Making healthcare reform work

CONGRATULATIONS, Governor-elect Deval Patrick. You defied conventional wisdom and won a hotly contested race your first time up on a statewide ballot. That is an amazing feat, but the hard part is just getting started. And healthcare will be one of your primary tests.

You would be wise to take the long view. Healthcare, especially the politics of healthcare, can often become a pitched battle of ideas, ideologies, and rhetoric. There will be hundreds of debates about the issue over the next four years, and if you and your team aren't careful, you could wake up four years from now and have little to show for your efforts. So, it is important for you, as you begin your tenure, to determine where you'd like to be on some key healthcare issues by 2010.

The short list should include policy initiatives that enhance affordability, improve quality, and increase coverage. This means, above all, implementing the recently enacted healthcare reform law. While Mitt Romney signed it, the task of making it real will fall to you and your team. Seeing it through will take a delicate balance of pragmatism, political diplomacy, and dil igence.

For example, virtually every decision made by the Connector Board, the independent state agency charged with implementing much of the new law, will be debated and discussed at length: The Connector Board's moving too slowly, it's not moving fast enough, it's charging too much, it's not transparent enough, it's too disruptive, it's not disruptive enough -- you get the idea.

To influence Connector Board policy on some details, many groups will try to persuade you with their own interpretations of what the Legislature intended. In some cases, though, the Legislature's only intent was to leave certain tough choices to the next administration. You'll need to make those choices.

The Connector Board is chaired by the secretary of administration and finance and includes the commissioner of insurance, the Medicaid director, and the executive director of the Group Insurance Commission (which purchases health insurance for state employees and retirees). You should fill these positions with people who share your expectations for healthcare and determine, with them, how your administration will define success. The Connector Board staff has demonstrated the knowledge, diligence, and persistence to make health reform work, needs a board and an administration that never lose sight of the ultimate goal.

That goal? Let's start with insuring some significant portion of the uninsured by 2010. Current estimates suggest that there are about 500,000 uninsured residents in Massachusetts. If there are 100,000 uninsured individuals in Massachusetts four years from now, you and your team should be able to claim significant success.

Making care more affordable will be tougher. But you need to understand that the increase in health care costs has a direct, negative impact on the ability of everyone, including the Connector Board, to pay for coverage. Therefore, every debate on healthcare issues must seriously consider whether a particular policy call makes costs rise, fall, or stay the same. And if a given proposal would make healthcare more expensive, there better be major public benefits to go ahead and do it anyway.

To have that debate, we need better information than we have now. Fortunately, you can charge your secretary of health and human services, who will chair the new Health Care Quality and Cost Council, with the responsibility for promoting transparency. Today, we all complain about high costs and uneven quality, but we rely on a mishmash of anecdotes and self-interested observations about why. But the council has the authority to lay out, in understandable terms, exactly why our high costs are climbing and where the quality of care is uneven.

Finally, there will be many other other healthcare issues that will arise over the next four years -- such as whether cities and towns should be able to purchase their health insurance coverage through the Group Insurance Commission, to pick just one. But in the end, you will be judged on whether you make the most of the new Health Care Reform Law. We all hope that you succeed.

Charles D. Baker is president and CEO of Harvard Pilgrim Health Care.