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Swenson: VT healthcare system can’t handle population growth

by Matt Swenson

Vermont makes a serious mistake when it treats more housing and a larger population as automatic progress. Every subdivision cut into a field, forest edge, hillside or former farm permanently removes part of the landscape that makes this state worth living in.

Open land is not vacant space waiting to be monetized. It provides agricultural capacity, wildlife habitat, flood resilience, groundwater protection and scenic character. Once covered by roads, utilities and buildings, it does not come back. What Vermont keeps calling growth increasingly looks like the suburbanization of the state.

The pressure is sharpest in Chittenden County. State planners project roughly 8,000 to 12,000 additional homeowner households there between 2025 and 2029, part of a statewide need estimated at 24,000 to 36,000 homes. Construction on that scale would not simply add housing; it would reshape traffic, public services, land use and whole communities. The debate cannot stop at how many units can be permitted. It has to reckon with what those units demand once people are living in them.

Vermont already lacks the medical capacity to support aggressive growth. New patients at the University of Vermont Medical Center have recently faced average waits exceeding 100 days, and waits at Central Vermont Medical Center have approached three months. Earlier state reviews documented specialist waits of two months or longer, with some patients scheduled six months out.

The state still does not adequately track how many patients deteriorate, land in emergency care or die while waiting. Research has established that some delays are dangerous: one major systematic review found increased mortality tied to four-week delays across several forms of cancer treatment. The absence of a Vermont-specific mortality count is an oversight failure, not evidence that no one is being harmed.

Cardiology shows the problem plainly. Some new patients report waits of five or six months for non-emergency appointments—a figure best treated as patient-reported rather than a verified statewide average, since Vermont does not publish current specialty-by-specialty access data. Urgent cases may be triaged sooner, but routine referrals can still involve conditions that worsen while people wait. Vermont should require every major hospital and health network to publish standardized waiting times for cardiology, neurology, oncology, psychiatry, surgery and primary care. Patients should not learn the scale of a shortage only after a referral has been submitted.

Many Vermonters already cross the river for advanced care. Dartmouth Hitchcock Medical Center reports that about 40 percent of its patients come from Vermont, making it a major extension of this state’s medical system whether or not our planners acknowledge the dependence. Vermont is not solving its capacity problem so much as exporting part of it into New Hampshire—which cannot be expected to absorb unlimited demand created by Vermont’s development choices.

Meanwhile, Vermont’s regulators are working to restrain hospital spending and revenue. In June 2026 UVM Health announced that 142 positions were eliminated or restructured, 76 of them permanently removed. The state cannot push rapid residential growth while squeezing the very institutions expected to serve the resulting population. If Chittenden County keeps expanding, it will eventually need another hospital or an equivalent build-out of regional capacity: more primary care, cardiology, outpatient surgery, emergency beds, psychiatric programs and EMS coverage. Housing cannot be approved first while medical infrastructure is left as a problem for a future administration.

Premiums belong in the same conversation. More residents do not automatically make coverage cheaper. A larger risk pool helps only when new enrollees are relatively healthy and do not overwhelm scarce providers. When demand outruns capacity, labor costs climb, delayed illnesses grow more expensive, and patients get pushed toward distant referrals and higher-acuity treatment—costs that come back as claims and premiums. Vermont’s approved 2026 individual-market increases ran from 1.3 percent to 9.6 percent depending on the insurer. Population growth will not lower premiums unless capacity and the underlying cost of care improve at least as fast.

The transportation math is just as blunt. Thousands of homes mean more vehicles, bigger intersections, sewer expansion, added emergency-service load and decades of road maintenance. If Vermont intends to turn rural corridors into suburban commuter routes, officials should say so out loud. Residents are being asked to accept Boston-style congestion without Boston-scale transit, medical capacity or wages.

Vermont should adopt a strong presumption against greenfield development and set a statewide goal of no net loss of open land. Prime agricultural soils, wildlife corridors, wetlands, floodplains and large connected tracts deserve the firmest protection. Large subdivisions on undeveloped land should face a moratorium unless a town can show that its roads, medical services, utilities, schools and emergency systems can absorb the project without degrading service for the people already there. Housing should be steered instead toward village centers, vacant commercial buildings, brownfields, oversized parking lots and land that is already disturbed. The burden should fall on developers to explain why another field or forest must go while redevelopment sites sit unused.

Vermont should also question the assumption that a bigger population is inherently good. A long-term planning target near 400,000 residents deserves serious study as a voluntary, multigenerational aim. That would not mean removing anyone or restricting movement—only retiring policies built around perpetual expansion and accepting gradual stabilization. The case for stabilizing is not only fiscal—fewer residents mean lighter demand on services and, plausibly, a lighter tax burden—but ecological. Vermont is still rewilding. Cleared to barely 20 percent forest cover by 1850, the state has recovered to about 75 percent today, yet less than 1 percent qualifies as old growth; its habitat and wildlife are still returning from that near-total deforestation. A state that chooses to stabilize rather than expand gives that recovery room to continue.

Labor shortages do not require endless growth, either. Every worker added is also a patient, a driver, a student and a new claim on public services. Vermont should instead make itself a national laboratory for robotics, automation and artificial intelligence—systems that can assist agriculture, maintenance, inspection, manufacturing and administration, and that in health care can strip away documentation and scheduling burdens so scarce clinicians spend more time treating patients.

Vermont should measure progress by preserved land, shorter medical waits, affordable insurance, functional roads, manageable taxes and quality of life—not by the number of subdivisions approved. A state that destroys its fields, forests and hillsides to become more crowded has not advanced. It has traded permanent natural wealth for congestion, higher costs and infrastructure that cannot keep up.

