Top of Mind: Charlie Baker, Extended Version

JB: How has this job changed the way you come at healthcare politically?

CB: …I didn’t really appreciate how incredibly powerful the influence of Medicare is on the basic day-to-day operations of what most people think of as traditional healthcare until I came here and started to see how it played out. It was amazing to me. …So that would be number one—how incredibly important Medicare is to the whole ship in ways I never understood. I’m not even sure if Washington understands how influential Medicare is on everything else.

The second thing would be a much better understanding of the difference between managing a public program, where you have beneficiaries for whom you’re the sole solution available, and being in a competitive market. …If we don’t prove our worth to [our customers and members] every single day, they may not come back. Which creates a sense of urgency around what you’re up to and how you make decisions that’s just different.

In the public sector, you’re in the news every day. Everything you’re doing is open-book. And you just get used to the fact that the media’s gonna write about what you’re doing. It just is, okay? But when you’re in the private sector, if you show up in the media, it’s usually bad news. And it’s usually worrisome for your customers, and troubling for your employees, and disruptive in a way that when you’re in the public sector, it’s just part of the game. That was really interesting for me. I was completely desensitized to the notion that every day was potentially a front-page story. It actually made me less inclined to get overly worked up when we were making a lot of bad news here in the late ’90s, when we were going through the turnaround and all the rest. But I did get a far deeper appreciation for how disruptive and troubling that was to customers and people around here.

…That was one reason we started sending out e-mails, every Friday, to staff. Every Friday: “Here’s what’s going on, here’s what’s gonna happen next week, here’s what’s gonna happen the week after, here’s what we’re gonna do about this, that, and the other thing.” Part of my objective was to try and stay ahead of the news cycle, but part of it was also to give people something to say on the soccer field and in the grocery store to their spouse when they went home at night. And to keep people from being just constantly surprised by what was coming out in the news.

JB: Let’s go back to how the job has affected the way you look at it politically. The second part of your answer, you kind of get to that idea about the market keeping you honest. People have options.

People have options!

The first part—the market’s so rigged…

CB: “Rigged” would be your word and not mine.

Um, slanted? Influenced?

CB: Influenced! Definitely influenced.

JB: But it can’t adjust, because one dominant player is so influential.

I can say with virtual certainty, day in and day out, I know more what’s on the minds of my members at Harvard Pilgrim, and our customers, than Medicare has a chance of knowing. We collect daily data on who’s calling us, what they’re calling us about, with an account on the member’s side. We know what issues are hot, why they’re hot, when they’re hot, and we’re there to deal with them. We spent a lot of time talking to our members on the account design, the plan design on our products and messaging and all the rest. It may not always look like it, but they have a tremendous amount of input into what we say and how we say what we say. Obviously the one thing that Medicare has that we don’t is just unbelievable scale and the power of the federal government.

…I don’t think there’s clear consensus in this country politically between the notion of a mixed model versus all the way one way or the other. There’s tremendous ambivalence, based on every survey I’ve ever seen. Do people want no choice? Of course not—people want choices. Do they want more choices, so many choices that they’re confused by their choices? Probably not. Do they want Medicare for all? At some level, yeah, until you actually explain to them what that means, and then it doesn’t look so good anymore. Do they want private plans providing all the services? No. To some extent, part of it is that while people might not feel great about us, their general view about government overall isn’t all that high, either.