Maximillian Alvarez:

Alright. Welcome everyone to Working People, a podcast about the lives, jobs, dreams, and struggles of the working class today. Working People is a proud member of the Labor Radio Podcast Network and is brought to you in partnership with In These Times Magazine and The Real News Network. This show is produced by Jules Taylor and made possible by the support of listeners just like you. My name is Maximillian Alvarez, and today we are headed north to the state of Vermont, where frontline healthcare workers and the patients they serve are facing a major crisis at the University of Vermont Health Network, the state’s leading healthcare provider. In an article published in the Rake Vermont, which is an independent worker-owned news outlet based in Vermont, writer Matt Moore breaks down the situation like this. “In June, UVM Health eliminated over 140 positions across its network, a third of which were union positions, according to AFT Vermont, which represents workers there.

The cuts which the hospital estimated will save $9.5 million comes as the network faces a $300 million budget shortfall. Rules set by the Green Mountain Care Board, which regulates Vermont hospitals, will require UVM Health to cut expenses by that amount over the next three years. Later that month, UVM Health handed down a speed up order to its medical group, which includes outpatient clinics and more than a thousand physicians, which practitioners say will result in briefer appointments with patients. Owen Foster, the former chair of the Green Mountain Care Board, took aim at what he saw as the excesses of UVM Health in a board meeting last September. “It’s essentially an expensive and ineffective layer of overpriced and unnecessary corporate bureaucracy that has proven itself both physically and spiritually distant and unconnected from the mission of our flagship academic medical center and the needs of Vermonters,” Foster said.

Foster found that the surplus revenue earned by UVM Medical Center was being siphoned off by UVM Health to subsidize its hospitals in New York State that the network has been unable to manage profitably to the tune of over a hundred million dollars over the last several years. He noted that at the same time that UVM Health was shutting down kidney dialysis services in St. Alban’s, Rutland, and Newport, it was moving $10 million from UVMMC to its New York hospitals. Multiple executives, many of whom had received a combined $3 million in bonuses in 2024, were laid off in October of 2025 as part of a restructuring process. However, the most recent round of cuts and likely future cuts are aimed directly at the caregiver and support levels, leading to reductions in the quality of care for a majority of Vermonters.” To talk about all of this, I am really grateful to be joined on the show today by two guests.

Melissa Lavalle is secretary of UVMMC Support Staff United and VP of Healthcare for AFT Vermont. And Teagan Cook is lead outpatient chemotherapy scheduler at her hospital and a chief steward in UVMMC Support Staff United. Melissa Teagan, thank you both so much for joining me today. I really appreciate it. And I know we got a lot to dig into here, and I want to talk to you about everything that’s happening now at the UVM system with these devastating cuts or restructurings or whatever we’re calling them and the events that led to this point. But before we do that, I’d really love to start by getting to know more about you all and the work that you do. Every week we strive to remind listeners that there are flesh and blood human beings and fellow workers behind every name tag, every job title, and every one of us has a story worth telling.

So please tell us more about yourselves and how you got into this work and the kind of jobs that you do.

Melissa Lavalle:

Thank you so much for having us. I’m Melissa and I’ve lived in Vermont my whole life. I was born here. My family lives here. I was the kid that moved furthest away because I was 45 minutes from mom and dad. I’ve worked retail. I’ve been a grocery store clerk. I was a photographer inside a Kmart for Holy Mills. And when they were going to cut my health insurance, I decided it was time to get into a job line that would give me health insurance. And that’s what brought me to working in medical. I’ve been a medical assistant and I am currently the finance and admin assistant for the psychiatry and mental health departments. There’s a lot of backend bureaucratic needs, paperwork, vacation time, continuing education stuff. And so I am the department Santa. I love my job and love serving the folks that are giving wonderful and such needed mental health care to our community.

Teagan Cook:

Thank you so much for having us. I’m Teagan. Like you said, I’m the lead outpatient chemotherapy scheduler here at UVMMC. And I got into my job after previously working in law, which is where I have a degree. Not the one you can actually do something with, but still a degree in law. And the industry of law has just so many miserable soul-sucking problems without a lot of real emotional reward, at least that I was feeling. So I ended up moving into healthcare, which is a place where you can actually make a real difference to real people. And not all of it is couched in a bunch of pseudo-Latin nonsense. A lot of it is just making real connections with your patients, understanding what their daily lives look like. A lot of what my day-to-day looks like, if you came behind my computer, it would look like I was playing Tetris a lot of the day because I’ve got the blocks of each person’s treatment that we’re trying to all stack together to make fit to get as many people as possible safely treated in the amount of time and the amount of space that we have.

