Blue Mass Group

There are four candidates running for Senator.

One is a millioinaire who plans to wrangle in business the thing that made him rich

The other is someone who got into the race becuase Teddy was an ally to his group.

The other is an AG with no legislative experience and will need as the others do a couple of lessons on Congress before they understand howit “really” works. That brings us to my choice to try to replace the greatest man Massachusetts has ever seen. Mike Capuano will need no training, has the connections he needs to bring home the bacon, and has been a terrific legislator all the way from school committee to Congess. He knows DC, he knows People, he knows how to bring home meaningful funds for our home state.

With the legislature bent on cramming municipal employees into the Group Insurance Commission health insurance program (GIC), it seems like a good idea to learn what we can about the organization. Offering municipal employees GIC insurance plans may be a money saver, though recent increases in copayments makes me wonder who actually saves the money. The story of a 21 year-old UMass student diagnosed with scleroderma being denied a treatment by the GIC and one of its insurers also raises the question of health care rationing and cost savings. 

Doctors are also unhapphy with the GIC. After working with the agency on shortcomings with its system for rating doctors, the Massachusetts’ Medical Society’s brought suit against the GIC, Tufts, and Unicare.  

A Little Background

The Group Insurance Commission(GIC) was established by the Legislature in 1955 to provide and administer health insurance and other benefits to the Commonwealth's employees and retirees, and their dependents and survivors…. [It] is a quasi-independent state agency governed by a fifteen-member Commission appointed by the Governor. Commission members encompass a range of interests and expertise including labor and retirees, the public interest, the administration, and health economics.

Tiering: Quality and Cost Control?

In July 2008, the GIC and its insurers implemented a “three-tier office visit co-pay structure.” Using an algorithm designed by a medical consulting firm, the GIC and its participating insurers sort doctors into tiers. A doctor’s tier is a rating. It is supposed to reflect the quality of patient care at a reasonable cost. A Tier 1 doctor, according to the GIC, is excellent, a Tier 2 doctor is merely good, a Tier 3 doctor, well, doesn’t suck, but is “standard.” Patients seeing a Tier 3 doctor pay higher co-pays. All rating systems depend on what is counted and how it is rated. Doctors say that the GIC’s tiered system to judging them is inaccurate, unfair, and makes patients pay more money or switch doctors.

In a blog post on WBUR’s website, Longmeadow pediatrician Sally Ginsburg detailed her Kafkaesque experience with the tiering system. When she tried to obtain the data that resulted in her Tier 2 rating, the GIC informed her that she would have to call each of the GIC insurers (there are several). When the information arrived from insurers, it came in the form of “an Excel spreadsheet of numbers along with a list of diagnoses. No patient names, no dates of visits used- just numbers.” If her patient care were truly less than excellent, Ginsburg says, she had no way of determining what she did wrong. So much for quality control. 

Ginsburg also argues that the tiering system also has built-in biases against women patients who pay higher copays when they choose a Tier 2 female over a Tier 3 male doctor. Certain treatments can also skew ratings, she says. The high cost of treating premature infants, for example, can also drag down a physician’s rating.

Office visits become logistically complicated when a Tier 1 and a Tier 2 doctor are on duty in the same practice. Copayments are structured so the patient would face the choice of waiting to see a Tier 1 doctor or pay more to see the Tier 2 doctor. 

BMG'ers, Just a quick note that our campaign website is now up and running – danhill2010.com.  There you will find links to our social media portals, preliminary issue positions and more.  I encourage everyone to follow us on Facebook and Twitter.  I formally announced my candidacy on Monday, and I'm hitting the ground running. I'm very interested in hearing from BMG folks and other progressives on legislative and policy issues as I develop my own platform.  Happy Thanksgiving to everyone.  -Dan 

As predicted in today’s Globe, Steve Pagliuca released an ad today that is probably the most aggressive of the campaign thus far.  It’s on health care, calling out Capuano and Coakley by name over their stated intention not to support a bill that includes Stupitts on final passage.  And it has the telltale “ominous voice” reading it, instead of Pags himself, whose voice appears only at the end when he “approves this message.”  And in other advertising news, Alan Khazei explained his ad with the kids by saying “I don’t want to run political ads during the holidays … I don’t think people care about that. Let’s do something different.”  Interesting — maybe there will be a new one after Thanksgiving weekend?  We shall see, I guess! Here’s Pags’ new ad.

jhj

My grandfather turned 100 years old earlier this year. Tomorrow I'll see him at the Thanksgiving table again.

