Expert tells Senate Health & Welfare that health-care ‘‘waste’’ is large and damages Vermont local economies

Elliot Fisher, a professor at Dartmouth and health-policy researcher, told the Vermont Senate Health & Welfare Committee that a substantial share of U.S. health-care spending — commonly estimated at roughly 20–33% — represents waste that harms patients and local economies.

Fisher said the state can reduce unnecessary spending through stronger primary care, better care coordination and payment reforms; he urged using some savings to invest in social supports that improve population health and local labor-market outcomes. "We can do better," Fisher said, summarizing the message of his slides and the evidence he presented.

The presentation reviewed published waste estimates and mechanisms behind them. Fisher cited academic work and large evidence syntheses showing broad categories of waste — failures of care delivery (poor chronic-disease control), overtreatment, administrative complexity, and pricing power at consolidated health systems. He summarized research by economists showing local economic effects of higher health-care prices, saying a 1% increase in health-care prices produces about a 0.4% decrease in payroll employment and larger county-level losses in labor income. "A 1% increase in health care prices causes a 0.4% decrease in payroll employment," Fisher said.

Fisher described a long-running simulation model (WeTHink Health) developed with MIT affiliates that projects the effects of coordinated investments in primary care, care coordination and social determinants. Using that model, he said, a sustained portfolio of reforms could lower health-care costs by roughly 15%, cut the burden of chronic illness about 20% and yield measurable gains in worker productivity and reductions in poverty over a multi-decade horizon.

Committee members discussed the implications for Vermont policy. Fisher tied the presentation to Act 167 (2022), saying the statute's emphasis on linking medical and social services aligns with the model's recommended portfolio. He suggested concrete resilience actions — a small planning or emergency-response team, a short dashboard for monitoring provider cash-on-hand and emergency-room use, and inclusion of primary-care leaders in any planning group — to detect and respond quickly if hospitals or clinics face financial distress. Fisher also recommended the committee consider simulation exercises and offered to circulate the model and related articles to staff.

Committee members asked about payers, transparency and where savings would accrue. Fisher said pricing and consolidation are major drivers in Vermont and urged identifying the total flows of money and drivers of higher prices before setting policy levers. He also described examples of integrated delivery (Kaiser, the VA) as models for care coordination but did not advocate turning Vermont systems into any single model.

The committee discussed next steps, including drafting statutory language to support planning and resilience work, coordinating with the governor's office and Agency of Human Services, and involving Vermont primary-care leaders, Dartmouth and UVM in informal planning. Fisher and staff agreed to share the simulation materials and an article summarizing the model.

The committee moved to a brief procedural discussion after the presentation and to other agenda items.