I greatly appreciate Sen. Jamie Eldridge locally, and Sen. Bernie Sanders and Sen. Elizabeth Warren nationally, pushing the debate on single payer forward. It is my belief that ACA was the best we were going to get under the 2008-2010 Congress, and I give President Obama and Speaker Pelosi tremendous credit for getting it done. I do think failing to push for single payer and negotiating ourselves to the center ultimately weakened ACA. Had Obama pushed for single payer first and we ended up with ACA, the public perception would be that it was the moderate plan rather than the socialized medicine it was attacked as. Politically, pushing for actual socialized medicine is smart politics. But is it smart policy?
In the same thread pushing single payer for MA, our resident centrist Central Mass Dad brings up a valid point: Vermont. It also failed recently in California. Why did it fail in those states, and would it fail here? The short answer is the one President Trump pointed to after his failure: health care is complicated.
Had Harry Truman successfully passed single payer back in 1946, there is no doubt in my mind the country would have been better off for it. Back then we had a series of individual providers and hospitals who banded together through the AMA to defeat his proposal. Insurers were rare and confined to a few cities and markets. Had they failed, it is very likely we would have an NHS style system here today where the government is the sole provider. And it would likely be better than what we have today.
Since 1946, we have seen a massive third party health care economy sprout up. HMOs,ACOs, PPOs, PBMs, hospital networks, provider networks, companies like Davita that provide a single service like dialysis, etc. Compounding the problem as these stakeholders have multiplied is that there are now literally hundreds of lobbyist trade groups where in 1946 there was just the AMA. This is a now a $49 trillion industry employing millions of Americans, including many in the Commonwealth.
Next to no elected progressives are calling for an NHS style system where the government becomes the sole provider. We can look to the VA system and already see long wait times and neglect, and it would be pretty easy for a right wing attack ad to say that system would be imposed on everyone else. Instead they are calling for single payer, where the government is the sole insurer. As John Oliver has already pointed out, doing this just for a single procedure dialysis has led to soaring costs and taken up 1% of our entire budget.
As Vermont shows us, doing this for an entire state and it’s healthcare needs could take anywhere between 60-75% of a state’s budget. In California it would’ve led to education cuts. In Vermont it would’ve led to massive tax increases that state’s progressive electorate balked at.
So moving forward we should be honest about costs and tax increases. Single payer is not a panacea and it may not lead to cost control in the short to mid term, even if it will in the long term. We have to anticipate this in our policies. It is great Sen. Jamie Eldridge is advancing this bill on a BMG thread, it would be even better if he discussed the tax increases it includes, the new bureaucracies it will create, and how he anticipates powerful local players like Partners to react to a bill that would arguably put them out of business.
Let me be clear: I philosophically support single payer and want it to happen. It is for that reason I want us to pass actual legislation, and be honest about the pros and cons, not symbolic resolutions like the 90 or so Obamacare repeal bills the Republican Congress passed with a Democrat in the White House it couldn’t pass once with a Republican in the White House. Voters see right through that on either side of the spectrum. So by all means, I want this policy to succeed. Which is why I want our debate to be honest.