2013 was a great year for patients in Massachusetts. Over 98% of us were covered by health insurance and able to benefit from the marvels of modern medicine. At the same time, we spent an astonishing 41% of our state’s budget last year on health care. By 2020, the state’s Executive Office for Administration and Finance predicts health care costs to grow to a whopping 50% of the state’s budget! Funding for schools, public transportation, and other social services will have to somehow be squeezed out of the remaining half of the money.
Chapter 224, a healthcare cost-containment law passed in 2012, is a step in the right direction, but many fear it will not do enough to alter our current spending trajectory. Faced with the same challenge of controlling health care costs while maintaining universal coverage, most other developed nations in the world have already adopted “single-payer health care.”
A single-payer health care system eliminates private health insurance companies in order to put all patients in a single, publicly-financed risk pool. “Medicare for All” is how many envision it functioning in the United States. However, even though doctors and hospitals would remain as private entities, many still fear such a proposal to be a “government takeover” of health care.
History has shown us, however, that “government takeovers” are not always a bad thing. Prior to the 1850s, municipal fire departments did not exist in the United States. Private firefighting companies were tasked with only protecting buildings displaying prominent fire insurance marks. Without fire insurance, unlucky homeowners were left to try to save their burning property on their own. Fortunately, public pressure eventually swayed the majority of cities and towns across America to establish the first public fire departments. Today, we can sleep soundly at night, because we know that firefighters will be at our door in a moment’s notice should we need them.
Why should we not have that same peace of mind when it comes to health care? With everyone in a single insurance pool in our state, the balance of power would shift back to the patients. Administrative costs would be minimized and the amount of money allocated for direct patient care would be maximized.
As an added bonus, businesses would be free to use money that they currently spend on their employees’ health insurance plans to hire new workers or pass the savings on to their customers. Our current employer-sponsored health insurance system is a relic from the 1940s. It is time for our state to show the rest of the country how well a 21st century single-payer system can work.
Jason Lewis continues to be a strong proponent for single-payer health care in Massachusetts; please consider voting for him on April 1. In addition, only one gubernatorial candidate has promised to fight for single-payer health care; his name is Don Berwick. Please consider supporting Don at the Convention and this fall in the Primary.
Note: This column was heavily influenced by an excellent 2009 piece from Nick Kristof. In addition, Mass-Care’s website has a great comprehensive FAQ section about single-payer that I would recommend.
A big reason I am supporting both!
If VT can do it, so can we!
the Connector is a convoluted nightmare for anyone who doesn’t fit into a neat little box in life, which makes it a disaster for anyone who, say, wants to start a business or who’s job situation could change more frequently than others, etc. Given that Massachusetts wants to be a hotbed of entrepreneurship in addition to the Mecca of health care, we should strive to have the simplest to navigate, best and best bang for the buck health care system in the world.
We’re not anywhere near that today. Look at anything beyond some of the cool surgeries or research that we have going on and Massachusetts is nothing to brag about. We’re actually near the bottom of the country on readmission rates while at the top on cost. The two are not unrelated.
We could cure almost all of these problems with single payer — complexity, cost and quality — and it’s well past time we get to it.
Business, especially real small business owners and self employed contractors would benefit the most from single payer. I’m always shocked the ones I know tend to oppose it most-getting them as stakeholders along with some bigger tech companies would expand this constituency. Berwick is the only candidate on record opposing casinos and with a long record of fighting for single payer and implementing these policies.
You say:
“2013 was a great year for patients in Massachusetts. Over 98% of us were covered by health insurance”
Actually according to the Massachusetts Center for Health Information and Analysis, the percentage in 2013 was about 96%, not 98%, getting back to close to where it was before RomneyCare near ruined the best health system in the world.
You say:
“At the same time, we spent an astonishing 41% of our state’s budget last year on health care.”
So by what logic would you adopt a government-run single payer system in which 85% of our state’s budget would be spent on health care?
You say:
“A single-payer health care system eliminates private health insurance companies… in order to put all patients in a single, publicly-financed risk pool. “Medicare for All” is how many envision it functioning in the United States.”
Actually I hate to deflate you but Medicare in the United States is totally run by private health insurance companies.
Is that you, George W? I have had employer-arranged health insurance for many years. I remember without fondness having to argue with BCBS to get them to pay for procedures my doctor prescribed. Before those many years commenced, I remember not taking my sick or injured self to the doctor, because I could not pay him.
