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Primer: If Earned Sick Time Passes in Mass., When Can I Call In?

This WBUR tracking poll shows that support for ballot question 4 on earned sick days remained strong through late October. (WBUR's Poll Vault)

This WBUR tracking poll shows that support for ballot question 4 on earned sick days remained strong through late October. Green is “yes,” red is “no” and gray is undecided. (WBUR’s Poll Vault)

Yes, it’s looking like the Massachusetts ballot measure on earned sick time will pass on Election Day, but no, that doesn’t mean you should plan to call in sick on Wednesday.

First of all, even if it does become law, “Question 4” won’t take effect until July 1, 2015. And second, it has a few nuances.

WBUR’s Ben Swasey explored the issues in this excellent feature, and sums up the measure thusly: it would allow all workers in Massachusetts — “including part- and full-timers and public and private employees — the chance to accrue and use up to five days of sick time in a year.” The mandated sick time would be paid or unpaid, depending on an employer’s size.

If the measure passes, employers would have to provide a minimum of one hour of sick time per 30 hours worked. Employees of companies with 10 or fewer workers could accrue up to 40 hours of unpaid sick time per calendar year, while employees of larger companies could accrue up to 40 hours of paid sick time. Workers could use sick time for themselves or to help an immediate family member — to tend to a medical condition, or get to a doctor’s appointment, or address the effects of domestic violence. After 90 days on a job, employees could begin to use their sick time, and they could carry over banked sick time to the next year.

Radio Boston pitted supporters against opponents in a substantive segment here, and summed up the two sides thusly:

Here in Massachusetts, 1 million workers lack paid sick time. And nearly one in four say that they’ve been fired, suspended or punished for taking time off due to personal illness. On the other hand, many small business owners say they can’t afford to offer paid sick leave and that if they had to, they’d be forced to raise prices or cut other benefits to make up the difference.

Quick political commentary: We often tout health care as the biggest economic sector in Massachusetts, and you could see some health-care clout being brought to bear on this issue. Boston Children’s Hospital, Partners HealthCare, Boston Medical Center, and Steward Health Care all endorsed Question 4, as did the Massachusetts chapter of the American Academy of Pediatrics. As a piece in the New England Journal of Medicine put it, “At the intersection between health and work, the health care community needs to provide a voice for patients and their families.”

Did the health-care voice make a difference in public opinion? I hope some polling pundit does that analysis.

Readers, lingering questions on how earned sick time would work? Please post them in the comments below. The backers of the measure have posted an FAQ here.

Primary Cheat Sheet On Mass. Governor Candidates’ Health Care Positions

Judging by your presence at this url, you are, perhaps, not entirely indifferent to health care? And you may, in fact, live in the lovely Bay State, according to the results of an unscientific reader survey we did once. So, in case you plan to vote in the 2014 state gubernatorial primaries, we’ve compiled a health care cheat sheet. We requested brief position statements from the five candidates facing a primary contest. In alphabetical order, and with a link to the full campaign site on each name:

Charlie Baker:
Massachusetts had a health care system that worked, with nearly every citizen having access to the high quality care they preferred, but the disastrous Health Connector website launch and the burdensome federal health overhaul disrupted that for far too many Massachusetts families. As Governor, I will fight for a waiver from the federal health law to protect Massachusetts’ exemplary health care system. I have also proposed a plan to improve the quality of health care, increase transparency and reduce costs for families. My proposals will allow patients to act as informed consumers, prioritize primary care – giving patients with multiple illnesses better treatment – and protect Massachusetts’ health system from federal burdens.

Don Berwick:
Massachusetts needs a Governor who understands how good care could be, what better payment systems look like, and how to reorganize care with patients at the center. Don is a pediatrician and an executive who has spent 30 years working to make health care work better, at a lower cost. He is the only candidate for governor supporting single payer health care – Medicare for all. Health care is now 42% of our state budget, up 59% in the last decade alone. Every other major line item in our budget is down. Single payer health care would be simpler, more affordable, more focused on the patient, and it would be a huge jobs creator.

