Whoever wins the gubernatorial race in Vermont, the campaign has pretty much failed to illuminate the issue of health care reform, one of the most momentous the state has ever faced. Health care now eats up 20 percent of the state's economic output and there is a broad consensus that the current trend is unsustainable.

The Green Mountain Care Board has now completed its approval process for the coming year's budgets for Vermont's 14 hospitals. It was the board's first effort and marked the third iteration in the state's effort to regulate health care costs. The first was the Hospital Data Council that ran through the 1980s and early 1990s; that morphed into BISHCA, which first got the power to set budgets in the mid-1990s; and now the Green Mountain Care Board, which has the same powers as BISHCA, but should have far greater weight than its predecessor.