Is "Too Big to Fail" Finding an Echo in Massachusetts Health Care Debate?

Tuesday, January 31, 2012

In his January 23rd State of the State address, Governor Deval Patrick pushed the legislature hard to act soon on a comprehensive health care cost control bill he introduced almost a year ago, House Bill 1849, An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments.

"Before you take up next year's budget, pass health care cost containment legislation," Patrick exhorted members of the legislature, who had assembled in the House chamber to hear the address.

Budget deliberations customarily begin in April, so Patrick was trying to set a March 31 deadline for enactment of H.B. 1849. It was not the first such attempt. Last October, he challenged the legislature to take up the bill in January.

Within two days of the State of the State address, it became clear that, one, the legislature would not be voting on health care cost control before it starts working on the Fiscal Year 2012-13 budget; and, two, legislative leaders are wary of changing the health care system because so much of the Massachusetts economy rides on health care.

The State House News Service reported that Dick Moore, Senate chairman of the Health Care Financing Committee, said, "We need to be very thoughtful about moving the health care system away from the current method of paying for volume of care toward paying for value of care. We need to get this right, or it could harm one of our most successful sectors of the state's economy. I'm confident that we'll have a good plan in the coming weeks, but it will differ significantly from the bill filed last year by the governor."

Moore's counterpart, House Health Care Financing Chairman Steve Walsh, later promised, "We will be doing something this session."

There's a rule requiring the legislature to adjourn by July 31 in years when legislative elections are held. This being one of those years, Walsh was committing only to a vote in the House on health care cost control in six months' time.

While acknowledging that "an awful lot of money can be squeezed out" of the health care system, Walsh said cost-cutting "can't be done overnight" without "harming patients, hurting employment, and hurting the industry, so we have to take an approach that is very sound and very smart. We can't turn that ocean liner immediately." (Was he thinking about the Costa Concordia when it made an ill-fated course adjustment off Italy not too long ago?)

Following the governor's address, House Speaker Robert DeLeo emphasized to the media that hospitals and other health care providers "are one of the major employers of people here in the Commonwealth, so we have to be extremely careful to try to make sure we get it right. It is my hope that we get it done this year."

We often hear how costly health care is, and how much it consumes of the U.S. gross domestic product (GDP): 20% and still rising. (Fifty years ago, it barely consumed 5% of GDP.) But we don't hear as often how crucial health care is to the Massachusetts economy and how many Massachusetts jobs are in health care, so it might be good to point out now that 49,000 of our fellow citizens work in health care and that the collective health care payroll in this state tops $4.5 billion per year.

Forty-nine thousand jobs represent 15% of all employment in Massachusetts: one out of six people work in health care. Here's another figure to consider: the Massachusetts health care sector generates cumulative economic activity of between $60 billion and $70 billion annually.

When the Great Recession hit three-and-a-half years ago, we heard about some banks and financial institutions being so large that Uncle Sam couldn't allow them to succumb to bankruptcy. They were "too big to fail"! A variant of that theme now haunts the members of the Massachusetts House of Representatives and Senate. We could have a health care system "too big to shrink"?

An Idea Whose Time Has Come: Pre-Paid Rides for Party-Time Pols

Friday, January 27, 2012

There's no reason to believe that politicians drink more or get into more trouble because of drinking than people in other lines of work. But when politicians-under-the-influence find themselves sideways with the law, they suffer more than the typical boozehound because of all the publicity. Witness the town administrator from a rural community in north-central Massachusetts community who recently had to admit to "sufficient facts" in a drunken driving case.

This man, age 33, was arrested one night in August of 2011 by Westboro police, who found him passed out on the hood of his car. He had miraculously pulled to a stop in the parking lot of a gas station on Route 9. One of the Boston TV stations heard about the story after the fact and had a camera crew on hand when the contrite offender, who has somehow managed to hold onto his town administrator's job, appeared in court to accept his punishment: one year of probation, alcohol education, fees totaling $1,380, and a restriction on nighttime driving.

