Single-Payer Backers in Massachusetts Say Trends Underscore Urgency

By Katie Lannan

As supporters of a government-based, single-payer health care system made their case to the Health Care Financing Committee that adopting such a model in Massachusetts could simplify the medical experience, help other families avoid hardships they’d faced and generate economic benefits, the committee’s Senate chair cautioned against viewing the policy as a silver bullet.

The committee heard testimony on a pair of bills (S 766, H 1267) that would eliminate co-pays, deductibles and coinsurance and set up a state trust fund to pay for the health care of Massachusetts residents and non-residents who work here at least 20 hours a week.

The bill proposes funding the trust with new taxes — an employer payroll tax of 7.5 percent, with the first $20,000 of an establishment’s payroll exempt; an employee payroll tax of 2.5 percent after the first $20,000 in income, and a 10 percent tax on unearned income above $20,000. Those taxes, supporters said, would be in lieu of the money currently spent on premiums and out-of-pocket costs.

Rep. Denise Garlick, who filed the legislation with Sen. Jamie Eldridge and Rep. Lindsay Sabadosa, said Massachusetts is grappling with the “symptoms of a failing health care system — the declining access, the decrease in affordability and the decrease in the quality of care.”

“We must acknowledge that the system is not about health or care any longer. It is about business and profit,” the Needham Democrat said. “This bill is essential for achieving and sustaining a just and efficient health care system.”

Supporters told lawmakers of struggles they’ve faced in trying to access coverage and pay for care.

Acton resident Rebecca Wood said that after delivering a baby at 26 weeks, she has over the years had to make “impossible choices” like whether to pay for her daughter’s medical care or her own. After once delaying her own care and developing an infection, she said, she lost all of her teeth and parts of her jaw.

Wood said a Medicare for All policy would allow her and her daughter “to thrive rather than struggle each day for mere survival.”

The bill has 74 co-sponsors, including 16 members of the 40-seat Senate and 58 from the 160-seat House. Every sitting lawmaker who is currently running for statewide office in 2022 — gubernatorial candidate Sen. Sonia Chang-Diaz, lieutenant governor hopefuls Rep. Tami Gouveia and Sen. Adam Hinds, and auditor candidate Sen. Diana DiZoglio, all Democrats — has signed onto the bill.

Gouveia — who told the committee she has supported single-payer health care since she was 13, when the Canadian government paid for the care of a cousin who got in a car accident there — said that municipalities and small businesses stand to save money on employee health costs under a single-payer system, tallying some of those savings at $28 million for the city of Lowell, $44 million each for Springfield and Waltham, and $50 million for Cambridge.

Hinds said the pandemic has underscored “the fundamental flaw” in the American health care system — the link between employment and insurance.

“It would seem unconscionable that during a public health crisis that in turn causes an economic downturn and subsequent job loss in many cases that we would simultaneously kick people off of health insurance and send them scrambling,” he said. “It’s just counterintuitive to how we can and should respond to a public health crisis.”

Single-payer bills have been filed for years on Beacon Hill, and while they are the focus of passionate advocacy and have the backing of more than a third of state lawmakers, the idea of making the move has met pushback from the insurance industry and has not gathered the necessary momentum with top Democrats who control the legislative agenda.

Lora Pellegrini, president of the Massachusetts Association of Health Plans, said that 98 percent of Massachusetts residents have health insurance coverage, and the debate around single-payer “ignores our state’s near universal coverage achievements and distracts from the critical work we must do to control health care costs for employers and consumers.”

“Mandating a one-size-fits-all, government-run health care system will eliminate health care options for patients and will dramatically increase taxes on residents and businesses across the Commonwealth,” Pellegrini said.

Mass-Care, an advocacy organization that supports Medicare-for-All legislation, said the bill’s cosponsors this session include a “slight majority” among Health Care Financing Committee members. The committee co-chairs, Sen. Cindy Friedman and Rep. John Lawn, are not among them.

Both Lawn and Friedman questioned supporters about details of the bill.

Friedman, who has been the Senate’s point person on health care legislation, said she wanted to acknowledge “how completely dysfunctional our health care system is” and said she supports “major changes” to it.

“I’m very concerned with the testimony because it sounds to me like everybody’s saying Medicare for All or single-payer for all will fix everything, and it’s very hard for us as legislators who have been working in health care to push that narrative, because we know it’s not true,” she said.

She said that Medicare decides what care and medications it will pay for, and asked “Why is that better than basically changing our system, capping hospital costs, shifting dollars to primary care?”

UMass Amherst economics professor Gerald Friedman said the simplicity of a single-payer system would be an improvement and that all medical systems will ration care. He said the current system makes those calls based on what insurers are willing to pay and a better model would make its decisions “transparently, openly and on the basis of our moral judgments trying to make life better for people.”

The bill stipulates that “covered benefits shall include all high quality health care determined to be medically necessary or appropriate by the Trust” and sets out several areas of care that would be included, such as preventive and diagnostic services, emergency treatment, mental health, palliative care, dental care, physical therapy, maternity and reproductive care, and long-term care.

Professor Friedman also fielded a question from Lawn, who asked what makes Massachusetts different from states like Vermont, where officials scuttled plans to adopt a single-payer system, and Colorado, where voters soundly rejected a single-payer ballot initiative in 2016.

Lawn said those states “found proposals for a single-payer health care system unworkable because of the amount of taxes and government spending required to fund it.”

Friedman replied, “I think what makes Massachusetts different is I think our politicians have the courage to take on serious problems.”