In Vermont, Where Almost Everyone Has Insurance, Many Can’t Find or Afford Care
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RICHMOND, Vt. — On a warm autumn morning, Roger Brown walked through a grove of towering trees whose sap fuels his maple syrup business. He was checking for damage after recent flooding. But these days, his workers’ health worries him more than his trees’.
The cost of Slopeside Syrup’s employee health insurance premiums spiked 24% this year. Next year it will rise 14%.
The jumps mean less money to pay workers, and expensive insurance coverage that doesn’t ensure employees can get care, Brown said. “Vermont is seen as the most progressive state, so how is health care here so screwed up?”
Vermont consistently ranks among the healthiest states, and its unemployment and uninsured rates are among the lowest. Yet Vermonters pay the highest prices nationwide for individual health coverage, and state reports show its providers and insurers are in financial trouble. Nine of the state’s 14 hospitals are losing money, and the state’s largest insurer is struggling to remain solvent. Long waits for care have become increasingly common, according to state reports and interviews with residents and industry officials.
Rising health costs are a problem across the country, but Vermont’s situation surprises health experts because virtually all its residents have insurance and the state regulates care and coverage prices.
For more than 15 years, federal and state policymakers have focused on increasing the number of people insured, which they expected would shore up hospital finances and make care more available and affordable.
“Vermont’s struggles are a wake-up call that insurance is only one piece of the puzzle to ensuring access to care,” said Keith Mueller, a rural health expert at the University of Iowa.
Regulators and consultants say the state’s small, aging population of about 650,000 makes spreading insurance risk difficult. That demographic challenge is compounded by geography, as many Vermonters live in rural areas, where it’s difficult to attract more health workers to address shortages.
At least part of the cost spike can be attributed to patients crossing state lines for quicker care in New York and Massachusetts. Those visits can be more expensive for both insurers and patients because of long ambulance rides and charges from out-of-network providers.
Patients who stay, like Lynne Drevik, face long waits. Drevik said her doctor told her in April that she needed knee replacement surgeries — but the earliest appointment would be in January for one knee and the following April for the other.
Drevik, 59, said it hurts to climb the stairs in the 19th-century farmhouse in Montgomery Center she and her husband operate as an inn and a spa. “My life is on hold here, and it’s hard to make any plans,” she said. “It’s terrible.”
Health experts say some of the state’s health system troubles are self-inflicted.
Unlike most states, Vermont regulates hospital and insurance prices through an independent agency, the Green Mountain Care Board. Until recently, the board typically approved whatever price changes companies wanted, said Julie Wasserman, a health consultant in Vermont.
The board allowed one health system — the University of Vermont Health Network — to control about two-thirds of the state’s hospital market and allowed its main facility, the University of Vermont Medical Center in Burlington, to raise its prices until it ranked among the nation’s most expensive, she said, citing data the board presented in September.
Hospital officials contend their prices are no higher than industry averages.
But for 2025, the board required the University of Vermont Medical Center to cut the prices it bills private insurers by 1%.
The nonprofit system says it is navigating its own challenges. Top officials say a severe lack of housing makes it hard to recruit workers, while too few mental health providers, nursing homes, and long-term care services often create delays in discharging patients, adding to costs.
Two-thirds of the system’s patients are covered by Medicare or Medicaid, said CEO Sunny Eappen. Both government programs pay providers lower rates than private insurance, which Eappen said makes it difficult to afford rising prices for drugs, medical devices, and labor.
Officials at the University of Vermont Medical Center point to several ways they are trying to adapt. They cited, for example, $9 million the hospital system has contributed to the construction of two large apartment buildings to house new workers, at a subsidized price for lower-income employees.
The hospital also has worked with community partners to open a mental health urgent care center, providing an alternative to the emergency room.
In the ER, curtains separate areas in the hallway where patients can lie on beds or gurneys for hours waiting for a room. The hospital also uses what was a storage closet as an overflow room to provide care.
