When Senator Elizabeth Warren released her detailed Medicare for All plan this month, a coalition of insurers, hospitals, and pharmaceutical companies denounced it as an unaffordable government takeover that would force Americans to pay more and wait longer for medical care.
But Dr. Eric W. Dickson thought it was the best health care plan he had seen all year.
Dickson, who runs UMass Memorial Health Care, a large Central Massachusetts hospital system, said a national single-payer program could remedy many of the problems in American health care, including the lack of affordable coverage for millions of people, the wide variation in hospital prices, and the administrative burden that is exhausting physicians.
“Medicare for All could definitely address those three things,” said Dickson, whose affinity for single-payer care scored him a Twitter shout-out from Warren. “We have to look at this as an option.”
Dickson’s position on the issue — one central to the 2020 Democratic presidential race — may seem blasphemous for a hospital chief. But he and several other hospital executives and physicians see the debate differently than the lobbying groups to which they pay dues, reflecting a stark divide in the industry.
Wealthier hospitals that rely heavily on private insurance payments would have more to lose under a system in which the government is the only payer for health care.
But the impact of a single-payer program could be very different for hospitals — including those overseen by Dickson — that have especially high shares of patients on public programs such as Medicare, which is currently for seniors, and Medicaid, which covers low-income individuals. Medicaid generally pays hospitals even less than Medicare does.
Kim Hollon, chief executive of Signature Healthcare, the parent company of Brockton Hospital, said a national health care program could ease the administrative workload of the current system, which includes numerous private insurance plans that each have their own rules and requirements for providers.
A single-payer system also could help level the vastly different prices that competing hospitals charge for the same services, Hollon said.
Warren’s Medicare for All plan would pay hospitals 110 percent of current Medicare reimbursements — a manageable number for Brockton Hospital.
“We’d be fine,” Hollon said. “I’d love to have an equal playing field where we just compete for doing a good job effectively and efficiently.”
Similarly, Kate Walsh, chief executive of Boston Medical Center, said the reimbursement rates in Warren’s proposal would be “wonderful” for her safety-net hospital, which treats a large share of low-income patients on Medicaid.
Walsh hasn’t endorsed any specific health care plan, but she noted the Democratic presidential debates have often focused on Medicare for All proposals.
“As health care executives, we have to listen to that,” she said. “We have to find a way to support the kind of change that needs to occur.”
Tufts Medical Center’s chief executive, Dr. Michael Apkon, spent several years running a hospital in Canada’s national health system and has called the quality of care in Canada “every bit as good as what I’ve experienced here.”
Apkon said he supports a public option — a government-run plan that would compete with private insurance plans — to help make health care more affordable and accessible for Americans.
That’s a different position from industry lobbying groups, which oppose a public option that could disrupt the insurance market.
“If we desire a single-payer system, I think the path to that is a public option that would allow government to set a minimum set of benefits,” Apkon recently told reporters.
While plans to dramatically restructure the health care system are unlikely to win approval from Congress anytime soon, trade groups that represent hospitals, insurers, and pharmaceutical companies are taking them seriously.
Insurance companies worry about being replaced by a government-run health system, and hospitals and drug makers are concerned a Medicare for All program wouldn’t pay them enough for their services and products.
Steve Walsh, president of the Massachusetts Health & Hospital Association, said Medicare doesn’t pay hospitals enough to cover the full costs of providing care. Hospitals would struggle if they had to survive on Medicare payments alone, without the higher reimbursements they now receive from private insurers, Walsh said.
“You’ll completely deplete any margin, any reserve they have,” he said. “They’ll be unable to invest in infrastructure, in technology, in access in their communities — and quality to patients will suffer.”
For many months, a national group called Partnership for America’s Health Care Future has been slamming single-payer and public option proposals in e-mail blasts, on social media, and in television ads.
The group was founded in 2018 by the American Hospital Association, America’s Health Insurance Plans, Pharmaceutical Research and Manufacturers of America, and the American Medical Association. It now includes scores of additional health care and business organizations.
“Most health care leaders don’t think we have the perfect health care system,” said Lauren Crawford Shaver, the partnership’s executive director. “But they don’t think we should throw it away and start all over.”
Shaver declined to discuss how much the group is spending on its campaign, which includes lobbying and public relations.
The American Medical Association withdrew from the partnership in August, saying in a statement that it remained opposed to Medicare for All proposals but left the partnership so it could spend more time pushing for “practical solutions.”
But an affiliated group of Massachusetts physicians takes a different view. Dr. Maryanne C. Bombaugh, president of the 25,000-member Massachusetts Medical Society, said single-payer should be among the options considered for achieving universal health coverage.
“We’re very open to anything that would improve the health of our patients,” Bombaugh said.
Insurance companies would be severely diminished under Medicare for All proposals such as Warren’s, and insurers appear to be more unified in their opposition to these plans.
But Andrew Dreyfus, chief executive of Blue Cross Blue Shield of Massachusetts, said: “It’s a grave mistake for the health care industry to criticize Medicare for All proposals. Instead, we should offer our own views on how to improve the American health care system.”
Some health care executives are reluctant to share a position on Medicare for All, or they say they’re still evaluating it.
“Rather than choosing a single-payer option, rather than choosing any one specific path now, I think we need to be very thoughtful and explore all the options,” said Dr. Anne Klibanski, chief executive of Partners HealthCare, Massachusetts’ largest hospital network.
Health care executives who support Medicare for All said it can be difficult to speak publicly.
“There’s a strong desire for all of us to hold the party line,” said Dickson, who has run
UMass Memorial since 2013 and still works occasional shifts in the emergency department.
“I’m for examining it,” he said. “This could be better for the people we serve, and therefore, I feel I have an obligation to speak out.”