TNR Video Series: ‘Travels With Charlie – Vermont Politics in Real Life’ (Episode 20)

In the 20th episode of “Travels With Charlie — Vermont Politics in Real Life,” host Charlie Papillo talks about the high cost of health care with Green Mountain Care Board member Tom Pelham and Northwestern Medical Center CFO Robyn Alvis.

As Charlie and his guests sit in the medical center in St. Albans, they discuss underpayment for services by government payers, the shift of that cost to commercial payers and patients, the high price of pharmaceuticals, and more.

Special thanks to AmCare and their wonderful staff for being a part of this episode. 

Image courtesy of TNR

8 thoughts on “TNR Video Series: ‘Travels With Charlie – Vermont Politics in Real Life’ (Episode 20)

  1. In all this complaining about the high cost of health care and the multitude of suggestions on how to reduce it, where oh where is there included in this discusion of the simplest and most effective solutions? Why has not tort reform been included? The simple answer to that one is there are far too many lawyers in the legislature!!!!!

  2. To my thinking and from past money issues involving Government and the people within, payolla, self profiteering and greed is the real government. With VT being 4th highest for medical costs, that’s too far of an unbalance. The state being highly Socialist, there is a money attraction here for outsiders and their manipulations. It’s all about them, not us.

    Need some 2 x 4 attitude adjustments.

  3. “We have a capitalistic healthcare program and we’ve done nothin’ to mitigate profits in those sectors.” Northwestern Medical Center CFO Robyn Alvis

    Not only have Robyn Alvis and Tom Pelham misrepresented the facts in this video (and thank you, Meg Hansen, for detailing some of them), the above statement by Ms. Alvis underscores her gross misunderstanding of free-market economics. In fact, her misrepresentation is typical of all ‘Socialists’ that have governed Vermont’s healthcare system for the last 20 years.

    Rather than try to explain the nuance and detail of true free market economics in this commentary, I simply point out the results Robyn Alvis’ socialized governance has created.

    Vermont now has the 4th most expensive healthcare… “in the world”!

  4. Neil, Thank you for bringing this video to my attention. 4 alarming takeaways from this interview:

    1) Northwestern Medical Center CFO Robyn Alvis asserts that they “reduced utilization to the tune of $6 million because they were doing more care coordination.” False.

    (a) Utilization has gone down for the last several years because they restrict access to primary care physicians and specialists, as well as diagnostic medical imaging. This is known as rationing of health services. 

    (b) The ACO All-Payer model (run by a private company called OneCare VT) has spent millions on various complex care coordination programs, but cannot show any independently verified outcomes for these efforts. The clinical database they use is incomplete and inaccurate, which makes their claims of success all the more problematic. 

    2) GMCB Board Member Tom Pelham praises Northwestern for “starting Rise VT.” 

    Here is an excerpt about this very organization from my OneCare VT investigations (

    “OneCare has requested $16 million for operating costs in 2019, which is up from $12.5 million last year. The increased amount includes $3.4 million to integrate an organization called RiseVT into its operations. The additional funds will pay for four full-time RiseVT staff as well two staff for mental health efforts.What are the job descriptions, qualifications, and salary and benefits packages of OneCare’s new employees? These details are required to clarify whether this expansion would duplicate the health services already offered by existing and effective community-based providers like Blueprint for Vermont.

    During our investigation, RiseVT executive director Marissa Parisi refused to speak to us (citing a busy schedule), and ignored follow-up communications, because we asked for information that quantifies the results of their various primary prevention programs. For example, how have RiseVT’s efforts specifically reduced adult obesity in Vermont? What is the methodology used to collect the data needed to track outcomes? The pattern of absent or inadequate transparency with OneCare and its affiliates should offer Vermonters ample cause for concern.”

    3) Both Pelham and Alvis tout the model’s population approach. A few weeks ago, I called on OneCare to use data from its population based approach to help Vermont prepare for the pandemic when it hit. (

    “Because the elderly and people with chronic medical conditions (e.g. hypertension, diabetes, and COPD) are at a high risk for serious COVID-19 illness and death, the following metrics will help identify at-risk persons and allow healthcare providers to target preemptive care. By Hospital Service Area (HSA) and age group, for the first quarter of 2020 (Q1) –
    (a) Number and results of A1C (diabetes blood test) scores recorded
    (b) Number and results of hypertension cases under control
    (c) Number of COPD cases by severity

    Further, how many Vermonters tested positive/ negative for the influenza virus in each HSA in Q1 2020? This data could predict the potential impact of COVID-19 and guide resource allocation.”

    No response and there has been no evidence that they used their data toward preemptive care. Why? Because the database, which has cost tens of millions, is faulty and unreliable.

    4) Alvis concludes by calling for the mandatory enrollment of all Vermonters in this billion-dollar failed experiment.

    Further Resources:
    “Unreliable Data Plagues VT’s All-Payer Model” (

    “Vermont’s OneCare All-Payer System Beset by Problems” (

    “What is Vermont’s All-Payer ACO model?”

    “Why are healthcare costs so high in Vermont?”

    “Untangling the US Pharmaceutical Supply Chain”

    • Meg, question.

      So they spent $16 million to reduce healthcare expenses to Vermonters by $6 million dollars?

      Doesn’t that mean they cost Vermonters another $10 million dollars for administration?

      Do I undestand that correctly?

      • Shoulnt they have gotten a better return on investment? At least paying for itself? They should have at least saved $32 million with a goal of saving 10x or $160 million

  5. It is unethical to charge people different rates for the same service. This causes discrimination, whether you want to acknowledge it or not. I have long maintained that nobody should have to pay more than the Medicaid rate. If that is what our government pays, it must be right. If the Medicaid rate isn’t enough to cover your costs then you must lower your costs. It can and must be done. It is the only answer because health care costs are so high that most people can no longer afford them. Taxpayers pay for Medicaid and taxpayers can’t pay more. People have the power to say I will no longer pay for cost shifting. Just think if you are covered by Medicare you would not need supplemental insurance because Medicare pays more than Medicaid. D

  6. if you can’t negotiate prices….how is that capitalism?

    We are paying 2x more than Germany because it’s cronyism, capitalism would get us below Germany’s cost are reduce our health care costs by 60%. People on low cost are forced to pay for expensive medication rather than generic…despite the doctor prescribing generic…..that’s cronyism, some sales rep or pharmaceutical company with government ties.

    Trusted the vision? How about knowing the math?

    I bet Meg Hansen has some ideas on all this!

    Enlightening, we the 4th most expensive in the world, above all the other states in America!!! and we’re also pretty healthy…soooo what gives??

    I’m here for health care reform…I’d cost shift….

    Great interview, you’ve shown people who are in control and the problem. Healthcare is one of the greatest swindles in our state, it’s epic. They just exposed the numbers proving it.

    Affordability……when Vermont has the 4th highest per capita health care in THE WORLD you’re gonna blame it on others? When everybody on the planet does it better.

    Vermont is in a deep coma, Lord help us see the light and wake up, see the obvious in front of our eyes. In Jesus name I pray.

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