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University of Vermont Medical Center officials say the state's largest hospital costs more than $2 billlion to operate. UVMMC President Stephen Leffler points to Vermont’s older population as one major reason. The Green Mountain Care Board, which recently approved "painfully high" double-digit health insurance premiums for the third year in a row, wants to hold down hospital costs, including cutting UVMMC's requested increase in patient revenues. Observers and consultants say Vermont's entire health care system is "broken," and without major reforms will be financially unsustainable by 2030. Dr. Leffler agrees: "Without change, yes, we have a giant problem."