The Attorney General’s settlement allowing Partners Healthcare to acquire South Shore Hospital and two North Shore community hospitals is a great and lasting disservice to the future of high quality, affordable health care in Massachusetts. Facing an opportunity to stand up for patients, business, laborers, and communities, Martha Coakley did not just blink; she closed her eyes.
Today I’m launching a petition asking Judge Janet Sanders to block the deal.
Partners is an important and revered health care leader, but it is also a behemoth, already able to dictate prices and raise costs due to its overwhelming dominance in the market. The Massachusetts Health Care Commission, which is charged to oversee and report in progress toward better and more affordable care, recommended against Partners’ acquisition of both South Shore and Hallmark, but the Attorney General pushed it through without the benefit of truly open and pubic scrutiny.
This agreement will assure continuing high prices for the Partners system. Patients and families will have less choice, constructive competition among providers will decrease, and high health care costs for workers and businesses will continue to drain their resources. Job losses are inevitable, since Massachusetts’ high health care costs are one of the most important reasons that businesses cite for leaving the state, for decreasing their growth, and for not coming to Massachusetts in the first place. Small businesses, especially, suffer from those costs.
Attorney General Coakley should have held the line and insisted that Partners do what an organization of its stature and excellence can do: lead progress in Massachusetts toward better care and lower cost at the same time. Instead, she chiseled the status quo in stone.
Now Massachusetts needs Judge Sanders to block the deal. Please add your voice.
Our Attorney General (and gubernatorial candidate) Martha Coakley has again, like her failed attempt to quash the anti-casino referendum and her successful political assassination of one-time opponent Tim Murray, used the powers of her constitutional office to advance her personal political agenda (in this case, making nice to powerful health industry power brokers).
I hope that Judge Sanders will reject this abuse of her office, just as the SJC rejected her similarly inappropriate attempt to silence casino opponents.
is now opposed to corporate medicine.
Running for office really changes a man.
… seems more gentle than the uprated one above it.
I haven’t rated either comment, but at least the first one is an attack on a candidate based on policy and specific actions in office; a reader trying to decide whether it’s fair — or, indeed, what it means — has a clue about where to start looking for further information. The one you’re calling gentle is entirely an insinuation about character as opposed to policy, and one so nonspecific that it’s hard to even begin to evaluate. (What does “corporate medicine” mean in this context? Is the argument that Berwick would have been pro-merger if he hadn’t been running for office? Where do you even start?)
I suspect that’s why it’s being downrated. It’s aimed, yes, but it’s not pointed; indeed, it’s difficult to discern whether it has any substantive point at all.
You mean Berwick’s snide comment about Coakley’s “backbone” in his post?
Berwick’s expressed disaapointment about very specific (in)action. This isn’t the first time you’ve gotten awfully touchy when Coakley has been criticized.
Berwick, I hope, knows the actual name of the commission, and wouldn’t have added the “backbone” wisecrack. He seems like a gentleman, not a hack.
And stick to the issues following our rules. The issue is Coakley and Berwick and their politics, not whether anyone has or has not “gotten awfully touchy when Coakley has been criticized.” That kind of back and forth is a specialty of this website, among others. Thanks very much.
…and I don’t think it’s an attack to call out an attitude that has repeated itself. I’ve both received and given I think, and we can move on.
Don Berwick explicitly (and correctly, in my view) calls her out.
That’s not a “snide” comment, nor is it an “insinuation”. If the facts are as they appear to be (and as they were with her similar action on the casino bill or, for that matter, in the McLaughlin case), then it is simply true.
It appears to me that some of us are fine with this long-standing pattern of behavior on the part of Ms. Coakley, and others of us are not.
I don’t really want to play this, but I started it, so OK.
– Donald Berwick is accused of taking a different position because of political convenience.
– Martha Coakley is accused of using her office to benefit the industry. In other words, of violating her oath of office.
It’s why I didn’t rate the comments. So I’ll leave it after this, but your response identifies why the Berwick accusation struck me as more problematic than the one aimed at Coakley.
If there are facts that would support the accusation that Berwick is taking a different position on this merger than he would have in the past because of political convenience, they’re not even alluded to in the comment. Has he ever supported a merger under similar circumstances? I don’t know, do you? If he has, I’d very much like to know about it, because that could indeed support the accusation, and be something I’d want to take a good hard look at. But the comment doesn’t tell us anything remotely like that. We’re apparently supposed to infer that it’s true, based on nothing more than that less-than-precise allusion to “corporate medicine.”
