Single-Payer Fight Moves to Massachusetts

This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.

It has been a disappointing week for advocates of health care justice.

As the GOP was working to take health care away from millions of Americans, news came that California’s single-payer health care bill was shelved by Assembly Speaker Anthony Rendon, provoking outrage among organizers and a strong condemnation from Sen. Bernie Sanders.

In Massachusetts, however, legislators and organizers are providing reason for hope that single-payer health care may in fact be possible at the state level. Last week, at a hearing before the state’s committee on health care financing, single-payer legislation was introduced that would bring this important reform to the Bay State. State Sen. Jamie Eldridge and Rep. Denise Garlick issued bills in both chambers of the Massachusetts State House (S.619 and H.2987) that would create a single-payer system in Massachusetts. Of the dozens who testified, including experts, activists, nurses and organizers, all but one person — a representative for the insurance industry — supported the reform.

“There is real energy behind this issue both in Massachusetts and nationally,” said Sen. Eldridge at a rally prior to the hearing, to loud applause. “The only way we can solve the issues of cost and of access is single-payer health care. We think Massachusetts should be a leader on this issue.”

Proving Single-Payer Saves Lives — and Money

Fighting for Our Lives: The Movement for Medicare for All

Massachusetts, of course, is not the first state to introduce this kind of legislation. What separates this effort from others, however, is that in addition to Eldridge’s bill, another piece of legislation was introduced into both chambers at the hearing. Sen. Julian Cyr and Rep. Jennifer Benson introduced “An Act to Ensure Effective Health Care Cost Control” (S.610 and H.596) at the hearing as well. This is a unique approach that would require the state’s nonpartisan Health Policy Commission, “an independent state agency,” which “monitors the performance of the health care system,” to measure the impact that single-payer would have on costs and delivery of care in Massachusetts.

This is not just another study, organizers say — it would have real teeth. Under the proposal, if the commission finds savings from single-payer, which studies indicate would be significant, the legislature would “be mandated to act,” as Ture Turnbull, director of the single-payer advocacy group MassCare, said in an interview with Truthout.

“Rather than just commission a study — which inevitably gets attacked for being partisan or biased — we have a quasi-public agency with no partisan affiliation measuring the impact,” Turnbull said. “People always want to see the numbers, so here, let’s show them the real numbers.”

This novel approach could serve to undermine one of the biggest hurdles to single-payer legislation at any level: the accusation that it would cost taxpayers a large amount of money. This has proved to be difficult since it is true that a switch to Medicare for All would require significant new taxes. This fact has enabled the likes of the Koch Brothers, the health industry and even Hillary Clinton (as she campaigned against Sanders) to scare voters with misleading claims. However, as Physicians for a National Health Program (PNHP) documents, “No increase in total health spending is needed to finance single payer. The increase in taxes required to finance national health insurance would be fully offset by a reduction in out of pocket costs and premiums.”

Until advocates can successfully educate the public about the real impact of single-payer, the reform will remain elusive. The Cyr/Benson legislation aims to do this in a credible way.

Why Massachusetts Should Lead on Single-Payer

Massachusetts could be the ideal state to take the lead on single-payer, especially now that California’s efforts have stalled. The state has a history of innovation at the state level, effectively implementing a version of Obamacare (Romneycare) four years ahead of the country. Years before the Affordable Care Act improved access for much of the country, Massachusetts insured 97 percent of its people, the best rate in the nation. Massachusetts is also a relatively large state, with a population of 6.6 million; it is the third most densely populated state in the country. If it were to implement single-payer, it would be able to do so on a scale that would demonstrate how this type of system can maximize savings.

Further, as the outpouring of support at the hearing showed, the state is a hub of single-payer activity, and home to many prominent experts and activists working on the issue. Harvard’s William Hsaio, who has designed or helped design universal systems in a dozen countries (and created three plans for Vermont), was among those who testified on the benefits of such a system. So did University of Massachusetts economist Gerald Friedman, who has studied the impacts of single-payer in numerous states, including Massachusetts. “We could lower health care spending by nearly 15 percent while improving access for all residents of the Commonwealth,” he testified. “What are we waiting for?”

