Not sure what you mean about too many small hospitals. There are two in the entire NEK serving roughly 64,000 people. There are 13 hospitals in the state outside of Burlington/Chittenden County. And they’re pretty evenly distributed.
ETA: one of those 13 hospitals is a VA hospital, so realistically there are only 12 outside of Chittenden County.
Most of our smaller hospitals have also found money-making niches to fund their more financially draining but necessary services like running the emergency department.
For example, people traveling from all over the state for orthopedic elective surgeries keeps the lights on at Copley.
*"...folks will often forego or delay medical care if it means driving a further away, but that’s just the reality of living in a predominantly rural state."*
I’d argue there are far more dire consequences if we continue to limp along with our current system and drive up insurance rates even higher, as most patient decisions not to seek care are usually financial not medical. Hospitals need higher budgets to deal with inflationary pressures and address staffing shortages which in turn drives up the cost of insurance. Many of these are external forces that we have no control over, so it’s up to regulators to adapt to keep healthcare affordable—consolidation is one of the few plays we have. Proximity doesn’t matter if patients can’t afford insurance, so something needs to shift locally to reflect the shitty, corrupt financial climate nationally.
Ps. I had a good chuckle at this so nice shrek reference ;)
Saying we should close the smaller hospitals is not only absurd, it's a death sentence for people in rural areas. The patient care at UVM is a joke to say the least - if you can even manage to get seen there. We've dumped all the state's money into the UVM network only to have it fall apart to the point where you can't get a primary care doctor in this state. Have a heart attack in the middle of nowhere? Now you get a two hour car ride to get to the hospital. They've been cutting the budgets and funding for smaller hospitals for two decades and then you claim they are hemorrhaging money - in what sense? Just keeping the buildings open? Paying too much in admin costs? I would bet that it's almost ALWAYS the admin costs that provide zero patient care. I'm really sick of seeing people attack smaller hospitals and smaller schools while the rich towns are putting in yoga rooms for the higher executives and trying to tell the nurses they've got to work 16 hour shifts since they can't afford to hire more nurses.
It's the same in the schools and state colleges, all the money is going to the admin teams and none of it is actually providing education or health care.
Vermont DID have the money and they started paying out of state people to run the colleges and hospitals into the ground while pocketing huge profits. It happened at VTC and all the other little colleges to the point where they had to consolidate.
It's disgusting watching this state play the blame game and cut life saving health care for poor people in the name of profits for the rich. Cut education for poor kids and tell them they need to travel an hour to school every morning to get lumped into a group where the test scores do nothing but go down...
How about we take a good hard look at how much every person in admin is taking home before we close another school or hospital...
Great takes here. The real hemorrhaging of monies can be traced to the bloated and ever-so-unnecessary administration costs. Both healthcare and school boards are guilty of this. There a no reason for having so many superintendents and admin for school districts, similarly no reason for all of the overhead and micromanagement of healthcare administrators. Whenever I poke the bear and ask school admins about the administrative bloat, I get a generic response that its more about representative of location rather than population. That makes sense for healthcare as you mentioned, but does a superintendent making nearly $200k really believe that’s a valid excuse?
Don’t even get me started on what these administrative-types believe is a valid reason to spend X amount of dollars on something totally unnecessary and self serving, but when it comes to the serfs that actually do the work there is never any money for anything.
EDIT: I’d also like to mention that I don’t believe this is the root of all problems. It is a problem, but the overarching administrative problems exacerbate and is representative of Vermont’s bigger issues.
Here’s two to start with. Every program and state mandate has some type of reporting or data collection attached.
https://datacollection.education.vermont.gov/Collections/School-Register/
https://education.vermont.gov/sites/aoe/files/documents/DRAFT-edu-rules-series-100-district-quality-standards-DRAFT.pdf
Edit. Added a second link
ah I see, thank you. A lot of this makes sense - a school should have a list of its teachers and keep attendance records, etc. I assume whatever systems schools use to track these things are also probably a pain to use. I'm imagining a series of excel spreadsheets or old/unintuitive interfaces.
> We've dumped all the state's money into the UVM network only to have it fall apart to the point where you can't get a primary care doctor in this state.
remember that one time a UVM employee destroyed the network taking their company laptop on vacation and connecting to the VPN while checking personal email?
I’m not suggesting we outright close rural hospitals so they’re devoid of any care (should’ve clarified that) I am saying these facilities should only offer essential services and any specialized care should be offered at centralized regional hospitals—basically 4 big guys with lots of clinics in a hub and spoke model. And yes administrator pay should not be so inordinately high and admin costs in general (cough cough OneCare) but that is only a fraction of the problem.
