Through the long reform debate, health care and Massachusetts went together like love and marriage—or so the media told us. But everything wasn’t lovey-dovey in the Bay State, as Campaign Desk repeatedly pointed out. Cracks were evident, and the election of Scott Brown last January partially reflected that. So why is it that health reform has not become Topic A in the gubernatorial race which pits the incumbent Democrat Deval Patrick against Charlie Baker, the former CEO of Harvard Pilgrim, one of the state’s big managed care organizations?
Kudos to Martha Bebinger at WBUR for taking a close look at the campaign’s non-issue. Listeners heard that health care is a top priority for Patrick and Baker, as well as for two other fringe candidates. But it is getting little attention, even though the rising costs of medical care threaten not only the state budgets, but those of its municipalities, businesses, and families as well. Money not important? Impossible!
So what gives? Has the electorate heard it all before? Do they believe that the very different solutions proposed by the candidates are simply campaign jabber without the prospect of actual change? Are they so disaffected that not even the state’s out-of-control health care spending—the highest in the nation—moves them? Or is it this season’s political malaise?
The answers aren’t clear from Bebinger’s piece, but the way she lets the candidates express their health care platforms and then succinctly summarizes their positions make for interesting radio. If you listen carefully, you get the picture of little consensus on what to do about a super-serious problem. And yes, we’ve heard these proposed “solutions” before some of which would sock it to the state’s powerful, medical industrial complex one way or another and patients too. I don’t know about the patients, but the mighty stakeholders in the complex are not about to let anything drastic move their cheese.
Green-Rainbow party candidate Jill Stein wants to cut insurance company waste. Who doesn’t? That would lead us to single-payer health care, she says, a Medicare-for-all approach that was killed off nationally last year.
Bebinger reports that Patrick’s solution is not as extreme, but would still “rock health care in the Commonwealth.” He wants to move to a model that pays for wellness instead of sickness, with something called global payments. How novel? The big fat global payment given to providers by insurers to care for a group of patients is supposed to incentivize the docs and hospitals to give better and more efficient care, so they can ultimately keep more of the money for themselves, rather than waste it on too much or bad quality care.
That sounds like the old managed care capitation payments with a new moniker, and maybe a new twist or two. As we know, those payments didn’t restrain costs in the end. But Patrick says: “If we don’t get control of health care costs and balance that with my view of health as a public good, then a lot of things we’re interested in doing in the Commonwealth and the country won’t happen.” No kidding. Bebinger reports that a state commission recommended global payments, but the medical folks are resisting. So much for that idea.
Charlie Baker weighs in with a typical Republican response. He doesn’t like global payments, and says the state can’t solve the affordability problem unless it deals with what he calls “the transparency problem.” He banks on market forces to bring down prices, which means giving patients more information so they will choose the cheapest care with the best quality, as if quality was easy to get at. “If you and I drive 20 minutes in any direction from here and I go in, and I get the same service with the same outcome, the price of that service can vary by as much as 500 percent. There’s no public disclosure around what anybody gets paid or how they perform,” he said.
The good doctors at Partners Health Care are not likely to be happy with that solution. In August, the state’s health care quality and cost council announced it was scrapping—for now—efforts to publicly post overall patient death rates for individual Massachusetts hospitals. It seems there is no “‘gold standard, ” said Secretary of Health and Human Services Dr. Judy Ann Bigby. The methodologies may yield confusing and inconsistent results. If that’s the case, Massachusetts residents may wonder what Baker has in mind. The shopping solution assumes that consumers should choose health care like canned peas. An ethicist I heard termed that approach “simplistic market rhetoric.”
Baker would also let insurance companies off the hook for providing some benefits—prescription drugs, for example. He talks about giving people the kinds of choices they had before and they were happy with. I guess that means they were happy digging into their pockets to pay for their medicines.
Giving more choice is also the mantra of independent candidate Tim Cahill, who says: “We have to give people more choices and lessen the number of mandates on our basic plan.” Does he want to shred state law? Dismantling, he says, is his last option, but the law must be fixed and improved. How? “We’re not going to be able to subsidize as many people with as much subsidization, and that’s something that everyone’s got to understand because we’re not in an environment or an economy where we can give things away for free? Does that mean that some residents will lose their widely touted coverage? What happens to the state’s claim that its law covers almost everyone? If Cahill is right, what does that sayfor national reform, which also calls for lots of subsidies for lots of people?
So there you have it—a stalemate in the health care trenches, and WBUR reveals it all. Is there any wonder the public has tuned out?
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.