I’ve learned a lot about the candidates for Governor of Massachusetts by interviewing all nine of them about healthcare policy. Starting today I’ll be summarizing the results from those discussions so readers can compare the candidates on specific issues.
The candidates have diverse backgrounds: from head of Medicare to surgeon to small business owner to Homeland Security official. Of the nine, five have significant healthcare experience. Even those that don’t come from healthcare have taken the time to study the issues and develop deep perspectives.
I asked everyone to describe how their backgrounds, especially in healthcare, prepared them for the job of Governor. Here are higlights of those answers.
Don Berwick has an international and national reputation in healthcare. He’s a pediatrician who founded the Institute for Healthcare Improvement and more recently ran the Centers for Medicare and Medicaid Services (CMS), an $800 billion federal agency. To put things in perspective, that budget is about 20x the size of the entire Massachusetts state budget. He pointed to his experience motivating the 5500 CMS employees and his conviction that government employees “are just as eager to be proud of their work, and just as amenable to learning about modern approaches to improvement as any workforce” if they have the right leadership. He wants to bring that approach to the Massachusetts government workforce.
Joe Avellone reflected on two major themes from his long career as a surgeon and healthcare executive. He understands the “absolute sanctity of the doctor-patient relationships” and the importance of preventive medicine. He pledges to keep in mind the individual, “inviolate” relationship between doctor and patient even when thinking systemically about big picture solutions. And he asserts that the state is the right agent to invest in preventive health because of the distant time horizon for a payoff. This means taking the long view on public health threats like childhood obesity, smoking, and Hepatitis C.
Charlie Baker’s experience as CEO of Harvard Pilgrim Health Care and as a senior official in the Weld and Celluci administrations is highly pragmatic. He pledges to create a culture of accountability by setting a high bar, recruiting top people, and measuring their performance. “One of the things I bring is a tremendous appreciation about how important it is to follow through and execute your plans.” He also wants to bring a “maniacal” approach to service delivery on behalf of the people, which will translate into a great experience for everyone doing business with the government.
Unlike some of the other candidates, Martha Coakley does not have a career in healthcare to fall back on when answering my wonky queries. But she points to her eight years as Attorney General and the various learning curves she’s traveled down including in healthcare. She’s learned to appreciate the bipartisan agreement on assuring universal insurance coverage and wants to leverage that consensus in order to cut costs, provide better prevention and address underlying cost drivers such as the prevalence of diabetes and asthma. She suggests that her experience working closely on healthcare issues as AG will translate into rapid progress as Governor and enable Massachusetts to act as a national leader on health reform.
Evan Falchuk was president of Best Doctors, a company that focuses on helping patients get the correct diagnosis. Once a disease is diagnosed properly the patient can get the right treatment. But with wrong diagnosis comes incorrect treatment, extra costs and poor results. Evan applies the analogy of diagnosis and treatment to the public realm. “It’s easy to treat the symptoms rather than the disease and to miss the underlying causes in an effort to take quick action.” He’s learned how hard it is to make complex decisions. “You have to be able to confront reality. You have to take action that is decisive and that reflects the best understanding of what will address the problem you’ve identified.”
Mark Fisher, a Tea Party Member running as a Republican, displays an interesting mix of libertarianism, paternalism and suspicion of big business. His main exposure to healthcare comes as owner of a small business providing health insurance benefits for employees. Health plans refused to provide coverage because he paid 100 percent of his employees’ out-of-pocket costs, thereby neutralizing the intended impact of member cost sharing and potentially driving up costs. “What I learned is that [health plans] are more concerned about making big profits than they are about providing care for those who are paying the premiums.” He intends to bring a “healthy dose of common sense” and skepticism of big healthcare players to Beacon Hill.
Steve Grossman says he’s learned from his private sector and government career (he’s State Treasurer) that job creation is about investing wisely and creating proper incentives. He cites his experience running a unionized shop that offered earned sick time for more than 25 years. “People who believe that you are willing to invest in them are going to invest in you.” He pledges to “level the playing field” to make sure no one in Massachusetts is left behind on access to quality healthcare even as we grapple with cost containment.
Jeff McCormick has 25 years of experience financing growth companies, including several in healthcare and biotech. He studied biology and molecular genetics in school and so is well versed in the fundamentals of health and medicine. He’s learned the value of a relentless focus on lowering costs and improving outcomes and plans to apply that philosophy to his work on healthcare and other issues as Governor. He vows to bring “a new set of eyes to identify these problems and solutions and not do more of the same old, same old.”
Juliette Kayyem has a background in homeland security in both the federal and state government. She looks at healthcare through the lens of harm reduction and public health preparedness. “Homeland Security… is really about buttressing preparedness through various systems that protect people.” As a result she says she wants to focus on public health and community health centers, and to strengthen relationships between elite hospitals and health centers.
Over the coming days I’ll be comparing the candidates’ answers on other key questions.
—-March 18, 2014