As (sequentially) a medical student, reporter, legislative lobbyist, researcher for a public interest group and later for a state agency in Hartford (from 1972 to 1990), I started to learn that the well-funded manufacture of the sausage of public opinion on contentious political issues too often produces cheap, low quality, or even worthless political baloney.
That lesson was reinforced by my recent examination of a linchpin for the Trumpian fear-mongering campaign against Question 1, which will appear statewide on our November 6 ballots. That linchpin is the much-touted study, released on October 3 by the Massachusetts Health Policy Commission, of the potential financial costs and systemic effects of the proposed law on health care services.
Question 1 would establish a law to require minimum nurse-patient staffing ratios for all Massachusetts hospitals, ratios that would vary widely depending on the service: emergency room, intensive care step-down units, stable medical floor patients, maternity patients, etc.
Many of the dramatic arguments against it are based on falsehoods, or unvetted assertions. A 700-word column can address adequately only one or two of the basic ones.
I have studied the issue of nurse staffing and some of the abundant professional literature on it, since it briefly became front-page news in May 2017, the eighth month of the protracted contract negotiations between Berkshire Medical Center RN nurses and BMC-BHS management.
A careful reading of the HPC study (written by Professor Joanne Spetz) reveals that it is technically flawed and incomplete. Its numbers are highly questionable.
For example, its attention-getting estimate that question 1 would add up to $969 million per year to total health care costs in Massachusetts was presented without even the baseline context of the HPC’s own estimates of that total for the years 2013 thru 2017. Such a basic omission was inexcusably sloppy.
Even if $969 million were an accurate estimate, it would be less than half the total increase of $2.1 billion in 2017. In a different political context, voters might not blanch at that figure. For many years we have tolerated, even sought, larger annual increases in our state’s share of the cost of operating the US medical-industrial complex.
The vital public policy issues which the HPC report attempts to address can’t be intelligently addressed through financial numbers alone, technically accurate or not. The practices of hospital-based medical care and good hospital management depend as much on compassionate treatment of both patients and caregivers as on number crunching, as any honest, experienced bedside clinician can testify.
How sustainable are these high non-monetary costs? What are the long-term prospects for patient safety, for clinical outcomes, and for premature staff turnover, if the current abundantly documented understaffing is not corrected?
Some of these costs are semi-quantifiable, and there is a professional literature that attempts to address them. They are completely ignored in the HPC’s report.
Its October 3 release was premature.
In soliciting Professor Spetz’s study without informing major stakeholders of its commissioning and existence until 9 days before its October 3 release, and in publishing it without independent professional vetting, the HPC created a classic “October surprise” on a vital political issue. This move deeply tarnishes the HPC’s institutional integrity and compromises its mandated mission to supply us with reliable, non-partisan information on health care issues.Â
My reading of the political winds, three days before the election, is that Question 1 will be defeated in a landslide. But the issues around RN nurse staffing will not disappear with its defeat, any more than the increasingly alarming effects of climate change on our state and country will disappear because some ideologues want to wish (or legislate) them away.
If, by some political miracle, Question 1 passes, it might need to be revised. If so, stakeholders would continue to advocate their viewpoints on this matter and on related ones, in our legislature. But that is a normal process for many new laws, and even for old ones, in a constitutional, representative polity.
John Breasted, a freelance writer and former legislative lobbyist, has lived in Great Barrington for 23 years.
