Sue Doctrow of Arlington asked me to post her comments on the Globe endorsement on her behalf. Glad to do it as I heartily agree.
While it does contain some good points, this strikes me as a lazy endorsement. As another commenter noted, the Globe did not do its homework on Don Berwick. “A medical professor and pediatrician by trade…” does not begin to describe his problem solving successes, globally impactful nonprofit entrepreneurship and strong executive experience, including leading an $800 billion federal agency. Of course, if you fail to conduct even cursory research on somebody’s world-renowned record delivering change to very complex systems, you are likely to have, as the Globe apparently does…” skepticism about whether they can deliver change, not just talk about it.”
Don Berwick’s plans for pursuing single payer healthcare in Massachusetts have been clearly outlined in his statements and written materials. For example, quoting a Berwick Campaign handout: ”On his first day as Governor, Don will convene and chair a planning commission tasked with defining a precise roadmap and crafting a legislative proposal….this is not uncharted territory – there are dozens of single payer systems around the world that have exceptional healthcare outcomes for far less money. This commission will build on best practices…and adapt them to the needs of Massachusetts patients and providers.” This information is considerably more substantive than “I’ll lead the conversation,” and certainly more than “wav[ing] a magic wand”, as Mr. Grossman appeared to characterize Don Berwick’s plans for single-payer in an early WBUR debate. Mr. Grossman himself has indicated that he believes single-payer healthcare should be on the table. Though, of all the candidates, it is Don Berwick who has effectively conveyed the economic urgency to reform an inefficient – as he is best positioned to judge – system that consumes over 40% of the state’s budget. Mr. Grossman’s promising a “conversation” is nothing even close to proposing a plan, justifying Don Berwick’s criticism of those words. I am quite confident that somebody with Don Berwick’s track record in healthcare systems improvement has a sound plan, as indicated in his written material. In contrast, on the “Steve Grossman for Governor” website, I am finding no information as to how he would address healthcare costs. Unlike those of the other two candidates, the Grossman website does not include a Healthcare section under “Issues”.
It strains credibility to, as the Globe endorsement does, describe as “politically inexperienced” a man who led the largest U.S. federal agency implementing controversial legislation amidst the hottest of partisan politics and, earlier, spent about two decades improving government healthcare systems throughout the world. Nonetheless, the progressive legislators who have endorsed Don Berwick and, it seems likely, plenty of others will be there to participate in the process and provide guidance through the idiosyncrasies of Massachusetts politics.
I’d already been disappointed in the Globe’s coverage of this primary campaign so was not really surprised by this endorsement. But, no matter…Don Berwick has my vote!.
If you use the search
you can find a bunch of stuff on Steve Grossman’s site related to healthcare. In particular
http://stevegrossman.com/wp-content/uploads/2014/03/Steve-Grossman-on-Compassionate-Common-Sense-Behavioral-Health-Care.pdf
includes a number of rather specific proposals. Mr. Grossman’s positions, after all, are not really determined by his webmaster.
Where is the vision for dealing with health care reform in terms of quality and costs? All that is there are behavioral health proposals and then one thing talking about implementing Chapter 224. Implementing an existing law is hardly a focus on the issue.
Again, behavioral health policies are not the same as policies on reforming crushing health care costs. That’s the real problem, and only one candidate is proposing real changes. Baker and Coakley both have a focus on “transparency,” which is entirely hollow, and Grossman has not put forth anything of note on the issue, except perhaps “we’ll leave single payer on the table.”
kbusch, doubleman already covered this, but, yes, I already had found that material on Grossman’s ideas about behavioral care. This does not address healthcare costs. It relates more to mental health parity, to ensure that mental health receives care similar to that available for other illnesses. Certainly, he has worthy positions on this issue. But, what I’m talking about is how to curb the rising costs of healthcare, which exceeds 40% of the state budget. Grossman’s website doesn’t address that at all. It’s surprising that he, especially as current treasurer, wouldn’t address something that affects our budget so much. As noted before, both Coakley and Berwick do have sections addressing healthcare costs on their websites. Even in the Globe endorsement, the editorial board said Grossman had not put forth specific plans. They just seemed to accept, on faith, that he would deal with it. Whereas, Berwick’s specific goals for addressing healthcare costs were dismissed as something he probably could not accomplish (due to supposed “political inexperience”). This is a major flaw with this endorsement.
A few points –
1) The cost of healthcare in the state budget revolves around employee benefits. The expense comes in providing health benefits to state employees. If Berwick wants to save the state money in its role as an employer, then he’s going to need to bring other MA employers on board. That will require an extended conversation and, ultimately, persuasion. His argument rests on single payer being smart for employers. I agree notionally, but we are a long way from making that sale.
