More States Considering Single-Payer

July 17--With polls showing a majority of Americans holding unfavorable views of plans to repeal and replace the Affordable Care Act, the conversation about replacing the current system with a single-payer or Medicare-for-all system is heating up.

Massachusetts is one of almost two dozen states that is exploring the idea of a single-payer, universal health care system, with bills in the state Senate and House of Representatives requiring the state to study or institute the system.

"We've been a leader here in Massachusetts" with health care reform under Republican Gov. Mitt Romney in 2006, said state Sen. Julian Cyr, D-Truro, a lead sponsor of one of the bills.

With efforts to control spending failing to rein in health care costs in a meaningful way, it's time to look at the health care systems embraced by a majority of the world's developed nations, Cyr said.

Americans are currently "paying a ton of money for OK care" and still leaving people behind, Cyr said.

He estimated that 20 to 30 percent of health care costs currently to go insurance administration and pharmacy benefits managements -- costs that could be nearly eliminated or greatly by a Medicare-for-all type of model.

If Republicans in Congress succeed in dismantling the ACA, also known as Obamacare, Gov. Charlie Baker said the state stands to lose $2 billion out of its $40 billion state budget, which is unsustainable, Cyr said.

The threat is forcing politicians and policymakers to ask if there is a better way to deliver health care coverage, Cyr said.

"If this is not the time to have a conversation about (single-payer), then I don't know when is," said Dr. Brian O'Malley, a recently retired Provincetown physician who is working on making single-payer a reality in Massachusetts.

Republican plans to reduce federal funding for Medicaid as part of repeal and replace are particularly unfavorable with the public, according to a July Kaiser Health Tracking Poll.

The poll said nearly two-thirds of the public -- 65 percent -- is against major reductions in Medicaid, while 61 percent of Americans continue to hold unfavorable views of the GOP's overall plan to repeal and replace the ACA.

"They are literally going after sick people," said Ture Turnbull, executive director of Mass-Care, an organization dedicated to bringing up a single-payer program in Massachusetts.

"If we believe health care is a human right, we'll have to create a single-payer system," Turnbull said.

He said there are 64 co-sponsors of single-payer legislation in the state Legislature, more than at any time in the past. And the co-sponsors include at least one Republican, state Sen. Bruce Tarr, of Gloucester, Turnbull said.

"It works in other countries because it makes the most sense," said Dr. James Garb, of Yarmouthport, a retired physician who said he was disappointed when the public option was not included in the ACA when President Obama signed it into law in 2010.

A single-payer system would relieve "employers of the burden of providing health care, which makes no sense to begin with," Garb said. He suggested that a single-payer system be phased in by basically lowering the age for a program like Medicare to 55, then 45 and 35 and so on until everyone was covered.

But people opposed to single-payer say turning health care coverage over to the government is not the answer.

Single-payer would be a government monopoly, heavy on bureaucracy and low on creativity, said Douglas D. MacDonald, president of Murray & MacDonald Insurance Services in Bourne.

"Single-payer is going to lack innovation," said MacDonald, who pointed to Uber and Google as paradigm-shifting services that came out of the private sector, not government.

In an opinion piece for the Cape Cod Times, MacDonald said the United States needs a new type of Manhattan Project or lunar landing mission -- both government-funded programs -- focusing on health care for all while driving costs down.

MacDonald said the government can help with research and development but he fears a government-run health care system would be as antiquated as he considers the Federal Aviation Administration and the Transportation Security Administration.

"You're going to be stuck in a bureaucratic sinkhole," MacDonald said.

But he said something has to be done to control costs, saying his company has had to increase family deductibles from $1,000 to $6,000 over the past seven years.

A family premium is now $21,600 per year -- 60 percent paid by the business -- compared to $9,210 in 2010, MacDonald said.

O'Malley acknowledges that Obamacare was not the answer.

"It sustained the private insurance model," he said.

The model should be Medicare for all, since Medicare manages to deliver care with an administrative overhead of only 2 to 3 percent, O'Malley said.

-- Follow Cynthia McCormick on Twitter: @Cmccormickcct.

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