UMass Economist Gerald Friedman illustrates how single-payer in Massachusetts would impact residents by income. This was submitted to the Massachusetts Joint Committee of Health Financing. (Photo: Gerald Friedman / Testimony to Mass Joint Committee on Health Financing)

University of Massachusetts Economist Gerald Friedman illustrates how single-payer in Massachusetts would impact residents by income. This was submitted to the Massachusetts Joint Committee of Health Financing. (Photo: Gerald Friedman / Testimony to Mass Joint Committee on Health Financing)

The national advocacy group Healthcare-Now! is based in Boston and its executive director Benjamin Day testified as well. So, too, did Donna Kelly Williams, the president of the Massachusetts Nurses Association (MNA), one of three founding members of National Nurses United. Some of the most important research on single-payer has been done by those with local ties: Steffie Woolhandler and David Himmelstein, among the founders of PNHP, spent decades working out of Cambridge, Massachusetts, and some of the organization’s crucial work has been published in the New England Journal of Medicine.

Importantly, Massachusetts is a progressive state, with Democrats outnumbering Republicans 124-35 in the State House. While the current governor is a Republican, Democrats running for office have been increasingly supportive of single-payer. In 2014, Donald Berwick ran for governor using single-payer as his key issue and had an impressive second-place showing in the primary. Candidates for the next gubernatorial election are already emphasizing single-payer health care as a key issue. Bob Massie, a candidate for Governor in 2018, was also among those who testified in favor of the bills at the hearing.

Massachusetts Gubernatorial candidate Bob Massie testifies in favor of single-payer at a hearing at the Massachusetts State House. (Photo: Rebecca Klein / MassCare)

Massachusetts gubernatorial candidate Bob Massie testifies in favor of single-payer at a hearing at the Massachusetts State House. (Photo: Rebecca Klein / MassCare)

Lastly, Massachusetts has led the way on important issues in the past, beyond health care. For instance, the state was first to legalize gay marriage in 2004, before other states (and eventually the nation) caught up. Barack Obama didn’t come out in favor of same-sex marriage until 2012. “Our state has taken the lead on key issues before,” said one activist who testified to the committee. “It is time to do it again.”

The Lonely Voice of Opposition and the Shumlin Effect

As noted, the hearing consisted of scores of people testifying, discussing virtually matters related to health care. Maia Olsen, an advocate from Boston, spoke about her life dealing with a chronic illness. Jordan Berg Powers, an advocate from Worcester, discussed racial disparities in the health system. “I know statistically I am likely to die younger than my white friends,” he said.

John Berg Powers, an advocate from Worcester, testifies about racial disparities in the US health system to Massachusetts legislators at a hearing for single-payer health care. (Photo: Rebecca Klein / MassCare)

John Berg Powers, an advocate from Worcester, testifies about racial disparities in the US health system to Massachusetts legislators at a hearing for single-payer health care. (Photo: Rebecca Klein / MassCare)

Every single person who spoke was in favor of the legislation, with one exception. The lone opponent of the legislation was Eric Linzer, an executive for Massachusetts Association of Health Plans, a lobbying group for the state’s for-profit insurance companies. Armed with predictable falsehoods about the issue, his presence angered some in attendance so much that the chairman of the hearing heard an audible hissing and used his gavel to call for order in the chamber.

Linzer relied on tired old tropes about single-payer that have been perpetuated for years by opponents. Linzer took aim at waiting times in Canada, arguing falsely that they were a byproduct of its single-payer system.

Most troubling, however, was his emphasis on failed efforts for single-payer in Vermont. As Truthout has previously documented, when Vermont Gov. Peter Shumlin surrendered on health care he deflected blame, wrongly, on the costs of such a plan. By parroting false talking points, he provided fodder for the insurance lobby to use for many years. Indeed, while the legislators in attendance did not ask many questions, among the only questions asked was, “Why didn’t it work in Vermont?” (For an answer to this question see Woolhandler and Himmelstein).

