Health care

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In an election defined by a dour economy, Massachusetts voters face a stark choice in the race for governor, with the four candidates advocating widely divergent strategies for creating jobs, cutting runaway health care costs and changing the way state produces energy.

In recent interviews with the Globe, Republican Charles Baker and Democratic incumbent Deval Patrick challenged each other's positions on taxes, business regulations and the Cape Wind project; Independent Timothy Cahill proposed a plan to waive taxes on Massachusetts start-ups; And Green Rainbow candidate Jill Stein advocated a single-payer health care system and called for a loan fund to support green businesses.

Watch video at the right for extended responses from each candidate on how they would tackle the issue of health care if they were elected governor, and read their abbreviated responses below.

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Republican hopeful in the race for the U.S. Senate, Mass. State Rep. Scott Brown, R-Wrentham, faces reporters moments after a debate recorded for broadcast on the show Greater Boston at the WGBH television studios in Boston, Monday, Dec. 7, 2009. Brown debated businessman Jack E. Robinson on the show. The two are the only Republicans vying for the U.S. Senate seat left vacant by the death of Sen. Edward M. Kennedy, D-Mass. (AP Photo/Steven Senne)


Governor
Deval
Patrick (D)

Republican hopeful in the race for the U.S. Senate, Mass. State Rep. Scott Brown, R-Wrentham, faces reporters moments after a debate recorded for broadcast on the show Greater Boston at the WGBH television studios in Boston, Monday, Dec. 7, 2009. Brown debated businessman Jack E. Robinson on the show. The two are the only Republicans vying for the U.S. Senate seat left vacant by the death of Sen. Edward M. Kennedy, D-Mass. (AP Photo/Steven Senne)

Charles
Baker (R)

Republican hopeful in the race for the U.S. Senate, Mass. State Rep. Scott Brown, R-Wrentham, faces reporters moments after a debate recorded for broadcast on the show Greater Boston at the WGBH television studios in Boston, Monday, Dec. 7, 2009. Brown debated businessman Jack E. Robinson on the show. The two are the only Republicans vying for the U.S. Senate seat left vacant by the death of Sen. Edward M. Kennedy, D-Mass. (AP Photo/Steven Senne)

Tim
Cahill (I)

Republican hopeful in the race for the U.S. Senate, Mass. State Rep. Scott Brown, R-Wrentham, faces reporters moments after a debate recorded for broadcast on the show Greater Boston at the WGBH television studios in Boston, Monday, Dec. 7, 2009. Brown debated businessman Jack E. Robinson on the show. The two are the only Republicans vying for the U.S. Senate seat left vacant by the death of Sen. Edward M. Kennedy, D-Mass. (AP Photo/Steven Senne)

Jill
Stein (G-R)

The health care reform that was enacted before I took office, and took effect the day I took office, has been a very solid success. Ninety-eight percent of our residents have health insurance today; No other state can touch that. Costs are an issue and they're an issue all across the country. What we're going to have to do is deal with the differences in reimbursement rates, deal with the differences in charges and so forth. I don't think the ultimate solution is going to be to regulate those, but I do think that to the extent that Medicare is a benchmark for a lot of the costs in the system, the federal government is going to have to be a part of this reform as well.
We need to have full and total public disclosure and transparency around what everybody gets paid and who pays what. It's very hard to create any kind of platform for reform -- and changing the way insurance plans are designed, the way services are paid for, the way networks are developed -- unless you have an open book on price and performance, which we currently don't have. This can't get solved through people fighting this over is some back room. Once you have disclosure, you can start designing network products and plans that encourage people to understand what their choices and options are, and then you can start to give them incentives to use high-value providers.
Start with competition. Open up the process so that people in Massachusetts can buy out of state, so you'd open competition much like we did with car insurance, where now you can get policies from other providers, not just in-state providers. You'd also have to lessen the mandates that a qualified plan would have and give people options. If people choose to use a community hospital versus a Boston teaching hospital, let them pocket some of those savings so there's an incentive for them to get their costs down. Let small businesses aggregate and leverage their size the way big business does, and bring real medical malpractice insurance reform onto the table. I would propose we create health administrative courts so they can adjudicate some of these issues. Doctors are leaving the state or choosing not to practice certain important specialties because of medical malpractice insurance.
We need to move to a single-payer system. We can reduce the overhead from 12 percent down to 3 percent, which is what Medicare pays. So there's a huge payoff. If you applied that to a $14 billion health care budget, a 10 percent savings is absolutely staggering and goes a long way to provide money for all kinds of things. In a single-payer system, we know that you gain so much money from cutting the red tape and bureaucracy that you can expand care. That's a key part of getting to an affordable and accessible health care system that covers everybody, where the burden no longer falls on small businesses and families. We're paying a shell game right now of basically handing costs back to consumers.