Top of Mind: Charlie Baker, Extended Version

JB: The merger between Mass General and the Brigham—a net positive for the people of Massachusetts?

CB: I think it depends upon how you want to define the objectives of the merger. …If you think back to 1993 or whenever it was that it took place, the big fear was that if you had all these big hospitals in downtown Boston slugging it out, you would create a medical arms race where everybody would have to do everything and be at every kind of service. And that would be wildly expensive, and not remotely efficient or effective. …People’s big fear was that if they all stayed as independents, that you’d have a proton beam machine in every provider organization, which didn’t make any sense at all.

[The merger] probably helped from a research point of view, in terms of applying for accessing and securing federal grants. It probably helped [boost] presence in the national stage. …And it certainly created an organization that had the capacity to build a lot of clinical information technology, which over the course of the next few years is supposed to produce some significant improvements in care quality and cost-effectiveness. But that’s kind of a potential opportunity at this point.

That’s the promise, I guess, of the merger, which was that eventually they would get around to being able to clinically integrate downtown services, community services, and wrap it all up into organized, integrated delivery system.

JB: Because of the expansion into other markets, not just downtown or in Boston proper, you have a proton beam race happening in a different way…

CB: That’s a real concern, and one that’s been expressed by a lot of people, not just me.

There was a study that was done after Harvard Pilgrim got into trouble. The state community healthcare commission…did a big analytic of what had happened to healthcare costs, 2000 through 2001, and one of the conclusions was that healthcare costs have risen at a pretty steady clip through the 1990s and the first couple of years of this decade. So the question was, Why is everybody so financially in trouble if, in fact, the growth rate at that point was 6 or 7 percent a year, and inflation was 2 or 3 percent? The argument was, it’s growing at twice the rate of inflation, so why is everybody so worried about this?

And what we figured out, when everybody dug into the data, was that we were starting to replace low-cost community capacity with high-cost, mostly downtown capacity. And so the question became, Is that a good thing or a bad thing from the public policy point of view? The low-cost folks can deliver the same quality as the high-cost folks—should there be some kind of policy to preserve some of that?

…That trend basically continued, and it continued throughout most of the course of the past six or seven years. And proponents [of expanding high-cost capacity] would say you’re going to end up with a better-capitalized and a more integrated care-delivery model at the than you would have had before. Others would say that you’re going to have a more expensive system that doesn’t necessarily deliver a level of care that’s any better then what was there previously. I think the jury’s out on which one is right, but I certainly have sympathy for the latter group when they talk about this issue, because intuitively, it makes sense to me.

JB: In general, given the financial climate, is there a sense that what has been accomplished by Massachusetts’ healthcare reform will endure?

CB: I said from the beginning that I thought the test for this over the long term would not be whether or not we could get people enrolled. It would be whether we could sustain the costs—whether we could make it affordable to the government and to the participants over time. That’s still the $64,000 question, probably more like the $64 million question, and on that one I think we still have our work cut out for us, bigtime.

JB: What’s your family hospital?

We’ve been Harvard Vanguard patients since my wife and I were first married. Our kids go to the same pediatrician that they started seeing when the one who’s now 18 was a year old, at the Kenmore center. And I go to the same doc and so does my wife—hers at Post Office Square and mine at the Kenmore center. All three of our kids were born at Beth Israel. …That’s not an impertinent question.