News

The “Dangerous” Democrat

Can gubernatorial hopeful Don Berwick win with the hot-button issues of single-payer healthcare and casinos?


Wednesday, April 23, 2014

It’s the kind of free publicity a left-leaning political candidate dreams about: to be deemed the “second most dangerous man in America” by conservative talk show host Glenn Beck.

The rogue in question? Don Berwick, who in July of 2010—when Beck made the charge on the Fox News show he hosted at the time—had just been named administrator of the federal Centers for Medicare and Medicaid Services by President Obama. (The only person more dangerous, in Beck’s view? Cass Sunstein, at the time head of the White House Office of Information and Regulatory Affairs.)

Republicans were unhappy with Berwick’s appointment because Obama had made it during a Congressional recess, bypassing a Senate confirmation hearing that Berwick seemed unlikely to pass.

But that wasn’t all that was sticking in Beck’s craw that day. Berwick—a doctor from Newton, Mass., and founder of the international nonprofit Institute for Healthcare Improvement—was, in Beck’s words, a “global redistribution of wealth socialist guy” determined to “blow up the best health care system in the world” and replace it with a single-payer model similar to England’s National Health Service. To bolster his case, Beck played a video clip of Berwick saying, “Any health care funding plan that is just, equitable, civilized and humane must—must—redistribute wealth from the richer among us to the poorer and the less fortunate.”

Such a plan, Beck warned his viewers, “will take good healthcare and destroy it and it will suck nationwide. It’s also about destroying businesses and any kind of wealth in this country.”

In the end, Republicans won the battle over Berwick’s appointment: in late 2011, he stepped down from the Medicare/Medicaid post, to be replaced by his deputy at the agency, Marilyn B. Tavenner, whom the New York Times described at the time as “more of a manager and less of a visionary” than Berwick.

Rocky though it was, Berwick’s time in government did not cool him on politics. “I’m no stranger to controversy or conflict,” he recently told the Advocate, pointing to his decades of work in healthcare reform. While Washington, he said, proved to be a “more vicious climate then I had seen before, it didn’t discourage me—it reinforced my commitment to focusing on the agenda I care about, the social justice agenda. …

“When you care deeply about change, you have to fight for it,” he added.

Now Berwick hopes to fight that battle from the Massachusetts governor’s office. Last summer, Berwick announced his candidacy for the seat, which will be left vacant at the end of Gov. Deval Patrick’s current term. He joins a crowded field of Democrats vying for the party’s nomination, a field that includes challengers with more name recognition and fundraising power than Berwick brings to the race.

But Berwick brings his own strengths, including an emerging identity as a progressive’s progressive—a title Democratic candidates are jockeying to claim, in these pre-primary days. In December, he walked away with 67 percent of the vote in a gubernatorial straw poll conducted by Progressive Massachusetts—an admittedly small field of respondents, but one that represents an activist core.

Indeed, as Berwick campaigns around the state, he embraces the very qualities and priorities that Beck and others from the political right have excoriated him for. And he makes the case that the entire commonwealth should, too. Massachusetts, the first state to “make healthcare a human right” and to legalize same-sex marriage, can be a progressive “beacon” for other states on addressing pressing national issues like economic and social disparities, he said, adding, “It’s even more important now for Massachusetts to show what’s possible.”

 

The 67-year-old Berwick grew up in rural Connecticut, coming to Massachusetts as a Harvard undergrad and staying at the university to get a medical degree and a master’s in public policy.

Berwick’s career path reflects that dual interest in medicine and policy. After years of practicing pediatrics, teaching, and working for Harvard Community Health Plan on quality-of-care initiatives, in 1989, he founded the reform-minded Institute for Healthcare Improvement, which focuses on innovating healthcare delivery, with projects on five continents. Berwick led that organization until moving to Washington for his ill-fated stint at the Centers for Medicare and Medicaid Services.

Given his background, it’s no surprise that healthcare reform is a major part of Berwick’s platform. It’s an issue, he said, in urgent need of addressing; while other line items have seen across-the-board cuts in the state budget, healthcare spending has increased by 60 percent over the past decade and, in fiscal 2014, accounts for 43 percent of the total budget.

Not only is the healthcare system inefficient and deeply flawed, its high public cost “hurts our ability to do other things we need to do,” Berwick said.

While Berwick praises the advances made by Massachusetts’ 2006 healthcare law, which has resulted in about 98 percent of adults, and almost all children, having insurance, work still needs to be done to improve quality and reduce costs, he said. Berwick calls for replacing the existing model, in which hospitals and providers are paid for the volume of services they provide—a costly system that shortchanges preventative care—with one that pays based on how well patients do. The work done at IHI, he said, shows that a streamlined, patient-centered approach to healthcare both reduces costs and improves outcomes.

