Is "Too Big to Fail" Finding an Echo in Massachusetts Health Care Debate?

Tuesday, January 31, 2012

In his January 23rd State of the State address, Governor Deval Patrick pushed the legislature hard to act soon on a comprehensive health care cost control bill he introduced almost a year ago, House Bill 1849, An Act Improving the Quality of Health Care and Controlling Costs by Reforming Health Systems and Payments.

"Before you take up next year's budget, pass health care cost containment legislation," Patrick exhorted members of the legislature, who had assembled in the House chamber to hear the address.

Budget deliberations customarily begin in April, so Patrick was trying to set a March 31 deadline for enactment of H.B. 1849. It was not the first such attempt. Last October, he challenged the legislature to take up the bill in January.

Within two days of the State of the State address, it became clear that, one, the legislature would not be voting on health care cost control before it starts working on the Fiscal Year 2012-13 budget; and, two, legislative leaders are wary of changing the health care system because so much of the Massachusetts economy rides on health care.

The State House News Service reported that Dick Moore, Senate chairman of the Health Care Financing Committee, said, "We need to be very thoughtful about moving the health care system away from the current method of paying for volume of care toward paying for value of care. We need to get this right, or it could harm one of our most successful sectors of the state's economy. I'm confident that we'll have a good plan in the coming weeks, but it will differ significantly from the bill filed last year by the governor."

Moore's counterpart, House Health Care Financing Chairman Steve Walsh, later promised, "We will be doing something this session."

There's a rule requiring the legislature to adjourn by July 31 in years when legislative elections are held. This being one of those years, Walsh was committing only to a vote in the House on health care cost control in six months' time.

While acknowledging that "an awful lot of money can be squeezed out" of the health care system, Walsh said cost-cutting "can't be done overnight" without "harming patients, hurting employment, and hurting the industry, so we have to take an approach that is very sound and very smart. We can't turn that ocean liner immediately." (Was he thinking about the Costa Concordia when it made an ill-fated course adjustment off Italy not too long ago?)

Following the governor's address, House Speaker Robert DeLeo emphasized to the media that hospitals and other health care providers "are one of the major employers of people here in the Commonwealth, so we have to be extremely careful to try to make sure we get it right. It is my hope that we get it done this year."

We often hear how costly health care is, and how much it consumes of the U.S. gross domestic product (GDP): 20% and still rising. (Fifty years ago, it barely consumed 5% of GDP.) But we don't hear as often how crucial health care is to the Massachusetts economy and how many Massachusetts jobs are in health care, so it might be good to point out now that 49,000 of our fellow citizens work in health care and that the collective health care payroll in this state tops $4.5 billion per year.

Forty-nine thousand jobs represent 15% of all employment in Massachusetts: one out of six people work in health care. Here's another figure to consider: the Massachusetts health care sector generates cumulative economic activity of between $60 billion and $70 billion annually.

When the Great Recession hit three-and-a-half years ago, we heard about some banks and financial institutions being so large that Uncle Sam couldn't allow them to succumb to bankruptcy. They were "too big to fail"! A variant of that theme now haunts the members of the Massachusetts House of Representatives and Senate. We could have a health care system "too big to shrink"?

An Idea Whose Time Has Come: Pre-Paid Rides for Party-Time Pols

Friday, January 27, 2012

There's no reason to believe that politicians drink more or get into more trouble because of drinking than people in other lines of work. But when politicians-under-the-influence find themselves sideways with the law, they suffer more than the typical boozehound because of all the publicity. Witness the town administrator from a rural community in north-central Massachusetts community who recently had to admit to "sufficient facts" in a drunken driving case.

This man, age 33, was arrested one night in August of 2011 by Westboro police, who found him passed out on the hood of his car. He had miraculously pulled to a stop in the parking lot of a gas station on Route 9. One of the Boston TV stations heard about the story after the fact and had a camera crew on hand when the contrite offender, who has somehow managed to hold onto his town administrator's job, appeared in court to accept his punishment: one year of probation, alcohol education, fees totaling $1,380, and a restriction on nighttime driving.

