London to Telegram & Gazette: Financing a single-payer health care system is complex

March 20, 2017

A proposal to bring single-payer health care to Massachusetts is aspirational because it lacks details and may need funding changes to be successful, UMass Medical School health policy expert Katharine London, MS, told the Telegram & Gazette. London led the team that developed the Vermont single-payer financing model.

"Moving from a privately financed system to a publicly financed system is incredibly complex," said London, principal at the Center for Health Law and Economics, a unit within Commonwealth Medicine.

The March 19 article outlines a bill from Massachusetts lawmakers that would establish a single-payer system in the Bay State funded through a health care trust. The bill is in contrast to the American Health Care Act, the plan Republican leaders have developed to replace the Affordable Care Act.

London called the plan “aspirational” in the article because it does not describe how to get to single-payer – there is no timeline, no changes to state law, no fiscal analysis.  There needs to be a detailed implementation plan and a large public discussion of the options in order to build a state program estimated to cost $60-100 billion, she said.

In addition, London told the Telegram that the 10 percent payroll tax needed to fund the single-player plan seems low. She also suggested Massachusetts try a different approach by establishing a public plan that residents can choose to participate in.

"If you build something people really like, they will move into it. Then you can start to phase out some of the private," London said. "If it's lower cost and better quality, people will choose it."

The Center for Health Law and Economics started working with Vermont on a financing model soon after its legislature voted to approve a single-payer system in 2011. Ultimately, Vermont did not proceed with the model.

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