Where is your 85% number coming from?
Hi Mr. Byron, the 98% coverage statistic is straight from http://www.mass.gov/bb/h1/fy13h1/exec_13/hbuddevhc.htm Can you please show me where you found the 96% statistic? In any case, 96% is still pretty good, wouldn’t you say?
As for your second point, a government-run single payer system would only eat up 85% of the state’s budget if it was poorly run and financed. I would assume that the state budget would increase dramatically if we moved to single-payer, so that the percentage allocated to health care costs would not substantially increase. Taxpayers would have to make up the difference, but remember, they would no longer have to pay premiums to private health insurance companies. In addition, the amount of money each person would pay in single-payer would be minimized with everyone in one risk pool. Ideally, if we could get the rest of the country onboard, those costs would be minimized even further!
I think that only a small subset of Medicare plans, namely Medicare Advantage plans, are administered by private health insurance companies, but I could be wrong. Could you please provide the source that said Medicare is totally run by private health insurance companies?
Thank you for your input.
CHIA estimated the current insured rate at 96.2%-97.0%: http://www.mass.gov/chia/docs/r/pubs/13/2012-mass-insurance-coverage.pdf
This uninsured rate of -4% is the lowest in the nation. All other states have at least 8% uninsured and the national average is 15%:
http://kff.org/other/state-indicator/total-population/
Your “single payer would mean we spend 85% of the state budget on health care” is ridiculous and unsupported by any facts.
Medicare is a publicly-financed (payroll tax) health insurance system administered by the federal government. Private insurance add-ons (Medicare Advantage) are available and the prescription drug program (Part D) is run through private insurance companies. But to say :Medicare in the United States is totally run by private health insurance companies” is utter nonsense.
Medicare Advantage plans are HMOs that are paid a capitated rate by Medicare for each enrollee. It’s possible for enrollees to pay extra premiums for extra services but most of the cost is paid by the government. These plans are very different from private insurance plans, where employers and individuals are the payers. They are more like the MassHealth MCOs we have in Massachusetts, where the state pays a capitated rate and the MCOs administer the medical benefits.
See this link
I could easily see this kind of hybrid system (combination of public and private plans) being adopted for the rest of the US population.
1. 96%, not 98% — to whomever asked that question, one of the others provided the CHIA link. An even better source is the U.S. Census Bureau’s Current Population Survey – ASEC series because it is not political like the CHIA material. But both show the same trend of the percentage of insured returning to where it was before RomneyCare. Is 96% “a good thing??” Not when you started at 94%. No one questions that the state of Massachusetts gave away free insurance or almost free insurance to 200,000 residents in 2007-2008. The important question has always been why 200,000 other people who qualified didn’t take the free insurance and why the people who took it are not renewing it.
2. 85%. This is merely the arithmetic of adding the $60 billion or so in Massachusetts total health care expenditures (according to the U.S. National Healthcare Expenditure Survey and the Massachusetts death panel group) that the state of Mass. does not already pay for to the rest of the current state budget and doing simple division. You are correct in your math only if you are assuming that because we add $60 billion to the state budget for health care that we will add more than another $60 billion for other things. No way would we raise taxes 5X so the budget could go from around $30 billion to over $140 billion. It would require doubling taxes (net; 3X actually) to afford single payer. And I think your hope that this change will not be “poorly run” is wishful. Your health care would be run by the same state bureaucracy that gave you a failed healthcare exchange, lost a five-year old, kidnapped a 15-year old, was in charge of the New England Compounding Company, and takes three or four months to process a MassHealth application.
3. Medicare. Most people are woefully unaware of how Medicare works (which is why they are shocked when they reach 65). All parts of Medicare — not just the public Part C Medicare Advantage program — are run by private insurance companies. All parts of Medicare — including Medicare Advantage — are paid for and highly regulated by the Federal government but run by private insurance companies. In Massachusetts the private insurance company that runs Medicare Parts A and B is Wellpoint, a company that the single-payer lobby constantly attacks as the worst of the blood-sucking for-profit private insurance companies. Wellpoint also ran the state of Massachusetts Group Insurance Commission plan the last time I checked. (As an aside, as rcmauro explains, the difference between Part C and Original Medicare is that Part C is capitated like Obamacare (maybe you prefer the term vouchered?) and Original Medicare is fee for service. But not all public Part C Medicare Advantage plans are HMOs.)
