Kudos to the Health Business Blog for the first full scoop on the health care positions of all nine of this year's candidates for Massachusetts governor.
Blogger David E. Williams is not a professional journalist — he's a health-care consultant and president of the Health Business Group — but he certainly seems to be first out with a roundup sure to be of interest to many in health care, the state's biggest employer.
I asked him whether he thought this November's gubernatorial election could be a bellwether for the politics of health care. "I think so," he said, "partly because we have so many people who are so knowledgable about health care, and not afraid to say things."
The election could have national import, he added, because Massachusetts is at a very interesting juncture: 'We've moved well beyond 'Should we repeal the ACA or not?' We've taken Romneycare and brought it to the next level with 224 [the latest health reform law aimed at containing costs]. So we're already a full step ahead, and now you've got people who are really looking to say in their first term: What goes beyond that? Can we keep universal coverage and get cost under control and improve quality?"
"I don't know that this election will be decided based on health care," he said, "but I think the discussion that goes on and the debate will actually ready the residents of the state for some potentially very significant and important changes with the new governor."
David is planning a broad analysis of the candidates' positions for March 18, but I asked him in the meanwhile what had most struck him in the nine sets of responses. A few points:
• Since you have so many people with deep health-care expertise, they really do apply their own knowledge and have pretty firm views in some of the areas. One striking thing is you have certain topics that wouldn't be on the table in the national debate. The single-payer system is one of them — you see that with [Donald] Berwick but also [Steve] Grossman talks about it, and I'm not sure everybody else has it off the table.
• Also, you have people who are independent candidates who maybe feel less beholden to any particular constituency speaking loud and clear. You've got [Evan] Falchuk from the United Independent Party — he has some very strong words to say about naming names in terms of powerful hospitals.
• And I thought it was interesting that another independent, Jeff McCormick — when asked about the expensive new drugs for Hepatitis C, he started talking about extending patent life and looking at this from the big-picture, systematic side. In the question about those new Hepatitis C drugs coming onto the market — they could bankrupt the system but they have a big impact — you have people like Berwick talking about the 'triple aim' and how we need to reduce waste to avoid rationing — and others, even the most libertarian candidates, like [Mark] Fisher on the Tea Party side, say the state maybe should have a role there.
• On the ballot questions — one on nurse staffing and the other on hospital financials and compensation — most didn't really want to go on the record but a couple did, including Joe Avellone, who was in favor of the nurse staffing ratios, and he's a physician. Most people would say you shouldn't legislate a ratio, but here's a doctor who said that it's a good idea. And there were a couple, including [Juliette] Kayyem, who aren't really in favor of ballot measures, but she'd respect the will of the people.
• [Martha] Coakley brought out in her discussion the need to remove the stigma from mental health treatments, and Avellone talked about substance abuse and looking at that as a serious issue.
In all, David said, "I think the Massachusetts voters can handle a very substantive and nuanced discussion about the issues, including health care. And I would love to see people who specialize in other areas do something similar — so that we have more emphasis on debating serious issues, and deeply, and less about the horse race and fundraising and the personalities. I was very gratified that all the candidates agreed to participate and gave serious consideration to these issues."
Personally, I was gratified that David did such yeoman's work in gathering all these substantive views. Readers, what health care positions would most win your vote?