I don’t mind candidates being criticized on substantive grounds. It may be uncomfortable from time to time, but we’re looking at putting people into an important job, and close examination of whether their words match their actions is a positive thing. All I ask, honestly, is that there be enough real information presented so that I can evaluate whatever argument or claim is being made. And here, at least, I don’t think that’s too much for people to ask.
To the extent that his post is a mischaracterization of the situation, it is a blunt and unfocused misprision and is not the nuanced public policy thinking I’ve been told to expect from Berwick
First he mis-characterizes the argument as a choice between, on one hand, an absolute good (“ standing up for…“) and, upon the other hand, undisguised political hackery. When in fact the choice, as I understand is to do, and to change, nothing or negotiate with Partners for limits. Then he asserts, in contravention of all reporting, that said political hackery allows a behemoth to become an unfettered behemoth… which is distinctly at odds with the very idea of negotiating with Partners… Coakley says the negotiations are very much about putting fetters upon the corporation as opposed to doing nothing and thus allowing the status quo to stand.
It remains to be seen whether or no Coakley has made a good decision and has negotiated limits to Partners growth over the course of the next decade… but it cannot be said that she is merely unleashing the Partners behemoth upon an unsuspecting CommonWealth in her quest to do the bidding of corporate overlords…
I think Ms. Coakley’s determination to put limits on Partners has about as much substance as her similarly-expressed determination to prosecute Big Dig corruption. She hasn’t even gone that far when it comes to putting fetters on the ongoing disability and pension mill for Boston police and fire. She was similarly disinterested in putting a halt to the liquor license racket operating by Mayor Menino’s city hall during the prosecution of Chuck Turner and Diane Wilkerson (ignoring, for example, the intentional destruction of emails by Ms. Wilkerson’s City Hall co-conspirator).
I find it an accurate characterization that has been held back too long by ALL the political opponents of Ms. Coakley — perhaps because of their fear of her clear willingness to again (ab)use the powers of her office and do to them what she did to Tim Murray.
If we want to discuss “character”, I think we saw the true stripes of Martha Coakley in her handling of her aspects of the Fells Acre case. It looks to me as though she is still the person today she was then — she now has more handlers and more scar tissue (from previous mis-steps) to protect her.
… whether or no you believe Coakley’s sincerity when attempting to limit Partners is irrelevant. Berwick is not making the accusation that Coakley is not sincere in her efforts. Berwick is making the accusation that she’s simply not making any efforts at all. You can say it’s a bad deal, and so it might be. You can say Coakley might be insincere when negotiating and so she might be. But that’s not what Berwick is saying. He’s saying she’s not negotiating at all. He’s saying, against all evidence, that she is simply allowing Partners to get bigger without let or hindrance… When in fact, however poorly or insincerely you think it done, she’s still negotiating..
In my view, “negotiating” requires a particular goal in order to be worth talking about. I have zero faith that Ms. Coakley has such a goal (other than advancing the political fortunes of Martha Coakley).
I parse Mr. Berwick’s statement differently from you, and I clearly parse Ms. Coakley’s actions differently from you.
It might be best for us to leave it at that.
Berwick clearly stated that Coakley “pushed” the merger when in fact it looks like is only allowing the merger under a certain set of conditions. He further states that she “chiseled the status quo in stone” when in fact the way to uphold the status quo would have been to block the merger wholesale.
You are entitled to your dislike of Coakley. You are not entitled to manufacture justifications for that dislike.
The approach being steam-rolled by Ms. Coakley chisels in stone constantly increasing prices, constantly declining services, and constantly increasing executive compensation and perks for industry execs.
You and she can smear as much lipstick on this deal as you want, and it’s still a bad deal for consumers and a worse deal for the commonwealth. It is, however, a good deal for the industry players involved — that’s why Ms. Coakley likes it, and that is her “negotiating” stance.
And therefore, a discussion I’m happy to have.