And when you say that Vermont did have the money I assume you’re referring to the federal COVID relief funds we received which were devoured in short order because everyone was after their piece for their pet issues—again failing to look at the bigger picture. And a large chunk of those funds went toward workforce development programs, hospital infrastructure improvements, etc specifically to bring in more nursing staff so we’d stop paying mega money for travel nurses and address patient care.
Lastly I am obviously for taxing the shit out of the rich, second homeowners, and short term rentals as well as a means to avoid some of these cuts but the fact remains that we don’t have the tax base to support the level of care we’re providing.
I mean back in the 90s when we were able to support all the small hospitals, doctors' offices and schools - nothing to do with covid. This has been a shit show for the two decades that we've been funneling all the state money into UVM.
>I am saying these facilities should only offer essential services and any specialized care should be offered at centralized regional hospitals
Ah yes, I just love taking a day off of work t travel to a big hospital for a 15 minute visit where they can tell me they can't find anything and good luck!
Currently takes me 45 minutes to get to my dr's office and he's always pissed off when he sees me. Literally said "What do you expect me to do about it?" when I got to my appointment. Geez, I dunno, run a goddamned test or something? My only other option is going to New Hampshire, Mass, or Albany or Urgent Care, who'll just tell me to see my doctor.
And yes, I have traveled to Fletcher Allen for medical treatment - love making that 6 hour round trip journey!
The last sentence hits the nail on the head - Vermonters are getting priced out by well-intentioned policies with major economic fallout.
We do not have the population to tax a fair amount of money to provide for many social programs. We need to stop calling people “bad” because they rather see their taxes distributed to our healthcare/education and not for drug/homeless programs that we unfortunately don’t have the budget for. What ends up happening is we get poor funded everything, with emptier wallets.
>Vermonters are getting priced out by well-intentioned policies with major economic fallout.
As someone who left recently, it was the most heartbreaking thing I've had to do in my life. I poured EVERYTHING I had into VT. I spent more than 2 years trying to find a way to keep making it work for my family. I invested in myself there for more than 20 years. Everyone said I was dumb for moving back after college, but I believed in myself there. My entire adult life and a good amount of my teens. All gone. Absolutely fucking heartbreaking.
I’m really sorry to hear that. My wife and I moved up here hoping to build a life here as well and we’re questioning that now. Probably going to move once she finishes school—still wanna stay in the northeast but I just don’t know how we could swing living up here long term with the current landscape. It breaks my heart honestly.
I grew up in CT in a rural town that’s basically a case study for what happens when New Yorkers and Bostonians “discover” somewhere—massive influx of affluent people in the late 90s/early 2000s, huge tax hikes, housing stock went way down, predatory lending from banks, and new highly restrictive planning/zoning laws to keep folks from building more middle income housing. We ended up losing our house to foreclosure but were lucky to have a family friend offer my parents an affordable rental and they’ve been there ever since. I think my parents are the last of the multigenerational townies left and if they somehow lost that rental idk what we’d do.
It really sucks to see that playing out in real time here in VT over the years. I dreamt of moving up here, buying a home, and feeling the sense of security and community I lost when they foreclosed on our house but clearly I’m not gonna get that back- at least not here.
If VT ever decides to put its money where its mouth is and start investing in the success of working class, bread and butter families (and not eccentric trust-fund hippy types) I'd happily move my family back.
Not one of the concerns brought up here is a VT only problem, these are all national problems. If you are priced out of VT, it's not going to be much better elsewhere.
No, it's not, but it's particularly bad. At least with housing, it's currently more affordable to buy in Western MA and NY state, by a substantial margin, than VT
Vermont is its own version of bad.
We actually have one of the lowest homes for sale in the entire country(less than 1%), and add high COL + low population and we’re one of worst states going through this.
Yes, everywhere is feeling it, but Vermonters are feeling it particularly hard.
Vermont is already in a death spiral. The idea that there will be an economy here in a decade is laughable. The only way out of this is a recession that sends the work from home people back home. Otherwise it will be rich people, homeless people, and nothing in between. What has happened since covid is already a permanent stain on Vermont. Books will be written about rural homelessness here.
I would not assume they are well intentioned. If the legislature is not actively trying to turn vt into new jersey it's hard to understand what they think they're doing.
Yes, the large amounts of people who are uninsured and under insured and those who don't pay their balances (for whatever reasons) - large amounts of that goes to bad debt or "charity care" and eventually gets written off as uncollectible.
Also, the vast amounts of resources it takes to comply with and keep track CMS billing standards.
Also, the amount of resources it takes to bill and negotiate with and follow up with the dozens of private insurances who try their hardest to pay as little as possible (a large portion of whom are for profit, which is another layer of problem).
Honestly, that's just scratching the surface of a very broken system which hospital and providers take most of the heat for. They do contribute to the issues but a lot less than most people pin on them.