“The way Shumlin handled it, he really set the whole movement back nationally,” Friedman told Truthout.


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Tuesday, June 20th at the State House is our chance! It is time that we lead again. Please join us at the steps of the State House at 10am on Tuesday June 20th for a Rally and then inside the building, room B1 at 11am for the Public Hearing!

For more information, please contact us at

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Ideas and Opinions |21 February 2017 Single-Payer Reform: The Only Way to Fulfill the President’s Pledge of More Coverage, Better Benefits, and Lower Costs

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Summary of Republican Congressional Health Reform Proposal

Summary of Republican Congressional Health Reform Proposal

Released 3/6/2017

Steffie Woolhandler, M.D., M.P.H., & David Himmelstein, M.D.

Most ACA insurance regulations unchanged (probably can’t be changed through reconciliation)
    Cover preexisting conditions
    No health status underwriting
    Meet actuarial value requirements
    Cover adult children up to age 26
    Cap out-of-pocket expenditures
    No lifetime or annual limits
    10 essential benefits
Medicaid – Cuts in Federal payments estimated at $370 billion/10 years
    Ends ACA expansion and essential health benefit requirements 1/1/2020
    Replaces Federal Medicaid match with per-enrollee funding 1/1/20.
    Full funding for those continually enrolled since 1/1/2020; reduces funding for new enrollees or re- enrollees by one third.

Federal payments to the states through Medicaid or any other program for Planned Parenthood would be prohibited

Insurance Regulation and Continuous Coverage Requirement
    Replaces mandate with continuous coverage requirement for individual/small group plans: Premiums increased by 30 percent for those with a gap in creditable coverage of at least 63 continuous days during the preceding 12 months (or, for people leaving dependent coverage, who did not enroll during the first available open enrollment period).
    Allows premiums to vary by a 5:1 ratio for old:young (vs. 3:1 under the ACA)
Coverage subsidies (tax credits)

Replace ACA subsidies with age-adjusted, fixed-dollar advanceable tax credit. Phased out for individuals with income > $75,000 (families > $150,000)o $2,000 for individuals under 30

  • $2,500 for those ages 30 to 40;
  • $3,000 for those ages 40 to 50;
  • $3,500 for those ages 50 to 60; and
  • $4,000 for those over 60 (<1/3 of the average cost of coverage for this age group)
    • Tax credits would only be available for individuals not eligible for employer coverage
    • Most non-citizens ineligible for tax credits
    • Prohibit using subsidies for any plan that covers abortions
Taxes repealed & new cuts (amounts in parentheses are amounts lost to treasury over 10 years)
    Medicare tax on unearned income for wealthiest 2% of taxpayers ($157.6 billion).
    Medicare surtax on high incomes >$200,000 ($117 billion)
    Tax on prescription drug firms ($24.8 billion).
    Tax on medical device firms ($19.6 billion).
    Tax on health insurers ($144.7 billion).
    Tax on health insurer executive compensation exceeding $500k ($400 million)
    Others: Tanning tax ($600 million);.med. expense deductions ($34.9 billion); FSAs ($18.6 billion); HSAs ($24.1 billion);
    Delays Cadillac tax
Other Provisions
    Cuts $1 billion from Prevention and Public Health Fund (i.e. CDC and public health departments).
    $100 billion in new funds for states to establish high risk pools etc.
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Thanks to Trump and GOP, a California single-payer healthcare system is now possible

Here’s an excellent article. It’s informative and hopeful.

Thanks to Trump and the GOP, a California single-payer healthcare system is now possible

Republican proposals for Medicaid block grants unintentionally would remove a key obstacle to California creating its own single-payer insurance system. (Getty Images)

David Lazarus
Contact Reporter

Could California have its own single-payer health insurance system providing coverage for all residents? A bill has been introduced in the state Legislature that would do just that — and its chances of success could be vastly improved by President Trump and the Republican-controlled Congress.

Thanks, guys!

1 (4)

First, a little history lesson. Stick with me because this is important.

