(EDITOR'S NOTE: The following was submitted by Lily Barrett.)

Mike Barrett, candidate for State Senate in the 3^rd Middlesex district, says four key ideas underlie his approach to containing health care costs, a major priority for the Mass. Legislature.  

“In my prior stint in politics I was Senate chair of the Legislature’s Joint Committee on Health Care,” Barrett says.  “When I left office in 1994 to run for Governor and then joined the private sector, I became CEO of the Visiting Nurse Associations of New England, a network of home health care providers.  Working with the VNAs got me hooked on the role computers can play, and by turns I came to specialize in ‘health care IT’ (information technology), the field in which I’ve made my living for the past 14 years.  I focus on the fascinating potential of the Internet to help people manage their chronic conditions.  Addressing complex topics in brief bullet points is tough, but I want to outline four ideas that influence my thinking on health care cost containment.”

Guiding idea #1: “Bring back the Kaiser model to Massachusetts.  Whether you call it a staff-model ACO (accountable care organization) or staff-model HMO (health maintenance organization), the important thing is to re-establish the concept of physicians cooperating in integrated networks, coordinating care between GPs and specialists, and working for a salary and outcomes-based bonuses rather than fee-for-service.  The approach survives today in the Kaiser Permanente consortium on the West Coast.  I’m not talking about making such models mandatory; I’m talking about making them a much bigger part of the mix in Massachusetts.

Guiding idea #2: “Alter “scope of practice” laws to enlarge the roles of non-MDs.  Augment the trend, already under way, of delegating routine health issues to nurses and other skilled non-physicians.  Don’t give up on integrating with doctors; ideally these non-MDs will be part of the same health care teams, use the same electronic health records, and embrace the same vision of coordinated, long-term care.

Guiding idea #3: “Adopt a single-payer system.  A non-radical way to approach single payer: Think single processor.  Reduce the mind-numbing bureaucratic side of health care to a bare minimum.  Create a commission to settle on a uniform coding system for medical conditions and a uniform coding system for services rendered.  Issue subcontracts to the private sector to design unified systems for provider credentialing and for billing.  Issue an RFP for the actual bill processing and let public, nonprofit and for-profit organizations bid for the work, subject to fair wage and work standards for employees.  Challenge health insurers to re-invent themselves as health and wellness companies.  That’s already the best part (and most difficult part) about their current roles, but today it takes a back seat to the bureaucratic stuff.