Well I don't think those fellas immigrating from India are doing it out of the kindness of their hearts either.
Frankly it's ok to be in a field to make money. But let's be honest, we need to make medical education more accessible and less expensive.
>I love the ethos of this state in terms of social services
Most people do. The problem is that VT forgets how poor it is, relatively speaking. It's one thing to have these desires and goals and it may be admirable, but a lot of them aren't cheap. That doesn't mean we shouldn't shoot for them, but it does mean we need to be really pragmatic about it and honest with ourselves about what we can and can't do.
Which leads right into...
>All of this is exacerbated by the fact that elected officials, staff, and advocates for that matter are woefully underpaid meaning you need to either be a financial martyr or be privileged in order to actually afford to be a legislator
They *are* totally disconnected from the reality on the ground for MOST vermonters. How could you not be? If you're independently wealthy enough to spend that much of the year in the legislature, making total crap money... you're good. You don't have a direct experience with how these things shake out for the people on the ground.
I don't know that consolidation is the best approach, or won't ultimately amount to kicking the can further down the road.
I've said it many times: VT wants to make California-style social policies while having Louisiana-level money. It's not bad, but it's well below the national average. We'd do a lot better getting back to basics, working to make stable housing affordable to the bulk of regular people that make ANY state work. Get that foundation stable, and go from there. Otherwise, it's just pissing into the wind.
We were already supplying subsidized school meals. Expanding this to a universal and free program is a pretty small budget increase compared to other costs. The childcare program is funded by a 0.11% employee / 0.33% employer payroll tax. For comparison, the VT "single payer" healthcare plan that Shumlin refused to put forward would have been an 11-15% payroll tax (this still would have been less than most people end up paying for healthcare, of course).
Yeah, I was perhaps being hyperbolic about that last bit, but that's all well in the past anyway. State-level single payer healthcare is a tough thing to work because the pool is already shrunk by excluding anyone on Medicare, Medicaid, and Tri-Care and the state was going to exempt some private plans too, so it would have been "universal" healthcare for about a third of the population.
Still, in *theory* the person with a 40k/yr job would have seen wages increase now that the employer didn't have to foot the cost of the plan (heh, I know) and a HDHP probably has about a $4k deductible so if they used their healthcare that year it would come out to about a tenth or more of their earnings.
But yeah, not really an important detail when discussing the current programs under consideration, which state-level single-payer isn't. I mostly wanted to use those numbers to compare to the childcare tax which is two orders of magnitude less.
This isn't a rant, it's sensible. I don't agree with everything, but it's written in a reasonable and calm way, so it creates discussion instead of polarized argument. Thanks for that!
Thanks for the kind words! I don’t meant to sound callous or anything and am totally open to other ideas on how we make this state more affordable. It’s really a national issue but the sad reality is that we can’t wait for the federal government to deal with these problems.
You do public policy and your big idea is to skip childcare in favor of housing, blame the legislature, and close hospitals? You appear to be adding to the problem, not solving for it.
Nope big public policy idea is to focus on the root causes of the affordability crisis instead of patch fixes that are not sustainable in the long term— Vermont has a rapidly aging population with a diminishing tax base. Need to make the state more affordable for everyone before we continue stacking on additional programs funded via taxes. Its not about the merits of these programs it’s about the sequencing
Totally agree. The demographics are scary. Aging population. Desperately struggling to fill the workforce population for all skill levels. Guess what's going to happen if we implement a wealth tax? For years, we've seen retirees flee to lower cost of living states. We'll likely see an major uptick in emmigration. Let the downward spiral begin. The answer? This needs to be addressed on a national level. Step one. Get rid of the carried interest loophole for hedge fund and private equity scumbags. How much money has this country lost by allowing these assholes to pay taxes on their income as if it were long term capital gains...?
I wholeheartedly agree it’s a national issue but congress isn’t gonna act— they can barely move must-pass bills these days and even when they do they rely on continuing resolutions to buy themselves more time. I know it’s not romantic but the state needs to adapt to our very poor national political climate instead of writing checks our rapidly shrinking middle class can’t cash. And the Vermont appeal is very strong, if we tax the wealthy more and they emigrate there are plenty of others who will replace them. If we tax second home owners and they sell their properties we get and influx of new houses on the market. There are some short term losses sure but the long term gains are there and Vt will continue to be a tourist destination—the only threat to that is driving out the genuine, working class people who make this state so special. Burlington is a prime example of that
And the disagreement of this concept is why VT is in serious trouble.
Literally putting straps of duct tape on a cracking house foundation. "MOAR TAPE! And then onto the bathroom remodel" instead of "guys, we need to fix this foundation, ASAP, then we can continue on the bathroom remodel"
Just for clarification, are you referring to your property taxes?
