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.