As goes Massachusetts; so goes the nation–at least when it comes to healthcare. In 2009 and 2010, in the midst of the debate on Obamacare, I wrote a series of 10 posts examining the Bay State’s 2006 law that served as a the blueprint for the Affordable Care Act. It’s time for an update. This is the first of an occasional series about Massachusetts healthcare and how the press is covering it.
Back in 2008, the Boston Globe published, as part of a series, what I later called “the best story on health policy I’ve seen” in the 15 years I’d been watching this space for CJR. I wrote:
The Globe‘s Spotlight Team examined the reasons why health care costs so much in Massachussetts. In doing so, the team took on the state’s largest health insurer, Blue Cross Blue Shield, and the state medical powerhouse, Partners HealthCare, which runs two of the country’s premier teaching hospitals, Massachussetts General and Brigham and Women’s Hospital.
The Globe story, part of an ongoing series entitled “Unhealthy System,” disclosed how Blue Cross and Partners, the state’s largest private employer and its biggest health care provider, sealed a deal in 2000 that raised health insurance costs across the state…[I]t reveals the difficulties in containing medical costs when dominant players and their market power seem to set the market’s rules.
I was reminded recently of that series thanks to news of a preliminary antitrust settlement between Partners and Massachussetts Attorney General Martha Coakley after “five years of government inquiries into Partners’ pricing, competitive practices, and market power.”
And yet, looking at the Globe‘s coverage of this latest Partners news–the settlement in play allows Partners “to complete its long-planned acquisition of three community hospitals in Eastern Massachusetts, in return for accepting limits on expansion and prices for the next five to 10 years”–it’s almost hard to believe it comes from the same news outlet that in 2008 was so dogged and thorough on the question of whether “medical giant Partners Healthcare [is] good for Massachussetts,” as the paper’s 2008 series put it. The “is this good for Massachussetts” question is just as relevant today, in light of the proposed agreement. So, where’s the scrutiny? Where’s the accountability spirit?
The Globe‘s coverage, instead, has been workmanlike, tepid, and very ho-hum: the business desk has covered the play-by-play since the tentative deal came to light in mid-May. Since then, readers have learned that: “Supporters, critics weigh in;” local groups call for “independent scrutiny” of the deal (so where’s the Globe‘s scrutiny?); “AG still negotiating final settlement with Partners”; “Partners, Coakely file agreement on expansion;” “Partners rivals seek to intervene in antitrust settlement;” the settlement is put on hold at the end of June; and, in mid-July, a judge grants Coakley a delay on the deal. Readers have also heard about the politics of it all (there’s a gubernatorial race in the Bay State this year and Coakley is one of three Democratic candidates). A June 9 Globe editorial sang the settlement’s praises (“will help contain health costs”); a June 28 editorial allowed that “rival hospitals deserve chance to challenge” the deal. No probing, no digging, no hard questioning!
In other words, the Globe has covered the story. Just without the tenacity, detail, and accountability mindset of 2008.
Paul Levy–who once ran Boston’s Beth Israel Deaconess Medical Center (which is among Partners’ competitors and is opposing the AG’s settlement) and now runs the Not Running a Hospital blog, offered a similar criticism in late May. The Globe‘s 2008 series, Levy wrote:
stands as an excellent example of journalism and shows what happens when the major newspaper decides to put its resources into a story of regional importance. From that pinnacle, the paper now offers prosaic stories using the “on the one hand/on the other hand” approach. It included a few comments from academics pointing out flaws in the deal to balance out the positive ones offered by the AG and a health care consultant. What is striking about the coverage is the degree to which the newspaper did not draw on the knowledge and perspectives of other key players in the region, the expanded information available from state agencies like CHIA, or even on material from its own previous stories.
Speaking of resources and reportorial manpower, I notice the Globe recently devoted time and space (over 3500 words) to what’s more or less a puff piece on Blue Cross Blue Shield CEO Andrew Dreyfus, “the last healthcare optimist” who heads the state’s largest insurance company–written, just like most of the Globe‘s recent Partners coverage, by Robert Weisman.
