hi i'm state representative dave rogers and this is the rogers report today i'm really pleased to be speaking with state representative steve walsh chairman of the joint committee on health care financing committee on which i sit first however i want to give you a brief update on what has been happening on be hill the most significant action in the house of representatives this fall was a vote on legislation to reform welfare in massachusetts a debate that arose amidst reports of waste and fraud of course i'm highly concerned whenever i hear reports of waste and inefficiency in government to maintain public confidence government programs need to be run efficiently and transparently that being said the data reveals that only a small percentage of the overall welfare budget is being spent questionably questionably let alone fraudulent so while i am in favor of measures to specifically target existing waste and fraud i went into the debate concerned that proposals would have the effect of not really preventing waste and fraud but make assistance difficult for the needy to come  by welfare reform should also be a means in my opinion to ensure that appropriate help is reaching those in need of assistance so my advocacy during the debate was in support of services to help those find employment and or education so they could move from welfare to work and in opposition to overbearing measures i thought would have been hard on folks who are already struggling and not really prevent fraud and abuse during the period of time leading up to the debate and on the day of the vote itself my colleagues and i both met personally and in groups with speaker de leo and chairman of ways and means brian dempsey who presided over the most open debate i have experienced so far in the leadership was great  allowing us to have significant input and after input from many groups was taken consensus was reached and the bill passed unanimously one hundred fifty two to nothing the bill introduced a number of measures to make system more efficient and more accurate but also had a number of measures to move people from welfare to work including six million dollars for employment services a particular victory for me during the debate was that the poverty commission which the legislation created the budget for that was double based on an amendment that i filed another action undertaken by the house this fall was passage of election law reforms to maintain our healthy democracy we must do all we can to ensure that people vote particularly younger voters whose voting habits will continue throughout the road rest of their lives as i believe voter participation is currently far too low i was pleased to support measures to help bring about change and bring more people to the poll so beginning in the year two thousand and sixteen massachusetts will have early voting leading up to presidential elections this should help make voting more accessible to those who are busy election day massachusetts will also be introducing online voter registration to help modernize and make the system more accessible to voters and i am now pleased to introduce my guest chairman of the joint committee on health care committee this term thank certainly hit the ground running and you're doing a great job and i think in support of your constituents know how hard i watch you work both in the building and outside of building for them every day so i was happy to be invited because i think it's important  someone like you that has so much talent and is working so hard it's important i think for your colleagues to be able to come to the community to also spread the message of the good work that you're doing so thanks for all your work on behalf and for the record i did not pay someone from your family may have that look i got into service the way i think a lot of us did and i know it's cliche but we wanted to make a difference but for me that came early you know my mother was the first woman elected vice president our city council in the city of lynn and she served for twenty two years so it was in the it was in the blood you know when we went when most kids are grown up at christmas day is an exciting day for them or thanksgiving you know election day was the exciting day in our house you know sure and so it was always something that i think i wanted to do and i think that more of us should serve in some capacity whether it be in volunteerism or in an advocacy or an elected office i think it's something that that we really ought to give back a little time and i think there's a lot of folks that that can sit on the sidelines  and you know throw rocks our direction here and there on a particular issue and the constitution gives them every right to do that but i think it's important that people step up and serve when they're called and certainly you have done that i have done that our colleagues have done that and many your constituents have done that in various ways so you know to this point it really has been the best job that i've had and it's been an honor i think to serve the people of lynn in the town i'm not sure well certainly they have a great public servant in you and i can you tell viewers a little bit about your career your maybe your first election how you got started how long you've served and a little bit about lynn in the hunt the district you represent yeah it's a you district you know probably not unlike the district that you serve you know the town of not would be considered a more affluent community a very small community three thousand or so folks and then lynn is a city of ninety thousand people a lot of that name and i don't know that you know the challenges of any big city you talked a little bit before in your opening about about well we're all for reform and election reform i mean those are th issues that are important to cities getting people to participate encouraging them to our part participate in any way through