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Peter Canellos

Don Berwick and the single-payer pitch

Don Berwick. John Tlumacki/Globe staff/Globe Staff

The rumpled blazer. The no-nonsense manner. The air of professorial pique. Squint your eyes a bit and Don Berwick, whose relatively strong performance at the state Democratic convention counted as the surprise of the week, looks a lot like Senator Bernie Sanders, the venerable Vermont socialist.

Like Sanders, who is so determined to go his own way that he remains an independent — though Democrats have long embraced him — Berwick thrives on counterprogramming. He eschewed the introductory video, spared the audience his family story, and barely cracked a smile. Nothing to distract from his air of high purpose.

But while Sanders came out of Vermont’s ’60s-era socialist movement and started his career in local politics, Berwick is a doctor and former Medicare administrator who comes armed with one major issue: single-payer health care. When his rivals claimed he wasn’t really offering anything new — just another health care commission — Berwick doubled down by calling it “Medicare for all,” a description that pretty much suggests he’d eliminate private insurance.


Now, with the Democratic race down to three candidates — Berwick, and two party regulars with histories of failing to excite voters — single-payer will finally get the attention it merits as essentially the only markedly different policy proposal to emerge from either party. A bold move to show the Obama administration what real reform looks like? A takeover that will roil the system? A vehicle for finally bringing about equality in health care? A threat to Massachusetts’ world-class doctors and hospitals? Single-payer could be all those and more. And if Massachusetts were to broadly restructure its health system, yet again, reverberations would be felt across the nation. With apologies to Governor Peter Shumlin, who is planning a single-payer conversion in Vermont, Massachusetts isn’t Vermont.

But precisely because Massachusetts is different — larger, more diverse, more entrenched in the current health care infrastructure — implementing single-payer here would bring complications unseen in Vermont. That’s a message that Attorney General Martha Coakley and Treasurer Steve Grossman probably hope to drive home to Berwick. And one that Berwick, as spiritual heir to Sanders, will work tirelessly to rebut.

Peter Canellos can be reached at canellos@globe.com.