# contentMap.en
Swenson: VT healthcare system can’t handle population growth

by Matt Swenson

Vermont makes a serious mistake when it treats more housing and a larger population as automatic progress. Every subdivision cut into a field, forest edge, hillside or former farm permanently removes part of the landscape that makes this state worth living in.

Open land is not vacant space waiting to be monetized. It provides agricultural capacity, wildlife habitat, flood resilience, groundwater protection and scenic character. Once covered by roads, utilities and buildings, it does not come back. What Vermont keeps calling growth increasingly looks like the suburbanization of the state.

The pressure is sharpest in Chittenden County. State planners project roughly 8,000 to 12,000 additional homeowner households there between 2025 and 2029, part of a statewide need estimated at 24,000 to 36,000 homes. Construction on that scale would not simply add housing; it would reshape traffic, public services, land use and whole communities. The debate cannot stop at how many units can be permitted. It has to reckon with what those units demand once people are living in them.

Vermont already lacks the medical capacity to support aggressive growth. New patients at the University of Vermont Medical Center have recently faced average waits exceeding 100 days, and waits at Central Vermont Medical Center have approached three months. Earlier state reviews documented specialist waits of two months or longer, with some patients scheduled six months out.

The state still does not adequately track how many patients deteriorate, land in emergency care or die while waiting. Research has established that some delays are dangerous: one major systematic review found increased mortality tied to four-week delays across several forms of cancer treatment. The absence of a Vermont-specific mortality count is an oversight failure, not evidence that no one is being harmed.

Cardiology shows the problem plainly. Some new patients report waits of five or six months for non-emergency appointments—a figure best treated as patient-reported rather than a verified statewide average, since Vermont does not publish current specialty-by-specialty access data. Urgent cases may be triaged sooner, but routine referrals can still involve conditions that worsen while people wait. Vermont should require every major hospital and health network to publish standardized waiting times for cardiology, neurology, oncology, psychiatry, surgery and primary care. Patients should not learn the scale of a shortage only after a referral has been submitted.

Many Vermonters already cross the river for advanced care. Dartmouth Hitchcock Medical Center reports that about 40 percent of its patients come from Vermont, making it a major extension of this state’s medical system whether or not our planners acknowledge the dependence. Vermont is not solving its capacity problem so much as exporting part of it into New Hampshire—which cannot be expected to absorb unlimited demand created by Vermont’s development choices.

Meanwhile, Vermont’s regulators are working to restrain hospital spending and revenue. In June 2026 UVM Health announced that 142 positions were eliminated or restructured, 76 of them permanently removed. The state cannot push rapid residential growth while squeezing the very institutions expected to serve the resulting population. If Chittenden County keeps expanding, it will eventually need another hospital or an equivalent build-out of regional capacity: more primary care, cardiology, outpatient surgery, emergency beds, psychiatric programs and EMS coverage. Housing cannot be approved first while medical infrastructure is left as a problem for a future administration.

Premiums belong in the same conversation. More residents do not automatically make coverage cheaper. A larger risk pool helps only when new enrollees are relatively healthy and do not overwhelm scarce providers. When demand outruns capacity, labor costs climb, delayed illnesses grow more expensive, and patients get pushed toward distant referrals and higher-acuity treatment—costs that come back as claims and premiums. Vermont’s approved 2026 individual-market increases ran from 1.3 percent to 9.6 percent depending on the insurer. Population growth will not lower premiums unless capacity and the underlying cost of care improve at least as fast.

The transportation math is just as blunt. Thousands of homes mean more vehicles, bigger intersections, sewer expansion, added emergency-service load and decades of road maintenance. If Vermont intends to turn rural corridors into suburban commuter routes, officials should say so out loud. Residents are being asked to accept Boston-style congestion without Boston-scale transit, medical capacity or wages.

Vermont should adopt a strong presumption against greenfield development and set a statewide goal of no net loss of open land. Prime agricultural soils, wildlife corridors, wetlands, floodplains and large connected tracts deserve the firmest protection. Large subdivisions on undeveloped land should face a moratorium unless a town can show that its roads, medical services, utilities, schools and emergency systems can absorb the project without degrading service for the people already there. Housing should be steered instead toward village centers, vacant commercial buildings, brownfields, oversized parking lots and land that is already disturbed. The burden should fall on developers to explain why another field or forest must go while redevelopment sites sit unused.

Vermont should also question the assumption that a bigger population is inherently good. A long-term planning target near 400,000 residents deserves serious study as a voluntary, multigenerational aim. That would not mean removing anyone or restricting movement—only retiring policies built around perpetual expansion and accepting gradual stabilization. The case for stabilizing is not only fiscal—fewer residents mean lighter demand on services and, plausibly, a lighter tax burden—but ecological. Vermont is still rewilding. Cleared to barely 20 percent forest cover by 1850, the state has recovered to about 75 percent today, yet less than 1 percent qualifies as old growth; its habitat and wildlife are still returning from that near-total deforestation. A state that chooses to stabilize rather than expand gives that recovery room to continue.

Labor shortages do not require endless growth, either. Every worker added is also a patient, a driver, a student and a new claim on public services. Vermont should instead make itself a national laboratory for robotics, automation and artificial intelligence—systems that can assist agriculture, maintenance, inspection, manufacturing and administration, and that in health care can strip away documentation and scheduling burdens so scarce clinicians spend more time treating patients.

Vermont should measure progress by preserved land, shorter medical waits, affordable insurance, functional roads, manageable taxes and quality of life—not by the number of subdivisions approved. A state that destroys its fields, forests and hillsides to become more crowded has not advanced. It has traded permanent natural wealth for congestion, higher costs and infrastructure that cannot keep up.