This commentary is by Patrick Flood of Woodbury. He is former commissioner of the Vermont Department of Mental Health and the Department of Disabilities, Aging and Independent Living, and former deputy secretary of the Agency of Human Services. Finally, we have a meaningful proposal for health care reform in Vermont. A consultant for the Green Mountain Care Board has provided a plan for health care reform that will better serve Vermonters and reduce costs. Now, the question is, will the governor and Legislature have the courage and wisdom to implement the reforms?The proposed reforms cover almost the entire breadth of the health care system from hospitals to non-medical services such as housing. The consultants clearly understand health care and Vermont’s situation. They understand Vermont because they spent two years talking to over 3,000 of us, from state officials to hospital administrators to doctors and nurses, and, importantly, to regular Vermonters who can neither access nor pay for the care they need.The consultants’ findings are stark: our healthcare system is broken and at severe risk of failing further. We cannot afford the hundreds of millions of dollars it will cost to support the status quo. Without immediate and major changes, costs will continue to grow and the lack of access will worsen. If we do not make dramatic  changes soon, hospitals will face bankruptcy. The supporters of the status quo are already trashing the report, stating that we can’t possibly take the recommended steps. But in effect what they are really saying is, too bad, Vermonters, we have to keep raising your insurance rates and taxes to pay for a bloated hospital system. The report lays out in great detail how to redesign our health care system to make it affordable and to provide Vermonters with the care  they need. Yes, there will be significant changes and there will be difficult decisions. But those changes and decisions should have been made years ago, when it would have been easier.Many people have been advocating for these types of changes for years. They are not rocket science. In basic terms, they boil down to three major changes:Move dollars into prevention and primary care, and fund community services like mental health and home health to keep people healthy and out of the hospital. Prior studies have shown that a large portion of expensive hospital funding — 30% or more in some Vermont hospitals — is for avoidable care that could and should have been provided in community settings. Put real limits on hospital spending. There are several methods in the report to accomplish this. Re-structure our hospital system to make it more efficient.The Green Mountain Care Board seems poised to pursue these changes, understanding, after much discussion, that this is the only approach that will bring down costs while expanding access. Will the Scott administration and the hospitals show leadership and adopt these recommendations, or will they do everything they can to preserve the status quo? After all, that’s all that has happened for the past decade, including such gimmicks as the failed accountable care organization, OneCare Vermont, which has cost over $100 million dollars and has almost nothing to show for it. Vermont is long overdue to implement these types of reforms. Let’s get started. Let’s convene the working groups that will be necessary to address the many proposals in the report. Let’s bring the public into the process now. Let’s not obstruct the process by arguing for the status quo – instead let’s ask, how can my community hospital change to better serve Vermonters? Let’s call upon the Legislature to hold hearings and propose legislation where necessary. The path to a highly functioning, affordable, high-quality and person-centered health care system has been laid out for us. Now we need the courage to implement it. Read the story on VTDigger here: Patrick Flood: Finally, a serious plan for health care reform.