Vermont Standard

By Kurt Staudter

Back in 2013, Governor Peter Shumlin took an obscure Burlington restaurateur and made him the Chairman and the business representative on the newly formed Green Mountain Care Board (GMCB). Al Gobeille was put in charge of our long-awaited move towards a single-payer, universal coverage, high quality healthcare system. Vermont would be first in the nation. However, in an introductory interview with Seven Days, he gives an early indication how he felt about the single-payer effort: “I never was a single-payer advocate, or an advocate of anything. Whatever we come to, as long as it works for doctors, patients and business, we’ll have dealt with the flooded basement. And I’m okay with that.”

The basement reference came earlier in the piece when he used it as a metaphor to say that all large jobs have a beginning. This simplistic approach to healthcare reform from the current leader of the effort should have been a warning that we weren’t going to have the best and the brightest working on this issue.

It was at this point that our effort to achieve a single-payer came off the rails. Although the GMCB was tasked with transforming our fee-for-service system into single-payer, it has never really moved beyond its regulatory role in reviewing hospital budgets and approving rate increases for the insurance companies. Instead, since the beginning, the GMCB has worked diligently to keep healthcare profitable in Vermont.

Gobeille jumps around a bit, and from the GMCB he gets appointed to one of the most important positions in state government as the Secretary of the Agency of Human Services. In this jump, he goes from being a regulator to being an administrator of the state healthcare plans. In this position he is tasked with negotiating with the feds on Medicaid/Medicare waivers, creating an “all payer model.” This gives birth to OneCare Vermont, an added layer of healthcare bureaucracy that siphons off millions for what purpose we may never know.

Two years ago, Al Gobeille announced that he would leave the Scott administration and return to running his restaurants. Meanwhile, at the UVM Health Network, they saw an opportunity and made Al an offer he couldn’t refuse. In a newly created Senior Vice President position in an already overly bloated hospital administration, he would likely see his compensation package go from $140K per year as an agency secretary, to an executive pay rate of around half a million dollars.

I know what you’re thinking — and yes, there are revolving door rules in the Vermont government — but the problem is that the laws are ambiguous. We need to do better. In an ethics oath that was created by Phil Scott for his staff and signed by Mr. Gobeille, the oath states in one place, “For one year after leaving office, a former Appointee shall not, for pecuniary gain, be an advocate for any Private Entity beforeany Public Body or before the State General Assembly or its committees, regarding any particular matter in which: a. the State is a party or has a direct and substantial interest; and b. the Appointee had participated personally and substantively while in State employ.” Well, that’s clear as mud. Simply put, for a year after you leave, you can’t advocate on behalf of your new employer to the state government. That didn’t happen; Gobeille went right to work in the “spirit of the oath.” Now comes a letter to the editor in VTDigger penned by Gobeille and UVM Health Network Chief Financial Officer Rick Vincent, which says in part, “Our goal is simple: To share with the GMCB — and the people we serve in Vermont and Northern New York — the work we’ve done to put forward the most responsible budget we could develop, while minimizing the impact on patients, protecting critical services people depend upon and continuing to make forward progress addressing access.” Translated: Give us more money for business as usual.

The GMCB is scrutinizing the budgets for hospitals in the state, and elsewhere in the letter they call their budget request “a significant increase” which turns out to be a whopping 19.9%. Well, for a guy that got on the GMCB for his skill in counting shrimp at his restaurants, he’s made out pretty good since he climbed aboard the healthcare gravy train. No, it couldn’t be; he isn’t being rewarded for services already rendered is he?

You’d think that after all these years of fighting for better healthcare we’d have more to show for it, right? Especially here in Vermont! Seems that there’s more suffering, and infinitely more talk about financial ruin than I ever remember and worse; we’re no longer getting the best care. The reason is largely because of the profits to be made off the defenseless sick and dying. We’re on the fast track to an unprecedented 20% of our GDP as the share for healthcare costs, and even if the carve-out for non-medical care is twenty-five cents on the dollar, we’re talking an obscene amount of money. Perhaps it’s finally time to close the revolving door.

Contact Kurt Staudter at