This is the transcript of my recent podcast interview with Mark Fisher, Republican/Tea Party candidate for Governor of Massachusetts. Visit the original post to listen to the podcast and read a summary. This is part of a series of interviews with all nine candidates for Governor. The full schedule is available here.
David E. Williams: This is David Williams from the Health Business Blog. I’m speaking today with Mark Fisher, candidate for Governor. Mark, thanks for joining me.
Mark Fisher: Thanks, David, for having me.
Williams: Mark, does Chapter 224 represent the right approach to addressing rising healthcare costs? And if not, where would you say it misses the mark and what would you do differently?
Fisher: I think it is the wrong approach. It’s a huge, costly government intrusion. It reminds me of the Grace Commission. Back in the 1980s, there was federal commission that was supposed to reduce the cost of government. They spent tons of money and had tons of consultants looking at it, yet it sits on a shelf in the Library of Congress and it’s unimplemented.
Chapter 224, creates two huge new entities and seven different task forces and committees that employ a total of 100 different people. It’s taking supposedly 50 million dollars from the casino licenses. It’s such a huge government intrusion. I don’t look to the government to reduce the cost of anything. It’s the wrong approach.
I do agree with the proposal to eliminate the limit on the number of physician assistants that can report to any one doctor. I also believe that a patient should be able to choose to have a physician’s assistant as their primary care provider. Chapter 224 does allow for that.
Williams: There are certain provider systems in Massachusetts that are reimbursed significantly more than others for the same services even though there are virtually no differences in quality. In your view, does the state have a part to play in addressing these disparities?
Fisher: The state involvement: no. The problem is that we, as the buyers, the patients, have a middleman called the insurer. We all believe, as individuals, we can’t control the cost. It’s between the providers and insurer. When we go for services, it’s the insurer who ends up paying the hospital or the doctor. If patients had more of a say in the selection of routine care, office visits and such and they had insurance only for more serious care, then we could start to address some of these problems. Then, we could see the differences in these costs and we would be paying them out of pocket, which we could afford to do because the premiums for this catastrophic insurance would be much lower than the premiums we’re paying now.
We have to be the people who see those differences and then make decisions accordingly. We can’t do that right now with the insurer paying for all those costs.
Williams: Mark, there are more than a dozen state agencies that have a role in healthcare. Is there an opportunity to consolidate or rationalize them?
Fisher: When I think about government, I don’t think about reason. [State agencies] exist to employ political allies. We have the highest premiums in the nation. We’ve been in this experiment with RomneyCare for nine years now. It was supposed to reduce cost and yet we have the highest cost in the nation. And it’s going to happen with the Affordable Care Act throughout the country. So, yes we have an opportunity to consolidate or even eliminate many of these agencies.
Williams: Government policy, and this is both at the federal level and the state level, has encouraged the adoption of electronic medical records. However, many providers complain about the systems, and the benefits have been slow to materialize. Should state government play a role in helping to realize the promise of health information technology?
Fisher: Once again, there’s a common thread here about the government’s playing a role. And I say no. And the reason is that the benefit of such technology should be plain for all to see. If it isn’t plain for all to see, there’s no way that the government is going to make it clearer. The government is just going to make it worse, they’re going to claim that they’ve made it better and then they’re going to send us the bill for their services. If there is a benefit, then it should be plain to see and it should be implemented by those who are using it, and the government is not going to play a role in that at all.
Williams: Hepatitis C is three or four times more common than HIV. New drugs that can cure the infection are coming on the market this year but they’re very expensive. What role should the state play in ensuring that residents are tested, linked to care and have access to these new medications?
Fisher: The government should have a role here, but I think that it’s best in the area of prevention. Hepatitis C has spread through the use of unsterile drug paraphernalia and needles, or through unlicensed facilities that are either performing tattoos or body piercings. Let’s make sure that those facilities are not spreading this disease. Then, we have to make people aware that Hepatitis C is also a sexually transmitted disease. It’s an STD. The government has a role to play here, but its focus should be in the area of prevention.
Williams: Mark, there are multiple healthcare-related ballot questions. What are your thoughts about them?
Fisher: There are some that are reasonable, like limiting the number of patients that are assigned to a nurse. However, in general, I’m wondering if it’s a legislative approach that we need, whether that’s the best way to go. For example, if the patient and nurse ratio is made known to the public, they can decide for themselves which facility they would prefer to use or be treated in. So, again, in general, I think many of them are well-intentioned. I just don’t think that making a new law is the best way to go.
Williams: What have you learned in your business career that will be useful as Governor?
Fisher: As a small business owner, I’ve been a victim of big business insurers. For example, multiple insurers have refused to provide health insurance for my employees. I reimburse 100% of my employees’ deductibles. They refuse to provide insurance unless I agree to cut the reimbursement in half, to 50%. And when I first heard this, I said it was craziness. But my broker told me no, because if the insurer sees that an employer is reimbursing their employees a majority of the deductible or 100% like I do, then the employees are more apt to do elective procedures and of course, that costs the insurers more. What I learned is that they are more concerned about making big profits than they are in providing care for the patients that are paying the premiums.
That’s the number one thing.
And then also, in running a small business, it’s like the way I run my family, my life. We balance our checkbook, we live within our means and have a healthy dose of common sense. Those are the things that make a big difference on this issue and all issues on Beacon Hill.
Williams: Much of the emphasis in healthcare reform is on adult patients. Is there a need for a specific focus on children’s health?
Fisher: There is a focus on children’s health as well as adults. Healthcare is provided to different age and gender and other demographics, and I don’t like pitting one group against another. We do not have to provide equal amounts of dollars to each group to say that we’re treating them equally. I’ve seen this play out even among charity groups of a particular disease, trying to raise more money for one versus the other. We do the best we can, and we know it’s not going to be perfect, and we provide the best available care with the means that we have. I don’t like this divide-and-conquer mentality or pitting one group against the other. We’re a Commonwealth. If we believe that and try to do the best we can, we will best serve all the different groups under our care.
Williams: Mark, I very much appreciate the fact that you’ve been willing to answer all the questions that I have set out here. But I would also like to give you an opportunity, in case there’s anything that you’d like to add that I haven’t asked you about.
Fisher: Three quick points. We’ve learned here in Massachusetts, and now we’re learning nationwide that government intrusion into healthcare is bad. We’ve been lied to. We’ve heard, “iIf you like your doctor, you can keep your doctor”. It’s not the case. And now, with the Affordable Care Act, as well as the statewide laws that we have here in Massachusetts, we have actually driven up cost. And it’s time that we learn from this tragedy and try to keep government out of this area. That’s number one.
The second one, I would challenge insurers to expand these lower premium, catastrophic only, insurance plans. And the reason for doing that, it would allow patients the flexibility to choose routine care based on the wide range of price differences that we see in the market. And this competition , in and of itself, will lower overall costs.
Lastly, the third point, let’s open up the marketplace to all insurance plans across state borders. We’ve seen how that worked with regard to auto insurance in the state. Premiums came down by over 12% when it was enacted a few years ago. This too will lower costs through competition. But first, we need to reject the Affordable Care Act in order to realize these cost savings as well.
Williams: I’ve been speaking today with Mark Fisher, candidate for Governor. Mark, thanks so much for your time.
Fisher: Great, David. Thanks for having me.
By health care consultant David E. Williams, president of the Health Business Group.February 27, 2014