By AL GOBEILLE
People often wonder what it would be like to switch jobs with someone for a day to see what it’s like to do something totally different. I’m a businessperson, and for over 20 years, I have owned and operated restaurants. In 2011 I was honored to accept an appointment as a Vermont public servant.
My journey in Vermont state government began with an appointment to the Green Mountain Care Board, a position regulating health care. In early 2017, my next stop was to accept an appointment to serve as Secretary of the Agency of Human Services, the largest agency in state government. I stepped down from this position at the end of June. Since that time, a few folks have asked me to describe what it was like, and what I discovered, during my time in state government.
In short: It was a great experience. Getting to work with such talented people as we tried to improve Vermonters’ lives was a privilege. I recommend that more business owners “take the leap,” as you will find that it will broaden your perspective and understanding of our state.
After hearing the positive, you should know what the hardest part of the job was. Some might expect that the greatest challenge was managing a budget of $2.5 billion dollars and a staff of 3,700 people, but the real answer is much deeper. The toughest part was knowing that some of the suffering that human service providers attempt to comfort was preventable. Prevention can be as simple as a Measles vaccine and fluoridated water, or as complicated as developing a system of nurse home visits to every newborn. The failure of prevention—unnecessary tooth decay for example—is painful, expensive, and loaded with unintended consequences. Preventable health conditions directly contribute to the cost of health insurance, and regrettably, human suffering.
I saw the impact of not investing in prevention efforts when, in 2015, we built a forecast model to estimate the cost of health insurance for a family of four. By 2025, the cost of these plans was estimated to balloon to almost $20/hour for a full-time employee. That’s almost $42,000 a year. Depending on where you stand in life, the cost will be shouldered by families purchasing health insurance, businesses, and other taxpayers. It was clear we needed to find a way to bend the cost curve or the growth would be unsustainable for all. Our ability to reform and grow a sustainable system could attract businesses and families to the state who are seeking predictable health care costs. In fact, a recent report from Fitch Ratings cited the leveling of Medicaid spending as a positive item for Vermont’s fiscal stability.
A lack of investment in prevention doesn’t just impact health care costs – for almost two decades, the Agency of Human Services’ budget has grown at almost 6%, while our economy’s ability to support the Agency has grown at 3.3%. I know our team did an admirable job of managing spending growth while delivering the services Vermonters need. However, the hard part about government is that some people are always going to want more, and some people are always going to want less. The voices for more services and more spending sometimes appear to own the high ground, while those professing the need for less can appear to lack compassion or understanding. There is always middle ground and we should strive to find it.
Vermonters have a choice and a responsibility to ourselves and to each other. There is something in each of us that holds concern for the suffering of others. We feel the pain and hardship that others endure. It doesn’t matter whether you work in business or in government, we have an obligation to draw on our empathy as we seek ways forward to prevent the tragedies that overwhelm our neighbors. My time in State Government reminded me that, though hard, each of us can play a part.
Al Gobeille served as Chairman of the Green Mountain Care Board and most recently as Secretary of the Agency of Human Services.