Issue Position: Health Care

Issue Position

Massachusetts has led the nation in working toward universal health insurance coverage for its citizens, and has, of late, begun tackling the problem of how to contain costs. However, our state has yet to really address two significant drivers of rising health care costs--the role of private, for-profit insurance companies in the health care system, and the woefully lagging investment in wellness and prevention throughout our policies to actually help keep people healthy. Quite likely these issues have been left largely untouched because they would require a cultural shift, as much as political courage, for their successful implementation. Nevertheless, our future as a Commonwealth depends upon our ability to make bold changes.

Single-Payer Model

The single-payer or so-called "Medicare for All" type of model holds the most promise of providing better care, better health outcomes, and lower overall costs. This kind of system--successfully working in many countries--cuts out the middleman private insurance companies which have significantly higher administrative costs, some aimed at trying their hardest to deny patient claims. Instead, the government acts as the insurer, and health care costs are paid through annual taxation rather than monthly premiums, sky-high deductibles and out-of-pocket co-pays. While some believe it risky to even talk about introducing a single-payer health insurance model, I believe one of the great benefits of the model is its ability to minimize risk. By diffusing the risk of sickness over a much larger pool of people, upfront costs may be lowered; but by covering all residents of Massachusetts through a state agency rather than individual employers, workers could more freely choose whichever jobs or ventures they would prefer to pursue. In minimizing risk, it would reward more entrepreneurship and risk-taking. Similarly, a single-payer system would unburden local city and town budgets of current employee health insurance and the looming unfunded liability for its retirees, as well as the sometimes contentious negotiations over municipal insurance plans. Massachusetts has arrived at nearly universal coverage through a pioneering patchwork of policies and private insurance companies, but in order to be a sustainable system which does not increasingly crowd out many of our other priorities, we must implement a systemic solution to the problem of affordably providing health care for all.

Family Medical Leave Legislation

As we reorganize our state's health care system to get better results, we might as well address the long-ignored issue that can play such a large role in a family's health. Whether to care for a newborn baby or an ill parent, yourself or a loved one, no one ought to be in danger of losing his or her livelihood for taking time off. Nor should it matter where one works. Too often low-wage retail and restaurant workers are forced out of fear to show up to work sick, increasing emergency room spending on chronically ill patients and increasing the risk of spreading disease to the general public. Pending legislation would allow workers to earn paid sick time up to seven days a year, depending on where they work. Another model in California and New Jersey has used contributions to a short-term disability insurance pool as a way to pay up to a certain percentage of regular income during extended leave. Studies have shown in these states and many countries with paid family medical leave policies not only improved health--particularly among newborns and young mothers--but also significant economic benefits in greater worker participation and employee retention and retirement security, especially for women. With more households headed by two working parents or a single working parent, the need for family medical leave has gradually grown. Clearly a renewed social compact for a happy and healthy Commonwealth would include laws that allowed citizens to return to work after caring for their family members, and supported them while they cared for each other.

Women and Infants

The United States is one of only four countries in the world to not guarantee paid maternity leave, the other three being Lesotho, Swaziland and Papua New Guinea--not pictures of perfect health. While the problem awaits national legislation, states can fill some of the gaps. In fact, if we want to grow a healthier Commonwealth, we must begin to take better care of our growing families. Paid maternity leave has unsurprisingly been linked positively to longer breastfed and healthier babies, and to lower infant mortality rates. We must develop science-based policies--including paid parental leave, early childhood care and learning, concurrent parental support, access to nutritional food and others--with the knowledge that a healthy beginning often leads to long-term health and success. Of particular concern is the alarming increase in caesarean births--nearly one in four--which can often put both child and mother at risk. We need to propose policies which change the culture of many hospitals to support natural births and allow mothers to make the best decisions for themselves and their babies. For example, health insurance ought to cover the expense of a doula, if requested, or post-natal care, regardless of whether the birth happened in a hospital, birthing center or at home. Massachusetts should also seek medical tort reform that can sometimes lead to poorer outcomes--in this case, higher c-section rates. As some have suggested, the state could even achieve payment reform from the current fee-for-service system to a more collaborative and holistic model of care--with a legislative deal with physicians who have sought reforms to medical tort law--and in the process, reduce overall costs to the system on both counts.

Pharmacy Ownership

In many European countries and in North Dakota, the ownership of pharmacies is limited to stores that are majority-owned by a locally licensed pharmacist, in recognition of the public health concern arising from national chains controlling a majority of the market share. More responsible, customer-focused service could grow with the reemergence of local, professionally-owned pharmacies in both currently-served and underserved areas, while large chain stores would still be allowed to lease space to independent pharmacists. Consumer satisfaction surveys have routinely reported higher satisfaction with independently-owned pharmacies. Enacting such a law would be a boon to the local economy as well consumers, as studies have also shown the significant economic impact of keeping local money in circulation and the favorable cost comparison of prescription drugs bought at pharmacist-owned stores to those purchased at large chains.

Prevention

Perhaps most important to our collective health are policies which promote wellness and prevention. Certainly a single-payer insurance system supports that trend, as it tends to encourage regular check-ups, screenings and early intervention before a treatable condition becomes catastrophic. Passing and implementing a paid leave law and more supportive policies for women and children will improve the health of our families and communities for years to come. What ought to be clear from all of these policy proposals is how interconnected they really are, that the health of our people can hardly be separated from other ideas found here:

 Early childhood daycare coverage and universal access to preschool

 Young parental adult education and job training initiatives

 Public Health Local Aid appropriation for nutritious school meal program, health and physical education, athletics, and special education needs

 Far-reaching Local Purchasing Policy to expand local farm-to-school programs and extend them to major institutions like hospitals and community health centers, universities and correctional institutions

 Comprehensive zoning reform for more affordable, higher quality housing, and efficient live/work land use patterns

 Fresh Food Financing Initiative to encourage development of farmer's markets, corner stores, grocery stores and food cooperatives to increase access to healthy food through the elimination of sales tax exemptions for unhealthy products

 Ambitious energy and environmental agenda for cleaner air, water, homes and neighborhoods that relies on more intelligent, decentralized systems for energy, water and waste

 Streets and transit planning which reduces emissions, designs for greater safety while lowering vehicle speeds, and invites more active transportation (walking and biking)--Safe Routes to School funding

 Ambitious plan to reduce hunger and homelessness, and provide widespread access to healthier housing options

These proposals represent a coordinated effort to solve systemic problems systematically by reordering incentives, realigning resources and rethinking regulations to empower individuals, families, small businesses and local communities to take advantage of more opportunities. They mandate only that state government act more responsibly and as an example to private enterprise, and provide support to groups and businesses that follow suit. Lastly, these policies constitute part of a larger renewed deal for Massachusetts, a social compact that reaffirms the rights and responsibilities of all our citizens, in order to grow a happy and healthy Commonwealth.

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