Top of Mind: Charlie Baker, Extended Version

JB: How optimistic is it that something significant will be done about healthcare reform in the next few years?

CB: You know, the big problem with healthcare reform has always been—and this is true whether you come at it from the right or the left—that your preferred alternative to getting what you want out of reform is the status quo. So unless you’re getting exactly what you’re looking for out of reform, most people fall back on the status quo as their second choice. So that’s made it really hard.

JB: The whole devil you know versus the devil you don’t…

Exactly! So that’s made it really hard for people to go all the way to the devil they don’t know, all right? But I would say that in the past few years, there’s a growing consensus in Washington that doing nothing is simply not financially sustainable. And therefore, the devil they don’t know, warts and all, is looking like a more viable alternative. And I think that’s going to lead to a much more intense and much more meaningful conversation than the one we’ve had previously.

What’s interesting is that it’s usually coverage that drives the debate around healthcare reform. This time I actually think cost is going to be right there with coverage in the larger picture. Now, that’s kind of the optimistic view, which is that you can’t solve the coverage problem if you don’t do something about the cost problem. You can’t really solve the cost problem if you’re not serious about it, so you actually have to do some things that disrupt the system—probably for people like me as much as anybody else. The pessimist in me thinks that we’ll do a whole lot of things that just sort of push the problem off, and actually makes it worse down the road then it is now. And, you know, it’s anybody’s guess as to which one we end up with….

JB: Did the debate change for your industry? If you listen to Michael Moore, the insurers are the “bad guys.”

CB: As a general rule…I think we insurers for the most part are always going to have a certain amount of negativity attached to us. But that’s because for all intents and purposes, we’re the ones who are told to stuff 50 pounds of stuff in a 20 pound bag. The intermediary is always the bad guy in a situation like this. …We’re the ones who are supposed to make sense of patient demand, new technologies, new capabilities, government underfunding, and employer expectations. You sort of put that all together and it’s a big, hairy ball of twine. And I think being the “bad guy,” if you want to put it like that, is almost unavoidable.

But I get enough positivity from the letters and the e-mail and the phone calls and the people who stop me on the street and at business meetings saying, “Your plan is the greatest! Let me tell you my story,” that I share with everybody who works here, that I don’t have any trouble getting out of bed in the morning. There are a lot of people who depend on us and I think we deliver on that, day in and day out. …I feel okay about our place.