In the course of the plea and sentencing, some rather embarassing details came out. For example, it was reported that the wayward town taskmaster had allegedly spent the hours prior to his arrest at a strip club in Worcester. (Way to complete the public official's perfect trifecta of danger, guy! Alcohol. Cars. Loose women.) Photos of the perpetrator, both before and after his snooze on the hood, were also released. There was no mistaking what had caused those stains on his untucked shirt and drooping drawers.

"I'm having a bad night," he supposedly told the police after failing his second field sobriety test, which would be like Gomez Addams saying his family was a little different.

In court, he told the judge, "I sincerely regret the events of the evening that led to my arrest. This lapse of judgment is very out of character for me. I have learned a lot from this incident." No doubt he has.

Will anyone else who holds a prominent position of public trust at the state or local levels learn anything from it? The obvious lesson: don't be your own chauffeur when you decide to go sight-seeing at your favorite strip club and drink like a former POW on his first toot.

When you think about it, the major political parties in this country could do the world a favor simply by setting up a transportation voucher system for office holders to utilize when they were incapable of driving safely due to alcohol consumption -- sort of Triple A for Party-Time Pols. The way it would work, a politician could dial up the service 24/7, get a ride all the way home, no matter how far it was, and pay the program back later.

For Mr. Town Administrator X, the cab fare from Worcester to his home in Danvers would have been a lot less than $1,380, and not one bit as regrettable as those photos that screamed, "Yes, I got really, really stupid."

Transgender Rights Advocates Did Admirable Job of Exploiting the Inevitable

Friday, January 20, 2012

I don't know if the many advocates for the new transgender rights law in Massachusetts consciously follow the political maxim, "Exploit the inevitable," but that is what they have done.

On Nov. 16, 2011, both houses of the legislature voted to enact House Bill 3810, An Act Relative to Gender Identity, and the governor signed it into law a week later before heading off to Atlanta to celebrate Thanksgiving with relatives. Yesterday, the governor, legislative leaders, transgender advocates and supporters held a ceremonial bill signing event for HB 3810 in the Senate Reading Room in order to properly celebrate this historic law, which had been before the legislature in one form or another for six long years.

"I signed this bill as a matter of conscience," Gov. Patrick said yesterday. "No individual should face discrimination because of who they are."

Speaking on the floor of the House the night the bill was first voted on, Rep. Carl Sciortino, D-Somerville, a primary sponsor of the measure, said, "...this bill is going to make an immediate difference in the lives of the state's transgender residents, who desperately need anti-discrimination protections in housing and employment. I have been so moved by the courage of constituents who've shared their stories with lawmakers and shown the critical need for these civil rights protections."

The day the bill was enacted, the Massachusetts Transgender Political Coalition issued a press release stating it was "proud to announce" that it would become law.

The bill adds the words "gender identity" to the state's non-discrimination laws for the purpose of preventing discrimination against transgender residents seeking housing, employment, credit or post-secondary education. It also expands the state's hate crimes statutes to include violence perpetrated against transgendered men and women.

An Act Relative to Gender Identity is indeed a good and necessary addition to the laws of the Commonwealth. Through hours of deeply moving testimony from transgendered men and women who had lost jobs, been kicked out of apartments, or attacked physically simply because they are different, and through a sustained, all-out lobbying push from a coalition of civil rights and progressive groups, the case was made that Massachusetts had to do something now to protect this distinct minority group. (The transgender population of this state is said to number about 33,000.)

Nevertheless, An Act Relative to Gender Identity is significantly different from earlier versions of the bill that transgender rights advocates unsuccessfully championed. For example, the bills that didn't make it would have extended new protections to persons based on both their gender identity and their "gender expression." They also would have included public accommodations among the categories where transgendered persons could avail themselves of specific legal rights and protections. The legislature rejected both because it felt that, one, the term gender expression was too wide and ambiguous, and, two, traditional standards of privacy and gender separation should prevail in public bathrooms, locker rooms, showers, etc. Many opponents of the bill argued that someone who had not completed the physical transformation to the opposite gender, a man who was just "feeling like" a woman, for instance, could theoretically abuse the law by claiming the right to enter a women's locker room.

