Points of view: Healthcare The Boston Globe
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Points of view: Healthcare

The Globe asked the three Democratic candidates for governor questions about healthcare.		 Christopher K. Gabrieli Deval L. Patrick Thomas F. Reilly
Q. The state's groundbreaking health insurance law, which requires all residents to have coverage by July 2007, requires many employers that don't provide insurance to contribute $295 per employee to a state fund. Do you think employers should contribute more or less than currently proposed? What other changes would you push for in the new law? First and foremost I am worried about the cost of the plans, and whether or not people will be able to afford them. Secondly, I am concerned that we may not have struck the appropriate balance among individuals, employers, and the government. Finally, I am worried that a fl at $295 assessment regardless of the size of the employer may not provide enough money to cover the state's liability. With the average cost of individual health insurance at approximately $4,000, I am worried that the numbers don't add up. There is much work to do to implement this legislation creatively, particularly efforts to control and contain costs. I prefer to live with the agreed $295 at the outset and see if we can make that work. Meanwhile, I am focused on making our system more cost efficient. Massachusetts currently spends 30 cents on every dollar administering the system we have. If we capture those inefficiencies, I believe we can afford the quality and accessibility of care we need and want. The next Governor should strive to make the new healthcare reform law succeed with the current $295 business assessment. I have no intention of increasing that assessment. Too often in Massachusetts, the first instinct of our political leaders is to raise taxes and fees. I believe we need to try to make this law work as is. That is why we need a governor with real healthcare experience and vision. Applying my experience in healthcare, I will work to achieve the law's goal of near-universal coverage in a way that protects consumers and our economic competitiveness.
Q. State regulators are debating how much to charge lower-income uninsured residents for health insurance under the new law. How much do you think adults between 100 and 300 percent of the federal poverty level should pay each month toward premiums? And if the state runs out of money for subsidies for this group, should it cap the number of people provided subsidized coverage, or would you seek additional money from the Legislature? In order to move people from the free care pool to being insured, they have to be able pay their bill every month. I am hopeful that the board is doing their best to keep plans affordable and consulting with experts to decide on what is an appropriate contribution. I recognize that they have to strike a delicate balance between making insurance affordable and being able to cover as many people as possible. In terms of funding, I believe we have to do more to be sure that employers pay their fair share, to take more of the burden off the state. The current recommendations are between 1 to 4.5% of an individual's monthly income and between 1.5 to 6.6% of a family's. This is a reasonable place to start. Preventive services such as immunizations, cancer screenings, and prenatal care should not require copayments. Copayments for other services and medications should be capped on a sliding scale. I would not cap the number of people who can enroll in the insurance program. We will end up paying for their healthcare any way – in far more expensive emergency rooms and hospitals. The uninsured should certainly make a fair and reasonable contribution to their health insurance costs. But charging them more than they can actually afford will defeat the purposes of the new health reform law and endanger the economic security of families living on the margin. The recommendations from a subcommittee of the Commonwealth Health Insurance Connector are a good start, providing a framework for further discussion. The key to offering high-quality care at a price we all can afford is to reduce the cost of healthcare – through technology, transparency, and prevention.
Q. Consumers and employers are struggling to pay rising medical costs, including soaring health insurance premiums. Many potential solutions being tested, including giving consumers more information about the cost and quality of providers, are unproven. What would you do to help control the cost of healthcare? Is there evidence your solutions work? First, we can invest in preventative care, which has the potential to save lives and financial resources. Second, the state must encourage hospitals to set high goals for reducing medical errors, which cost the healthcare system millions of dollars. Third, our healthcare system should be moving toward better healthcare information technology, which will save time, reduce errors, and streamline the administrative process. Finally, we will save money when more people have health insurance, because hospitals and clinics will not pass on the cost of care for the uninsured on to people who pay for health insurance. My administration will pursue every available strategy, including: expanding primary care, so that care is delivered in less costly settings than in emergency rooms; putting in place a uniform system of billing codes and forms to reduce the administrative paperwork; modernizing patient record systems by allowing for medical records to be managed and maintained on a secure, confidential electronic system accessible to and controlled by patients; restoring our public health infrastructure so that we place a renewed emphasis on wellness; and, reducing the cost of prescription drugs through negotiated bulk purchases and the development of new channels of supply. To sustain coverage expansion and make care affordable for all, we must rein in healthcare costs. We should expand the use of electronic medical records to reduce paperwork and duplicative care and improve safety. We should promote greater transparency — including posting pricing information for prescription drugs, medical procedures, and claims information on the Internet to help consumers compare and save. We should provide coordinated care to reduce emergency room visits by those with chronic conditions. And we should encourage healthier lifestyles.