California flirted with a single-payer system when the Legislature signed off on the idea in 2006 and again in 2008. The bills were vetoed by former Gov. Arnold Schwarzenegger, who declared in 2006 that “socialized medicine is not the solution to our state’s healthcare problems.”

Those legislative efforts were spearheaded by Sheila Kuehl, who was then a state senator and is now a Los Angeles County supervisor. She and I spoke frequently during California’s flirtation with single payer and we caught up on the topic this week.

Her biggest mistake in 2008, Kuehl told me, was not effectively countering the “socialized medicine” line from Republicans and conservative critics.

“What we should have done from the very beginning was use the phrase ‘Medicare for all,’ ” she said. “People are familiar with how Medicare works. They would have understood that we weren’t taking over healthcare providers.”

Under the typical single-payer system, payroll taxes replace premiums, deductibles and co-pays as a funding mechanism for health insurance. This is how almost all other developed countries succeed in providing affordable coverage for everyone — and for about half as much as what Americans pay.

No one is proposing a government takeover of hospitals and doctors’ offices.

“Single-payer isn’t socialized medicine,” Kuehl said. “It has nothing to do with hospitals and doctors. It’s purely a form of insurance. But we didn’t communicate that as well as we could have.”

Messaging aside, she thinks the public has become more open to new ideas.

“With so much uncertainty from the Trump administration,” Kuehl said, “I’m more convinced than ever that single-payer is the way to go for California. It’s a very, very good idea.”

The idea is back in play thanks to state Sen. Ricardo Lara (D-Bell Gardens), who last week introduced a bill aimed at creating a Medicare-for-all system for Californians.

It doesn’t yet say how this would be accomplished. Instead, it declares the Legislature’s “intent” to pass a law that would “establish a comprehensive universal single-payer healthcare coverage program and a healthcare cost control system for the benefit of all residents of the state.”

Details, presumably, will come later.

“If Republicans abandon California and Congress moves to cut Medicaid, we will insist that the federal government treat us like any other state and give us the flexibility and freedom to address the health needs of our entire population through a universal healthcare system,” Lara told me.

Studies have shown that a single-payer system would result in lower out-of-pocket costs for most California residents.

But one big problem with Kuehl’s earlier bills was how the $100-billion Medi-Cal program — the state’s version of Medicaid — would integrate with a California single-payer system. Medi-Cal covers about a third of the state’s population. About $67 billion in funding comes from the federal government.

That state-federal partnership meant Washington would have needed to sign off on any move to incorporate Medi-Cal into a state single-payer plan, and Kuehl acknowledged at the time that this probably would have been hard to obtain.

Thanks to Trump and the Republican-controlled Congress, things are now very different.

“We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out,” Trump said in his speech to Congress this week.

What he and Republican leaders mean by that is giving states a fixed amount of Medicaid money in the form of block grants to cover low-income people. States currently are guaranteed at least $1 in federal funds for every $1 in state spending.

The Republicans’ goal is for the federal government to pay less for Medicaid annually. But what they’re also unintentionally doing is removing perhaps the biggest obstacle to California and other states establishing their own single-payer systems.

With block grants, states wouldn’t need congressional approval to use Medicaid money for a broader insurance program.

“Yes, that solves the problem,” said Gerald Kominski, director of the UCLA Center for Health Policy Research.

But he noted that block grants create a different issue in the form of program sustainability. Unless the annual grants grow with healthcare costs, states will find themselves increasingly underfunded in covering Medicaid populations.

“If the grants are linked to inflation, that won’t be sufficient,” Kominski said. “Healthcare spending always grows faster than the overall economy.”

The average cost of living for Americans rose about 2% last year. Healthcare spending, meanwhile, climbed 4.8%, and is expected by the Centers for Medicare and Medicaid Services to rise 5.4% this year.

“Block grants are a poison pill,” Kominski said. “They’re a slow-acting poison that cuts off your healthcare funds.”

That’s not an insurmountable problem. California could structure a single-payer system so that it’s sustained by a greater share of state tax revenue, with program efficiencies offsetting a gradual decline in federal dollars.

