Single Payer Reform: The Right Choice for Massachusetts

The patient sat quietly on his hospital bed, his dark skin contrasting with the sterile white sheets beneath him. Motionless, he slowly relayed how his leukemia had returned over the past few years, words trailing from his mouth like the continuous IV drip attached to his right arm.

Even with one year of medical training, we knew that his outcome was abnormal. Although the treatment for his leukemia was simple and highly effective—most patients experience a complete remission of cancer with a daily tyrosine kinase inhibitor –this patient faced another battle.

"I stopped taking my medications three years ago," he clarifies quietly, his eyes suddenly avoiding ours. "I couldn’t afford them."

Stories like these are not uncommon. In Massachusetts, twenty-four percent of residents report avoiding treatment due to cost. This leads to worse and even more expensive health outcomes, as patients are forced to choose between healthcare and daily necessities. Unfortunately, more than half of all bankruptcies in Massachusetts result from insurmountable medical expenses.

Medical students and physicians want to treat patients based on medical need, not socioeconomic status. However, corporate interests treat healthcare like a commodity, and the market forces exclude those who are unable to pay.

This is why many of us advocate for a single-payer system-- improved Medicare for all--that would cover every Massachusetts resident for medically necessary services. Under a single-payer system, our patient would have received lifesaving leukemia medications with no out-of-pocket costs.

The most important reason to support single-payer reform is because it is the right choice for our patients. However, implementing a single-payer system is also a fiscally responsible decision that would save Massachusetts up to $9.9 billion on administrative expenses. Every year, our state’s healthcare spending rises, while funding for other social programs is consistently slashed. In 2013, healthcare consumed an overwhelming forty-three percent of the state budget. In order to continue investing in social programs, we must restructure our healthcare system and eliminate underlying inefficiencies.

By streamlining healthcare financing into a single public agency like Medicare, we could reduce the administrative waste of multiple for-profit insurers, pool risk across the entire population, and negotiate down the prices of expensive prescription drugs and medical services.

Doctors would still function independently, but instead of billing and seeking approvals from hundreds of different insurers, they would send all bills to one payer. Under single-payer, the burden of billing and paperwork would be dramatically reduced. Doctors would have more time to spend with patients. Patients would also have more freedom to choose their providers, as private insurers would no longer restrict patient autonomy with narrow provider networks.

Right now, Massachusetts is in a unique position to lead on single-payer reform. In 2006, we enacted the reforms that later inspired the Affordable Care Act, resulting in the lowest rate of uninsured individuals in the country. Although we have historically led on healthcare, we currently have the highest healthcare expenditures per capita and the highest premiums in the country. We already know that these reforms are not sustainable. What we need is a leader committed to making healthcare simpler, accessible, and truly universal.

Only one gubernatorial candidate has both the expertise and political will to implement Medicare-for-all in Massachusetts: Don Berwick.

As a Harvard-trained pediatrician, founder of the Institute for Healthcare Improvement, and the former chief administrator of the Centers for Medicare and Medicaid Services, Don Berwick understands the intricacies of healthcare reform and is dedicated to bringing Medicare-for-all to the Commonwealth.

"The very idea of having Dr. Don Berwick as governor of our great state gives me hope, as a doctor and as a citizen, for a future in which the notion of the commonwealth – of shared dreams and shared plans to achieve both – comes to replace the fractured and contradictory claims of contemporary politics," says Paul Farmer, a professor at Harvard Medical School and a founder of Partners in Health.

Many other doctors and medical students, including us, are working to ensure that Don Berwick becomes our next governor. Our efforts contributed toward his success at the Massachusetts Democratic Convention, where Berwick electrified the crowd of progressives and won a place on the election ballot for the Democratic primary.

We are deeply inspired by Berwick’s declaration: “Healthcare is a human right, period.” We believe that the private insurance industry’s relentless demand for profits at the expense of patients undermines the ethical standards of the medical profession. We consider health inequality to be a cancer upon society, a disease that affects us all regardless of class, race, gender, or political affiliation.

Let us continue our legacy of leadership in healthcare and social justice in Massachusetts. On September 9, when Democrats go to the polls to select their nominees for the November elections, join us in supporting candidates who place patients above profits. Together, we can lead the nation toward a truly just, single-payer healthcare system and treat the underlying disease of social inequality.

Danielle K. Bäck is a second-year student at Harvard Medical School. Jawad Husain is a second-year student at Boston University School of Medicine.