Mind you, I’m not at all sure I agree with you about how far the original post is a mischaracterization of the situation. Certainly the sentence you quote is blunt, but it’s not wholly without nuance, since its meaning is informed by the following paragraphs. And those paragraphs refer to what are at least potentially important facts in support of the conclusion. I’d want to look at what the Massachusetts Health Care Commission said in recommending against the approval of the merger, and the circumstances under which its recommendation was rejected by the Attorney General, before concluding that he’s wrong about whether any negotiating the AG’s office can now do constitutes any genuine check on the harmful effects of allowing the merger that the Commission may have identified. I’d want to know why the Commission’s recommendation was rejected, too, before I drew any conclusions about whether today’s post is more strongly worded than is entirely justified.
But the thing is? Berwick’s own post gives me references I can readily use to check on how accurately he’s characterizing the situation. It’s an executive summary, not a four-page memo analyzing why he thinks Coakley’s characterization of the situation is wrong (which is hardly surprising, since most readers would scream and run at the very sight of such a thing, however much you or I would welcome it). But it’s a reasoned argument, one based at least in part on ascertainable and referenced facts. We can argue about it on the merits.
tl;dr: The argument in methuenprogressive’s comment is that Berwick is wrong or not worth listening to on this point because of a defect of character. Berwick’s argument is that Coakley is wrong for identified policy reasons backed by the regulatory history, and his characterization of her action here is based on his judgment as to the likely results of her policy choices. It’s not at all the same thing.
… is sorta like the old joke about the restaurant: the food was horrible and the portions were small… The sentence is at odds with itself.
You can’t really say the AG pushed something through for a particular reason and then say the process was so shrouded in secrecy and scrutiny as to affect an ability to discern the particular reason for the push. Especially if the AG’s efforts can also be seen in the light of affecting the commissions precis: progress towards better and more affordable care, as Berwick puts it. If Berwicks argument is that Coakley has failed to perfect health care in the CommonWealth, well then allright. But that’s not his argument: he’s arguing, clearly here and without reference to anything else — ‘executive summary” notwithstanding — that Coakley was faced with a clear choice between a good outcome and a bad outcome and she chose the bad… Whereas the choice was clearly between two less than desirable outcomes: keeping things as they are (for the short term) or trying to negotiate a solution that, at best, is a crappy compromise.
Also, there was a six month period of public commentary. I think it ends this week, if not next, that was, I’m given to understand, ordered by the judge who had to OK the deal. So I don’t get ‘no public scrutiny’.
I don’t object to Berwick making hay over a possible misstep or even actual perfidy on the part of Coakley. If that’s what happened someone should… I do object to Berwick manufacturing rationales over which to make hay. I also think making shit up has the added detriment of not helping his cause just as as it pointedly fails to hurt the other side…
It looks to me as though the timeline is roughly as follows: The Commission filed its final report on February 19 of this year. It clearly had extensive hearings and opportunity for the public to comment ahead of its final report; I haven’t looked, but six months wouldn’t surprise me at all. As we know, it had grave doubts about the merger, and referred its report to the AG.
The AG’s consent degree approving the merger was filed in court on June 24, only a few weeks ago. I haven’t read any of it yet, but one would normally expect a consent decree to be the result of negotiations between the AG and the entities bound by it; you wouldn’t have public hearings at that point. And indeed, an official at Beth Israel is quoted in media as saying there was no opportunity for public review. From a report here: “Jamie Katz, senior vice president at Beth Israel Deaconess Medical Center, wanted a public review of the agreement and was disappointed the attorney general’s office filed without notice, according to WBUR, although Coakley said that was required as part of ongoing negotiations.”
Then on July 1, the judge declined to approve the consent decree without further input from the parties and the public, and ordered a short comment period now in effect. According to this article: “On July 1, 2014, Massachusetts Suffolk Superior Court Judge Janet L. Sanders ruled that the tentative settlement reached between the state of Massachusetts and Partners Healthcare System (“Partners”) would be delayed. The judge’s ruling subjects the settlement to a public comment period of three weeks, with responses from the Massachusetts Attorney General’s office due by August 1, and a hearing before the court on August 5, prior to the settlement’s being finalized by the court.”
So unless I’ve missed something, it looks to me as though the only public comment period or review of the settlement (as opposed to review of Partners’ original proposal) is the brief one now in effect, ordered by the court itself. That’s not actually a lot of time for public scrutiny of a complex transaction, by third parties who haven’t been privy to all the details from the very beginning.
