As Results in the 5th Again Showed, Not Voting's a Good Way to Affect the Outcome

There are 34,007 registered voters in Waltham, Mass.

Of those, 18,695 are Independents (Unenrolled), 12,102 are Democrats, 3,009 are Republicans, and the rest belong to low-voltage parties, like the Green and the Socialist.

Waltham is part of the state’s 5^th Congressional District.  On Tuesday, Oct. 15, a primary election was held for the purpose of choosing the Democrat and Republican nominees for the district’s seat in the U.S. House of Representatives.  This was a special election made necessary by the election in June to the U.S. Senate of longtime 5^th District incumbent Ed Markey. The final election will be on Dec. 10.

At 19%, voter turnout in Waltham that day was low, as it was throughout the district.  Folks in Waltham are like folks everywhere in the U.S. today.  They do not think their vote matters much.    

Of the 34,007 eligible to vote there on Oct. 15, only 6,461 did.  Of those 6,461 voters, 5,622 cast Democratic ballots. 

Most of the Democratic votes went to the hometown favorite, Middlesex County Sheriff Peter Koutoujian.  He represented Waltham in the Massachusetts House for 14 years before becoming sheriff in early 2011.  His family has been entrenched politically in the community for decades.

Koutoujian got 4,148 votes, 73% of the Democratic ballots.

Let’s take Waltham as an example of Anytown USA and play a game of what if. 

What if 80% of Waltham’s registered voters went to the polls on Oct. 15? Is that asking too much? 

What if that 80% turnout rate had applied equally to Independents and Democrats? 

What if Koutoujian were equally popular among Independents and Democrats by virtue of his local origins, popularity and effectiveness as a local legislator and a county official?  In partisan primaries, the Unenrolled may participate by requesting a party ballot.  The law makes it easy for them to put on Democrat or Republican clothes for the occasion, so to speak, and change back to their Unenrolled wear right away.

An 80% turnout would have produced 9,681 Democrat and 14,956 Independent votes. 

If Koutoujian captured 73% of both the Democrat and Independent votes on an 80% turnout day, he would have had 7,068 and 10,918 votes, respectively.  Those figures add up to 17,986.

The difference between his actual vote of 4,148 and his what-if vote of 17,986 is 13,838.

Koutoujian was the runner-up in the primary.   He lost by 6,680 votes to State Senator Katherine Clark of Melrose, who’s a shoe-in to beat her Republican opponent, Frank Addivinola, on Dec. 10.

District-wide, the actual vote totals were: Clark, 21,983; Koutoujian, 15,303; State Rep. Carl M. Sciortino, Jr., 11,160; State Senator William N. Brownsberger, 10,163; State Senator Karen E. Spilka, 9,088; Paul J. Maisano, 1,520; and Martin Long, 398.  When you throw in the blanks and write-ins for stray candidates, the total vote in the 5^th came to 69,786 -- less than 10% of the population of the average U.S. House district today, which is about 710,000.

Under our what if scenario, where Koutoujian gets an additional 13,838 votes in Waltham, his district-wide total climbs to 29,141, he beats Clark by 7,158 votes, and he starts looking for an apartment in Washington. 

Of course, this rests on an assumption of impossibility, i.e., 80% turnout in Waltham and sub-20% turnout everywhere else in the district. 

Regardless, the point stands that Waltham voters had it within their power on Oct. 15 to send one of their own into the heart of national and international affairs and, potentially, the history books.   By declining to act, enough of them demonstrated the inverse of the old truth that a small sub-set of highly motivated voters can dramatically affect the outcome of any election.

History May Prove Charlie Baker Right When He Mused on 'Trying One Casino First'

It will probably be two or three years before Massachusetts has three casinos and one parlor for slot machines up and running.

So Charlie Baker, who has recently embarked on his second campaign for governor, will have to wait a while before he can say, “I told you so.”

Remember what Baker said about casinos during his first campaign, four years ago, when the casino bill had not yet been enacted by the legislature?

He said no one could say for sure how multiple casinos would affect our economy and society, and that perhaps we should license just one casino and see how it went before licensing more.

