Quite an "only in Massachusetts" moment.
Patriots owner Robert Kraft and leaders of Raytheon, Suffolk Construction and Putnam Investments have all filed letters in support of an anti-trust agreement that would not normally see the light of day before a judge approves the deal. The opposition includes public health professors, a group of top economists and politicians battling Attorney General Martha Coakley in the governor's race.
This show of force is weighing in on a deal Coakley negotiated with Partners HealthCare. It would let the state's largest hospital network expand its market power, but with constraints, some of which would last for 10 years.
Here, in the medical mecca that is Boston, health care is big business, an issue in the governor's race and a top concern for consumers and employers who struggle to pay for it.
So the agreement is setting a new precedent for public scrutiny. Insurers, physicians and patients are poring through the document, line by line, to understand what it might mean for them and the future of health care in Massachusetts. AG Coakley is collecting public comments through September 15th. She'll have a week to respond and then Suffolk Superior Court Judge Janet Sanders has scheduled a hearing on the agreement September 29th.
In the first batch of comments out today, most of the supporters focus on Partners' leadership in the medical community and don't dive into the details of its alleged anti-trust practices and the proposed remedies. Opponents, on the other hand, plunge right in. Here are a some highlights:
The South Shore Hospital community has submitted at least a dozen letters in support of the agreement, which would clear the way for the hospital to join Partners. Weymouth Mayor Susan Kay applauds the AG's "significant and even historic benefits for the acute care market place." And Norfolk County Central Labor Council Secretary James Howard says "enough is enough." Please, Howard urges Coakley, "stop letting self interested parties hinder this process."
I imagine Howard refers to the coalition of Partners' competitors who say the deal will raise costs, but maybe he means Coakley's rivals in the race for governor. Democrat Steve Grossman calls the deal a failure that could "take us down the wrong path for many years to come." And Don Berwick, who also faces Coakley in the Democratic primary, has submitted a petition with 456 signatures called "Block the Partners deal."
Some of the city's most prominent business leaders are represented in the pile of pro-agreement comments Judge Sanders will review. Putnam Investments CEO Robert Reynolds calls Partners a "leader in providing world-class medical care." John Fish, chairman and CEO at Suffolk Construction, says Partners is "vital to the city and region's economy." Kraft says he's writing to "underscore the importance of Partners HealthCare to the health of the individuals, families and communities of Massachusetts."
Raytheon chairman William Swanson says he knows how challenging it can be to balance costs and quality and he's "convinced that Partners is on the right track."
But the employers are not united in support of the Partners deal. Rick Lord, president of the state's largest employer group, Associated Industries of Massachusetts (AIM), says it "would cause increases in medical spending that would far exceed any potential savings." The agreement needs further review, Lord concludes. Lord is a member of the state's Health Policy Commission, which has already raised concerns about whether capping Partners' prices would control costs.
Several unions, including the International Brotherhood of Electrical Workers (IBEW), local 103, citing Coakley's reports that revealed Partners' high prices, asks the AG for two changes in the agreement. First, make Partners post its prices and second, make Partners lower its prices before limits on future increases take effect.
Partners has many allies who want to make sure that the network remains strong. Foxborough Police Chief Edward O'Leary says staff at the five-year-old Brigham/MGH office in town have worked hard on domestic violence prevention program and projects in the local schools. Leaders at Boston Health Care for the Homeless Program don't comment on whether the deal will rein in Partners' market clout but say they couldn't continue their critical work "without the support of Partners HealthCare."
Much of the opposition is from academic experts. Nancy Kane and Nancy Turnbull, both at the Harvard School of Public Health, say the Coakley-Partners plan would hurt "the long-term affordability of health care in Massachusetts" and the viability of some of Partners' competitors. They question whether the AG's office has the techincal and political capacity to monitor Partners' already vast network for the next 10 years, as proposed.
BU Professor of Health Policy and Management, Alan Sager says Partners has been claiming for years that it would save money and improve quality as its network grew, but "has adduced no credible evidence to support those claims." And Coakley's constraints, says Sager, "look like feeble regulatory Lilliputians, unable to restrain Partners' Gulliver." He urges Coakley to sue Partners in an effort to divide the system in half.
A group of economists, experts in anti-trust, competition policy and health economics, are asking Judge Sanders to block the deal "until and unless a full trial on the merits can be held." They say mergers do not lead to lower costs.
"Partners 20-year track record of integration paired with high prices and high medical costs casts serious doubt on its assertions that the proposed acquisitions would yield substantial efficiencies, let alone of the magnitude necessary to outweigh the alleged anticompetitive effects," say the 21 professors from top schools across the country.
Anti-trust cases are difficult, says former AG Tom Reilly, who served from 1999-2007 and reviewed allegations of Partners' anti-competitive behavior. While it was clear that Partners was "large and dominant, we faced serious challenges to a successful prosecution under anti-trust laws," Reilly says in his comment. "Given these obstacles, what the Attorney General (Coakley) has achieved in the proposed judgement is quite impressive."