Health care reform: a Massachusetts perspective

Massachusetts already has universal individual mandates and a system of subsidies for lower-income individuals to buy private health insurance. How do Massachusetts single payer activists feel about passage of health care reform? MassCare, the state's single-payer coalition, weighs in:

Late last night the House passed health reform into law, along with a "reconciliation" bill that the Senate is expected also to pass along party lines this week. What does this mean for the movement to make health care a right in Massachusetts, and how should single payer advocates respond?

Millions of uninsured residents in other states will receive life-altering assistance, and the prescription drug 'donut hole' faced by seniors under Medicare will be closed over time - it's important not to understate what a victory this is for many of our supporters and allies.

However, the law will create winners and losers. It contains no meaningful cost controls; the tax on workplace health benefits used to pay for the law will serve as a powerful driver towards universal underinsurance; and Massachusetts in particular will be a 'net loser' under the law, as many of its benefits are already in place here and we will be paying more under the new taxes than most states.

The bill is projected to cover 32 million uninsured people by 2019... However, by 2016 - if health costs and income continue to rise as they have been - the average cost of a family health insurance plan will consume 34% to 45% of an average family income! We know that this is not conceivable for a household budget or for a business that offers coverage to its workers. This tells us something important: we will HAVE to have another major health reform debate - one that does not ignore costs, and does not just shift them onto patients - way before the bill that just passed has been fully implemented. We also know that there is no country on earth, or any region of any country on earth, that has successfully controlled costs without a single payer system or regulations so stringent that private insurers are forced to behave like a single payer system.

This cost crisis will likely reach a head in Massachusetts, where we have the highest health care costs in the nation, before anywhere else. The debate here on how to control health care costs before our health care system implodes will be a crucial moment for the single payer movement to mobilize and ensure that we get health reform that works.