The day may come when we learn that Baker was right.

Although Baker never offered an opinion on where that single casino ought to be, the obvious choice was Boston, the biggest city in New England.

It’s in the nature of big cities to offer all kinds of attractions to all kinds of people.  You do not have to partake or approve of everything available in a big city to see the wisdom of providing so many options for self-expression and self-gratification in one place.  Let freedom ring.

Baker’s common sense approach never had a real chance in a political system designed to respond, correctly so, to different constituencies and different parts of the state.  We thus have a law that will give us casinos in the western, eastern, and southeastern parts of the state and a slot parlor not legally tethered to a particular region but likely to end up somewhere in the 495 belt.

Considering the crying need for new state revenue, the perennial truth that all politics is local, and the knowledge we have (and don’t have) of how casinos impact populations, communities and governments, the legislature did an outstanding job in crafting the casino legislation, Chapter 194 of the Acts of 2011, An Act Establishing Expanded Gaming in the Commonwealth.

The only problem was, lawmakers had to take a shot at a moving target.  Then, as now, the casino industry was rapidly expanding.  It remains on a fast evolutionary track leading to places we cannot fully see or understand.

In 2011, Massachusetts became the 17^th state to allow standard casinos by state law.  Twelve other states allowed slot machines at race tracks at that point, and Indian tribes operated gambling facilities in 28 states.

The Institute for American Values, in a recent report titled “Why Casinos Matter,” noted that casinos “began to enter the mainstream of American society” around 1990.

During its post-1990 expansion, the report says, “casino gambling itself changed dramatically.  A national market headquartered in Nevada and Atlantic City has been joined by dozens of new regional markets across the country.  Table games catering to high rollers have largely given way to slot machines catering to middle and low rollers.  Casino gambling as a once or twice a year vacation has largely given way to casino gambling as a once or twice a month or once or twice or more a week pattern of life.”

As more states permit casinos in the hope of capturing the revenue their residents generate on visits to neighboring-state casinos -- as Massachusetts has done with an eye on Connecticut, Rhode Island and New York -- the competition for the spoils of state-sponsored gambling gets hotter and hotter.

“Casinos may begin by making lots for money for the state government,” the Institute for American Values report laments, “but the economic dynamics over time tend to become increasingly negative and zero-sum, as politicians try to solve the problem of sagging gambling revenues by sponsoring more gambling, and as every state tries harder and harder to poach gamblers from other states.”

The report perceives a connection between the nation-wide expansion of casinos and the definition by the American Psychiatric Association in 1980 of gambling as a specific medical problem “for those individuals uniquely susceptible to its appeal.”  This definition had three significant consequences, according to the Institute for American Values:

• One, it divided the American public “into two separate and unequal groups: on one side is the great majority of the population who can enjoy gambling as healthy fun; and on the other side is a small clinical population that fits the specific diagnostic criteria of gambling addiction.”

• Two, it allowed the gambling lobby to use the new definition “to promote the idea that the harms of gambling are limited and manageable and that the gambling industry itself – the producer of the harms – is also the best source of research and investigation into limiting those harms.”

• Three, it exempted states “from their traditional public health responsibility to prevent the known harms of gambling” and, instead, allowed “government to shift responsibility for treatment onto the gambler herself and onto mental health professionals.”

When a number of states allowed casino gambling to spread beyond its traditional bastions in the Nevada desert and the Jersey shore, they instigated a social experiment of vast and historic proportions.  Massachusetts is about to become a guinea pig in that experiment.

Maybe it will work out fine…or maybe not.  We may not know for sure until 2020.

You can find the Institute for American Values report on casinos at:

http://www.americanvalues.org/pdfs/Why-Casinos-Matter.pdf.

Meeting Boston's Transit Needs Is as Crucial Today as Finding Water Was in the 1930s

My brother Stephen, who lives out in West Brookfield, took me for a ride down Route 9 and into the Quabbin Reservoir on a Saturday afternoon not too long ago.