election reform and also making sure those folks that need help get help when that when they need it i think that's what we did with welfare reform so you know i have that unique perspective where i get to see both sides i think representing the community that i do and you know i was actually prior to being elected i ran a nonprofit in the city so i was involved in social services i was involved in the arts and i was doing some teaching and what kind of nonprofit was it was an art  right and so i took that opportunity you know those are those are once in a lifetime chances when those those seats open and you know if you have it in your blood and you want to work and pound the pavement and and wear out some shoes then i think you run and i would i like you were successful enough to win you know under those circumstances right and that was in two thousand and two yeah one in two thousand and two was sworn in two thousand and three that's great it was not a special election or in the normal no the normal year was a special percent of the normal for  wow wow it's great and how has serving in state government obviously newer to state government how how has it changed over the time you've been in there yeah you know i think that i served also through the great recession you served through a very some pretty bad time of prosperity times of leaner leaner budgets and that's so you i mean you you certainly you certainly have to think about those times when there is more you think you can do more in those times when you're last but ultimately you know i think that the overarching theme that i've seen in the decade has been really a change in the way we look at our elected officials and i think it's incumbent upon us more than anyone to continue to work hard to put dignity into public service to make sure that folks understand that we're we're there for the right reasons that we care about people we do it for the right reasons and that you know you almost open up the newspaper for a while and you know reading you know stories that didn't didn't paint us in the best light and i think that that's what i've seen change over the decade with the with the you know the rise of the twenty four hour news cycle we have got to be better and we have got to be working hard each and every day and doing the right thing and i have our constituents so that they trust in what we're doing on beacon hill because you know having served there folks were pretty hard you have some talented colleagues that really care about what they're doing but that has been the biggest change i think i've seen that the biggest change has been a cynicism and skepticism towards government which is unhealthy and we've got to read to gauge our constituency to help us make the right decisions right well well hopefully day by day we'll will be continuing continuing to do that i guess i'd say you most like about about serving what do you find most exciting most challenging most interesting about you know you just it used to be the people i met all the time and i so love meeting new people and seeing where they come from and how the neighborhoods are different  and it you know it is different when you travel the state is very different when you get out to the berkshires or great barrington or right you know and north adams and then you get on the cape and you got to north shore and you come here to your neck of the woods  people the very differently they really do and that's kind of a fun when you get around the state you see that it's a unique perspective depending on you know you know we have colleagues that travel three hours in the morning to yes to get to work to vote right somehow go back and forth go back and forth yeah and i kind of do what i guess yeah i must really dive into some of the some of the good material and some of the things that i think we've been able to do over the past few years you know specifically most recently for me health care as you mention short of before that i was at the committee and stated ministration and before that it was a small business and community development and then bonding and i tried to use those committees as an opportunity to learn should i know if i if i felt if i left the building and i hadn't learned as much as i could about the subject matters that i was fortunate enough to be able to work on that i had done a disservice to myself right well clearly you've done some important work and speaking of policy as some of our viewers may be aware the state passed a landmark health care cost containment law  literally i think all forty nine other states now are going to be watching massachusetts to see how this plays out in as chair of health care financing obviously you played a pivotal role in that process so i'd like to ask you a few questions about that please first what  was the genesis of the law or how did the idea get going in the first place well we knew after two thousand and six where we did the access piece and we got folks covered with insurance we knew we would have to come back later on and do cost containment and quality and that's what chapter twenty four did it it took it to the next level where what we said was this system is broken we now have people that are covered but they're covered in a way that's far too expensive for us to be able to afford last year in massachusetts we spent sixty six billion dollars in health care about a third more than we needed to you know when you talk to your viewers earlier on tonight about the waste and inefficiency in government and that being something that's troubling to you the waste and inefficiency in health care should be troubling to all of us you know since one thousand nine hundred our state budget has grown about a billion dollars a year just in health care so if social services are important to you if education's important or the environment or public safety or you name it anything else that may be important that has been