Single-payer health system 'a long shot' Docs, advocates push lawmakers on universal care

The Berkshire Eagle

Local activists and doctors supporting state-run universal health care are proclaiming their disgust that Massachusetts lawmakers seem to be ignoring the wishes of strong majorities of voters' in 20 legislative districts.

Lawmakers are straying so far from many voters' wishes, the House's progressive caucus, which has 61 members, is not even unanimously in favor of the universal health care bill, state Rep. Tricia Farley-Bouvier, D-Pittsfield, is saying.

In the 2022 midterm election, voters in the 20 legislative districts with the nonbinding question on the ballot urged their lawmakers by between 55 and 88 percent to pass universal health care. The question passed with 61 percent of the vote in Speaker of the House Ron Mariano's district. In Farley-Bouvier's district in Pittsfield, universal health care won with 75 percent of the vote.

Nevertheless, Farley-Bouvier told her constituents she would not lead the effort to pass universal health care, often referred to as Medicare for All.

"That's just not what we do in the caucus, twist each other's arms on things," Farley-Bouvier told The Eagle. "We have a member [state Rep. Lindsay Sabadosa, D-Northampton] of the caucus who is leading this effort on Medicare for All. Our job is to support her in her work."

Farley-Bouvier co-chairs that caucus.

Henry Rose, of Dalton, a retired physician and a member of Mass-Care, a nonprofit advocating for state-paid universal health coverage, criticized Farley-Bouvier after the January meeting. He and other community members said Farley-Bouvier was not pushing vigorously enough for the single-payer program, which she says she favors.

In the meeting, Farley-Bouvier "told us she will support the bill if it comes to the floor, but she won't twist arms, especially with party leadership," Rose said. "That doesn't mean a lot unless all the members of the

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progressive caucus get together on this and promote it the best they can among their colleagues to try to get it out of committee."

Rose and others want Farley- Bouvier to champion the bill and have implored her to co-lead the charge.

Mass-Care Director Stephanie Nakajima criticized Farley-Bouvier for shifting to Sabadosa alone the responsibility for persuading other lawmakers to back state-paid universal health care.

"One wonders what is even the point of having a progressive caucus? They don't want to move together progressively and hold each other accountable to be progressive," Nakajima said.

Jeanne Kempthorne, former chief of appeals and public records officer in the Berkshire District Attorney's Office, criticized Farley-Bouvier's rationale for refraining from pushing the bill. Farley- Bouvier argues that if Speaker Mariano, D-Quincy, isn't on board for the bill, it will not pass, no matter her efforts.

Kempthorne accuses Mariano of defending his turf: "The speaker would be most concerned about the impact of the legislation on community hospitals because that's his key constituency and his greatest concern. Our directives to [Farley-Bouvier] have fallen on deaf ears, and she's forgotten who she works for. She doesn't work for us, she works for the speaker."

Farley-Bouvier said the speaker controls the House's agenda.

"There are those who wouldn't co-sponsor something unless they knew the speaker was on it," she said.

Neither Mariano's office nor Gov. Maura Healey's office responded to a request for comment.

"There's a lot of people out there who don't want it to change," Farley-Bouvier said of the current system. "Blue Cross Blue Shield [the private health insurance giant] is a powerful entity in Massachusetts, what happens to them? There are bills out there without losers … In this situation there are winners and losers. I happen to think that the consumer, the taxpayer, medical professionals, are the winners, but the insurance industry would look very different."

Massachusetts has debated single payer for decades: The first single-payer bill was introduced in 1986. Lawmakers point out that Massachusetts, which led the nation in mandating health insurance for residents in 2006, currently has near-universal coverage, with less than 3 percent of the population uninsured.

"It's a patchwork insurance with your co-pays, deductibles and high drug costs," Rose said of the present system. "There are out-of-pocket costs that are beyond the reach of a lot of average citizens."

Proponents of Medicare for All argue that for-profit insurance companies raise costs more than what it would cost in taxes to fund universal health care. Mass-Care writes of single-payer: "Medical care would be free at the point of service. All doctors and hospitals would be accessible to any resident without the restrictions currently imposed by insurance companies and employers. Fair, progressive taxation would replace premiums and co-pays."

Single-payer could reduce health care costs by nearly 10 percent, according to a University of Massachusetts Amherst study. Nakajima noted that 41 percent of Massachusetts families struggle to afford health care right now.

The Berkshire delegation all publicly support Medicare for All in Massachusetts, but none of them have made it a priority.

State Rep. John Barrett, D-North Adams, said he believes in the concept, but he isn't sure of its efficacy with the projected costs for the program. He and other members of the delegation have long co-sponsored the legislation.

In addition to federal Medicare and Medicaid funds, under the bill, single-payer health care in Massachusetts would be paid for with a 7.5 percent tax on employers, with an additional half-percent on employers with more than 100 employees; a 2.5 percent tax on employees; a 10 percent tax on the self-employed; and a 10 percent tax on unearned income. These taxes are on all income above $20,000. Payroll taxes for employees would often replace what they pay into for their company health insurance.

"I've been a co-sponsor of that bill for 20 years in the legislature, but I think it's a long shot," state Rep. Smitty Pignatelli, D-Lenox, said. "We've got to find a balance of giving people quality health care and maintaining small hospitals in the Berk-shires, making sure they're financially stable."

Pignatelli echoed the concerns of local activists on the outsized influence of insurance lobbies at the State-house.

"Insurance lobbies have way too much influence on politics period," he said.

According to the Boston Globe, In 2005, when the legislature took up health care legislation that later became Romneycare, "lobbyists for hospitals, insurance companies, and other major players in the health care industry were paid at least $7.5 million."

Michael Kaplan, a doctor and the president of the Berkshire District of Massachusetts Medical Society, said he has seen insurance companies in the state funnel in millions of dollars over the years to defeat attempts at establishing Medicare for All.

"If the insurance companies become threatened, they have a lot of resources," he said.

Kaplan thinks skepticism of universal health care comes from a lack of understanding.

"If you ask people the question, do you support a government- sponsored health plan that's paid for by taxes, they say yes," he said. "It would cost more in tax dollars because it's tax-funded. But it replaces premiums and workers comp, so big picture, it doesn't cost more. You have to raise taxes to pay for it, but the proposal doesn't raise taxes on 95 percent of people."

Kaplan said he believes the majority of physicians support single-payer. While some surveys buttress that belief, many doctors are split on the issue, though they have begun to come around to the idea more in recent years.

State Sen. Paul Mark said he sees a reluctance to become the first state to offer single-payer. He said there is a general concern among legislators about hurting the insurance industry.

"There's from some a fear that we don't want to be the first to take the leap because we don't want to cause any harm to what is one of the five most important industries in the state," he said, adding that hospitals and the health insurance industry "have a lot of sway in legislative circles."

Mark doesn't buy private committee meetings and votes as an obstacle to single- payer, as Nakajima and Kempthorne posited.

Nakajima said Mass-Care is planning on building grassroots support with labor groups.

"Organizing unions and other larger community groups will be the vanguard of the movement for Medicare for All," she said. "It'll be essential to passing it in the Statehouse."

Sten Spinella can be reached at [email protected].

Cheryl Rose, left, and Henry Rose standing at the Pittsfield Common in 2022. Henry Rose and others want state Rep. Tricia Farley-Bouvier, D-Pittsfield, to champion single-payer health care and have implored her to co-lead the charge. EAGLE FILE PHOTO