The Quabbin is the largest inland body of water in Massachusetts.  When you first glimpse how big and beautiful it is, you can’t help but go, “Wow.”  I’ve lived in Massachusetts my whole life but I’d never seen it before.  It’s like those historical sites in Boston I walk by every day and have never visited.  We take the wonders in our backyards for granted.

The Quabbin is a place of natural splendor but it is not a work of nature.  It sprang entirely from the calculating mind of man. 

Before it could be built in the 1930s, the Republican-dominated legislature enacted a law that allowed the state to dis-incorporate and take over four towns, order the relocation of everyone who lived in those towns, and dam the Swift River, a tributary of the Chicopee River, which runs to the Connecticut River. 

The Swift had to flow for seven long years before the reservoir reached its intended breadth and depth.  From just below Route 2 in the north to just above Route 9 in the south, the Quabbin covers 38.6 square miles and contains more than 400 billion gallons of water. 

The towns of Dana, Enfield, Greenwich and Prescott were obliterated, and the natural patrimony of that region was expropriated, so that the City of Boston, 65 miles to the east, could have a reliable source of clean drinking water.

It was all about the economy.  The legislature understood that metropolitan Boston could not continue to grow without more water.  To get that water, it was willing to make some tough decisions, and to face some very strong and impassioned opposition.

The townspeople of the Swift River valley challenged the eminent domain takings in court. The case went all the way to the Massachusetts Supreme Judicial Court before being decided in favor of the Commonwealth.  And the state of Connecticut sued the state of Massachusetts, claiming that water naturally intended to supplement the flow of the Connecticut River would be illegally diverted to the new reservoir, threatening navigation on the Connecticut, New England’s longest river.  That lawsuit failed, too.

I don’t know what’s more amazing, the engineering skill and prodigious labor that built the reservoir or the political will that allowed it to be built.

Some eighty years ago, the elected leaders of Massachusetts faced up to, and solved, a critical infrastructure problem, a lack of water in the east, the growing metropolitan area that propelled the state’s economy.

Today, our elected leaders are confronted with a challenge of comparable historic importance: a public transit system that does not have enough money to maintain and improve its ability to move people quickly into and around the City of Boston. 

The problems are obvious to anyone who rides the T on a regular basis: overcrowded subway cars and buses at every rush hour, old trains and track switches that are prone to breakdowns, frequent mystery glitches that cause full trains to stand by between stations for “scheduling adjustments,” slow and inadequate service during off-peak hours, too many employees who are indifferent, unhelpful or surly (particularly to tourists), non-existent overnight service, and prohibitively expensive commuter rail fares. 

And those are just a few of the problems…Don’t get me started on the escalators that are broken more often than not, the pedestrian tunnels that smell like urinals, and the drivers who scream like Nazis when your train is unexpectedly being put out of service:  “No passengers! No passengers!  This train is out of service! OUT OF SERVICE!”  Wouldn’t it be delightful if restaurants announced they were closing in similar fashion before you finished your dessert?  “No diners!  NO DINERS!”

If you want a snapshot of what I’m talking about, try squeezing onto a jam-packed, in-bound train at Wellington Station at 7:45 a.m., or an outbound train at State at 5:30 p.m.  Then imagine what the Orange Line will be like when the T opens a new station at Assembly Square late next year.   That station is a nightmare waiting to happen: many hundreds of new passengers a day on a line served by the same number of rusty, worn-out, sticky-floored, 40-year-old cars.

Paul McMorrow, one of the editors of the estimable Commonwealth Magazine, summarized what the wretched state of the MBTA implies for the future of our economy in a column published Tuesday, Oct. 8, in the Boston Globe, “Starving MBTA will stunt Boston’s growth.”

“Boston is growing at a pace not seen in the better part of a century,” McMorrow wrote.  “The city has more residents than it has at any point since the 1970s, and has arrived at the renaissance moment city leaders have been chasing for 60 years.  There’s no reason the city can’t keep up with the growth it’s seeing now, as long as it can build places for all these new people to live.

