If two new reports see daylight, they could put radical health-care reform back
on the agenda in Massachusetts
Medicine by Tinker Ready
If you click on the Massachusetts Medical Society Web page and search for two
new reports on health-care reform, you find the links and then hit a cyberspace
wall. The documents -- which reportedly come out in favor of a Canadian-style
health-care system for Massachusetts -- are off-limits to everyone except
members of the medical society. The organization is refusing to release the
studies until members can debate them at their May meeting. Consumer advocates
say the doctors' group wants to keep the reports hush-hush for as long as
possible because members don't agree with the findings. If that is the case,
though, the doctors' reticence could backfire. The tug of war over the reports
may very well re-ignite long-dormant interest in the Canadian "single-payer"
approach, which supporters say offers a solution to our current health-care
"These results have shaken up the medical community," says state senator
Robert Travaglini (D-Boston), who supports the Canadian approach.
shifted the spotlight back upon the single-payer system."
The documents reportedly spell out how the state could work a miracle --
provide health insurance to the uninsured and save millions, or perhaps
billions, of dollars. Sound too good to be true? It is, if you're particularly
attached to the private insurance industry or averse to getting your health
coverage from a state agency.
Under the single-payer approach, the delivery system -- doctors, hospitals,
clinics, and drug companies -- remains private. But the private insurance
industry -- including Blue Cross and all of the HMOs -- disappears, and is
replaced by a state-run health plan. So instead of paying premiums to your
employer, you pay extra taxes to the government. The savings come mostly from
cutting out the profits and the middleman. It's an approach that the
Massachusetts Medical Society has rejected in the past, but one that is
embraced by a coalition of medical and consumer groups called Mass Care. For
years, Mass Care has been trying to get the state legislature to pass a bill
that would explore the possibility of a single-payer system. The bill is up for
consideration again this year, and Mass Care wants the MMS to release its data
in time for legislative hearings scheduled in March and April.
The MMS has said no.
"These reports were developed for internal discussion purposes," says MMS
president Marylou Buyse. "It is our policy not to release such reports until
they are approved for release by our house of delegates."
But that was not the understanding of the Mass Care activists two years ago,
when the Senate Ways and Means Committee decided to rely on the planned MMS
reports rather than sponsor its own study, says Mass Care president Richard
"We were very clear that we wanted to have the results ready for [the] hearing
in the spring," he said. "We feel that legislators need this, and legislators
have told us that they won't sign on until they see the data."
So far, only MMS members and Ways and Means Committee members have been
granted access to the reports. Professor Alan Sager and analyst Deborah
Socolar, of the Access and Affordability Monitoring Project at the Boston
University School of Public Health, did much of the work. They've been tracking
Massachusetts's insurance trends ever since the state's ill-fated 1988 attempt
to implement universal health care. Socolar says she's not at liberty to talk
about the findings.
"It's their report," she says, after a long pause. But she does confirm that
the research puts the single-player plan in a "positive light."
"The evidence indicates that it would be possible to cover everyone
comprehensively and spend less than we are spending on health care today,"
Socolar says. Some of the numbers in a report on the uninsured in
Massachusetts, done last September by the BU team, tell the story. In 1996, the
US -- the only industrialized nation without national health coverage -- spent
$3898 per person on health care. That's more than any other country in the
world. In Massachusetts, the tab for everything from prescriptions to doctors'
fees to crutches to MRIs added up to about $5060 per person. That's probably
the highest per capita health-care spending in the world, and it's more
than twice the per capita rate of Germany ($2233), Japan ($1673), or
Canada ($2065), where everyone has guaranteed health-care coverage. In the US,
more than 40 million people have no insurance. That includes 755,000 in
Massachusetts, up from 495,000 10 years ago, according to the BU report.
In the report, the BU researchers estimate that, in 1999, Massachusetts
residents will pay about $35.4 billion for health-care services. If the
state were to switch to a single-payer system, the tab would be about
Some health-care reformers managed to get the single-payer system on the
national table in the early 1990s, but it has always been a long shot. The
notion of a government-run health-insurance program conjures up images of
crowded clinics and overworked doctors. Virulent opposition from the insurance
industry and the American Medical Association helped steer policymakers toward
incremental reforms that would expand coverage but preserve private insurance.
The result was the Clinton administration's cumbersome "managed competition"
plan, which crashed and burned in 1994, taking the impetus for health-care
reform with it.
It's news to Robert Hughes, president of the Massachusetts Association of
Health Maintenance Organizations, that anyone is even talking about the
single-payer approach anymore. He says he is unaware of the debate over the MMS
studies but doubts that anything will revive interest in the single-payer
"I'm surprised that people think it still has a chance," he says. And for
those who point north as an example, Hughes cites recent news reports about
long waits and poor care at Canadian hospitals.
"The Canadian system is in meltdown," he says. Indeed, several years of tight
budgeting have hurt the quality of care in Canada, which serves as a model for
the single-player plan. Last year, doctors in British Columbia went on strike,
and this year, patients are coping with long waits for doctors' appointments
and hospital beds. Even among critics, though, there is little talk of
scrapping the system.
Back in Boston, some on Beacon Hill want to press the MMS to release its
reports in time for the spring legislative hearings. More likely, the hearings
will be postponed until after the doctors meet in May. But supporters of the
single-payer bill worry that a delay could kill the proposal by pushing it to
the bottom of a crowded agenda. On the other hand, private insurers are not
winning any popularity contests these days. If activists start talking about
the single-payer system again, they may find the public more ready to accept
the radical changes it would require.
"The number of uninsured is going up and the costs are going up," says Mass
Care's Mason. "The problem isn't fixed. . . . There is a time
when people are willing to accept sea change. There are going to be powerful
political forces lined up against single-payer. But I think the numbers are in
Tinker Ready, a freelance science writer living in Cambridge, can be reached at