Many Democrats in the Massachusetts Legislature think so.
They want everyone to have it, regardless of citizenship status.
Bills filed in both the Massachusetts Senate (SD.546) and House of Representatives (SD.2656) in this legislative session aim to establish Medicare-for-all in Massachusetts. If enacted, the legislation would make Massachusetts the first state in the country to achieve universal health care.
The primary sponsors of the bill are state Senator Jamie Eldridge (D-Acton) in the Senate; and state Representative Denise Garlick (D-Needham) and state Representative Lindsay Sabadosa (D-Northampton). The name of the single-payer in this scheme would be the Massachusetts Health Care Trust.
That’s the desired goal for supporters, who argue that a single-payer health care system is the most efficient system and that it is the only way to ensure that everyone has access to high-quality coverage. Supporters of single-payer health care oftentimes say that they believe that health care is a human right.
Eldridge spoke to NewBostonPost by telephone earlier this week about his support for the bill.
“I think it’s one of the most important bills we can pass this session from the perspective of helping working-class people to improve health care outcomes and reducing health care spending,” he added.
How does he think it will save money?
“When you think about the health care spending that happens today, think about all of the wasted money through paperwork between doctors and health insurance companies, the administrative cost at health insurance companies including the salaries of a lot of executives, and say a constituent of mine loses their job, loses their health insurance, and contacts my office to get onto MassHealth, there’s a lot of costs to that,” Eldridge said. “Under a single-payer system, people would have health care as a right. It wouldn’t be tied to employment. You wouldn’t have private companies burning their money on health care and have the bureaucracy of state health care.”
He said that he would prefer a federal solution, but thinks that passing Medicare for all at the state level is more feasible now since President Joe Biden isn’t a supporter of it on a nationwide basis.
Opponents of universal health care argue that such a proposal would raise taxes substantially, kill jobs, take private health coverage away from people who like their coverage, and result in inferior quality of care.
Some also are concerned about the breadth and types of coverage.
Pro-lifers and immigration restrictionists, for instance, also have reasons to oppose the bill — even if they might otherwise support a robust single-payer system.
The proposal would cover in-staters and out-of-staters who work in Massachusetts and otherwise qualify for it. The bill says that it would cover “all Massachusetts residents, regardless of citizenship status, including incarcerated persons.” Plus, it says that it would cover all non-residents who “work 20 hours or more per week in Massachusetts; pay all applicable Massachusetts personal income and payroll taxes; and pay any additional premiums established by the Trust to cover non-residents.”
Paul Craney, spokesman for the Massachusetts Fiscal Alliance, said that giving free health care to illegal immigrants is a bad idea.
“It’s complete fantasy,” Craney told NeeBostonPost via email. “While it’s important to help those in need, and the state does an exceptional job at that, Senator Eldridge wants to write a blank check to the world. His idea is a bit looney and should never be considered.”
Eldridge said he doesn’t think the plan would result in an influx of illegal immigrants to the state. He also defended the decision to include them in his proposal.
“For undocumented immigrants, they’re paying taxes,” Eldridge said. “There’s a payroll tax. Just like anyone, undocumented workers pay taxes. I just think it’s really important to emphasize why immigrants come to this country. At the end of the day, the undocumented immigrants that I represent are a person working extremely hard and taking jobs where there’s no one else really stepping up. I think that’s why they’re coming to Massachusetts and universal health care wouldn’t really make a difference.”
Patricia Stewart, executive director of Massachusetts for Life, takes issue with the bill’s proposal to fund abortions in the state.
“Massachusetts taxpayers already pay for abortions covered by MassHealth,” Stewart told NewBostonPost in an email message. “SD.546 will expand exponentially the obligation of taxpayers who oppose abortion on moral or religious grounds to fund a practice they deem abhorrent. To remedy this inequity, Mass. Citizens for Life introduced HD.4023 to permit taxpayers to redirect the amount of their tax dollars allocated for abortion to, instead, support the life-saving Baby Safe Haven program.”
In contrast, Eldridge supports legal abortion. He voted for the ROE Act abortion expansion bill in December 2020 and said “abortion is healthcare” in a statement last year when expressing his support for the bill.
So how do supporters of the plan want to pay for Medicare for all?
Mostly, through a progressive payroll tax.
