Can Vermont Lose Weight?

As someone who’s weighed just shy of 500 pounds and now weighs 200 pounds less, I’m comfortable talking about weight loss. It’s often said that Vermont has an “affordability problem,” but I think it’s more helpful to think of it as a weight problem. Like many of us, Vermont’s having trouble losing weight. And weight loss is not always about eating less, but often about eating better. Technology, social needs, and businesses have changed, and our communities with them. Many of our Vermont agencies and institutions, missioned in the past, have yet to respond to these changes.

As our population ages and shrinks (for now) and our birthrate declines, we’re having trouble shedding the infrastructure weight put on before small-town centers began shrinking. The economic flight from once vital, small towns to urban centers has left lots of once-necessary cultural, administrative, and real estate infrastructure in disuse.

But just as the human body defends against weight loss, so does the body politic. A community of 625,000 people sharing 10,000 square miles with few near-term growth prospects can and must right-size itself,  making more effective use of its income and assets than we currently do.

This is not about “affordability,” or “lower taxes”, or all the worn anti-government retreads. It’s about having the courage to look at and assess what’s changed, and what’s likely to change even more, agreeing on emerging priorities, reordering funding priorities, and creating a more sustainable, responsive, and visionary economy in the government and non-profit sectors. It’s sometimes called “creative destruction,” but it’s really about strategic thinking backed up by data, and then developing a consensus on a consolidated vision (BTW consensus does NOT mean that everyone has to agree!), courageous leadership, and reinvestment.

For example. we have 14 critical-access hospitals when what we need is more accessible and cost-efficient community clinics with primary care doctors, physician assistants, nurse practitioners, pediatricians, and geriatricians, and fewer specialists and hospitals.

Vermont has 264 school districts and needs perhaps 14. We have four public colleges, two of which are struggling to survive. Why not reinvent them to meet the current needs of our broader learning population and our economy? Without closing campuses, we could satisfy – more cost-efficiently – the emerging market for a new universe of learners, as well as those seeking new skills in a rapidly changing economy.

We spend $88 million a year on seven correctional facilities. That’s for a total state and federal prison population of about 1800 prisoners – and the number of prisoners is shrinking. By moving investments from incarceration to restorative justice, diversion, mentorship, transitional housing, mental and physical healthcare, as well as eliminating the administrative hurdles that feed prosecution, we could then spend much less on corrections, end the unintended consequence of criminalizing poverty, and help prior offenders find their way back into the community.

Vermont has 25 different categories of policing (State, Capital, Homeland Security, campus, sheriffs, deputies, constables, etc,)  Canada has one. The Burlington area alone has some ten police and fire departments within 15 miles of Church Street, even as statistically, crime and fires are down. Can we not have much more cost-efficient Chittenden County Police and Fire Departments with central dispatch integrated with our State Police?

We have multiple public broadcast entities (VPR, VTPBS, RETN, VCAM, and community access networks like Orca, Channel 17). Many states integrate these under one administrative infrastructure, preserving diverse content resources but consolidating technology and admin.

We have 6000 non-profits, including five cultural non-profits (History, Humanities, Arts, Folklife, each with their own real estate, administration and technology. Should we not be exploring options for collaboration? How many of our non-profits are mission-driven, business-driven or ego-driven?

Our combined state and local governments employ 50,000 people (40,000 FTEs), 26% more than the national average or 16% of all Vermont jobs. I am grateful for the employment provided by the State to Vermonters but is all that energy and productivity focused on our areas of greatest need? Do we know?

All of these institutions fill or have filled a vital need in Vermont’s growth and culture but change demands reconsideration and redesign. The taxing and philanthropic capacity of Vermont has limits, which means we need to reallocate our investments more wisely.

I grew up in Morrisville, a town of about 2000. I was deeply affected by my community, but it’s different today and its needs have changed. Then, the retail community drove much of downtown activity, along with the Grange, the library, a museum, four churches, a golf course, a hospital, and, later an airport. In 2019, only the bare threads of retail persist, although the core elements of social adhesion, community gathering places, remain strong there.

When we made our semiannual trips to Burlington, the first sign of the city on Route 2 was an active farm that is now a hotel and conference center and then UVM. The ten surrounding towns were discreet communities, not suburbs as they are today.

In general, we must redirect more of our resources toward the causes of our downstream costs – take preventive measures to strengthen the social safety net, health care affordability, affordable housing, and early education. We can do so by strategically aiming revenues towards emerging priorities and away from waning ones – spending to prevent rather than repair.

A guiding term is “population health,” the goal of which is to invest upfront in the health and well-being of the entire population in order to prevent the much more expensive costs of treating those sickened by disease, poverty, and addiction.

We’ve made a good first stab here in Vermont with our commitment to move from “fee-for-service” to “accountable care” as the basis for health care remuneration. But there is more we can do. Vermonters suffering from homelessness, mental health issues, addiction, or poverty, or who are uninsured, account for a significant number of emergency room and urgent care admissions and these are far more expensive in the long run than the preventive investments we could make. If we refocus our investments upstream, our considerable downstream costs will diminish in time.

We must stop being reactive and, instead, systematically gather data, learn from successful policies and programs elsewhere, listen to one another, and then devise and execute plans that fill today’s needs.

Most of what I was told  about weight loss was hokum. Over many years and failures, I learned it’s less about how much we eat than what we eat that makes us healthier. If we don’t address our weight problem, our health will continue to decline.