Vermont’s Ageing Legacy Systems

Vermont’s Ageing Legacy Governing Systems

How we understand our complex systems affects the quality of our discussion about them, as well as any agreements we might make toward progress. Too often, we are myopic and imagine decisions we make in Vermont are the sole determinant of outcomes, when in fact our geographic boundaries mean less and less. As a friend recently pointed out, the decision by the Saud royal family to sell Aramco may have a greater impact on Vermont than all our energy management efforts combined. We are buffeted by regional, national, and global winds that have more impact on us than we understand. We are 620,000 people living on 10,000 square miles. To make progress on the challenges presented by Vermont’s complex systems, we’ll need to remember we exist and interact in a larger social, cultural, legal, economic, and ecological universe. That cognitive humility will help us make wiser and more effective plans.

We will have to abandon or at least question our long held mythologies and acknowledge the reality of change: If we market Vermont more effectively people will come. Economic development, lower taxes, and less regulation will create jobs. More laws will make us safer and so on…

Beyond trusted leadership’s bully pulpit, the only toolsets of government are financial (taxing and budget authority), legislative and regulatory (making new laws and regulations) and judicial, (interpreting existing law), whereas many of our problems are beyond the reach of these tools – cultural, technical, macroeconomic, health-related, ethical etc.

A craftsperson, however, uses what they have at hand, so our complex and dated legacy systems are relentlessly tweaked in an effort to solve every quotidian or acute problem that presents itself. Many of our laws and regulations now on the books set up legal or administrative conflicts that defy their intent.

To further complicate matters, our shortsighted two-year leadership terms defy long-term goal setting and accountability and propel the turnstile of agency leadership. We have no strategic planning resource, so our executive and legislative arms must govern over the stern of the ship of state. How can we set future goals if we have no glimpse of what the future might bring? A resource that studies economic, social, demographic, commercial, environmental, medical, and commerce-related trends would provide give our leaders and law-givers a weather report on Vermont’s future. We have nothing.

The complex systems, that have evolved over decades, are wearing out and breaking down in the face of accelerating change. Government tends to react reflexively to acute breakdowns rather than asking the bigger question of whether chronic breakdowns might indicate endemic failure. We invest in repairs rather than pre-emptive redesign, ballooning our costs as we sidestep the challenges of acknowledging reality and investing in reinvention and prevention. The $200 million spent in a failed enterprise-level healthcare transaction management system is one example. The $2.2B or 40% of Vermont’s budget we spend on Human Services to remediate the basic social and economic injustices with which we live could be much better spent.

Our Legacy Systems:

 

I. Health Care: Quality, Cost, Network infrastructure, and access: Ageing & Dying, Chronic Disease Management, Mental Health Care, Addiction Treatment

Considerations:

  1. Cost for outcomes inadequate, yet most expensive in world.
  2. Stranded cost of failed Health-Connect initiative vastly exceeded entire Vermont budget shortfall for 2016.
  3. Need to engage in creative destruction or repurposing to reduce the number of competitive hospitals, while increasing the number of primary care clinics. Need to increase number of primary care and pediatric practitioners.
  4. Need to redesign provider compensation and radically reduce transactional costs.
  5. We need regulated open architecture in electronic medical records (EMR) to reduce cost and enhance utility
  6. We need to eliminate for-profit insurance and move to a regulated ROI monopoly such as BC/BS
  7. Pharma must be re-regulated nationally for both quality, price, access, and consumer marketing.
  8. Need to better educate doctors and patients about end-of-life options that don’t automatically involve “heroic measures”: require advance directives, expand palliative care, in-home hospice, and death-with-dignity
  9. Need to increase public mental health treatment infrastructure and options.
  10. Need to increase public addiction treatment infrastructure and options.
  11. Need to implement less addictive pain management drugs and monitor noncompliance (“Dr. Feelgoods”)
  12. Need to eliminate the “guild mentality” of dentists protecting their franchise and force them into mainstream healthcare where they belong.

 

II. Social Safety Net: We must understand this area as completely inter-related at human scale. Homelessness, Youth-at-Risk, Child Protection, Hunger, Step-Up and Training, Addiction Services (Education and Recovery) must be seen in the context of families at risk.

Considerations:

  1. Government Sector: Don’t disassemble Agency of Human Services into dysfunctional silos.
  2. Non-Profit Organizations: Competition vs. Collaboration, Results-based State Contracting, & Philanthropic education about needs and accountability.
  3. Integrate efforts between the government, non-profit and business sectors to work together to solve problem rather than competing for solutions.

 

III. Public Education: Quality, Equity, Cost, Access and Administrative and Infrastructure Efficiency

Considerations:

  1. Cost for outcomes inadequate – most expensive in world.
  2. Is it “education” or “child-management” with 760 special ed professionals and 3200 teachers in kindergarten through elementary school?
  3. Do we need 250 school districts and 62 supervisory unions for 86,000 students?
  4. Eliminate the term and concept of “childcare” and call it what it is “public education.” Avoid another silo to regulate childcare.