It looks like I conflated any public comments on the original proposal with three weeks period the judge ordered. My apologies. Once I realized that I had done this, I went and immediately fell upon my sword. It was a sword made out of plastic and it crumbled under my more-than-ample weight… and in fact it wasn’t even my sword, but a relic of my now teenage sons’ youthful enchantment with all things piratical… but I wanted you to know that my first reaction was to fall upon a sword. Having survived that, this public apology will have to suffice… It was not my intention to muddy the waters further. I agree that three weeks isn’t that long of a time to assess and
I will, however, double-down on the in-validity to Berwicks depiction and say that, should the AG’s settlement differ significantly from the original Partners proposal — public comment or no — using the fact that the commission said no isn’t an indication of Coakley having ignored, steamrolled or rejected the commission. Quite the opposite could be true: that is to say Coakley may have used the commission report to craft the conduct remedy. We cannot say that the report was rejected if Coakley used it to change the proposal. I don’t assert that it is definitively true… In fact, I assert that I can’t know that. And neither can Berwick. I only assert that Berwicks surety and characterization are of things that cannot be known… or can only be known if we trust Martha Coakley to tell the truth about her process: which trust is, apparently, something Berwick (and others here at BMG) are unwilling to extend…
Even a plastic, crumbling sword might be a little excessive. Rhetorical swords only, and no doing any damage, okay?
Back to the discussion itself, though: I don’t read Berwick as making any claim at all that Coakley ignored the commission report in the sense of not using it in the course of the negotiations. It’s obviously true that none of us can know precisely what a set of closed-door negotiations were like, but I’d be astonished to learn that the AG didn’t use the Commission report. Why wouldn’t she, or her delegates, try to address the problems identified in that report? And why wouldn’t they use the negotiating leverage that the existence of the report gave them?
Rather, I read this as being directed to the results of the negotiations: the actual content of the consent decree, which has now been filed with the court and made available to the public. What he’s asserting here is that it’s a bad enough deal that it ought not to have been made, and that the AG rejected or ignored the Commission’s concerns because the consent decree doesn’t effectively or adequately address them.
That’s a judgement call, and one I’m certainly not equipped to make. It’s possible that Berwick’s judgement here is wrong, though this statement suggests he’s awfully sure that he’s right, and he is speaking to an area where he has a good deal of expert knowledge. But even if he’s wrong, he’s not misrepresenting anything I can see. He’s saying it’s a terrible deal that shouldn’t go forward, based on his stated conclusions about its likely effects. And surely that’s a reasonable statement for a candidate to make about an issue he believes to be important?
I don’t see any other reading possible. Berwick, some two or three scrolls above this very sentence, says:
“ The Massachusetts Health Care Commission, which is charged to oversee and report in progress toward better and more affordable care, recommended against Partners’ acquisition of both South Shore and Hallmark, but the Attorney General pushed it through without the benefit of truly open and pubic scrutiny.”
I would paraphrase that as the commission saying “no” to a specific thing and Coakley saying “yes” that very same specific thing. If Coakley negotiated to mitigate the deleterious affects of the merger… then it’s possible, also to say that both Coakley and the Commission said “no” to the original proposal. If we could run back the clock and substitute the original proposal would the Commixsion still say no? Hard to say but harder, still, to ignore is that Berwick would rather conflate the original proposal with the negotiated proposal and thwap Coakley with it.
His statement is a political statement and, based upon the ham-handedness of it, I’d have to say expertise in making political statements is distinctly lacking.
I’d also have to say that Coakley isn’t chopped liver. She’s the AG of the CommonWealth, and by all measures a good one. She, too, has a great deal of expert knowledge. If you’re going to give Berwick the benefit based upon perceived expert knowledge you have no basis with which to deny the same benefit to Coakley.
In the first paragraph he misrepresents the choice Coakley was faced with… Paraphrasing, again, it’s just “Coakley had a choice between good and bad and she choose the bad.” When there isn’t much upside to either choice.
In the second paragraph he clearly tries to gain traction from the Commissions rejection of the original proposal by insinuating that she pushed the original proposal through without scrutiny.
In the third paragraph he tries scare tactics asserting that high prices, job losses and patient choices will all go to zero in the limit of Partners now unlimited power (which isn’t really unlimited if Coakley negotiated limits to it… the very fact that Partners sits down to negotiate with the AG means that their power isn’t unlimited. )
And then he accuses Coakley of failing to do what she may, in fact, have actually done. The phrase “ insisted that Partners do what an organization of its stature and excellence can do: lead progress in Massachusetts toward better care and lower cost at the same time” could be seen as what Coakley is actually attempting to do. You can argue about the efficacy of it, and the outcome, but it’s a clear misrepresentation to say that she’s failed to even try.