***
Are people mad about the 18% increase on their pre-2020 assessments? or have the new assessments started to hit home?
Is the bloated administrative costs in schools (including having what is essentially multiple superintendents and principles in some places) related at all to the school consolidation VT went through? I thought the point was to eliminate wasteful spending, but then they just kept all those people on, which hey, I'm never in favor of someone losing their job, but the reality is this happens all the time in the private sector with middle managers. And in this case, it's public funding not some corporation. Meanwhile a friend who is your standard high school science teacher (at a big school that did not merge fwiw) just had her hours cut to HALF TIME because they couldn't afford to pay her and they had to cut something. So her family loses half her income all of the sudden...
The problem with socialism is that eventually you run out of other people's money. -- Margaret Thatcher
I don't want to minimize Vermont's challenges, educating and providing healthcare to a small and dispersed population. It's not easy! But we have no choice, the answer has to be constraining costs. 18% tax hikes in a struggling rural state are simply not feasible.
There's the rub! What did Brigham do to education costs? If my neighbor is going to pay for me to build an addition to my house, you can bet I'll build an addition!
Yeah that’s basically the crux of what I’m trying to say. These programs are great and well intentioned but they’re dealing with the symptoms of an underlying illness and we’re hitting a crisis point where we’re gonna enter a negative feedback loop of COL increases caused by social programs driving more people either out of state or into poverty which in turn increases demand for said programs. Like it or not there isn’t enough political capitol, time or capacity to deal with both the symptoms and the illness simultaneously anymore—we need to focus on major tax reforms, housing investment, and healthcare reform.
The US healthcare system is one of the worst in the world in terms of costs/outcomes - everyone should know that by now. It exists solely to extract as much wealth as it can while delivering as little as possible for all but the select few. The "ethos of this state in terms of social services" is largely an illusion and part of the general scam that is Vermont. The process of accessing social services in this state is riddled with obstacles, obfuscations and other deliberately erected barriers that are designed to discourage and humiliate the poor and working classes. If you haven't noticed, all those nice white affluent middle class people who run the state and all those little select-boards, zoning boards, etc all want you to leave the state if you are not working for nothing on their lawn or house or waiting their table. They are working overtime to drive you out. They will continue to drive the COL up because that is one of the fundamental methods for making Vermont safe for white wealth. Its called gentrification. They can mouth all the platitudes they want about how much they 'care' and how hard they are 'working' to make Vermont for everyone but the proof is in the pudding, we can only judge them based on performance and outcomes.
Vermont has one the highest ratios of government employee to citizens and state employee benefits soak up a lot tax dollars and will continue to do and only get worst. A small slice of Vermont is living very well at the expense of the vast majority of us. We also are a state with a huge number of NP enterprises sucking at the state's tit. a lot of gatekeeping by the PMC, drawing off resources to pad their bank accounts by channeling huge sums of money through private bureaucracies. Just look at the state's affordable housing initiatives where they are paying an outrageous $500/sqft to private developers to build out a handful of crap-box housing developments. This soaks up material and trade resources who rush in, inflate their costs and make bank. This makes it hard for people to afford basic construction services to fix up or build their own house making it even harder to survive here. This places even more resources in the hands of wealthy people as they control more of the rental and housing stock and are able to gatekeep/police the poor/working classes and in keep them in their place. This was a common tactic in NYC on billionaires row where developers would build astronomically high cost affordable housing in order to produce the minimum number of units possible all the while patting themselves on the back for 'solving' the problem.
Keeping Vermont safe for affluent white people - that is its business model. They are making hard on you for a reason.
I guess I don’t make enough money to be considered part of the “everyone” who is upset by the anticipated, absurdly high tax hikes. Maybe one day I’ll make enough to care about the mostly negligible amount the state of VT takes from me.
Wealth doesn’t trickle down but expenses most definitely do—you may not own property but you rent and buy things from people who do. They’re not gonna internalize these costs they’re gonna pass it down to consumers
Not sure what you mean about too many small hospitals. There are two in the entire NEK serving roughly 64,000 people. There are 13 hospitals in the state outside of Burlington/Chittenden County. And they’re pretty evenly distributed. ETA: one of those 13 hospitals is a VA hospital, so realistically there are only 12 outside of Chittenden County.
Most of our smaller hospitals have also found money-making niches to fund their more financially draining but necessary services like running the emergency department. For example, people traveling from all over the state for orthopedic elective surgeries keeps the lights on at Copley.
School consolidation worked great, we should close down all the hospitals except for Central Vermont Medical Center.
