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Last night Democratic governor candidate Don Berwick held a “Medicare For All” town meeting at Bakst Auditorium in Boston University Medical School. The site was appropriate, and as a pediatrician, Dr. Berwick is the right candidate to discuss “Single Payer.” Unfortunately, in almost two hours of explanation and question answering, Berwick didn’t tell us how to get there, nor did he say much about what “Medicare for all'” would look like as a program specific to Massachusetts.

Berwick did make clear that he wants single payer; that ‘all means all,’ and that that would be a priority were he to be elected governor. He said that Massachusetts’s current universal health care — which he congratulated our state for being first in, without mentioning that it was done by a Republican governor — is too costly, too confusing, too opaque; that we spend ten times as much on administration as we should; that with a single payer system, 90 % of that administrative cost could be devoted to actual health care; that the coding and bill processing burden takes up far too much of health care professionals’ time; and that it’s almost impossible for users to figure out the rules for what is or is not covered.

All true. Yet Berwick said not one word about the collapse, at great expense, of our state’s health care connector to Obamacare — at Forums he decries it; why wasn’t it on his speech list last night ? He said nothing about seeking a waiver from the AC. Indeed, after rapidly listing “technical issues and (Federal) pre-emption,” he said nothing about how the state would overcome these : only that “we can do it and should do it.”

He was much applauded. Clearly his supporters do want single payer. So do many of us. We all know what Medicare is and many of us know how cost effective a system it is. But Medicare is a Federal operation. Berwick seeks a single payer system that would operate only in Massachusetts. Last night he said that it would work better on a state level: but as i have already noted, he said nothing at all about how it would work, who would administer it, how it would be paid for. He of course said nothing about how we would go about replacing the universal health care system that we put in place only eight years ago.

There is, in Vermont, another move to establish single payer in one state only: but Berwick didn’t mention Vermont, and from what I gather, the Vermont proposal has yet to be worked out.

It would be nice to know how the single payer state system would be paid for and by whom administered. I suspect, unhappily, that administration of it would be mishandled — as is much of Massachusetts social service — by an overburdened management, despite Berwick’s insistence last night that he “will never compromise on management excellence.”

If he has answers to these questions, he needs to start giving them soon. Otherwise it will be hard to give serious attention to an issue that only he, among all 6 serious governor candidates, has raised and which I do not hear high on most voters’ list of priorities.

That said, there’s no denying Berwick’s commitment to cost-effective, simple to understand health care for all. And to “medicare for all” being a social justice issue too. Over and over he emphasized that health care should be a human right. Who could not be moved — I sure was — by the story he told, at the event’s end, of a 15-year old African-American whom he helped cure of leukemia, a disease almost always fatal at that late age ? “we threw the book at his leukemia and we cured it,” Berwick said. “But what happened to that young man ? He ended up later on dying on the streets.

“He had two fatal diseases, leukemia and injustice. The one, we cured. the other we could not.”

—- Mike Freedberg / Here and Sphere


NOTE : this article was UPDATED at 2.45 pm on 04/17/14


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^ a scene he’ll have to repeat about 500,000 times : Charlie Baker wins a voter

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Both new polls of the Massachusetts Governor race make clear that Charlie Baker has a 30 percent chance of winning. Give or take, about 30 percent of Massachusetts voters support him no matter who his November opponent will be.

It’s a simple calculation. 30 percent support means 30 percent chance of winning, just aa 60 percent support means 60 percent chance of winning.

I say this even though about 33 percent of our state’s voters poll “undecided.” If Baker is to win, he will need to carry the undecided voters about two to one. Very rarely does a block of voters that large — in Massachusetts, 33 percent equals about 1,000,000 voters — pick any candidate by two to one.