2) For the bulk of the next governor’s first term, we will not have a single payer system, so what are the short-term fixes that can be applied and how would Berwick move forward on other initiatives before he gets his supposed single payer windfall?
3) I am not convinced health care is anywhere near #1 on the priority list in MA. It’s a direction in which we probably ought to move, but I rank it well behind economy, transportation and education. If Berwick wants to be the single payer guy, then he can do that while working for the next governor.
Your comment here is founded on a fundamental misunderstanding about the reality of health care costs for government and employer:
This “fact” is not at all true. Health benefits for state employees is about a $1.3 billion annual cost. Real money, sure, but dwarfed by the $14 billion spent on Medicaid annually. For details, you know facts and all, see here: http://www.massbudget.org/browser/subcat.php?id=State+Employee+Health+Insurance
Meanwhile, Medicare spends about $15 billion a year while the commercially insured spend about $18 billion a year on medical costs alone while siphoning off $1.8 billion for non-medical costs of private health insurance (administration and other “profit”). See:
http://commonhealth.wbur.org/2014/09/mass-health-costs-first-year
I’d submit that when you take a real look at the health care system in Massachusetts, single payer seems like a fair better solution than when you narrow the question to what to do about state employees.
I tend back out Medicaid costs because, while massive, it is functionally a single payer system. Major potential savings single payer offers Medicaid are in care for the un- or underinsured (less of an issue in MA) and in admin costs. There are some increases on the other end in terms of more people covered and people availing themselves of more health services since they’re now covered.
Short answer is I’m skeptical single payer is going to create a ton of Medicaid savings since the program already has bulk buying power, lower overhead and cost containment. Obviously small percentage savings can net big dollar amounts in such a large program, but the major savings come from weeding out the middle man costs that currently jack up rates on the insured.
Of course “we are a long way…” from it if we don’t start the process and don’t take the need seriously. A very long way.. I think that the pain of healthcare costs for employers, not only the state as employer, is pretty widely acknowledged. And, employees are paying more and more themselves. Berwick’s value as a potential governor goes way beyond his healthcare expertise, in any case. My post above was aimed only at addressing the mischaracterizations of the Globe’s endorsement, not the entire case for Berwick. The Globe dismissed his ability to get single payer to happen, as well as his political experience and sophistication. For more info about Berwick’s overall credentials, you should probably see jbrach2014’s recent post of Helena Long’s letter. For starters….As for whether he would work for a different governor, I hope that isn’t a move he needs to contemplate. 😉
Ad nauseam. It comes from the divide between what Berwick would do – the comprehensive process you describe – and his rhetoric on the trail, which suggests he can “get it done” with a snap of his fingers. His thorough plan to study, etc., suggests he knows he can’t do that. Far from absolving him, that fact makes his rhetoric worse in my mind. I believe he wants voters to think this will be easier than he knows it will be.
While Grossman has taken the heat for the “magic wand” remark, let us not forget it was Berwick who tried to score political points by mocking Steve’s statement that he’d lead a conversation on single payer.
When I heard it, the “magic wand” sounded unexpectedly patronizing from somebody who had always impressed me as a respectful person. I think Steve got enough pushback on that to stop the patronizing tone toward Don in future debates. (And, as it happens, turn his full fire on Martha). In the context of minimal acknowledgment of the problem of heathcare costs on his website, “a conversation” does not sound like much to offer (or any will to think about it right now) so I can understand Don’s taking issue with it (“mocking” is not how I would have described it; objecting that it wasn’t enough, was what it sounded like when I heard it on WBUR). Though, I”m sure Steve fully understands, as much as anybody, that healthcare costs impact our budget greatly. At the Convention, several of us turned to one another in surprise when he mentioned single payer in his speech, thinking maybe it was a reaction to Don’s bringing it to the forefront. Though, my friend and fellow delegate, a longtime Grossman admirer, said she’s heard Steve mention single payer many times over the years, for what that’s worth…”a conversation” is, of course, better than “we’re not there yet”, the answer I’ve heard from the third candidate.
Political process and being a Democrat is not enough to solve this state’s problems. Don Berwick’s approach is tried and true. Study the facts, and solutions. Line up support legislatively, and publicly by outlining how this is an improvement and does not tread on any cherished traditions, but actually makes them work better and affordably. The others will produce more of the same which is not bad, but not great. Wasteful insurers, poor infrastructure, pockets of inadequate public education, poverty, homelessness, affordable housing, lack of a living wage by too many individuals and families all cry out for bolder approaches. Don Berwick by his background, knowledge, and attitude says he’s up for the task. I believe him because he is forthright without any horse race hedging.
affordably=affordable