Politics & Policy

Injecting Single-Payer Health Care Into Massachusetts Politics


Don Berwick speaks at the state Democratic Convention in Lowell, Massachusetts on July 13

Photograph by Michael Dwyer/AP Photo

Don Berwick speaks at the state Democratic Convention in Lowell, Massachusetts on July 13

Conservatives now have one more reason to hate Massachusetts: Don Berwick, the former Medicare chief who is running for governor there, just floated the idea of single-payer healthcare for the state.

From Berwick’s campaign website:

It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone—patients, families, clinicians, and employers.

The bolding is Berwick’s. He promises to create a commission that would report back in one year on whether a single-payer system is a good idea for Massachusetts and how it would work. “Single-payer” means one entity, usually controlled by the government, makes payments to health-care providers, rather than an array of private insurance companies, public programs, and individuals paying out-of-pocket.

Berwick ran the Centers for Medicare and Medicaid Services until 2011, when Senate Republicans made it clear they wouldn’t confirm his appointment, originally made during a legislative recess. Medicare, of course, is the single-payer system through which the U.S. covers those over 65 or with disabilities. Berwick’s admiration for Britain’s single-payer National Health Service stoked GOP opposition.

So Berwick’s interest in bringing a single-payer system to Massachusetts, while unsurprising, does come at an awkward time for his old boss. Turning the proposal into a campaign issue will likely feed the right-wing fears that the Affordable Care Act is just a prelude to a British-style system in the U.S.

Quick health policy refresher: In 2006, then-Massachusetts Gov. Mitt Romney began reforming the state health system by requiring everybody to buy insurance and giving subsidies to help. Romneycare traces its roots to conservative health reform plans advocated by the Heritage Foundation in the 1990s. It also became the model for Obamacare.

The right-wing talk radio narrative isn’t difficult to fathom: If, in a hypothetical Berwick statehouse, Romneycare becomes a stepping stone to single-payer system, then surely Obamacare will follow the same path.

Making it work might not be as easy as single-payer fans who pitch “Medicare for all” would imagine. For one thing, Medicare pays doctors and hospitals less than commercial insurance, and the world-class hospitals in Massachusetts rely on the revenue from commercial payers. Vermont, the crunchy neighbor to the north, began the path to a single-payer system two years ago and is is still struggling to figure out how to pay for it.

A September poll had Berwick in the single digits in a crowded field dominated by Martha Coakley. (Irony alert: She’s the one who nearly blew up President Obama’s health-reform plans when she lost the special election to fill Ted Kennedy’s Senate seat in 2010, leaving health reform short of votes to get through the Senate.)

Polls mean little a year out from a primary election. Berwick’s interest in single-payer, amid the messy backdrop of Obamacare’s floundering launch, should at least make it an issue in the Massachusetts gubernatorial primary—and plenty of fodder for talking heads on Fox News.

John_tozzi
Tozzi is a reporter for Bloomberg Businessweek in New York.

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