Two legislative sessions ago (2006-08), the first transgender rights bill was introduced containing the gender expression and public accommodations provisions. It ran into a lot of opposition and never got out of the Judiciary Committee.

Next session (2009-10), another transgender rights bill with these same provisions was filed. It, too, died in Judiciary.

Hoping the third time would be the charm, advocates again filed a bill with these provisions for the current (2011-12) session.

Obviously, though, they found that gender expression and public accommodations remained unmovable obstacles to passage. And, rather than suffer a third consecutive defeat, they decided to embrace a modified bill crafted under the prudent leadership of the House and Senate chairs of Judiciary, Chelsea's Eugene O'Flaherty and Brookline's Cynthia Creem, respectively. The modest, middle-of-the-road, O'Flaherty-Creem approach thus became the inevitability exploited by the transgender rights coalition when it trumpeted the bill in November (and again this week) as a victory, while softly conceding it is not what they had struggled long and hard to achieve.

And no one admitted that, if they had wanted to, they could have had this bill on the books three or four years ago.

Gunner Scott, executive director of the Massachusetts Transgender Political Caucus, had the final quotation in the press release issued by governor's office on Nov. 23, the day Patrick signed the bill, and it was a good one. Said Scott, "This law will make a significant difference in the lives of transgender youth and adults across the state who need jobs, a safe place to live and a quality education." Around that same time, one of the most passionate and articulate members of the transgender rights coalition, Atty. Jennifer Levi, was describing An Act Relative to Gender Identity as a "first step," and promising to push for a new and improved version of the bill in the next (2013-14) session. "We support this bill," said Levi, director of Gay & Lesbian Advocates and Defenders (GLAD). "We want complete protections for transgender people -- including in public accommodations -- but also know that in order to get there, we cannot walk away from the legislature's first step toward achieving those full protections."

We'll have to wait a while to see if the legislature, after six years of wrangling with one transgender bill, has the appetite to take on An Act Relative to Gender Identity, Part Two.

In Coming Class Warfare, Romney Hopes His Vest Is Bullet-Proof

Monday, January 16, 2012

Even if he had the charisma of Ronald Reagan and the personality of George W. Bush, Mitt Romney would still have trouble relating to average working men and women. Almost all super-successful Republicans do. And wealthy Republicans who grew up in exclusive suburban enclaves, attended Ivy League colleges, and achieved fabulous success in business at an early age, as Romney did, have an especially hard time relating.

So if you're trying to figure out how Romney, the presumptive Republican nominee for president, is doing in the next few months, watch closely how he handles the issue of increasing disparities of wealth among Americans and how he defends himself against the inevitable "you're a filthy rich man" attacks from the Democrats.

To date, the former Massachusetts governor seems to be settling into the classic Republican position that Republicans don't have a wealth problem, Democrats have any envy problem.

As Romney put it during his victory speech in New Hampshire, President Obama is a "leader who divides us with the bitter politics of envy."

But not to worry, folks, there will be no class warfare from this owner of an estate on Lake Winnipesaukee. On the contrary, Romney wants to "lead us down a different path, where we are lifted up by our desire to succeed, not dragged down by a resentment of success."

This could work. Americans are an optimistic lot. They still rightly believe this is the land of opportunity, and they still rightly distrust government as the fixer of all problems. But it won't be easy for Romney to glide over the battlefields in the intensifying "war" among economic classes, as prosecuted by Democrats and Republicans alike.

(Class warfare is like negative political advertising: everybody says they disapprove of it, and everybody responds to it.)

Consider the findings of the latest survey by the Pew Research Center, released Jan. 11, which indicate that roughly two-thirds of Americans now believe there are "strong conflicts" between rich and poor in our nation. Two years ago, when Pew did a similar survey, 47% of respondents said there were strong rich-poor conflicts.

Consider a U.S. Commerce Department report from last August showing that corporate profits increased by 8.3% in 2009 and 10.8% in 2010, two years when wages continued to decline as a percentage of national income. "That continued decline may help explain the economic worries of many Americans who have jobs but still fear they are falling behind," New York Times reporter Floyd Norris observed.

