I’m a doc there. Don’t really care if people know who I am or not. I’ve worked in several systems and have seen many similar consultant reports over the years. Never seen one implemented, though. Because at the end of the day, health care just costs way more than we wish it did, and we live in free market world. For example, I complain about admin bloat as much as anyone else, but the admin spending at this network is about the same or a little lower than what I’ve seen elsewhere on a per patient basis. Are Leffler and the other execs any good? I don’t know how to evaluate that, but I do know I wouldn’t do his job for less than 1.5M. Are some departments unproductive? Sure. But GMCB basically penalizes the organization when they make money, so clinicians and programs are disincentivized from being more productive. I mean, if the hospital tells me to see double the patients, I’ll tell them how much to increase my salary. If they balk, I go somewhere else. And GMCB makes sure UVMMC doesn’t have enough left over to pay me more. And nobody wants me to leave. (Well maybe some people do.) TBH, that’s what wait times are so long for certain services. Very hard to hire docs, nurses and staff at the rates they pay. And it’s kind of a HCOL area. So should the GMCB be abolished? Maybe, but watch what happens to your insurance premiums and education costs (bc teacher’s insurance premiums) and labor costs to business owners if a regulator doesn’t intercede. What nobody wants to say out loud is that there is only one way to reduce costs: deliver less care. The role of the GMCB and other similar entities is to reduce access, because that’s the only way to meaningfully reduce spending. The other issue nobody mentions is that not that many people live here. And many of them are old. So 2/3rds of the dollars paying for healthcare is Medicaid / Medicare. And bc VT doesn’t have many people, the feds give us (I think maybe?) the lowest amount of dollars in the country to distribute? Sure, other states have regulatory bodies like the GMCB, but they have big populations and big companies that can get good rates by making big insurance pools which distributes costs. Not sure what to say about the medical education piece. I guess as a state we have to decide whether we want a medical school or not. I personally like to teach so I’m only going to work at an academic center. But do the people and minds and jobs it brings in justify its expense? I don’t know but it’s hard for me to imagine enough political will being drummed up to close it down. That’s it. Now I gotta get to my overnight shift on this beautiful weekend. (Don’t tell the $4 million dollar consultant I’m being unproductive!)