Then he says that she’s ‘chiseled the status quo in stone’ when in fact the way to uphold the status quo was to block the merger and leave things as they are. I’m sure he thinks he means Partners bargaining power in the state, but that’s also a misrepresentation if Coakley deliberately negotiated to limit Partners abilities.
It is, in fact, ALL misrepresentations.
And if you ignore the way language works. (And, arguably, if you ignore the way public decisionmaking works, but that’s an entirely different comment, and people are trying to haul me away from the keyboard even as I type. So later on that one, if at all.)
Your argument from the text only works if and to the extent that we accept your extremely narrow (and to my mind, implausible) reading of the meaning of the specific sentences you’re excerpting. Let’s take your first point. Going line by line:
But that’s not the way language works in this context. Under your reading, if the commission had advised against a proposal, and the proponent had come back with one that was identical except that now the deal had a paragraph promising to contribute $1000 a year to local public schools, and the AG had then approved the new version, it would be wrong to say that the AG had approved a deal the commission rejected.
Since that would defy common sense, as well as be so misleading as to defeat the purpose of talking to each other, it’s not surprising to find that in the real world, no one would have any hesitation about calling them the same deal, only now with a trivial sweetener thrown in. Which is more or less what the statement here is doing. The claim it makes is not that the deal in the consent decree is exactly the same thing the parties originally proposed, but rather that the deal as set forth in the consent decree will still create the same harms that caused the commission to advise against it in the first place.
It’s certainly possible to say that, if you think that the facts and the provisions of the consent decree support it. It is not, however, necessary to say it, as you seem to be arguing. Berwick’s position here, on a natural reading of the language, is that the provisions of the consent decree do not support it — that is, that the changes from the original proposal, whatever they are, aren’t (and perhaps, by the nature of the transaction, could not possibly be) sufficient to protect against the harms the commission identified.
Or, to put it another way, Berwick’s assertion is that while the deal is not exactly the same one Partners originally proposed, and may be better in many ways, the deal set forth in the consent decree is materially the same as the original proposal in its impact on competition, costs, patient protection, etc. “Materially the same” isn’t some arcane hair-splitting concept, either; it’s no more than a fancy name for a common-sense evaluation that people make all the time in day-to-day life. That most readers here understood what Berwick was saying without the explication is a demonstration of how familiar and natural this kind of usage is.
As I said, it’s a judgement call. Berwick’s judgement is that it would, assuming that the concerns it originally raised were genuinely held (and there’s no reason not to assume that).
That’s pure conclusion on your part: it depends on accepting your argument that you can’t say the deal now before the court is the same deal if it’s only materially the same in the respects that raised concerns, or if it will only have effectively the same results on competition, prices, etc. Indeed, it depends on accepting that to the point that you believe that your sense of how the language should be read is obvious and universal, to the point where no one would use it otherwise without some ulterior dishonest motive. Because if you don’t accept all that, you can’t conclude anything about what Berwick would “rather” do.
Obviously, I and many others here don’t accept it. Your proposed reading strikes me as strained and artificial: at best, a demand that no one make a statement in ordinary English without the footnotes, elaboration, and annotation appropriate to a regulatory ruling on a bit of tax code.
And to step back for a moment, if anything, the surrounding circumstances seem to me to argue powerfully against this being an instance of Berwick straining to find something to support an attack against Coakley. As a political matter, it’s not an obvious attention-grabber. It’s not something most people will have strong feelings about — it’s too technical for that, and even if it weren’t too technical and dry in terms of pure subject matter, once you start arguing about it on the merits we’re instantly down into weeds of detail about the nature of the deal, what the problem is supposed to be anyway, whether the consent decree fixes the problem and why or why not, on and on and on.
As an attention-getter, it stinks. But it is a matter solidly within the core areas that Berwick has spent most of his life working on, and that he obviously feels passionately about. Occam’s Razor would suggest to me that what we have here is an instance of candidate sincerity — that he really thinks the deal set forth in the consent decree stinks to high heaven, and is saying so despite it not being an obvious positive step for his campaign.
how Donald Berwick worked for corporate medicine? Are you saying his being a pediatrician at a Harvard Pilgrim clinic makes him management? The bulk of his time was at the Institute for Healthcare Improvement which he started, and is a strong advocate for single payer. Where does this “corporate medicine” come in?