Yesterday’s U Mass Poll gave us a more detailed look at the governor race than did Western Mass University’s poll last week. Let’s look both polls’ numbers now :

U Mass Poll                       Western Mass U Poll

Baker 34                             Baker 25
Coakley 45 ( und 21)     Coakley 54 (und 21)

Baker 29                              Baker 29
Grossman 35 ( und 36 ) Grossman 38 ( und 33 )

Baker 32
Kayyem 32 ( und 36 )

Baker polled much better in the U Mass Poll against Coakley, no better at all against Grossman. But this poll allows us a peek at something more ominous : how Baker polls against Juliette Kayyem. She draws a mere 3 % of the Democratic Primary vote — according to the poll — and so is, basically, a “generic Democratic vote.” Against a “generic Democrat,” therefore, Baker polls dead heat — but no better. This cannot be good news for a man now running his second statewide campaign for governor.

I said, last week in analyzing the Western Mass University poll, that Baker has a very narrow window to victory. The new poll confirms it. Against Coakley, he is down by 11 points with only 21 percent undecided. To beat her he’d have to win the undecideds by 17 to 4; that will not happen. If he wins the undecideds by 12 to 9 — which could happen — he loses to Coakley by 54 to 46, only a two point difference from the result suggested in the western Mass poll.

Against Grossman, U Mass’s poll offers Baker a marginally better chance than did the Western Mass. From that one, I suggested a 52 to 48 Grossman win (and an opportunity, among legislative insiders, for Baker to turn it around). The U Mass poll has a full 36 percent undecided; if Baker wins them 21 to 15 — a result very doable — he and Grossman tie at 50-50. If that happens, the insider action that I suggested in my previous column would almost certainly give Baker the corner office.

I say “would almost” rather than ‘will” because there’s other factors at work that the U Mass Poll highlights. You will note the “word cloud” statistic ? OK, what words do come to mind — in descending order of frequency — when you think of Baker ? Of Coakley ? Of Grossman ?

For Coakley : 1st, smart; 2nd, liberal; 3rd, honest; 4th, good’; 5th, strong. Democrat / that comes 6th.

For Grossman ; 1st, unknown; 2nd, unsure; 3rd, know; 4th, none.

For Baker : 1st, Republican; 2nd, unknown; 3rd, conservative; Businessman ? Hardly appears at all. Good ? Only a little better. Experienced ? way down the list.

These are hardly good associations for Baker. To be known chiefly as a Republican is, in Massachusetts, to have some ‘splainin’ to do. Conservative, even more ‘splainin’. Baker needs badly to rebrand himself, and he has very little time to do it. And no chance at all to beat Coakley to the words that generate a vote : smart, good, honest, strong — not to mention Democrat.

Baker’s associations do look more vote-productive than Grossman’s. How can an elected statewide office holder, the State Treasurer, poll unknown, unsure, none ? Grossman has spent tons of money to become known, so it seems, only by Democratic activists. With about seven months remaining in the campaign he is not on most voters’ radar. And yet — and yet ! — against the much better known — but “Republican, conservative” — Baker, he polls 6 to 9 points ahead.

The word cloud tells me that my prognosis for Baker in a contest against Grossman has been far too optimistic . If “unknown, unsure” Grossman beats Baker by 6 to 9 points, what will Grossman poll once he does become better known ?

Baker has to be sweating it. But this is what it’s like when you are a “conservative, Republican” drawing about 30 percent in Massachusetts. You have a 30 percent chance to win.

When it’s like that, and you’re in it, you gamble. You throw the dice as far ahead of you as you can.

—- Mike Freedberg / Here and Sphere

UPDATE : April 18, 2014 at 10 AM — turnout might help Baker a little,. In his home Congressional District, the 6th, there is an expensive, very close contest underway between incumbent Democrat John Tierney and Republican challenger Richard Tisei. This is a re-match for the two men; both are well known. Turnout will almost certainly tally higher than otherwise, by maybe 20,000 votes; and as Baker lives in Swampscott — the heart of the contest — he can only benefit. — MF