Martha Coakley:
As Governor, Martha will have three goals for our healthcare system: expanding access, maintaining quality, and driving down cost. She has already taken the lead on controlling costs, publishing a series of groundbreaking reports that shed light on the cost-drivers in our system, and going forward she will focus on investing in proven prevention, promoting the role of community health centers, and increasing transparency. She is especially committed to improving care for those struggling with mental and behavioral illness and substance abuse; she has called for higher reimbursements for community-based services, more coverage from private insurance, and incentives for greater coordination of care. She believes we must end the stigma associated with mental and behavioral health.

Mark Fisher:
Did not respond but his campaign’s Web page on health care is here.

Steve Grossman:
We need to revolutionize the delivery of health care services to reduce or eliminate health disparities, primarily by significantly increasing our commitment to and investment in community hospitals and health centers. We must also use every appropriate tool to rein in excessive price increases at our largest medical institutions that could severely undermine achieving the goals of Chapter 224. That’s why I oppose the Partners HealthCare deal Martha Coakley has negotiated, which according to the Health Policy Commission, would raise costs by tens of millions of dollars and harm Massachusetts families and businesses. As governor, I plan to lead a serious conversation with the people of Massachusetts concerning single payer as a vehicle for reforming our health payment system, a conversation that the Boston Globe described in its editorial endorsement of me as “precisely what’s in order.”

Note: We don’t include the independents because we focused on the candidates running in the primary.

Doctors ‘Aghast’ That Surgeon General Nominee Blocked For Gun Control Views

Dr. Vivek Hallegere Murthy (AP, provided by Brigham and Women's Hospital)

Dr. Vivek Hallegere Murthy (AP, provided by Brigham and Women’s Hospital)

Opposition from gun groups is holding up — and may ultimately block — confirmation of U.S. surgeon general nominee Vivek Murthy, who expressed support for gun control in the wake of the Newtown shootings.

Doctor/author Atul Gawande recently tweeted: “The success of the attack on Vivek Murthy’s nomination for surgeon general, for holding views on guns that the AMA holds, is infuriating.”

Here, two doctors and one doctor-to-be who know Dr. Murthy — a Harvard- and Yale-trained physician — react similarly to the news that his nomination may be scuttled.

By Ali Khan, M.D., Sanjay Kishore and Christopher Lillis, M.D.
Guest contributors

His is the story of which American dreams are made: a first-generation immigrant who grew up in South Florida, where he worked on weekends to support his father’s small business. After winning a spot at Harvard at 16, he set his sights on medicine and leadership. He founded an international non-profit focused on HIV/AIDS youth education while at Yale for medical school – and threw on an MBA for good measure before heading back to Boston for residency training at Harvard’s Brigham and Women’s Hospital.

Since then, he’s practiced medicine while working as a serial entrepreneur, starting both private and non-profit organizations in medical research and health advocacy. He wields a blinding smile and a voice that immediately commands a room.

He’s even been to the White House – and he took his mom with him.

Dr. Murthy has been ‘derailed for a moderate position on gun violence that aligns with the vast majority of America’s health professionals.’

In another time and place, a nominee like Dr. Vivek Murthy, with a narrative so akin to conservative politicians like Sens. Ted Cruz and Marco Rubio, would sail through Senate confirmation as the nation’s surgeon general.

But in our time and place, special interest groups have hijacked Dr. Murthy’s nomination, as they have the entirety of the American political process. As physicians and students of public service, we are aghast.

Under the guise that his mere mention of “gun control” following the Newtown tragedy is akin to repudiation of the Second Amendment, the National Rifle Association has signaled its intense opposition to Dr. Murthy’s nomination. The NRA now promises to “score” a confirmation vote for Murthy as the basis of electoral support in the 2014 midterms – a prospect that has multiple senators wavering in their support. White House rumors suggest that a Senate vote on Dr. Murthy’s nomination will be delayed until after the midterms, in order to protect those candidates who hold the key to a Democratic Senate majority.