BUT that makes him more qualified to oppose the acquisition, not less. Don is concerned about the quality and cost of care if this goes through. Seems uniquely positioned to make that claim to me.
The argument for blocking is consumer harm, I assume, and Partners is big. But have other buyers come forward? What happens if no one buys it?
(Full disclosure: I’ve been hanging out in Partners facilities a lot in the last two years.)
Have mergers raised or lowered costs? Is care any better? Hospitals, if they are to be viable institutions, need proper management, and not substitute more bureaucracy and less efficient management. While you’re hanging around Partners take a gander at their organizational chart. It will blow your mind how anyone knows what the left and right hand are doing.
But care is better at Partners facilities.
All the in town hospitals provide top notch care. Most community hospitals do also. Partners does not have a corner on excellent care. They do have a good PR department though.
That’s how I formed my opinion.
For some routine things, Partners facilities have slightly lower average quality than some regional hospitals and much higher prices. If needing a limb transplant, they are the best, though!
The problem is that Partners is both big and expensive, and that its acquisition of lower-cost community hospitals makes it much more difficult, systemically speaking, to keep costs for hospital care that doesn’t require the kind of specialization that can be delivered in the big expensive institutions under control. So the merger is likely to inflate costs for things like, say, routine gall bladder surgery at the community hospitals to be acquired, without delivering any benefit in terms of quality of care.
Which will be a ruthless oversimplification of a complex issue, at best, so take it with an appropriate few grains of salt. I’m basing it to a great extent on Richard Mayhew’s terrific work over at Balloon Juice; he’s an insurance professional who’s been blogging extensively about network design and cost containment, and he’s written about the problems of community hospital acquisition by more expensive hospital systems.
At least, not from the Health Policy Commission’s final report on the proposed merger, which I’m looking at now. Under the summary of conclusions, the report states:
The report also states that SSH’s care is as good as Partners’: “there is very little material variation in quality performance between them.” It looks at first glance as though the Commission’s concern is indeed that the merger would create an entity that controlled too much of the relevant market, creating all the usual economic risks of extreme market consolidation. Again, quoting from the summary:
The AG’s agreement, on a non-expert’s first glance and based solely on press reports of its terms, seems to do a good deal to mitigate the risk of disproportionate price increases in the short term. But not in the long term, since the guarantees against disproportionate price increases expire a few years out. And it does nothing to address Partners’ prices now, which some might consider to be already too high: to the extent it restrains price inflation, it’s still doing it against a high established baseline — probably what the post here is talking about in that language about chiseling the status quo in stone.
… and altogether a rather ham-handed hatchet job. Which is not what I expected from Berwick.
My understanding of Coakley’s position is that she had the choice to block the deal, which would change no single thing, for either good or ill in the CommonWealth… that is to say, things would be tomorrow as they are right now… or she could negotiate with Partners to allow this merger with caveats and limits on their future ability to expand. It literally was the choice between doing, and changing, nothing and between making an effort to rein in a ‘behemoth”.
For Berwick to spin this as a failed ” opportunity to stand up for patients, business, laborers, and communities,” is grasping at straws that aren’t there and trying to turn those straws into a rather blunt hatchet… for political purposes.
There remains to be seen whether it is a good deal that changes things for the better or for the worse, but there is not cause to say that negotiating with Partners represents a “failure to stand up for patients” as the present system isn’t the beaux ideal, as Berwick (in other circumstances) will tell you…
Using the facts at hand to make an argument?
As an aside, mimolette is on fire today and has become one if my favorite new posters. Great work!
… I am specifically and, I thought, clearly stating that Berwick either misunderstands the facts or is deliberately twisting them.
I guess that counts as ‘using’ them… but his description of the situation does not comport with reality… Whatever you think of the AG, the choice here is very clearly NOT between “standing up for patients, etc…” and being Snidely Whiplash.
For Berwick to ham-handedly present it as such represents a departure for him and, frankly, not a very flattering one…
You make me feel much less obnoxious about the endless columns of text I seem to be dumping all over the pages here lately, and I am grateful.
that our primary candidates are playing politics. What a disgrace!
