Five years after redrawing the lines in the national health care debate, Beacon Hill is looking at new reforms, closely studying payment system plans to lower costs and examining a government-controlled single-payer model.
“We will end up with a government option at some point. We will end up with a single-payer at some point, and wouldn’t it be wonderful if that point was now, and the place was Massachusetts?” said Cape and Islands Senator Dan Wolf at a December 15 afternoon legislative hearing.
Everyone who spoke at the nearly three-hour hearing was in favor of An Act Establishing Medicare for All in Massachusetts, but it has its detractors including the Pioneer Institute, which submitted written testimony arguing it would cause regulatory problems at the federal level and could create a “two-tiered medical system.”
Massachusetts made history in the 2006 health care reform signed by Gov. Mitt Romney, but single-payer advocates say that law fell short and blame it for a new host of problems.
“Ironically the growing intrusion of insurance companies was sort of kicked off by the passage of health care reform, which kind of emboldened them,” said Dr. Carroll Eastman, who said she left an administrative position in health care because the job was increasingly concerned with billing, rather than treating patients.
The cause for a single-payer health care system is not new, but it has some burgeoning support among doctors and nurses who are fed up with the demands of private insurance companies.
Dr. Leo Stollbach, a member of the Massachusetts Medical Society, said a recent survey showed that 41 percent of members support a single-payer system, up 7 percentage points since 2010. Another 23 percent support a broadly available public health insurance option, Stollbach said.
“At what point are we going to decide that we’re going to stop living in a Charles Dickens novel,” said Marisa DeFranco, a U.S. Senate Democratic candidate, at the Joint Committee on Health Care Financing Committee hearing. “Please do not play defense to Republicans on this.”
Single-payer health care has been a perennial issue on Beacon Hill. Despite some support over the years in the higher echelons of legislative leaders, the idea has never advanced.
The chief focus among legislative leaders and Gov. Deval Patrick is on the governor’s health reform bill and competing plans aimed at controlling escalating costs by altering the payment system to make it focus on the health of patients rather than how many services are provided.
Sen. Jamie Eldridge (D-Acton), who sponsored the single-payer legislation, asked the committee to pass a bill that “has elements of a single-payer” system.
Single-payer would be like MediCare for everyone, said supporters, creating a baseline of coverage that people could add to with private plans. Another option proposed by reformers is adding a public option, a government-run system that anyone could sign up for.
During the recent national debate on expanded health care, critics lambasted the idea of a public option, until it was eventually scrapped from the bill signed by President Barack Obama.
But supporters of single-payer said it would free up business by removing the requirement for business owners to provide healthcare to employees.
“The biggest single inhibitor, the biggest ball and chain around small business growth… is the cost and the complexity of health care,” said Wolf, who founded Cape Air about 24 years ago, a company that now employs more than 1,000 people.
“On a macro level, the United States spends almost twice as much per capita on health care as Canada, which has a single-payer system, but Canada has a longer life expectancy,” said Gerald Friedman, a professor of economics at UMass Amherst.
“We spend more to receive worse health care than virtually every other country,” Friedman said. “It’s just getting worse and worse.”
Meanwhile, Vermont has already reportedly passed a single-payer bill last March, though Sen. Richard Moore (D-Uxbridge) quipped that Vermont is also “the only state without a constitutional regulation to balance the budget.”
Moore, the committee co-chairman, gave few other clues about what the committee might be considering in its own legislation.