As reported in a recent VTDigger article published by the Valley News (“UVM professor finds link between lobbyists, rising health care costs”; Oct. 25), Dr. Alex Garlick has provided a number of positive recommendations for addressing the current health care cost crisis in Vermont. These include strengthening the Green Mountain Care Board, expanding housing options for health care providers, and limiting the impact of lobbyists.
However, I strongly disagree with his suggestion to increase the number of clinics and hospitals with the intent of fostering competition among providers to reduce fees.
There are two major problems with a market-based approach to health care in Vermont.
First is the matter of scale, which Dr. Garlick himself mentions. Even in Chittenden County, Vermont is simply too small to support multiple facilities competing against each other—except in limited areas such as urgent care, ambulatory surgery, and imaging. In fact, we face the opposite issue: birthing centers and other essential services are closing due to low volume.
More fundamentally, health care does not conform to a typical supply-and-demand model. In ongoing debates over the Affordable Care Act, Medicare, and Medicaid, there may be differences in how far coverage should extend, but there is near-universal agreement on one point: we have an ethical duty to provide necessary health care to those who need it, not just those who can afford to pay.
By its very nature, this commitment draws us away from free-market principles and toward governmental fiscal and regulatory involvement in the health care system.
Additionally, when their health and lives are at stake, most people do not spend time shopping around for the best deal. They prioritize timeliness, quality of care, and proximity. Those who can afford it purchase health insurance and let the insurer handle the costs. Those without insurance often ignore costs altogether when accessing health care services.
Given these realities, increasing the number of providers in Vermont would not stimulate vibrant competition. Instead, it would likely lead to increased expenses and lower revenue per provider.
If health care billing were more understandable and transparent, we might see some increase in consumers seeking cost information before treatment. More importantly, simplifying the billing process could substantially reduce administrative costs for both providers and insurers.
For example, bundled payments per procedure would be far simpler and clearer than the current fee-for-service model, which bills individually for many aspects of treatment. Billing rates could also be standardized across providers through state-regulated rates rather than individualized negotiations between providers and insurers.
These are just a few ways we can streamline the nonclinical aspects of health care instead of relying on market principles to contain costs.
Ultimately, Vermont stands to gain more through collaboration than through competition or consolidation.
**Gus Meyer** is a licensed psychologist and former member of the Gifford Health Care Board of Directors.
https://vnews.com/2025/11/06/competition-vs-collaboration-vermont-healthcare/
