here is always a gap between politics and government. And that gap is inevitably as wide and deep, or as narrow and shallow, as the gap between promise and performance.
Candidates invariably reach for the levers that move people, the emotional flashpoints that trigger the vote in the booth. So we're subjected to last-minute barrages from would-be presidents: Who resurrected Willie Horton? Should a little Cuban kid be denied his freshly widowed father?
Of vastly more import to the voters of Massachusetts (and Rhode Island) is the collapse of Harvard Pilgrim, the bankrupt medical insurance colossus, in whose jumble of mismanaged computer files lie the numbers and ailments of a million subscribers.
Health care, or, more properly, the fear of the loss of adequate health insurance, is the second-most-important issue in New Hampshire, according to one candidate's polling, only tw points behind education. No other issues - not taxes, not crime, not environment - are even close. But health insurance - who gets and doesn't get it and who pays for them that ain't insured - is a third-rail issue in American politics: Touch it the wrong way and your candidacy is cooked.
The Democrats are having a big mud-pie fight over whose health care scheme is better. Bill Bradley is Mr. Big Idea and Al Gore is Mr. Once-burned-twice-shy. Dollar Bill bet his bankroll on making health care his breakthrough issue. Gore, having seen how Mr. and Mrs. Clinton were savaged in the administration's ill-fated first-term national health insurance initiative, opts for incremental steps and keeps pointing to the protective endorsement of his buddy, Senator Ted Kennedy.
The Republicans are gulping for air on this one; their party doesn't like big government or entitlement programs, and Republican voters tend to have their health insurance already, thank you, and don't particularly care to pay more for someone else's.
But none of the election-year blather does anything for the 1 million Massachusetts citizens whose coverage is in jeopardy because of the way Harvard Pilgrim managed itself into receivership on Jan. 4.
The one-time wunderkind of the Weld administration, Charlie Baker, parachuted into the driver's seat at Harvard Pilgrim several months ago. Good Old Charlie will fix it came the assurances from those supposedly in the know. Well, Good Old Charlie didn't have a clue, apparently, about how bad things actually were.
Whoever was doing the due diligence was out to lunch. The accountants were AWOL, or else taking their money under false pretenses. The situation was far worse than advertised, we're now told. No one knew how much money had been lost where. And Good Old Charlie Baker, who made the fiscal trains run on time for Weld-Cellucci, arrived on the scene like a firefighter entering a burning building. He promptly fell through the floor into the cellar.
The atmosphere in the health care community has changed permanently. There's too much at stake now, too much money owed, too many careers on the line. No more business as usual. Whatever numbers Baker comes up with now will be looked at with jaundiced eyes. The system has careened out of control.
Into the breach has stepped Attorney General Tom Reilly, whose expertise is prosecuting criminals, not sorting out bankruptcies. His first order of business is to stabilize the situation and figure out who gets first crack at reorganizing the medical care delivery system in Massachusetts.
He designated some investment bankers to sort through the options. As with any kind of train wreck, the first helpers on the scene set up a triage station, sorting out the badly hurt from the cases who can wait and making the hard decisions about not wasting valuable time and manpower on cases that are too far gone. Clearly, there will have to be the inevitable blue ribbon commission to sort out this mess.
No one in the Cellucci administration's current lineup inspires the sort of confidence that is essential at this stage: not the governor, who was away in Florida vacationing while the Harvard Pilgrim meltdown took place; not his lieutenant governor, who has difficulty sorting out her babysitting arrangements; and not his insurance commissioner, on whose watch the train wreck occurred.
Once Reilly's no-nonsense initial sort-through takes place, the Legislature will have to be involved. Do we let Harvard Pilgrim fold? Does the state jump in with a big bailout? Do we sell off the wreckage to a white knight, a for-profit private insurer that may turn out to be a black knight? Do we set up a new kind of not-for-profit entity?
Speaker Tom Finneran's credentials as a rugged fiscal conservative who will not be bullied into a panic solution are well established. We'll need Finneran's crusty resolve on this one. Senate President Birmingham's gubernatorial ambitions, plus his ties to organized labor, should prove useful in selling what eventually must be sold to the senators.
Clearly, the inevitable commission will have to include providers (hospitals and doctors), employers (who pay the premiums now), state regulators, and the HMOs. Just as clearly, there is not enough money in the system as it exists. We will have to pay more. We have to invent a new system on the fly.
David Nyhan is a Globe columnist.