It’s very rewarding. I get to make contact with a lot of different people from across the state. I’ve got patients in New York, I’ve got patients in New Hampshire, I’ve got some patients in Canada. And working here has been really incredibly rewarding. But unfortunately, as time has gone on over just the past three years that I’ve been here, sometimes the stress and the weight has started to outweigh that reward in some ways that are really specifically related to the way that our labor as workers here is treated.

Maximillian Alvarez:

And I want to really talk to y’all about that at the shop floor day-to-day level. But I guess I need your help here because I want to talk about the crisis that is happening right now in the UVM Health Network. And first we need to help our listeners understand what is this crisis exactly? What do folks need to understand? Is it a budget crisis? Are you facing draconian cuts? Is it a shortfall? I guess we don’t have to get too far into the weeds that we lose sight of the whole plot, but help us understand what exactly the nature of the crisis that y’all are facing there at UVM is right now.

Melissa Lavalle:

It is incredibly complex, and I can kind of scratch the surface. For years, for decades, management at the top was kind of left alone to do what they want. And what they wanted to do was give incredible salaries to the folks at the very top. We went from being Fletcher Allen to University of Vermont Medical Center, and then the Health Network was formed. So now the network encompasses five hospitals in Vermont, and I think two or maybe three in Northern New York as well. So that necessitated an extra level of administrative folks at the top, and they’re not the ones making $20 an hour by any stretch of the imagination. Vermont’s really unique that we have what’s called the Green Mountain Care Board. It came out of the work of activists in 2011 in the passing of Act 48, which ostensibly created universal healthcare in Vermont.

We never had a governor that was able or willing to find funding for that. So instead this advisory board was created and yearly Green Mountain Care Board reviews and either approves or denies budgets for hospitals in the state. About three years ago, Green Mountain Care Board really put their foot down. Vermont is the most expensive state in the country to buy or get healthcare. And they said, “This is insane. UVM Health has an obvious monopoly on the state. You folks have been making way too much profit for too long, and now it’s going to be a cut.” So the budget, instead of having any growth to it, actually had a reduced amount of profit that was allowable. So now that they’re not able to charge the most exorbitant prices for literally everything, they are saying, “We’re losing money every day. Austerity measures need to go into place.” And what that looks like is those 140 cuts and staff just being overworked in almost all locations.

Teagan Cook:

Yeah, Melissa has a much more of a bird’s-eye view of it than I do because Melissa is much deeper into the daily goings on of the union. So she’s much more well-briefed than I am. But as far as how I’ve seen this in my day-to-day work, it’s been, for example, in my clinic, which is the outpatient cancer clinic at the flagship hospital in the network, the scheduling team is about three weeks behind at any given moment, which doesn’t necessarily sound like a big deal if what you’re generally familiar with as far as healthcare scheduling is just a primary care physician’s office. If you’re three weeks behind looking at that, generally it’s not going to be a huge deal for scheduling. But here in the outpatient cancer clinic, these are patients who are coming in twice a week or every single day, five days long once a month, or they’re coming in every other week, which means that if we get three weeks behind, we are operating so far behind the patient’s actual reality that it functionally doesn’t even make sense for us to be doing our jobs because we are working with outdated information that we then have to crosscheck with the more up-to-date information that we’re seeing in the chart.

Everything takes longer because we have to do that. We get further and further behind. Patient care falls further and further behind. And we’re all very concerned about the safety of the care that we’re able to deliver because of this. And this could be solved with safer, better staffing by increasing our numbers by just two or three more people. And we’ve been refused for months and months and months. Even while going through an official grievance process to try to address the issue, we have continued to be denied.

Maximillian Alvarez:

Well, I want to ask one more kind of clarifying question here because it seems like in all the kind of research I was able to do before we started recording this episode, there’s some competing narratives going on here, and that’s sort of muddling the picture and making it hard for folks to understand what’s going on here and why it’s so egregious. So I wanted to ask who is behind the narrative that this is a $300 million budget shortfall that requires squeezing people at the bedside level, people in the office level, and cutting back the most essential labor and piling more work onto the most essential workers?