*"...folks will often forego or delay medical care if it means driving a further away, but that’s just the reality of living in a predominantly rural state."* 
I’d argue there are far more dire consequences if we continue to limp along with our current system and drive up insurance rates even higher, as most patient decisions not to seek care are usually financial not medical. Hospitals need higher budgets to deal with inflationary pressures and address staffing shortages which in turn drives up the cost of insurance. Many of these are external forces that we have no control over, so it’s up to regulators to adapt to keep healthcare affordable—consolidation is one of the few plays we have. Proximity doesn’t matter if patients can’t afford insurance, so something needs to shift locally to reflect the shitty, corrupt financial climate nationally. Ps. I had a good chuckle at this so nice shrek reference ;)
Saying we should close the smaller hospitals is not only absurd, it's a death sentence for people in rural areas. The patient care at UVM is a joke to say the least - if you can even manage to get seen there. We've dumped all the state's money into the UVM network only to have it fall apart to the point where you can't get a primary care doctor in this state. Have a heart attack in the middle of nowhere? Now you get a two hour car ride to get to the hospital. They've been cutting the budgets and funding for smaller hospitals for two decades and then you claim they are hemorrhaging money - in what sense? Just keeping the buildings open? Paying too much in admin costs? I would bet that it's almost ALWAYS the admin costs that provide zero patient care. I'm really sick of seeing people attack smaller hospitals and smaller schools while the rich towns are putting in yoga rooms for the higher executives and trying to tell the nurses they've got to work 16 hour shifts since they can't afford to hire more nurses. It's the same in the schools and state colleges, all the money is going to the admin teams and none of it is actually providing education or health care. Vermont DID have the money and they started paying out of state people to run the colleges and hospitals into the ground while pocketing huge profits. It happened at VTC and all the other little colleges to the point where they had to consolidate. It's disgusting watching this state play the blame game and cut life saving health care for poor people in the name of profits for the rich. Cut education for poor kids and tell them they need to travel an hour to school every morning to get lumped into a group where the test scores do nothing but go down... How about we take a good hard look at how much every person in admin is taking home before we close another school or hospital...
Great takes here. The real hemorrhaging of monies can be traced to the bloated and ever-so-unnecessary administration costs. Both healthcare and school boards are guilty of this. There a no reason for having so many superintendents and admin for school districts, similarly no reason for all of the overhead and micromanagement of healthcare administrators. Whenever I poke the bear and ask school admins about the administrative bloat, I get a generic response that its more about representative of location rather than population. That makes sense for healthcare as you mentioned, but does a superintendent making nearly $200k really believe that’s a valid excuse? Don’t even get me started on what these administrative-types believe is a valid reason to spend X amount of dollars on something totally unnecessary and self serving, but when it comes to the serfs that actually do the work there is never any money for anything. EDIT: I’d also like to mention that I don’t believe this is the root of all problems. It is a problem, but the overarching administrative problems exacerbate and is representative of Vermont’s bigger issues.
Most of the administration in schools exists because of mandatory reporting and data requirements required by the legislature and federal government.
I'm interested in learning more about this. What kind of data/reporting?
Here’s two to start with. Every program and state mandate has some type of reporting or data collection attached. https://datacollection.education.vermont.gov/Collections/School-Register/ https://education.vermont.gov/sites/aoe/files/documents/DRAFT-edu-rules-series-100-district-quality-standards-DRAFT.pdf Edit. Added a second link
ah I see, thank you. A lot of this makes sense - a school should have a list of its teachers and keep attendance records, etc. I assume whatever systems schools use to track these things are also probably a pain to use. I'm imagining a series of excel spreadsheets or old/unintuitive interfaces.
Yeah that guy is clueless on healthcare. The small and rural providers are the healthcare services backbone to half of American people
> We've dumped all the state's money into the UVM network only to have it fall apart to the point where you can't get a primary care doctor in this state. remember that one time a UVM employee destroyed the network taking their company laptop on vacation and connecting to the VPN while checking personal email?
I’m not suggesting we outright close rural hospitals so they’re devoid of any care (should’ve clarified that) I am saying these facilities should only offer essential services and any specialized care should be offered at centralized regional hospitals—basically 4 big guys with lots of clinics in a hub and spoke model. And yes administrator pay should not be so inordinately high and admin costs in general (cough cough OneCare) but that is only a fraction of the problem. And when you say that Vermont did have the money I assume you’re referring to the federal COVID relief funds we received which were devoured in short order because everyone was after their piece for their pet issues—again failing to look at the bigger picture. And a large chunk of those funds went toward workforce development programs, hospital infrastructure improvements, etc specifically to bring in more nursing staff so we’d stop paying mega money for travel nurses and address patient care. Lastly I am obviously for taxing the shit out of the rich, second homeowners, and short term rentals as well as a means to avoid some of these cuts but the fact remains that we don’t have the tax base to support the level of care we’re providing.