caught to make way for the increase in cost and health care so the opponents was we don't have a choice but you thousand and twenty one if we don't do do something we're going to be out of business so this was a necessary move for us to begin to move our health care away from fee for service right a broken system tha incense you for being sick and moving towards a system that rewards you for being healthy great and the i think you alluded to it there in your most recent comment but can you give viewers just a general description of the law and the overarching themes behind this by short i mean i guess i started with the big piece which was was fee for service but there's a lot of small things in there if you think about healthcare if you if you were presented an emergency room tonight they don't know who you are they don't know what your medical history is why is it that banks  figured out through the a t m that you can put a card in and get money anywhere in the world and they know your balances they know how much you can take out right yet the most personal thing that we have is our own health and there's no access to our own medical records so the first thing we said is that by two thousand and seventeen everybody will have access to improper interoperable records so if you go go someplace they'll know who you are what your medical history is and they'll be able to make sure that you are over tested or overbuilt because where we're getting rid of a whole number of other things right now if you if you go to the emergency room they run you through the car wash to give you every test that's reimbursable partly because they have to because they don't know they don't know history is right so i think this is a really important way for us to get healthy and to generate some efficiencies the second thing i think we talk about is is transparency and disclosure we don't know what health care costs if you have any health care service you might get three pieces of paper in the mail piece of paper that says what your insurance covered what the actual bill might be what your share of it might be then you get an explanation of benefits why can't we just get one piece of paper the end of the month here's what you'd be here's what you used here's what you paid here's what you know right master card visa american express they figured it out right we can't figure out health care so and why why aren't you told what something costs me to do your body don't you have the right to know what the risks are what the costs are and what the potential outcomes are so anything that's being done to you right you know if someone knows that a in a cat scan is two hundred forty times the radiation of an x ray but may not show anything more maybe the patient would opt out of that right or if they knew that you know the m r i down at this end of the street is five hundred seventy five dollars but over here it's eight hundred dollars maybe they would make a different choice so it's also about giving information to consumers so that they begin to quarterback their own health with their physician we don't have a third party payer without medical training making decision about what's important for you and your family so that's a piece that's been very important here the other piece is our workforce development medical malpracti reform really low hanging fruit of things that we really needed to do to make this system a successful one and then we we put a lot of focus on prevention and wellness you have right we are one of the few countries that just have never ever made it a priority to be healthy now if you go every day for a year or two and all you can eat buffet and i go every day for a year to a gym are our health care premium goes up the exact same amount the next year right why isn't there a benefit why don't you derive some benefit if you take care of yourself right in on a risk adjusted benefit it doesn't matter where you start you may be unhealthy today but if you get better over the course of the year if someone's really paying attention your health care your premiums should go down your family should save money that's what their business plan says that over the next three years we'll be able to put ourself in a position so we can save roughly twenty five hundred dollars a year on your family plan while that's real money that's a big so i i throw sixty almost billion out well sixty six billion that right but what does that really mean people you know there's too many zeros there for us to really focus on that but twenty five hundred dollars for your family that's real money you know and so you do it by beginning to reward your doctors and your providers for focusing on you being healthy and not being sick in the way you do that is moving from a fee for service transactional medicine th reward you for the number of tests before and we were warned you for your outcomes and for your health so the byproduct of this is that we have healthier communities that are less expensive to treat and we're able to put some of our necessary funds and resources into other areas that we care about that's great that's great and i know a statistic maybe viewers have heard certainly i've heard you is that we spend a lot more on health care in this country and i'm sure in the state and than other our counterparts other advanced western industrialized countries and yet we don't get appreciably better outcomes so hopefully this law i guess is going to move us toward getting better outcomes and spending less money yeah i mean the you know one of the we also have some of the sickest folks here folks coming from other countries that are sick i mean they certainly come to our neighborhood as the best of the last polls but you're right and and one of the things that has been a challenge is we really don't have apples to apples comparison of what quality is so what are the other things we say in this law is we've got to define what