Rick Lord has a unique perspective on health care in Massachusetts. He serves on the state’s Health Policy Commission. He stepped down in May after more than 28 years as head of the business group Associated Industries of Massachusetts. And previously he served as the budget director of the House Ways and Means Committee on Beacon Hill.

 Lord talked health care on this week’s Health and Consequences segment of the CommonWealth Codcast with John McDonough of Harvard’s TH Chan School of Public Health and Paul Hattis of Tufts University Medical School. To give you a taste of the discussion, here are seven questions posed to Lord.

What kind of grade would you give the Health Policy Commission?

“I would give it an A -,” Lord said, noting that the annual process of setting a health cost growth benchmark has focused attention on the rising cost of health care. Lord said the commission’s advisory role in analyzing the impact of mergers and acquisitions has also been helpful. The proposed acquisition of South Shore Hospital and Hallmark Health System was blocked in part because a Health Policy Commission analysis concluded it would increase costs. “Fifteen years ago it would have [been approved] because nobody was looking at those kinds of transactions in the marketplace,” Lord said.

Are rising health care costs less of a problem today?

“The bigger employers seem to not see health care inflation as the kind of real challenge it might have been 10 years ago. For smaller employers, however, particularly in the small group market, which is 50 and under, they don’t have those tools, the resources. They’re in that market that’s group rated, and those premium increases continue to be over the benchmark, which is currently 3.1 percent and was 3.6 percent. They don’t feel as comfortable about our success here, so we have more work to do.

Lord said there are many other cost challenges facing Massachusetts, including wasteful spending on emergency room visits, high readmission rates, and overuse of teaching and academic center hospitals.

Does it make sense for employers to provide insurance to their workers?

“We’re in the situation we are kind of due to an accident of history. It was during World War II. There were wage and price controls and employers couldn’t give salary increases so they started offering benefits like health insurance. And that became the way that, as you said, most employees, people in the workforce, now get their health insurance through their employer. If we had to start all over again, I don’t think the three of us would design the system that we have. On the other hand, I don’t see us moving off of it. I know there are a lot of discussions, certainly at the national level and in the presidential debate, about Medicare for All. I don’t see us going off in that direction, at least in the near future. Most people are comfortable with the current system. We’ve made it work as best we can.”

Why do businesses oppose changing the way health care is paid for?

“The benefit packages that employers offer are part of the way they attract the types of employees that they’re looking for. It’s part of their compensation strategy, so that’s one reason they wouldn’t want to see it go. Secondly, I think they feel they have more control, particularly, again, the larger ones because they can self-insure, they can design the benefit plans, provide some more flexibility. They would be concerned about losing all of that and having it taken over nationally. Third, I think there’s a lot of evidence that commercial insurance rates to providers help subsidize the public payers like Medicare and Medicaid. It’s not like employers aren’t going to be paying into a national system, and who knows what they’ll be paying in order to finance it if we did go, for example, to Medicare for All. It’s not like they’re going to be off the hook. They’re going to be paying into that system in some way. At least right now they feel more comfortable with the system we currently have.”

Do you think the Beth Israel-Lahey merger will create a true competitor to Partners?

“That was the rationale basically for approving that merger. …After these transactions occur, I think we need to do a better job of looking back to see if we achieved what was promised during those conversations. It’s obviously way too early to know what the outcome will be.”

What about the proposed merger of insurers Harvard Pilgrim Health Care and Tufts Health Plan?

“I’ll refrain from commenting on that. I think individual mergers and acquisitions have to be looked at on their own.”

What’s the secret to getting health care legislation passed on Beacon Hill?

In 1988, when Lord was working on Beacon Hill, a universal health care law was passed along with an employer mandate of $1,680 per person. “The employer community in general was not at all supportive of that law,” Lord said. “I’m not sure how actively they participated in the conversation. Anyway, we passed a law that the employer community opposed.” Republican governor William Weld came into office vowing to repeal the law, and most of it was discarded. In 2004 and 2005, when universal health care resurfaced under Mitt Romney, business groups were all key participants. “It showed me that, if you can get the stakeholders at the table and everybody’s willing to give, you can accomplish some great things.”

