Massachusetts is going to need a Governor who understands how good care could be, what better payment systems look like, and how to reorganize care with patients at the center. That has been my work for 30 years, and I will bring that knowledge and experience to the Corner Office.
Since the passage of our 2006 law, Massachusetts has stood proud to be the first state in the nation to make health care a human right, thereby joining every other developed democracy on earth. I believe deeply that health care should be a human right, not just in Massachusetts, but throughout our nation. Our state is almost there: almost 98% of our adults and over 99% of our children now have health insurance.
I know from my first-hand experience in Washington guiding the early implementation of the Affordable Care Act that all eyes in the nation are on Massachusetts. Champions of real health care reform are crossing their fingers for us to succeed; opponents are hoping for us to fail. It is crucial that we lead, and show the rest of the nation that treating health care as a right, not a privilege, is sensible and successful public policy.
We are now ensuring that the vast majority of our citizens have access to care, but we have not gone nearly far enough to curb the cost or improve the quality of our health care system. In the Massachusetts state budget, almost every key line item has gone down by 20%, 30%, or 40% in real terms since 2000 except health care, which has gone up by 60%. In 2013, 43% of state expenditures are for health care – that’s more than double what we spend on education.
Massachusetts’ health care is among the most expensive in the country. It doesn’t have to be that way.
What we need to achieve is what I call the Triple Aim: better care, better health, and lower cost through improvement – all at the same time. Our 2011 health care cost-containment law, Chapter 224, was a step in the right direction, but we will need to be even more aggressive in implementing policies that move us toward the Triple Aim.
The Triple Aim is absolutely achievable. The current health care payment system pays most hospitals and doctors for volume (how much they do) rather than for results (how well patients do). And, it is not sufficiently focused on the upstream prevention of disease. The result is very high cost without sufficiently high value. Those high costs come right out of the wages of workers – in taxes, deductions, and out-of-pocket payments – and rob both government and families of opportunities to use their hard earned income for other important purposes.
Here is one answer: move our state away from fee-for-service payment and from fragmented delivery into coordinated, team-based, integrated care. For patients and families, this will lead to care that is much more responsive, helpful, and respectful. Outcomes will be better and costs will fall significantly. And, in addition, we need to focus much more on prevention.
- On day one, I will convene a summit of all stakeholders to conduct a top to bottom review of Chapter 224 and develop an action plan to ensure it meets Triple Aim goals of better care, better health, and lower cost. If Chapter 224 results lag behind, within my first 100 days I will work with the Legislature to craft a new wave of stronger legislation to incentivize increased transparency, payment changes, and care reorganization.
- It is time to find a way to get to yes on a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone - patients, families, doctors, and employers. On day one, I will appoint a multi-stakeholder Single Payer Advisory Panel to investigate and report back within six months on how Massachusetts moves to a single payer health insurance system like Medicare for all.
- I will personally lead a statewide initiative to make Massachusetts the healthiest state in the nation, through smoking cessation, obesity prevention and reduction, and specific programs to curb domestic and physical violence.
- We will stop the obesity epidemic in Massachusetts. I will strengthen our state’s disease prevention and health improvement programs, with a special emphasis on innovations adopted from best practices from all over the world.
- I will assure that high-quality mental health care is more and more incorporated into the center of our health care system, in full parity with other components of care. We will reduce substance abuse and suicide rates by 50% in Massachusetts in the next decade.
- Massachusetts will be the national leader in patient safety. Many of our hospitals have made progress toward safer care - reducing infections and complications in hospitals, reducing medication errors, and more. This is the moment to bring patient safety to full scale in the Commonwealth, in every hospital and in every community. I will convene the stakeholders in Massachusetts health care and launch a five-year, comprehensive, collaborative, statewide project to bring the levels of injuries to patients due to errors in care to the lowest level in the nation.