quality measures we're going to use and then we've got to measure everyone against them so as you know i don't mind if a patient wants to choose a limited service network or a higher tier product and but if they're doing that we should give them the information to be able to make an educator's what's the quality what's the cost was i think patients deserve that information right absolutely and this sort of groundbreaking stuff i mean as we're the first of probably the fifty states and i think you said you got invitations to speak around the country and even around the world once this law passed because again it was it really is groundbreaking policy can you talk about that a little have you gone around to other states and other regions to talk about i think you know i think there's some good things happening in other states i mean we're not the only one you know virginia's doing some unique things there there's there are some programs in florida around med mal that are working really well i mean it's it's more or less about best practice yes and we're trying to identify what the best practices are and share that with folks that that that want to want to want to to learn about it and to do their own and i think that people are going to be basing their cost containment laws on what's happened in massachusetts but we've got to be successful right we just celebrate our one year anniversary right we're starting to see things move in the right direction but it's a long road and so people have to be patient and we have to work really hard at it because it's not going to happen overnight it's you know move slowly moving the titanic will will squeeze the waste and inefficiency out but you can't move healthcare that quickly and the reason being is because it's so personal right you don't want to change a system or have folks think that if they need services for them and a loved one they're not available you know and i mean again i i talk about this is a policymaker but as a parent you know you know when one of my one of my children was born and one of my twins and  as a parent i wasn't saying is there a low cost provider out there you know what is this going to cost you know i mean i was saying get him the best get it now as we all would if our loved ones in a time in need right and so i think what we had to do was move slowly enough so that no one felt or feels that we're ever going to ration their care change their care in a way that they're not going to get it when they need it it's about getting smarter care it's about preventive visits has opposed to it's about incenting you to be a well as opposed to rewarding you for being unhealthy i mean those are the kind of things that i think we change and we do it with grants for community hospitals so people can get the care they need in their community we do it for grants around prevention and wellness so that you know your town your city can can have the ability to make some innovative programs that help them make your community healthier so i think we've approached it in a way that smart but i also think that you know some folks want results and they want to now and that's not really the way this is going to work is going to take a little bit of time sure are there any early indications i know we're only a year into a new law and that's that's a very short sample period but is there any data or statistics coming in the first reports will come out shortly i think what i think what you are seeing is you're seeing some some some movement right away among providers to get consumers their information just three weeks ago for the first time consumers would have the ability to ask the payer for the information they want the costs of the tasks right rest of their tasks you know that's that's groundbreaking now everyone didn't ask immediately right a lot of people still don't know so i think it's too about educating the consumer but that's a big deal i think the health policy commission taking a very good look at mergers and consolidations of the market in the market that we're seeing is very good for consumers who are saying that look it's not that you can affiliate with a commune oswal or merge with a commune ospital but you've got to keep that care in the community and you've got to keep it at a low cost setting so i think we're seeing that happen a little bit more right and you know when you when you travel the state it's you know there are but sixty nine licenses or so and you know we visit about sixty four of the hospitals in the state we have too many bets i mean health care is no longer about being in the hospital you know if you're sick the last place you want me to last we get sick or we're going to hole so health care now is about moving folks back into the community changing the way we think about health sending folks home with an i pad even so they can be in constant contact with their doctor setting folks home with you know a community worker who's going to check on them on a regular basis to make sure they're taking their medication they're getting their exercise doing the things that they do to be well it's not about staying in a hospital bed any longer for three five seven ten days those beds are available if needed but we really don't we got to think about the way we provide our health care right and that said i guess  challenging but pulling back from the the day to day fight over that of the headlines and controversy can we just talk about a little bit how the federal law interacts with the state law that we passed here when romney mitt romney was governor and how those two meld together and so so this is an interesting example i think of when you move maybe a little bit too quickly it's also an interesting example of what happens when our elected leaders won't work together or compromise there are some very easy tweaks and changes that are necessary in obamacare sometimes we like to call romney care right here in