Pretend for a minute that you’re in the hot dog business. And you’re struggling.
You have a beat-up push cart. The hot dog and the bun cost you $1. But because you work in a poor area, you can only charge 60 cents.
Meantime, your competitor is cleaning your clock. No push cart for him. He has a shiny new food truck. He works in an affluent neighborhood. The hot dog and the bun costs him $1, too, but he charges $2.50.
People think he’s got some super-duper meat that makes his hot dog special. But they’re wrong. It’s the same thing.
That’s precisely how Spiros Hatiras feels. Except he’s not a hot dog salesman. He’s the president and chief executive officer of Holyoke Medical Center. And he deals with patients, not hot dogs.
“I lose money on every single one,’’ he said. “It’s not that complicated really.’’
Maybe not for him. But for most of us, health care finance is like trying to understand nuclear fusion.
And that complexity has led to dysfunction — an expensive dysfunction that’s made Massachusetts health care costs among the nation’s highest.
Eight years ago, I was a member of the Globe Spotlight Team that examined the market clout of two of our world-class hospitals — Massachusetts General and Brigham and Women’s — and found they typically are paid 15 percent to 60 percent more than the same work done at community hospitals like Hatiras’s. And they command those big prices even though the quality of care Partners provides for routine procedures is no better.
What’s happened since then? “We’re exactly in the same place, because the forces that led to those anomalies are still in place,’’ said Stuart H. Altman, chairman of the state’s Health Policy Commission, which has produced a key study showing exactly that. “If anything, things have gotten worse, because a higher proportion of Massachusetts patients now go to the most expensive hospitals, and that’s been growing.’’
So the gap between the haves and the have-nots is widening. And now along comes a ballot measure that would take millions from the haves and give it to the have-nots. Sounds tantalizing, doesn’t it?
It’s a terrible way to make public policy, especially public policy this complex and this critical. But the stakeholders here have no one to blame but themselves. They’ve had years to fix it. And haven’t.
Nearly all the state’s hospitals are against the ballot initiative that is being promoted by the Service Employees International Union. Signatures are still being collected.
In the meantime, the threat of the measure is a welcome cudgel to force a public policy discussion among lawmakers, insurance companies, and hospital executives who so far have had laryngitis.
“There’s a serious conversation going on right now on Beacon Hill about how to address this issue that I’m sure would never go on without this ballot initiative,’’ said John McDonough, a Harvard School of Public Health professor. “It’s messy and it’s not what you would like from a Kennedy School textbook but, damn it, sometimes it works.’’
The issue here is not whether big academic medical centers like those in the Partners network should be paid more. They should. But now they’re being paid too much and community hospitals are being paid too little.
When I asked Attorney General Maura Healey about all of this, she said the time is “ripe for action.’’
“Despite our efforts over the past five years, significant disparities exist that have real-world consequences for people trying to access quality, affordable health care,’’ Healey said in an e-mail. “It’s time to tackle this issue head-on.’’
Actually, it’s well past time for that.
And voters are poised to act if the key stakeholders here continue to run around in circles.
By the way, the union pushing the ballot measure estimates it would mean an extra $4.3 million a year for Spiros Hatiras’s Holyoke Medical Center.
Hatiras so far opposes the ballot measure. But he’s growing impatient. That $4.3 million would buy a lot of hot dogs.
Follow-up: My column last week about Juan Pu Nolasco, the 8-year-old Guatemalan boy who was badly burned when he fell into a pot of boiling water, brought an overwhelming response. Contributions from Globe readers will more than replenish the funds his family had intended to use to buy some land for a new home — money that went instead toward inadequate medical care in Guatemala. His family is grateful beyond words except these: Thank you.Thomas Farragher is a Globe columnist. He can be reached at firstname.lastname@example.org.