It’s nearly half the state budget, almost 20 percent of the state’s economy and a perennial top concern for voters. The issue is health care, and so far, neither Democrat Martha Coakley nor Republican Charlie Baker has taken the lead on this topic with voters in the gubernatorial race.
“Coakley has perhaps a slight edge on the general health care issue, as well as the affordability issue, but neither campaign has really broken away” on health care, said Steve Koczela, president of the MassINC Polling Group. “It’s not like taxes, which go big for Baker. It’s not like education, which tends to go a bit bigger Coakley. It’s an issue that is still very closely fought.”
So where do the gubernatorial candidates stand on some of the key concerns in health care? Below is a summary of the candidates' proposals for how to treat the health of the state.
On Making Health Care More Affordable:
BAKER: He argues that giving patients information about how much tests and procedures cost, in advance, will help us become informed consumers of care. We’ll spend less money, because we’ll choose to have a baby, for example, at the hospital with the lowest cost and best quality scores. As of Oct. 1, health plans in Massachusetts are required to post what they pay each hospital and doctor.
Baker would take a next step. “I’d like to get to the point where hospitals just post prices and people can see them plain as day,” Baker said. “As governor, I’m going to lean really hard on this.”
Some health care analysts say Baker’s strategy for reducing health care costs could backfire. Patients may assume that the most expensive hospital is the best even though that’s generally not true. And letting Brockton Hospital, for example, know that it is paid about half of what Massachusetts General Hospital receives for a C-section may mean Brockton Hospital demands more money, instead of MGH saying, “OK, I’m going to lower my prices to compete.” In addition, some of the expensive hospitals say their higher prices subsidize teaching and research.
COAKLEY: She argues she is uniquely positioned to tackle health care spending. She created a health care division in the attorney general's office, issued the first detailed reports on health care costs and used her leverage to negotiate a deal that would limit the price increases Partners HealthCare could demand in the near future.
“The agreement that we have reached, to be approved by the court, caps costs and lowers costs as opposed to maintaining the status quo, which we all agree is too expensive,” Coakley said during a campaign debate on WBZ-TV.
But Coakley’s deal has been widely criticized, because it lets Partners add doctors and hospitals and expand the market power Coakley’s reports say have driven up costs.
Coakley suggests the state's attorney general needs more power to effectively block harmful health care mergers. She would file legislation giving the attorney general authority to file suit based on a recommendation from the state’s Health Policy Commission.
“It would allow us to work more quickly and with a different and lower threshold [than the anti-trust statute] to address cost containment in mergers, acquisitions, other transactions in the health care field, that we think negatively would affect cost containment," she said.
And Coakley would consider setting price limits for tests and procedures if the state does not meet its health care spending goal.
“We’ve always said if the market can’t correct, there’s always the opportunity to look at price convergence and have the state more involved,” she said.
Independent Candidates In 2014 Governor's Race Health Care Goals In Summary:
EVAN FALCHUK: He would try to break hospital monopolies whose prices “lead to skyrocketing premiums for consumers.” And Falchuk would “create a fee schedule that will apply equally to all hospitals.”
JEFFREY MCCORMICK: His approach includes a focus on primary care, especially community-based and home care options.
SCOTT LIVELY: He says the state can lower health care spending by creating “nonprofit risk pools that are much less costly, where people are not restricted to the doctors and hospitals they can go to and where the members are stakeholders in the billing process which has a substantial downward pressure on costs.”
On Improving Health Care:
COAKLEY: She says the state has to build up mental health services and merge care for the body and mind.
“We haven’t been able to coordinate care, and it’s put costs way up on the physical health side," Coakley said.
This is personal for Coakley, who has told the story of her brother Edward’s suicide throughout the campaign to explain her commitment to mental health care. She’d push for more screening to catch problems early on and expand access to programs and therapists.
Coakley would keep Taunton State Hospital open. She would require that mental health evaluations be done in a civil facility, not at Bridgewater State Hospital, and be conducted by staff from the Department of Mental Health, not Corrections.