A 2005 study by the Lewin Group found that a single-payer insurance plan would save California nearly $344 billion over 10 years, primarily by streamlining bureaucratic overhead and relying more on bulk purchases of prescription drugs and medical equipment.

The study also predicted a significant economic boost for businesses because they’d no longer be responsible for employees’ health coverage. This, in turn, would probably spur job creation.

A single-payer system would be a clear improvement for California and would serve as a model for the rest of the nation. Don’t forget: Canada didn’t adopt a single-payer system overnight. It rolled out its universal-coverage program gradually, province by province. The same methodical approach would be prudent for the United States.

But now another question arises: What sort of single-payer system do we want? They’re not all created equal.

On Tuesday, we’ll look at alternative approaches to covering everyone.

David Lazarus‘ column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send your tips or feedback to

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Copyright © 2017, Los Angeles Times


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Call to Action! Call your Rep. and Senator TODAY!

From day one, President Trump has been working to repeal ObamaCare, the only way to ensure true healthcare justice is to expand Medicare to Everyone!

Please take 3 min to contact your State Rep. and State Senator to ask them to Co-Sponsor our NEW legislation. They only have a week to add their name as a Co-Sponsor, so please call them today!

The phone number for the State House is 617-722-2000

1.“An act establishing improved Medicare for All in Massachusetts” SD698 (lead sponsor Senator Eldridge) HD 3249 (lead sponsor Rep. Garlick)  
2. “An act to ensure effective health care cost control” SD1281 (lead sponsor Senator Cyr); HD1501 (lead sponsor Rep.Benson.)

If you do not know your State Rep. and/or State Senator, you can look it up quickly by putting your address into this link:

It is time that we Fight for Single Payer / Medicare for All here in the Commonwealth!
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Our Healthcare Costs are the Highest in the Nation / World

Today, the HPC released select findings from the 2016 Cost Trends Report. Annually, the HPC releases a report on health care cost trends, which examines health care spending and delivery in Massachusetts, opportunities to improve quality and efficiency, and progress in key areas. In February, the HPC will release the final 2016 Cost Trends Report, which will offer policy recommendations building from the HPC’s research and data.
Click here to view the PowerPoint presentation highlighting the select findings.
It is time that we Fight for Single Payer / Medicare for All here in the Commonwealth!
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Op-ed: Importance of Boston City Council Supporting Single Payer Health Care Reform

Op-ed: Importance of Boston City Council Supporting Single Payer Health Care Reform

By: Ture Richard Turnbull | August 22, 2016

The Boston City Council will take a bold step on Wednesday, August 24 by passing a resolution reaffirming its support for a single payer health care system.  The resolution calls upon the state legislature in the upcoming 2017- 2018 legislative session to propose and pass a measure to achieve a single payer system in the Commonwealth.

This resolution is an extremely important endorsement for true health care reform that would make health care a right for all Massachusetts citizens and “provide availability and affordability of healthcare for all Massachusetts citizens.”

In 2001 the Boston City Council passed a similar resolution supporting single payer (also known as Improved Medicare for All). In 2008 the Commonwealth adopted Chapter 58 in an attempt to cover more people by mandating that everyone must buy health insurance or pay a stiff fine; but it lacked the ability to control health care costs. We now have the Affordable Care Act (ACA) that is largely based on Chapter 58. It does cover more people, but it is still unable to control costs. In Massachusetts there are about 300,000 people who are uninsured and many more who have insurance, but the co-pays, deductibles, co-insurance and high cost of medications make it impossible to access the medical care they need.

We need to ask ourselves why our present health care system fails to provide everyone with affordable, high quality coverage. If we look at the money trail it is clear that the private health insurance companies, the pharmaceutical corporations, and the big hospital groups are stashing away billions of dollars while patients are struggling to pay for needed and routine medical care. We have a profit-based or market-based system that basically allows the health insurance companies to make huge profits by skimping on medical care creating a large profit margin that satisfies their shareholders. The pharmaceutical companies are on a rampage to raise prices on their prescription drugs to the point that in some cases life-saving medications for HIV, hepatitis C, and cystic fibrosis will cost as much as $300,000 per year. These corporations say they need the money for research and development, but most of the money goes to the CEOs with obscene salaries and to payouts to satisfy their shareholders. We need a health care system that is patient-centered not market-based.

