This commentary is by Matt Swenson, the founder of Omnidex Solutions, an independent research and strategic analysis company. He lives in Vermont.
Vermont’s healthcare debate has spent years arguing about prices. I think the scarier question is simpler: Can you actually get care when you need it? For me, that’s not some abstract policy question. It’s personal.
I moved to Vermont partly for its reputation for good medical care, after a rough career in environmental toxicology that left me with permanent injuries and health problems to manage. Vermont doctors have done right by me. The physicians themselves are good; what’s gone downhill is the system around them, especially primary care inside the big hospital networks. I eventually switched to direct primary care, and it’s been a relief. I can actually get seen, and it feels like medicine again instead of fighting an institution.
That’s why the current contraction worries me. The University of Vermont Health network just announced changes affecting 199 positions, with 55 new or restructured positions being created. Dartmouth Health cut 124 positions and eliminated hundreds of vacant positions at Dartmouth Hitchcock Medical Center and its southern clinics. Even UVM Health’s own leadership acknowledges that the system is financially strained while patients struggle to afford and access care.
This isn’t just one bad round of layoffs. Vermont’s physician census found only 529 primary care doctors practicing in 2024, down from 569 in 2022 and 634 in 2004. Health Commissioner Rick Hildebrant has acknowledged that the state hasn’t done enough to reverse that trend. The state’s own health assessments point to familiar problems: burnout, paperwork, compensation and even difficulty finding housing when doctors relocate here. Rural Vermont has it worse than Chittenden County.
That should change how we think about health policy. The Green Mountain Care Board has regulated hospital budgets since 2013, and now Vermont is moving toward reference-based pricing to rein in commercial hospital costs. Fine — affordability matters. But price can’t be the only thing we measure.
Vermont needs an access-to-care dashboard alongside all that financial regulation. Show us specialty wait times, delayed surgeries, emergency room boarding, transfer delays, canceled procedures and how many practices are actually taking new patients. You can make healthcare cheaper on paper while making it harder to actually get. That’s not a win.
Hospital administration needs the same hard look. Every dollar spent on administration, consultants and communications staff ought to be examined openly, especially when Vermont is losing the people who actually treat patients. The question is not whether every administrative position is unnecessary. The question is whether the system is directing enough of its resources toward patient care and access.
Compare that with education spending. Vermont recently put roughly $100 million in one-time funding to soften the education property tax increase, even while spending near the top of the country per pupil as enrollment continues to fall. Shuffling general fund money around can hide a tax increase for a year. It doesn’t fix what’s broken.
Gov. Phil Scott is pushing school restructuring again, but we’ve covered much of this ground before. Act 46 and predecessor laws helped drive a consolidation process in which 206 districts in 185 towns ultimately formed 50 new union school districts. After a decade of restructuring, Vermont is still arguing about consolidation, declining enrollment and costs.
Scott reminds me of Mr. Rogers sometimes — soft-spoken, always looking for the nice way to say things, never wanting to pick a fight if he can avoid one. That’s a fine way to run a neighborhood. It is not a strategy for a workforce crisis. You don’t fix a shrinking physician pipeline or a hollowed-out rural health system simply by being agreeable at the negotiating table. Being liked has kept Scott popular for years, but popularity isn’t the same thing as confronting difficult structural problems. At some point, the nice-guy approach has to give way to naming the problem and pushing back on the institutions making it worse.
For the doctors we’re trying to recruit, taxes stack up alongside housing, pay, workload and whether there is real opportunity here. The same problem applies to single-payer generally. Changing who writes the check doesn’t make more doctors. A new financing system doesn’t build an operating room. An insurance card doesn’t mean much when nobody is taking new patients and the specialist can’t see you for six months.
Here’s the other half nobody wants to say out loud: None of this gets paid for by wishing for the Vermont of 40 years ago. We’re not going to tax our way to a healthy system on top of an economy that isn’t growing. If Vermont wants the revenue to rebuild capacity, it needs a real future-tech economy — not hopes and vibes.
That means competing for data centers and the tax base that can accompany them instead of watching investment land across the border. It also means bringing serious artificial intelligence into our hospitals — not as a gimmick or a substitute for physicians, but as technology that can assist diagnostics, triage and administrative work. Used intelligently, technology should take weight off clinicians and free the providers we already have to spend more time treating patients.
Vermont can regulate its way toward lower prices. It cannot regulate its way to more doctors, more capacity or more economic growth. Those things have to be built.
I sold my Vermont property years ago and have rented ever since, partly because I want a way out if the state keeps heading in this direction. I suspect plenty of other people are making the same calculation. And I understand why young Vermonters leave.
If I were young today, looking at the housing, the taxes and healthcare getting harder to reach every year, I wouldn’t walk out of this state.
I’d run.
