So it’s that time again. Too many campaign commercials and appearances. Not enough substance.
Healthcare turns out to be important for any governor to know and know well, although I’ve never met one who does. Healthcare, via Medicaid, consumes more than 30 percent of Rhode Island’s budget. It’s also the largest sector of the state’s economy and the sector that employs the most people, so we might want a governor who knows healthcare inside and out. That said, no governor that I can remember knew much about health policy at all, which is part of how and why we’ve made such a mess over time, and why our health care remains expensive, officious, and ridiculously complicated.
So I thought it might be interesting to look at what the three candidates for governor were saying about health care, just to see if there’s a chance that it might be different this time.
For clarity, I’m an independent – I don’t like or trust either political party – and I’ve approached this particular race without bias, since, from my distance, I haven’t been overwhelmed by any of the candidates, and I don’t know any of them well at all. I also don’t watch any TV or use social media, so I haven’t had to look at their advertising, thank goodness. You should also know that health care is known as the third rail of politics – it’s complicated and partisan, and most political advisors suggest that candidates just say as little or say anything that might cost them votes.
Here’s what I did to learn about the candidate’s health care ideas: I looked at their websites, and I googled around to see what I could find – and found a debate or two — which had all of about three minutes of them talking about health care.
Here’s the good news:
(the above line is blank because there isn’t any good news!)
Only one of the three candidates has an issue brief on health care on their website. That brief wasn’t terrible, and it did what campaign websites for politicians usually do, which is to say very little about lots of different issues, so at least that person (or, more likely, some staffer) took the time to see what the issues are. But it didn’t lay out a coherent approach to solving our health care problem, which is, how do we get the best health outcomes at a price we can afford, as we keep health care personal, accessible, human – and make sure everyone has it. The central focus of that candidate’s proposal, which is to try to make sure fewer people get kicked off Medicaid, is okay in the short run, and at least can’t do any immediate harm, to the extent it is achievable. Medicaid helps people get access to care but doesn’t deliver that care. Keeping more people on Medicaid doesn’t address the real problem for Rhode Island, which is making sure that all Rhode Islanders get the best prevention and the care they need, and get that care close to home in a way that is comfortable, easy for them to use, and affordable. Medicaid helps prop up hospitals, insurers and pharma, but it doesn’t force any of them to focus on producing the best health outcomes. Instead, they all make gobs of money, at public expense, when you prop up Medicaid. You insure more people, but what you also do is further burden taxpayers, as you let folks who are taking public money take even more. Whoops.
Another candidate’s big health care idea was to try to convene other New England governors to create a big regional insurance process and a bigger risk pool, to spread the costs over more people. Nice idea on paper, sort of, assuming you can get six governors to agree on anything and even agree to meet. But it can’t work. The cost drivers of health care are price and utilization. The main driver of utilization is the character of the services that are available to people in their own communities when they get sick. How sick people get, and our effectiveness at preventing widespread and expensive disease, is also hugely important. This is an amateurish proposal, advanced in an amateurish way.
The third candidate’s big idea is to create a loan program for doctors, aimed at persuading more of the 600-plus medical residents who train in Rhode Island to stay in Rhode Island. It’s not a terrible idea and perhaps it could be part of our workforce solution. But we have loan repayment programs already, and no one thinks loan repayment has much impact on long term retention. (Loan repayment is an effective way to keep physicians in the state, as long as they qualify. But they tend to disappear as soon as their loans are paid off.)
We need a much more robust approach to health care, one that treats hospitals like the public assets they are (instead of private businesses), and one that rearchitects the health care service delivery system, if we are to improve the public health, make health care affordable, and keep health care from being a huge burden on taxpayers and on our businesses.
(Hint to all candidates: it’s the delivery system, to paraphrase an old Bill Clinton slogan. Right size the delivery system – hospitals, doctors, EMS, home health and nursing homes, and outcomes improve as costs come down.)
I don’t think any of the three candidates for governor have a deeper understanding of health policy than any of their predecessors. That’s sad. And crazy.
I wish the current attorney general had decided to run for governor. He and I disagree on a number of issues. But he has a much more robust understanding of the importance of leadership and health care policy than the three people who did run.
Speaking of ducks, which have apparently become a big issue in this election. I’m thinking of writing in Daffy Duck…. Because the other choices are a little crazy.
PS It’s flu shot time now. Get immunized. Particularly if you are over 65 or have a chronic disease. Don’t forget.
Flu vaccine protects against hospitalization and death. And saves us all money, when we all get immunized.
You can find Michael Fine’s commentaries and short stories on
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