Friday, July 4, 2014

I admit to having a limited set of contacts and friends, but within that group I try to maintain relationships with people of diverse political backgrounds.  There is always something new to learn, and it is also good to have one's own opinions put to the test by other thoughtful folks.

It is striking then, that I have yet to find anyone--from those embedded in the health care field to those with just a "person on the street" understanding--who feels that the Attorney General's deal with Partners Healthcare is good for health care, good for the economy, or good for the cause of competition.

What is striking, too, is the shallowness with which the state's largest newspaper has covered the issue.  When it comes to editorials, there is only the one that parrots the press release offered by the AG.  And whether in the news stories or in a recent analysis, there seems to be no effort to find knowledgeable observers beyond a few "regulars" in the reporters' Rolodexes.

One such person who could be helpful is Gene Lindsey, former CEO of Atrius Health, the state's largest multi-specialty group.  Gene is truly one of the grand old men (sorry Gene!) of health care in Massachusetts.  He is well read, clear thinking, and with an undeniable commitment to the greater good and the needs of patients and families in the region.  Gene's weekly observations are sent to a group of colleagues in the field. I have quoted some of them here, and Commonwealth Magazine has done likewise.  Simply put, he thinks the deal is a sell-out:

What appears to be an impressive list of extracted concessions that a tough AG had demanded of a large and powerful system added up to nothing or perhaps were even advantageous gift-wrapping.

To steal a concept from Joel Chandler Harris and the tale of “Br’er Rabbit,” Partners has been thrown into a pretty comfortable “briar patch” with this deal.

But this week's email from Gene presents a real gift to the readers, and I share it here.  He relates a conversation he had with David Spackman, Chief Legal Officer for Lahey Clinic. He was once the Assistant Attorney General, under Attorney General Coakley, for issues related to non-profit organizations. Here are Spackman's comment about the Partners deal:

STRUCTURAL remedies are the ones the FTC and the DOJ use--don't require monitoring, no complicated formula, no disputes over meaning. . . . You want to add a hospital? A group of physicians? What will you give up in return? Simple, no dispute, they work. CONDUCT remedies involve endless monitoring, court entanglement, constant disagreement--that is why the Feds reject them. The AG's remedies--price caps, component contracting--are all CONDUCT remedies--doomed to failure, social experiment, not a single example of success.

Compare that to this unsupported assertion (second sentence below) in the Globe's recent analysis:

The deal will allow the state’s largest health system to become larger. But it will also inhibit its contracting clout and force the system to revamp the way it delivers medical care, under the watchful eyes of a monitor.

Ok, you say, Spackman has a vested interest in that his current employer is opposed to the deal. I get that.  But the point he raises is a testable hypothesis. Why can't the reporter pose it to national anti-trust experts before restating its opposite as gospel?

Likewise, I have brought up recent economic research that suggests that the component contracting provision of the AG's agreement has been found to be ineffective in another jurisdiction.  I don't ever (especially now) expect the Globe to question me about my article, but I would hope that they might call the authors and get their expert points of view on such matters.  We might even have hoped that the newspaper would have done its own research about similar types of cases in other regions and use its analysis to compare the AG's deal with the actions taken by other AG's and the FTC.

There used to be a joke in some sections of Boston, taking off from a then-current advertisement:

A person says to a friend, "Have you seen the Globe today?"

The friend's response: "Why, did I get something wrong?"

If you are relying on this newspaper to reach a judgment on this issue, you are likely to get something wrong.  In contrast, read what Lindsey says:

The question is not whether Partners should be broken up, although I think that is certainly worth considering; that would surely be jousting with windmills. It is a simple question. Do we need to risk the little progress we have made toward a marketplace that works by allowing Partners to get even larger? Deals to control “conduct” have never worked and there is no reason to expect that they will work now. The entire package that the AG presents is a package of “conduct remedies that have never worked before." All the payers, all the employers, and all those who dream of affordable care and universal quality and access, should speak and should speak loudly in the next few weeks so that the community and the judge can know where they stand. Speaking out and saying that Partners should not be allowed to expand is not an indictment of the wonderful care that its doctors, nurses and allied health professionals provide their patients.

Speaking out does not mean that the current patients should be threatened that their future care might be compromised. What is threatened by not speaking is the care that everyone else in our community might enjoy because of the business practices of Partners the enterprise. Yes, it should be possible for the employees and patients of Partners to see that the continued expansion of the system threatens the marketplace that might have a chance to improve care for everyone. To argue that Partners must expand to improve the health of the community holds no water. “Conduct” remedies from the AG are an extension of the fantasy that Partners can’t be denied because it is so important. “Conduct” remedies are an empty rationalization and a poor attempt to have it all politically.

Finally, anyone who wants to be governor and lead this state through the critical next four years of healthcare evolution should be embarrassed if they do not put out a clear position on this critical question. We know one candidate’s point of view. If you do not understand the issue well enough to have a point of view you are not ready to be governor of Massachusetts. Candidate Coakley is defending a deal that makes no sense to me. As a voter I would love to hear from the other candidates.


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