Smith: The question isn't Pelham, it's the GMCB

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Smith: The question isn't Pelham, it's the GMCB

Sun, 12/10/2017 - 8:36pm -- tim

by Mike Smith The liberal advocacy group Rights and Democracy is calling on the Vermont Senate not to confirm Tom Pelham, Governor Phil Scott’s recent appointment to the Green Mountain Care Board. The reasoning: He’s too fiscally conservative. The group describes Pelham as “a voice for more health care austerity” and lacking “an everyday patient’s perspective.” His sin: He was critical of former Governor Peter Shumlin’s single-payer health care plan.

But Pelham was right to be critical. To fund single payer would have required massive tax increases. And the promised decreases in health insurance premiums to offset those costs didn’t exist. It simply was too high a price tag for Vermonters to pay.

Let me disclose this fact: When I was secretary of the Agency of Administration, Tom Pelham was the tax commissioner. His department was part of my agency. I view him as a longtime public servant who is nonpartisan (he’s worked for governors of both parties for decades). He also served as an independent state representative. I know him to be incredibly passionate about Vermont, the state he grew up in.

And here’s some background on the nominating process to the Green Mountain Care Board, because it gives perspective to this discussion.

People interested in serving on the board submit their resumes and other information to a nine-member nominating committee appointed by the speaker of the House, Senate president and governor. This committee reviews the information, determines who is qualified and forwards a list to the governor. The governor then selects a person from that list.

Sen. Claire Ayer, D-Addison, chair of the Health and Welfare committee — the panel responsible for reviewing Pelham’s nomination before sending it on for Senate confirmation — said that although she may disagree with him there is little doubt he is competent to sit on the board.

Ayer said, “My assumption is that we will go ahead and approve him. We try and honor appointments.”

Rights and Democracy’s attempt to disqualify Pelham based on his fiscal conservatism raises questions that are the same ones being hotly debated in many of our most successful companies. Conservatives employed by tech firms such as Apple, Facebook and Google will hide their political leanings for fear of losing their jobs, according to a recent report by CNN. Diversity of political thought is not allowed, according to conservative employees of these companies.

Political conformity in the workplace is the kind of environment these Silicon Valley companies once railed against. In Apple’s famous commercial titled “1984,” which depicts a world that prohibits thought other than what leaders say is permissible, Apple hoped to get people to think about a different kind of world (in this case the world of computing), where conformity was evil and diversity of thought needed to prevail.

There is no doubt that Vermont is a deep-blue state, and it’s easy to ignore or attempt to stifle the thoughts of those who are more conservative. But in doing so, does that make us better or more enlightened?

I have written previously that attempting to stifle speech is dangerous, especially to a democracy, because ultimately the goal is to ban opposing thought. If you are on the losing end of what is deemed acceptable speech or thought, then what will probably follow is some form of persecution for your beliefs.

Fortunately, there appears to be little chance that Pelham will not be confirmed. The Senate would have to break a long-standing tradition of approving qualified gubernatorial nominees, which would send the nominating process into chaos. And it would send a signal that political diversity in Vermont is not welcomed.

But what is emerging now is a debate on the type of qualifications you need to sit on the Green Mountain Care Board, and some legislators, at the urging of the Vermont Medical Society, plan to introduce legislation to require the board to include someone from the medical profession.

The governor’s office questions the wisdom of such a step. The administration asks: Would the state place an active utilities executive on the Public Utility Commission, the body that regulates power and telephone companies? It’s likely the Legislature would balk at such a proposal.

Of course, attacking Pelham for his ideology, or trying to tie the hands of the governor — so future nominees are more to the liking of one group or another — diverts attention from a much larger and more complicated question.

The Green Mountain Care Board is one of the most powerful in state government. It is the overseer of health care in this state and through its regulatory powers controls a large portion of an industry that represents 20 percent or more of Vermont’s economy.

When the Legislature established the board its main responsibility was to oversee and regulate the state’s planned single-payer health care system. To carry out its mission, it was given extraordinary powers and independence along with a massive budget and staff when compared with any of its predecessors.

And yet since the demise of the single-payer plan, these extraordinary powers as well as the board’s independence and budget have not been carefully reviewed or substantially revised by the Legislature.

The primary purpose of the board nowadays is to regulate health care spending. It does that by regulating hospital budgets as well as the budget of the state’s accountable care organization. Members also regulate health insurance premiums and oversee the certificate of need process, which determines the cost and need for health care growth, including buildings and other infrastructure. This focus is similar to what its predecessor boards did, not what the Green Mountain Care Board was established to do.

Responsible regulation in the health care industry is important to ensure costs are reasonable and access to high-quality care is maintained. Given likely changes forthcoming in health care, especially at the federal level, this could be an opportune time to review and possibly revise not only the role of the board but the entire state health care bureaucracy.

Therefore, the much larger question to focus on is this: Should the Green Mountain Care Board exist in its current form, or could it be redesigned to better meet the needs of Vermonters, since its responsibilities have changed substantially? This question is far more important than quibbling over a qualified person’s ideology or the addition of credentials to serve on this board.

In Washington, D.C., political leaders often ignore the substance in policy debates and instead concentrate on politics. It would be a shame to allow this to happen in Vermont when it comes to something as important as health care.

Mike Smith is a regular columnist for Vermont Business Magazine, and VTDigger. He hosts the radio program “Open Mike with Mike Smith” on WDEV 550 AM and 96.1, 96.5, 98.3 and 101.9 FM and is a political analyst for WCAX-TV and WVMT radio. He was the secretary of administration and secretary of human services under former Governor Jim Douglas.