What is single payer?

Single Payer (also known as Medicare for All) is a streamlined health insurance system in which a state organizes and finances health care. In Massachusetts, this would replace our current expensive and complicated system of multiple insurance companies and would result in great cost savings and access to health care for everyone. Under a Single Payer/Medicare for All system in Massachusetts, all state residents would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug, and medical supply costs.

Why is Medicare For All Needed In Massachusetts?

Massachusetts needs to extend quality health care to all residents that is affordable and controls costs. High costs, primarily due to administrative costs, are steadily consuming state, municipal, business, and household budgets. Attempts to control these costs within the present private insurance system have failed. Single Payer systems around the world have been proven to reduce inequalities in health care, improve access to care, and reduce costs for families, businesses, municipalities, and states.

 Is single payer/Medicare For All socialized medicine?

No. Delivery of care would remain private. Patients would have free choice of doctors and hospitals, and doctors would regain autonomy over patient care.

It is a myth that the government will make the medical decisions. In a publicly financed, Single Payer/Medicare for All system, medical decisions are left to the patient and doctor, as they should be.

Won't this result in rationing like Canada?

The U.S. already rations care. Rationing in U.S. health care is based on income: if you can afford care, you get it; if you can’t, you don’t. Despite advances in coverage through the Affordable Care Act and Medicaid, thousands of Americans still die every year because they can't afford to go to the doctor, or to pay for the treatments their doctor prescribes. Many skip treatments that their insurance company refuses to cover. That’s rationing.

Who will run single payer/Medicare For All in Massachusetts?

The Massachusetts Health Care Trust would be formed and governed by a Board of Trustees with 29 members, including but not limited to the Secretary of Health and Human Services, the Secretary of Administration and Finance, the Commissioner of Public Health, with public accountability through elected members and appointees representing various constituencies, including two Single Payer advocates. The Board would make policy and regulatory decisions regarding the system and would appoint an executive director to administer the trust.

With Medicare for All the public has a say in how its health care system is run. Representatives of patients and medical experts would decide on what treatments, medications, and services should be covered, based on community needs and medical science, and allocate capital for major new investments based on assessments of where need is greatest..

Will Medicare For All save money?

Yes. A study by UMass Amherst economist Gerald Friedman estimates that, after improving the system to cover all residents for all medically necessary care, Massachusetts would save over 30% of our current spending on health care in the state – over $34 billion. It does so primarily by eliminating administrative waste in the commercial health insurance market. Savings also come from using the negotiating power of the Trust to lower the price of prescription drugs and medical devices, by having a global budget, and by streamlining the system.

People will seek care earlier when chronic diseases such as hypertension and diabetes are more treatable. We know that both the uninsured and many of those with skimpy private coverage delay care because they can’t afford it with the ever-increasing costs of our current system.

Our present bureaucratic system spends 20 to 31% of every health care dollar on administrative costs, profits, and CEO salaries, while our national Medicare system spends only 2 to 3% on overhead costs.

How would providers be paid under Medicare For All in Massachusetts?

The Health Care Trust would become the single payer. Prompt payments would be sent to providers and facilities for covered services and capital needs. Institutions and organizations, like hospitals, clinics and health centers, and physician practices would develop and use global budgeting.

What will happen to physician incomes?

On the basis of the Canadian experience under national health insurance, we expect that average physician incomes should change little. However, the income disparity between specialties is likely to shrink.

How will we keep drug prices under control?

Drug prices will be controlled with bulk purchasing power.

What will happen to the insurance companies with single payer/Medicare For All?

Insurance companies would not be allowed to offer the same benefits as the Massachusetts Health Care Trust. Allowing such duplication of coverage weakens and eventually destabilizes the health care system.

What will happen to those who work for the insurance companies?

Administration will obviously shrink and this will eliminate the need for many insurance workers. The proposed bill requires the Trust to set aside funds for transitioning displaced workers. They will be offered job retraining, placement programs, and extended unemployment benefits. Some insurance company employees may find positions in the administration of the Trust.

How will Medicare For All in Massachusetts be financed? Won't it raise my taxes?

The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll taxes on employers (7.5% + .05% on employers of 100+ employees), employees (2.5%), and the self-employed, and a tax on unearned income (10%), each with a $20,000 exemption. The payroll taxes eliminate and replace all other employer and employee expenses for health insurance (premiums, co-pays, deductibles, and all other out-of-pocket payments).

For the vast majority of people, this tax would be less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution. There would be no tax on Social Security, pension, or unemployment benefits.

Employers could pay all or part of the employee payroll tax, and that payment would not be considered income taxable under the Massachusetts income tax.

Isn't a payroll tax unfair to small businesses?

The payroll tax means a cost increase for businesses that are not currently insuring their workers. However, it is much less than what they would pay at present for adequate coverage for themselves and their workers. For most small (and large) businesses already providing coverage, the payroll tax will mean substantial savings.