Narrowing the gap between the generous insurance reimbursements awarded to Massachusetts’ biggest medical centers and smaller payments made to community hospitals has long been the subject of debate. With every passing year, alarms about the underfunding of struggling hospitals grow louder. The state legislature’s failure to do its job and address this issue has produced two unpalatable options, which both have the potential to do further harm.
Clearly, something must be done, but forging health care-payment reform behind closed doors isn’t the way to go about it. Regrettably, that’s what now appears to be taking place. State hospital executives and representatives of the Service Employees International Union, Local 1199, have been secretly meeting to work out a deal that would keep a SEIU health care-funding initiative from going before voters in November. The union is collecting signatures for a ballot question that would redistribute health care reimbursements made to Massachusetts hospitals. It calls for draining about $450 million annually from Partners HealthCare — the state’s mightiest health care provider — and $17 million from South Shore Hospital in Weymouth. Some other providers, including the for-profit Steward Health Care, would significantly benefit. In addition, as much as $200 million would be returned to insurance companies. That money, the SEIU says, would be used to reduce premiums.
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Partners suggests that if the referendum question passes, it would be forced to cut as many as 5,000 jobs. It also maintains the proposal does little to help underfunded independent hospitals in communities with large populations of low-income patients.
The level of frustration over payment-reform inertia is understandable. Eight years ago, a Globe Spotlight Team investigation detailed what it called the “Partners Effect” — the chain’s ability to use its market dominance to command higher payments for the same services offered by other providers at lower prices. Since then, two Massachusetts attorneys general have released separate reports that found pricing disparities are making medical care more expensive. Earlier this year, another study — this one by the state’s Health Policy Commission — echoed those findings.
Some of the blame lies with state legislators, whose hand-wringing ability is unparalleled when it comes to fretting over health care price disparities. Governor Charlie Baker also has repeatedly expressed concern, but considering his resume, Baker should be taking more of a leadership role. He was chief executive of Harvard Pilgrim Health Care from 1999 to 2009 and is credited with resuscitating the gravely ill insurer.
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Regardless, elected officials’ lack of fortitude on pricing doesn’t mean a complex public health policy matter should come down to a yes-or-no vote at the polls. And it certainly doesn’t warrant a short-circuit maneuver like the private-meeting arrangement between SEIU and, primarily, Partners. Back-room sessions validate the perception that the system is rigged. Here’s a plausible scenario: The powerful parties huddle, come to some kind of agreement, and congratulate each other for making headway on a tough problem. Consumers are kept in the dark, making it impossible to know what really went down. So much for transparency.
Something even more troublesome may be taking place here — SEIU apparently is using the possibility of a November referendum as leverage in its effort to gain more union jobs at Partners facilities. If Partners agrees to let the union make inroads, SEIU might not push the ballot question. Neither side wants to publicly address that negotiation point, but they also aren’t denying it. “The ballot question is not the only approach,” says Tim Foley, SEIU’s assistant division director for Massachusetts. “We’re willing to work with stakeholders across the Commonwealth, including Partners, to figure out how we can fix this price variation.” Partners spokesman Rich Copp told the Globe’s Priyanka Dayal McCluskey that it’s “currently in conversations with many stakeholders, including the SEIU, in the hope that we can avoid a messy ballot fight.”
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A ballot battle would entail a blitz of dueling advertising campaigns and scare tactics. That prospect, however unpleasant, is preferable to the thought of union and hospital officials shaking hands in the dark. The solution to the state’s health care pricing dilemma, whatever it might be, can only be found under the bright and cleansing light of a public process.
Disclosure: Ellen Clegg, the editorial page editor, is married to Ellen J. Zucker, a Boston attorney who serves as counsel to Dr. Dennis Burke, an orthopedic surgeon who has been publicly critical of policies at Massachusetts General Hospital. In keeping with the Globe’s guidelines on ethics, Clegg recused herself in August 2015 from any role overseeing editorials, opinon columns, or letters pertaining to MGH. The Globe’s opinion pages are a separate operation from the Globe’s newsroom, which is run by Editor Brian McGrory; Clegg has no role in determining news coverage. Editorials involving MGH are overseen by Deputy Managing Editor Katie Kingsbury; opinion columns and letters involving MGH are overseen by Deputy Managing Editor Marjorie Pritchard. Kingsbury and Pritchard can be reached by email at: katie.kingsbury@globe.com and marjorie.pritchard@globe.com.