Berwick’s platform includes other public health priorities, including reducing smoking, drug abuse, obesity rates and violence, and improving the quality of mental health care. Most dramatically: if elected, he promises to convene an advisory panel to develop a plan for moving Massachusetts to a single-payer healthcare system. A single-payer, or “Medicare for All,” model would result in significantly reduced administrative costs by eliminating the complex payment system now in place—a system that places undue burdens on healthcare providers as well as patients and their families and results in extreme waste, he said.

While such a major change would provoke fierce resistance from the insurance industry and its lobbyists, Berwick is undaunted by that prospect. “Change is never easy, and big change is even harder,” he said. “The most important thing is the voter, the citizens. … I think the voice of the public here may be loud and strong, if leaders speak out on their behalf.”

Is Berwick concerned that the technical problems that plagued the launch of the federal Affordable Care Act will make people wary of trusting the government to take a greater role in healthcare? No, he told the Advocate; on the campaign trail, he said, he sees a strong voter appetite for the single-payer model. “People are tired of the complexity of the system, the waste, the cost,” he said. “I feel very strong positive support here.”

As for the ACA, he said, “I’m not at all happy about the rollout. … But it’s very important to keep our eye on the big picture.” As governor, he said, he would bring to the task his decades of healthcare leadership and would convene a consortium of other states considering single-payer systems to put together an effective plan.

Berwick’s position has earned him the endorsement of Mass-Care, a pro-single-payer advocacy group. Mass-Care member Alice Swift of Amherst, who first met Berwick last year at a meet-and-greet event at his brother’s South Hadley home, cited his healthcare positions as a major reason she supports his candidacy. “He knows about the structure of healthcare and knows how it should be reorganized so that we could save a lot of money,” she said. Beyond his resume, she added, “He has a genuine concern for people and people’s lives. … He has integrity—he doesn’t change his message to suit the politics.”

Like other Berwick supporters who spoke to the Advocate, Swift noted his campaign’s frequent references to the inspiration he finds in a famous quote from former Vice President Hubert Humphrey: “[T]he moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

“I can see all of those in what he talks about,” Swift said of Berwick.

 

Among the Democratic gubernatorial candidates—a group that includes Berwick, Attorney General Martha Coakley, state treasurer Steve Grossman, one-time Homeland Security official Juliette Kayyem and Joseph Avellone, a former Wellesley selectman—there is, more or less, unanimity on a good number of liberal litmus tests, such as raising the minimum wage, guaranteeing paid sick leave to workers, promoting gay rights and protecting reproductive freedoms.

But Berwick’s support for single-payer healthcare isn’t the only thing that distinguishes him from the other Democratic candidates: he’s also the only one to call for repealing the 2011 law that legalized casinos in Massachusetts. (Independent gubernatorial candidate Jeff McCormick also supports repealing that law.) An effort to put the matter before voters on the November ballot was stymied late last year when Coakley ruled that the question was unconstitutional. The group behind the proposed question, Repeal the Casino Deal, is now challenging the AG’s decision in court.

“I think casinos are a bad bargain for the state,” Berwick told the Advocate. “The costs vastly outweigh the benefits.” Casinos, he said, raise crime rates, hurt small businesses and further stress an already overburdened healthcare system through increased gambling addiction.

“I don’t see why we would invite that in,” Berwick said. “These are very large corporations that come into our communities but are not oriented to those communities’ growth.” (As he put it on his campaign website: “Casinos will bring into Massachusetts enormous outside corporate forces—some, frankly, with questionable ethics—that have little real commitment to the long-term wellbeing of our state and communities.”)

The revenues promised to the state by casino supporters are overstated, Berwick continued. And casinos would “cannibalize” the Mass. Lottery, which provides local aid. Berwick acknowledges the legitimacy of casino backers’ argument that Massachusetts needs more jobs. But casinos aren’t the way to create them, he maintains. “They sound good in the short run,” he said. “One of the challenges we have as a commonwealth and as a nation is to invest for the long haul . … We need leaders and public dialogue that takes a deep breath. The quick fixes can be very deceptive.” Massachusetts, he argues, should look past the “quick fix” of casino development toward sustainable means of growth, finding ways to attract and retain businesses and preparing workers for high-tech industries.

If he were to be elected governor and the casino law were to remain intact, Berwick told the Advocate, he would “use the power of the bully pulpit” to draw attention to the evidence showing the significant risks of gambling.

And, he added, “If we have to move ahead with the casinos, we would want a very strong Gaming Commission.” The work so far of the Mass. Gaming Commission—which will award the casino licenses allowed under the 2011 law—has been “good, but it could be better,” Berwick said. In particular, he voiced concern about a February report in Boston Business Journal that found, in that paper’s words, “repeated instances of lavish employee spending” by the MGC on hotels, meals and other things. “There really needs to be no inside game here,” Berwick said.

