Last week, I testified before the Joint Committee on Health Care Financing in support of the single-payer health care bill I filed this session: S.515, An Act Establishing Medicare for All in Massachusetts. This legislation would guarantee that every resident has access to affordable, high quality health care, while also reducing costs for businesses and consumers. It was heartening to see legislators, nurses and doctors, labor unions, small businesses, social justice advocates, and students testify in support of the bill at the hearing.
It was an interesting time for the bill to be heard, as Congress ended the federal government shutdown caused by Tea Party Republicans trying to stop the implementation of Obamacare, and the media focused on the glitches found in the rollout of healthcare exchanges and healthcare.gov.
The discussion that has revolved around the implementation of the Affordable Care Act reminded me of 2006, when the Massachusetts Legislature and Governor Romney passed MGL Chapter 58, the health care law that provided near-universal heath insurance access to Massachusetts residents. A vote was also taken that year at the Legislature’s Constitutional Convention to include a proposal on the ballot to establish health care as a right.
I voted both for the 2006 universal health care law and the universal health care proposal on the ballot, although the ballot proposal was sent to a study by a vote of 118-76 on July 12, 2006. I voted for the universal health care bill because I strongly support any opportunity to expand health care coverage for more Massachusetts residents. For that same reason, I voted for the constitutional amendment because I believed that a universal health care system is the best health care system for society.
With the Affordable Care Act now being implemented, it is very exciting to hear about the prohibition of insurance companies removing consumers from their plan because of pre-existing conditions, young adults remaining on a parent’s plan until they turn 26 years old, the expansion of Medicaid, and greater access to birth control for women across the country.
However, the United States, including Massachusetts, will continue to have the highest health care costs in the world, with generally worse health care outcomes than other first world nations. Most health insurance plans still have significant gaps of coverage, especially mental health services and for long-term sicknesses and there continues to be a lack of access to quality health care in many poor communities.
After talking with single-payer health care advocates at the committee hearing last week, the question on everyone’s mind was, “What can we do to advance the bill?” I have a few ideas about the ACA as Massachusetts adjusts to Obamacare:
- Labor unions need to play a greater role in the single-payer movement. Steve Tolman, the Massachusetts AFL-CIO President (who was the lead sponsor of the single-payer bill when he was in the Senate) can’t be the only labor representative testifying before the health care committee in support of S.515. In 2011, a key reason that the Vermont Legislature and Governor Shumlin passed the law declaring healthcare a public good is because the Vermont Workers’ Center had begun organizing around health care as a right in 2008.
- Single-payer advocates need to more closely engage with the business community, especially small business owners. The more business owners that get on board with single-payer (recognizing the savings in costs, increase in worker productivity, and the reduction in paperwork), the more likely a break between big business (including health insurance companies) and small business will occur, something that legislators will respond to.
- Amplify the voices of health care professionals who support single-payer health care. Doctors, nurses, and other health care professionals who are fed up with the current system, and already realize that single-payer is the way to go need to more fully organize in support of the legislation.
As the benefits and limitations of Obamacare come to light over the next couple of years, universal health care advocates will have the opportunity to make the point about how single-payer health care would be an improvement over our current health care system, including in Massachusetts. But we will never get there if the same people who were together in that State House hearing room last Tuesday just continue to talk to one another. Like every other “pipe dream” progressive issue, the organizing begins now. I look forward to being part of that movement going forward.
would work in Massachusetts and how it would change the current health care law?
I support the concept of single-payer. The biggest hurdle will be the transition. Why? Because it will obviously need to be paid for and that money will need to come out of people’s paychecks, but there is great incentive for employers to try and take that money instead.
For example: Let’s say I make $75k/year for my stated salary, plus benefits which include health care. My company is likely paying anywhere from 25% to 75% of the premiums, and I’m paying the rest.
Let’s assume I’m paying 25%, and that the plan costs me $350/month, and it costs my employer $1,000/month. Total plan cost is then $1,300 per month.
Between my employer and me, we can afford a tax increase of $15,600 per year without feeling any pain, if the tax increase was in return for single-payer health insurance. However that is going to be a very difficult concept for people to get past, because the people who oppose single-payer are going to be screaming that your taxes are going up by $15,600 per year !!!!!
Plus, what incentive does an employer have to pay the $12,600 per year that they were paying for my health insurance to me so that I can pay it in taxes? They are more apt to say “your salary is still $75k, but now the government is giving you insurance so I don’t have to”.
The incentive is to put a tax on my business, but that defeats the idea of separating health insurance from employment – it makes me more expensive as an employee, and one of the major benefits of single-payer is that employees become cheaper to hire since there are less hidden costs in hiring one.
Now I’m sure that there are plenty of smart people – maybe even some who went through this in Canada – who can solve that problem. But it’s going to be the biggest issue I can see.
Obviously the second biggest issue is to prevent free riding, like people who move to Massachusetts just to get free health care. I cringe when I write that, though, because although I’m sure it would happen, it sounds too much like the conservative bugaboo about “people moving to Massachusetts to get better welfare”. It is likely going to be a far smaller problem than people make it out to be, and I’m sure laws can be put into place to discourage it.