I’ve read the comments above and too many have missed the point….surprising for this astute crowd.
This is being presented as about $$$$….that’s not the sole problem.
Compass invaded the South Shore…what I see:
1. too many part-time employees [including doctors] creating a lack of commitment to long term patient care and the community
2. it recently required 3 Emergency Ambulance runs, 3 expensive hospital admissions to CCU to determine a COMMON PRESCRIPTION DRUG ALLERY! A LIFE THREATENING SITUATION!
3. the abundance of LPNs who lack adequate educational knowledge to answer basic medical questions is significant! Most seem extremely young, lacking experience.
4. a PCP, who seems disinterested, ignored AMEMIA and several other issues revealed simply in the blood test of an elderly patient. [When challenged, he wrote a snarky comment about me in the record.] I have submitted medication lists to him repeatedly, informed him verbally of the errors and he continues to list the wrong medications that was recently FAXed on a hospital admission.
5. far too many of the doctors are foreign – while I have absolutely no problem with foreign doctors, they are unfamiliar with the availability of testing they recommend or order, have no comprehension in writing the appropriate prescriptions and much else. After submitting clearly written requests for required prescriptions, they’ve still been incorrect.
6. in several cases, the ‘hospitalists’ seemed impressive in their skills and knowledge, but are spread so thin, at one point, we waited 5 HOURS to have DISCHARGE INSTRUCTIONS explained and questions answered.
7. an Emergency Room nurse [who was really sharp and well educated, knew precisely what the doctor would order] confided that he was ‘CONTRACT LABOR’ from another state, so poorly paid, he depended on patient leftovers for his meals, was sleeping in his car.
I’ve had to insist on follow-up blood tests and much else.
I’ve had to argue to obtain medical records, in some cases, filing complaints. In some cases never receiving them.
If you lack medical records, how do you assure continuity of care?
The above are merely highlights because the litany has been endless.
The cost savings and profits will come out of PATIENT CARE!
If you get ill and require hospitalization, you dammn well better make sure you have a vocal advocate by your side with a HIPPA RELEASE!
Take the politics, personalities and candidates out of the mix – this SUCKS!
That’s why they aren’t elected at least in MA.
Another is surviving a Governor’s Council vote. I guess that’s preferable to being elected. Depends on the Governor.
The point is I feel very strongly about the independence of the judiciary and that the law rather than popular demand should guide a judge’s decision.
and if they are interested in getting appointed to a new opening in a higher court, don’t you think they think about strategies to get themselves nominated by the current Governor and approved by the current Governor’s council?
There won’t necessarily be an opening under the current Governor and Council.
Will be strategic in about the sitting Governor and Governor’s coucil.
…but you never know when the party of the Governor might change. You make it sound like a judge wouldn’t consider the law and that the Governor in Council might not look for someone who actually does his/her job, which is what I find cynical. No different than working your way up the federal judiciary, for better or worse.
Petitions are public comment. Do you think public comment should be limited to lawyer statements, or what?
I didn’t realize that was practice – still seems odd. I think of amicus briefs, but not petitions as a way to intervene in a case.
http://www.nytimes.com/2014/07/07/opinion/the-risks-of-hospital-mergers.html?_r=0
Have we forgotten the Globe series that cast Partners as an 800-pound gorilla, able to force insurers to pay multiples of what other hospitals charged for the same procedures, sometimes performed by the same doctors? Temporary restrictions on the gorilla aren’t much comfort, thanks.
Your point that “Large-scale mergers almost always lead to higher prices” is reason enough to prevent this one. Partners is too big already.
That of the NYTimes editorial board.
I just didn’t want their view to go unanswered. I guess they don’t read The Globe.
because a Rube Goldberg solution to prevent Partners from taking advantage of their monopolistic position was fashioned. Further this acquisition is only a small part of their network, so nothing stops them from increasing prices elsewhere. Partners hospitals are not models of efficiency, and tout treatments that do more to add to their bottom line than actually serve the more general public. There has been no merger, Steward, Lahey, BI, Hallmark that has resulted in lower costs or for that matter better care. Costs are increased because of the overlaying bureaucracy needed, and the inefficiencies that creep up from more distant and divided management. It has been shown that the hospitals who are the most efficient in terms of job description and staff operate at a lower cost and deliver better care. This deal is going in the wrong direction.