As she campaigns for governor, Attorney General Martha Coakley says she wants to be a voice for the people. But when it comes to the deal she struck with Partners Healthcare, so far the voices she’s most interested in hearing belong to the powerful players behind Partners.
In May, she announced a tentative pact with the health care behemoth that allows it to acquire South Shore Hospital and three more hospitals down the road — Lawrence Memorial Hospital in Medford, Melrose-Wakefield Hospital, and Emerson Hospital in Concord. She contends this deal will cap prices, physician network growth, and future hospital expansion.
The broad terms of the agreement are public, but only the parties know all the details. For now, there’s no formal mechanism for public hearings or comment — but there should be. Partners is already the dominant health care force in Massachusetts. If this deal makes the playing field less competitive than it already is, it affects everyone’s access to affordable, quality health care.
Coakley initially said she would submit the agreement for approval by the state’s highest court by June 16. That didn’t happen, after rival hospitals, community activists, and some business interests warned it would have “profound and negative effects on the cost of health care” and possibly lead to the “extinction” of some hospitals.
Is the deal on hold, as reported earlier this week by WBUR? A spokesman for the AG said only that negotiations are continuing, and reiterated the AG’s commitment to transparency. But Coakley might also be recalculating one pricetag — the political one for her.
Built out from a core of Harvard teaching hospitals, Partners is a world-renowned brand and a major force in the Massachusetts economy. A founding premise behind its endless quest to grow is that consolidation will reduce cost, partly by redirecting patients to lower-cost community providers in its network.
If there’s evidence of that outcome, its backers should be delighted to produce it. For years, Coakley herself said the opposite is true. As AG, she presided over headline-generating reports that underscore the high cost of Massachusetts health care, mostly due to the dominance of Partners.
Of course, rival hospitals have a business interest in challenging Partners. Yet, they raise valid concerns about the ripple effect of the network’s continued expansion. Its competitors are already the lower-cost health care providers in Massachusetts, and they, too, are major economic engines. Their survival matters.
The strength of the Partners agreement depends on the meaning of “cap.” For example, it allows Partners to recruit 600 new physicians to its network. So, what, exactly, did Partners give up? Who is in charge of monitoring the terms of this deal? And what happens if those restrictions are violated in the future?
Don Berwick, the Democratic candidate for governor who came within a percentage point of beating Coakley at last week’s state convention, said the agreement “essentially makes permanent Partners’ already unacceptably high costs without requiring the reduction in prices that is needed, tying the state to a fundamentally flawed pricing structure for the future.”
John McDonough, a health care policy expert who played a key role in the passage and implementation of the 2006 Massachusetts health reform law, said the consequences of this agreement are “enormous.” The question, he said, “is will we in fact move toward a genuinely more competitive market or will we freeze or even expand the marketplace dominance of Partners?”
As for Coakley’s role, McDonough — a Berwick backer — said, “She is doing her utmost to have it both ways. She is trying very hard to put out a public posture of being tough on Partners and at the same time, giving them the important advantages they are seeking.”
That’s another way of saying Coakley has two goals to juggle: her political ambition to be governor, and her duty as AG to be the people’s watchdog.