 

IV. Vermont State College System: VSAC and the five colleges

Considerations:

  1. Should we re-purpose one or two of our four stressed state colleges and make them into regional economic hubs in partnership with area businesses and non-profits?
  2. Can one of the colleges help forge a path to re-entry for non-violent offenders?
  3. Can one of the colleges specialize in a curriculum for Vermont immigrants including ESL, job training, civics, and acculturation?
  4. Can we reduce student tuition costs by reducing residency somewhat and reparsing pedagogical methods online?
  5. Should be discussing free or first two-years free tuition?
  6. Is tenure still relevant?

 

V. Public Safety: Police, Fire and Emergency Services, Firearm Regulation

Considerations:

  1. We have nine independent police forces and fire departments within 15 miles of downtown Burlington without central dispatch. Is this cost effective?
  2. We have over 70 levels of police hierarchy in VT and little or no citizen oversight. It is virtually impossible to decertify a corrupt or under-performing policeman. Is this effective or accountable management? Police licensing, citizen oversight?
  3. Can we create a firearm policy that encourages hunting, discourages violent crime, abuse, suicide, and carriage by those with mental health issues?
  4. Are our traditional volunteer and professional fire response and safety infrastructures appropriate to the steep reduction in residential fires?

 

VI. Criminal Justice: Incarceration costs Vermonters $188M a year

Considerations:

  1. Corrections:
    1. Mission should be to return offenders to society as safely and as rapidly as possible.
    2. Current cost is disproportionate to poor recidivist outcomes.
  • Has become surrogate holding facility for addicts and mental health – both health issues, not criminal
  1. Expand restorative justice and court diversion options in lieu of prison
  2. Overly aggressive prosecution, underfunded public defender system.
  3. Forge an offender re-entry path back to family, community, shelter, and the economy. (see 6. b)
  4. Legislature: criminalizing too many behaviors in new proscriptive laws. Administrative laws are adding to recidivism and occupancy.

 

VII. Communications Infrastructure: Broadband, Telecom, Satellite, Terrestrial Broadcast, Cable – Public and Private Systems

Considerations:

  1. Consumer content moving to Internet streaming away from terrestrial broadcast, cable and satellite and terrestrial broadcast spectrum being re-allocated more efficiently.
  2. Confusion in the consumer/wholesale relationships and pricing
  3. Net neutrality policy still under debate and intense lobbying
  4. Broadband build out is progressing but needs a plan for financing and completion.

 

VIII. Economic Development:

Considerations:

  1. What do emerging companies really want? Low taxes and deregulation or a healthy socioeconomic environment with good housing, education, recreation, healthcare, and participatory options for their employees?
  2. Consumer (tourism) – focus on niche tourism, cultural, eco-, agri-tourism, wild game, canoeing, cycling, climbing, hiking, history etc.
  3. The traditional economic development “tool kit” is empty.

 

IX. Transportation:

Considerations

  1. Road and bridge Infrastructure – no room for “deferred maintenance”
  2. Public Transportation: bus, rail, and air – needs reanalysis
  3. Consumer: Cars, cycling, walking – public fleets in urban areas?

 

X. Vermont Tax Code and Fee Structure:

Considerations:

  1. Fairness – Is it fair to all individuals and businesses?
  2. Competitiveness – Does it negatively impact competiveness?
  3. Simplicity – Is it comprehensible and useable by non-professional filers?
  4. Transparency – Is the code and its rationale accessible to all?
  5. Neutrality – Is it policy-neutral, or does it dissuade and incent behaviors?
  6. Interoperability – does it mesh with other tax domains i.e. federal?
  7. Sustainability – does it produce adequate revenue on a sustained basis to fund government?
  8. Executive and Legislative Accountability to Taxpayers – do legislators and tax department officials periodically review the code to ensure current relevance to original intent, especially with regard to “tax expenditures” and “carve-outs?”
  9. Compliance & Enforcement – is it consistently and fairly applied and enforced?

 

XI. Governance:

Considerations:

  1. Public:
    1. Gubernatorial & Legislative Terms – move to 4-year terms
    2. Ethics – establish an independent Ethics Commission
  • Transparency – reduce public meeting exemptions and make transparency and openness the norm rather than the exception
  1. Strategic Planning – The State must look ahead at what is coming not backward to see what might need fixing.
  1. Non-Profit:
    1. Board roles and responsibility – to many VT Non-profit boards have little or no understanding of their roles and responsibilities
    2. Redundancy – too many non-profits competing for limited government contracts and philanthropy rather than collaborating to accomplish missions.
  • Accountability to Mission – not enough mission alignment between budgets, staffing and programs
  1. Business:
    1. Regulation – business needs strategic regulation, not micro management or deregulation
    2. Taxation – Business taxes need review

 

XII. Environmental Protection:

Considerations:

  1. Water Quality – diminishing rapidly, needs real time monitoring.
  2. Invasives – may not be controllable
  3. Wildlife Management pretty good it would seem given habitat growth
  4. Waste Management – reduce source packaging and put recycling cost burden on manufacturers.
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