The Green Mountain Care Board last week approved rate hikes for Blue Cross Blue Shield and MVP Health Care that it said were “unaffordable.” The increases, 12.4 percent for BCBS and 10.1 percent for MVP, go into effect Jan. 1, 2020, when they will become “unaffordable” and unexplained to Vermonters.

Kevin Mullen, chair of the GMCB, said, “These rates are not affordable. We acknowledge they are not affordable. But at the same time we can’t put a company out of business.”

The board acknowledged both insurers had lost money last year and they also heard from the insurers that the problem rested with the board and its failure to grant the insurers the rate increases they have needed for the last five years.

This same story is being played out with Vermont’s hospitals. Almost half the state’s hospitals are losing money and the GMCB has played the same game with the hospitals in recent years. Whatever rate increases the hospitals propose, the board gives them less.

The question is whether Mr. Mullin and the other four members of the board will respond to the hospitals’ proposed budgets with the same “we can’t put a company out of business” defense.

That question prompts another: Why would the GMCB hear from the insurers, and decide upon their budget requests, before they would go through the same process with the hospitals?

They have it exactly backwards. The board can’t get a handle on future costs until they hear from the hospitals, and if they don’t know future costs how can they decide what rates are necessary for the survival of the insurers?

They can’t.

What should, by now, be equally apparent [and puzzling] is that we have no leadership to guide us through our quickly evolving, and highly fragile, health care landscape. There is no one to answer the questions, or offer guidance. All the players are hunkered down in their silos protective of their own, communicating within their own, meanwhile, to the average Vermonter, the system seems to be fraying at the edges. All the public sees or hears about is a system struggling to keep its head above water. All they hear about is a rate increase they can’t afford.

All questions, no answers.

The insurers point to high usage issues as one of the reasons they need more money. Where? And by whom? And for what reasons? And how can that be addressed if it’s not understood, if it’s not talked about?

Within the next three years roughly 70 percent of the state’s health care network is slated to be part of OneCare Vermont, a payment reform model that ditches the traditional fee-for-service model for one based on health care outcomes. It’s a radical change from what we have and the number of people who truly understand it can easily fit in a small room. Yet we’re redesigning our hospitals – and spending a lot of money doing so – convinced it is going to happen. The insurers are part of that equation, and part of the puzzle.

Doesn’t that beg for some leadership? Doesn’t that beg for a big time effort to explain to Vermonters what’s going on and why?

It’s actually a good story. Properly told it would help explain a lot of what is going on with Vermont’s health care system. Properly told it would lay out the vision of how Vermont’s health care system becomes more efficient and oriented towards a healthier health care culture.

But we hear nothing. Crickets.

The truth? That silence is also “unaffordable.”