In this podcast interview, Juliette Kayyem, Democratic candidate for Governor of Massachusetts discusses her views on healthcare with healthcare business consultant David E. Williams, president of the Health Business Group. This is the last in a series of nine in-depth interviews with the candidates. For a complete schedule and an explanation of the questions visit the intro post.
Excerpts from the interview are below. The full transcript is available here.
Question 1: Does Chapter 224 represent the right approach to addressing rising health care costs? If not, where does it miss the mark and what would you do differently?
“It’s absolutely the right approach in terms of Massachusetts being the first state to try to crack the nut of rising healthcare costs.”
“While it is a great start, there’s no way we can think that we’re done with the challenge of healthcare, both in terms of the burden that places on our state budget, but also in terms of looking at other ways to relieve a healthcare system that’s under stress.”
Question 2: Certain provider systems in Massachusetts are reimbursed significantly more than others for the same services even though there are virtually no differences in quality. Does the state have a part to play in addressing these disparities?
“There’s more that the state can do. But we need to realize that it’s a competitive field and that there are going to be limitations to what the market can correct. Transparency is good, and litigating or having causes of action against abuses is good. Then let the market begin to drive some better behavior, which I do believe it will.”
Question 3: More than a dozen state agencies have a role in health care. Is there an opportunity to consolidate or rationalize them?
“There is no question that rationalizing and consolidating them is important.”
“We need to work through all those different layers to ensure that agencies are working together. What we need to do, what the new Governor needs to do is to ask, can the delivery of service become more efficient?”
Question 4: Government policy has encouraged 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?
“Medical data is the most private and therefore must be the most secure. It’s understandable that medical records have taken some time to catch up. The state can do a lot to encourage hospitals to adopt and invent new storage protocols and transfer protocols while protecting privacy.”
“This is eminently doable with state government, both providing the best practices, the R&D, and the support for private and public hospitals to do this. In the next couple of years this will begin to come to fruition.”
Question 5: Hepatitis C is 3 or 4 times more common than HIV. New drugs that can cure the infection are coming on the market this year but they are very expensive. What role should the state play in ensuring that residents are tested, linked to care, and have access to these new medications?
“We can make things, we can buy them in bulk, we can get them down to the right hospitals or community health centers, but can we actually get them to individuals? I’m committed to finding ways in which we can do what we call that ‘last mile,’ which is most important.”
“Most importantly, we need to look at prevention of Hepatitis C. That’s only going to occur with strong public health education programs, and strong commitment to community health centers and other public education providers that are out in communities helping people live healthier lives.”
Question 6: There are multiple health care related ballot questions. What are your thoughts about them?
“I prefer ballot initiatives going through the legislature. Ballot initiatives don’t allow for the kind of negotiations that are often required for proper implementation.”
“I would support both the fixed nurse-patient staffing ratio and the hospital financial question. If the citizens of the state passed them, I’m not going to oppose them. On the other hand, I would also like to work with the nurses’ union, with hospitals and others to get the legislation that is necessary to ensure that nurses have adequate staffing levels, and whatever other legislation might be appropriate for this space.”
Question 7: In your campaign platform, you talked about reducing health disparities in the Baystate’s underprivileged communities. Are there specific steps you have in mind to achieve this?
“I want to do more in terms of supporting our community health centers, not just empowering them, but actually helping to grow the partnerships between them and hospitals. This will allow hospitals to adapt policies to properly accommodate changing populations in the state, such as the impoverished.”
“I want an ecosystem of the delivery of services that go from the most elite hospitals in the state, which we are incredibly grateful for having, to the community health centers, which are really at the forefront of the delivery of services to our underprovided communities.”
Question 8: Much of the emphasis in health care reform is on adult patients. Is there a need for a specific focus on children’s health?
“It’s about public education. People have to understand that the health and livelihood of our children is dependent on responsible behavior of other parents about their children.”
“If you think of the burden on our healthcare system, a lot of that can be relieved by focusing on our children, and then being healthier in the future.”
“I am into risk reduction. That is what Homeland Security is about. One of the risks that I see coming down our way is the challenge of climate change and how that’s going to impact our children’s health.”
Question 9: Is there anything you’d like to add?
“Campaigns have a tendency to make us have a healthcare policy, and an education policy, and then an employment and a criminal justice policy. Part of what I bring to this race, in conflicts and crisis management in both state and federal government, is a capacity to think about solving the problems of our time in a way that is very holistic.”
“We should begin to view healthcare not as a separate issue reserved for the professionals in the health businesses and the healthcare providers, but one that is intimately tied to educating our children, the delivery of health services through our infrastructure, and that is tied to our economy and economic growth.”
—-March 13, 2014