Top of Mind: Charlie Baker, Extended Version

Boston editor James Burnett: What do you think is the one thing that could have the most impact on improving healthcare?

Charlie Baker: Since you have this on [gesturing at recorder], I’m going to give you a long answer, and you can always shorten it.

If you want to change the healthcare system in the U.S., the place to start is the way Medicare pays for services. …The irony is while we don’t have a universal coverage system, we do have a single payer in the sense that everyone’s payment methodology ultimately gets converted into a Medicare equivalent. So if I choose to pay a group of hospitals and docs one way, they will take that way of paying them and they will convert it to a Medicare fee-for-service equivalent, to keep score. You know, “What am I getting paid as a percent of Medicare?” And Medicare favors technology, transactions, and volume. Medicare does not pay much at all for time—never has. And as a result we have a system that’s built around that basic operating model.

…[So] I would change the way Medicare pays. I would pay more for time, and less for technology. And I think because Medicare is such a bigfoot on the system overall, I think what would happen almost immediately is you would see the system that would be more oriented toward time and a little less oriented toward technology.

JB: How much does patient demand factor in?

CB: I think it’s one of these things that, you know, they sort of feed on one another. People, generally speaking, like the new-new thing. If you look at the way this works in most other countries, they put a little more emphasis on understanding more about how we apply what we already know, a little less emphasis on whatever the next new thing is.

JB: The changes in Medicare—that would have to be a federally mandated thing.

CB: The feds would have to do it, although to hear the new administration talk, to hear Senator [Judd] Gregg, Senator [Max] Baucus talk, to hear Senator [Ted] Kennedy talk, they all seem to be saying that one of the fundamental solutions to healthcare reform at the federal level is going to have to require a change in the way Medicare pays for services. And they’re all basically saying the same thing: More for time, less for technology.