Why should Massachusetts move to a single payer system?

  • It guarantees access to medical care for everyone, up front, with no co-pays, deductibles, or high out-of-pocket costs.
  • It is continuous from birth to death, no eligibility requirements if you reside in Massachusetts, with no loss of coverage if you change or lose a job, and no need to stay in a bad job just because of the health insurance it provides.
  • Businesses and municipalities would benefit because they would no longer be responsible for providing health insurance for their employees. Instead they would pay a payroll tax that would be predictable for long-term planning and in most cases would cost less than what they pay now, allowing for growth in businesses and more funding for vital municipal programs such as schools and fire and police for towns and cities.
  • A single payer system would be funded by income taxes made as progressive as possible under Massachusetts law, a business contribution through a payroll tax, and possibly taxes on unearned income. State income taxes might rise for some people, but the rise in taxes would be in most cases much less than what we pay now for health insurance premiums (around $22,000?!?! for a family of four), co-pays, deductibles, co-insurance, all of which would be eliminated.
  • Private health insurance companies would be streamlined to cover only things not covered by the single payer system. This would eliminate the wasted money spent on unnecessary administrative functions and the profits that are siphoned off the system estimated to be around 30% of total health care expenses for the state. Pharmaceutical companies would be forced to negotiate their prices with the single payer administration. This would keep the cost of medications affordable and set better guidelines for development of new drugs.
  • Hospitals and large medical groups would be funded by a negotiated budget for all hospital expenses. Capital improvements would have to be approved by the single payer administration to avoid duplicated services that aren’t necessary for the system.
  • A single payer system is a patient-oriented system that would reduce health disparities since everyone is covered, and improve the quality of care. It would also strengthen the healing power of the doctor-patient relationship by giving doctors the right to make decisions about medical care instead of insurance bureaucrats allowed full choice of doctors. A single payer system is based on the premise that a healthy society promotes opportunities for the young, comfort and dignity for the elderly, and good healthcare for families that make up the workforce of the country.

The timing of the resolution by the Boston City Council is tremendously important. A single payer system is being championed by candidates across the country and it is now a mainstay of the large and growing progressive movement. In Massachusetts there are many new candidates who will be added to the strong group of legislators who already support a single payer system. The primaries will be held September 8th and it is extremely important for everyone to vote and to support the candidates who will vote for a single payer system. Cities and towns across the Commonwealth have the incentive now to follow the Boston City Council and make resolutions of their own to support a single payer system. The 2017-2018 legislative session will show whether we have the political will to achieve what almost all the other countries in the world already provide, a single payer (Improved Medicare for All) system that covers everyone with high quality care, is affordable, sustainable, and equitable.

Thank you Boston City Council!

For more info visit

Posted in Jamaica Plain News:

Ture Richard Turnbull is the executive director for Mass-Care. Mass-Care’s mission is to establish a single payer health care system in Massachusetts. 


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Boston City Council Resolution Calling for a Single Payer System

Dear Single Payer Supporter:

The political revolution continues! On Wednesday, Aug. 24th at 12pm in the City Council chambers in City Hall, PLEASE JOIN US as the City Council will sign a resolution calling for the creation on a Medicare for All / Single Payer healthcare system for the Commonwealth!


This is a bold step and we thank the City Council for their leadership as we set the stage for the next legislative session for the Commonwealth. Please join us and make sure to VOTE for the state’s primary on THURSDAY, September 8th!

If you are unable to join us next Wednesday, please contact your City Councilor to ask them for their support of the resolution. Contact info HERE! 

In solidarity.

Ture Turnbull
Catherine DeLorey
Pat Berger
Jackie Wolf

Ture Richard Turnbull
Executive Director of Mass-Care

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