Massachusetts News 
By Naomi Schaefer 

September 2--More than 50 organizations are banding together to bring socialized medicine to Massachusetts. 

They have formed a group called Mass-Care. 

There are 15 Senators on Beacon Hill who support the proposal and 49 Representatives in the House. They claim that the Senate President has indicated his support. The lead sponsor in the Senate is Robert Travaglini (D-Boston). 

This has been done very quietly so far. Consumers appear to have little knowledge of the effort. 

It is similar to the failed attempt by Bill Clinton in 1994 to put the federal government in charge of hospitals and doctors. 

The matter surfaced briefly at the end of April when Alan Sager, a professor at Boston University School of Public Health, and three of his colleagues published an article in The Boston Globe detailing the plans for a single-payer health care system in Massachusetts. They cited the high number of uninsured Massachusetts residents (about ten percent) and concluded that there was a significant need for reform of the health care system. 

Their solution: Take all the money, both public and private, currently spent on health care and give it to the state, which would give people the money as they need it to pay for an insurance plan or HMO of their choice. 

Who Will Ration The Care? 

The crucial question as to who would be in charge of all of this money and how it would be spent has not been determined, according to Sager. 

Michael Tanner, the director of health and welfare studies at the Cato Institute in Washington, wonders who is worrying about the consumers. He tells Massachusetts News: "Every single-payer health care system rations the availability of care." He explains there would be two ways of doing this. The first is the direct way. "In Great Britain, the National Health Service tells you if you are over the age of 65 you are not eligible for kidney dialysis, even if it will save your life." In Canada, Tanner explains, they ration health care indirectly. "When you need a medical procedure, you go on a waiting list." Many people, Tanner explains, die while on waiting lists. 

While some of the details of the proposal remain a little fuzzy, the campaign for single-payer care in Massachusetts has moved beyond academic discussion. The coalition of 50 groups including a number of unions and non-profits like the Senior Action Council, the League of Women Voters, and the Massachusetts Nurses Association, has launched a grassroots campaign and has already submitted billsto the House and Senate. 

The health care specialist for the state’s League of Women Voters, Barbara Sullivan, believes that the bill is important "because it guarantees universal care and strong cost controls." According to Sullivan, support for this bill was not exactly a state-level decision. "We found that there was this bill which is consistent with the League’s national position on health care." She explained the long process by which the national leaders arrived at this position, but when asked to explain why this Massachusetts legislation is worthy of passage, she replied only, "Well, it’s consistent with our national position." The League was also in favor of Clinton’s proposal in 1994. 

Gaining Support 

Regardless of whether the grassroots organizations have a real commitment, or even an understanding of the issue, the legislation is gaining a lot of support in the state’s government. 

Senator Travaglini’s legislative aide Christian Scorzoni tells Massachusetts News that Travaglini has "long supported such legislation in different forms," but he adds that the "current version is the most realistic one." He says that the Senator hopes to "get all sides at the table during the upcoming legislative session." 

Aside from the number of uninsured citizens, Senator Travaglini sees other health care problems in Massachusetts. "Basically, what you see now," according to Scorzoni, "are closings of community health care centers, problems with nursing and home health care and pharmacy problems." Scorzoni claims that Travaglini is worried about the state "taking a piecemeal approach to solving all of these problems." He says the senator’s goal is to ensure "equal coverage and equal access." 

Despite what has been described as a groundswell of support for the legislation, there seems to be little in the way of organized opposition. John Brockelman, executive director of the Republican Party in Massachusetts, objected to the tax hike, which would be involved in such a proposal. "The single-payer health plan is a $3 billion tax hike which would decimate the Massachusetts economy." He added confidently, "I can tell you right now there is no way that such a tax would ever pass the legislature." 

Brockelman did not have much to say about the plan itself. Citing the high quality of health care in Massachusetts, he explained, "Canada has a single-payer system and you don’t see individuals from across the world going to Canada; they come to Boston." 

But Sager claims this is a very common argument. He even calls the people who use this argument "tricksters." "Our system," he explains, "won’t mean Canadian or British style rationing [of  health care]." 