“It’s good to get patients into a hallway, as it’s better than a chair,” said Mariah McNamara, an ER doctor and associate chief medical officer with the hospital.
For the about 250 days a year when the hospital is full, doctors face pressure to discharge patients without the ideal home or community care setup, she said. “We have to go in the direction of letting you go home without patient services and giving that a try, because otherwise the hospital is going to be full of people, and that includes people that don’t need to be here,” McNamara said.
Searching for solutions, the Green Mountain Care Board hired a consultant who recommended a number of changes, including converting four rural hospitals into outpatient facilities, in a worst-case scenario, and consolidating specialty services at several others.
The consultant, Bruce Hamory, said in a call with reporters that his report provides a road map for Vermont, where “the health care system is no match for demographic, workforce, and housing challenges.”
But he cautioned that any fix would require sacrifice from everyone, including patients, employers, and health providers. “There is no simple single policy solution,” he said.
One place Hamory recommended converting to an outpatient center only was North Country Hospital in Newport, a village in Vermont’s least populated region, known as the Northeast Kingdom.
The 25-bed hospital has lost money for years, partly because of an electronic health record system that has made it difficult to bill patients. But the hospital also has struggled to attract providers and make enough money to pay them.
Officials said they would fight any plans to close the hospital, which recently dropped several specialty services, including pulmonology, neurology, urology, and orthopedics. It doesn’t have the cash to upgrade patient rooms to include bathroom doors wide enough for wheelchairs.
On a recent morning, CEO Tom Frank walked the halls of his hospital. The facility was quiet, with just 14 admitted patients and only a couple of people in the ER. “This place used to be bustling,” he said of the former pulmonology clinic.
Frank said the hospital breaks even treating Medicare patients, loses money treating Medicaid patients, and makes money from a dwindling number of privately insured patients.
The state’s strict regulations have earned it an antihousing, antibusiness reputation, he said. “The cost of health care is a symptom of a larger problem.”
About 30 miles south of Newport, Andy Kehler often worries about the cost of providing health insurance to the 85 workers at Jasper Hill Farm, the cheesemaking business he co-owns.
“It’s an issue every year for us, and it looks like there is no end in sight,” he said.
Jasper Hill pays half the cost of its workers’ health insurance premiums because that’s all it can afford, Kehler said. Employees pay $1,700 a month for a family, with a $5,000 deductible.
“The coverage we provide is inadequate for what you pay,” he said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Somatic Exercises For Nervous System Regulation – by Rose Kilian
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We’ve written before about the vagus nerve, its importance, and how to make use of it, but it’s easy to let it slip from one’s mind when it comes to exercises. This book fixes that!
The promised 35 exercises are quite a range, and are organized into sections:
- Revitalizing through breath
- Stress and tension release
- Spinal and postural health
- Mindfulness and grounding
- Movements for flexibility
- Graceful balance and focus
While it’s not necessary to do all 35 exercises, it’s recommended to do at least some from each section, to “cover one’s bases”, and enjoy the best of all worlds.
The exercises are drawn from many sources, but tai chi and yoga are certainly the most well-represented. Others, meanwhile, are straight from physiotherapy or are things one might expect to be advised at a neurology consultation.
Bottom line: if you’d like to take better care of your vagus nerve, the better for it to take care of you, this book can certainly help with that.
Click here to check out Somatic Exercises For Nervous System Regulation, and take care of yourself!
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Black Cohosh vs The Menopause
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Black Cohosh, By Any Other Name…
Black cohosh is a flowering plant whose extracts are popularly used to relieve menopausal (and postmenopausal) symptoms.
Note on terms: we’ll use “black cohosh” in this article, but if you see the botanical names in studies, the reason it sometimes appears as Actaea racemosa and sometimes as Cimicfuga racemosa, is because it got changed and changed back on account of some disagreements between botanists. It’s the same plant, in any case!
