IN HIS State of the Commonwealth address, Governor Patrick acknowledged the need for continued budget discipline while calling on the Legislature to stand up to some long-term problems. He reminded lawmakers of the hard choices they’ve confronted in the past, while also committing to health care and workforce-development reforms that - if executed well - could clear away obstacles to future economic growth.
Still, the initiatives the governor spoke of are already well in the pipeline - which makes it all the odder that Patrick didn’t devote any attention to the biggest looming threat of all, the long-term deficit in public transportation. For a speech about courage and facing up to problems, it didn’t quite go far enough.
Even as its economy brightens, Massachusetts suffers from a mismatch between the skills of unemployed workers and those demanded by local employers: Nearly 120,000 jobs are going unfilled for that reason, Patrick argued; while employers want more lab technicians and solar installers, not enough workers have the right training. Patrick would use the state’s 15 public community colleges to close the skills gap - by refocusing the schools’ mission on jobs and skill training, centralizing control of their budgets, and challenging business leaders to kick in as well. Individual college presidents may be reluctant to give up control to a more centralized system. But a recent report by the Boston Foundation suggests that sacrifice is worth it.
Patrick’s promise to reform health care payments contains similar promise - though the implementation promises to be complicated.
After years of disturbing increases in health care costs, the recent news has been more encouraging. State insurance regulators’ refusal to approve higher rates has given insurers a push to drive harder bargains with health care providers. Insurance companies are developing tiered plans that reward more cost-effective providers. Yet over the long term, health care costs can’t be clubbed down by regulatory fiat; the rules of the market have to be reshaped so that consumers can exert downward pressure on costs, and so that providers are paid for maintaining patients’ health rather than for providing more services. Last night, Patrick asked lawmakers to pass legislation to move away from fee-for-service compensation. This is a far-reaching goal, and Patrick and lawmakers will have to aim high.
But even as he warned lawmakers of the need for uncomfortable decisions, Patrick declined to take aim at what may be the most thankless area of state policymaking - transportation. Even as past reforms of the state transportation bureaucracy begin to yield some savings, the MBTA is limping under crippling debts. Lower health care costs and a properly skilled workforce should make Massachusetts an even better place to do business, but that progress will be threatened if the T’s woes make more discomfort for transit riders and drivers alike.