Massachusetts Candidates on Health Care: A Quick Primer

Before anything else: don’t forget that there is a primary election on Tuesday, September 9 in Massachusetts. All statewide offices are up for election, so be sure to go to nominate your choices for governor, treasurer, attorney general and auditor–and seriously, don’t neglect the auditor.

Health care is big in Massachusetts. Not only does the state have some global-best hospitals, a number of health insurance companies and a great many medical schools, it also spends more of the state’s budget on health care than most anything else. Romneycare, for all its flaws, has been pretty good for the Bay State. However, it’s not enough to contain costs.

If you pay attention to coverage of the Massachusetts 2014 gubernatorial race, you won’t hear many names mentioned. On the Democratic side you’ll hear Martha Coakley and Steve Grossman, each of whom currently holds a statewide office (Attorney General and Treasurer, respectively); on the Republican side you’ll hear Charlie Baker, the GOP standard-bearer in the 2010 race for the governor’s mansion.

A name you probably won’t hear often is Don Berwick. It’s a pity, because he has some very good liberal ideas–especially on healthcare. More after the squiggly cloud currently on loan from Hallmark.

Martha Coakley wants to bring down costs and improve the effectiveness of health care in Massachusetts, but aside from discussions about a stronger commitment to mental health care–care which usually does languish in health care discussions–she is mostly nibbling around the edges. She has been a good AG for Massachusetts. She has focused on the law and fairness under it, and her office does take phone calls. She has a good idea on improving access to mental health care, but she does not have the strongest proposal for care. As an aside, her website is one of the more difficult ones to read.

Steve Grossman may feel that health care needs to be improved, such as a dearth of primary care physicians (PCPs) and that everyone should have a right to health care. He also wants all workers to have paid sick leave, something he has fought for as a business owner as well as a politician. However, he does not devote any space on his official website to health care. This shouldn’t be taken to mean he does not care about the issue; it just means it is not as high a priority for him as certain other items. He does want to address some of the issues but still nibbles around the edges. I have a friend who knows him personally, and I expect he’s a stand-up fellow who would do a good job generally.

Don Berwick is the standout on healthcare in the Democratic field. He wants to get an ACA waiver to move the state to Medicare for All, aka single payer, and brings up moving away from fee-for-service over to paying for outcomes, which is a best practice of the well-known Mayo Clinic. He feels that this would decrease the cost of health care in the Bay State, and if the costs of single payer outside the US are any indication he is probably right. We’d be second after Vermont, but second doing something great beats not doing it at all.

Last but not least comes the Republican frontrunner, Charlie Baker. He’s not a Teapublican in his proposals, at least, and certain of his proposals do make sense. He wants to increase pay for PCP services, which would improve the presence of PCPs in the medical marketplace, and make the costs of healthcare transparent to the average citizen, meaning we’d get to see what the usual costs are from hospital master fee schedules. He’d also try to get a federal waiver from the ACA to bring us back to Romneycare–and before you say this is just two names for the same thing, there are a few differences in the measures that have made a difference.

A friend of mine who had Commonwealth Care and was happy with it mentioned that the plan he was on went away because the plan did not allow gender-specific treatments for people of the opposite gender. This could be a problem for the sliver of the population that is trans, but that could be remedied by a quick fix if need be. Instead, Commonwealth Care as we knew it has gone away.

Still, like most of the others, Charlie Baker is nibbling around the edges of the problem.

If you took the measures each of the other candidate has suggested and put them all together–better mental health care, bulk medication purchases, price transparency, better access to PCPs–you’d get something about 75% as good as what Don Berwick would promote, and it would still be more expensive.

So, if you are a single issue voter in Massachusetts, and health care is your issue, and you believe Medicare would be good for people of all ages instead of just seniors, I highly suggest you look at Don Berwick’s site and give him your vote on September 9

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