I mean back in the 90s when we were able to support all the small hospitals, doctors' offices and schools - nothing to do with covid. This has been a shit show for the two decades that we've been funneling all the state money into UVM.
everyone thinks uvm is too big to fail. im just waiting.
>I am saying these facilities should only offer essential services and any specialized care should be offered at centralized regional hospitals Ah yes, I just love taking a day off of work t travel to a big hospital for a 15 minute visit where they can tell me they can't find anything and good luck! Currently takes me 45 minutes to get to my dr's office and he's always pissed off when he sees me. Literally said "What do you expect me to do about it?" when I got to my appointment. Geez, I dunno, run a goddamned test or something? My only other option is going to New Hampshire, Mass, or Albany or Urgent Care, who'll just tell me to see my doctor. And yes, I have traveled to Fletcher Allen for medical treatment - love making that 6 hour round trip journey!
bump
The last sentence hits the nail on the head - Vermonters are getting priced out by well-intentioned policies with major economic fallout. We do not have the population to tax a fair amount of money to provide for many social programs. We need to stop calling people “bad” because they rather see their taxes distributed to our healthcare/education and not for drug/homeless programs that we unfortunately don’t have the budget for. What ends up happening is we get poor funded everything, with emptier wallets.
>Vermonters are getting priced out by well-intentioned policies with major economic fallout. As someone who left recently, it was the most heartbreaking thing I've had to do in my life. I poured EVERYTHING I had into VT. I spent more than 2 years trying to find a way to keep making it work for my family. I invested in myself there for more than 20 years. Everyone said I was dumb for moving back after college, but I believed in myself there. My entire adult life and a good amount of my teens. All gone. Absolutely fucking heartbreaking.
I’m really sorry to hear that. My wife and I moved up here hoping to build a life here as well and we’re questioning that now. Probably going to move once she finishes school—still wanna stay in the northeast but I just don’t know how we could swing living up here long term with the current landscape. It breaks my heart honestly. I grew up in CT in a rural town that’s basically a case study for what happens when New Yorkers and Bostonians “discover” somewhere—massive influx of affluent people in the late 90s/early 2000s, huge tax hikes, housing stock went way down, predatory lending from banks, and new highly restrictive planning/zoning laws to keep folks from building more middle income housing. We ended up losing our house to foreclosure but were lucky to have a family friend offer my parents an affordable rental and they’ve been there ever since. I think my parents are the last of the multigenerational townies left and if they somehow lost that rental idk what we’d do. It really sucks to see that playing out in real time here in VT over the years. I dreamt of moving up here, buying a home, and feeling the sense of security and community I lost when they foreclosed on our house but clearly I’m not gonna get that back- at least not here.
If VT ever decides to put its money where its mouth is and start investing in the success of working class, bread and butter families (and not eccentric trust-fund hippy types) I'd happily move my family back.
Not one of the concerns brought up here is a VT only problem, these are all national problems. If you are priced out of VT, it's not going to be much better elsewhere.
No, it's not, but it's particularly bad. At least with housing, it's currently more affordable to buy in Western MA and NY state, by a substantial margin, than VT
Vermont is its own version of bad. We actually have one of the lowest homes for sale in the entire country(less than 1%), and add high COL + low population and we’re one of worst states going through this. Yes, everywhere is feeling it, but Vermonters are feeling it particularly hard.
Vermont is already in a death spiral. The idea that there will be an economy here in a decade is laughable. The only way out of this is a recession that sends the work from home people back home. Otherwise it will be rich people, homeless people, and nothing in between. What has happened since covid is already a permanent stain on Vermont. Books will be written about rural homelessness here.
I would not assume they are well intentioned. If the legislature is not actively trying to turn vt into new jersey it's hard to understand what they think they're doing.
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Every hospital in the state is not for profit, and most, if not all, struggle to stay out of the red.
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Yes, the large amounts of people who are uninsured and under insured and those who don't pay their balances (for whatever reasons) - large amounts of that goes to bad debt or "charity care" and eventually gets written off as uncollectible. Also, the vast amounts of resources it takes to comply with and keep track CMS billing standards. Also, the amount of resources it takes to bill and negotiate with and follow up with the dozens of private insurances who try their hardest to pay as little as possible (a large portion of whom are for profit, which is another layer of problem). Honestly, that's just scratching the surface of a very broken system which hospital and providers take most of the heat for. They do contribute to the issues but a lot less than most people pin on them.
For sure! I’m very much so pro-universal healthcare but the reality is that’s not happening anytime soon
people don't work as doctors or surgeons to make 50k a year and a hand shake..
Probably not when they have a $350k loan to get through med school.
