Coakley’s Partners settlement tripping up Baker, Grossman

You don’t have to go to the beach to look for flip-flops this summer. There’s a pair in the gubernatorial race.

What’s got Steve Grossman and Charlie Baker all tripped up is Martha Coakley’s proposed settlement with Partners HealthCare that would allow the mammoth system to take over three more hospitals and sign up hundreds of doctors on the condition that it caps price increases for most of a decade.

In May, Grossman told The Boston Globe it was a “common-sense solution,” and Baker described it as a good start.

But as criticism over the terms of the attorney general’s settlement has mounted, Grossman and Baker have changed their tune on their chief political opponent’s proposal. Last week, Grossman, the Democratic state treasurer, called the settlement a “bad deal” and said Coakley’s handling of the negotiations demonstrated a “failure of leadership” because they were conducted in secret.

Baker, the leading Republican in the race, decided to do his own 180 in an interview Monday at Brothers Deli, the Mattapan restaurant that has become a see-and-be-seen stop for anyone running for office. While Grossman’s shift reeks of pure politics, Baker seemed to have thought it through based on his experience running Harvard Pilgrim Health Care years ago.

In between handshakes with patrons and bites of a turkey club, Baker told me he no longer supports Partners’s expansion, unless its rates are frozen for the first five years and no more doctors are added to its network. He also called for more transparency in pricing, with the idea that if patients better understood what they were paying for at Partners, they would flock to lower cost providers.

He also didn’t like the framework of the settlement, which is based more on trying to monitor the company’s conduct than changing its structure.

“The agreement is pretty complicated,” said Baker. “I worry about the ability of the next AG to enforce it.”

That’s a concern I’ve heard from others. Sure, there is the state-created Health Policy Commission, stacked with boldface names, but with no real power.

Both Baker and Grossman objected to being called flip-floppers, explaining they shifted positions once they learned more about the settlement. Or, they realized they better get on the right side of a decision that will affect nearly everyone in Massachusetts for decades.

Baker’s relationship with Partners is as complicated as the deal itself. In 1994, he was a wunderkind in the Weld administration as the governor’s secretary of health and human services. Baker signed off on the merger between Massachusetts General and Brigham and Women’s that established Partners, which today consists of 10 hospitals and over 6,000 doctors.

Critics say the marriage allowed Partners to become a Goliath that controls the market and drives up prices.

In a 2008 interview with the Globe, Baker said he had come to regret the decision, comparing it to “having the grenade that you throw on one end of the boat roll back down and blow up on you when the boat shifts.”

A few weeks ago, The New York Times editorial board called the merger “a serious mistake” and raised the idea that the Legislature should study whether it should be “undone in some way.”

Candidate Baker refrains from using such colorful language to describe what happened in 1994, but said “hindsight is a great thing.” As for undoing the merger, he said “it would be pretty hard.”

To his credit, Grossman doesn’t pretend to be a health care expert and knows it doesn’t look good when politicians switch positions. “People can say what they want,” he said Tuesday.

He said he follows what the Health Policy Commission does, and when he thought the agency was happy about the deal, so was he. The commission is not taking a formal position, but when it reported recently that pact could increase medical spending by tens of millions of dollars annually, Grossman stopped liking the agreement.

Still, the treasurer believes a deal of some kind is better than the attorney general suing Partners to prevent it from acquiring more hospitals, including the coveted South Shore Hospital in Weymouth.

For her part, Coakley stands by her deal, the best one the Democrat could wrangle out of Partners without filing an antitrust suit. A judge will hold a hearing in September to consider whether to approve the settlement.

“This agreement in no way forecloses future action,” she said in interview this week at a Roxbury campaign stop.

Nor will it end the arguing over how to control health care costs.