A major transition: Jeffrey Sanchez has been picked by Speaker DeLeo as the next House Ways and Means chair. Ways and Means could be a stepping stone to the Speakership; that’s where DeLeo was 2005-2009. DeLeo has given no indication that he’s leaving anytime soon.
Does the House tilt somewhat more to the progressive side with Sanchez? Sanchez receives only a B- from ProgressiveMass voting scorecard, compared to DeLeo’s C+.
Most intriguing about Sanchez is that he’s been House Chair of the Joint Committee on Health Care Financing, and has worked on controlling health care costs. This is a massive part of the budget, of course; and represents the politically-elusive El Dorado of policy.
We’ve watched Congressional Republicans clownishly squeeze the balloon of costs: If you squeeze premiums, deductibles bulge; squeeze risk, coverage losses bulge. The costs don’t magically disappear! And unlike, say, socks, prices in health care are inelastic; people can’t, won’t, and probably shouldn’t “shop around” for the lowest prices. (And Republicans always seem so amazed to find this out: Who knew it was so complicated …)
They’ve avoided tackling the central, real problem of the Affordable Care Act, which is the failure to live up to the word Affordable. There are indeed certain cost controls and attempts at efficiency, but it hasn’t completely remade the health care cost structure, applying the potentially very heavy hand of government to keep prices of services, drugs, and devices down: Price-setting, basically. Even single-payer advocates tend to soft-pedal this approach.
In Massachusetts we’ve had a health care Cost Advisory board since Chapter 58 passed in 2006. But the state is reluctant to confront its prize industry and employer — from PhRMA and devices to docs and hospitals — even as it strains to pay for its Medicaid population. Sanchez’s remarks to the Health Policy Commission in 2016 reflect this tension.
But at least that’s the correct emphasis. Gov. Baker consistently tries to constrain MassHealth eligibility to cut the state’s costs. That this is counter-productive should go without saying. Insuring people of limited means is the whole purpose of the program.
In any event, this might be a sign that Speaker DeLeo is at least looking in the right places for budgetary savings. It’s not the coverage, per se — it’s the costs.