As physicians, we are appalled that a candidate of such high caliber – with impeccable credentials, a well-earned reputation as a “doctor’s doctor” and formidable experience in management and leadership – could be derailed for a moderate position on gun violence that aligns with the vast majority of America’s health professionals. (Never mind the fact that Dr. Murthy’s position on gun violence is no different from that of the American Medical Association, or that he explicitly confirmed that obesity, tobacco and mental health – and not gun control – would be his priorities as surgeon general.)

As Americans, however, we strongly believe that the NRA’s entry into this debate – and its immediate support by Sen. Rand Paul and others – cannot be taken lightly.

Will every qualified public health leader be held to a new standard: that a mere mention of the word “gun” is a disqualifier from public service? This new style of McCarthyism comes at a time when the United States leads the world in gun deaths and 15 months after the tragedy at Newtown. After all, even C. Everett Koop, the legendary surgeon general nominated by Ronald Reagan, described gun violence as a public health emergency.

But in our America, facts such as these have little impact in the national debate. The NRA’s influence – and that of countless special interest groups like it – cannot be ignored.

In our America, sterling qualifications, vast experience and the support of the broad medical and public health community, however, seemingly can.

Dr. Ali Khan is a practicing internist at Yale-New Haven Hospital. Sanjay Kishore is a rising medical student and recent Duke graduate. Dr. Christopher Lillis is a private practice internist in Fredericksburg, Virginia.

Further reading:

CommonHealth: Boston Medical Center Trauma Docs Speak Out On Gun Control

Bloomberg Business Week: How the NRA Defeated Obama’s Surgeon General Choice: Four Blunt Points

New Commissioner Of Health Care Finance And Policy Appointed

This just in from the Patrick Administration:

BOSTON – The Patrick-Murray Administration today announced the appointment of Áron Boros as Commissioner of the Division of Health Care Finance and Policy. Since 2008, Boros has served as Director of Federal Finance for state’s Office of Medicaid (MassHealth). He will assume his new role on September 15.

“Aron’s extensive experience in health policy and keen understanding of hospital financials will make him a capable and strong leader at the Division,” said Secretary of Health and Human Services Dr. JudyAnn Bigby. “For the past two years, he has been a key advisor to me and to the Medicaid Director on vital features of Massachusetts’ Medicaid Program, and I know he will effectively manage the vital work of the Division. I also want to thank Seena Perumal Carrington, who has served as Acting Commissioner, for ensuring that the agency’s vital analytic and regulatory work continued full force during this transition.”

In his capacity as Director of Federal Finance at MassHealth, Áron has been engaged in key MassHealth initiatives, including federal expenditures. Over the last several years, he has been deeply involved in a variety of hospital payment initiatives, including the Essential Community Provider Trust Fund and Health Safety Net programs.

Boros is also an attorney and received his J.D. from the University of Michigan at Ann Arbor. He also holds a Masters degree in Public Policy. Prior to joining the Office of Medicaid, Boros was an Associate at Boston law firm Foley Hoag, where he researched and implemented strategic initiatives for health care industry clients. His work included initiatives related to chronic disease management, health information technology, and evidence-based medicine. In this role, Boros became an expert on Medicaid and Medicare regulatory issues, including national coverage decisions, coding and payment concerns. Boros also has experience in a hospital setting, having served as a Law Clerk at Trinity Health’s Saint Joseph Mercy Hospital in Michigan.

Talking Back To The Screen On Health Care


Given the size of the problem, last night’s final gubernatorial debate included surprisingly little about health care and its ever-spiraling costs. But there were a few choice bits. Nancy Turnbull, associate dean of the Harvard School of Public Health, and Jon Hurst, president of the Retailers Association of Massachusetts, kindly agreed to share their reactions with CommonHealth.

Democratic incumbent Deval Patrick: “Small businesses make up 85% of the businesses here. Their two biggest complaints are the cost of health care and access to capital. And we’ve done more in these areas than any other administration in a very, very long time…in permitting small businesses to buy their health insurance in aggregate through cooperatives to get the same buying power that bigger businesses do.”

