BETWEEN THE LINES: Massachusetts May Offer First Universal Health Care System

Among the many referenda on state ballots this election year, Proposition 5 in Massachusetts is perhaps one of the most closely watched, particularly by those in the health care industry. If approved by voters on Nov. 7, Question 5 would mandate universal health care for all of the state's citizens by July, 2002. Many of those backing Question 5 support a single-payer system similar to that now operating in Canada; however, the ballot measure empowers the state to formulate the details of a universal care plan.

Question 5 also establishes a patient's bill of rights and limits HMOs from spending more than 10 percent on advertising and executive salaries. Although recent polls indicate that the health care ballot initiative has broad public support, the managed care and insurance industry is spending some $4 million to defeat the measure.

Between The Lines' Scott Harris spoke with Dr. Alan Meyers, a Boston pediatrician and member of the Ad Hoc Committee to Defend Health Care, who explains why he supports Question 5. He speculates on the national impact of the measure if Massachusetts voters should approve it.

Dr. Alan Meyers: Question 5 has three basic parts to it. The first part is the most important and that is: "There shall be established a patient-centered system of health care that will insure comprehensive, high-quality health care and health coverage for all residents of the commonwealth to be in effect no later than July 1, 2002."

The second part is a moratorium on the conversion of not-for-profit hospitals, HMOs and health insurance companies to for-profit status. In other words, if this passes, a very large for-profit such as Columbia HCA could not come in and buy up a not-for-profit hospital in this state, at least until this universal system is in place.

The third part of this proposal is a patient's bill of rights -- that includes a number of measures some of which overlap past state legislation. With regards to the universal system which would be created under Question 5, it is not specified what that system would look like or how it would be paid for. What is specified is that there is a process that will consider all of the options and make a recommendation to the legislature.

People say, "How will you pay for this? How are you going pay for everyone to have health insurance?" According to the Census Bureau, there are over 600,000 uninsured people in Massachusetts. The state's figures are lower, but even if those numbers are true, we have 350,000 people. That's a lot of people. How are we going to buy all them health insurance?

Well, it would be a budget buster if we were going to buy it for them under the system as it exists now. If we were just going to say, "Let's find some money, let's go buy market rate policies to cover all these people," sure, it would cost billions of dollars.

In the United States, we spend twice what any other industrialized country spends to cover all of their residents. Every other industrialized nation in Europe, Japan -- they all cover every resident who lives there and they do it for half of the price of what we're spending in the United States. In Massachusetts, we spend even more. We spend three-fold what the average European country spends on health care.

Why is that? It's because our system is fragmented. It's a market-competition model, which is a terrible thing to do to health care for lots of reasons. It doesn't work to control costs. It doesn't work to take care of people in the fashion that we could. There is plenty of money in the system if just organized more equitably.

Between The Lines: Dr. Meyers, tell us about the forces that are opposed to Question 5, what they've been doing on television lately.

Dr. Alan Meyers: The opponents, the Vote No people, are businesses, especially big business -- health insurance companies, all the big health insurers and HMOs, and chambers of commerce. People who are in business are afraid that their narrow self-interests may be threatened if the status quo really does change, and that's what we're talking about doing. We're talking about changing the status quo of the financing and administration of health care.

They have said to the press that they have budgeted $4 million to do outreach, mostly for advertising. Three million of that $4 million is going to go directly into the broadcast media, mostly television and some radio. All of it focused in the last four to five weeks prior to election day, so we're right in that period now. In fact, the airwaves are full of those ads.

Between The Lines: Could you assess the national impact of the Question 5 referendum in Massachusetts. If it passes, what do you think will happen nationwide if you state is forced by its citizens to go into a universal health care program?

Dr. Alan Meyer: It's a great question. The reason that many of us have turned our attention to the state level is that on the national level, there is nothing on the horizon. If you look at the administration we're going to get, whether it's a Gore or Bush administration, it doesn't seem like either is going to push for any kind of comprehensive solution. Al Gore is talking about insuring all children in the country in the next five years. Well, I'm all for that, don't get me wrong; you have to do the little things as well as working for the big things. But Gore and Bush explicitly, say no, they don't believe there should be a solution coming from the center.

So we look at the state. We think that if one state could (implement a universal health care program) and it worked, then other states would be able to look, not to other countries, but to other states next door, and say, "Hey, look at how well that's working; we're going to do that too." This is a logjam that needs to be broken. That is how it happened in Canada, in one province in 1961. In Saskatchewan it worked so well that the other provinces chose to follow suit.

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