The Shumlin Administration has made it quite clear -- the state will be in charge of the delivery of healthcare in Vermont. For the moment let's set aside the philosophical and political issues that are attached to such takeovers and address the state's existing performance in key areas.
Few question the state's willingness to take over much of our lives. But does anyone question whether the state has the operational skills in which to do so? I don't believe it does.
For example, the state, for many years has operated the only public mental health facility, the 52-bed Waterbury mental health hospital (destroyed by tropical storm Irene). Twice, the state failed to meet the standards that were in place by CMS, the federal agency that oversees facilities receiving Medicare and Medicaid. As a result, the state does not receive upwards of $12 million annually in federal aid to operate the hospital. The funding must come out of the state's operating budget. This was not a 1,000-bed hospital but a 52-bed institution.
One of the hallmarks of the 1997 education funding allocation system (Act 60 and later Act 68) was to bring control over education spending as well as to redistribute funds to those school districts that had inadequate grand list assessment capacity. After much animus, the controversy over the state's taking over the funding mechanics quieted down. In 1998, when the program commenced, there were about 109,000 students enrolled in Vermont's public schools. Today, there are approximately 80,000 students and the cost has about doubled.
Another major program that falls under state government is the state's long-term criminal incarceration system. The system's cost has gone up geometrically over the last 10 years. One of Vermont's costly "export" items is the nearly 700 inmates who are sent to prisons, as far away as Kentucky and Arizona. The major reason is lack of space -- and let's not ignore, a lack of planning for the inevitable increase in prison population.
The Vermont State government is the gatekeeper of the state's employee retirement system (pension/health benefits) for the thousands of retired teachers and state employees. These former employees and their families depend on how well the retirement system is operated. The investment pool designated for their benefit is under-funded by over $3 billion. This financial nightmare has not been addressed -- and will not be. It is just too big a problem in which to do so.
Recently, Gov. Shumlin announced that the state is losing the battle to control the distribution and use of illegal drugs. For the chief executive of a state, the size of Vermont, to make such an admission is disappointing and discouraging. The drug problem did not come into existence overnight. It was in evidence 20 years ago but little attention was paid to the devastating impact it would have on Vermonters.
The governor was not alone in acknowledging failure. According to VPR commentator, Bill Schubart, writing in VTdigger.com noted, "Human Services Secretary Doug Racine recently acknowledged his own agency's defeat in reducing childhood poverty in Vermont..."
And let's not leave out the fact that so many Vermonters go hungry each day. In some reports it amounts to approximately 30 percent. The problem has only become more tragic in recent years. And to make matters worse, the state is paying fines to the federal government, totaling three quarters of million dollars, for mismanaging the Vermont food stamp program. And if a story in Vermontbiz.com on Dec. 16 is correct, there could be another $960,000 in fines levied against the state for not mandating able-bodied recipients to find employment.
There are many activities for which state government does quite well and others it does not. One would think that it would work on those activities that it needs to improve upon before it embarks on taking control of the healthcare system, which represents a sixth of the state's economy.
Mediocrity, carelessness and lack of planning maybe acceptable in many areas of state government. They have no place in the operation of the state's health care system -- this is not a political or philosophical matter -- it becomes a personal matter.
Clearly, state government, based on its track record, does not have operational skills to manage the healthcare system. It's time it recognized this and reverse course.
Don Keelan writes a bi-weekly column and lives in Arlington.