In the course of the plea and sentencing, some rather embarassing details came out. For example, it was reported that the wayward town taskmaster had allegedly spent the hours prior to his arrest at a strip club in Worcester. (Way to complete the public official's perfect trifecta of danger, guy! Alcohol. Cars. Loose women.) Photos of the perpetrator, both before and after his snooze on the hood, were also released. There was no mistaking what had caused those stains on his untucked shirt and drooping drawers.

"I'm having a bad night," he supposedly told the police after failing his second field sobriety test, which would be like Gomez Addams saying his family was a little different.

In court, he told the judge, "I sincerely regret the events of the evening that led to my arrest. This lapse of judgment is very out of character for me. I have learned a lot from this incident." No doubt he has.

Will anyone else who holds a prominent position of public trust at the state or local levels learn anything from it? The obvious lesson: don't be your own chauffeur when you decide to go sight-seeing at your favorite strip club and drink like a former POW on his first toot.

When you think about it, the major political parties in this country could do the world a favor simply by setting up a transportation voucher system for office holders to utilize when they were incapable of driving safely due to alcohol consumption -- sort of Triple A for Party-Time Pols. The way it would work, a politician could dial up the service 24/7, get a ride all the way home, no matter how far it was, and pay the program back later.

For Mr. Town Administrator X, the cab fare from Worcester to his home in Danvers would have been a lot less than $1,380, and not one bit as regrettable as those photos that screamed, "Yes, I got really, really stupid."

Transgender Rights Advocates Did Admirable Job of Exploiting the Inevitable

Friday, January 20, 2012

I don't know if the many advocates for the new transgender rights law in Massachusetts consciously follow the political maxim, "Exploit the inevitable," but that is what they have done.

On Nov. 16, 2011, both houses of the legislature voted to enact House Bill 3810, An Act Relative to Gender Identity, and the governor signed it into law a week later before heading off to Atlanta to celebrate Thanksgiving with relatives. Yesterday, the governor, legislative leaders, transgender advocates and supporters held a ceremonial bill signing event for HB 3810 in the Senate Reading Room in order to properly celebrate this historic law, which had been before the legislature in one form or another for six long years.

"I signed this bill as a matter of conscience," Gov. Patrick said yesterday. "No individual should face discrimination because of who they are."

Speaking on the floor of the House the night the bill was first voted on, Rep. Carl Sciortino, D-Somerville, a primary sponsor of the measure, said, "...this bill is going to make an immediate difference in the lives of the state's transgender residents, who desperately need anti-discrimination protections in housing and employment. I have been so moved by the courage of constituents who've shared their stories with lawmakers and shown the critical need for these civil rights protections."

The day the bill was enacted, the Massachusetts Transgender Political Coalition issued a press release stating it was "proud to announce" that it would become law.

The bill adds the words "gender identity" to the state's non-discrimination laws for the purpose of preventing discrimination against transgender residents seeking housing, employment, credit or post-secondary education. It also expands the state's hate crimes statutes to include violence perpetrated against transgendered men and women.

An Act Relative to Gender Identity is indeed a good and necessary addition to the laws of the Commonwealth. Through hours of deeply moving testimony from transgendered men and women who had lost jobs, been kicked out of apartments, or attacked physically simply because they are different, and through a sustained, all-out lobbying push from a coalition of civil rights and progressive groups, the case was made that Massachusetts had to do something now to protect this distinct minority group. (The transgender population of this state is said to number about 33,000.)

Nevertheless, An Act Relative to Gender Identity is significantly different from earlier versions of the bill that transgender rights advocates unsuccessfully championed. For example, the bills that didn't make it would have extended new protections to persons based on both their gender identity and their "gender expression." They also would have included public accommodations among the categories where transgendered persons could avail themselves of specific legal rights and protections. The legislature rejected both because it felt that, one, the term gender expression was too wide and ambiguous, and, two, traditional standards of privacy and gender separation should prevail in public bathrooms, locker rooms, showers, etc. Many opponents of the bill argued that someone who had not completed the physical transformation to the opposite gender, a man who was just "feeling like" a woman, for instance, could theoretically abuse the law by claiming the right to enter a women's locker room.

