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January 3, 2005 - Health Care is a vital component of the Massachusetts economy. More people are employed in health care – one in seven – than in manufacturing or financial services. Our health care sector includes traditional health care providers as well as the biotechnology, pharmaceutical, and medical device industries. The excellence of our health care sector is evidenced by its capture of 9.8% ($1.9 billion in 2002) of all National Institutes for Health (NIH) grants nationally, the highest in the nation. (Source: Health Care Leadership Forum) A sector of our economy that is so vital to the economic health of our Commonwealth and to the physical and mental health of all Massachusetts residents deserves a leadership position in the administration of state government.

Currently, health care activities of state government are grouped within the Executive Office of Health and Human Services. However, even with the most recent re-organization it is so large as to be difficult to manage. There is no comprehensive statewide health policy to guide the expenditures, investments, and allocation of state resources in health care. When budget cuts have had to be made there is no guide to suggest what should constitute an appropriate health care system below which we must not go. The current administration has promised to develop a reform plan to deliver universal health care, but has so far missed three suggested goals for announcing the plan. The number of uninsured continues to grow in Massachusetts even though we have a lower rate than the nation as a whole. The cost of health insurance for business and for employees continues to rise toward unaffordable levels. There is no strong statewide system connecting local boards of health and regional health entities. There is no clear understanding in the administration of which official – the secretary of health and human services or the commissioner of public health – should declare a public health emergency, yet the commissioner has the statutory responsibility. Capacity for acute hospital beds is near crisis levels with most acute care hospitals functioning at 85-90% capacity 90% of the year. There is no comprehensive plan for long term care although our elder population is growing and will double in the next decade. The health care workforce is experiencing serious shortages of nurses and a variety of health specialties. Professional medical liability reform that raises health costs, reduces available professionals, and fails to protect the majority of patients injured by the health system has, to date, been unachievable. The state activities in the area of mental health appear woefully inadequate. The list could well go on.

Fortunately, after years of advocacy by countless individuals and organizations in and out of the health care system, it appears that state government leaders are ready and willing to raise health care reform to the highest priority in the coming legislative term. Senate President Robert E. Travaglini initiated the call for health care reform in his address to the Blue Cross Health Summit, and Speaker Salvatore DiMasi has added his endorsement to the effort to craft a solution. Governor Mitt Romney has set forth an outline of what could be done to improve access to care at an affordable price.

Given the importance of health care to the Commonwealth and its people, I believe that state government needs to provide leadership in the health care field that is not distracted by the vast array of issues and concerns in the human services sector. A system that places both health care and human services together in a state such a Massachusetts does not adequately address the needs and priorities of either sector. Having served as Senate Chair of the Committee on Health Care for the past six years, I suggest that real reform of health care requires the establishment of an executive office of health and mental hygiene charged with the development and updating of a comprehensive state health policy. The executive office needs to be empowered to address the public health system of the state, the health care workforce issues, and the need for containing health care costs through an emphasis on quality and safety rather than simply budget reduction and cost shifting. The state needs to be in the forefront of bringing health care into the 21st century with strong state government leadership advocating significant investment and use of technology for both administrative and clinical areas and revolutionizing the delivery of safe, high quality health care to all residents of the Commonwealth.

Five major bills will be filed to respond to the issues addressed above. They are: 

• the creation of a new Secretary of Health and Mental Hygiene with the charge to develop a comprehensive state health policy framework for physical and mental health
  

• a plan to increase access to safe, high quality affordable health care for all Massachusetts residents
  

• a plan to address the nursing shortage in Massachusetts by requiring publication of hospital staffing patterns and measurement of patient care outcomes, but does not establish mandatory nurse staffing ratios
  

• a major reform of professional medical liability malpractice law to reduce defensive medicine and its high costs, stem the tide of physicians leaving their practice or the state because of exorbitant malpractice insurance rates, and expand the number of injured patients whose complaints are addressed
  

• an investment in health care technology to reduce costs and waste, as well as improve patient and provider safety

Many people of good will in both political parties are stepping forward with suggestions for improving the Massachusetts Health Care System. Legislation that will be filed on December 1, 2004 will cover other very important reforms that should also be considered as we develop a consensus for major health care reform in Massachusetts. Among the list of issues, that is in no way all inclusive of the needs to address, legislative proposals will be filed to seek to address: 

• Improving Long Term Care – promoting greater opportunities for care in the home, new proposals for financing long term care, and improvement to care delivered in skilled nursing facilities. 

• Reducing Drug Costs – promoting safe access to drugs through Canada, programs for bulk purchasing of medications, mandating reduction of drug costs, promoting more thoughtful use of drugs, preventing unethical practices by pharmaceutical companies or providers.

• Treating and Preventing Obesity – promoting healthier school lunches and snacks, promoting requirements for physical education in schools, promoting healthier lifestyles.

• Improving Oral Health – increasing access to dentists for MassHealth clients, requiring fluoridation on a state wide scale, promoting early oral health for newborns and pregnant women.

• Promoting Patient Safety – limiting the hours worked by medical interns and residents, requiring credentialing of certain allied health specialties, expanding disciplinary options for health professionals including treatment of those with mental and physical illness or personality issues, developing performance standards for physicians and other professionals. 

• Strengthening Prevention – improving screening for various forms of cancer, promoting restoration of tobacco control programs.

• Health Emergencies & Bio-terrorism – updating public health emergency law to deal with 21st Century public health challenges, creating a biological agent registry.

• Reducing Transmission of Disease – providing for decriminalization of needle possession to promote use of clean needles and encourage addicts to seek treatment.

• Improving Correctional Health – promoting programs is the correctional system to minimize recidivism and transfer of disease to those on the outside.

• Reducing Health Disparities – providing incentives, training, protocols to improve health care access and care for women and minorities.

• Expanding Consumer Options for Patients – modernizing optometric care, promoting collaboration between physicians and pharmacists.

• Improving Public Health Care Facilities – improving the financial support for the public health hospitals and the Soldier’s Homes.

• Improving End of Life Care – providing pediatric palliative care options for terminally ill children and expanding hospice opportunities and coverage.

• Financing the Health Care Safety Net – reforming the Uncompensated Care Pool, providing oversight by the State Auditor of safety net programs, improving Medicaid reimbursement rates for all providers, providing health insurance for direct care staff.

• Improving School Health – expanding the access to school nursing services and expanding the number of school-based health centers.

• Improving Mental Health Services – gaining greater access to mental health services for Medicaid recipients, training for best use of medications for adolescents with mental illness, providing adequate resources for behavioral health facilities, creating more acute, and intermediate level adolescent psychiatric facilities.

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