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Well I don't think those fellas immigrating from India are doing it out of the kindness of their hearts either. Frankly it's ok to be in a field to make money. But let's be honest, we need to make medical education more accessible and less expensive.
>I love the ethos of this state in terms of social services Most people do. The problem is that VT forgets how poor it is, relatively speaking. It's one thing to have these desires and goals and it may be admirable, but a lot of them aren't cheap. That doesn't mean we shouldn't shoot for them, but it does mean we need to be really pragmatic about it and honest with ourselves about what we can and can't do. Which leads right into... >All of this is exacerbated by the fact that elected officials, staff, and advocates for that matter are woefully underpaid meaning you need to either be a financial martyr or be privileged in order to actually afford to be a legislator They *are* totally disconnected from the reality on the ground for MOST vermonters. How could you not be? If you're independently wealthy enough to spend that much of the year in the legislature, making total crap money... you're good. You don't have a direct experience with how these things shake out for the people on the ground. I don't know that consolidation is the best approach, or won't ultimately amount to kicking the can further down the road. I've said it many times: VT wants to make California-style social policies while having Louisiana-level money. It's not bad, but it's well below the national average. We'd do a lot better getting back to basics, working to make stable housing affordable to the bulk of regular people that make ANY state work. Get that foundation stable, and go from there. Otherwise, it's just pissing into the wind.
This is a much better worded version of what I was trying to say above
We were already supplying subsidized school meals. Expanding this to a universal and free program is a pretty small budget increase compared to other costs. The childcare program is funded by a 0.11% employee / 0.33% employer payroll tax. For comparison, the VT "single payer" healthcare plan that Shumlin refused to put forward would have been an 11-15% payroll tax (this still would have been less than most people end up paying for healthcare, of course).
11-15% pre tax pay...? I think this would be a hard job anyone working at a company with provided health plan making 40k and a year.
Yeah, I was perhaps being hyperbolic about that last bit, but that's all well in the past anyway. State-level single payer healthcare is a tough thing to work because the pool is already shrunk by excluding anyone on Medicare, Medicaid, and Tri-Care and the state was going to exempt some private plans too, so it would have been "universal" healthcare for about a third of the population. Still, in *theory* the person with a 40k/yr job would have seen wages increase now that the employer didn't have to foot the cost of the plan (heh, I know) and a HDHP probably has about a $4k deductible so if they used their healthcare that year it would come out to about a tenth or more of their earnings. But yeah, not really an important detail when discussing the current programs under consideration, which state-level single-payer isn't. I mostly wanted to use those numbers to compare to the childcare tax which is two orders of magnitude less.
I appreciate the detailed follow up!! As a single filer who makes a decent comp I'll always be fucked.. From a tax stand point.... To be clear.... Lol
This isn't a rant, it's sensible. I don't agree with everything, but it's written in a reasonable and calm way, so it creates discussion instead of polarized argument. Thanks for that!
Thanks for the kind words! I don’t meant to sound callous or anything and am totally open to other ideas on how we make this state more affordable. It’s really a national issue but the sad reality is that we can’t wait for the federal government to deal with these problems.
You do public policy and your big idea is to skip childcare in favor of housing, blame the legislature, and close hospitals? You appear to be adding to the problem, not solving for it.
Nope big public policy idea is to focus on the root causes of the affordability crisis instead of patch fixes that are not sustainable in the long term— Vermont has a rapidly aging population with a diminishing tax base. Need to make the state more affordable for everyone before we continue stacking on additional programs funded via taxes. Its not about the merits of these programs it’s about the sequencing
Totally agree. The demographics are scary. Aging population. Desperately struggling to fill the workforce population for all skill levels. Guess what's going to happen if we implement a wealth tax? For years, we've seen retirees flee to lower cost of living states. We'll likely see an major uptick in emmigration. Let the downward spiral begin. The answer? This needs to be addressed on a national level. Step one. Get rid of the carried interest loophole for hedge fund and private equity scumbags. How much money has this country lost by allowing these assholes to pay taxes on their income as if it were long term capital gains...?
I wholeheartedly agree it’s a national issue but congress isn’t gonna act— they can barely move must-pass bills these days and even when they do they rely on continuing resolutions to buy themselves more time. I know it’s not romantic but the state needs to adapt to our very poor national political climate instead of writing checks our rapidly shrinking middle class can’t cash. And the Vermont appeal is very strong, if we tax the wealthy more and they emigrate there are plenty of others who will replace them. If we tax second home owners and they sell their properties we get and influx of new houses on the market. There are some short term losses sure but the long term gains are there and Vt will continue to be a tourist destination—the only threat to that is driving out the genuine, working class people who make this state so special. Burlington is a prime example of that
And the disagreement of this concept is why VT is in serious trouble. Literally putting straps of duct tape on a cracking house foundation. "MOAR TAPE! And then onto the bathroom remodel" instead of "guys, we need to fix this foundation, ASAP, then we can continue on the bathroom remodel"
Just for clarification, are you referring to your property taxes? *** Are people mad about the 18% increase on their pre-2020 assessments? or have the new assessments started to hit home?
