We must agree to disagreeis a fair resolution to any discussion and such was the case with a thoughtful discussion I had recently about S. 107, a bill to split the Agency of Human Services into its traditional social safety net role and a new “Agency of Health Care Administration”. The rationale in the bill’s language is this:

The breadth and scope of the programs in the Agency of Human Services, its statutory obligations, its funding streams, and its other responsibilities are beyond the capacity of one individual agency head to oversee and manage effectively.

In our discussion, we agreed on the faulty reasoning and political decision-making leading up to the complex and wasteful morass that our efforts to consolidate health care policy and practice have become. However, this agreement led us to different conclusions about how to go forward.

People use the tools they have to make progress. Legislators are lawmakers and that’s their toolset. Thus we have S.107 which, in my view, merely rearranges deck chairs and sidesteps the underlying political challenge – leadership, measurement, and accountability.

With something this complex, it is tempting to cut it in half, create two departments and hire another “leader.” But complexity and expense are only increased by endless cellular division – what biology calls cancer. So, perhaps, we can simply concede that leadership failed and hire a new leader. Google, Tesla, and Apple thrive with one leader. These companies succeed by integration, not disintegration.

Periodically, AHS has had brilliant leadership but too often, politics has trumped excellence. Governor Douglas took apart the prescient work in metrics, accountability, and case management of AHS Secretary Con Hogan for political reasons. The best of Hogan’s work is just now being restored by Secretary Cohen.

Governor Shumlin’s decision to channel Lincoln and co-opt his “team of rivals” to run complex agencies further diminished government effectiveness. Far too many government appointments are predicated on political fealty rather than leadership and management excellence. So agency effectiveness cycles back and forth on the spectrum of politics while bewildered Vermonters and their legislators watch complexity and cost of government metastasize.

If the political winner gets to choose his agency managers, perhaps agencies might benefit from having a lay Board of Directors who, along with the Governor, advise and hold agency heads accountable to mission.

I’m sympathetic to the problem, but rearranging deck chairs or agency architecture simply sidesteps it. Choose proven leaders, hold them accountable to the metrics of success they put forward, and replace them if they fail.


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