It's been five years since the Massachusetts Senate last waded into the issue of single-payer health care, and debate beginning Wednesday could bring the topic back to the floor.
A Sen. Julian Cyr amendment to the 100-page health care reform bill up for discussion Wednesday and Thursday would charge the state with measuring its annual health care spending against the projected costs of a single-payer system that "offers continuous, comprehensive, affordable coverage for all Massachusetts residents regardless of income, assets, health status, or availability of other health coverage." If single-payer proved to be less expensive, officials would have to develop a plan to put that model into place.
A similar single-payer benchmark plan was defeated in May 2012 as part of debate on health care cost control legislation. The full Senate has not debated single-payer since then, though bills to move the state in that direction have been filed each session and the idea has gained currency in Washington.
Single-payer opponents have argued that patients may lose choices under such a system, driving up costs, while supporters say the current system involving both public and private insurance is failing to adequately cover all people while also overburdening the budgets of governments, businesses and families.
The national conversation around single-payer has shifted since 2012, driven in part by the prominence U.S. Sen. Bernie Sanders of Vermont brought to the issue in his presidential bid last year.
Both U.S. senators from Massachusetts, Elizabeth Warren and Ed Markey, have signed on to Sanders' bill to create a national single-payer system. Setti Warren and Jay Gonzalez, Democrats running for governor, have called for single-payer at the state level.
The amendment from Cyr, a first-term senator from Truro, could put members of the Senate on record in their support or opposition for single-payer, though not all amendments receive recorded votes and some are withdrawn or redrafted before reaching the floor.
Sen. Jamie Eldridge of Acton offered the 2012 single-payer benchmark amendment, which failed 15-22. Issues raised in that debate could resurface this week.
"The way we control health care costs is through looking at more of a regulatory structure, by saying that government has a role to play in the delivery of health care and how hospitals and doctors and nurses are paid for that," Eldridge said at the time. "Health care is financially ruinous for many household, business and government budgets. The number one reason that families fall into bankruptcy in the United States and in Massachusetts is medical bankruptcy."
Former Sen. Richard Moore, who was then co-chair of the Health Care Financing Committee, was among those who argued against the idea, warning of "an endless spiral of increasing costs" in a single-payer system. "It sounds great on paper but it isn't realistic," he said.
The then-chairman of the Senate Ways and Means Committee, Stephen Brewer, also argued against the idea, warning that it could jeopardize an industry vital to employment in Massachusetts, and cast aside years of work aimed at reforming the private model.
Sen. Sonia Chang-Diaz called it "foolish and stubborn" to opt against even studying single-payer. "Even though I think the evidence is that single-payer is our best bet, this amendment does not presuppose that's right," the Jamaica Plain Democrat said.
Several senators who voted in favor of the amendment remain in the chamber today: Eldridge, Chang-Diaz and Sens. William Brownsberger, Cynthia Creem, Sal DiDomenico, Patricia Jehlen, Thomas McGee, Mark Montigny and Stanley Rosenberg, now the Senate president.
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“This is a once-in-a-lifetime opportunity for Massachusetts to take a quantum leap or two on some of the things that voters have been telling Beacon Hill for a long time that they want to see us do,” Chang-Díaz said.