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Mass voters may get a new angle on health care

Health Reform Program report makes the case for single-payer program

Alan Sager and Deborah Socolar are hoping the political tide will turn toward universal coverage. Photo by Vernon Doucette

A once unpopular plan for health care reform in Massachusetts is gaining support from legislators and with an upcoming vote on an amendment to the state constitution, it may have a new chance to enter the spotlight.

The plan calls for a single-payer health care system, and Alan Sager, an SPH professor, and Deborah Socolar, an SPH health sciences project manager, hope Massachusetts voters will support it. Sager and Socolar codirect the BU-based Health Reform Program. Their recent report, titled $1 Billion Per Week is Enough, asserts that the money wasted on health care overhead and other unnecessary costs in Massachusetts would cover the health care costs of every resident.

As many as 10 percent of the Commonwealth’s more than six million residents are uninsured, yet individuals and businesses spend $52.7 billion a year on health care, according to the report, which served as testimony on behalf of Senate Bill 755. The proposal to establish the Massachusetts Health Care Trust is now in the lap of the Joint Committee on Health Care Financing.

The proposal would cover all the state’s residents and contain costs by allowing doctors to manage the budget, but not benefit from it. One budget would compensate doctors, another would go toward health care expenses. Doctors would manage only the latter. A large portion of excess cost in the current health care system is paperwork, Sager says, “and the mistrust is the largest source of paperwork. The clerks and the doctors and hospitals fighting insurance companies are not adding an ounce to human health or security. Only when doctors have to make tradeoffs will they have the ability and willingness to weed out clinical waste.”

In the past, such effective solutions lacked political support. “What won’t work can pass,” he says, “but what will work won’t pass.” But efforts to reform the Massachusetts health care system could take an unexpected turn this fall.

An amendment that would require the Commonwealth to provide health insurance to all residents passed overwhelmingly at last year’s constitutional convention. If the amendment passes again at this year’s convention, scheduled for September 14, it would be put before the voters. (Proposed amendments must be approved twice by the legislature before being placed on a ballot.) If voters endorse it, the Commonwealth must find a plan to achieve it. New debates on how to best cover all residents would be sparked, giving new relevance to ideas once cast aside.

The proposal to establish a Health Care Trust is not the first attempt to create a single-payer health care system in Massachusetts, but the idea has not always been marketed very well, Sager says. “The phrase ‘single-payer’ is four syllables,” he says, “and includes two of the most unpopular words in America.” But such a solution is increasingly relevant, according to bill cosponsor Senator Steven Tolman (D-Boston).

“Once you hear the facts about what’s going on in our health care system, you don’t have to be a rocket scientist to realize that we have a major problem,” Tolman says “A third of our dollars are not going to direct care.”

In addition to covering all residents, regardless of whether they can afford it, a single-payer system has other benefits, such as taking the pressure off businesses and municipal governments to provide health benefits and unemployment insurance.

Tolman, who has supported a single-payer solution in the past, says the public is likely to accept such a measure only incrementally. “People are afraid of change,” he says. “We know that, but the work [Sager and Socolar] have done has clearly given us the evidence that the money is in the system.”