This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.
It has been a disappointing week for advocates of health care justice.
As the GOP was working to take health care away from millions of Americans, news came that California's single-payer health care bill was shelved by Assembly Speaker Anthony Rendon, provoking outrage among organizers and a strong condemnation from Sen. Bernie Sanders.
In Massachusetts, however, legislators and organizers are providing reason for hope that single-payer health care may in fact be possible at the state level. Last week, at a hearing before the state's committee on health care financing, single-payer legislation was introduced that would bring this important reform to the Bay State. State Sen. Jamie Eldridge and Rep. Denise Garlick issued bills in both chambers of the Massachusetts State House (S.619 and H.2987) that would create a single-payer system in Massachusetts. Of the dozens who testified, including experts, activists, nurses and organizers, all but one person -- a representative for the insurance industry -- supported the reform.
"There is real energy behind this issue both in Massachusetts and nationally," said Sen. Eldridge at a rally prior to the hearing, to loud applause. "The only way we can solve the issues of cost and of access is single-payer health care. We think Massachusetts should be a leader on this issue."
Proving Single-Payer Saves Lives -- and Money
Massachusetts, of course, is not the first state to introduce this kind of legislation. What separates this effort from others, however, is that in addition to Eldridge's bill, another piece of legislation was introduced into both chambers at the hearing. Sen. Julian Cyr and Rep. Jennifer Benson introduced "An Act to Ensure Effective Health Care Cost Control" (S.610 and H.596) at the hearing as well. This is a unique approach that would require the state's nonpartisan Health Policy Commission, "an independent state agency," which "monitors the performance of the health care system," to measure the impact that single-payer would have on costs and delivery of care in Massachusetts.
This is not just another study, organizers say -- it would have real teeth. Under the proposal, if the commission finds savings from single-payer, which studies indicate would be significant, the legislature would "be mandated to act," as Ture Turnbull, director of the single-payer advocacy group MassCare, said in an interview with Truthout.
"Rather than just commission a study -- which inevitably gets attacked for being partisan or biased -- we have a quasi-public agency with no partisan affiliation measuring the impact," Turnbull said. "People always want to see the numbers, so here, let's show them the real numbers."
This novel approach could serve to undermine one of the biggest hurdles to single-payer legislation at any level: the accusation that it would cost taxpayers a large amount of money. This has proved to be difficult since it is true that a switch to Medicare for All would require significant new taxes. This fact has enabled the likes of the Koch Brothers, the health industry and even Hillary Clinton (as she campaigned against Sanders) to scare voters with misleading claims. However, as Physicians for a National Health Program (PNHP) documents, "No increase in total health spending is needed to finance single payer. The increase in taxes required to finance national health insurance would be fully offset by a reduction in out of pocket costs and premiums."
Until advocates can successfully educate the public about the real impact of single-payer, the reform will remain elusive. The Cyr/Benson legislation aims to do this in a credible way.
Why Massachusetts Should Lead on Single-Payer
Massachusetts could be the ideal state to take the lead on single-payer, especially now that California's efforts have stalled. The state has a history of innovation at the state level, effectively implementing a version of Obamacare (Romneycare) four years ahead of the country. Years before the Affordable Care Act improved access for much of the country, Massachusetts insured 97 percent of its people, the best rate in the nation. Massachusetts is also a relatively large state, with a population of 6.6 million; it is the third most densely populated state in the country. If it were to implement single-payer, it would be able to do so on a scale that would demonstrate how this type of system can maximize savings.
Further, as the outpouring of support at the hearing showed, the state is a hub of single-payer activity, and home to many prominent experts and activists working on the issue. Harvard's William Hsaio, who has designed or helped design universal systems in a dozen countries (and created three plans for Vermont), was among those who testified on the benefits of such a system. So did University of Massachusetts economist Gerald Friedman, who has studied the impacts of single-payer in numerous states, including Massachusetts. "We could lower health care spending by nearly 15 percent while improving access for all residents of the Commonwealth," he testified. "What are we waiting for?"
The national advocacy group Healthcare-Now! is based in Boston and its executive director Benjamin Day testified as well. So, too, did Donna Kelly Williams, the president of the Massachusetts Nurses Association (MNA), one of three founding members of National Nurses United. Some of the most important research on single-payer has been done by those with local ties: Steffie Woolhandler and David Himmelstein, among the founders of PNHP, spent decades working out of Cambridge, Massachusetts, and some of the organization's crucial work has been published in the New England Journal of Medicine.
