West

The Argument

Should the state adopt a single-payer health care system?

Yes

John May of Franklin, a member of Progressive Massachusetts

Did you know that we have lower-cost easily accessible single-payer health care here in Massachusetts? It’s true! It’s called Medicare. Why not expand what we already have in place?

I am 60 years old and wonder: “If Medicare is good for me in five years, why is it not good for me now?”

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Single payer is cost-efficient and yields better results. A doctor’s office dealing with a single payer is more efficient than one dealing with complexities of numerous insurers, each with varied rules and payment procedures. When medical professionals spend more time with medicine and less with paperwork, we all benefit. As evidence, a 2014 study by the Commonwealth Fund found that despite having the most expensive health care system, the United States ranks last overall among 11 industrialized countries on measures of health system quality, efficiency, access to care, equity, and healthy lives.

Of all the developed nations of the world with single payer, not one has a large number of its citizens rallying to reject it, not one.

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Single payer offers freedom. Opponents of single payer say we will not be able to choose our own doctors; government bureaucrats will dictate what doctor we can see. The irony is that with our current system, the limited number of doctors we are allowed to choose from is handpicked by an insurance company that, for most of us, was chosen by our employer. Every year our employer can switch policies, and that may mean we need to change doctors again. Under single payer, we will be free from our employers dictating what insurance will be purchased with our money and what doctors we can and cannot see. Further, if we decide to change employers, we will no longer be burdened with the fear of losing our health insurance or having to pay extra for a bridge policy until our new employer decides to cover us. This freedom could also unleash a wave of entrepreneurial spirit that will improve the economy.

Lower costs, better results, worldwide success, freedom, a boost to the economy — yes, we should have single-payer health insurance in Massachusetts.

No

David G. Tuerck of Franklin, is executive director of the Beacon Hill Institute and Professor of Economics at Suffolk University.

The continued unpopularity of Obamacare has led to renewed interest in the idea of a single-payer health care system, under which government would both finance and dispense health care and do so without charge and without regard to ability to pay. Advocates claim that, by eliminating the health insurance companies, single payer would lower health care costs.

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However, no one believes that we could reduce the cost of car repair by eliminating the automobile insurance companies. That’s because those companies keep down costs by requiring deductibles and by adjusting rates according to the risks of providing insurance.

Health insurance companies, when not burdened by mandates and rules that compel them to subsidize high-risk policy holders, perform the same function. They keep costs low in the same way automobile insurance companies do. Actual health insurance has, to be sure, morphed into something very costly. In effect, what we call insurance has become prepaid health care. To require health insurance companies to pay for birth control pills is akin to requiring car insurance companies to pay for oil changes and tire rotation.

Proponents of single payer promise unlimited health care for all. But that promise is impossible to keep. The provision of any economic good requires some method of rationing the limited supply of that good between competing users. Where there is a free market in health insurance, the price system performs that role. Under single payer, and increasingly under the status quo, the rationing system is bureaucratic panels that decide who gets health care and who doesn’t. And single payer shifts the responsibility for paying for health care from the patient to taxpayers, eliminating much of the incentive to take preventive measures that keep costs down. The burgeoning cost of single-payer health care to taxpayers in Vermont caused that state to abandon the idea.

Society does and should have an interest in providing health care for people too poor to pay for coverage of chronic pre-existing conditions. But that can be accomplished through a government-subsidized, means-tested risk pool. It is not necessary to create many losers through higher taxes in order to make health care affordable to the needy.

As told to Globe Correspondent John Laidler. He can be reached at laidler@globe.com
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