Q. In recent years, the state has cut public health programs, such as substance abuse and smoking cessation programs. What are your top three priorities for adding new public health services or expanding existing ones? My top three public health priorities include, expanding school-based health services, preventing childhood obesity and obesity-related diseases, and substance abuse and smoking cessation programs. School nurses are often our first line of prevention for childhood diseases. I am committed to expanding after-school programs and extending learning time. This way, children will have sufficient time during their school day for enrichment activities, including physical activity. Finally, I will support substance abuse programs and smoking cessation programs. Wellness and prevention should be cornerstones of our healthcare system and of the Department of Public Health. They are also cornerstones of any sensible strategy for long-term cost control. Therefore, when I am governor I will lead Massachusetts back to having one of the strongest public health departments in the nation. Specifically, I will emphasize public education on and treatment for substance abuse, HIV/AIDS and prenatal and children's health, including immunization and nutrition programs. Under the Romney/Healey administration, Massachusetts has dropped from the top five healthiest states — a trend we must reverse. I have called for setting bold goals for improving children's health, with specific policies to encourage healthier eating and more exercise among young people, protect kids from tobacco, and ensure comprehensive primary care for children. We must also be prepared for public health emergencies, from bioterrorism to avian flu to natural disasters. And we must make reducing medical errors an even higher public health priority.
Q. Do you favor legalizing the purchase of hypodermic needles to curb the spread of disease among addicts? Yes, I support this effort and others that seek to prevent the spread of diseases like HIV and hepatitis C. This has proven effective in many other states, and Massachusetts should follow suit. Yes. In my mind this is a public health issue and will help stop the spread of diseases including HIV and hepatitis C. Similar laws in other states have shown that programs such as these decrease the rates of disease infection without increasing drug use. I am pleased that Massachusetts recently enacted legislation to join 47 other states that allow over-the-counter sales of hypodermic needles. This will improve public health by helping to prevent the spread of (certain) diseases and reduce healthcare costs. As governor, I will treat public health as a priority to improve the health of our citizens, eliminate racial and ethnic disparities, and reduce healthcare costs.
Q. When was the last time you or a family member was a hospital patient? If you were chief executive of a hospital, how would you have improved the experience for you or your family member? As the father of five young, energetic children, trips to hospitals and even the emergency room are an all-too-frequent occurrence. I believe our hospitals and healthcare centers are the envy of the world, and the staff do an amazing job of providing comfort and caring at important moments in the lives of their patients. What I would change is cost. Healthcare costs are out of control, and the problem is systemic, not narrowly the issue of any individual facility. My mother died last year after suffering from both uterine cancer and hepatitis. Her primary care physician told her she needed to see two or three specialists on an urgent basis. Three weeks later she got the appointments. When we arrived, it was a minor miracle that her patient records showed up when she did, but the doctor still had not had a chance to review them in advance. The point is that you can see the inefficiencies and duplication in the system, where the administrative expense goes. I understand the difference that quality healthcare can make. I had knee replacement surgery on both knees after years of activity and exercise. I benefited not just from extraordinary surgical skills but also high-quality care every step of the way. Many residents of Massachusetts have had similar experiences with their healthcare, but others have lacked access to high-quality, affordable care. As governor, my goal will be to ensure that everyone has affordable access to high-quality healthcare.