Melissa Lavalle:

So there’s always yours, mine and theirs, but Green Mountain Care Boards saying, “You folks have made way too much money off of Vermonters for way too long. You need to lower your prices.” UVM Health is saying, “Oh my God, we used to make this much money, but now we’re only allowed to make this much money.” So normally in my mind, folks would lower the prices of things. What they’ve done instead is lower the number of available inpatient beds. So they’re seeing fewer patients, so therefore less money is getting made. And there was a law that went in that said they had to drop their prices on cancer infusion drugs because those were just astronomical through the roof. So care board says you’re making too much. Hospitals says we’re not making enough any longer. And from the union’s perspective, we’re saying this was poor management over decades and you’re now asking your lowest paid workers to bear that burden.

Maximillian Alvarez:

Well, let’s talk about that sort of how we got here question. Because sadly, this is a story that I have heard from healthcare workers across the country in different contexts. I’ve talked to workers on the picket line at a private Catholic hospital here in Baltimore saying very similar things. I’ve interviewed workers on strike at Kaiser Permanente in the Pacific Northwest saying similar things. Workers in Chicago at a university healthcare system there, very similar story. But the devil is also in the details and not every story’s the same. But it feels like the effects that people are feeling are very similar, which is that workers are being burnt out because they’re being asked to do more with less for less while either hedge fund type corporations are buying up their hospitals and forcing them to speed up production for the sake of more profits. Or you got a system like your guys’ system where you’re being forced to claw back your operations to sustain an unreasonably poorly managed from the top down system.

Again, those are different situations, but the effect is very similar on the workers and the patients. But as you said, Melissa, that didn’t happen overnight. And so I wanted to ask how the hell did it happen? And how did you all as rank and file workers experience this over that time?

Melissa Lavalle:

A fact I heard once that really blew my mind was most hospitals used to be owned by the doctors. They were kind of co-ops that the doctors owned. And so if something terrible happened, you know whose door to knock on to complain. But letting hedge fund managers, letting private equity into healthcare. And even in Vermont, UVM Health is a nonprofit network, but letting business managers run health decisions does not work. And every other industrialized country in the world has figured it out that it’s most effective not to be paying these insurance middlemen to do nothing but mostly deny folks. Are governments capable of administering Medicare, which folks are generally happy with. With Medicaid, folks are generally happy with. And this introduction of the business element into health is where things went wrong, to be totally honest. Folks are making money off of something that should not be a money-making enterprise.

Teagan Cook:

I mean, I think what it boils down to, to your point, Melissa, is the fact that hedge fund managers, extremely well-paid executives in the healthcare industry, it’s kind of like the final frontier of late stage capitalism. This is the last way that you can profit off of not only your workforce, but the physical bodies of your workforce and the people around you. UVM Health has a monopoly on healthcare in Vermont, which means that all of their workers are here receiving care from them for the vast, vast majority, which means that not only are we struggling to get them to pay us wages that are meaningful in the economy of Vermont, which is total trash garbage right now, but there’s also the fact that we are functionally handcuffed to whatever decisions they’re making about what our healthcare is going to be like. I know, and I’m not alone in this, my fiance and I have been having to have really serious talks about when we get married, what’s going to happen to his healthcare?

Is it going to be worth it? Are we going to have to delay our wedding? I don’t know when I’m going to be getting married until we get a new contract for our union because I don’t know what my healthcare is going to look like. I don’t know what guarantees I’m going to have, and I’m not going to be able to get married if I have to pay $800 a month for me and my fiance to both have care as chronically ill people.

Maximillian Alvarez:

Jesus, man. I don’t know how people can hear stories like that from everybody everywhere all over the place. And we all just accept it as like, well, I guess that’s just the way things got to be, but that’s not the way things got to be. And I do want to talk about in the end, what can be done? What can folks listening do? But by way of getting there, I wanted to bring things back down to that worker and patient eye level. Can you tell us how, since those initial cuts, what this is translating to for frontline workers providing healthcare and for patients seeking healthcare?

Melissa Lavalle:

Patients seeking healthcare are definitely experiencing waits. They know it. They know why. When my husband goes to his primary care that’s part of the network, there’s one person to check in and check out folks in an office with 25 providers. You’re waiting longer when you call in to try to talk to a nurse to get a prescription refilled from your primary care. It’s just more work, more stress. You know that the cuts happened. And it’s so weird how they always seem to happen a couple of months before bargaining. So we have been in bargaining. And when we did our pre-bargaining survey, we’re doing combined bargaining between our support staff unit and the technical professionals unit of the VFNHP nurses union. So your radiologists, your respiratory therapists, those sort of folks.

