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Last night Democratic governor candidate Don Berwick held a “Medicare For All” town meeting at Bakst Auditorium in Boston University Medical School. The site was appropriate, and as a pediatrician, Dr. Berwick is the right candidate to discuss “Single Payer.” Unfortunately, in almost two hours of explanation and question answering, Berwick didn’t tell us how to get there, nor did he say much about what “Medicare for all'” would look like as a program specific to Massachusetts.

Berwick did make clear that he wants single payer; that ‘all means all,’ and that that would be a priority were he to be elected governor. He said that Massachusetts’s current universal health care — which he congratulated our state for being first in, without mentioning that it was done by a Republican governor — is too costly, too confusing, too opaque; that we spend ten times as much on administration as we should; that with a single payer system, 90 % of that administrative cost could be devoted to actual health care; that the coding and bill processing burden takes up far too much of health care professionals’ time; and that it’s almost impossible for users to figure out the rules for what is or is not covered.

All true. Yet Berwick said not one word about the collapse, at great expense, of our state’s health care connector to Obamacare — at Forums he decries it; why wasn’t it on his speech list last night ? He said nothing about seeking a waiver from the AC. Indeed, after rapidly listing “technical issues and (Federal) pre-emption,” he said nothing about how the state would overcome these : only that “we can do it and should do it.”

He was much applauded. Clearly his supporters do want single payer. So do many of us. We all know what Medicare is and many of us know how cost effective a system it is. But Medicare is a Federal operation. Berwick seeks a single payer system that would operate only in Massachusetts. Last night he said that it would work better on a state level: but as i have already noted, he said nothing at all about how it would work, who would administer it, how it would be paid for. He of course said nothing about how we would go about replacing the universal health care system that we put in place only eight years ago.

There is, in Vermont, another move to establish single payer in one state only: but Berwick didn’t mention Vermont, and from what I gather, the Vermont proposal has yet to be worked out.

It would be nice to know how the single payer state system would be paid for and by whom administered. I suspect, unhappily, that administration of it would be mishandled — as is much of Massachusetts social service — by an overburdened management, despite Berwick’s insistence last night that he “will never compromise on management excellence.”

If he has answers to these questions, he needs to start giving them soon. Otherwise it will be hard to give serious attention to an issue that only he, among all 6 serious governor candidates, has raised and which I do not hear high on most voters’ list of priorities.

That said, there’s no denying Berwick’s commitment to cost-effective, simple to understand health care for all. And to “medicare for all” being a social justice issue too. Over and over he emphasized that health care should be a human right. Who could not be moved — I sure was — by the story he told, at the event’s end, of a 15-year old African-American whom he helped cure of leukemia, a disease almost always fatal at that late age ? “we threw the book at his leukemia and we cured it,” Berwick said. “But what happened to that young man ? He ended up later on dying on the streets.

“He had two fatal diseases, leukemia and injustice. The one, we cured. the other we could not.”

—- Mike Freedberg / Here and Sphere


NOTE : this article was UPDATED at 2.45 pm on 04/17/14


  1. How to get there ought to be obvious. Remove the minimum age requirement of 65. The paperwork, the providers and networks, the medical necessity criteria for treatments, it’s all in place already! Elite specialist doctors will dislike it, because Medicare has fee-for-service caps, but Primary Care Providers, Urgent Cares and Emergency Departments of hospitals will all do better than now. It would greatly simplify billing for every doctor, so that ancillary industry of having collection specialists and biller/coder specialists will be reduced. Some of their jobs will be lost, but those people cost as much as the actual care providers, and they are only needed because our systems are so complex.

    (I’m a medical imaging technologist now, but I began as an administrative medical assistant and biller/coder.)


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