Importantly, Massachusetts is a progressive state, with Democrats outnumbering Republicans 124-35 in the State House. While the current governor is a Republican, Democrats running for office have been increasingly supportive of single-payer. In 2014, Donald Berwick ran for governor using single-payer as his key issue and had an impressive second-place showing in the primary. Candidates for the next gubernatorial election are already emphasizing single-payer health care as a key issue. Bob Massie, a candidate for Governor in 2018, was also among those who testified in favor of the bills at the hearing.
Lastly, Massachusetts has led the way on important issues in the past, beyond health care. For instance, the state was first to legalize gay marriage in 2004, before other states (and eventually the nation) caught up. Barack Obama didn't come out in favor of same-sex marriage until 2012. "Our state has taken the lead on key issues before," said one activist who testified to the committee. "It is time to do it again."
The Lonely Voice of Opposition and the Shumlin Effect
As noted, the hearing consisted of scores of people testifying, discussing virtually matters related to health care. Maia Olsen, an advocate from Boston, spoke about her life dealing with a chronic illness. Jordan Berg Powers, an advocate from Worcester, discussed racial disparities in the health system. "I know statistically I am likely to die younger than my white friends," he said.
Every single person who spoke was in favor of the legislation, with one exception. The lone opponent of the legislation was Eric Linzer, an executive for Massachusetts Association of Health Plans, a lobbying group for the state's for-profit insurance companies. Armed with predictable falsehoods about the issue, his presence angered some in attendance so much that the chairman of the hearing heard an audible hissing and used his gavel to call for order in the chamber.
Linzer relied on tired old tropes about single-payer that have been perpetuated for years by opponents. Linzer took aim at waiting times in Canada, arguing falsely that they were a byproduct of its single-payer system.
Most troubling, however, was his emphasis on failed efforts for single-payer in Vermont. As Truthout has previously documented, when Vermont Gov. Peter Shumlin surrendered on health care he deflected blame, wrongly, on the costs of such a plan. By parroting false talking points, he provided fodder for the insurance lobby to use for many years. Indeed, while the legislators in attendance did not ask many questions, among the only questions asked was, "Why didn't it work in Vermont?" (For an answer to this question see Woolhandler and Himmelstein).
"The way Shumlin handled it, he really set the whole movement back nationally," Friedman told Truthout.
His words have since been used to argue against the policy in Colorado and California. It has been cited by establishment Democrats and their friends in the media to smear Bernie Sanders's plan for Medicare for All. And now Linzer is already using it as a chief talking point to try and take down the efforts in Massachusetts. It is a stunning turnaround for Shumlin who in 2009 won the support of the single-payer community when he ran commercials promising to create a "single-payer system to contain costs" as the first plank of his agenda.
Why Statewide Efforts Keep Coming Short
Shumlin's flip-flop on the economic impacts of single-payer are a key reason why Massachusetts introduced two pieces of legislation, not just one. The legislation that aims to measure the bill's impact on finances can serve to help settle the cost question, organizers hope.
Indeed, when Colorado Care was defeated soundly by a ballot initiative in 2016, Dr. Don McCanne of PNHP observed that when it comes to single-payer, clarity is key. "If you find that you have to keep explaining what your proposal is, you haven't done enough, and your opponents can and will destroy your efforts with a few soundbites," he said.
Of course, despite many reasons for hope that single-payer could become a reality in Massachusetts, the battle will likely be a long, difficult one. Should the legislation prompting the Health Policy Commission to measure single-payer savings become law, it would have the option to measure the savings for as long as three years. Or, Turnbull notes, they could study the policy going back three years, which could expedite the process. Or they could find some middle ground. In any event, even under the most optimistic of scenarios, single-payer becoming law in Massachusetts is a few years away.
But if Massachusetts hopes to buck the trend of states trying and failing to pass a single-payer system, the work must continue today. There is reason for optimism. The national Medicare for All proposal, HR676, has a record 112 cosponsors in the US House of Representatives. The momentum behind Sanders -- now the most popular politician in the country -- has sparked a great deal of interest in the policy. Sanders has said he will introduce a bill into the Senate, though when this will happen is unclear.
The ongoing Trumpcare efforts have reminded many Americans how awful it is to allow health care to be treated like a commodity. Searches for "Medicare for All" and "single-payer" spiked when Trumpcare had peak media attention.
In a perfect world, the moral argument for single-payer would be enough to pass it, in Massachusetts and across the country. As images circulate of wheelchair users being physically removed by police while pleading with senators to spare Medicaid cuts, the moral imperative to save lives and minimize suffering has never been clearer.
But this is far from a perfect world and, since single-payer is far more efficient than private health care, it makes sense to make a strong economic argument as well. The efforts in Massachusetts to emphasize both the economic and moral reasons for health care justice will be needed across the country if single-payer, at any level, is to become a reality.