Q1: A blunt instrument for a complex problem

The real question voters should be asking is, who do you trust?

THE HEALTH CARE SYSTEM in America has grown from a patient-first approach into an intricate web of bureaucratic red tape. Every effort to address a health care problem must be deliberate, precise, and balanced.

As a state representative, I have been deeply involved in health care policy since 2006 when I helped write the health care reform legislation that served as the model for the Affordable Care Act. In total, I have contributed to three major pieces of health care legislation. We have made important progress in Massachusetts at containing the increasing cost of health care, but it has been hard won.

Question 1’s mandated nurse staffing ratio, however, is a blunt instrument for a complex problem.

Question 1 asks you, the voter, for an up or down vote on a complicated subject. Unlike Question 3, which urges voters to voice their values, Question 1 asks voters to make an informed analysis of facts with which they are unfamiliar. With so much confusion, the key question voters are implicitly asked in the barrage of campaign advertising is a simple one: Who do you trust?

House Majority Leader Ronald Mariano of Quincy.

Question 1 is proposed by a group representing just a fraction of nurses. Nurses are actually split on the issue. Rather than be swayed by the compelling anecdotes of nurses on either side of the argument with a vested interest, we should instead look to independent institutions that have a more complete view of the issue.

The Health Policy Commission is an independent state agency established in 2012 to monitor health care spending growth in Massachusetts. It is also the agency that Question 1 tasks with implementing the nurse staffing ratios should the question pass. In accordance with their statutory responsibility, the commission recently conducted a thorough analysis of Question 1, with the help of a health economist from California who has been studying the results of a similar nurse staffing law passed in that state in 1999. The commission’s conclusions are troubling.

Meet the Author

Ronald Mariano

House majority leader/state rep, Quincy
Of greatest concern to me is that the hardest hit by the mandated staffing ratios would be community hospitals and nursing homes. Hospitals with a higher percentage of private payers would be able to afford the staffing ratios, but only by siphoning off nurses from nearby community hospitals and nursing homes. As a result, the Commonwealth’s most vulnerable residents will have reduced access to key services and lower quality of care. I watched as my district lost an important health care resource with the closure of Quincy Hospital in 2015. I do not want to see residents of other communities experience the same loss.

Ronald Mariano is the House majority leader and a state representative from Quincy.