At the first stop of my Innovating Massachusetts Tour, I outlined my vision for health care in Massachusetts and released my campaign’s health care policy proposal.
Health care costs accounted for 23 percent of the state budget in 2000 and increased to 41 percent in 2013. If costs continue to rise at the current rate, more than half of the state budget will be devoted to health care by the end of the decade, diverting resources from other important state programs.
If we want to invest in the future of our Commonwealth – in roads, in bridges, in schools, in protecting our environment, and in keeping our communities safe, we need to get health care costs under control. Containing the cost of care will give us the opportunity to invest in sorely needed programs to ensure that Massachusetts remains the best state in the nation to live and work.
I’ve based my health care platform on a strategy known as the Triple Aim, which strives for better health, better care, and lower costs – all at the same time. In order to achieve the Triple Aim, I will take the following steps:
- As Governor:
- On day one, I will convene a summit of all stakeholders to conduct a top to bottom review of Chapter 224 and develop an action plan to ensure it meets Triple Aim goals of better care, better health, and lower cost. If Chapter 224 results lag behind, within my first 100 days I will work with the Legislature to craft a new wave of stronger legislation to incentivize increased transparency, payment changes, and care reorganization.
- It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone – patients, families, clinicians, and employers. I will work with the Legislature assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.
- I will personally lead a statewide initiative to make Massachusetts the healthiest state in the nation, through smoking cessation, obesity prevention and reduction, and specific programs to curb domestic and physical violence.
- We will stop the obesity epidemic in Massachusetts. I will strengthen our state’s disease prevention and health improvement programs, with a special emphasis on innovations adopted from best practices from all over the world.
- I will assure that high-quality mental health care is more and more incorporated into the center of our health care system, in full parity with other components of care. We will reduce substance abuse and suicide rates by 50% in Massachusetts in the next decade.
- Massachusetts will be the national leader in patient safety. Many of our hospitals have made progress toward safer care – reducing infections and complications in hospitals, reducing medication errors, and more. This is the moment to bring patient safety to full scale in the Commonwealth, in every hospital and in every community. I will convene the stakeholders in Massachusetts health care and launch a five-year, comprehensive, collaborative, statewide project to bring the levels of injuries to patients due to errors in care to the lowest level in the nation.
Massachusetts was the first state to stand up and make health care a human right, and today almost 98% of adults and 99% of children have coverage. However, our system is the most expensive in the nation. Now is the time to get our health care costs under control. To do that, we need a Governor who understands how good care could be, what better payment systems look like, and how to reorganize care with patients at the center. That has been my work for 30 years, and I will bring that knowledge and experience to the Corner Office.
My full plan can be found at: http://berwickforgovernor.com/health-care
I would deeply like to see single payer in Massachusetts. I suspect most physicians would too because it would simplify billing so much. However my worry is that if the legislature gets its hands on it, we will not be able to control costs. The legislature should appropriate the money and leave the running of the system to an appointed or elected committee with long terms in office. Otherwise we are going to have decisions made by lobbying and sob stories.
First, I commend you on running for office. You presumably get a lot of “How the heck can you win?” and it takes courage even to try. Good for you.
Second, you got my attention with the statistic of how health care is crowding out all other things. The Triple Win, though, evokes perhaps for me another triple….the Triple Lindy — an impossible feat.
I.e., I’d be interested in a candidate who described cost control as a North Star, or who described better outcomes….but to hear “Everything will be better” makes me a bit less interested, not more interested.
Even though you no doubt authentically believe that you’ll achieve the Triple Aim (a la Rodney Dangerfield in BTS), I wonder about the political viability of that message. You might be at an advantage if you embrace and talk about some tradeoffs?
First, let’s examine your statement about how healthcare has grown as a percentage of the budget from 2000 to 2013. While it’s correct that it’s grown from 23% to 41%, you’ve left out a two important facts: Romneycare and the recession. Romneycare caused an expansion of Medicaid, which was partially subsidized by the federal government. The 2008 recession caused a reduction of revenue that forced the budget to contract. Medicaid expenses could not contract, however, and that’s why the percentage increased.
