Globe Local


Should Massachusetts move to a single payer health care system?


Senator James B. Eldridge

James B. Eldridge

State senator, Acton Democrat

Misinformation is easy to spread, and it takes years to undo its damage. For over two decades, people who take money from big pharmaceutical and health insurance companies have actively waged a war on single payer health care systems, such as Medicare for All.

Consequently, instead of passing bold, comprehensive reform that makes access to quality health care a universal right, we have nationally focused our efforts on a patchwork of bills. We’ve tried forcing more health conditions and medical treatments to be covered by health insurance plans. We’ve expanded Medicaid to ensure that more low-income residents have access to care. And, of course, we’ve passed legislation mandating that everyone be insured.

Despite these efforts, health care costs keep rising for individuals, families, and businesses, while access remains a problem for many Americans who forego treatment because of high co-pays, or are denied necessary preventative procedures by health insurance companies. As a result, millions of Americans end up with crippling medical debt when they need life-saving care. That’s because the multibillion-dollar private health insurance industry always finds ways to skirt any patchwork laws to maximize their earnings at the expense of working families. Moving to Medicare for All is the only way to ensure we all have access to quality care, and we should set an example in the Commonwealth by implementing a single payer system in our state.


Medicare for All would remove profit-driven health insurance companies as the barrier between patients and providers, and instead allow the government to reimburse health care providers directly. Administrative costs for hospitals, businesses, and municipalities would decrease. It would also end the practice of needing to ask an insurance company for permission before seeking care.

Get Today's Headlines in your inbox:
The day's top stories delivered every morning.
Thank you for signing up! Sign up for more newsletters here

Over 70 percent of Americans — including 52 percent of Republicans — support Medicare for All, according to a Reuters–Ipsos survey. This critical reform would guarantee access to health care services regardless of age, income, place of work, or pre-existing conditions. Medicare is already cost effective, and our most popular health care program. Expanding it to include all Americans will allow us to achieve the health care goals we share. As a national leader on health care reform, Massachusetts should again lead the way by passing Medicare for All legislation.


Josh Archambault

Josh Archambault

Senior Fellow in Healthcare at Pioneer Institute, a Boston-based think tank; Quincy resident

The idea of moving all Massachusetts residents to a government-run health care system is currently in vogue. Yet single-payer programs require trade-offs that I believe the public largely opposes.

Single-payer plans typically are at least partially funded by taking money currently dedicated to Medicare and using it to help pay for the government-run plan. They can also require huge new taxes on employers, redirecting revenue from the 64 percent of residents with private insurance to state officials, who would decide what kind of care we all receive.

In Massachusetts, those state officials, who already run MassHealth for the low-income and disabled, don’t have a great track record. That program now accounts for 40 percent of the state budget, crowding out spending on education and public safety. It “saves” money by paying providers low rates, but as a result, access to health care is a serious issue in parts of the state, based on data provided in 2013 by the Massachusetts Medical Society. This would become the reality for all residents, not just Medicaid recipients.


Perhaps that’s why efforts to launch statewide single-payer programs in Colorado and Vermont have fallen flat.

Single-payer would leave public officials with limited options when health care costs rise. One is rationing care, which results in longer waits and fewer services, and would translate to seniors and individuals who rely on Medicare competing with able-bodied adults for limited resources and appointments. In Canada, the median wait time for medically necessary treatment is over 21 weeks, according to the Fraser Institute.

Medicare is already facing financial struggles. Actuaries for The Centers for Medicare and Medicaid Services have noted that unless changes are made, beneficiaries will face access and quality issues. Expanding this structure would only exacerbate those issues.

Finally, Massachusetts has for years been a leader in health care innovation. We can kiss that goodbye if everyone is on lower-paying government-run care.

Health care is too expensive, in my view, because of excessive government regulations and mandates, and too little transparency and competition. Rather than single-payer, we should pay patients to shop for high-quality, low-cost options; remove regulations that prevent better and cheaper services; and demand full transparency.

This is not a scientific poll. Please vote only once.

As told to Globe correspondent John Laidler. Anyone interested in suggesting a topic or writing a piece can contact him at [email protected].