Linda Matys O’Connell of Springfield, a Berwick supporter who works in adult education and voter engagement (and, in the 1970s, co-founded the Valley Advocate), applauds his anti-casino position. She opposes casinos not because she has a moralistic aversion to gambling, she said, but because she doesn’t believe they’re the economic engines they’re touted to be. “It seems like the least respectful way to try to bring economic development and prosperity to a city,” she said.

While O’Connell hopes to see Massachusetts’ gaming law repealed, if it isn’t, she added, the state will need someone like Berwick as its chief executive. “Having a governor with concerns [about casinos] will be helpful with the only thing we have left, which is holding the casino operators’ feet to the fire about keeping their promises,” she said.

 

Berwick’s distinctive positions on the hot-button issues of single-payer healthcare and casinos have, no doubt, been enough to win him the backing of voters who care deeply about those issues. But in conversations with the Advocate, Berwick supporters were eager to counter any impression that he might be a one- or two-issue candidate.

Indeed, Berwick has a deep and detailed platform based in a belief that government should play a vital role in bettering peoples’ lives and communities, starting with righting the social inequities that he says underlie so many problems. “We have become a society that’s divided into two societies. I hear and see that almost everywhere. Almost everyone feels touched by this social rift that’s growing,” he said.

Mending that rift, he continued, requires addressing disparities in areas like healthcare, job creation and, most crucial, education, from early childhood through college. His platform promises increased supports for families with young children, including day care and universal pre-kindergarten. He calls for a focus on preparing older students for science, technology, engineering, and mathematics, or STEM, jobs, including through partnerships with industries in need of qualified workers. He also backs increased funding for public higher ed; programs to help students from low-income backgrounds complete their degrees; and in-state tuition rates for undocumented students.

Berwick supports reforms in the corrections system, which he describes as unnecessarily overburdened, costly and insufficiently focused on preparing inmates for post-release re-entry. Right now, Berwick said, “We are using our county houses of corrections as training houses for criminality.” He calls for reducing the prison population through sentencing reforms and alternative programs—including mental health and substance abuse treatment—for people whose crimes don’t warrant prison, and he opposes the use of mandatory minimum sentences that prevent judges from exercising their discretion.

Berwick supports the use of marijuana for medical purposes—as a doctor, he said, he understands its usefulness to some patients—and is open to the idea of legalizing all marijuana use, although he’d like first to see how things play out in Colorado and Washington, both states where recreational marijuana use is now legal.

On the environment, Berwick advocates an aggressive approach to reducing carbon emissions by, among other measures, expanding the use of electric vehicles and increasing the development of renewable energy sources such as solar and offshore wind energy. His platform emphasizes protecting natural resources such as wetlands; diverting food and yard waste from overburdened landfills into anaerobic digestion systems that produce clean energy; and addressing poor air quality by fighting for the closure of polluting plants around the region.

And Berwick supports efforts to reduce the influence of money on public policy—something he saw firsthand during his time in Washington, he said—including overturning the U.S. Supreme Court’s 2010 Citizens United decision, which opened the floodgates to unprecedented levels of political spending. Earlier this month, after the Court’s ruling in McCutcheon v. FEC struck down caps on the total contributions a donor can make to candidates or political committees (limits on donations to individual campaigns remain intact), Berwick released a statement saying he was “deeply concerned” by the decision, which “giv[es] even more political influence to very few extremely wealthy individuals.

“This is yet another step in the wrong direction, building on the destructive Citizens United decision, and threatening to undermine the principle of ‘one-person-one-vote,’” he continued. “With income inequality continuing to grow in this Commonwealth and across the nation, the last thing we need is even more influence concentrated in the hands of the wealthy and well connected. We need to move—quickly—toward repealing Citizens United and implementing publicly financed elections, guaranteeing equal voice for everyone.”

 

In March, the Massachusetts Republican Party picked its nominee, Charlie Baker, at its party convention. (His challenger for that nomination, Mark Fisher, disputed the ballot count at the convention that kept his name off the ballot, and recently sued the party.) The gubernatorial field also includes Independents Evan Falchuk, Jeff McCormick and Scott Lively, an evangelical minister from Springfield.

The Democrats will hold their annual convention in Worcester on June 13 and 14. Like his fellow Democrats, Berwick spent his weekends in February and early March canvassing local Democratic caucuses around the state in hopes of wooing delegates to support him at that convention. To secure a spot on the Sept. 9 primary ballot, candidates must have the backing of at least 15 percent of the convention delegates—a threshold Berwick’s campaign says he will meet. Not surprisingly, he did well in traditionally liberal communities; at the Amherst caucus, for instance, about two-thirds of the 23 delegates committed to Berwick, and a number of others remained uncommitted to any candidate, according to Swift.