massachusetts right but there are some very easy changes and fixes that have not taken place because the partisan brinksmanship in washington is so bad that they're not there they're unwilling to open the law because it may cause some additional problems so what we're left with is you said it was a challenging rollout that's really putting it kindly i mean it's been abysmal right and i was trying to be different i know i appreciate that but the problem i think we have as as policy leaders that want this to work is that the concept makes perfect sense the more people that are insured the less people that walk into an emergency room that are uninsured that all of that you me and all of your construction uncompensated care that we just can't afford that so you get folks access and then you follow up with cost containment quality which is what we the the path and the road map to this makes perfect sense the focus on prevention makes perfect sense the fact that obamacare suggests that you shouldn't have to pay co pays if it's preventive medicine makes perfect sense and courage people to go to the doctors when they don't need to to make sure there's not cat some catastrophic incident right by waiting long so when you look at it individually the plan makes perfect sense but if you slowed it down just a little bit would have to find ways to make sure people could stay with their own doctor if you like the plan iran you can stand your own place if there's something if there's some benefit that you're driving in your state that isn't available there has to be some mechanism by which to appeal that and make sure that states like massachusetts that may be doing more are still able to continue to do things the right to doing successfully so we're not that affected by you know the affordable care act for us it is more about i think our trepidation that if this doesn't work you may see this get thrown out and then what happens because i think we in two or three short years from now will have a case study that shows that it works right it shows that access to cost containment to quality makes sense it can be very successful and save an awful lot of money so if you don't like obamacare then give us another let's not just tear it down for the sake of tearing it down let's get some good ideas going we nobody wants to talk about universal coverage nobody wants to talk about a single payer system you know they're concerned what happens in germany well germany has some of the best numbers that we've ever seen in terms of outcomes on stroke extraordinary but in germany you might wait six weeks for an m r i our population has not accepted that you know you have some similar similar things that are happening with the canadian system but there are things that we could learn and that we could do a little bit better and i think it would be devastating to our future health and the future health of a whole lot of other folks and ultimately more expensive if we punted on obamacare now and when a different direction we've got to get together sit around a table and fix the things that aren't working slow down the implementation a little bit and get it right because we may only have one shot at this right and i guess we'd be entering into the land of speculation but do you have any as someone chair of a important health care committee and obviously extremely knowledgeable about it do you do you have any sense of what's going to happen at the national level or are you confident we'll get through this this tempestuous period in the controversial period and that the law t we i think that it is now up to voters to demand that congress work together except absolute and that is going to be i think what you're going to see in the next elections if you're going to see a movement towards you know what we don't elect you to go and fight at it and he was so talented that's the type of leadership we're going to need now to get to get this right it's going to have to come from from doesn't matter whether you know it's a good democratic idea or a good republican idea if it's a good idea we ought to be a breeze absolutely and i guess  we're getting toward the end of the show and i just ask a more broad general question and as a leader in state government what broader message would you share with our viewers about the functioning of state government and and the role it plays in creating a healthy society here in massachusetts but i just think people have to participate i mean it's your government you know how many times we say when folks was of the billing this is your bill that and i'm always shocked at the number of people that haven't stepped foot in the building and what it was and what it what a spectacular  place we have that we get to walk in and work in every day that we'd love to share with members of the public that want to come visit us you know i think that oftentimes there's a disconnect and people talk about those folks up on beacon hill well those folks up on be are also those folks that live on belmont street and it's not you know and the reality is we want to hear from people apps and i think that's what folks don't understand we want participation a greater than twenty percent we can run that we can't we can't run government effectively with one fifth of the people picking our leaders i mean we need people to participate we need them to to set aside some of their individual differences or cynicism and say you know what i want to challenge you want to challenge you on your ideas i want to challenge you in your beliefs  have a good and open dialogue about it that's how we get the best ideas great you know we're two hundred strong but we could should be six million strong there's an awful lot of good ideas that come out of the public absolutely well steve thank you so much for being here appreciate you coming to belmont and thanks so much for your time and for a lively conversation thank you yeah thanks so much