Top of Mind: Charlie Baker, Extended Version

JB: How big a deal is the $1.1 billion in the stimulus bill set aside for comparative effectiveness research?

CB: Well, it turned out to be a really big deal. …That seemed to have generated as much noise in Washington as almost anything else in the bill, which is really interesting to me because a) it’s not a lot of money, and b) it’s not a new idea. It’s a concept that’s been banging around in federal policy discussions for a long time, and it’s built on this notion that the feds have a tremendous stake in the cost of healthcare—we kind of all do—and maybe we ought to put some of that stake into studying what works and what doesn’t.

JB: And so do you favor it?

CB: I’m for it. Yeah, I think at the end of the day, we should do more of this kind of research, not less. I think the big debate on it ends up being about what’s the process we’re doing it, how do you allocate the funds, what’s the right way to organize it.

JB: Because then you get into the whole “rationing” argument.

CB: I don’t think it’s the rationing issue as much as it’s this argument about who do you want making a decision about care delivery, a bureaucrat or a doctor? Right? At the end of the day, if it does end up being the kind of thing where the bureaucrat makes the decision instead of a doctor, that’s a problem. In my mind the thought was always, You do the research the same way you do a lot of the basic research now: Feds fund it, research is done by research institutions, okay, published in peer-reviewed journals—I mean, I wouldn’t think the process would be that much different. And then the information becomes incorporated into the way it becomes available in the practicing community, and the practicing community incorporates it into the way they make decisions.

JB: Does it frustrate you that your organization is part of an industry where the trend line, at least in terms of public perception, is headed downward?

CB: Sure! Yes! …I think people around here work pretty hard on trying to make the products that we offer and the services we provide both understandable and accessible and affordable. But I’m acutely aware that affordability has been a hard one to achieve over the course of the past four or five years. Now, the interesting thing is if you look at the trend data back to 1965 or so, it’s not that much different now than it was then—it was always growing at about 2 percent more than GDP on an annual basis. That’s been pretty much the number for 40 years. What’s different now is the cumulative impact of it. What it was doing when it was 5 or 6 percent of GDP, it wasn’t anywhere near as obvious to people as it is now that it’s 16 or 18 percent.

The other thing is, back then you didn’t have the same cost differential between what the public sector was paying for services and what the private sector was paying. You’re now in a situation where the private sector’s probably paying 40 percent more than the public sector’s paying for most services. And that has created a much greater awareness for those people who have purchased insurance from us that they’re carrying a pretty heavy load here for the Medicare program, the Medicaid program, and the uninsured population. Which they weren’t carrying 20 years ago, when Medicare and Medicaid were more or less paying their fair share of the puzzle.