As Democrats nationally become increasingly supportive of single-payer health care, the three Democrats running for Massachusetts governor in 2018 have jumped on the single-payer bandwagon.
In interviews, Newton Mayor Setti Warren, former health insurance executive and state budget chief Jay Gonzalez, and environmentalist and entrepreneur Bob Massie all said they support moving the state to a single-payer system.
“Right now, we’ve got a system that is way too complicated for people to navigate,” said Gonzalez, the former CEO of health insurer CeltiCare. “It is way too expensive, and the quality isn’t as good as it should be.”
A September poll by Politico/Morning Consult of 1,994 registered voters nationally found that 67 percent of Democratic voters say they support single-payer health care and 18 percent do not. That number is up from April, when 54 percent of Democrats supported single-payer and 30 percent did not.
Critics of single-payer health care have said if a national health insurance program pays less for care, some hospitals or medical practices could shut down. Some countries with nationalized health care have longer waits for care. In some places, wealthier people end up buying supplemental plans since the national system does not cover enough services. It may also mean higher federal taxes to pay for health insurance.
The views of the three candidates provide some insight into why many Democrats are moving in that direction — even though no state has successfully implemented a single-payer system, and discussions typically fall apart over the issue of how to pay for one.
Massie was born with hemophilia and has had serious health problems as a result. He said his own experience made him more sensitive to treating health care as a universal human right. He got expensive health care for free as a child when his family spent a year in France, which has a national health care system.
Part of the problem, Massie said, is having concentrated market power in large medical systems, which can drive prices up. He supports single-payer health care as a way to eliminate some administrative costs.
Massie noted that national health insurance programs like Medicare, Medicaid and a federal children’s health insurance program were already created to cover more vulnerable populations that insurers otherwise may not want to cover — older, younger and poorer residents.
“We need to find a system that matches revenues and expenses, either through national health insurance, as is done other countries, or single-payer,” Massie said.
Gonzalez said his experience as a health insurance CEO taught him how “dysfunctional” the current system is.
“I think we need to move to a single-payer system that is simpler and cheaper and better,” Gonzalez said.
Gonzalez said he knows moving to a new way of providing health care would be difficult and take time. But he said he would talk to individuals in the health care industry and work with them to try to implement one.
Gonzalez said single-payer is a fairer system. Today, since doctors get paid different amounts for doing the same procedure depending on the insurer, they have an incentive not to take Medicaid patients because of Medicaid’s low reimbursement rates.
“Every single person should have access to the health care services they need, and it should not be a function of their income or their wealth,” Gonzalez said.
Gonzalez said a single-payer system would save money by eliminating the need for each hospital and insurer to have teams of people to negotiate contracts, keep track of contracts and fix billing errors. It would also lower advertising, marketing and administrative costs.
“There’s tons of costs and waste and inefficiency by duplicating this across all the different health plans, and every doctor and hospital has to have their own team of people to deal with all these different health plans,” Gonzalez said.
Warren said although Massachusetts remains a top state in terms of health care quality and health insurance access, it is also one of the most expensive health care systems in the country.
“We’ve got to make sure we have a system that is accessible and affordable for people,” Warren said.
Warren said he wants to see a single-payer system based on the principles that people’s health outcomes are most important, that health care should be accessible no matter where someone lives, and that it should be affordable and offer appropriate coverage.
“Part of the issue around health care now is you may have health insurance, but you may not have the coverage that it takes to keep you healthy or to prevent you from getting sick,” Warren said.
Warren said a single-payer system would reduce administrative costs and drug costs and would also allow for more coordinated care.
Asked about Vermont, where an attempt to create a single-payer system failed, Warren said the problem was Vermont did not have a sustainable revenue source in mind. He suggested Massachusetts could be in a better position because the state is home to many health care experts and also already has a lot of money in the health care system.