Research & Commentary: Massachusetts Is Latest State to Consider Single-Payer Health Care

Published July 13, 2016

Despite possessing the nation’s highest health insurance coverage rate, Massachusetts lawmakers are now considering two bills that would institute a statewide single-payer health care system known as MassCare. Massachusetts would be the third state to attempt to create a single-payer health care system; the first was Vermont, which abandoned its plans in December 2014, and the second is Colorado.

Single-payer systems face major obstacles that make implementation difficult, if not impossible. MassCare’s proponents have greatly underestimated the costs of implementing and maintaining a single-payer health insurance system and the effects it would have on individual patients and the health care market. Massachusetts has already taken dramatic steps to reform its health care system. In 2006, Massachusetts implemented an individual mandate that required residents to buy health insurance or pay a fine, a model that was emulated in the Affordable Care Act.

Bill Vernon, state director of the Massachusetts branch of the National Federation of Independent Business, argues the 2006 reforms have failed to produce the promised savings and have led to a reduction in access to care. Vernon also says the cost of health care is guaranteed to rise under a single-payer system, because demand naturally increases at a greater rate than the supply of health care providers. “Utilization would probably go up, not down, and costs would go up, not down,” Vernon told reporters Ben Johnson and Luke Karnick in an article published by Health Care News (HCN).

Johnson and Karnick also points to a February report by the University of Massachusetts Medical School that found around 75 percent of the state’s 200,000 uninsured residents said high costs are the primary reason for choosing not to purchase health insurance, proving the Massachusetts plan has not resulted in the high level of access to care and low health insurance prices originally promised.

A single-payer system would only increase the current problems the state faces. Amy Lischko, a senior fellow at the Pioneer Institute for Public Policy Research and associate professor at Tufts University School of Medicine, told HCN adoption of a single-payer health care system would have a strong negative impact on the availability and quality of health care in the state. “Quality and access currently are not significant problems in the Massachusetts health care system,” Lischko told HCN. “It’s the cost of care that is problematic. My guess is that implementing a single-payer system would negatively affect quality and access, at least in the short run.”

Supporters of single-payer plans have long argued health care is a natural right of all citizens and that a government-controlled system would and should make health insurance available to everyone. Single-payer systems, however, have proven unsuccessful when tried elsewhere. In a report examining single-payer systems, John C. Goodman and Devon M. Herrick, both then at the National Center for Policy Analysis, argued other single-payer systems across the world have largely failed to provide needed care: “When health care is made free at the point of consumption, rationing by waiting is inevitable. Government control of the health care system makes the rationing problem worse as governments attempt to slow the use of services by limiting access to modern medical technology. Under government management, both efficiency and quality of patient care steadily deteriorate.”

In its issue suite on health care, The Heartland Institute argues the best way to preserve individual freedom, improve the quality of health care, and enhance the efficiency of the nation’s health care system is to empower individuals by giving them more control over the dollars spent on their behalf. Single-payer systems do the exact opposite. Massachusetts should resist completing the transition to MassCare and instead pursue policies emphasizing consumer-driven health care.

The following documents offer additional information about single-payer health care systems.

Massachusetts Considers Imposing Statewide Single-Payer Health Care System
Ben Johnson reports in this Health Care News article about two bills Massachusetts lawmakers are considering that would institute a statewide single-payer health care system. “Vernon says under a single-payer system, the costs of health care would rise because demand naturally increases more rapidly than the supply of health care providers. ‘Utilization would probably go up, not down, and costs would go up, not down,’ Vernon said.” 

Single-Payer Health Care Is Not Right for Colorado or Any State
In this article published by The Daily Sentinel (Grand Junction, CO), Heartland Senior Policy Analyst Matthew Glans argues against single-payer health care in any state. “Single-payer systems across the world have failed to provide needed care and have caused rationing and a deterioration of medical innovation. When government sets prices on health care products and services—limiting the profit incentive of providers—efficiency, quality, and innovation will always suffer. Instead of imposing a monolithic single-payer system on Coloradans, the government should pursue policies emphasizing consumer-driven health care, such as health savings accounts, which empower individuals by giving them more control over their hard-earned dollars,” Glans wrote. 