We often talk about current affairs. As an old Rockefeller Republican, over the years, he's  been more conservative than I; but that has changed over the last few years. Last year he supported Obama when I was still pulling for John Edwards (cue groan); sometimes someone just shows a spark, he said. He was right.

Earlier this year, I remember talking to my grandfather about the financial crisis, specifically bond rating agencies. Isn't there an inherent conflict of interest in an organization paying a ratings agency to rate its own bonds? “Sure there is,” he said; “but what the agencies forgot is that their honesty and independence were worth money.”

So there's that. But last night watching Frontline's show on credit cards, I was reminded of the tension between the demands of market economics and “rational action”, and a personal ethical baseline, a sense that “I won't do it simply and only because it's wrong.” I don't disagree with my grandfather: I agree that trust is like oil in the engine of an economy; trust is an assumption of your partner's integrity. But integrity and self-interest are not always mutually supportive, particularly when there's an imbalance of power and information. And we need to admit that. Sometimes your smarts and skill in playing the incentives leads you to do wrong … just plain wrong.

Anyway, my grandfather is an early 1930's graduate of Harvard Business School. Late last year the HBS alumni received a letter from the Dean regarding the school's response to the financial crisis: It counted the new ways in which the school was instructing its students (e.g. adding Bear Stearns to its case studies) and helping alumni ride out the crisis. It was all rather technical, analytical, self-congratulatory … and strangely cold-blooded, in that familiar Harvard way. For example:

Developing an understanding of the crisis touches virtually everything we teach in the MBA program, and will permeate our curriculum for years to come. The beauty of the case method and our classroom is that we can incorporate new materials extremely quickly, allowing learning to happen in real-time. [etc.]

… The months ahead will bring many challenges. The School's operating philosophy will be one of caution and prudence; in all our efforts, we must focus on the core and distinguishing elements of the School: delivering outstanding educational programs, developing path breaking research that is close to practice, and communicating important ideas worldwide.

Got all that? You'll have to trust me that the rest wasn't all that much more specific or enlightening.

My grandfather wrote this letter in reply. I hope the moral note is not missed:

December 20, 2008

Jay O. Light
Dean of the Faculty
[address @ HBS]

Dear Dean Light,

Thank you for your letter of December 1, 2008. I have read it over carefully three times. It is good to have your update on what you feel are the School's problems and the proposed efforts you and the faculty will undertake in making improvements.

But you have, in my opinion, completely missed two critical areas of management and scholarship that also need attention from you and your faculty.

Item 1: If, as we all assume, the Harvard Business School is the principal leader in the nation in scholarship and teaching in the field of business, and an integral part of the team of graduate schools at Harvard University, then the Harvard Business School must also recognize that the enormous source of failures that have created the recent financial crises may also be the partial fault of the school, due to lack of oversight and critical thinking. 

In hindsight, we wonder how anyone, with a good understanding of banking, could think that an agent of the bank could bundle together weak home mortgages and thereby create a reliable investment. The fact is that the sales agent got immediate pay, with no responsibility, and then rode on the trust and favorable reputation of the issuing company, violating two basic principles of banking. 

Where was the management course of our Business school? What do we teach differently in the future? 

If you try to go to a local supermarket tomorrow, the Puritans might just lock you up.  ;-) Safe travels to all BMGers traveling over the next few days.  Have a wonderful Thanksgiving, everyone!

Forget the allusion to turkeys, but isn't it past time for endorsements by BMG readers — bloggers and everyone else? I finally popped up out of my own ballot box yesterday, so I put out the call.

A few of us have plugged our candidates. So far it has tended to be people working on the various campaigns. While I don't know that the picks here will predict the December 8th outcome, I'd love to read whom people are endorsing and why.

Email received yesterday from Mary Beth Cahill: As Senator Edward Kennedy’s former chief of staff, I know no one can ever really fill his shoes. But in just 14 days, we have a wonderful opportunity to secure the Democratic nomination for someone who shares his vision, tenacity, and progressive values — and make history at the same time. Massachusetts Attorney General Martha Coakley has promised to follow in Senator Kennedy’s footsteps every day, and I know she’ll also blaze a few trails of her own. As a Massachusetts native, I am thrilled by this historic opportunity to elect the state’s first woman senator. I’ve worked on enough campaigns to know that the last weeks are when the rubber hits the road. Martha’s opponents will do whatever they can to knock down Martha, the frontrunner, and gain ground. I have no doubt that we will see a barrage of attacks leveled at Martha as the December 8 election draws closer Martha has worked tirelessly to promote progressive values, improve the lives of women and families, and protect the right to choose. She is a true progressive who has consistently stood up to special interests to do what’s right for the people [...]