When in a hospital bed or emergency room, who doesn’t want the best health care possible? When we are that vulnerable, we all hope to be in the hands of competent, professional doctors and nurses who are not tired or pulled in too many directions.
Question 1 on the Nov. 6 midterm election ballot aims to address that fear, to ensure that in Massachusetts acute care hospitals, we needn’t worry about nurses stretched too thin. This is a laudable goal, one that everyone can support, but we worry that Question 1’s one-size-fits-all mandate proposed by the state’s nurses union is the wrong way to achieve that goal.
Delivering health care inside a hospital efficiently and effectively is just too complex and intimate a process to be governed by a rule book codified in a ballot booth by voters, many of whom very likely won’t have read the three-page “question.” Rather, many of us will be inclined to act on a gut feeling that more is better when you are in a hospital bed. But there is no guarantee that this proposal will produce the desired result. What the union has put on the table removes common sense from the process that decides who gets what care when and how. Not all nurses have the same level of experience, patients’ conditions improve and worsen, census and circumstances can change rapidly on a shift. Common sense and flexibility will outperform a referendum-mandated rule book.
California, the only other state in the country to try to legislate staffing levels at hospitals, still hasn’t decided 14 years later whether care has improved. We would feel much better if there were clear, undisputed evidence that staffing mandates there did make a big difference.
The Massachusetts Health Policy Commission also noted the California change yielded no systematic improvement in patient outcomes.
And after both sides of the question have spent millions of dollars and months of campaigning, we still don’t have enough neutral, trustworthy information to make an informed decision on a proposal that will change the entire state’s health care system — a system that is a huge part of our personal finances and the state economy, and most importantly, can have huge consequence in our personal lives.
Mandating staffing ratios won’t come free. The Health Policy Commission estimated the overall financial impact of Question 1 at $676 million to $949 million annually — a number the nurses union disputes. But whatever the cost, it will ripple through the health care system in terms of insurance premiums, state taxes and spending priorities — likely triggering unforeseen, unintended consequences.
We think that making such a significant move in the absence of little more than trust-me, he-said-she-said talking points is dangerous and irresponsible.
Rather, if we believe that our health care is important enough to legislate how hospitals operate, then we shouldn’t rush to enact a referendum mandate any more than we would want our nurses to rush our bedside care.
We’d prefer that this question be rejected in favor of the governor or Legislature appointing a blue-ribbon commission, representing all the major stakeholders — nurses, doctors, hospitals, patients and so on — to thoroughly study the merits or drawbacks of state-mandated nurse staffing.
Then we, as voters, or our elected lawmakers, will have something solid on which to base a decision, something beyond our own gut feelings, some reliable information about possible outcomes.
We think we should vote “No” on Question 1. Instead we should ask for a thoughtful, thorough analysis of the idea, so that if Massachusetts ultimately follows California’s lead, it will be with confidence we are doing what makes sense and is worth the costs, rather than something that just feels good in the moment.
Would you decide to have major surgery any less carefully?