised it at the time: stop futzing around, get it fixed, and set the stage for the single-payer debate.

Since then, a couple things have happened that cast doubt on my sunny interpretation. A few days later, VTDigger’s Morgan True reported that the VHC shutdown had as much to do with a site-security crisis as with a sudden onset of managerial diligence.

Over the summer the federal government provided a timeline for reducing security risks, which expired 10 days ago…

Miller and Harry Chen, the secretary of the Agency of Human Services, decided to take down the website last weekend because the state was unable to meet a Sept. 8 federal deadline for security controls; the determination was not the result of a security breach or a specific threat.

“Rather than asking for more time, we decided to disconnect from the federal hub,” Miller said.

Miller could not rule out the possibility that the feds might have ordered a VHC shutdown if the state had failed to act.

Which puts quite a different complexion on the shutdown. And Miller didn’t reassure much when, speaking about security issues, he had trouble with verb tenses:

… it needs to be a high priority; it needed to be a higher priority than it was.

A curiously passive tone, methinks.

The very next day, we learned that top state lawmakers were displeased that they learned of the VHC shutdown through the media. Sen. Ginny Lyons, chair of the Senate Health Care Oversight Committee, said “We’re legislators, so we need to know.” Miller’s response? Officials kept it quiet for security reasons.

“The nature of the announcement was also an abundance of caution. Security advisers say when you’re going to do something for security reasons you do not telegraph that ahead of time.”

Uh, sorry, but no.

The federal government has crafted ways to share top-secret information about things like war, terrorism, and intelligence with appropriate members of Congress. I think Shumlin’s people could have passed a quiet word to, say, legislative leadership and the chairs of the health care committees. I think those people could have been trusted to keep a secret, for a couple of days, for good reason.

Miller’s explanation, of course, implies that lawmakers cannot be trusted. I think if I were Ginny Lyons or Mike Fisher, I’d be insulted by that.

And next winter, when Shumlin starts the push for single-payer, he’s going to need the support, good will, and trust of those leaders. Well, Miller as much as said he didn’t trust them.

I sincerely hope we’ve emptied out the Pandora’s Box of VHC. If there are still some dark, unexamined corners and crevices, then I implore the Administration to throw open the lid and let the sun shine in.

Lasers, lasers everywhere

This morning, the Shumlin Administration did a very good thing. It announced that the Vermont Health Connect website will go offline for several weeks, to try to fix its problems before the start of the next open-enrollment period on November 15. In the meantime, VHC access will be offered through a call center.

If the Administration hadn’t taken this drastic step, the repairs would have had to be postponed until after the open enrollment period —  in February, right at the time when lawmakers will be asked to approve single-payer health care. And how could they do so, if VHC wasn’t yet working properly?

So yes, this is a positive development. I hope we get progress reports in the interim, and I really hope they can pull it off by mid-November. That’d clear the decks for single-payer.

Also today, while the Governor didn’t take my advice (shocking, I know) and “fire some folks,” he did shuffle Health Access Commissioner Mark Larson off to the side:

Shumlin moved oversight for the insurance program from Larson’s department and placed it under the leadership of Miller, the governor’s longtime troubleshooter and former secretary of commerce.

… Larson appeared at the press conference but did not speak.

I’ve been told that the Governor is loyal to those who are loyal to him, and is loath to let people go. (Didn’t apply, obvs., to Doug Racine.) Which is a laudable trait, but can sometimes go too far.

Anyway, give Larson other stuff to do. Fine.

I do have one other suggestion for the Governor: find a new metaphor. Today:

“We have more work to do to make sure Vermonters have a well-functioning website by November 15,” Shumlin said at a press conference in Winooski. “I’m focused on that goal like a laser.”

That “laser focus” thing sounds great, but not when he uses it every time he faces a challenge. December 2012:

“There isn’t a Democratic governor who doesn’t understand climate change is the challenge we must focus on like a laser,” he said.

Also December 2012: 

Shumlin also told House Democrats to “focus like a laser” on health care implementation.

At the September launch of his 2012 re-election bid:

“When I ran two years ago I promised that I would focus like a laser on getting tough things done to create jobs and better economic opportunities for Vermonters.