Two legislative sessions ago (2006-08), the first transgender rights bill was introduced containing the gender expression and public accommodations provisions. It ran into a lot of opposition and never got out of the Judiciary Committee.

Next session (2009-10), another transgender rights bill with these same provisions was filed. It, too, died in Judiciary.

Hoping the third time would be the charm, advocates again filed a bill with these provisions for the current (2011-12) session.

Obviously, though, they found that gender expression and public accommodations remained unmovable obstacles to passage. And, rather than suffer a third consecutive defeat, they decided to embrace a modified bill crafted under the prudent leadership of the House and Senate chairs of Judiciary, Chelsea's Eugene O'Flaherty and Brookline's Cynthia Creem, respectively. The modest, middle-of-the-road, O'Flaherty-Creem approach thus became the inevitability exploited by the transgender rights coalition when it trumpeted the bill in November (and again this week) as a victory, while softly conceding it is not what they had struggled long and hard to achieve.

And no one admitted that, if they had wanted to, they could have had this bill on the books three or four years ago.

Gunner Scott, executive director of the Massachusetts Transgender Political Caucus, had the final quotation in the press release issued by governor's office on Nov. 23, the day Patrick signed the bill, and it was a good one. Said Scott, "This law will make a significant difference in the lives of transgender youth and adults across the state who need jobs, a safe place to live and a quality education." Around that same time, one of the most passionate and articulate members of the transgender rights coalition, Atty. Jennifer Levi, was describing An Act Relative to Gender Identity as a "first step," and promising to push for a new and improved version of the bill in the next (2013-14) session. "We support this bill," said Levi, director of Gay & Lesbian Advocates and Defenders (GLAD). "We want complete protections for transgender people -- including in public accommodations -- but also know that in order to get there, we cannot walk away from the legislature's first step toward achieving those full protections."

We'll have to wait a while to see if the legislature, after six years of wrangling with one transgender bill, has the appetite to take on An Act Relative to Gender Identity, Part Two.

In Coming Class Warfare, Romney Hopes His Vest Is Bullet-Proof

Monday, January 16, 2012

Even if he had the charisma of Ronald Reagan and the personality of George W. Bush, Mitt Romney would still have trouble relating to average working men and women. Almost all super-successful Republicans do. And wealthy Republicans who grew up in exclusive suburban enclaves, attended Ivy League colleges, and achieved fabulous success in business at an early age, as Romney did, have an especially hard time relating.

So if you're trying to figure out how Romney, the presumptive Republican nominee for president, is doing in the next few months, watch closely how he handles the issue of increasing disparities of wealth among Americans and how he defends himself against the inevitable "you're a filthy rich man" attacks from the Democrats.

To date, the former Massachusetts governor seems to be settling into the classic Republican position that Republicans don't have a wealth problem, Democrats have any envy problem.

As Romney put it during his victory speech in New Hampshire, President Obama is a "leader who divides us with the bitter politics of envy."

But not to worry, folks, there will be no class warfare from this owner of an estate on Lake Winnipesaukee. On the contrary, Romney wants to "lead us down a different path, where we are lifted up by our desire to succeed, not dragged down by a resentment of success."

This could work. Americans are an optimistic lot. They still rightly believe this is the land of opportunity, and they still rightly distrust government as the fixer of all problems. But it won't be easy for Romney to glide over the battlefields in the intensifying "war" among economic classes, as prosecuted by Democrats and Republicans alike.

(Class warfare is like negative political advertising: everybody says they disapprove of it, and everybody responds to it.)

Consider the findings of the latest survey by the Pew Research Center, released Jan. 11, which indicate that roughly two-thirds of Americans now believe there are "strong conflicts" between rich and poor in our nation. Two years ago, when Pew did a similar survey, 47% of respondents said there were strong rich-poor conflicts.

Consider a U.S. Commerce Department report from last August showing that corporate profits increased by 8.3% in 2009 and 10.8% in 2010, two years when wages continued to decline as a percentage of national income. "That continued decline may help explain the economic worries of many Americans who have jobs but still fear they are falling behind," New York Times reporter Floyd Norris observed.

And consider the declining ratio of employment to population: in June 2007, some 63% of adults were employed; two years later, 59.4% were employed; and in June 2011, 58.2% had jobs.

