Berwick Platform: ‘Seriously’ Explore Single Payer, Review Cost Control

Dr. Donald Berwick (Jesse Costa/WBUR)

Dr. Donald Berwick (Jesse Costa/WBUR)

Granted, a candidate releasing his platform on health care for a race that’s a full year away might not strike you as big breaking news. But what if that candidate is one of the country’s leading health policy thinkers? And what if he’s stepping right into territory that proved highly contentious on the federal level?

That candidate is Dr. Donald Berwick, former chief of Medicare in the Obama administration, and that territory is the idea of a “single-payer” system — a sort of “Medicare for all” that’s common in other developed countries but that faces some strong opposition in the United States. (On the national political scene, Berwick took some major flak from opponents for expressing enthusiasm for Great Britain’s National Health Service.)

Berwick released his official health care platform for Massachusetts this morning, and it includes these two points — Chapter 224 refers to the state’s latest health reform, aimed at controlling costs:

As Governor:

On day one, I will convene a summit of all stakeholders to conduct a top to bottom review of Chapter 224 and develop an action plan to ensure it meets Triple Aim goals of better care, better health, and lower cost. If Chapter 224 results lag behind, within my first 100 days I will work with the Legislature to craft a new wave of stronger legislation to incentivize increased transparency, payment changes, and care reorganization.

It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone – patients, families, clinicians, and employers. I will work with the Legislature assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.

Readers, reactions? Let’s note that neighboring Vermont is already pursuing a statewide single-payer system, so the idea is not all that revolutionary around here. But Massachusetts is a very different state, where health care dominates the economy to a far greater extent than in Vermont. Will the idea fly here? Does it make you more or less likely to vote for him in that distant election? Does it mean that at the very least, the pros and cons of a single-payer system will figure in campaign debates?

Berwick’s full health care platform is here. A couple of other points worth highlighting:

I will assure that high-quality mental health care is more and more incorporated into the center of our health care system, in full parity with other components of care. We will reduce substance abuse and suicide rates by 50% in Massachusetts in the next decade.

Massachusetts will be the national leader in patient safety. Many of our hospitals have made progress toward safer care – reducing infections and complications in hospitals, reducing medication errors, and more. This is the moment to bring patient safety to full scale in the Commonwealth, in every hospital and in every community. I will convene the stakeholders in Massachusetts health care and launch a five-year, comprehensive, collaborative, statewide project to bring the levels of injuries to patients due to errors in care to the lowest level in the nation.

Read our recent interview with Dr. Berwick here: What Makes Berwick Run: Spurned Medicare Chief Seeks To Lead Massachusetts.

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  • The Man With No Name As A Name

    Why do people have such a mystical faith in single-payer? Medicare is single payer for the elderly. Let’s see: It loses $60 billion a year in fraud, does a horrible job of containing costs, enshrined a wasteful fee-for-service model, led to an oversupply of specialists due to the RUC (along with the beggaring of primary care), a boom in hospital building — and has trillions in unfunded liabilities and slated to run out of money!.

    Yes, clearly the answer is more of it…

    • jefe68

      Medicare is not what I would hold up as a good example of a single payer system. You could point to any other nation such as France, Denmark, Canada, Germany, and Great Britain who all have some from of a national health care system that spends less and gets better results.

      So keep the system as it is? Is this your solution? Do nothing? Repeal the ACA as well while you’re at it.

      The problem is our fee for service, for profit insurance, dysfunctional health care system. Doing nothing is not an option anymore.

    • dude


  • Peter Cohen

    As a physician and member of Physicians for a National Health Program which is working toward a nationwide single payer system, I applaud Don Berwicks’s initiative and will support his (admittedly somewhat quixotic) pursuit of the corner office. He is smart, pragmatic and very well-spoken but risks positioning himself as a one-issue candidate.

  • Amy

    I want to elect this man. Please ask him if he will consider moving to MN to run for something.

  • philip george

    Any reasonable, sensible person who takes the time to absorb the facts will support universal ,single payer healthcare!

    • The Man With No Name As A Name

      Here are some inconvenient facts to consider:

      1. Medicare is single-payer for the elderly. It has been around for a long time now.
      2. Medicare’s own trustees say Part A will run out of money in 2026. In other words, it is going broke.

      3. Medicare’s trustees also say it has nearly five trillion in unfunded liabilities.
      4. CBS 60 Minutes (not know for a right-wing slant) says Medicare loses $60 billion a year to fraud.
      5. Medicare enshrined the very same fee-for-service payment system that we are now told is imperative to get rid of to control costs.
      6. Medicare and the RUC contributed greatly to the oversupply (and overpayment) of specialists and the beggaring of primary care. Why does the US have 60% specialists and 40% primary care when the rest of the world is the opposite? The answer: Medicare payment policy.