And consider the declining ratio of employment to population: in June 2007, some 63% of adults were employed; two years later, 59.4% were employed; and in June 2011, 58.2% had jobs.

No millionaire has ever looked to me for advice, but if I were Mitt Romney, I'd be careful using that "envy" line. A 58-year-old man who's been out of work for two years does not want to be scolded for believing the system is stacked against him. And a single mom who's lost her home to foreclosure does not want a lecture on the virtues of a system that bailed out the banks first.

Republicans like Gov. Romney believe this nation can grow itself out of the deep hole it's in, while moderates of both major parties -- Hello, Alan Simpson! Hello, Erskine Bowles! -- believe a mixture of tax increases, tax reform, and restraints on big entitlement programs like Medicare will do the trick.

The GOP and its supporters will spend tens of millions of dollars trying to convince Americans Obama is a crypto-socialist bent on turning the U.S. into what Romney calls a "European-style entitlement society," while Obama, exploiting the tremendous, natural advantages of an incumbent president, will plant himself firmly on that middle/moderate, Simpson-Bowles-like ground.

Amazing, isn't it, how much this presidential election is starting to look like the 2010 gubernatorial election in Massachusetts, when another aggressive, business-savvy Republican took on a centrist Democrat with middling job approval ratings?

Will Romney Ever Achieve Total Proficiency as a Dispenser of Red Meat?

Wednesday, January 11, 2012

Mitt Romney delivered the goods last night during his victory speech in New Hampshire and the audience ate it up. Much of what he had to say was lifted from his standard stump speech and TV commercials, so he unloaded the words fairly easily, one fastball after another to Obama's head. He said:

"President Obama wants to put free enterprise on trial."

"Our campaign is about more than replacing a President, it is about saving the soul of America."

"President Obama wants to fundamentally transform America."

"He wants to turn America into a European-style entitlement society."

"This President takes his inspiration from the capitals of Europe."

"Internationally, President Obama has adopted an appeasement strategy."

"He apologizes for America."

"If this election is a bidding war for who can promise more benefits, then I'm not your President. You have that President today."

It was strong stuff, stuff meant to call forth strong emotions, some of which the audience would not be consciously aware of, such as fear and resentment of a different-looking leader with a very foreign name.

I have a theory that Romney doesn't really believe a lot of what he's saying on the campaign trail, that he is uncomfortable with the rhetorical demands of red-meat politicking, and that his discomfort often shows in the smiles and eyes that hold something back, and in the posture that can suggest a freshman at his first dance. He's simply not good at faking sincerity, which might tell us his parents did a good job putting some bedrock under his character.

Mitt Romney is a highly intelligent man. He earned an MBA and a law degree simultaneously at Harvard. He made a fortune for himself and his colleagues at Bain Capital by putting together solid business deals. He's a "deals" superstar. He succeeded because he can look at the world dispassionately, evaluate events objectively, and make decisions bloodlessly on facts and numbers alone. Those who have worked with Romney say you can never give him too much data.

So the first time he said in public that his election is tantamount to "saving the soul of America," it must have been hard for him. He was crossing a big threshold, proclaiming an historical mission of national salvation, which is something they don't practice much at Harvard Business School and Bain Capital.

I remember a story about Romney, soon after taking office as governor of Massachusetts, visiting a state representative who had graduated from Harvard Business School and asking her, "What is the value of intelligence in this building (the State House)?" (It was explained to me that "value of intelligence" is a term used at Harvard to denote the quality of information one receives from others in any given situation. High-quality intelligence is therefore the truest and most reliable by objective standards. People making business deals obviously have a burning need for intelligence like that.) The rep answered Romney by saying, "Governor, the value of intelligence as you understand it does not exist in this building." I'm sure Romney appreciated the rep's candor even as he shuddered within.

Romney is now far removed from the world of business. He not only functions full-time in a world where the value of intelligence, as he once crucially understood it, does not exist, but also has become, of necessity, a skilled player in that world, even as he paradoxically stakes his claim to the Presidency on his business acumen.