Read: Reclassification of Actaea to include Cimicifuga and Souliea (Ranunculaceae)
Does it work?
In few words: it works for physical symptoms, but not emotional ones, based on this large (n=2,310) meta-analysis of studies:
❝Black cohosh extracts were associated with significant improvements in overall menopausal symptoms (Hedges’ g = 0.575, 95% CI = 0.283 to 0.867, P < 0.001), as well as in hot flashes (Hedges’ g = 0.315, 95% CIs = 0.107 to 0.524, P = 0.003), and somatic symptoms (Hedges’ g = 0.418, 95% CI = 0.165 to 0.670, P = 0.001), compared with placebo.
However, black cohosh did not significantly improve anxiety (Hedges’ g = 0.194, 95% CI = -0.296 to 0.684, P = 0.438) or depressive symptoms (Hedges’ g = 0.406, 95% CI = -0.121 to 0.932, P = 0.131)❞
~ Dr. Ryochi Sadahiro et al., 2023
Source: Black cohosh extracts in women with menopausal symptoms: an updated pairwise meta-analysis
Here’s an even larger (n=43,759) one that found similarly, and also noted on safety:
❝Treatment with iCR/iCR+HP was well tolerated with few minor adverse events, with a frequency comparable to placebo. The clinical data did not reveal any evidence of hepatotoxicity.
Hormone levels remained unchanged and estrogen-sensitive tissues (e.g. breast, endometrium) were unaffected by iCR treatment.
As benefits clearly outweigh risks, iCR/iCR+HP should be recommended as an evidence-based treatment option for natural climacteric symptoms.
With its good safety profile in general and at estrogen-sensitive organs, iCR as a non-hormonal herbal therapy can also be used in patients with hormone-dependent diseases who suffer from iatrogenic climacteric symptoms.❞
~ Dr. Castelo-Branco et al., 2020
(iCR = isopropanolic Cimicifuga racemosa)
So, is this estrogenic or not?
This is the question many scientists were asking, about 20 or so years ago. There are many papers from around 2000–2005, but here’s a good one that’s quite representative:
❝These new data dispute the estrogenic theory and demonstrate that extracts of black cohosh do not bind to the estrogen receptor in vitro, up-regulate estrogen-dependent genes, or stimulate the growth of estrogen-dependent tumors❞
Source: Is Black Cohosh Estrogenic?
(the abstract is a little vague, but if you click on the PDF icon, you can read the full paper, which is a lot clearer and more detailed)
The short answer: no, black cohosh is not estrogenic
Is it safe?
As ever, check with your doctor as everyone’s situation can vary, but broadly speaking, yes, it has a very good safety profile—including for breast cancer patients, at that. See for example:
- Black cohosh efficacy and safety for menopausal symptoms: the Spanish Menopause Society statement
- Black cohosh (Cimicifuga racemosa): safety and efficacy for cancer patients
- The safety of black cohosh (Actaea racemosa, Cimicifuga racemosa)
Where can I get some?
We don’t sell it, but here for your convenience is an example product on Amazon
Enjoy!
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Cherries vs Grapes – Which is Healthier?
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Our Verdict
When comparing cherries to grapes, we picked the cherries.
Why?
First, let’s mention: we are looking at sour cherries and Californian grapes. Even those will of course vary in quality, but the nutritional values here are quite reliable averages.
In terms of macros you might have guessed this one: cherries have nearly 2x the fiber and grapes have about 50% more carbs. So, while neither fruit is bad and they are both low glycemic index foods, cherry is the winner in this category.
When it comes to vitamins, cherries have more of vitamins A, B3, B5, B9, C, and choline, while grapes have more of vitamins B1, B2, B6, E, and K. That’s a 6:5 win for cherries, and the respective margins of difference bear that out too.
In the category of minerals, cherries have more calcium, copper, iron, magnesium, phosphorus, and zinc, while grapes have more manganese and potassium. An easy 6:2 win for cherries.
