Paul Dame: Green Mountain Care Board fails to ‘do no harm’

Editor’s note: This commentary is by Paul Dame, a former state representative for Essex Junction who served on the House Human Services Committee.

Nearly 10 years ago Vermont was plunged into an experiment in health care that ended up failing. The Green Mountain Care Board was originally set up to be the bureaucratic decision makers about what kinds of health care Vermonters were allowed to get under Gov. Shumlin’s experimental Single Payer Health Care system. Thankfully, Gov. Shumlin did the math and realized our state could not afford to move forward with the experiment and he pulled the plug. With no Single Payer program to enact, the Green Mountain Care Board did what most government agencies do — searched for a new purpose. Normally government is too big for us to notice a single agency or program wandering through the relevance wilderness completely lost — as long as they do no harm. But have they really done no harm?

It seems clear that even the modified mission of the GMCB as stated has gone unfulfilled. They are there to supposedly reduce health care costs. But they routinely approve the budgets of every major hospital and every insurance carrier with very little changes. After all, with zero health care providers or insurance company reps on the board they don’t have the expertise to object to nearly anything. Not only have they been unable to get our entire health care system’s spending under control, they themselves have more than tripled their own budget from around $2 million in 2010 to $7.7 million this year. How will they reduce the cost of a broader system when they can’t even control their own?

But the reason that 2021 is the year to finally disband the Green Mountain Care Board is because not only have they have been benign, they have actually done harm. One of the biggest negative effects that the Green Mountain Care Board has had on our system has been to specifically, intentionally deny health care providers from opening up. With a second wave of COVID warming up, people are starting to get worried once again about the capacity of our health care system. But few people realize that the GMCB has systematically been limiting the capacity of our health care system on purpose for years through the certificate of need process.

While fewer and fewer people are comfortable with putting their family members into nursing home, the GMCB has intentionally prohibited any new home health care agencies from getting a certificate of need. Why is this? Because 10 years ago they agreed not to award certificates of need until the current providers told them what the “need” was. Can you imagine allowing McDonalds to decide how many hamburgers need to be produced in Vermont before Al’s French Fries was allowed to open? The GMCB has never taken this monopoly-making power away from the current home health agencies and given it back to the people. And now, when Vermonters need this service the most, the GMCB makes it literally illegal for a new agency to provide service and care for older Vermonters. This keeps more older at-risk people stuck in nursing homes awaiting the next COVID outbreak.

Earlier this year the surgical center that opened in Colchester was denied the right to provide services for which its physicians are trained and certified. Why? Because the Green Mountain Care Board did not grant the certificate of need. Just days ago UVMMC’s Fanny Allen shut down their operating rooms again because of mysterious odor that was giving people headaches. Instead of letting people get such surgeries at a brand new facility, patients will line up behind those already waiting for the backlog of rescheduled operations at Fletcher Allen.

Lastly the recent IT failure at the UVM Medical Center has been another evidence that the push the GMCB has had towards efficiency, centralization and optimization has resulted in greater vulnerability. When the UVM system goes down, it affects nearly every patient in Chittenden County, even those who don’t need any services at the hospital. The GMCB’s push for OneCare has resulted in a collapse and consolidation of smaller, independent practices that have been gobbled up by UVMMC.

Our health care system could reach capacity this year because it was not allowed to grow naturally during the last decade. Years of the GMCB throttling demand has not has the desired effect of reducing costs — and now it has come with the additional cost of leaving us with the protection of a legacy system that is too centralized, too fragile and less resilient to the stress it finds itself in today.

By eliminating the GMCB and the certificate of need process, we would have another $7 million that could go towards treating patients instead of propping up bureaucratic salaries. And we would also allow the health care system to respond dynamically to the demand we need and build the missing capacity not only for this crisis, but also for any needs yet to come.

Image courtesy of Wikimedia Commons/Public domain

8 thoughts on “Paul Dame: Green Mountain Care Board fails to ‘do no harm’

  1. There’s surely plenty to critically examine when looking at the GMCB as Paul Dame points out.

    Now let me be super picky and point out one statement in Paul’s first paragraph concerning Gov. Shumlin and his Single Payer boondoggled that drew my attention and probably that of many other Vermonters:

    “Thankfully, Gov. Shumlin did the math and realized our state could not afford to move forward with the experiment and he pulled the plug.”

    This sentence implies that Shumlin administered the attempted Single Payer enactment effort in an objective, rational and business like manner. If we look back, that was hardly the case. Shumlin’s push of Single Payer was more like a multi-year drunken joy ride that ended with him crashing into a brick wall after doing more than $200 million in damages (State & Federal money wasted).

    When dragged out of the wrecked Single Payer Mobile, Shumlin blamed the Single Payer crash on rising health care costs and the dysfunctional Health Care Connect component of the effort……..At this point it was hardly a case of doing the math……He was busted for medical system malpractice and Single Payer ended.

    Oh, Wendy Wilton did do the math in 2016 and told Gov. Shumlin and all of Vermont that Single Payer could never work economically……She was right.

  2. Great article, Paul! I was on the Healthcare Committee the year the supermajority passed the Single Payer failure. The cost of this failure is outrageous, and there has been no accountability for it. Everything the bill promised has not come to pass; transparency, affordability, accessibility, and better quality. And all of this expense when only about 7% of our population at the time we’re uninsured, and half of them were uninsured because they wanted to pay out of pocket instead of using health insurance.

  3. Gov Scott some time back ask his agencies to find and list, ALL the existing boards and commissions in their many areas of authority ??? They have in total huge authorites!

    No result ever appeared. if I remember correctly Gov Scott finally said scrap the project, Nobody Knows how MANY boards and commisions we have set up and never heard from since. Or how much they all co$t the taxpayers.

  4. The Vermont Legislature created the GMCB of unelected officials to regulate the health care industry and control health care costs. When Gov. Shumlin’s Single Payer Health Plan failed, The GMCB should have been abolished. The GMCB has failed to control health care costs. Health care costs have risen faster than inflation for decades. Now the GMCB has another doomed to fail plan called the All Payer Waver which will pay health care providers to keep people healthy instead of a fee for service. It will take years to find out if the plan is working. All indications are the plan is not working . Goals are not being met . There is talk of making the goals more lenient and eliminating some of the services the reduced health care costs would have covered. But there are no reduced health care costs. The GMCB cares more about the sustainability of the insurance companies and the hospitals than it cares about people’s ability to afford care. People in Vermont are going without needed care because they can’t afford health insurance and the high deductibles. The GMCB has failed. It should be abolished. I really appreciate this commentary by Paul Dame.

  5. It’s unconstitutional on many levels, what are we going to do?

    Vermont likes it’s cozy monopolies protected by those in Government, that’s why we are so expensive and no matter what the minimum wage, NOBODY can afford anything.

    We are the most corrupt state in the union, this is but another example, they are everywhere.

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