This past June, signing a bill promoting clean heating technologies:

“For years, through Efficiency Vermont and other organizations, our state has focused like a laser on reducing our electric energy consumption.

Old Habits Die Hard: Back in 2002 when he was running for Lieutenant Governor, Shumlin promised a three-for-one deal:

There are three things I’m going to focus on like a laser beam. The first is bringing about fair prices for prescription drugs. …The second issue is juvenile justice. …The third is job creation.

One of the rules of handling metaphors: they lose their impact with repeated use.

The Friday Afternoon Newsdump of the Year

Gee, what a co-inky-dink. A new report on the rumblin’, stumblin’, fumblin’ rollout of Vermont Health Connect was released on Friday afternoon. 

Before Labor Day weekend. 

When Governor Shumlin was hundreds of miles away, at his vacation home in Nova Scotia. 

Ah, leadership. 

The report is pretty damning, and should have been tackled head-on by the Governor instead of being shuffled quietly out the door on a holiday weekend. It’s not too late; he could come back to work, express dismay at the report’s conclusions, take repsonsibility for administrative failures, promise to learn lessons and do better in the future, and maybe even fire a few people. 

Now, that would be leadership. And it would allow the Governor to launch his re-election campaign next Monday in a strong, purposeful, and accountable manner. Do I think that will happen? Eh, probably not. But it’d be nice. 

The report was written by Optum, the consulting firm that’s trying to fix the mess left behind by former contractor CGI. Topline, per VTDigger: 

A lack of leadership at Vermont Health Connect left the tech firm CGI unaccountable for work it was supposed to complete on the state’s health care exchange, according to a consultant’s report released Friday.

 

The state “ceded” responsibility for the project’s success to CGI, …and as a result, “CGI has not met its commitments.”

This is bad. This is not a technology issue in a super-complicated new system, as the Administration has insisted; it’s a failure of management on the part of Administration officials who should have been riding herd on CGI. Instead, the Vermont Press Bureau’s Neal Goswami says, 

Optum found that accountability for program management is unclear. “Neither (the state) nor CGI believe they are accountable for project outcomes,” the report says.

Am I the only one who’s appalled by that? CGI was fired for poor performance; but state officials failed to make CGI “accountable for project outcomes.” As any business-school professor could tell you, that’s fucked up. And if CGI deserved to be fired, so do the government officials who played a big part in its failure.

And none of those officials are named “Doug Racine.” 

Optum recommended that the state hire a project manager with experience in handling large-scale IT projects. State health care reform chief Lawrence Miller says the state is about to hire such a person. 

Well, huzzah. That’s a little bit late, isn’t it? 

In March, TIME Magazine published a cover story about how the federal health care exchange was on the brink of complete failure last fall. The Obama Administration realized, belatedly, that while they had a lot of policy expertise, they were woefully short in IT. So they basically called the Geek Squad: a team of IT experts from Silicon Valley “dropped what they were doing… and came together in mid-October to save the website. … Washington contractors had spent over $300 million building a site that didn’t work, this ad hoc team rescued it and, arguably, Obama’s chance at a health-reform legacy.”

You’d think, after all of that, the Shumlin Administration would have known it had a huge challenge on its hands, and that it required both IT expertise and intensive management oversight to fix the health care exchange. 

Instead, only now are we hiring an IT expert. 

On Friday, in the Governor’s absence, Lawrence Miller and Health Access Commissioner Mark Larson released the Optum report. And their statements were not at all encouraging; they downplayed the significance of the report and the need for further action. Miller called the report “something of a snapshot,” although as Goswami says, “the findings… are similar to previous assessments by independent parties.” In other words, this report may have been a snapshot, but the picture has stayed pretty much the same over time. 

Miller also said the Administration would use the report “to make decisions about the best way forward with the project.” Well, that’s half right. But you should also use the report to assess the failings of the past — so that you stop repeating them. 

For his part, Larson was even more determinedly lipsticking the Optum pig: 

“On a broad level what we have taken, generally, from this report is that we have worked hard with our vendor partners to create a foundation for Vermont Health Connect.” 