No millionaire has ever looked to me for advice, but if I were Mitt Romney, I'd be careful using that "envy" line. A 58-year-old man who's been out of work for two years does not want to be scolded for believing the system is stacked against him. And a single mom who's lost her home to foreclosure does not want a lecture on the virtues of a system that bailed out the banks first.

Republicans like Gov. Romney believe this nation can grow itself out of the deep hole it's in, while moderates of both major parties -- Hello, Alan Simpson! Hello, Erskine Bowles! -- believe a mixture of tax increases, tax reform, and restraints on big entitlement programs like Medicare will do the trick.

The GOP and its supporters will spend tens of millions of dollars trying to convince Americans Obama is a crypto-socialist bent on turning the U.S. into what Romney calls a "European-style entitlement society," while Obama, exploiting the tremendous, natural advantages of an incumbent president, will plant himself firmly on that middle/moderate, Simpson-Bowles-like ground.

Amazing, isn't it, how much this presidential election is starting to look like the 2010 gubernatorial election in Massachusetts, when another aggressive, business-savvy Republican took on a centrist Democrat with middling job approval ratings?

Will Romney Ever Achieve Total Proficiency as a Dispenser of Red Meat?

Wednesday, January 11, 2012

Mitt Romney delivered the goods last night during his victory speech in New Hampshire and the audience ate it up. Much of what he had to say was lifted from his standard stump speech and TV commercials, so he unloaded the words fairly easily, one fastball after another to Obama's head. He said:

"President Obama wants to put free enterprise on trial."

"Our campaign is about more than replacing a President, it is about saving the soul of America."

"President Obama wants to fundamentally transform America."

"He wants to turn America into a European-style entitlement society."

"This President takes his inspiration from the capitals of Europe."

"Internationally, President Obama has adopted an appeasement strategy."

"He apologizes for America."

"If this election is a bidding war for who can promise more benefits, then I'm not your President. You have that President today."

It was strong stuff, stuff meant to call forth strong emotions, some of which the audience would not be consciously aware of, such as fear and resentment of a different-looking leader with a very foreign name.

I have a theory that Romney doesn't really believe a lot of what he's saying on the campaign trail, that he is uncomfortable with the rhetorical demands of red-meat politicking, and that his discomfort often shows in the smiles and eyes that hold something back, and in the posture that can suggest a freshman at his first dance. He's simply not good at faking sincerity, which might tell us his parents did a good job putting some bedrock under his character.

Mitt Romney is a highly intelligent man. He earned an MBA and a law degree simultaneously at Harvard. He made a fortune for himself and his colleagues at Bain Capital by putting together solid business deals. He's a "deals" superstar. He succeeded because he can look at the world dispassionately, evaluate events objectively, and make decisions bloodlessly on facts and numbers alone. Those who have worked with Romney say you can never give him too much data.

So the first time he said in public that his election is tantamount to "saving the soul of America," it must have been hard for him. He was crossing a big threshold, proclaiming an historical mission of national salvation, which is something they don't practice much at Harvard Business School and Bain Capital.

I remember a story about Romney, soon after taking office as governor of Massachusetts, visiting a state representative who had graduated from Harvard Business School and asking her, "What is the value of intelligence in this building (the State House)?" (It was explained to me that "value of intelligence" is a term used at Harvard to denote the quality of information one receives from others in any given situation. High-quality intelligence is therefore the truest and most reliable by objective standards. People making business deals obviously have a burning need for intelligence like that.) The rep answered Romney by saying, "Governor, the value of intelligence as you understand it does not exist in this building." I'm sure Romney appreciated the rep's candor even as he shuddered within.

Romney is now far removed from the world of business. He not only functions full-time in a world where the value of intelligence, as he once crucially understood it, does not exist, but also has become, of necessity, a skilled player in that world, even as he paradoxically stakes his claim to the Presidency on his business acumen.