The proposed funding mechanism is a 7.5 percent employer-side payroll tax and a 2.5 percent employee-side payroll tax. The first $20,000 of an employee’s income would be exempt on both sides. However, businesses that employ more than 100 people would have to pay an additional 0.5 percent payroll tax on the employer side.
Self-employed individuals would pay a 10 percent payroll tax — with the first $20,000 of their income exempt. Additionally, the bill would create a 10 percent tax on “unearned income” above $20,000 annually. Examples include inheritance and passive investments that earn dividends.
The health care proposal would come in addition to existing taxes on various sorts of income that support government services such as Social Security, unemployment benefits, Supplemental Security Income, and Social Security Disability Insurance taxable.
The plan would cover more health care needs than Medicare does and would have no copayments, deductibles, or other forms of patient cost-sharing, the bill states.
The bill doesn’t specify all the types of health care service the plan would cover. Instead, it says, the plan would cover everything deemed medically necessary or appropriate by the Trust.
However, plan includes a lengthy — albeit partial — list of covered benefits:
(1) prevention, diagnosis and treatment of illness and injury, including laboratory, diagnostic imaging, inpatient, ambulatory and emergency medical care, blood and blood products, dialysis, mental health services, palliative care, dental care, acupuncture, physical therapy, chiropractic and podiatric services;
(2) promotion and maintenance of individual health through appropriate screening, counseling and health education;
(3) the rehabilitation of sick and disabled persons, including physical, psychological, and other specialized therapies;
(4) mental health services, including supportive residences, occupational therapy, and ongoing outpatient services;
(5) behavioral health services, including supportive residences, occupational therapy, and ongoing outpatient services;
(6) substance misuse services, including supportive residences and ongoing outpatient service;
(7) prenatal, perinatal and maternity care, family planning, fertility and reproductive health care, including abortion;
(8) long-term services and supports including home health care and personal support care;
(9) long term care in institutional and community-based settings;
(10) hospice care;
(11) language interpretation and such other medical or remedial services as the Trust shall determine;
(12) emergency and other medically necessary transportation;
(13) the full scale of dental services, other than cosmetic dentistry;
(14) basic vision care and correction, including glasses, other than laser vision correction for cosmetic purposes;
(15) hearing evaluation and treatment including hearing aids;
(16) prescription drugs;
(17) durable and non-durable medical equipment, supplies, and appliances, including complex rehabilitation technology products and services as medically necessary, individually-configured manual and power wheelchair systems, adaptive seating systems, alternative positioning systems, and other mobility devices that require evaluation, fitting, configuration, adjustment or programming; and
(18) all new emerging technologies irrespective of where the parent company is located, such as telemedicine and telehealth practitioners.
The United States is one of the few highly developed countries that does not have universal health care. However, forms of universal health care vary from country to country. In places like Singapore, the government largely provides funding for catastrophic coverage. In countries like Switzerland and Netherlands, there are subsidies and individual mandates for private insurance. Meanwhile, countries like Canada and the United Kingdom have single-payer systems.
So what is it about Medicare-for-all that proponents like better than all of the existing universal health care systems throughout the world?
“What’s important to emphasize here is that it’s a form of single-payer,” Eldridge said. “There’s a lot of ways to do it, but we’re paying through taxes to make health care a right rather than doing it through our employers. Medicare-for-all, what I think makes it so attractive in Massachusetts is that we pride ourselves on providing excellent health care, but if you’re less well off you’re not going to get as good of health care. I think that’s contrary to Massachusetts values and Medicare-for-all would provide excellent health care to all.”
This is the fifth time Eldridge has filed a version of this bill. The first one came in 2013 (S.515). Not one of the bills haa ever come up for a vote on the floor or received a vote out of committee.
So does Eldridge think it could pass this time around? He said it’s making progress.
“I think it’s become an even more popular issue,” he said. “It’s always a challenge to pass this bill into law, but we’re seeing more and more Americans think health care should be a right, so support is growing.”
“I think the pandemic has not only shown how stark the health care disparities are for working-class people, people of color, but also what an incredibly inefficient system it is,” he added. “I’m trying to help cities and towns set up regional vaccination clinics, and the first question is how they process everyone’s health insurance. If we had a single-payer system, that wouldn’t be a question. The state could provide the vaccine for free and there wouldn’t be these two, three, four-week delays for setups. We’re talking about saving lives.”
The offices for the other sponsors of the bill, Garlick and Sabadosa, could not be reached for comment on Monday or Tuesday this week.
Courtesy of Flickr 