“New homes equal new residents, and new residents equal growth.  It sounds like a straightforward equation, but it isn’t.  Boston doesn’t control its own development fate.  As tough as many of Boston’s neighborhoods can be on developers, the biggest threat to the city’s growth lies with legislators on Beacon Hill.  Lawmakers are starving the MBTA of funds the transit agency needs to support the Boston region’s growth.  And as long as the T’s finances remain anemic, robust growth in Boston will be unsustainable.”

The MBTA is being “starved” for the simple reason that there are no easy or politically appealing ways for lawmakers to get the money needed to bring the T into the 21^st century.  I don’t envy them for their options: cutting the wages and benefits of the agency’s unionized workforce, abrogating costly pension commitments, and/or raising taxes. 

Creating a freshwater sea in the middle the state almost looks like child’s play by comparison.

For This Candidate for High Office in MA, Only a New Political Party Would Do

If you like someone who dreams big, you may develop a soft spot for Evan Falchuk. 

The question is, Will you vote for him?

Falchuk is a 43-year-old resident of the Auburndale section of Newton and the married father of three children.  He graduated Phi Beta Kappa from Lehigh University and earned a law degree from the University of Pennsylvania, an Ivy League school, in 1994.

He has worked as a lawyer in Washington, D.C., and as an executive in leadership roles at Best Doctors, Inc., a Boston-based global health company.

In January of this year, Falchuk founded the United Independent Party in Massachusetts.  A press release describes the party as committed “to moving from ‘small government versus big government’ debate between Democrats and Republicans to one focused on greater accountability to voters, stronger protection of social freedoms, and more innovative, fiscally pragmatic solutions that improve the day-to-day lives of individuals, families and communities.”

The party stands for “socially progressive ideas and fiscally sensible solutions for Massachusetts.”  This is a “pragmatic combination” that neither Democrats nor Republicans offer the voters, Falchuk believes.

If you go to the party’s web site --  http://www.unitedindependent.org/our-leadership -- you’ll see that Falchuk credits his late grandfather, Solomon Falchuk, with inspiring his willingness to challenge the status quo.

Solomon Falchuk, the web site says, “escaped from Russia at the end of World War I, where as a boy he saw members of his family killed because of their Jewish faith.  With next to nothing to his name, he set off for America but was sent instead to Cuba.  After several years, he moved to Venezuela, where he started his own successful business.  Solomon lived to be 101, having realized his dream that his family would one day have better lives in America – lives that included education, healthy children, security, and the freedom of self-determination.”

It seems to me that Grandson Falchuk has also been inspired by the example of Deval Patrick, circa 2005.  Up to then, Patrick had never sought or held elective office.  Evan Falchuk has never held elective office. 

Now, he's a candidate for Governor of Massachusetts.

ROBOTIC SURGERY BILL UPDATE:  In a blog post three weeks ago this date, (“Legislation Poses the Question: Are Surgical Robots Automatically Good?”), I wrote about Senator Dick Moore’s bill, SB 1069, which would create a special commission to investigate and review the use of robotic surgery in Massachusetts.  The legislature’s Joint Committee on Public Health conducted a hearing on the bill on Sept. 24.  On Oct. 1, the committee issued a favorable report on it, a first necessary step toward enactment.  SB 1069 has a long way to go still.  I hope it picks up momentum, and keeps moving all the way to the governor’s desk.

Conventional Wisdom Wrong Again: Mayor Menino Is a Master of Verbal Jujitsu

When you think of how cunningly Boston Mayor Tom Menino can send a message, you have to wonder why any supposedly intelligent person would think of him as verbally challenged.

Consider his oft-quoted comment to the effect that he would remain neutral in the race to choose his successor -- as long as none of the candidates “attack” the City of Boston.

Menino knew when he said it that no serious candidate thought he could win votes by attacking the city.

The candidate who said something like “anyone who says Boston is in good shape now ought to have his head examined” was the candidate headed to oblivion.

This wasn’t about attacking the city, and it wasn’t about attacking Menino. 

Because of the special status Menino enjoys after 20 very successful years in office, no candidate would dare risk a frontal assault on him.

Rather, it was a case of the mayor reminding his would-be replacements that he’s sensitive to criticism and slights of any kind.  Even implied criticism will get you on my bad side, the mayor was hinting. 