Fiscal Policies Championed by Tom Finneran Helped See Us Through the Great Recession

Thursday, December 29, 2011

As 2011 becomes history, there are definite signs the economy of Massachusetts is moving in a better direction. For example:

- Some 5,000 new jobs were created in November, (the second straight month of employment gains), pushing the state's unemployment rate down to 7%.
- On Jan. 1, the Massachusetts income tax rate will drop from 5.3% to 5.25%, a change that will put an extra $110 to $115 million in taxpayers' pockets next year. (Income taxes are coming down because tax receipts rose in 2011 at a sufficient pace to trigger a mandated decrease that went on the books in November, 2000, when voters passed a tax cut ballot referendum. If our economy had not improved, the rate would have stayed at 5.3%.)

So maybe this is a good time to recognize one of the unsung heroes of the Bay State turnaround: Tom Finneran, former Speaker of the Massachusetts House of Representatives. How, you rightly ask, did someone who left office in 2004 help our state rebound from an economic crisis that began in 2008 and quickly led to the worst economic conditions our nation has experienced since the Great Depression? The answer is found in three words: Rainy Day Fund.

During the 1990s, and particularly in the second half of the decade, the Massachusetts economy was booming. Revenue flowed into the state treasury like a surging river in springtime. Every year seemed to produce surpluses in the hundreds of millions of dollars in the budget of the Commonwealth. As tax revenue proliferated, so did the ideas for spending that windfall -- every penny of it -- in the legislature.

However, Finneran, who had mastered the intricacies of the budget as House Chairman of Ways and Means before being elected Speaker in 1996, always insisted that a truly significant portion of those surpluses be set aside in the Stabilization Fund, or Rainy Day Fund, as it is more commonly known. His strong and principled voice on this matter, coupled with the formidable powers of the speakership, which Finneran showed a knack for making progressively more formidable, were enough to carry the argument year after year. Eventually, the idea that Massachusetts should have the largest possible Rainy Day Fund became Beacon Hill orthodoxy, to the point that the fund topped $3 billion by the time Finneran left office.

At the end of Fiscal Year 2008, (July 1, 2007-June 30, 2008), as the Great Recession was just starting, the Rainy Day Fund stood at $2.3 billion. Over the next three years, the state spent that account down to $700 million as it made up for recession-driven revenue declines and dealt with a host of problems related to the poor economy.

Had the state not had $1.6 billion available to deal with the Great Recession, conditions in Massachusetts would have been far worse than they actually were, which were quite bad enough as they were. Cuts to vital programs, such as Medicaid, would have been devastating, and employment in the public sector would have been slashed much deeper than it actually was. There are literally thousands of teachers, social workers, police officers and firefighters who kept their jobs, and thus their ability to care for their families, because Massachusetts had a big Rainy Day Fund when the economy tanked in 2008-09.

Since Tom Finneran was more responsible than any other elected governmental leader for embedding the Rainy Day ethos in modern state fiscal policy, it is no stretch to credit him with helping to save the state from economic ruin and to make it possible for the state to set a course toward economic recovery, whose signs we discern at the dawn of 2012.

Finneran was never a really popular statewide figure. There are many who consider him to have been an ironfisted, autocratic and needlessly pugnacious. And there are some who relished his fall from grace in the years after his speakership, considering it his just desserts. But there is no critic who can take an ounce of credit from him for having been right in a huge way on how to build a budget and plan for the future. No critic can diminish the satisfaction he is entitled to for having created the circumstances that allowed so many citizens of Massachusetts to dodge the worst blows of the Great Recession.

As Michael Cahill, the former rep from Beverly who served in the House with Finneran, puts it, "He (Finneran), more than anyone else, deserves the credit for enforcing on us the right things -- so many of the right things -- we did on the budget in the 1990s and the early-2000s. You cannot overstate the positive impact Tom Finneran had on the fiscal health of Massachusetts."

So if you and your family are breathing a little easier, feeling a little more confident about the future, this New Year's Eve, consider raising a glass to Tom Finneran.

For Purposes of Prognostication, View Senate Race Through the Prism of High School

Thursday, December 22, 2011

"Running for public office is no different from running for senior class president in high school," I remember a legislator telling me years ago.

In reply, I said something intelligent like, "What do you mean?" And he said, "Do you have anything between those big ears of yours? Popularity! It's simple: every election is a popularity contest."