I’m sure they’ve all worked hard. But I’m not convinced that they have worked well or effectively. In fact, if the Optun report is accurate, a lot of the hard work has been wasted or misdirected thanks to a lack of accountability and oversight. Working hard is not an excuse for failing to deliver the goods. 

Oh, and the other news from the ultimate Friday afternoon newsdump: on Optum’s advice, Vermont Health Connect has stopped working on fixing the system. Instead, it will try to make the incomplete system more customer-friendly in advance of the November-February open enrollment period. Further work on fixing the system won’t resume until after open enrollment. 

Great. Even as Governor Shumlin is unveiling his single-payer health care system and asking the Legislature to approve it, Vermont Health Connect will still be an unproven work in progress. 

You know, if I were a lawmaker, I’d refuse to take any action on single-payer until Vermont Health Connect is fully functional. The Governor can’t, in fairness, ask lawmakers to vote for a huge new system as long as the health care exchange isn’t working. 

I’m fully aware that single-payer will actually be simpler than Vermont Health Connect. On a policy level it makes perfect sense. But on a political level, you can’t take the next step in the process until you’ve successfully finished the previous one. 

Beyond the immediate situation, bad as it is, I have a more existential concern. Governor Shumlin earned a reputation as a capable manager in his first term, thanks largely to his response to Tropical Storm Irene. The endlessly-troubled health care rollout threatens his reputation for good management. And that’s why I’d advise him to step up strongly and take his medicine. And, yes, fire  the people who failed to hold CGI accountable. 

If he doesn’t, I fear the best days of the Shumlin Administration may be over. When you’ve been in office for a while, and the opposing party is in disarray, there’s a natural tendency to relax a bit, start seeing yourself as invulnerable, and pay more attention to your image than to the quality of your work. That is the beginning of the end for great leaders everywhere throughout history. Is it the beginning of the end for Peter Shumlin? 

And for single-payer health care?

A head has rolled

Shocking, but not surprising news this morning out of the capitol city. Paul “The Huntsman” Heintz:

Gov. Peter Shumlin has dismissed onetime political rival Doug Racine as secretary of the embattled Agency of Human Services.

“These decisions are difficult, but the governor felt a change in leadership at AHS was needed at this time,” Shumlin spokeswoman Sue Allen said Tuesday morning.

Doug 'n Pete in a happier moment. (Photo from VPR)

Doug ‘n Pete in a happier moment. (Photo from VPR)

Laura Krantz at VTDigger writes it as a Racine departure, not a firing. Which makes me wonder if the last straw was last week’s emergency budget adjustment, with its calls for further cuts in an already-overstretched agency. Maybe Racine stood up for his people, and got shot down for his trouble. I have no inside information on that point, but the timing certainly fits.

Whether a push or a jump, the shock is the suddenness of it all and the fact that the scythe took its first cut at the top level rather than, say, taking a Mark Larson or a Robin Lunge. It’s not surprising because sooner or later someone in state government had to take the fall for Vermont Health Connect’s continued troubles.

I say so not because any one of the three is more or less culpable for the VHC mess, but because Larson and Lunge were more directly involved. And because a cabinet member is a key gubernatorial appointment, this is a more direct reflection on the Governor himself.

But as Heintz points out, the trouble isn’t all health care-related. AHS’ Department of Children and Families has also come in for criticism following the deaths of two young children under its supervision. In that context, Racine was the most relevant target.

Health Commissioner Dr. Harry Chen will be interim AHS chief, with an appointment through the end of the year.

My take, and I have absolutely no knowledge of how AHS works or doesn’t: It was an almost impossible job. In fact, when Shumlin appointed his chief political rival to the post, I wondered whether it was an honor or an exile. AHS is a big, complicated operation that’s usually overtaxed and underresourced. Racine took the job after years of Jim Douglas-mandated cuts, and the disastrous implementation of Challenges for Change. It was the kind of job that was almost certain to leave Racine with a tainted reputation as a manager, especially with the Governor’s aversion to tax hikes and obsession with cost-cutting. And on top of all that, AHS was home base for health care reform and its myriad pitfalls.

It was a thankless job, and Racine kept at it for almost four years. And did his job largely out of the public spotlight, with a dignity and dedication that speaks well of him.