Hell, faint praise will get you in trouble with this guy.

The state of the mayor’s feelings is particularly relevant now that we’ve moved from the preliminary election to the final. The last thing either finalist, John Connolly or Martin Walsh, needs is to have a miffed mayor putting the word out to his superb campaign organization that he’s against him.

This could be a close election; every little thing matters.  

With that brief “attack” comment, Menino guaranteed there will be nothing even remotely critical of his tenure coming from the Connolly and Walsh camps.  He thus made progress toward the only major goal left in his public life: protecting and enhancing his legacy.

Menino’s ability to get inside other people’s heads has always been a key to his effectiveness. 

Everyone knows there’s a penalty for letting the man down, never mind crossing him.  This has worked to Menino’s advantage, as it does to every boss’s.   Last year we saw the proof of that again when the mayor was unable to come to work for many weeks due to illness and the city operated just fine in his absence.

An effective leader doesn’t have to be physically at his post when he resides permanently in the mind of every underling and inferior. 

Make no mistake.  No matter who is elected mayor of Boston on November 5, that person will remain Menino’s inferior in the political pecking order for a long time to come, maybe even forever, depending on what he’s able to get done in office.

That’s why you’ll see the new mayor being very solicitous of the former mayor.  The new mayor will desperately need the former mayor for expanding and securing his base.  The former mayor will deign to accept the blandishments of the new mayor. 

That is how icons keep their glow.