In that context, consider the 2012 election for U.S. Senate in Massachusetts as a way to answer the question, "Would Elizabeth 'Professor' Warren have beaten Scott 'Centerfold' Brown for senior class president?" Ask yourself, "Who would have won if Warren and Brown had been in my senior class," and you'll have the answer that everyone else will have to wait until the night of Nov. 6, 2012, for.

I grew up in a city where Republicans were as rare as nuns in a nudist colony, but I'm pretty sure Brown would have beaten Warren at my school pretty easily. And judging by what I heard historian Doris Kearns Goodwin say yesterday on "Morning Joe," I'm inferring that Brown would have beaten Warren at Kearns Goodwin's school, too.

"...we need Scott Browns in this world," said she, who once worked for Lyndon Johnson and used to teach at Harvard, and who is, let's face it, pretty much a liberal darling. "If there were more Scott Browns in more states and more cities, then perhaps this partisanship (in Congress) would not be as dysfunctional as it is because he's able to cross party lines, he's able to think independently."

Within hours of Kearns Goodwin's appearance on "Morning Joe," the Scott Brown for U.S. Senate Committee had issued a press release drawing attention to her comments and using them as a starting point for a proclamation of Brown's bona fides as an Independent with a capital I. The release quoted "Brown's aides" (unnamed) as saying the former state lawmaker "has shown an independent streak since the day he defied political oddsmakers and won a January 2010 special election to succeed the late Sen. Ted Kennedy, the liberal lion who had kept the seat in Democratic hands for 46 years."

Elsewhere, unnamed "campaign aides" were quoted as saying, "It's about more than politics for Brown. The moves are part of his campaign promise to be an independent voice and moderate voter in the Senate...Aides rattle off a laundry list of examples showing Brown bucking his party from his earliest days in the Senate: he voted for the new START treaty with Russia, voted to repeal the 'don't ask, don't tell' policy banning gays in the military. He also voted against Rep. Paul Ryan's budget plan and an effort to defund Planned Parenthood."

And if clueless readers had somehow missed the point that Scott Brown is an Independent guy with a capital I, the release ended on this note: "Scott Brown has never been a right-wing ideologue," said one campaign aide. "He has always approached each issue with an open mind and independent manner, and votes in the best interests of his constituents and state, regardless of party affiliation."

Brown didn't go from the Massachusetts Senate to the U.S. Senate in 2010 because all the Republicans voted for him, and Warren won't move from Cambridge to Washington, D.C. next year if all the Democrats vote for her. There are not enough registered Democrats or Republicans in the Bay State to tip an electoral contest to any of their respective statewide candidates. Independents rule! As of this past spring, 36.5% of all registered voters were Democrats and 11.3% were Republicans, whereas 51.9% were "unenrolled," which is to say they consider themselves independent. And that's a category that has been growing every year for a long time now.

According to the Elections Division of the office of the Massachusetts Secretary of State, Bill Galvin, independents are heavily concentrated in the central and western parts of the state, and are least likely to be found in urban areas. Every suburban community seems to have a high percentage of unenrolled voters. For example, in Plymouth, the largest community in the state, territory-wise, 60% of voters are independents.

You're bound to see Scott Brown in his pick-up truck cruising the burbs next year, but you'll also see him stuck in traffic in Boston a lot because that's where there are tons of Democrats. He'll want to keep them in tune to his song of independent political expression or persuade them to join his cool kids choir.

Judging by what Boston Mayor Tom Menino, long a poohbah of the Democratic Party, has said this year about Brown, Ted Kennedy's successor has made serious inroads in the Hub. Please recall Menino emerging from a breakfast meeting with Brown at the Parkman House in January and telling reporters, "He's a Republican and I'm a Democrat, but those days are over." And don't forget Menino telling the Boston Globe in early September, "Scott Brown has something about him that people gravitate to," and then wondering if Elizabeth Warren's candidacy is "saleable." He said, "Do I know she can be saleable? I don't know that. But there are some people -- who have greater political minds than mine -- who believe so. But I think you have to be out there and squeeze the flesh and see how they feel."

Saleable. Isn't that a synonym for popular?