But the layoffs really also energized our members to see that this is why we’re bargaining. And when we did our pre-bargaining survey, 3,300 members across the board, the priority was safe staffing. And our folks are not in great economic shape. We know wages are a thing, but we work in healthcare because we care about our patients and because we know we are the patients as well. And that was far and away what folks cared about, that when community members are coming to us, that we are safely staffed and they’re not going to get worse because they came to UVMC for care.

Teagan Cook:

Yeah, I think that the staffing is really the critical issue. And some of those layoffs did affect union members and some of them were non-unionized staff. For example, folks in IT, folks who were in MGET, which is medical group education and training. Those are the folks who train newly oncoming doctors how to use our health record system, which is byzantine and complex. So you know how it is. The money that the people at the top are getting is never going to trickle down, but the consequences that the people at the top impose trickles down. So it takes longer for these doctors to get appropriately onboarded. It takes longer for them to get the hang of how things are supposed to be done in these systems so that things are going through workflows correctly so that people like me are making sure that you are getting scheduled out for your treatments appropriately and safely.

People in IT getting laid off. I have had a ticket out for a fax machine that my unit uses to get looked at since April, and nothing has happened about it. And that doesn’t sound like a big deal except for the fact that not all outside facilities will accept electronic faxes. And that means that we are not able to, until that gets addressed, send imaging orders to those other hospitals because they won’t accept them because they’re only e-faxable right now because we don’t have a fax machine, which can result in patients getting delayed care in something as important as getting imaging done to figure out if their chemotherapy is working or not.

It’s difficult. The layoffs and the threat of more layoffs has created such an environment of paranoia and distrust, which is the exact opposite thing that anyone needs. We’re already all struggling enough, but it’s just created an incredibly difficult work environment from the things that are tangible, like the stupid fax machine, to wondering every day when you come into work, is this the day where I find out that I don’t have a job anymore and that my patients are going to call in and just end up waiting on the line for three hours to get a simple answer.

Maximillian Alvarez:

So where do things stand now and what can be done about this? And what can anyone who is listening to this conversation right now do to help?

Melissa Lavalle:

The base of the problem is the for-profit healthcare system. That just has to be the foundation that we’re working from. In our bargaining, like I said, priority safe staffing, we’re fighting for safe staffing committees. The hospital came proposing takebacks from our first contract. So that is one of the places where we’re kind of far apart. But one of the things we’re also doing on top of joint bargaining is a common good platform. We’re asking for protections for our immigrant coworkers. If they get detained, they don’t lose their jobs position, they don’t lose their health insurance. They get time off to go to these appointments when they need to, even if it’s short notice, like we know is happening more and more often. We’re asking the hospital to join our local community group as Migrant Justice, and they have a Milk with Dignity program to only source milk from farms in Vermont that treat their workers appropriately, give them safe housing, give them safe work conditions, pay them fairly.

And we are also saying that the hospital, in all its poverty, stop using its very high paid lobbyists and publicity folks to fight us in our plate for universal healthcare. Act 48 is on the books. We intend to get it funded and enforced. And every time we’ve tried in the past, the hospital, which is a huge economic driver in the state, has had their people at the state house pushing back, pushing back. And the time has come to stop. We cannot cut our way out of this. And I would encourage everybody listening, if they don’t have a union that they can get involved in and push them to fight for universal healthcare, get involved with a grassroots organization. They are just literally everywhere. Folks see this problem, and we know what the solution is. It’s a single-payer healthcare system.

Teagan Cook:

Yeah. I mean, what Melissa said, what it comes down to is that the for-profit healthcare system is functionally a vampire that is sucking us out of money without any real significant payoff. I don’t know anyone who has gone from being on Medicaid or Medicare to being on private health insurance and gone, wow, this is so much better.

Maximillian Alvarez:

All right, gang, that’s going to wrap things up for us today. I want to thank our guests, Melissa Lavalle, Secretary of UVMMC Support Staff United and VP of Healthcare for AFT Vermont, and Teagan Cook, lead outpatient chemotherapy scheduled at her hospital, and a chief steward in UVMMC Support Staff United. And of course, I want to thank you all for listening, and I want to thank you for caring. We’ll see y’all back here for another episode of Working People. And in the meantime, go explore all the great work that we’re doing at the Real News Network, where we do grassroots reporting that lifts up the voices and stories from the front lines of struggle. Check us out across our YouTube channel, our podcast feeds, our website, and our different social media pages, and help us do more work like this by going to therealnews.com/donate and becoming a supporter today.

I promise you guys, it really makes a difference. I’m Maximillian Alvarez. Take care of yourselves. Take care of each other. Solidarity forever.