Chasing health care’s ‘big white whale’

As Margot Sanger-Katz wrote in the New York Times on Monday, Democrats “giddy” from their recent health victory were ready to reach for the big prize — a single-payer health care system.

That happened Wednesday, when Vermont Sen. Bernie Sanders rolled out his “Medicare for all” legislation. The speed with which Democrats have gone from wary of single-payer to full embrace of the idea is remarkable.

But so is the pushback from those on the left who see the move as a colossal waste of energy and focus, at best, and potentially a politically dangerous gambit for Democrats.

A majority of House Democrats have signed onto Michigan congressman John Conyers’s version of a single-payer bill. And now, nearly every Democratic senator being mentioned as a possible 2020 presidential candidate has signed onto the Sanders bill, including our own Elizabeth Warren (and Ed Markey) along with Cory Booker, Kristen Gillibrand, Kamala Harris, and Jeff Merkley. (Notably, Democratic congressional leaders Chuck Schumer and Nancy Pelosi have so far not joined the stampede toward what a Herald editorial calls single-payer “loopiness.”)

“The solution to this crisis is not hard to understand,” Sanders wrote yesterday in a New York Times op-ed pushing single-payer as the way to address the problem of Americans who lack health coverage. He says Medicare has shown how to provide quality, government-paid coverage for a huge swath of Americans. “Now is the time to expand and improve Medicare to cover all Americans.”

But that solution is actually far harder to understand than Sanders acknowledges.

“Nearly any single-payer plan would require substantial disruptions in the current health care system,” wrote Sanger-Katz, pointing out that more than 150 million Americans currently get coverage through their employer.  “Such a proposal would reshuffle the winners and losers in our current system.”

“Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare,” writes Jonathan Chait in New York. “That is not a detail to be worked out. It is the entire problem.” He says that’s why LBJ gave up on a universal coverage plan and focused on covering the elderly — who generally don’t have employment coverage — when he devised Medicare in the mid-1960s, and it’s why Obamacare developed coverage plans that wrap around the country’s employer-based coverage system.

As for the politics, Michael Cohen writes in the Globe that the push for single-payer ignores the lessons of the Republicans’ failure to repeal the Affordable Care Act: It was a popular idea in the abstract, but when it came to the details of an actual plan to do it, support cratered.

The single-payer effort could “end up being the Democrats’ version of ‘repeal and replace,’” writes liberal pundit Bill Scher. “When grandiose promises on the campaign trail aren’t kept once attaining power, a party’s base becomes demoralized and recriminations follow.”

Scher calls the single-payer push a “big mistake.” He stopped short of terming it “political suicide,” however, which is how he might have branded such a move a year ago.

He says single-payer advocates will eagerly point to two national polls since then showing 51 percent and 57 percent support for a “Medicare for all” system. Sanger-Katz cites much lower support in a recent Gallup poll — 43 percent — but says that is nearly 10 points higher than Gallup’s finding from 2010. As Scher points out, though, the Kaiser Health Tracking poll (which reported 57 percent support) noted that “the public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments.”

For great insight into the single-payer issue, have a listen to what John McDonough said in late June on The Codcast, when Warren first floated the idea of embracing the idea. (His comments begin at 25:45.)

McDonough, who teaches at the Harvard Chan School of Public Health, helped craft the 2006 Massachusetts coverage law, and then went to Washington to work for Sen. Ted Kennedy on the early versions of the Affordable Care Act.

“It’s an extremely popular message with the Democratic base,” McDonough said of the single-payer idea. “At the same time, I am deeply concerned that it is a monumental distraction from going after what’s actually achievable.”

McDonough, a former liberal Massachusetts state rep, who may be as knowledgeable about health care policy and politics as anyone in the country, reels off the dates and results of state ballot questions to enact single-payer systems, all which have been defeated by huge margins. The most recent came just last November in Colorado, where voters rejected the plan by an 80-20 margin.

“The truth is there’s all different ways to get to universal coverage and effective cost control and most of them are not single-payer,” he said. While Australia has a great single-payer system, he says Germany has a great multi-payer system, as do many other countries with universal coverage.

“It’s chasing a big white whale,” he says of the single-payer effort in the US. “I worry that that’s a distraction from focusing on the ways we can actually make major, significant, important, and appreciated improvements in the system, working on what we’ve got right now.”



Massachusetts voters have lots of doubts about the state’s ability to fairly and safely implement the new marijuana law, according to a poll commissioned by the Boston Herald. The poll was conducted by the Bernett Group, where former TV reporter Andy Hiller is now the managing director.

