Baker, Gonzalez split over single-payer health care

Sept. 24--BOSTON -- Gov. Charlie Baker and his reelection challenger, Jay Gonzalez, are both former health care executives who have spent years working to expand access to affordable treatment and reduce costs.

But the two have vastly different visions for the direction of coverage in Massachusetts, which has long been a leader in setting health care policy.

Gonzalez, a former state budget chief and CEO of the health insurer CeltiCare, thinks the state should shift to a single-payer system whereby employers and employees pay through payroll taxes instead of premiums that go to private insurers.

"We're can't afford not to do this," said Gonzalez, a Needham Democrat, in an interview Thursday. "Everyone should have access to the health care services they need, and the system we have today does not provide that. Our system is way too complicated and costly, and it's not financially sustainable."

Gonzalez hasn't released specifics of his plan but said it could be accomplished by "cutting out administrative waste."

"If we did this thoughtfully, it would save a lot of money," he said. "There's so much waste and inefficiency in the current system."

Previous proposals on Beacon Hill for single-payer health systems have called for new payroll taxes, ranging from 2.5 to 7.5 percent, with exemptions for an employee's first $30,000 in earnings. Money would be deposited into a state-managed fund to pay for the program.

Similar to MassHealth -- the state's Medicaid program -- employees would get a health care card that could be used at hospitals and clinics.

But the idea has plenty of opposition, notably from the powerful insurance industry, which stands to lose billions of dollars if the current health care system is upended.

Baker, a former CEO of Harvard/Pilgrim Healthcare, is critical of government-run health care and doesn't support a shift to a single-payer system.

The Republican's campaign touts his record of reducing health care costs and improving access to treatment, saying the approach is producing results.

Baker campaign spokesman Terry MacCormack ticked off a list of Baker's accomplishments including "fixing the Health Connector, opposing federal health care plans misaligned with the commonwealth's best interests, enacting nation-leading reforms to combat the opioid crisis, protecting taxpayers from out-of-control MassHealth costs, and delivering more transparency to help consumers make cost-effective choices."

"Gov. Baker is proud that Massachusetts is a national leader on delivering access to quality, affordable healthcare for all," MacCormack said.

Gonzalez said Baker isn't doing enough to improve the state's health care system, and he argues that "radical" change is needed.

"He's not proposing any fundamental reforms," he said. "The status quo is working well for him and his wealthy supporters, but it is not working well for everyone else in the state who can't access to the health care that they need."

In Massachusetts and elsewhere, switching to a single-payer system, much like those of Canada and Europe, has been a dream deferred for progressives within the Democratic Party.

In the 1970s, Sen. Ted Kennedy fought unsuccessfully to pass legislation in Congress to create a government-run insurance plan.

In 2006, then-Gov. Mitt Romney signed a law making health insurance mandatory in Massachusetts and setting up an insurance exchange. It became the template for the federal Affordable Care Act, known as Obamacare.

A 2016 study by the Blue Cross/Blue Shield of Massachusetts Foundation found 95.7 percent of working-age adults in the Bay State are insured.

But single-payer supporters say, even with near-universal coverage, many people struggle to afford it.

If elected, Gonzalez could find ready allies for his plans in the Democratic-controlled Legislature.

Nearly 40 of 200 state lawmakers -- including some in leadership -- have signaled support for proposals to create a single-payer system.

Overall, health care costs in Massachusetts are rising despite efforts to rein them in.

A recent report by the state Center for Health Information and Analysis found that health care spending grew 1.6 percent from 2016 to 2017, with costs totaling $61.1 billion, below a benchmark set by the state Health Policy Commission.

The average resident spent about $8,900 on health care in 2017, the agency said.

One of the biggest drivers of costs is MassHealth, which covers more than 1.9 million people and consumes 40 percent of the state's $41 billion budget.

Baker has proposed a number of MassHealth reforms since taking office in 2014 but the Democrat-controlled Legislature has blocked many of them.

Lawmakers were considering an overhaul of the health care system to improve access to medical care in part by shifting hundreds of millions of dollars to community hospitals. But they failed to approve the package before the July 31 end of the legislative session.

Despite Baker and Gonzalez's backgrounds in health care, Beacon Hill watchers said the issue isn't getting enough attention from either campaign.

"The silence on health care has been deafening," said Jim Stergios, executive director of the Pioneer Institute, a right-leaning Boston think-tank. "The reality is the budgetary pressures we feel as a state are not being driven by transportation and education, but skyrocketing health care costs."

Whomever wins the governor's race, Amy Rosenthal, executive director of the nonprofit Health Care For All, said there are a litany of health care related issues that they will need to wrestle with in coming years, ranging from the rising cost of prescription drugs to rollbacks of the federal health care law.

"There's been constant attacks on a federal level of the Affordable Care Act, Medicaid and women's reproductive health," said Rosenthal, whose group doesn't endorse political candidates or their platforms. "So we're going need to figure out Massachusetts solutions to these attacks."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites. Email him at cwade@cnhi.com

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