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Baker, Gonzalez diverge on visions for health care

Governor Charlie Baker (left) and challenger Jay Gonzalez.Jim Davis/Globe Staff

Jay Gonzalez used to run a health insurance company. Now he wants to put health insurance companies out of business.

The Democrat running for Massachusetts governor in Tuesday’s election is promoting an idea championed by liberals but unproved anywhere in the country: If elected, Gonzalez plans to completely overhaul the state’s health care system and move to a government-run single-payer program. Everyone would have the same coverage and the same access to care — and costs, he insists, would be lower.

Gonzalez and Governor Charlie Baker have similar backgrounds — Baker, too, used to run a health insurer, and both are former state budget chiefs — but their approaches to health care diverge sharply.


Unlike his opponent, Baker has not laid out a grand vision for the state’s health system. His approach has been more measured, targeted, for example, on attacking the opioid crisis and tamping down spending in the state Medicaid program.

The candidates are also on opposite sides of this year’s most controversial health care issue, a ballot question to limit the numbers of patients assigned to hospital nurses. Baker plans to vote “no,” while Gonzalez supports the proposal, backed by a nurses union.

Massachusetts has the highest rate of health coverage in the nation, but medical costs remain a challenge for patients, employers, and the state budget.

“I really believe going to a single-payer health care system will reduce the cost overall,” Gonzalez said in an interview. “It’ll cut out a lot of the administrative waste and inefficiency. . . and it will radically simplify the system for people.”

He laid out an ambitious timeline. If elected, he said, he would assemble a working group or commission to develop a plan, within about a year, for moving Massachusetts to a single-payer system. He would hope to implement that plan by the end of his first term.


Gonzalez shared few specifics about his vision. How much would it cost? How would the system be funded? How would consumers pay into the program — and how much would they pay?

“Those are the details we would need to work out,” said Gonzalez, the former chief executive of CeltiCare Health Plan, which no longer operates in Massachusetts.

And what about the thousands of residents who work for private health insurers, whose jobs would disappear under his plan? Gonzalez said his administration would help transition them to other jobs.

“There definitely would be some disruption . . . but that’s not a reason not to do it,” he said.

Vermont made a serious attempt at moving from a private-insurance-based health system to a government-run one. But Vermont officials abandoned their plan in 2014 after projecting that it would nearly double the size of the state budget and require large tax increases.

“It always most significantly falls apart on the finances,” said John E. McDonough, a professor at the Harvard T. H. Chan School of Public Health. “While the [single-payer] issue is very popular among the Democratic base . . . no one has figured out in the US how to translate this to a general election audience.”

Baker, a former chief executive of Harvard Pilgrim Health Care, has shrugged off his opponent’s single-payer plan as costly and unnecessary, noting that Vermont couldn’t make the switch even though it’s “not that big and not that complicated” compared to Massachusetts.


Baker’s campaign officials did not make him available for an interview to discuss his health care plans. In a televised debate Thursday, the governor laughed when Gonzalez claimed that a single-payer system would save money.

Baker said in October that one of his top health care priorities in a second term would be to rein in the soaring costs of prescription drugs in the state Medicaid program, which covers low-income residents.

“It’s pretty clear that . . . the rising cost of health care in Massachusetts is driven by pharmaceuticals, especially by specialty pharmaceuticals,” he said in response to a question from the Globe.

Baker’s earlier plan to slash prescription drug costs in the Medicaid program, known as MassHealth, was rejected by federal officials this year. Another idea to save money in MassHealth, by shifting thousands of people out of the program, rankled advocates for the poor, and it was eventually nixed by federal officials and the state Legislature.

But the Baker administration has managed to better control costs in the MassHealth program — where spending actually dipped 0.2 percent last year — in part by removing people from the rolls when they were no longer eligible for benefits.

In 2016, administration officials also secured five years of federal funding for MassHealth, allowing them to launch the biggest restructuring of the program in decades. The redesign includes new accountable care organizations, or networks of doctors and hospitals, that work together to manage patients’ care.


When President Trump and Republicans in Congress tried to repeal the federal Affordable Care Act last year, Baker broke with his party and defended the law, including in front of senators in Washington.

Baker has called for greater transparency in health care costs in Massachusetts, and in May, state officials launched a long-delayed website with cost and other health care information for consumers.

His administration also smoothed the enrollment process for residents who buy medical coverage through the Massachusetts Health Connector, after the agency’s website broke down in 2013 and 2014, causing chaos for thousands.

Baker leads Gonzalez by about 40 points in the latest polls, and his supporters include many Democrats. But if Gonzalez were to pull off an upset and follow through on his single-payer plan, he would face the massive challenge of persuading health care executives, elected officials, and residents to back the move.

(In 2014, gubernatorial candidate Dr. Donald Berwick also campaigned for single-payer health care; he lost the Democratic primary to Martha Coakley.)

Gonzalez, as a former insurance executive, sat on the board of the Massachusetts Association of Health Plans, an insurance industry lobbying group. Even then, he said, he felt that insurance companies didn’t have much value to offer consumers, but he didn’t share his doubts with his fellow board members at the time.

“Most of what our company did was facilitate a bunch of useless transactions,” such as processing medical claims, Gonzalez said.

Health insurers, unsurprisingly, oppose the concept of a government-controlled health system.

“We have made substantial advances in this state in covering our residents. . . . Our next challenge is really to control costs,” said Lora M. Pellegrini, chief executive of the insurers association. “I think the whole conversation around single-payer is really a distraction.”


Contact McCluskey at priyanka.mccluskey@globe. com.