BRUCE MOHL

BEACON HILL

Saying rideshare accounts for 8 percent of vehicle miles traveled in Suffolk County, Tyler George of Lyft says universal congestion pricing is the way to go. (CommonWealth)

A Globe editorial says the problems with the whole system of clerk-magistrates, which the paper has been railing against for years, are underscored by Gov. Charlie Baker’s recent nomination for one post of a police lieutenant with no law degree — but a background coaching Lt. Gov. Karyn Polito’s son in youth football — and selecting a member of the Governor’s Council, the body that must confirm judicial picks, for another. 

A year before the scandal at the Registry of Motor Vehicles exploded, a hearing officer with the agency sounded the alarm about the agency’s processing of out-of-state driving infractions. (Boston Herald) 

MUNICIPAL MATTERS

Worcester mortician Peter Stefan stored nine abandoned and decomposing bodies in his basement while officials delayed action on permits to cremate them. The stench became so bad that local and state officials are investigating. (Telegram & Gazette)

The city reflects on the life of Rev. Michael Haynes, the “conscience of Boston,” with thoughts from Mel King, Ray Flynn, and others. (CommonWealth)

Haverhill Mayor James Fiorentini wants to do away with civil service requirements to speed up the hiring of more new police officers. (Eagle-Tribune)

A kayaker floated around in rough seas for hours before being rescued outside Manchester Harbor. (Salem News)

Shark-tracking technology has been demonstrated on the Cape by Miami-based company Altametry, although Wellfleet officials are balking at the price to implement the system. (Cape Cod Times) 

WASHINGTON/NATIONAL/INTERNATIONAL

There were some snickers when state Rep. Shawn Dooley first raised spying concerns a year ago in relation to the MBTA buying new subway cars from the state-owned Chinese firm CRRC, which is making Red and Orange line cars at a facility in Springfield. But it now looks as though Congress will pass legislation effectively banning the company from vying for any new contracts in the US. (New York Times) 

ELECTIONS

The Massachusetts Republican Party is stepping up its outreach, targeting House Democrats seen as vulnerable and hosting a fundraising event featuring Trump campaign officials. (CommonWealth)

Mayor Marty Walsh says no one should worry that three members of Boston’s Zoning Board of Appeal have resigned in the last week. (Boston Herald) 

Yvonne Abraham says Walsh has problems. (Boston Globe) 

Charles Blow says Joe Biden is problematic. (New York Times) 

BUSINESS/ECONOMY

John Ward has a revolutionary idea for a pro soccer venue in Boston — a spiffed-up Harvard Stadium (CommonWealth)

What defines the true Patriot Way? Winning at all costs without regard for pesky distractions of player misogyny, or rape allegations, says the Herald’s Tom Keegan. Dan Shaughnessy says pretty much the same thing. (Boston Globe) 

First Doyle’s, now it looks like it will soon be curtains for Out of Town News in Harvard Square. (Boston Globe)

EDUCATION

Lane Glenn, the president of Northern Essex Community College, says it’s time to invest in student success. (CommonWealth)

The suicides of nine Harvard undergraduates, six of whom were of Asian descent, over the course of a decade is prompting questions about the university’s role in preventing suicide and the particular challenges Asian students face. (WGBH)

ARTS/CULTURE

Worcester celebrated StART on the Street Sunday. (Telegram & Gazette)

CRIMINAL JUSTICE/COURTS

Karen Ross of UMass Boston says Repairing Harm is a promising program for rehabilitating inmates. (CommonWealth)

David Ortiz gives his first interview with an English language publication to the Globe. WGBH’s Adam Reilly wonders about some questions he would like to see posed to Ortiz to try to get at the real story behind his June 9 shooting in the Dominican Republic. 

All four of Mayor Jasiel Correia’s alleged co-conspirators in a political corruption and extortion scheme are due back in federal court this week, including his former chief of staff, Gen Andrade. (Herald News) 

A Norfolk County grand jury has indicted Marlon Alexander of Boston on assault charges after he was accused of trying to kill his pregnant ex-girlfriend by crashing a car he was driving into her car on Route 3. (Patriot Ledger) 

MEDIA

The Daily Hampshire Gazette is opening a one-person bureau in Holyoke. In an editor’s note announcing the move, the Gazette recalled a CommonWealth piece from 2011 by Tom Fiedler entitled: “What happens when a community loses its newspaper?”