Pondering Pelham: Questions Raised About Health Care Board Appointment | Fair Game | Seven Days | Vermont's Independent Voice

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Pondering Pelham: Questions Raised About Health Care Board Appointment


Published November 15, 2017 at 10:00 a.m.
Updated December 27, 2017 at 12:23 a.m.

Fair Game is Seven Days’ weekly political column.
  • Jeb Wallace-Brodeur
  • Tom Pelham

Gov. Phil Scott's appointment of Tom Pelham to the Green Mountain Care Board has attracted a fair share of critics who are concerned about the lack of medical expertise on the board and about Pelham's track record as a critic of health care reform.

The board has broad authority over health care reform and the final word on insurance rates, hospital budgets and capital investments. Pelham is a formidable choice. He's an expert in state finances and has served in the administrations of four governors. In a written statement, Scott's communications director, Rebecca Kelley, cited that experience as a key factor in the governor's choice.

"Given that he was replacing Con Hogan — someone with extensive institutional knowledge and experience in state government — Gov. Scott thought it was important to appoint someone with a similar background," Kelley wrote. Hogan is a former human services secretary and gubernatorial candidate who's a widely respected source of knowledge about all aspects of the government.

But Pelham's appointment means that the state's medical community remains unrepresented on the board. Its other four members are former state senator Kevin Mullin, finance professional Maureen Usifer, economist Jessica Holmes and Robin Lunge, formerly governor Peter Shumlin's director of health care reform.

"I was really surprised [Scott] didn't choose a health care provider," says Sen. Claire Ayer (D-Addison). "It makes so much sense; you don't have regulations about electricians or plumbers without any practitioners involved."

On November 4, two days after Pelham's appointment, Vermont Medical Society members passed a resolution calling for a law mandating that, in the future, the board would have to include at least one health care provider. Deborah Snell, president of the American Federation of Teachers Vermont, which represents many of the state's nurses, says her union would "absolutely support" the society's proposal.

"It makes a big difference if at least one member is a health care professional," says Jessa Barnard, the medical society's incoming executive vice president. "It's conceptual versus reality. Are concepts going to work on the ground? What do they mean for patients?" She emphasized that the society has no beef with Pelham specifically; its resolution had been in the works for months.

Kelley pushes back on the idea. "Generally, it'd be questionable to appoint an active utility executive to the Public Utility Commission," she wrote, "so there is a question about appointing an active health care provider to a board that has oversight of the health care system, which includes the provider community."

That's a substantial change in philosophy. As recently as last September, two members of the board were health care professionals.

Pelham describes himself as an independent. He was finance commissioner under Democratic governor Howard Dean, and tax commissioner under Republican governor Jim Douglas. But, in recent years, he has been a vociferous critic of Democratic fiscal policies and health care reform efforts — including Act 48, the legislation that created the Green Mountain Care Board itself.

"Act 48, Vermont's 'first in the nation' health care reform effort, has brought anything but reform," Pelham wrote in an April 2016 opinion piece posted on VTDigger.org. He chronicled a lengthy list of offenses: Vermonters "herded into insurance policies not of their choosing"; employers being assessed fees for failing to provide insurance coverage; and "the provider network ... being corralled into a few large [health care] monopolies overseen by a five-person board appointed by the governor."

Pelham now says, "I'm not going to get too prescriptive; I have a lot to learn," and seeks to downplay his own influence. "It is a board," he notes. "Five bright, capable people. It's a team effort."

But he does have strong views. He notes that the United States spends more per capita on health care than any other nation, and that Vermont ranks No. 5 among states for its health care spending. "From a fiscal point of view, there is capacity to look for constraints," he says.

Pelham's appointment "gives us an indication of where the governor stands," says House Speaker Mitzi Johnson (D-South Hero). "It's more of a political appointment."

There's broad agreement that Vermont's health care system needs strong, effective cost control. The question is whether Pelham is the right person for the job — and whether a provider's perspective would strengthen the board.

Carbon Tax 2.0

An impressive group of business leaders, academics and policy experts has released a new proposal to lower Vermont's greenhouse gas emissions. The ESSEX Plan was unveiled at a climate summit meeting last week in Burlington. (ESSEX is an almost-acronym for "an Economy Strengthening Strategic Energy eXchange.")

And, yes, it does involve a carbon tax — or "carbon pricing," as advocates prefer. But it purports to do so without economic harm. In fact, backers claim it would be a significant boost to the Vermont economy.

How it works, in brief: A tax on carbon emissions would be phased in over eight years, eventually reaching 35 cents a gallon. The proceeds would be directly applied to lowering the cost of electricity. Fuel prices would be higher, but electric power would be cheaper. And it would encourage a shift toward electricity, which would help Vermont meet its policy goals, because much of the state's electricity comes from renewable sources. In effect, fossil fuels would subsidize the cost of electricity, leaving Vermont with the lowest power rates in the region.