Of Casinos, Senate Leaders, Mayoral Legacies, etc. Some Wayward Friday Thoughts

Dan Conley, the Suffolk County District Attorney who’s running for Mayor of Boston, stuck his neck out early in the race by saying the entire city should vote on accepting a casino at Suffolk Downs, and not just East Boston, as the casino enabling legislation allows, as the owners of Suffolk Downs want, and as outgoing Mayor Tom Menino prefers it to go.  Polls now show a majority of Boston voters agree with Dan Conley.  Questions: Will Conley emphasize that position in the closing days of the preliminary election campaign? Will voters reward Conley by making him one of the two finalists in the November election?...Stan Rosenberg of Amherst, the Majority Leader of the Massachusetts Senate, has the votes sewed up to become the Senate President in late-February, 2015, when Therese Murray’s allotted four terms are up.  He will be following in the footsteps of another illustrious politician from the Pioneer Valley, Calvin Coolidge, the Northampton lawyer who went from Senate President to Governor to Vice President to President of the U.S.  Lest you think there are no parallels, other than the geographic, between Rosenberg, a liberal, pro-activist-government Democrat, and Coolidge, a small-government Yankee Republican of the old school, consider that both Rosenberg and Coolidge were carpetbaggers who captured the hearts of their adopted communities in Western Mass.  Both moved to the Pioneer Valley as young men from places far different from Amherst and Northampton.  Rosenberg was born and raised in Revere, a densely settled haven for immigrants on the Atlantic coast, while Coolidge was a product of the small, insular, mountain village of Plymouth Notch, Vermont…To paraphrase Robert Frost, who advised John Kennedy at the start of his presidency to "be more Irish than Harvard," I hope Stan Rosenberg is more Revere than Amherst when he's leading the Senate…They’re going to tear down and relocate Malden City Hall, which is not even 40 years old.  Will Boston City Hall be the next to go?  The problem with Malden City Hall, originally known as the Malden Government Center, is that it sits in the middle of what was once the community’s main east-west thoroughfare, Pleasant Street/Route 60.  When it was built in the mid-Seventies, pedestrian malls were the rage. The new Government Center was designed as the western anchor of a mall extending east three blocks to the intersection of Pleasant and Main Streets, where a now-long-gone Jordan Marsh department store stood at the time.  The mall was supposed to revive the fortunes of downtown Malden, once a diverse retail center that drew shoppers from many neighboring communities and then a shadow of its former self, having been eviscerated by the new shopping malls in roomier suburbs.  It just never worked out.  The blocking of Pleasant Street to vehicular through-traffic slowed commerce, rather than intensifying it…From the outside, the city halls in Malden and Boston could not be more different.  The one in Malden is a square, brick-covered box with identical rows of square windows on all of its six floors.  The one in Boston is constructed mainly of concrete, and tapers outward, like a wedge, as it rises.  Malden City Hall is a predictable cube; Boston City Hall puzzles the eye with different levels, planes and angles.  But they share a common architectural vice in that both make a visitor feel small and isolated.  Malden and Boston City Halls are almost totally lacking in humanity and warmth…It’s hard to see many people shedding a tear when they implode that monster that’s squatted in Pleasant Street, Malden, all these years.  Yet I will wince to see a part of the Walter Kelliher legacy blown to bits.   He was the longtime mayor of Malden who championed the plan for that mall and pushed it through the City Council.  And that’s not all he did in 16 years as mayor.  Kelliher was an absolute master at winning state and federal grants for redevelopment projects: new and rebuilt roads, schools, parks, playgrounds, apartment buildings for the elderly, parking garages, etc.  He traveled regularly to the State House in Boston and the Capitol in Washington to shake the government money trees.  He was big stuff.  There was no mayor anywhere in Massachusetts, and maybe all of New England, who was better at obtaining state and federal grants in the Sixties and Seventies than Walter Kelliher.  But if you walked down any street in Malden today and asked people at random, “Who was Walter Kelliher,” most would probably say, “Who?”  It’s not Kelliher’s fault, that’s just the way things are.  Legacies are fragile, short-lived things.  Anyone knocking himself out in a publicly elected position, and making headlines as easily as falling out of bed, should keep that in mind…About ten years ago, I had a meeting at Malden City Hall with an at-large member of the City Council.  I went out to Malden early on a summer afternoon just to walk around and see how all those changes made downtown twenty years before had stood the test of time.  When I entered the meeting, I mentioned that I had enjoyed my visit to his city because it gave me the opportunity to walk the lanes I’d walked as a young reporter at the Malden Evening News (1974-84).  “It’s amazing to think,” I said, apropos of nothing, “that there were years when Walter Kelliher won all of the discretionary Chapter 90 (road-building) funds in the state.  He could put together an application faster than anyone.”  I expected the councilor, who was anything but dull-witted, to nod and say something like, “Oh, yeah, Walter was incredible.”  Instead, he looked at me blankly and said, “He did?”  Kelliher hadn’t been dead ten years at that point…Speaking of Malden, former U.S. House member and newly minted U.S. Senator Edward J. Markey, who grew up in the Edgeworth section of the city and still has a home there, issued a press release yesterday on the passage in the Senate of a bill to keep the federal helium reserve open.  This was important, Markey noted, because helium is used in MRI machines, the manufacture of computer chips, and NASA rockets, not to mention those nifty balloons that float to the heavens when you let go of the string.  “This legislation is proof that we can work together to keep important government services up and running,” Markey said, “not shut them down over ideological battles.  As co-author of this bill in the House, I know this bill can pass and get signed into law, which is more than we can say for most bills these days.”  I love Markey for his optimism.  But anyone who thinks Congress can avert a government shutdown over the budget as easily as it will keep the helium flowing has been taking too many whiffs of another kind of gas, nitrous oxide, a.k.a. laughing gas.  Come to think of it, I'd like to administer a powerful dose of that to every Tea Party Republican every day Congress convenes…We’ve seen this kind of story too often. “Rides to Nowhere, for No One: Owner of Medical Transportation Company Allegedly Billed Taxpayers for Rides Under Dead People’s Names.”  That was the headline on a press release today from the office of Attorney General Martha Coakley.  The case concerns the owner of a medical transportation company in Webster, MA, who stands accused of defrauding the state’s Medicaid program of more than $470,000 by billing for services under the names of deceased individuals, and for other medical trips that were never provided.  As we used to say in Revere, crime does pay.  Well.  For a time.  And often much longer.

Legislation Poses the Question: Are Surgical Robots Automatically Good?

Senator Dick Moore is one of those legislators who know how to “move an issue,” as they say at the State House.  That’s a good thing for anyone who may ever become a patient at a Massachusetts hospital or surgical center.

