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Charlie Baker Speaks on Health Care (I)

Posted by John McDonough  February 26, 2014 08:15 PM

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Last Monday, Massachusetts Republican gubernatorial candidate Charlie Baker spoke at a forum at the Boston College Graduate School of Social Work about health policy matters in Massachusetts. This is good! Yeah for Charlie!

Two issues stuck out and I'll address them in sequential posts: first, Partners Healthcare's charlie baker.jpgproposed acquisition of South Shore Hospital; and second, Massachusetts waiving out of the Affordable Care Act. First, let's consider the Partners matter which I discussed in this recent post.

As reported by State House News Service and reprinted in Commonwealth Magazine, Charlie refused to disclose if he has a position on the Massachusetts Health Policy Commission's (HPC) recommendation that the acquisition be stopped from happening. "Asked specifically about Partners and South Shore Hospital, Baker repeatedly talked about the need for transparency." This has been Charlie's reflexive posture for years now: whenever asked a question he doesn't want to answer, up comes "transparency." Good for thee and not for me, or something like that.

"'I've been saying for about 10 years now that I think there's nowhere near enough transparency in the health care business. I do believe price and performance matters and it should be publicly available information and I think in a world in which there was complete transparency around what people were getting paid and how they were performing some of the issues around consolidation would become less important,' Baker said."

Question for Charlie: have you read the HPC's 123-page report on the proposed acquisition? It's probably the most exhaustive and "transparent" dissection of a proposal of this sort ever. So what more information do you need to make a decision, Charlie?

This is not a trivial matter. After years of trying, the Massachusetts Legislature and Governor Patrick established the HPC to get tough on health care spending. The really tough decisions and challenges will come under the next Administration starting in 2015, and the next Governor will name his/her own appointees to the Commission Board and set the direction. Will the next Governor be tough on costs and support the HPC, or will he/she blink under health industry pressure? Partners-South Shore is the first test -- for all of us.

This applies to all the candidates for governor -- no hiding on this one. I'm picking on Charlie now because he just ducked the issue in public.

But there's more.  Baker:

"I think the consolidation that has taken place is mostly being driven, to some extent, by the federal reforms which are creating all kinds of issues for smaller players with respect to being able to figure out what the rules of the game are and how they fit."

In other words, it's all the ACA's fault. If it weren't for that darn 2010 law, none of this acquisition stuff would be happening.

That didn't sound right to me, so I went checking.

Happily, the Massachusetts Hospital Association's website let's us examine Charlie's hypothesis with real facts. Here are the key stats:

Massachusetts Hospital Closures and Conversions:
1980s: 23
1990s: 30
2000s: 6

Massachusetts Hospital Mergers:
1980s: 2
1990s: 21
2000s: 1

Massachusetts Hospital Acquisitions:
1980s: 3
1990s: 28
2000s: 18 (12 of these were from Steward's acquisition of Caritas Christi)

All Categories:
1980s: 28
1990s: 79
2000s: 25

"... driven, to some extent, by the federal reforms..."

Actually, according to the data, the hyperactive period of closures, conversations, mergers, and acquisitions hasn't happened since March 23, 2010 (the date of the ACA's signing), it happened in the 1990s. Whatever could that have been about?

Hmmm, if my memory serves me, in 1991, when Charlie Baker was Undersecretary of Health & Human Services in the new Administration of Republican Gov. William Weld, he led the Governor's agenda to deregulate the state's healthcare industry in general, and the state's hospital financing system in particular. In the unforgettable words of former Framingham State Senator Ed Burke:

"Let's put all the scorpions in a bottle and see who comes out alive."

Were it not for the merger mania set off by the unpredictable dynamic of deregulation, the merger of Mass. General Hospital and Brigham & Women's Hospital into Partners Healthcare never would have happened.

And, by the way, it was Health & Human Services Secretary Charlie Baker who, in 1994, signed off on the Weld Administration's approval on the MGH-B&W merger into Partners Healthcare.

So Charlie, please don't use the Affordable Care Act as a scapegoat to avoid taking a stand on the Partners-South Shore acquisition. It's not ... becoming. And too many of us in this state have long memories.

More to come.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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