Healthcare czar faces his big test

Leading the second public meeting of the state's new healthcare reform authority recently, Jon M. Kingsdale looked unusually happy for a man who had just taken a $150,000-a-year pay cut.

As he cheerfully guided his board of directors through a series of slides about setting rules for new Medicaid insurance plans that will go on sale this fall, Kingsdale somehow kept the hour long discussion from turning tedious.

``I'd like to stress this is all about balancing," he told the board in his distinctive, reedy tones, occasionally stepping to an easel to draw a quick diagram.

The newly appointed executive director of the Commonwealth Health Insurance Connector Authority suddenly is one of the most important people in Massachusetts healthcare. The connector is the key government body in the state's ambitious plan to extend health insurance to the 460,000 residents who do not now have coverage. The authority will set standards for new low-cost and subsidized health insurance plans, operate a market for companies and individuals to buy coverage, and create incentives to control costs.

The connector was created by the landmark healthcare law signed by Governor Mitt Romney in April. Before his appointment May 25, the 57-year-old Kingsdale was little known outside of Boston's medical-industrial complex. He worked for nearly 20 years at Tufts Health Plan, largely in behind-the-scenes roles. He designed insurance products, led strategic planning, and organized lobbying efforts -- tasks that seemed to suit his neat, low-key attire and owlish looks.

But he's well known at the hospitals, health insurers, and government agencies he will now be working with, and they give him high praise.

``Jon has spent more time thinking about health insurance product design than almost anybody else," said Jeff Levin-Scherz , a former Tufts official who is now chief medical officer at Partners Healthcare Systems, the parent of Massachusetts General Hospital and other major Boston hospitals. ``This is a really hard job he's taken on. The state is awfully lucky to find somebody of his caliber. It's a big sacrifice for him."

Kingsdale has a three-year-contract to run the connector at $225,000 a year, far less than the roughly $375,000 salary he earned as a senior vice president at Tufts until just a few weeks ago.

The Newton native's interest in healthcare started soon after he earned a degree in history from the University of Pennsylvania. As a reporter for the business magazine Forbes, he covered healthcare. In a 1976 article, he wrote about for-profit hospitals, which were just beginning to gain market share, and argued against congressional adoption of national health insurance, which could have killed the for-profit hospital movement.

``The for-profits may not have the magic formula for slashing hospital costs," Kingsdale wrote, ``but they seem to deserve a better fate than death by legislative fiat."

After earning a doctorate in economic history from the University of Michigan in Ann Arbor, he taught hospital accounting and cost trends at the Harvard School of Public Health before joining Blue Cross of Massachusetts, which has since become the state's dominant health insurer. He paved the way to his next job with equal measures of audacity and self-confidence.

Dr. Harris Berman , then first chief executive of Tufts Health Plan, recalled receiving a phone call from Kingsdale in 1986. ``He said to me, `You need a planner and I'm the right guy for the job.' He was right," Berman said.

On his resume, Kingsdale describes himself as a ``big picture, strategic thinker with a passion for innovation." To colleagues at Tufts, he used to say, ``I specialize in where the rubber meets the sky."

Kingsdale also has a pragmatic streak, pushing for what will work in the real world. Berman was convinced of that years ago. Tufts had expanded into Rhode Island, New Hampshire, and Maine, and even though it was wasn't going well, most Tufts employees were ``plugging along, thinking things would eventually get better," Berman said.

``He came into my office and said, `Why are you staying there? Get out of there.' He was the guy who could walk into my office and say the emperor has no clothes."

Tufts pulled the plug on its New England expansion in 1999 after posting a one-year loss of $45 million from the out-of-state operations.

Kingsdale left Tufts in June 2005 to do consulting work after then-chief executive Nancy Leaming decided there was less need for strategic planning. Three months later, Leaming was ousted and general counsel James Roosevelt Jr. became chief executive. Kingsdale was his first hire.

``I felt he had a unique set of skills and perspective on how people can pay for healthcare," said Roosevelt.

As he had done all along, Kingsdale challenged his new boss. ``The one thing I most remember him saying is, `That doesn't make any sense,' " Roosevelt said. ``You have to be ready to engage in that intellectual contest with him."

Kingsdale was committed to Tufts, despite its troubles. In early 2000, the Massachusetts Hospital Association released a report questioning Tufts' financial health. Kingsdale was soon on the phone with Andrew Dreyfus , a hospital association vice president who is now senior vice president at Blue Cross and Blue Shield of Massachusetts.

``Jon was angry," Dreyfus recalled, ``and he expressed his concern in pretty strong language. There was no profanity, but I was struck by the intensity."

Julie Rosen , who handled public relations for Tufts for many years, said Kingsdale could call at any time to talk strategy.

``I remember standing in a checkout line in the Shaw's supermarket over the turnpike in Newton, with my three kids in tow, when Jon called me on my cell phone," said Rosen. ``He wanted to go over some PR strategies on how to position the organization. I told him I was in the middle of a grocery store. He said, `I want to talk about this now.' "

But it's that same intensity that has some healthcare officials worried. Tom Lee , head of the physicians' network at Partners and a close friend of Kingsdale, said, ``It's one thing to be prickly on behalf of one HMO," Lee said. ``It's another thing to be prickly and scrappy and relentless in pushing for a cause like universal access to healthcare."

A lot is changing among some entrenched, powerful businesses. Insurers who earned generous profits in stable markets are going to see the rules change. Enormous sums of money that went to provide free care will be redistributed. Insurers and hospitals are going to have to provide care for new groups of people.

Massachusetts' healthcare overhaul may not become a model for other states because of some circumstances unique to the state. Nonetheless, the effort will be closely watched by healthcare officials nationwide, and Romney could point to the new law as an achievement if he runs for president.

For Kingsdale, there's the risk of failure, and a high likelihood that others will take credit if healthcare reform succeeds. Either way, bitter battles between interested parties are inevitable. So why would anybody want the job?

``I became fascinated by this issue in Washington, D.C., in the 1970s," Kingsdale said. ``How do you make this really good stuff -- healthcare -- affordable and accessible? Running the connector is a great opportunity to take that problem on a statewide stage. I really feel like I've been training for this job for 30 years."

Jeffrey Krasner can be reached at krasner@globe.com.