Coauthors of the plan include University of Vermont professor Jon Erickson, former state environmental commissioner David Mears, Jen Kimmich of the Alchemist brewery, Mark Curran of Black River Produce and Karen Lafayette of the Vermont Low Income Advocacy Council. Thirteen carbon-fighting plans were introduced at the summit; attendees then voted for their favorites. The ESSEX Plan came in first.

So, hooray, right? A climate-change-fighting effort with broad buy-in that attempts to address the concerns of carbon-tax opponents like the governor because it provides immediate relief for ratepayers while promising economic growth opportunities galore. Can't miss.

Can it?

"The ESSEX Plan is still a carbon tax, and Gov. Scott does not believe a carbon tax is the right approach," wrote Kelley. "The current iteration of the plan ... will add costs and leave many Vermonters behind."

Well, the Republican administration doesn't like Carbon Tax 2.0; what about the Democratic legislature? Are they ready to get on board?

Not really.

"It is our duty to look at climate change and do whatever we can," says House Speaker Johnson. But she adds that a carbon tax would "affect different Vermonters differently. Rural Vermonters have to drive farther and generally live in older, less efficient housing. I'm very cautious about adversely affecting them."

Sen. Chris Bray (D-Addison), chair of the Senate Natural Resources and Energy Committee, says the carbon-tax idea has been poisoned by years of Republican attacks. "We have a governor who literally ran on 'Democrats want to tax your gas and heating oil,'" he says. "It wouldn't surprise me if a proposal like this would be treated the same way."

Indeed, the Vermont Republican Party is ever-ready to bash the Dems on the issue. Delegates to the GOP's November 4 meeting were given a packet of information about party business — and a bumper sticker slamming the carbon tax. There is, in fact, no organized Democratic effort to promote the idea, and it sounds like the Dems are thoroughly spooked.

Last word goes to Johanna Miller, energy program director for the Vermont Natural Resources Council. She is the one and only full-time environmental advocate on the governor's 21-member Vermont Climate Action Commission.

"There needs to be a meaningful conversation about carbon pricing," she says. "If not this, then what? We need to move from talk to action."

But as far as opponents to the ESSEX Plan are concerned, the mere idea of "talk" is apparently out of bounds.

Weinstein World

Recent weeks have brought a wave of allegations of sexual misconduct against influential men in all walks of life. The political world is far from immune; aside from the accusations against Alabama Republican U.S. Senate candidate Roy Moore, there have been scandals in state capitals across the country. From California to Florida to Massachusetts, women have come forward to report specific incidents or a general climate of harassment. Some are contemporary; some go back decades, like the charges against Moore.

So far, there hasn't been much from Vermont. Last week, VTDigger's Elizabeth Hewitt quoted one current and one former lawmaker, both female, who reported instances of sexual harassment. Two other women were quoted anonymously.

But I'll tell you this: Given the scope of the problem, it's almost certain there's more to tell. And I'd like to make a plea to those who have been targets of unwanted sexual attention or assault: Please consider coming forward. This is a moment in history when stories of abuse are being taken seriously.

I realize it's very easy for me to write this. It's much harder for those on the short end of the power dynamic. I wouldn't blame anyone who decided to keep their story secret.

Nonetheless, I ask, and here's why. We cannot know the full story of Vermont politics without knowing the truth about harassment. Vermont women have struggled to gain a place in politics, especially at high levels. There are plenty of female lawmakers, many in positions of leadership, but Vermont has yet to elect a woman to Congress. We've had only one woman governor. There's one woman among our six statewide elected officials.

How much of this sad legacy is because women were subjected to a toxic environment? How many settled for low-level positions or even left politics altogether because of what went on at the Statehouse?

Some say that we should examine the current atmosphere but let the past stay in the past. I couldn't disagree more. The past informs the present. We can't know how we got here unless we know the route we have taken.

It's our history, and it can't be told without full disclosure — just like the stories involving Moore and the Roman Catholic sex scandals and Vermont's experiments in eugenics.

There is an opening right now for the truth to come out. Who knows how long it will last?

Media Note

By the end of the year, VTDigger will have lost two of its longest-tenured reporters. One has suddenly left the online news outlet, while another has given his notice.

Health care reporter Erin Mansfield departed last week; neither she nor VTDigger founder and editor Anne Galloway will discuss the circumstances on the record.

The other departing staffer is Morgan True, currently the Burlington bureau chief. He's leaving on December 20 after four years at VTDigger.

"I'm ready to try something different," he says. "I want to find something new that may or may not involve journalism."

VTDigger has begun to reload. It recently hired former Burlington Free Press and Associated Press reporter Cory Dawson for the Burlington beat and is advertising for two more full-time reporters.