BAKER: He would boost primary care as a whole, beginning with a Medicaid waiver that would increase pay for primary care doctors.
“If we simply invested in primary care,” Baker said, “we would spend less on health care overall, and we’d have healthier happier people. I really believe that.”
On The Move From Fee For Service And Toward Global Budgets Or Payments:
How you get paid doesn’t really seem to relate all that much to how expensive you are or how high quality you are. What seems to drive that more than anything is the culture of your group, and my view has been for a while that if a group wants to be compensated under a global budget and is willing to do the work that’s associated with being compensated that way…then I’m like, ‘Sure, go for it!’ But I think we need to be careful about pushing people into that type of arrangement, because I don’t think they’ll be very effective participants. There’s evidence out there that as long as you have the right incentives and the right culture in place, you can make a fee for service model work too.
As we move away from fee for service and try to get into our communities more affordable and integrated health care, it is the one way where you’re going to be able to address mental health care and behavioral health care.
On The Affordable Care Act And The Connector:
One big unknown for the next governor is whether the Connector website will be working, and if enrolling the roughly 450,000 residents who’ve been in limbo this year will be going smoothly when the new governor takes office.
COAKLEY: “The roll out of the Connector website was unacceptable," she said. "I’ve also said that it’s very important that Massachusetts maintain control over what we are doing here. I’m glad that we are not going down the federal path [merging with the federal site, Healthcare.gov]. I have advocated with my colleagues around the country to say, we need a ‘not one size fits all program.’ We’ve done well here in Massachusetts, we need to keep moving forward on that.”
BAKER: He says “job number one has to be to get the website to work.”
There is some confusion about what Baker means when he says he would ask for a waiver or waivers from the Affordable Care Act.
“I’d like to be in a situation where the commonwealth can actually advocate for its own interests and if there are things we think we can do and make the case to the federal government that they’re the right things to do for the people of Massachusetts and fit within some framework that relates to the goals and objectives of the Affordable Care Act (ACA)," he explained. "I think we should be able to do that. That’s what I mean when I talk about a waiver.”
Baker has not outlined items in the ACA for which he would seek a Massachusetts waiver.
On Opening Medical Marijuana Dispensaries, Would The Candidates Continue The Current Process Or Stop And Start Over?
I’d want to take a look at where we are. No licenses have been issued yet. I think that the vetting that is supposed to take place is taking place. If it isn’t where it should be, I’m happy to start over. I’m not saying we need to do that. I want to make sure that we move as quickly as possible, but we have the regulatory piece in place.
We have huge process credibility issues here; we have pending lawsuits. I think it might be best to just redo this. I mean, compress the time frame, but get some real experts involved in it and do something that I think would have more integrity. I also worry about the fact that as far as I can tell we’re going to come nowhere near meeting the requirement that these dispensaries be available to the people within a certain geography. If you look at a map of Massachusetts and you point these things on that map, there are huge gaps in access and coverage.
On Legalizing Marijuana (An Issue Likely To Come Up During First Four Years):
BAKER: “I am against legalization. I’ve talked to too many people in the addiction community and too many people in law enforcement community. The addiction community, their stories and their concerns are particularly telling.”
COAKLEY: “We would like to see where Washington and Colorado go — states that are ahead of us on medical marijuana dispensaries and have legalized it.”
On Opiate Abuse:
BAKER: “I’ve had some friends who’ve either lost or come very close to losing children over the heroin problem. We need to have a real heart-to-heart about the way the health care community prescribes opiates.”
Baker would require all doctors to consult the state’s Prescription Monitoring Program before writing or renewing a patient’s prescription for pain medication.
COAKLEY: “One out of the three people is at risk for becoming addicted to something like Oxycontin. We have seen too many drugs prescribed, not monitored by doctors and pharmacists. We also need to find better ways for people who are addicted to get them off that and provide for rehabilitation. It is a burning issue for me. Sixty to 80 percent of people sitting in a house of correction have some kind of a mental health or substance abuse issue."
Coakley has not released a plan to address opiate abuse.
Election Day is Tuesday, Nov. 4.