Editor’s note: Hamilton Davis writes the blog A Vermont Journal. The following post ran on Oct. 31, 2023. Davis has been a journalist and policy analyst for more than 50 years. His main areas of interest are health care reform, American politics, agriculture and food, the environment and education.

There is no shortage of complexity involved in Vermont’s healthcare reform project. Act 48, passed by the Legislature in 2011 ran to 141 pages. In 2022, the lawmakers added another 19 pages in Act 167, which after just 11 years of work provided some touching up and encouragement. A total wonk fest and lawyers’ dream. No section or subparagraph, however, counts for as much as the political support for the substance of reform itself. And in Vermont, no political voice can match up with that of Governor Philip Scott.
So, where does Scott stand on reform of the state’s doctor-and-hospital system, which accounts for 10 percent of Vermont’s state product and constitutes arguably the biggest prop under the Vermont economy? Well, it’s hard to say—and that’s a huge problem, for the health care system and for the state as a whole. 

Let’s look at the record.

The reform project encompasses two major problems—the financial standing of the UVM Health Network, and specifically the flagship Medical Center Hospital in Burlington; and rationalizing the non-UVM small hospital network, which operates 11 very small and pretty small facilities across the state. The Medical Center is the most critical issue, and it is in serious trouble, which Phil Scott knows.

Evidence. On June 1 of 2022, Scott wrote a blistering letter to the Green Mountain Care Board, saying their performance was unacceptable, and that he was ordering that body to address the problem immediately. Immediately clearly referred to the FY 2023 hospital budgets, which were about to undergo their annual review. To drive the point home, Scott said that he was ordering his Agency of Human Services to set up a “Committee” to oversee that process, to be managed by his Secretary of Human Services, Jenny Samuelson. The Committee members were to be a small group of senior physicians and hospital managers to advise on where the system should go; the process was to be entirely transparent, and the decisions of the Committee would be released to the public. 

Virtually all the specifics set out in the Governor’s June 1 letter went glimmering in the first few days—the envisioned membership of eight or nine blew out to 26 as every lobbyist and advocate in town howled at the moon; and over the summer the whole Committee scheme slid into irrelevance. Samuelson had no idea how to manage a gnarly political process and neither did her chief deputy, Shayla Livingston. That wasn’t the worst of it, however. 

In the late summer of the 2022 budget process, the Green Mountain Care Board made as big a hash of the budget process as it had each year since 2018—grinding down the UVMMC budget while ignoring the much higher spending and markedly worse quality in the 11-unit small hospital system. Yet, when Scott was asked his reaction, he responded that he had “full confidence in the Green Mountain Care Board to carry out its duties in a responsible way.” Okay, wow, so much for aggressive oversight. 

And Scott’s hands-off treatment of the single most financial, cultural and politically significant issue facing the state continues. The latest example is totally inside baseball—the public won’t even notice it, let alone care about it. Nevertheless, it confirms the proposition above: that in complicated matters, the Scott Administration simply doesn’t play. The event was the announcement a few days ago that Scott was reappointing Robin Lunge to her seat on the Green Mountain Care Board. 

Lunge served as the Director of Health Care Reform in the early years of the Shumlin Administration; Shumlin named her to fill a vacancy on the Board in the mid-teens. Her term was to expire on Nov. 1 of this year. In early 2022, Lunge collaborated with Board Member Jessica Holmes in an effort to get Lunge appointed the new chair following the retirement of then-Chair Kevin Mullin, who was retiring in August of 2022. 

The Scotties, however, informed Lunge that she could forget the chairpersonship, and that, in fact, they wouldn’t even let her keep her current seat…which they just did. Lunge is of no particular importance one way or another, but Scott’s disinterest in the mechanics of healthcare reform is of enormous importance to the future of the hospital-doctor system in the state. 

As of today, nobody has his or her hand on the political tiller of the state. It is unmistakable on health care, and it is pretty obvious, too, on issues like the state colleges, where we are running three when we can afford one, on the outlook for Lake Champlain, where we have no idea how to both maintain the dairy industry and cure the Lake’s ills, or the problem of how to maintain our rural high schools when they have lost half their students, or to manage our rural counties when you can run your computer only with difficulty and your phone is worse than cranky…

All 645,570, give or take, Vermonters need to be concerned about that.