by Hamilton E. Davis
Over the five-decade course of health care reform in Vermont, there have been a relative handful of outstanding performers who have put their shoulders to the wheel. I mentioned a few of them in my earlier posts. Today, I want to introduce my tiny corps of brilliant readers to Gretchen Morse, one of the three or four most important players in health care reform, who was a founder of the movement in the early 1970s and knows more about reform than any of the active players today.
As a Republican state representative from Shelburne and Charlotte in the mid-1970s, Morse worked closely with former Gov. Richard Snelling to launch the first health care reform bill in the state, and one of the first in the United States. The first major iteration was legislation establishing the Vermont Hospital Data Council to grapple with hospital costs that were rising at three to four times the rate of inflation in the broad economy. Demand for care was being driven by Government financing for the elderly and the poor—Medicare and Medicaid—and by the appeal of sophisticated techniques developed by military doctors in World War II.
Although Snelling and Morse hoped initially to get tougher provisions into the first reform bill, local resistance reduced its reach considerably: the Data Council could compel hospitals to submit their annual budgets, but the Council could not change them in any way. Still, significant progress was made. All the hospitals got put on a single fiscal year, for example, and many smaller ones had to adopt common business principles, such as building in “margins” so they could invest in their companies.
In 1985, Morse left the Legislature to serve in the cabinet of the newly elected Democratic Gov. Madeleine Kunin. Her job was the biggest in state government—Secretary of Human Services. In that capacity, Morse oversaw departments responsible for Medicaid, public health, aging and independent Living, mental health, and prisons. She also served four years as a member of the Hospital Data Council. When Kunin retired in 1992, Morse took over the United Way, and in off hours, served for several years on the Board of UVM’s Medical Center Hospital.
Now 81 and fully retired, she should be excused for easing back. Instead, she’s gotten stronger and more active. Over the last couple of years, Gretchen has repeatedly urged her former colleagues in the medical, political, business, and legislative worlds to intervene in the unholy mess the Scott Administration and the Green Mountain Care Board have made of Vermont’s hospital system, especially the UVM Health Network.
In mid-December, she wrote a formal letter to her friends, making her case. I have watched the reform process since the 1970s, and I have heard none of the players so much as mention the fundamental issues involved in health care reform.
Last year, State Sen. Ginny Lyons, a Chittenden County Democrat, tried to clarify the responsibilities of the Agency of Human Services and the Green Mountain Care Board along the lines of the Public Service Board and the Public Service Department, which regulate stuff like electric power and telephone services. The Lyons effort went nowhere. Morse’s reaction:
I’m concerned the pressure to control costs may prompt the Legislature to give more regulatory direction to GMCB and continue to neglect the executive branch’s lack of accountability in planning and policy development of a statewide health care system, I believe the current conundrum is caused in part because decision making is not guided by or responsive to a state wide plan…for hospital-based health care.
Morse went on to write that Vermont law in Title 18 requires the Vermont Health Department to “conduct studies, develop State plans, and administer programs and State plans for hospital surveys and construction, hospital operations and maintenance, medical care, and treatment”, which the Department did routinely for 35 years. Morse again:
During the past 10 years, there has been no “big picture” for hospital-based health care. Testimony at GMCB budget hearings is “he said, she said.” There is no objective Executive Branch analysis and publicly accountable framework that goes beyond the financial “bottom line” and considers the impact on how and where care should be delivered.
Well, there was much more, of course, as Gretchen laid out her chapter-and-verse analysis. The fact that neither Morse nor anyone else is getting anywhere with the GMCB, the Scotties, or the Legislature is simply indicative of the depth of the hole we’ve dug on reform.
I often wonder if Gretchen could move the players if she could just talk to them. I remember the evening about a year ago when I sat next to her in the South Burlington High School library to hear a much-hyped presentation on health care reform by the Green Mountain Care Board. The main event was a presentation by a Board consultant, with a guest performance by Dr. Steve Leffler, the spokesman for the UVM Health Network. The idea was for the audience to ask questions of these worthies, but it seemed dreary to me—mostly a rehash of stuff that has been around for years. Morse laid it out like this, based on a story about a similar event in Brattleboro, reported by The Commons, a local newspaper:
“This is ridiculous: no quality, utilization, and cost data given to Brattleboro about where it stands, especially with regard to nearby hospitals in Springfield, Bennington, Rutland. Were there no themes in the GMCB data and/or assumptions so that the 60 people at the Brattleboro meeting could respond or comment? This is shameful.
“At this point, using national data and demographic projections without relating them to specific Vermont experience is an insult.”
Yup, it was just bad. And it’s worse now.