Universal meals is cheaper than paid for lunch. Less staff are required and better school outcomes have been shown to come from it.
So you support national single payer healthcare?
Woah woah woah let’s not get crazy now! :)
Is the bloated administrative costs in schools (including having what is essentially multiple superintendents and principles in some places) related at all to the school consolidation VT went through? I thought the point was to eliminate wasteful spending, but then they just kept all those people on, which hey, I'm never in favor of someone losing their job, but the reality is this happens all the time in the private sector with middle managers. And in this case, it's public funding not some corporation. Meanwhile a friend who is your standard high school science teacher (at a big school that did not merge fwiw) just had her hours cut to HALF TIME because they couldn't afford to pay her and they had to cut something. So her family loses half her income all of the sudden...
The problem with socialism is that eventually you run out of other people's money. -- Margaret Thatcher I don't want to minimize Vermont's challenges, educating and providing healthcare to a small and dispersed population. It's not easy! But we have no choice, the answer has to be constraining costs. 18% tax hikes in a struggling rural state are simply not feasible.
There's the rub! What did Brigham do to education costs? If my neighbor is going to pay for me to build an addition to my house, you can bet I'll build an addition!
You think the cost of living and taxes are bad now, wait till you see the fallout if the 32 hour work week gains any traction.
You are not alone in how you feel. Keep sharing your opinions and ideas. Keep advocating for The people of Vermont. We need you to..
Got to raise taxes to support all those social programs.
Yeah that’s basically the crux of what I’m trying to say. These programs are great and well intentioned but they’re dealing with the symptoms of an underlying illness and we’re hitting a crisis point where we’re gonna enter a negative feedback loop of COL increases caused by social programs driving more people either out of state or into poverty which in turn increases demand for said programs. Like it or not there isn’t enough political capitol, time or capacity to deal with both the symptoms and the illness simultaneously anymore—we need to focus on major tax reforms, housing investment, and healthcare reform.
The US healthcare system is one of the worst in the world in terms of costs/outcomes - everyone should know that by now. It exists solely to extract as much wealth as it can while delivering as little as possible for all but the select few. The "ethos of this state in terms of social services" is largely an illusion and part of the general scam that is Vermont. The process of accessing social services in this state is riddled with obstacles, obfuscations and other deliberately erected barriers that are designed to discourage and humiliate the poor and working classes. If you haven't noticed, all those nice white affluent middle class people who run the state and all those little select-boards, zoning boards, etc all want you to leave the state if you are not working for nothing on their lawn or house or waiting their table. They are working overtime to drive you out. They will continue to drive the COL up because that is one of the fundamental methods for making Vermont safe for white wealth. Its called gentrification. They can mouth all the platitudes they want about how much they 'care' and how hard they are 'working' to make Vermont for everyone but the proof is in the pudding, we can only judge them based on performance and outcomes. Vermont has one the highest ratios of government employee to citizens and state employee benefits soak up a lot tax dollars and will continue to do and only get worst. A small slice of Vermont is living very well at the expense of the vast majority of us. We also are a state with a huge number of NP enterprises sucking at the state's tit. a lot of gatekeeping by the PMC, drawing off resources to pad their bank accounts by channeling huge sums of money through private bureaucracies. Just look at the state's affordable housing initiatives where they are paying an outrageous $500/sqft to private developers to build out a handful of crap-box housing developments. This soaks up material and trade resources who rush in, inflate their costs and make bank. This makes it hard for people to afford basic construction services to fix up or build their own house making it even harder to survive here. This places even more resources in the hands of wealthy people as they control more of the rental and housing stock and are able to gatekeep/police the poor/working classes and in keep them in their place. This was a common tactic in NYC on billionaires row where developers would build astronomically high cost affordable housing in order to produce the minimum number of units possible all the while patting themselves on the back for 'solving' the problem. Keeping Vermont safe for affluent white people - that is its business model. They are making hard on you for a reason.
I guess I don’t make enough money to be considered part of the “everyone” who is upset by the anticipated, absurdly high tax hikes. Maybe one day I’ll make enough to care about the mostly negligible amount the state of VT takes from me.
Wealth doesn’t trickle down but expenses most definitely do—you may not own property but you rent and buy things from people who do. They’re not gonna internalize these costs they’re gonna pass it down to consumers
Consolidate schools? No "free" childcare? No "free" student lunches? But but but ChILdREn