“In terms of health care, I like and am proud of our hybrid system — it’s a public-private reform. But I think the next big frontier is cost control, and payment reform is the way to get there, and that will take political courage.”

Nancy Turnbull: Health cooperatives were just authorized in Chapter 288 and are not up and running yet, so no small businesses have saved any money from this approach. And it’s not sure that such cooperatives will result in lower premiums. If they do, it’s quite likely that savings for the cooperatives will come at the expense of higher premiums for other small employers and individuals, which is why many health policy people and consumer groups opposed this provision of the legislation, including me.

Jon Hurst: The cooperatives legislation is a reform the small business community has pushed hard for ever since mandated health insurance passed in 2006. And for good reason. Small businesses have been hammered with 73% increases (about 3 X the rate of big business & big government) since the law passed, and that doesn’t include the increased out of pocket deductible and co-pay costs which have ballooned during this recession. The cooperatives still need implementing regulations which will determine whether small businesses will indeed have equal rights with big employers, allowing them to use cost saving tools including self insurance and more flexible rating systems to encourage wellness and better choices among providers. The legislation was certainly a political compromise and will in fact only allow 85,000 lives to join the cooperatives—representing 10% of the merged marketplace. Perhaps the most important outcome of the cooperatives effort will be whether the results show that the antiquated community rating system used in Massachusetts for groups of 50 and under is indeed discriminatory, as well as counterproductive to the important goals of achieving a healthier and more educated consumer of health care services. Continue reading

Daily Rounds: Depression Guidelines; Paying Docs; Hospital Art; Baker Channels His Feminine Side

Medical News: Debate Over, New Depression Guideline Out – in Psychiatry, Depression from MedPage Today “The American Psychiatric Association hadn't updated guidelines for treatment of major depression since 2000, and now, after five years on the drawing board, the APA finally unveiled new guidelines that are so purposefully vague as to raise questions about their usefulness.” (medpagetoday.com)

Doctor and Patient – Paying Doctors for Patient Performance – NYTimes.com “Researchers from the Massachusetts General Hospital in Boston and Harvard Medical School have found that whom doctors care for can have as much of an influence on pay-for-performance rankings as what those doctors do.” (The New York Times)

Rx Art For Hospitals: Just What The Curator Ordered | WBUR & NPR “In Boston, artist John Monti has covered the walls of a children's hospital with flower-like 3-D patterns. In Oak Lawn, Ill., pop artist Jeff Koons has put monkey faces on a CT scanner.
And in New York, artist Jason Middlebrook has painted a glorious abundance of flowers and seeds in the Bone Marrow Transplant Unit at Mount Sinai Hospital.” (WBUR | 90.9 FM)

Baker takes time out to show a softer side – The Boston Globe Baker is seeking to improve his likability rating among women. “I’m not a complicated guy,’’ Baker, clutching a microphone with his shirtsleeves rolled up, told the audience at Benjamin Franklin Institute of Technology in Boston. “I go to my kid’s football games. I go to my daughter’s shows. And I just sit there and cry when she sings.’’ (Boston Globe)

Opponent Of Embryonic Stem Cell Research Back In Spotlight

James Sherley

Photo/MIT

James Sherley

James Sherley has finally gotten his way.

Remember Sherley? He’s the former MIT associate professor who went on a hunger strike in 2007 because he was denied tenure — and claimed the decision was based on the fact that he’s black.

Well, Sherley is also an outspoken critic of embryonic stem cell research and opposes abortion, according to reports (he uses adult stem cells in his own research). And, as it turns out, he’s one of the remaining plaintiffs in the lawsuit that at least temporarily blocked President Obama’s executive order that allowed expanded embryonic stem cell research. Today’s ruling, which says that the president’s order violates a ban on using federal funds to destroy embryos, could render all embryonic stem cell research illegal, according to The New York Times.

Sherley, a biological engineer, now works at the Boston Biomedical Research Institute. I tried him by phone and email, but didn’t get a response.