You might be wondering about polyphenols: both are very abundant in very many polyphenols; so much and so many, in fact, that we couldn’t possibly try to adjudicate between them without doing some complex statistical modeling (especially given how much this can vary from one sample to another, much more so than the micro-and macronutrient values discussed above), so we’ll call it a tie on these.
Adding up the section makes for a clear win for cherries, but of course, enjoy either or both!
Want to learn more?
You might like to read:
Cherries’ Very Healthy Wealth Of Benefits!
Resveratrol & Healthy AgingTake care!
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Getting to Neutral – by Trevor Moawad
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We all know that a pessimistic outlook is self-defeating… And yet, toxic positivity can also be a set-up for failure! At some point, reckless faith in the kindly nature of the universe will get crushed, badly. Sometimes that point is a low point in life… sometimes it’s six times a day. But one thing’s for sure: we can’t “just decide everything will go great!” because the world just doesn’t work that way.
That’s where Trevor Moawad comes in. “Getting to neutral” is not a popular selling point. Everyone wants joy, abundance, and high after high. And neutrality itself is often associated with boredom and soullessness. But, Moawad argues, it doesn’t have to be that way.
This book’s goal—which it accomplishes well—is to provide a framework for being a genuine realist. What does that mean?
“I’m not a pessimist; I’m a realist” – every pessimist ever.
^Not that. That’s not what it means. What it means instead is:
- Hope for the best
- Prepare for the worst
- Adapt as you go
…taking care to use past experiences to inform future decisions, but without falling into the trap of thinking that because something happened a certain way before, it always will in the future.
To be rational, in short. Consciously and actively rational.
Feel the highs! Feel the lows! But keep your baseline when actually making decisions.
Bottom line: this book is as much an antidote to pessimism and self-defeat, as it is to reckless optimism and resultant fragility. Highly recommendable.
Click here to check out “Getting to Neutral” and start creating your best, most reason-based life!
PS: in this book, Moawad draws heavily from his own experiences of battling adversity in the form of cancer—of which he died, before this book’s publication. A poignant reminder that he was right: we won’t always get the most positive outcome of any given situation, so what matters the most is making the best use of the time we have.
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Quit Like a Woman – by Holly Whitaker
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We’ve reviewed “quit drinking” books before, so what makes this one different?
While others focus on the science of addiction and the tips and tricks of habit breaking/forming, this one is more about environmental factors, and that because of society being as it is, we as women often face different challenges when it comes to drinking (or not). Not necessarily easier or harder than men’s in this case, but different. And that sometimes calls for different methods to deal with them. This book explores those.
She also looks at such matters as how to quit alcohol when you’ve never stuck to a diet, and other such very down-to-earth topics, in a well-researched and non-preachy fashion.
Bottom line: if you’ve sometimes tried to quit drinking or even just to cut back, but found the deck stacked against you and things conspire to undermine your efforts, this book will give you a clearer path forward.
Click here to check out Quite Like A Woman, And Take Care Of Yourself!
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Passion Fruit vs Blueberries – Which is Healthier?
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Our Verdict
When comparing passion fruit to blueberries, we picked the passion fruit.
Why?
It wasn’t close!
In terms of macros, the passion fruit has 3x the protein, 1.5x the carbs, and more than 4x the fiber. An easy win for passion fruit!
In the category of vitamins, passion fruit has more of vitamins A, B2, B3, B5, B6, B7, B9, C, and choline, while blueberries have more of vitamins B1, E, and K. So, blueberries are not without their merits, but all in all, another win for passion fruit here.
When it comes to minerals, passion fruit has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and selenium, while blueberries have slightly more zinc.
Looking at polyphenols, this is one category where blueberry wins, and by a fair margin. We think that’s a great reason to enjoy blueberries, but not enough to reverse the win for passion fruit based on all the other categories!
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Enjoy!
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