by Rob Roper
Governor Peter Shumlin acknowledged that everyone is right to be worried about what his administration is trying to do in regards to healthcare because government has “gotten it wrong every single time.” But this time, he assures us, Vermont is going to get it right by putting “really smart people” in charge of the process. Well, the call went out on June 17th for those really smart people to come forward.
The deadline for getting your resume in for the five positions on the Green Mountain Health Care Board is Monday, July 11 at 2:00 pm. According to Sen. Kevin Mullin (R-Rutland) who is on the nominating committee, “About a dozen [resumes] are in so far,” but based on conversations with potential applicants he expects more will be in by the deadline.
Why such a paltry response to such a national, historic opportunity?
Committee member Kevin Kelley is concerned the salary being offered is not compatible with the size and scope of the job. Kelley runs Community Health Services of Lamoille Valley, a Federally Qualified Healthcare Center (FQHC).
“I think the money that was placed in the bill, H.202 which is now Act 48, is an initial offering that I think is going to have to be increased very quickly,” said Kelley. “We want somebody in that position that knows what they’re doing, that’s an expert on finance, especially healthcare finance, to help control these costs…. When you’re comparing it to the CEO salaries of some of the larger healthcare institutions in the state, I think it’s a dramatic disparity between what we’re offering the Green Mountain Care board chairman, and the co-members on that board.”
Indeed, outgoing CEO of Fletcher Allen, Dr. Melinda Estes started her job in 2003 at $700,000 a year, and was earning $1.9 million in 2009. And, with no disrespect to Dr. Estes, the job of GMC chair appears to be much bigger than running just one hospital. The advertisement for the GMC position describes the job:
… the first charge to the Board is controlling the growth of health care costs by revamping the way doctors and hospitals get paid.
The Board’s oversight responsibilities include reviewing a health information technology plan, a health care workforce development plan and a resource allocation plan. The Board will set rates for health care providers. The Board will also have the final approval for insurance rate requests, hospital budgets and capital projects requiring certificates of need.
The Board will adopt a benefit package providing Vermont residents timely, high quality health care from the provider of their choice.
This is a gargantuan (some would say impossible) task, and we are not ponying up the dollars necessary to attract top talent in this marketplace. Shumlin has essentially promised success by getting us the best shortstop in the league while offering to pay the league minimum. Ain’t gonna happen.
This presents some serious problems. Practically, if instead of attracting “really smart people” to the job, we end up with mediocre middle management in over their heads, this scheme is headed for certain disaster. But, politically, if the objective is to control costs by getting the evil allure of money and profits out of our healthcare, how could proponents of GMC justify paying these five elite political appointees the hundreds of thousands of dollars they could otherwise get elsewhere?
Another worrisome aspect of this process is the list of qualifications the board thinks are necessary to do the job:
- Commitment to the principles expressed in the law;
- Knowledge of or expertise [emphasis added] in health care policy, health care delivery, or health care financing, and openness to alternative approaches to health care; and
- Possession of desirable personal characteristics, including integrity, impartiality, health, empathy, experience, diligence, neutrality, administrative and communication skills, social consciousness, public service, and regard for the public good.
The first qualification is ideological. The Kool Aid must be drunk. But it is the second bullet point that should send off sirens. The nominating committee does not require “Expertise” in healthcare policy, delivery, financing, etc. to be a necessary skill to run our healthcare system. It’s an “OR” proposition. Yikes!
So, the question for the board in the coming weeks is who of these dozen (maybe more) people will get a recommendation to the governor. The questions for Vermonters are, do we want a vastly underpaid non-expert running every facet of our $5 billion healthcare system, and will we surprised when we, like every other government Shumlin cites, “get it wrong” again?