Issue Brief: Healthcare and Single Payer
The Ethan Allen Institute examines recent developments in health care reform in Vermont, including the state’s single payer proposal. The author describes the single payer program and concludes it may not work the way its supporters claim. 

Single Payer: Why Government-Run Health Care Will Harm Both Patients and Doctors
Robert A. Book, a senior research fellow at The Heritage Foundation, argues in this paper the establishment of a single-payer health care system would inevitably result in lower payments for physicians and other health care providers. “The immediate effect of having a single (‘stingy’) payer would be lower incomes for physicians and a reduction in the supply of active physicians, thereby impairing access to health care for all patients. However, the result of ‘single/stingy payer’ health care will not only be lower incomes for physicians now but reduced access and lower quality health care for future generations as well.” 

Vermont Single-Payer Plan Full of Holes
Joshua Archambault of the Pioneer Institute argues Vermont’s single-payer plan has many serious, fundamental problems that should not be lost in the excitement that seems to arrive whenever a state tries something big. “Many of the issues that a single payer system is attempting to address can be dealt with by greater consumer engagement, a federal tax policy change to delink insurance from employment status, and greater transparency in the health system,” he wrote. 

Amendment 69: What You Need to Know About the “ColoradoCare” Single-Payer Health Care Measure
Linda Gorman, director of the Health Care Policy Center at the Independence Institute, was appointed in 2015 to the Colorado Commission on Affordable Health Care. This Issue Brief highlights seven things people need to know about Amendment 69, “a state constitutional amendment which would create ‘ColoradoCare,’ a single-payer, government run health care system in Colorado.” 

Green Mountain Care Could Cost Vermonters Nearly $10 Billion a Year
Writing in the Heartlander, Sarah McIntosh discusses a report to Vermont lawmakers that raises concerns about the costs of implementing Green Mountain Care, a proposed universal single-payer health care system for the state: “The report, ‘Costs of Vermont’s Health Care System Comparison of Baseline and Reformed System,’ was issued in November. According to its projections, Green Mountain Care would cost as much as $9.5 billion a year.” 

Twenty Myths About Single-Payer Health Insurance: International Evidence of the Effects of National Health Insurance in Countries Around the World
Health care experts John C. Goodman and Devon M. Herrick identify 20 myths about single-payer health care and provide evidence single-payer is inferior to our admittedly flawed current system.

Vermont Continues Push Toward Single Payer System Without Funding Clarity
Writing for the Heartlander, Loren Heal reports on the push in Vermont to implement the nation’s first single-payer health insurance program. Heal reports its main flaw is funding. It remains unclear how the state plans to pay for the $1.6 billion annual cost of the program.

Research & Commentary: The Dangers of a Single-Payer Health System
Kendall Antekeier of The Heartland Institute argues single-payer systems do not benefit patients but instead place them under government control while subjecting them to inferior health care.

Ten Hard Questions about Single Payer Health Care
The Ethan Allen Institute identifies ten important problems with Vermont’s single payer health care plan, in the form of ten questions about the program’s structure, funding, and prospects for long-term success.

Decoding the Language of Green Mountain Care
John McClaughry of the Ethan Allen Institute argues Vermont’s single payer plan is likely to result in “rationing, waiting lines, maddening bureaucracies, demoralized doctors and nurses, shabby facilities, obsolete technology, declining quality of care, and of course much higher taxation.”

Vermont Is Waking Up from Its Single-Payer Dream to a Taxpayer Nightmare
Tyler Hartsfield and Grace-Marie Turner of the Galen Institute argue against Vermont’s single payer system and conclude the state’s experience may act as a cautionary tale. “Maybe this exercise will help the left-leaning voters in Vermont and across the country realize that government services – even for something as worthy as health care – aren’t free,” they wrote.


Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database, at

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