Single payer is tried, tested; it’s Mass. plan that’s risky

The Boston Globe, Jan. 9, 2011

On last Sunday’s editorial page, the Globe supports two courses toward controlling health care costs: It backs Governor Patrick’s efforts to change the health care industry’s fee-for-service system to “global payments," and it suggests that Vermont’s plan to implement a single-payer health care system should be supported as an experiment, or “a laboratory of democracy."

The Globe seems to have mixed up its rationales, as almost every developed nation in the world has a single-payer health care system or something close to it, and we have mountains of evidence that such a system works at controlling costs while delivering the same or better outcomes. The Massachusetts plan to implement payment reform, however, is highly experimental, and there is little evidence supporting the hope that it would effectively control our costs.

A 2009 Urban Institute survey of the evidence on global payment reform found that the concept would not be a game changer for cost control in the short run, but that further experiments would be welcome. Moreover, we know that fee-for-service is not causing our high and rising health care costs; two recent studies by the state both found that it is rising costs per service, not growing utilization of care, that are driving our costs.

The Globe is correct that Governor Patrick’s commitment to cost control is much needed. Now we need a path to cost control that is proven and not based on a misdiagnosis.

Benjamin Day
Executive director, Mass-Care: The Massachusetts Campaign for Single Payer Health Care