PITTSFIELD — In September 1941, as his nation reeled from the Second World War still months before the United States would officially join it, Winston Churchill visited a 19th-century Buckinghamshire estate called Bletchley Park.

Inside, a group of codebreakers led by computing pioneer Alan Turing and immortalized on film in "The Imitation Game" were toiling to crack Enigma, the ever-changing mechanical German cypher that brought every detail of the Nazi High Command within reach — as unreadable gobbledygook.

To crack it, Turing and his colleagues managed to invent modern computing. And to do that, they needed a lot of money. The public couldn't possibly find out about what was happening at Bletchley, and indeed it wouldn't for decades.

But, that October, as his nation rationed everything and ripped up iron fenceposts for the war effort, Winston Churchill issued a communique regarding the Bletchley Park project: "Make sure they have all they want on extreme priority."

His words rang true to me this December, 77 years on, as I spent four days at Berkshire Medical Center with a debilitating but benign form of viral vertigo that made sitting up nauseating and walking without help impossible.

As nurses managed my care, my food, my every need alongside those of myriad other patients with myriad other, far more complex ones, I couldn't help but think of Question 1, the failed November ballot referendum that would have mandated nurse staffing levels by state law.

I voted for Question 1 because the primary organ of nurses' organized labor endorsed it, and I support organized labor. The measure's independently reached price tag, between $700 million and $900 million, did give me pause. But as I lay in a gurney, unable to turn over without doing mental barrel rolls, I kept returning to Churchill's words: "Make sure they have all they want" — "on extreme priority."


Question 1 fell victim to several pitfalls of a plebiscite. Its technicality made it beyond most voters' comprehension, a fact easily manipulated by either side. Its legal scope constrained it to an unfunded mandate — similar to the issue that doomed a would-be Question 4, the so-called Millionaire's Tax. These two issues combined to create a narrative of cost that framed the question entirely wrong.

Detractors found the price tag untenable, and they were right that hospitals ought not to bear the brunt of those hundreds of millions.

But if nurses say they need these staffing levels, and the state says it will cost up to $900 million, that doesn't mean we stop and throw our hands up. It means we, the Commonwealth, aren't spending enough on nurses, and we need to spend a whole lot more — in the neighborhood of $900 million more.

I am not an expert on nursing. I have no idea what kind of staffing level is appropriate. I'd bet the lion's share of Massachusetts voters doesn't either. In my internal calculus, that means defer to the people who do, in this case the nurses. But a ballot initiative knowingly puts complex issues in the hands of the electorate — and being an expert is rightfully no barrier to the ballot box.

Nine-hundred million is a lot of dollars. I don't want my copays or deductibles to go up, and I don't want care to suffer at Massachusetts hospitals, some among the world's best. This money can and should come from state coffers, divvied up equitably among taxpayers. But a ballot initiative knowingly limits petitioners and voters to one area of action: we can mandate a level, but we can't simultaneously allocate the money to fund it.

We saw this with the millionaires' tax, which would have collected revenue but also promised to earmark it for education. No dice, said the Supreme Judicial Court. No multitasking in a plebiscite.


The weaknesses of referenda are clear, and they're knowingly structured to make ballot initiatives the last resort of legislation. Even when they are enacted, the state has immense power to drag its feet on enforcement. Just look at recreational marijuana.

They are what petitioners turn to when Beacon Hill has given them the cold shoulder, doing political double duty for elected officials: any result allows lawmakers to hide behind "the will of the people" and a failure allows them to table an issue indefinitely as voters may think it has come and gone.

We must not allow issues like nurse staffing to come and go. The General Court must grow some legislative teeth and address the issue in the session to come.

Gov. Charlie Baker, the former health insurance executive reelected with a greater mandate than his first term and the highest popularity in the country, could lead the charge if he wanted.

He's made clear that reallocation of state funds directly to local entities is a Baker-Polito modus operandi. Why not to hospitals, or regional health authorities? Reframe it as a landmark, billion dollar investment in our state's nurses and I think the "will of the people" might change.

During my stay at BMC, I watched a nursing associate work through a splitting headache to keep the floor running. I watched a housekeeper step in to help lift my roommate out of his bed when everyone else was busy. I heard a registered nurse worry about her own brother, also hospitalized, as she disbursed medication to patients. Through it all, I received excellent medical attention.

These women and men should have everything they need and more. They do an extraordinarily difficult job driven by what can only be described as the calling to care.

The voters failed in rejecting Question 1, and because of the process' limitations, I can't even blame them.

Now, it's up to Baker to return to the State House and govern. He should work with the legislature to fund and mandate massive increases in nurse staffing levels, determined in tandem with labor and management.

This issue is critical and must be solved — "on extreme priority."

Evan Berkowitz is an Eagle news designer.