As for having to argue with Blue Cross for them to pay for a medical procedure, think about how it would work if you had to argue with the Registry.
Are you this Dennis Byron? The one who believes that USA Today is “far-left-wing?”
It is confusing because WellPoint does run Medicare Advantage plans but they also serve as a claims processor for traditional Medicare in certain regions. When you pay for your groceries with a debit card the store and bank point-of-sale systems are involved in the transaction but we don’t say that they are “paying” for your groceries.
I really think that a universally available public option is the missing piece to our health care reform.
The only thing we have done up this this point is to buck up the previous, failing, substantially private system with the force of government and subsidies to support the bloated and inefficient existing price structures.
If all un-enrolled persons were presumed to be covered at least by Medicare, or a state-based public option in this case, and that in order to receive care at the point of service, an uninsured person had to claim an enrollment, in either a private or public (Medicare) plan, with a schedule of benefits (and penalties) for not having the coverage ahead of time, then I think a mandate would stand and the drive to total coverage would work.
I do think that a hybrid public and private system could work, and that the transition does not need to be 100% to single payer.
First of all, a majority of people and families access health care through their work. I don’t see any reasonable defense for disallowing healthy young people, professionals , small and large businesses from opting into Medicare. In fact, the benefit to all of us would be the expanded risk pool within Medicare.
This period of less than 100 percent coverage for the U.S. population must be viewed as a transitional phase at this point. The fact is that the political and computer related problems with Obamacare sign ups, nationally and here in Massachusetts has made it more difficult. But, that transition can be eased, and it would be if we embraced the presumption that everyone is covered at the very least by a baseline public coverage. In truth, they are, by the uninsured care pool and other mechanisms that deliver publicly funded reimbursements to caregivers without providing direct benefit to individuals.
Under a revised `presumption of care’ scenario, when a person without insurance needs health care they would have to elect an enrollment at the point of service. The would have to do this if they had procrastinated earlier, if they were against choosing, or were incapable for one reason or another; if they were too cheap to buy, too poor, or too inclined to mumble `Fuck the man’ all the time.
Try saying that when you can’t understand what that pain is in your gut, or when you break a leg on a sheet of ice in your driveway.
This is not a lot different than the basic presumption that a person who shows up at a hospital must be cared for. It just structures coverage in terms of personal responsibility — the decision at the hospital to claim either a Medicare membership or private insurance membership — would be a personal election.
At that point, people who were not covered would become responsible for a period of back insurance premiums related to their refusal, or reluctance. The penalties could be capped. They would function similar to deductibles in private insurance and could be recoverable in a public way, through tax filings.
I don’t see how this would be a government intrusion at this point because it would rely, ultimately, on a choice by an individual.
Merely caring for the uninsured and then floating those costs across an inefficient bureaucracy without structuring the delivery of that care, i.e. not allowing the uninsured to join Medicare as a last resort, is irresponsible. And it really is a status quo that is being preserved by the enormous business interests in health care that want to contain the bargaining power of the the biggest player at the table.
After a few years under this transitional model, we would arrive at a system that would count 100 percent health care coverage of our citizens at what I believe would be significantly less cost.
I think that the reflective business response that opening up Medicare to elective enrollment would be a threat to private providers is a ginned up, squawking paranoia broadcast to preserve the severe inefficiencies in the current system even as it undergoes its transition under Obamacare.
Private insurance would remain appealing for many reasons. Among them: better care and service available in pools with smaller doctor-patient ratios and the cache of a premium plan as one’s employment climbs the economic ladder. In fact, as mentioned above, many private insurers would be delivering the so-called `public option’ as they do now under Medicare. Private insurance providers would not go out of business if a public option were opened up for individuals and businesses to buy into.
That insurers as recently as two years ago were able to dismiss or reject claimants for `pre-existing conditions’ for so long should be a national embarrassment.
I remain extremely disappointed that Obama abandoned the public option, really without a fight and I think that is a source of many of the problems with the roll out right now.
If the Medicare bureaucracy needed to sign up a large number, of healthy, premium-paying enrollees over a transitional period of months, I don’t doubt for a minute that they could do it.
Massachusetts could forge the way ahead by crafting a buy-in to an aggressively priced a public option.
I hope it does