Still, Berwick has a lot of work to do between now and the primary. Polling so far shows Coakley as the one to beat in the Democratic field; in a mid-March poll by WBUR and MassINC, 45 percent of respondents likely to vote Democrat said they would choose her in the primary. Grossman finished a distant second, with 14 percent. Berwick placed third, with 4 percent.

The poll also showed Coakley as the only Democrat who could beat Baker, 41 to 26 percent. In a Grossman/Baker match-up, the Republican led 32 to 24 percent. In a Berwick/Baker scenario, Baker led 36 to 17 percent. (A more recent poll, released earlier this month by the Western New England University Polling Institute, showed Grossman making headway; while Coakley still had the biggest lead in a match-up with Baker, 54 percent to 25 percent, the poll also showed voters favoring Grossman over Baker, 38 to 29 percent.)

Berwick’s problem isn’t necessarily that voters don’t like him or his platform; only 2 percent of respondents to the WBUR/MassINC poll, and 5 percent in the WNEU poll, had an unfavorable opinion of him. (Four percent of WNEU respondents said they had a favorable view of Berwick.) In contrast, Coakley had an unfavorable rating of 27 percent in the WNEU poll. (Baker’s was 13 percent). Rather, at this point, at least, Berwick’s bigger problem appears to be that voters don’t know who he is: 74 percent of those surveyed by WNEU said they’d never heard of the candidate.

In fundraising, Berwick falls toward the back of the Democratic pack. According to his most recent filing with the state Office of Campaign and Political Finance, on March 31, Berwick had $150,000 in his campaign account. That put him ahead of Avellone, who had a campaign balance of $142,000, but behind Kayyem, whose balance rose to $244,000 last month, in large part thanks to a $200,000 loan she made to her campaign. Coakley had $519,000 in her account. All the candidates were eclipsed by Grossman, whose March 31 report showed him with $967,000 on hand. Baker, the Republican, had a balance of $731,000.

Fundraising is an issue, Berwick acknowledged. “The election is not for sale, but you do need to reach people you can’t reach personally,” he said. Meeting people personally, he continued, creates a “virtuous cycle” in which people who have the chance to hear from him directly about his credentials and his vision for Massachusetts will donate to the campaign, allowing him to spread his message further.

Like any wise candidate, Berwick says he doesn’t put much stock in polling numbers, especially this early in a race. (Indeed, Coakley, the Democratic frontrunner, can attest to the unreliability of early polls; she’d initially held a firm lead in polls over Republican Scott Brown in the 2010 special Senate race but went on to lose the election—a result that some Democrats still hold against her, and that likely contributes to her unfavorable ratings in the gubernatorial race.) The high numbers of undecided voters in the various polls—26 percent of likely Democratic voters in the WBUR poll still didn’t know whom they’d vote for in the primary—certainly suggest there’s plenty of room for candidates to make moves.

For the Berwick campaign, those moves will happen on the grassroots level. While Berwick has won the endorsements of some of the most progressive Democrats in the state—state senators Jamie Eldridge and Sonia Chang-Diaz, Rep. Denise Provost—he lacks the deep, long-standing party allegiances of a candidate like Grossman, who, before running for public office, spent decades as a high-level Democratic activist and fundraiser on the state and national levels. Berwick came into the race without an established political base, although he has picked up spirited volunteers from other, like-minded organizations, including Elizabeth Warren’s and Ed Markey’s recent Senate campaigns.

That group includes Jesse Lederman, a student and political activist who last winter organized a Berwick campaign stop in his hometown of Springfield. While many candidates try to court voters by emphasizing that they’re not “career politicians,” Lederman said, “Personally that doesn’t impress me, as someone who’s worked in politics since I was 14 and really views government … as a source of good. I don’t have problems with people who spend their careers in politics.” Nonetheless, Lederman said, he believes Berwick’s varied background—as a physician and then leader of a large nonprofit organization prior to taking a government position—leaves him well prepared for the job of governor.

Lederman also believes that Berwick’s unwavering embrace of progressive stances would help, not hurt, the candidate should he find himself competing in November against Baker, the presumed Republican nominee and a political centrist. “Elizabeth Warren showed us strong progressives can win in Massachusetts,” he said.

And, added O’Connell, those strong Massachusetts progressives can help make the commonwealth the national model Berwick believes it can be. “We have had a governor who has moved in that direction,” she said of incumbent Deval Patrick. “We’re at a critical juncture where we can continue to move in that direction … or we can do business as usual.”•

 

© 2014 The Valley Advocate