Ballot questions have always had a divisive effect on a state, and this year is no different. While Question 2 and 3 are expected to pass by a large margin, Question 1 has left voters deeply divided on its issue, with the last poll in September showing a slight favor to “no”. The question itself is framed around nurse to patient limits. Meaning, if passed, the bill would force hospitals to hire more nurses to reach a specific nurse-to-patient ratio. The proposition has quickly evolved into pitting unions and the far left of Massachusetts against hospitals and the more socially centered, economically right-leaning part of Massachusetts. Not only has the question divided the general populace of Mass, but also the political leaders of our state. While both senators, Marty Walsh, and soon to be House Representative Ayanna Pressley have supported the proposition, Governor Charlie Baker, The Boston Globe editorial board, and other prominent Massachusetts Republicans have spoken up against the proposition. So why vote for Question 1? Well, the fundamental concept of the proposition is to limit the number of patients one nurse can tend to. Hypothetically, the measure would reduce the work nurses would have to do and thus improve the job quality of nurses. Proponents say the bill is a necessary step to improving one of the largest job sectors in Massachusetts. But opponents say that it will dramatically increase the cost of healthcare, cause hospitals to shut down, and is government overreach.
The cost is really where the argument for the bill begins to fall apart. While logical theoretically, the consequences of this bill could have an extremely adverse effect in harming our health care system. The independent Massachusetts Health Policy (MHP) group has estimated that if passed, the bill would increase the cost of running hospitals in Massachusetts by $676 million to $949 million annually, far different from the yes estimate ($37-$47 million). Consequently, while large hospitals may be able to bear the brunt of a sharp increase in cost, smaller hospitals, such as rural community hospitals will not. The sudden hike in cost could mean a large number of already struggling hospitals would have to close their doors, or alternatively increase the cost of healthcare. Massachusetts healthcare, while having large problems, is arguably the best in the world. The proposition could have a deep impact on the way our healthcare system works, and would most likely lead to a massive increase in hospitals bills, as well as forcing many hospitals to close their doors.
There is also the issue of whether or not the bill would actually improve health care. The only other state to pass a bill like this is California. However, there are stark differences between the bill in California and the bill in Massachusetts. The bill in California was passed in 1999, and was slowly implemented all the way up until 2004. The Massachusetts bill would take effect only 2 months after the vote. The limits in California were significantly less extreme, and there have been multiple studies that show that the bill has not had the effect that proponents say it will. MHP has found that there has not been a systemic improvement in health care quality in California since the bill was implemented, and the effects have varied by hospital. This bill is risky and has no evidence to back up solution. Beyond this, the main issue with the bill is that it is a solution looking for a problem. Massachusetts healthcare is ranked #1 in the country and is arguably #1 in the world. Mass General is arguably the single best hospital in the world, and our healthcare system is a model for other places. We also already have an extremely high ratio of nurses to patients relatively speaking. Therefore, the proposition is not looking to solve a real issue or improve on a weak link. A WBUR poll found that even nurses were divided on the subject, with only 48% of nurses saying they will vote yes, 45% saying they will vote no, and 7% are undecided. Simply put, Question 1 looks to solve an issue that doesn’t exist, is far too extreme, and will do more damage to our great healthcare system that it will do good.