Levy also singled out a May Globe story that offered readers a hospital consultant’s take on the Partners agreement (“strikes me as a very fair approach and very smart approach”) without disclosing (or maybe even asking about?) the consultant’s client list and potential conflicts of interest.
A bright spot: a June 28 column by the Globe‘s Joan Vennochi explaining how the Partners deal may sound good to–but may not actually be good for–consumers. Wrote Vennochi:
If you’re a Partners rival, none of this is good news. For many consumers, the downside may not be as evident. The Partners brand is associated with top medical institutions, such as Massachusetts General Hospital and Brigham and Women’s Hospital. Conditioned by access to Harvard teaching hospitals — and health insurance — Bay Staters are less apt to choose their medical care by price than by the facility’s reputation.
But over time, the public will be paying more for health care under this scheme. That’s what’s happening across the country, as hospitals adopt the bigger-is-better model common throughout the private sector. If you prefer a lower-cost option in your community hospital, it could disappear if an enlarged Partners squeezes out its rivals. And while people may not price-shop for hospitals, they do notice when insurance premiums increase and deductibles rise–another likely side effect of these mergers.
We are used to one-party politics in Massachusetts. Are we also ready to accept one-hospital-network health care?
A similar sentiment appeared late in the Globe‘s May 17 story on the deal–appearing right after the hospital consultant’s “very fair,” “very smart” quote. Boston University professor of health policy Alan Sager told the paper:
This strikes me as more of a political deal than a health care deal. If we’re relying on competition to hold down health care costs, the more competitors the better. The harm to the public will accrue more slowly under this deal, but the harm will occur.
Readers might be curious whether this “public harm” assessment holds any weight. This is one the Globe might want to investigate.
The story is still moving–a superior court judge has yet to approve the deal and after a group of competitors, academics, and small businesses demanded public input, a public comment period runs to September. The Globe still has time to redeem itself now that the deal won’t be finalized for several weeks. Given the paper’s institutional knowledge of Partners, it shouldn’t be hard for the paper to identify and ask probing questions if it wants to.
Scrutiny of the Massachussetts Health Policy Commission might be a good place to start. Stuart Altman, the Commission chair and a health policy professor at Brandeis, told the Globe in late May he was “very pleased” with the agreement, which he said “doesn’t do everything, but it sets in motion the potential to really improve the marketplace in Massachussetts.” Potential? What does that mean? The Globe might have asked–and could, still. In July, the Commission released findings showing that Partners’ takeover of Hallmark (one of the hospitals) would reinforce Partners market power, raise spending on care by $15.5 million to $23 million per year and increase premiums for employers and consumers. Globe health editor Gideon Gil told me the paper hasn’t “looked in depth at the Commission” but added, “that’s a good idea.” I also asked Gil if the paper has looked at Partners in any depth. “We haven’t talked about a big, year-long project,” he told me, “but we write quite regularly about them.”
For edification and perhaps inspiration, reporters at the Globe (and elsewhere) might want to check out a piece from the trade publication Becker’s Hospital Review by Molly Gamble, who writes “there are several characters and storylines” in Partners’ proposed hospital acquisitions. She lists “15 things to know” about the deal that should help anyone trying to figure out the tangle of claims. Good reporting is a must, especially as the Bay State approaches a gubernatorial election in the fall where the deal is sure to be a major issue (two Democratic candidates–Steve Grossman, the current state treasurer, and Don Berwick, the former head of Medicare–are opposing it).
To end on an ominous note, a July editorial in The New York Times editorial questioning the Coakley deal said:
The experience in Massachusetts offers a cautionary tale to other states about the risks of big hospital mergers and the limits of antitrust law as a tool to break up a powerful market-dominating system once it is entrenched.
It’s a cautionary tale for reporters, too.
Related content:
The Big Boys: hospitals and their pricing muscles
What We’re Learning Aboaut Hospitals, Part One
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.