the argument

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

Yes: Ben Wright, director of Progressive Massachusetts, a political advocacy group focused on social justice and equality

Ben Wright
Ben Wright handout

Massachusetts should adopt a single-payer health care system to improve individual health outcomes, expand care to everyone, and reduce costs for both individuals and the government. In 2012, per capita health care spending was $8,233 in the United States, more than 2.5 times higher than in most developed nations. However, we have proportionately fewer physicians and hospital beds, and our life expectancy increases since 1960 are below those of other developed nations, according to a PBS news report. We have a huge spending problem, and single-payer is the simplest solution. With so many other priorities – including education, transportation and infrastructure - we should be implementing solutions that will reduce costs to society and improve care.


Despite Massachusetts’ nation-leading health care reform in 2006, 4 percent of Massachusetts residents remained without health care in 2013. This leads to unnecessary deaths and illnesses, and strains our emergency medical services when people neglect routine care. Beyond just those who don’t have any health insurance, the Commonwealth Fund estimates that more than half a million Massachusetts residents are under-insured, meaning they devote a large share of their income to cover costs like copayments and deductibles, preventing them from seeking care.

A single-payer system would guarantee that everyone in Massachusetts is covered. Employer-based health insurance is exceptionally inefficient. And even for low-income or unemployed individuals who could qualify for free or reduced cost care, the administrative barriers to enrolling in that care are prohibitive.

We spend too much on overhead, administration, and paper work. Studies commissioned by the Massachusetts Medical Society and the Legislature “found that the administrative savings under single payer would be enough to cover all of the uninsured, eliminate all co-pays and deductibles, and upgrade coverage for Medicare enrollees,” according to Physicians for a National Health Program. The group has compiled dozens of studies demonstrating that a single-payer system adopted federally would save billions of dollars every year for consumers and governments.


Right now, there are two bills that would move Massachusetts toward a single-payer system, with state Representatives Tackey Chan of Quincy and Paul McMurtry of Dedham among the co-sponsors. Their colleagues on Beacon Hill should adopt the legislation swiftly so we can save money for other priorities and improve the health of all of us.

No: Susan Williams Gifford, Republican state representative from Wareham

Susan Williams Gifford
Susan Williams Gifford handout

When Massachusetts passed its landmark Health Care Reform Act in 2006, the immediate short-term goal was to provide insurance to residents who lacked coverage. The more challenging problem, which remains, is how to hold down health care costs.

Over the past decade, the Legislature has continued to grapple with this question. But moving to a single-payer health care system is not the answer.

For starters, the price tag associated with transitioning to a single-payer model would be prohibitively expensive, as Vermont officials recently discovered.

In 2011, Vermont legislators voted to establish single-payer health care by 2017. But Vermont abandoned those plans when it was determined it would cost $2.6 billion in 2017 and would require an 11.5 percent state payroll tax on businesses. This would have been devastating for the economy and would probably have driven many employers – and jobs – out of the state.


Fifteen years ago, the Beacon Hill Institute warned that adopting a single-payer system in Massachusetts in 2002 would cost the Commonwealth $14.393 billion, along with 917,000 lost jobs, and would require increasing the income tax to 13.76 percent. If a similar study were conducted today, the costs would surely be even higher.

Those who advocate for a government-run health insurance system should be careful what they wish for: Government does not always deliver services as efficiently and cost-effectively as the private sector, as the ongoing problems at the Health Care Connector have proven.

To hold down costs, a single-payer system requires government-imposed price controls and scaled-back services. Consumers would have fewer choices under this “one size fits all” approach, and would not be able to shop around for an insurer that best fits their individual health care needs.

Under a single-payer system, health care providers would receive substantially lower payments, creating a disincentive for investing in new technology, stifling innovation, and potentially driving people away from the profession. Patients would find themselves waiting much longer for a doctor’s appointment, and would experience significant delays in receiving treatment.

There are many options worth pursuing to reduce the costs of health care, but switching to a single-payer system is not one of them.

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