Question 1 opponents say it isn’t the answer to the problem. Meanwhile, the battle over this ballot question has turned into an ugly street fight, with a yes or no vote equated with life or death, depending on which side you’re on. Lost in the extreme rhetoric — as Walsh acknowledges — are legitimate workplace issues connected to the stress of caring for very sick patients. And that’s the real shame of this expensive and nasty campaign to win votes on Nov. 6.

That’s how Massachusetts Health & Hospital Association president Steve Walsh described Question 1’s call for mandatory nurse-to-patient ratios, during a recent meeting with the Globe editorial board. Yet any empathy he might feel hasn’t stopped Walsh and the hospitals he represents from doing all they can to defeat the ballot question, which is backed by the Massachusetts Nurses Association.


As of this week, the “no” side seems to be winning the argument. A Suffolk University/Boston Globe poll found 58.8 percent of 500 likely voters are against Question 1. That represents a sharp shift from a month ago, when 52 percent of voters who were surveyed said they favor the measure. Consider it proof that if you pour millions of dollars into scary TV ads suggesting, for example, that a little boy with breathing problems won’t be able to get into the ER because of mandated nurse-to-patient ratios, voters will start to think nurse-to-patient ratios are a bad idea. It’s hard for me to believe a child in that dire situation would ever be turned away by Massachusetts health care professionals. But on Election Day, Question 1 opponents want you to envision him gasping for air because of state-mandated staffing requirements.

Question 1 opponents were also bolstered by a well-timed report from the state Health Policy Commission, which concluded that if the ballot question passes, it would increase health care costs by a whopping $676 million to $949 million a year. The Massachusetts Nurses Association estimates a much lower cost increase, of $47 million. I don’t know whose numbers are correct. But I do know that in Massachusetts, rising health care costs are not usually enough to kill a proposal. Two years ago, Boston Children’s Hospital got the go-ahead, with conditions, for a $1 billion expansion plan, even after the HPC projected increased health care costs associated with the project. And last July, the HPC said the proposed merger of Lahey Health System, Beth Israel Deaconess Medical Center, and their affiliated hospitals would increase total health care spending by an estimate $138 million to $191 million a year. In response, state public health officials are imposing restrictions aimed at containing costs and maintaining access to low-income patients.


In other words, state policy makers find a way to help the management side of the health care industry. How about working out a compromise with the workforce? The Massachusetts Nurses Association, a union representing 23,000 nurses, has been trying for years to get the Legislature to enact nurse staffing laws. In 2014, lawmakers instituted a mini version of Question 1, which applies to intensive care units. Evidence so far about its effectiveness is inconclusive.

Yet, as Walsh, a former legislator, will tell you, health care worker burnout is real. Why? “Because they’re really tired,” he said. “Because they’re dealing with people who are really sick and it’s a really hard job.” Question 1, added Walsh, has prompted “a legitimate discussion about whether the workforce needs additional resources to do their job. And it’s a fair discussion we should have. . . . We have to own that problem.”


So there’s a real problem, which deserves real attention from state policy makers.

Tell us, Question 1 opponents: What, beyond a “yes” vote, will make you hear the cry for help from nurses and respond to it?

Joan Vennochi can be reached at vennochi@globe.com. Follow her on Twitter @Joan_Vennochi.