Also, this state’s ability to implement a single payer approach is limited, because the state can’t pay Medicare claims. In my opinion, a single payer solution would only work if it could also cover Medicare.
a state can pay for what Medicare does not. Vermont is taking this approach and will implement single payer is 2017.
http://www.minnpost.com/community-voices/2013/11/health-insurance-problems-keep-arising-vermont-offers-ray-hope
Dr. Berwick, your speech at the Democratic state convention last July was the best offering from the candidates for Governor — passionate, inspiring and refreshing! You were the buzz! Now you have been called, the “Elizabeth Warren of Health Care,” and you have offered us a bold and visionary plan to improve health care for our state. What do you say to those who may ask if you are a one-issue candidate and what in your background has prepared you to work well with our very independent and sometimes intractable legislature?
I admire your goals. I think your focus is wrong.
If you want to advance the triple aim, you should start with the Department of Public Health and the related healthcare regulatory agencies. DPH has been a mess for years, as shown by the crime lab fiasco and the compounding pharmacy disaster. Under new leadership, DPH is now well positioned to boldly march forward into the 1990s. The Division of Health Care Quality is obsessed with paperwork and administrivia. The Determination of Need program rewards high volume providers with permits to build new facilities, while innovation in care processes and increases in efficiency are ignored.
Single payer has its virtues, but it is not a magic bullet. You would still need to figure out the best way to pay physicians, hospitals, and other providers, how to set budgets and the like. From a political point of view, I question whether the legislature will have the appetite to tackle another big healthcare bill only two years after Chapter 224. Improvements and adjustments are much more likely to pass and there are many opportunities for incremental improvement in our system that do not involve flipping over the table.
Vermont has not enacted single payer. Vermont has approved the creation of a plan to create a single payer system. Crucially, the law did not include a funding mechanism to pay for it, and this is still up for debate in Vermont. One of the architects of the plan proposed to fund it with an 11% payroll tax, but that has not yet been enacted. Also, the Vermont plan requires a Medicare and ACA waiver, neither of which have been applied for.
There are a lot of benefits to a single-payer system, but, from a state perspective, there is a serious question about funding the effort.
Incidentally, if you carefully read Don Berwick’s statement, he does not say that Massachusetts will get single-payer. He just says he will study the possibility of a single-payer approach.
I tend to agree. My bias is as an incrementalist so this fits my bias, and I understand that you run for office on bold plans, not tweaks.
Still, I agree that the lege won’t want a “new” Ch. 224. It seems far more likely — and especially reasonable with a Governor Berwick — that the executive branch can make lots of process improvements and maybe get the lege to pass some small changes necessary for the executive branch’s improvements (in care and cost).
P.S. Want single payer to spread like wildfire? Set up single payer prenatal, delivery, and early childhood (& mom) care. You do that for a few years and you’ll have a bunch of 20somethings and 30somethings clammoring for a system more like those who are 65+ have. As a bonus, the Dems can point to the right way to love unborn babies and their parents.
What will you do about transit, education, and job creation? No offense but it’s unlikely we are revisiting healthcare anytime soon. Romneycare is better than nothing, and we aren’t getting anything better in a post-ACA rollout political environment.
How will you realistically balance your policy vision with the political realities in the legislature?
What are your priorities and platform beyond healthcare issues, and how will you approach those issues outside of healthcare where you don’t have the same expert level knowledge or policy experience?
The Corner Office is the center of a sprawling state government that touches many facets and not just the one you seem to be focused on, what’s your broader agenda and approach?
I ask these questions critically, but I am intrigued by your candidacy and open to voting for you. I just gotta hear about more than healthcare!
I’ve committed to a different candidate, but it’s good to see new candidates. Best of luck.