      These are just a half-dozen items. There are many more. Again, if single-payer is the panacea, then why is Medicare (a single-payer system) contributing to the VERY PROBLEMS that expanding it is supposed to solve?

      Please look at Miami and McAllen and the bleeding of Medicare that has gone on for years and explain how more people in a program that can’t even stop blatant theft is the answer?

      • pvphoto

        Medicare is not going broke. Very small changes in the input of funds by the rich and very rich (raising the cap), completely solves the whole “going broke” BS. Medicare is not single payer health care. Until insurance leaches are removed from the system nothing will change.

  • Gloria

    Very, very good idea! So much more common sense than anything we have ever had!

  • jefe68

    Yes! Lets be the second state, after Vermont, to have a single payer system and show the fro profit health insurance corporations the door.

  • Lachlan Forrow

    Yes, BRAVO to Dr. Berwick. And yes, we clearly need to control health care costs, including because they account for so much (?>40% of the state budget) that unless we control them we will not have money for so many other things important to us (and our health), including schools for our children, safe neighborhoods, safe/reliable/affordable transportation, protection of the environment, etc. etc. But I think we should be speaking and thinking less in the language of “cost control”, and instead primarily in terms of “maximizing patient-centered value” from every penny spent on health, which we are clearly not doing. Dr. Berwick has been among our foremost thinkers and effective advocates for health system reforms that focus on improving patient-centered value, accountable to patients for delivering that. I look forward to the public debates, with active engagement especially from patients themselves (ultimately all of us), about how we want money spent. Ultimately it is OUR money (through our taxes, our insurance premiums, our employer contributions that otherwise could go to higher wages, etc. etc.). WE are the “payers”, so this debate must not be dominated by insurers and health systems, since it is OUR money they are using so inefficiently.

  • JG

    Bravo to Berwick. A single-payer system is certainly the best way to control costs while providing quality universal coverage. Yes, staking out a bold position on health care makes me inclined to support his candidacy.

    • The Man With No Name As A Name

      We have had a single-payer system for the elderly since 1964 and it is running trillions in unfunded liabilities, scheduled to run out of money in 2026 (per its own trustee’s report), and loses $60 billion a year to fraud (a number from CBS’ 60 Minutes, not me). Yes, clearly we need more of it!

  • Norman

    Single payer is the way to go.

    But I disagree with Tom. We are not giving money away to insurance companies, especially with Obamacare’s rules about the medical loss ratio. Instead, the fundamental reason health insurance is expensive is that health care is expensive. And there are many reasons for that.

    Even countries with strong single-payer systems still face rising health care costs as a share of GDP, and it’s not just driven by older populations. One of the fundamental drivers is constant medical innovation and new technology, which contrary to popular belief, does not tend to lower costs but rather to increase them. To live within our means and to have enough money for education, social security, defense, and other governmental functions, we will need to ration medical care in some sensible and fair way.

    • DHK

      That is all true, but it should be added that in other western countries the % of their GDP that goes into health care is much smaller than it is here, and that, in spite of this, their ‘results’ (measured by such indicators as infant mortality and morbidity) are usually much better than they are here. I lived in England for many years, and it was such a comfort to know that I needed never be concerned about paying insurance, copayments or other health-related bills.

      • pennyroyal

        other indicators, too. In Europe you don’t have to fear a catastrophic illness will take away your retirement money and cost you your house. The sense of well-being, the lack of anxiety about paying for healthcare is substantial.

        • The Man With No Name As A Name

          A trade-off is that if you have a cancer diagnosis in the US, you have 35% better survival odds. So, one may be bankrupt, but still alive. There is also a dramatic difference in survival odds if one is born premature. So long as people are willing to accept the trade-offs (like much higher taxes, lower survival odds for certain diseases, longer waits for treatments), then that is one thing. The problem is that advocates don’t seem ready to discuss the pros and cons. Are people in this country willing to accept the very real restrictions that come with a European system? I see little to indicate this is the case.

          • jefe68

            Let’s keep the system how it is. Let’s do nothing and let the system bankrupt the nation. You don’t offer any solutions other than touting cherry picked arguments that point to European nations as failures, when they are not.

            I have personal experience with British NH service. I’ve seen it work, and have known of two people who received liver transplants in their lifetimes. Both them did not have to wait any longer than anyone in this country would have. One who had a rare live disease would never have been able to get insurance in this country as she had what we in this nation perversely put up with, the preexisting condition..
            The NH system saved her life, end of story.
            The British NH system is hardly perfect, but I wonder if you could find many in the GB who would change it for our for profit system.