But Tanner disagrees. Because Sager’s plan involves government-imposed price controls, there is no way to get around rationing. "This is Economics 101," Tanner said. "There are a limited amount of health care goods and services. If you won’t allow prices to determine availability of those goods and services, it will have to be the Massachusetts government imposing its own set of priorities. He emphasizes that "it will not be individual consumers deciding what kind and how much health care they want." 

Sager insists however, that "Americans spend three times what the British spend, and Massachusetts spends three or four times what the rest of America spends." The reason that Sager believes his plan will not result in rationing is that "we will be spending American-style money." 

No Consumer Choice 

Tanner argues, however, that no matter how much money is spent on health care, it won’t matter. "You could spend an unlimited amount of money. The difference is that the consumer won’t be involved in making those decisions," he says. "That’s the reason people are complaining about managed care plans now – they are rationing care." Tanner claims that Sager’s plan sounds even worse than others like it do. Other plans to centralize control of  health care at least attempt to eliminate administrative costs, whereas Sager’s plan, "by keeping the HMOs and other types of insurance doesn’t even get the so-called administrative benefits." 

But Sager claims that if all of the money were pooled together, then administrative costs would be eliminated. "The key thing," according to Sager is "to collect all streams of money in one reservoir," and then redistribute that money so that "everyone is covered." 

Who would be in control of this "reservoir" has yet to be determined, according to Sager. 

Sager complains, saying, "We do have the money to take much better care of ourselves, but instead of doing that, we are torturing ourselves with more administrative waste, more closing of hospitals and more bureaucratic tortures for physicians and patients." But Brockelman finds this a little far-fetched. "We have the best health care system in the world. Is it perfect? No." Instead he suggests other strategies for helping the uninsured in Massachusetts, like "tax credits for small businesses and premium subsidies for private insurance." 

Tanner also offers some suggestions on solving the problem of the uninsured, which is about 10% of the population in Massachusetts. He says, "This is largely a question of changing the link between employment and insurance." Tanner laments, saying "We have a system in which employer-provided insurance receives a subsidy through our tax code, but an individual who purchases the same insurance does not receive those tax benefits. This penalizes people who earn low wages because we have essentially priced individual insurance out of the market." Tanner proposes redefining the tax system on health care so that "each individual can purchase the health insurance that best suits their needs." People who are low wage earners or who are not in a high risk bracket would be able to purchase inexpensive catastrophic insurance, he explains. 

Regardless of the alternative measures which the Massachusetts legislature might undertake to fix the problem of the uninsured population, Tanner guarantees that, "The citizens of Massachusetts will find themselves very unhappy with single- payer health care." 

Not only is there little grassroots awareness of the issue, but insurance companies and HMOs are not taking a particularly strong stand against the bill. Peter Ajemian, a spokesman for the Massachusetts Association of HMOs says he thinks that the system here "works pretty well. "He agrees that something should be done about the large number of uninsured in the state, but worries about "the tremendous change involved" in switching to a single-payer system. "They would have to demonstrate," Ajemian says, "that a new way of doing things will work better." Of course, he admits, "You have to take certain risks, but you have to demonstrate that there is at least a higher potential for the new program to work better." 

But Sager doesn’t agree that this change will require such a great effort. He claims that "public intervention to pool the money and cover everyone will be a quick, surgical procedure." 

Ajemian emphasizes that regardless of the effort, "The vast majority of people are getting good care." As for the complaints by people like Mr. Sager, Ajemian said, "If you really stop and look at whether people are basically satisfied with the care they are getting, the answer is yes." Ajemian’s assertion is evidenced in a poll by Everett Ladd of the Roper Center in Washington, which finds that 90% of Americans say they’re satisfied with the quality of the health care they have received. 

Aside from this assertion, however, Ajemian would not comment on specific problems with the single-payer care proposal. 

Sager claims that his plan does not have many of the problems, which, for instance, plagued Hillary Clinton’s plan for the national level. He claims, for instance, that physicians and patients would be making all of the decisions about health care. 

But Frank Fortin, the communications director at the Massachusetts Medical Society, said that while he was not sure about the details of the plan, he is skeptical about this claim. He thinks members of the society might be worried about the concentration of accountability." He is concerned about having "one organization with all of the money setting the rules." 

Apparently, though, opponents of the plan have not been concerned enough about the effects to form any organized opposition. 
 

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