This commentary is by Tom Sullivan, president emeritus and professor of law and political science at the University of Vermont.
Much has been discussed recently about how Vermont should finance health care for the welfare of all Vermonters. I share the perspective of Dr. Nat Mulkey’s thoughtful, recent essay in VTDigger on finding a “new narrative” to resolve Vermont’s health care challenges.
The current Vermont regulation over health care in the state grew out of an earlier proposal that Vermont should have a “single-payer” system. The Green Mountain Care Board was designed to fit that model of regulating health care. The “single-payer” proposal was dropped years ago, although the regulatory scheme under the GMCB remains.
The statute enacted by the Legislature at the time had worthy goals: broad access to quality health care at a reasonable cost. Surely, all Vermonters would agree that those important values and goals are still critical for a healthy society and for prosperous communities, whether large or small, in Vermont.
It is time to come together — our hospitals, medical centers, insurance carriers, the GMCB and the Legislature — to seek reform that will lead to an amenable, different path forward for Vermont. That includes full and equal consideration of a wide variety of facts that influence and impact our health and health care, as well as the need for consistent key investments to produce a strong and sustainable health care system for all.
Indeed, the statute giving the GMCB oversight references “enhancing the patient and health care professional experience of care,” as well as “recruiting and retaining high quality health care professionals,” and “achieving administrative simplification in health care financing and delivery.” Importantly, the statutory mandate focuses on not compromising “access to care and the quality of health care.”
I hope we all agree that, throughout the United States, health care is too expensive. But a single-bullet approach of “capping revenue” for hospitals is having the opposite effect of the statute’s goals and is contrary to the common sense of Vermonters.
Quality care with successful outcomes is essential and comes only through needed (and sometimes costly) investments. We need to be clear that those needed investments in professional personnel, and research and clinical equipment, are reasonable costs with discernible, specific metrics, and relevant, competent data by which to measure.
Do we want to continue a focus largely on affordability at the expense of quality care, positive patient outcomes, and timely access to that care? Cutting revenues and hospital budgets cannot be the sole answer. Logic and experience tell us that approach will only lead to reduced patient access, lower quality care and fewer positive patient outcomes for Vermonters. Clearly, those consequences will erode our present critical health care quality and safety in a state that has the second-oldest population in the country, living in largely rural areas.
Let’s consider several facts in this context:
- UVM Medical Center is both a research-centric, academic medical center and a community hospital, offering specialized care that patients need and cannot get elsewhere in Vermont.
- The Medical Center has more than 1.3 million patients each year, plus nearly 70,000 emergency visits.
- The transformative research that happens at the UVM Medical Center and the University of Vermont brings advancements to patients in this state, this region, and around the world.
- The Medical Center and University together are educating the next generation of providers amidst a nationwide health care workforce shortage. (32% of all physicians practicing in Vermont completed either their medical school education or residency training at the Larner College of Medicine and/or UVMMC.)
- UVM Health Network, in 2024, has an estimated $2.7 billion in economic impact in Vermont, including nearly 13,000 employees across the state – Vermont’s largest private employer — as well as thousands of other jobs supported indirectly.
- UVM Health Network generated $348 million in “community benefits” in Vermont in 2024 through its grants, donations, subsidized healthcare, and investments in addressing the social determinants of health.
UVM Medical Center continues to maintain its “four-star” status, placing it in the rating of “good.” This rating is well above the average for hospitals nationwide. It is the highest rating of any publicly accessible hospital in Vermont. Other medical institutions in New England that currently share the same rating as UVMMC include Dartmouth Hitchcock, Yale University New Haven, Harvard’s Beth Israel Deaconess and UMass Memorial Medical Center.
In sum, it is time for all health care providers, regulators, insurance carriers and the Legislature to come together to achieve “a meeting of the minds” and find common ground for a path forward to create a reformed, sustainable high quality health care system for Vermont. By working together with open minds and in good faith, all Vermonters will benefit.
Read the story on VTDigger here: Tom Sullivan: It’s time to come together to find common ground and an amicable path forward for health care reform in Vermont.