BOSTON — Dr. Donald Berwick, the former Obama administration health official who is now running for governor of Massachusetts, staked out liberal ground Monday on everything from tax policy to guns and health care, defending the federal health reform law as a “big step” for the country and “on track” for success.
Berwick sat down for an interview with several members of the media, casting himself as a progressive Democrat in much the same mold as Gov. Deval Patrick with a belief that the wealthy should pay more in taxes and a focus on reducing health care costs, investing in education and fighting poverty by protecting safety net programs.
“My general attitude toward the tax system is it should be progressive. I firmly believe that people who have much more should be paying more, and people who have less should be paying less. I think we should use the tax system to help people of greater means contribute more to the well-being of the Commonwealth. They have more, and they should contribute more. To me, that’s fair,” said Berwick, a pediatrician by training.
Though implementing a progressive income tax would require changing the Constitution, Berwick said Patrick’s proposal in January to increase the income tax and lower the sales tax had merit. “It’s the right direction. From what I understand, the calculations I’ve seen, it is a more progressive system,” he said.
Lawmakers rejected Patrick’s plan, showing little interest in changing either the income or sales tax rates.
While much of the conversation focused on national and state efforts to rein in health spending, Berwick also spoke about the importance of investing in education at all levels and fighting poverty and homelessness.
“We don’t have to have a single homeless person in Massachusetts,” he said during a nearly hour-long interview at the Omni Parker House.
Asked specifically about his poverty agenda, Berwick said, “End it.”
Berwick served for a year and a half as administrator of the Centers for Medicare and Medicaid Services before resigning in December 2011 in the face of Republican opposition to his permanent confirmation. During that time, he estimated he helped implement over 60 percent of the regulations central to the Affordable Care Act.
Berwick said he was most excited by the idea of “health care as a human right,” suggesting the ACA will allow the United States to catch up to most other western democracies by reaching for universal coverage.
Lawmakers recently voted to pass legislation aligning Massachusetts with the contours of the ACA, but much of the debate driven particularly by Republicans focused on why the state should alter its own system that has worked relatively well, and served as a model for national reform. One concern, in particular, has been the requirement that Massachusetts reduce the number of factors used to calculate small group premiums from nine to four, a shift that business groups say will drive up premiums for employers.
“I would keep Massachusetts on the track it was on if I could, but I’m willing to be a citizen of the country if the finding is we have to participate in a federal structure,” Berwick said. Though he supports a formal request for a waiver, he said the majority of premium increases will be “within range and affordable” and the number of people experiencing big hikes “relatively small.”
Berwick said he didn’t envision any trouble meeting the cost-growth benchmarks laid out in last year’s state health care reform law, provided the right amount of “political will and professional commitment.” He applauded the goals of the legislation to promote more integrated models of care delivery and payment methodologies.
With over 30 years working on health policy, Berwick said there are two ways to cut health care costs: cut coverage and increase premiums, or improve patient health. He said cutting back on coverage and shifting the financial burden to patients is especially risky for poorer populations.
“We don’t have to do that. We don’t have to do that. I know from the work I’ve done for years that we can improve our way out of this problem. I’ve seen it. I’ve seen health care system and health care delivery processes that function much better at much lower cost,” he said.
As for the problem of the shortage of primary care physicians in the system, Berwick it can be solved by allowing non-doctors to be an entry point for patients. “If we start to think of the primary care supply as much broader than just physicians, we can much more easily find a route out of this,” Berwick said, offering his support for expanding the scope of primary care practices to include advanced nurse practitioners and physicians assistants.
Berwick has watched much of the debate on Beacon Hill between Patrick and the Legislature over transportation financing, and said investing in the system is the right goal for the economy.
“The details of exactly how much to invest and when is a highly technical matter, but I really do trust the governor’s judgment on this about how far we have to go by when. We can’t say jobs, jobs, jobs, and stronger economy, better communities, places people want to live and work and let the transportation structure decay. It makes no sense,” Berwick said.
Berwick also said he supports a minimum wage increase, though he would not say how high, and believes in doing whatever necessary to get assault weapons off the streets.