Moore sits today in the second-highest place in the upper branch of the Massachusetts legislature: Senate President Pro Tempore.  But for years he was the Senate’s point person on health care as the co-chair of the Joint Committee on Health Care Financing.

There are few state legislators across the nation, and certainly in Massachusetts, who know as much about health care practices, policies and costs as Moore.  Senator Minority Leader Bruce Tarr likes to tease Moore during Senate budget debates by referring to him as “the high commander of health care.”

Moore’s knowledge and leadership proved crucial in 2006 to the enactment of the state’s universal health care legislation, which in turn became the template for federal health care reform in 2009, the Patient Protection and Affordable Care Act, also known as Obamacare.

So if Dick Moore thinks we need a new law governing the use of robotic surgical devices, you can bet that surgeons and hospital administrators everywhere in Massachusetts are taking notice.   

And you can reasonably expect that the doctors and hospitals who have lately made big investments in robotic surgical training and equipment will be represented in some effective way at the State House on Tuesday morning, September 24, when the Joint Committee on Public Health holds a hearing on Moore’s “Act Relative to Robotic Surgery in the Commonwealth,” Senate Bill 1069.

SB 1069 would create a special commission to investigate and review the use of robotic surgery throughout the state.  This commission would develop a process for certifying applications by hospitals for any new robotic surgery programs, and establish guidelines for the training and experience of all surgeons who wish to perform robotic surgery.

I’m probably like most folks in that I have been vaguely aware of the existence of robotic surgical devices.  I’ve heard they’re supposed to be good for removing prostate glands, for example. I never want to find out how good.   

I’m like most folks, too, I assume, in not wanting to dwell on the mental image of a computer-driven robot slicing me open on an operating table someday. I was born too long ago to have an ingénue-like trust in anything that runs on microchips.

There seems to be no stopping the rise of the robots in the surgical suites of America.

“…robotic surgery has grown dramatically,” the New York Times reported on September 9, 2013, “increasing more than 400 percent in the United States between 2007 and 2011.”

According to that article, headlined “New Concerns on Robotic Surgeries,” U.S. hospitals have acquired approximately 1,400 surgical robots known as the da Vinci system from a California company called Intuitive Surgical, Inc.  The da Vinci systems cost between $1.5 and $2.5 million apiece.

If they buy it, you can be sure they’ll use it as much as possible.

There’s conflicting evidence on whether there are more or less surgical errors associated with robotic equipment, and the federal government is looking into the question.  But there can be no doubt that innovations like surgical robots are adding to the nation’s already staggering health care bill.

Dr. Martin A. Makary, an associate professor of surgery at Johns Hopkins University, asserted in that September 9^th New York Times piece that the expansion of robotic surgery has occurred without proper evaluation and monitoring of the benefits.

“This whole issue is symbolic of a larger problem in American health care, which is the lack of proper evaluation of what we do,” Dr. Makary was quoted as saying.  “We adopt expensive new technologies, but we don’t even know what we’re getting for our money – if it’s of good value or harmful.”

That article may be found at:

http://well.blogs.nytimes.com/2013/09/09/new-concerns-on-robotic-sugeries/

I’ve never spoken with Senator Moore about his robotic surgery bill, but I am certain he considers it one means to the end of getting good value for all the money we spend on health care in Massachusetts.  I’m basing that on the senator’s many persuasive public comments on the importance of controlling health care costs so that we can maintain our state’s popular system of universal health coverage over the long haul.

It will take many measures like SB 1069 to get us where we need to be.  The sooner it’s passed the better.

ADDENDUM:  There are at least two other New York Times articles I'd recommend to anyone interested in robotic surgery and its implications for the health care system.  One was written by Roni Caryn Rabin: "Salesmen in the Surgical Suite," 3-25-13, the other by Ezekiel J. Emanuel: "In Medicine, Falling for Fake Innovation," 5-27-12.  They may be found, respectively, at the following:

http://www.nytimes.com/2013/03/26/health/salesmen-in-the-surgical-suite.html?pagewanted=all

http://opinionator.blogs.nytimes.com/2012/05/27/in-medicine-falling-for-fake-innovation/