In this podcast interview, Steve Grossman, State Treasurer and Democratic candidate for Governor of Massachusetts discusses his views on healthcare with healthcare business consultant David E. Williams, president of the Health Business Group. This is the eighth 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 a solid approach to curb the rising cost of healthcare. By limiting the growth of healthcare cost to the growth of the state economy, it gives a very achievable target”
“It’s going to take several years to really assess how effective it is, and how effective the various ingredients contained in it are at achieving the desired for results.”
“I would like some thought given to how we can reduce the cost of prescription drugs. As I look at the community health centers and see the pharmacies contained in the community health centers, it’s clear that they have been successful at using the authority they have legally to reduce the cost of prescription drugs.”
“One of the weaknesses of the Affordable Care Act is the failure to include the multiplicity rating factors that Massachusetts was using to help reduce the cost of healthcare for small businesses.”
“I have made it clear that single payer should be on the table and should be examined very, very carefully”
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?
“It has a role to play. One of the roles is to drive transparency as a very, very important ingredient, to the extent that the consumer, the customer, knows of the differences in reimbursement rates for various and sundry procedures.”
“The state has a responsibility to make sure that people are aware of the differences in cost. By trying to balance quality and cost, you can demonstrate to the consumer that they are just as well-off, if not better, going to a local medical institution for care they may have sought from a higher-cost provider over a period of time.”
“As a fundamental principle we need to consistently articulate that equity and fairness in payments that protect both teaching hospitals and community hospitals, is something we care about.”
Question 3: More than a dozen state agencies have a role in health care. Is there an opportunity to consolidate or rationalize them?
“The answer, in principle, is unquestionably yes. In other parts of state government I’ve seen a number of issues that are being dealt with by a multiplicity of state agencies. Oftentimes, we are harmed by a silo approach to problem-solving: different agencies maintaining their role, holding on to their role fiercely when more collegiality and collaboration would be an entirely appropriate approach.”
“If you want to utilize taxpayers’ funds wisely, you’ve got to think about how we can be fast, flexible and entrepreneurial in terms of the way we solve problems.”
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?
“Unquestionably, yes. State government should play a role and is playing a role.”
“Presumably, a portion of the investment that we’re making with struggling community hospitals will give those community hospitals the tools they need to be 21st century institutions dealing with health information technology.”
“The fact is that the cost of implementing health information technology can drive smaller medical institutions into the arms of the larger ones. They simply can’t afford the health information technology that they must purchase or acquire in order to be competitive.”
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?
“I don’t think a caring society can afford in any way, shape, or form not to play a significant role.”
“State budgets have been cut in almost every area over the past five years. State funding for HIV/AIDS, and viral hepatitis have been cut dramatically, by nearly 40% over the past 10 to 15 years. It’s hurting us. We have to find a way to make additional investments in the health of our citizens, because we will get a return on investment in the long term, and because it’s the right thing to do.”
Question 6: There are multiple health care related ballot questions. What are your thoughts about them?
On compensation for hospital executives:
“I’m an opponent of extravagant compensation. I would join most citizens of Massachusetts in opposing that.”
“Institutions that deliver healthcare are using taxpayer dollars in a very significant way, whether it’s state dollars or federal dollars, so it is a valid initiative.”
“By requiring hospitals to be far more transparent, it will require them to limit compensation and claw back excess profits, to make sure that taxpayer dollars are used to provide safe patient care and necessary services.”
“That’s a ballot question that I have no doubt will pass and represents good common sense.”
On nurse staffing ratios:
“We’ve got to carefully consider whether rigid ratios are practical at a time when we’re in a period of great transition.”
“Knowing that roughly one in every six jobs in Massachusetts is directly or indirectly related to healthcare, the question is whether we can afford tight and rigid ratios at a time when these institutions need to maintain their financial balance and economic health and well-being.”
Question 7: What have you learned in your business and government career that will be useful as Governor?
“To the best of my knowledge, I’m the only Democrat running for Governor who has spent a lifetime creating jobs in the private sector. I have a track record, a long track record of 35 years. I took that successful track record into the Treasurer’s Office.”
“I understood that small businesses, which are the backbone of our economy, needed help. Help meant access to capital, and access to capital meant a small business banking partnership that’s poured over $350 million into business loans all over the state.”
“What I have learned in business and in my government career as State Treasurer is that job creation, while complicated, is about investing wisely and about creating incentives that will make it easier for businesses – including businesses that are owned by women, people of color, immigrants and veterans – to flourish.”
“People who believe that you are willing to invest in them are going to invest in you. It’s a win-win partnership that I’ve created in my own business, that I’ve created at Treasury, and that will be useful as Governor.”
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?
“Let me focus on the issue of emotional health and well-being of our kids. Massachusetts is a national leader in screening children for behavioral health issues. Now, whether the children are getting the care they need once they’ve been screened, that’s another question, and it’s worthy of a lot of time, effort, and attention.”
“Without diagnosis, you don’t get treatment. Making sure that we actually deliver the treatment is a critical ingredient here. That is one of the things that we should focus on. If they don’t catch issues early, they become crises. They become more difficult to manage. They result in more heavy-duty medications that children may not really need. Once the federal judge mandated that we had failed to provide early diagnosis and treatment for poor children of mental illness, our aggressiveness [in Massachusetts] moved us significantly forward.”
“I take a holistic approach to children’s health. It’s about their physical health, their mental health, and it’s about their education. I’m a big believer in universal pre-K, and all four year-olds having an opportunity to learn to read by the time they are in the third grade.”
“The instability of the family unit – substance abuse being a factor in so many families – hurts the health of children.”
“As more resources are invested in research, and more resources are spent –not just financial resources but human resources– in understanding how to deal with children on the autism spectrum, we will have a really positive impact on those children who are on that spectrum.”
Question 9: Is there anything you’d like to add?
“Rather than only focusing on income and economic disparity, we should talk in the same conversation about healthcare disparities.”
“We’ve done an extraordinary job at covering a vast majority of people in Massachusetts, particularly children. As we grapple with wrapping our arms around healthcare cost and cost containment, we need to make sure that those communities and those citizens who live in older industrial cities – neighborhoods in Boston even and also rural areas – have a level playing field. Leveling the playing field and leaving no one behind in terms of healthcare access and quality is a hugely important issue.”
—-March 11, 2014