Gov. Charlie Baker nominated a key inside player at the T, general counsel John Englander, for the state Appeals Court. (CommonWealth)

The House rebuffs Baker, restoring $275 million in spending that the governor had cut from the fiscal 2018 budget. (State House News)

A host of politicians past and present gathered to say goodbye to former state auditor Joe DeNucci, who died Friday at his home in Newton. (Boston Globe)


Four fans at Fenway Park draped a huge banner over the Green Monster proclaiming, “Racism is as American as baseball,” during the game. (Boston Globe)

Cape Verdean residents decry the ongoing plague of gang violence in their community at a neighborhood meeting in Dorchester. (Boston Globe) Haverhill Mayor James Fiorentini appoints a gang violence task force, saying he views gang violence as more of a social problem than a police problem. (Eagle-Tribune)

Following a shooting there earlier this week, park advocates and area residents say more needs to be done to crackdown on crime on Boston Common. (Boston Herald)

Three properties in Manchester are getting historically accurate makeovers to make them look like they did in the 1800s. (Gloucester Times)

Provincetown voters at a special town meeting rejected zoning changes that would have restricted medical marijuana dispensaries to limited commercial areas, letting the facilities operate in the larger residential zones. (Cape Cod Times)


Senate Minority Leader Chuck Schumer and House Minority Leader Nancy Pelosi say they’ve reached a deal on young immigrants after having dinner with President Trump. Trump, of course, tweeted out no deal has been reached. (New York Times)


Claims about voter fraud in New Hampshire during the last presidential election baffle officials in Massachusetts. (CommonWealth)

The Boston Herald whacks one of its own. The tabloid reports that Holly Robichaud, described as a freelance columnist on leave while she works on the US Senate campaign of Geoffrey Diehl, has been lobbying for the Saudi Arabian government against a bill that would allow the families of terrorist victims to sue foreign governments.

State Sen. Barbara L’Italien of Andover looks likely to jump into the Democratic race to succeed retiring US Rep. Niki Tsongas. (Boston Herald)

A Herald editorial says mayoral challenger Tito Jackson’s negative comments about Boston pursuing Amazon’s second headquarters make no sense.

In addition to voting in all new officials to start Framingham’s new city government, voters will also face questions on approving the local option tax on recreational pot and whether to allow the new City Council to restrict the number of retail marijuana shops. (MetroWest Daily News)


Developer Thomas Hynes says Boston has what it takes for Amazon’s second headquarters. (Boston Globe) Globe columnist Dante Ramos hopes Amazon lands here, too, but not under heavily skewed terms that are only about the company’s quest for the most generous financial incentives.

Former pharmaceutical company CEO Martin Shkreli heads to jail after offering $5,000 for a hair (with follicle) belonging to Hillary Clinton. Shkreli had been out on bail in connection with other charges filed against him. (Associated Press)

Household income rose 5.3 percent last year in Massachusetts, the second highest rate of growth of any state, and the gains were experienced all along the income spectrum. (Boston Globe) Incomes are rising in most states, but income inequality isn’t going away. (Governing)


State Education Secretary James Peyser said the state takeover of the Lawrence schools led by Jeff Riley has been “quite impressive.” (Eagle-Tribune)

Worcester State University tries to entice more out-of-state students by cutting the fees they pay. (Telegram & Gazette)

Joan Vennochi scratches her head at some of the people being tapped as visiting fellows at Harvard’s Institute of Politics — including Corey Lewandowski and Chelsea Manning — under its acting director, former congressman Bill Delahunt, who she says has gone, improbably, from dodgy medical marijuana lobbyist to Ivy League player. (Boston Globe)

Matt Damon speaks at a Boston showing of a new documentary he narrates that decries the charter school and school voucher movement. (Boston Herald)


Health care spending in Massachusetts rose 2.8 percent last year, slower grower than in previous years, but still topped $59 billion. (State House News)

The state Department of Mental Health shut down Lowell Treatment Center after a surprise inspection uncovered patient safety and cleanliness issues. (Lowell Sun)


Sean Gallagher of the Solar Energy Industries Association said Eversource’s solar proposal has to go. (CommonWealth)

Some Middleboro residents fear their wells will be contaminated by soil a abutting landowner’s plans to truck in from Boston construction sites to fill an abandoned cranberry bog. (The Enterprise)

Ten pipeline protesters were arrested at a Tennessee Gas Co. facility in Sandisfield. (Berkshire Eagle)


Alexander Krause describes the wrenching process of trying to comprehend the quadruple murder his son, Orion Krause, is accused of committing. (Boston Globe)

A federal judge has decided not to hold Bristol Sheriff Thomas Hodgson in contempt for arriving two hours late to testify in the corruption trial of a former deputy sheriff. (Herald News)


Globe editor Brian McGrory says the paper is facing “challenges” with the new printing presses in Taunton but insists the problems are being addressed. Skip to the 1:40:00 mark. (Boston Public Radio)