By Kyle Chene
Belmont (Mass.) Citizen-Herald
Wed Oct 21, 2009
Boston, Mass. – Although state leaders have bristled at the pointed, dismissive and sometimes downright false claims made about the Massachusetts health care system by outsiders, they have said little about the dissent from within.
A quarter of the Legislature has signed onto a proposal to scrap the stateĆ¢ā¬™s landmark health care system, which still relies on private insurance companies to cover millions of residents, in favor of a single-payer system, publicly run and available to all residents.
Backers of the single-payer plan (H 2127) argued Tuesday that the stateĆ¢ā¬™s current system has failed to control costs, prevented even insured residents from obtaining needed care and left as much as 5 percent of the population without coverage.
The legislative supporters include Rep. Ellen Story (D-Amherst), a member of House Speaker Robert DeLeoĆ¢ā¬™s leadership team and a stable of reliably liberal legislators. Officials from the League of Women Voters, the National Association of Social Workers, the Massachusetts Nurses Association and other social advocacy organizations were also on hand to register support. While such proposals have sparked fierce opposition nationally, no opponents spoke at the hearing.
The proposal by Rep. Matt Patrick (D-Falmouth) would establish a “Massachusetts Health Care Trust” reimbursing providers for health care costs, investing in health care facilities, streamlining health care bureaucracy and incentivizing quality of care. The trust would be funded by a “dedicated tax” on employers, workers and citizens, intended to replace funds currently spent on insurance premiums. The trust would also consolidate all municipal and federal health care dollars.
The trust would be overseen by a board that includes the secretary of health and human services, the secretary of administration and finance, the commission of public health, three gubernatorial appointees, three appointees of the attorney general and eight members elected by state residents.
All Massachusetts residents would be eligible to receive health care through the trust, as well as non-residents who work more than 20 hours a week in Massachusetts, pay Massachusetts income and payroll taxes and pay premiums established by the trust. Benefits would include prescription drugs, emergency care, doctor visits, hearing, vision and dental care, home health, maternity coverage and various other medical procedures.
The debate comes at a time that the governor and top lawmakers are eyeing a fundamental overhaul in the way the state pays for care. A special commission of legislators, administration officials, doctors, hospitals, insurers and health care experts recommended over the summer that Massachusetts implement a system of “global payments” aimed at curbing health care costs by coordinating individual patientsĆ¢ā¬™ care among various providers.
Gov. Deval Patrick has said he expects legislation enshrining such a system to be ready by the end of the month, and stakeholders from across the health care system voiced conditional support for ending the stateĆ¢ā¬™s current “fee-for-service” model.
Noting that the commission report “sounded the alarm” about soaring health care costs, Rep. Patrick questioned the recommendations because the members did not consider a single payer system.
“I dare you to read the report and tell me how it will work,” he said.
Sen. Patricia Jehlen (D-Somerville), a sponsor of the proposal, said passing it this year would be “politically unrealistic,” although she said health care costs would crowd out other government programs if left unchecked.
Despite the criticism of the stateĆ¢ā¬™s current system, aimed at offering universal access to health insurance, there is a wide array of support. Backers of the existing structure, while acknowledging that health care costs have continued to climb, note that the state has covered about 430,000 residents since the inception of health care reform in 2006. Individuals are required to purchase health insurance, and low-income residents without access to health care through their employers may obtain partially or fully-subsidized care through the stateĆ¢ā¬™s Connector Authority, an exchange that pairs consumers with private plans.
Opponents of single-payer care worry that it places government bureaucrats in charge of important health care decisions, would add layers of bureaucracy to the existing system, would reduce the quality of care and would disrupt relationships between doctors and patients, arguments that single-payer backers reject.
For much of the hearing, single-payer backers spoke to a sparse panel of legislators, as House members flitted between a Democratic caucus and the basement hearing room. In addition, Senate Chair Susan Fargo (D-Lincoln) and Vice Chair Mark Montigny (D-New Bedford) were absent, leaving Sen. Jennifer Flanagan (D-Leominster) with the gavel for much of the hearing. House Chair Jeffrey Sanchez (D-Boston) and Reps. Jason Lewis (D-Winchester), Cleon Turner (D-Barnstable) and Michael Brady (D-Brockton) attended parts of the hearing.
Single-payer advocate Benjamin Day, executive director of MassCare, said his favored system often fails to gain political traction because of intense lobbying efforts by the insurance industry.
“I think itĆ¢ā¬™s tough because single-payer contains effective cost control,” he said. “Every bill that contains cost control is a political slugfest.”
He and other proponents of a single-payer system argued that every ambitious health care reform plan enacted by states has ultimately failed because of unsustainable costs.
Dr. Steffie Woolhandler, a Harvard University professor and advocate with Physicians for a National Health Program, questioned a 97.4 percent health insurance rate in Massachusetts, a figure highly touted by the Patrick administration.
“ThatĆ¢ā¬™s a single organization, the Urban Institute, that gives that number,” she said. “The problem of underinsurance, being unable to afford care despite having insurance, has actually gotten worse in the state … WeĆ¢ā¬™ve tried a reform in this state thatĆ¢ā¬™s left 5 percent of the people uninsured, costing the commonwealth $1.3 billion this year.”
Rep. Timothy Madden, a freshman Democrat from Nantucket, said his family has “been through the mill” with insurance companies.
“I think the system is broken,” he said. “We should set the tenor in the leadership and the message to Washington.”