          • pvphoto

            “bankrupt, but still alive.” what a wonderful choice! Your information is seriously incorrect!

      • The Man With No Name As A Name

        Be wary of international comparisons, especially with infant mortality. The reality is that there is no common measure used across all of the countries reporting stats. This is something well-known to those who work with health care stats. Even Wikipedia talks about it:

        “However, the method of calculating IMR often varies widely between countries, and is based on how they define a live birth and how many premature infants are born in the country. Infant mortality rates can be flawed depending on a nations’ live birth criterion, vital registration system, and reporting practices.[23]
        Certain practices of measurements have the potential to be underestimated. Measurements provide a statistical way of measuring the standard of living of residents living in each nation. Increases and decreases of the infant mortality rate reflect social and technical capacities of a nations’ population.[6] The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, heartbeat, umbilical cord pulsation or definite movement of voluntary muscles.[24] This definition is practised in Austria, for example.[25] In Germany the WHO definition is practised as well but with one little adjustment: the muscle movement is not considered as a sign of life.[26] Many countries, however, including certain European states (e.g. France) and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[27] In the Czech Republic and Bulgaria, for instance, requirements for live birth are even higher.[28]”

        Also, be careful imputing insurance with infant mortality improvement. For example, Texas famously leads the nation in uninsured. Yet, its infant mortality rate is well below the national average. Indeed, it exceeds the Healthy People 2020 goals for this measure. Then, to make it stranger, the best regions in Texas are all along the Rio Grande — which has the highest poverty and the lowest insured rate.

  • Collin F

    Definitely worth exploring, it allows the Commonwealth to set an example for the rest of the country. Go Don!

    • jefe68

      Vermont has already done this. They will be fully single payer by 2017.

  • Tom

    The idea that moving to single payer would bankrupt any state or the country is a ridiculous farce. We spend more just giving money away to private health insurance companies than would be required to simply give people health insurance.

    • The Man With No Name As A Name

      Really, so you mean Medicare ISN’T running up trillions in unfunded liabilities and on a schedule to run out of money? You mean its OWN TRUSTEES don’t know what they are talking about when they issue these ominous reports each year?

      Here are a couple of quotes from the 2013 Trustees Report:

      “The projected depletion date of the trust fund is 2026, at which time cumulative expenditures would have exceeded cumulative tax revenues by enough to equal the initial fund assets accumulated with interest.”

      “The estimated unfunded obligation of $4.6 trillion and the closely
      associated present value of the actuarial deficit ($4.8 trillion) are useful indicators of the sizable financial burden facing the American public. In
      other words, increases in revenues and/or reductions in benefit expenditures equivalent to a lump-sum amount today of about $5 trillion would be necessary to bring the HI trust fund into long-range financial balance.”

      C’mon folks, it took maybe five seconds with Google to look this up.

      • pvphoto

        Your answer would be NO.

      • Garrett Connelly

        Simple answer, No Name, remove the cap on paying. Everyone keeps paying in no matter how much they earn.

        Really, why should a person stop paying into health care above a certain income level? The concept is as bizarre as thinking a farmer can succeed caring for only half the field.

        Medicare for all is a money maker for the nation.

  • Mark

    Everyone I know from England has to by additional insurance above the base insurance to feel like they have secure health care coverage.

    • Tom

      10 percent of the British public have additional insurance above what is provided by the government. Two thirds of that is those who get supplemental insurance through an employer. A whopping estimated 3.3 percent of the British public chooses to buy supplemental insurance to the NHS. Please spout some more fabricated anecdotal evidence.

    • Helen

      You must be talking about a different England to the one I live in. I don’t really know anyone here in England who has additional health insurance apart from a few friends with very well paid jobs who get it through their employers. If you want to get an objective sense of a) how people in the UK feel about their single payer system, b) how secure they feel about it and c) how easy they find it to access, see this recent report from The Commonwealth Fund of the USA It compares patient perceptions across eleven countries. The NHS provides cradle to grave care for more than 60 million people. It doesn’t always get it right for every patient but overall, it does a pretty good job. Us Brits, across the entire demographic/economic spectrum, trust and use our NHS, a million of us a day. We cherish the NHS more than we cherish the Royal Family or the military (See Not a bad advert for a single-payer system, still going strong after 65 years

    • jefe68

      By the way, it’s Great Britain not England. There is Scotland, Wales and Northern Ireland.

      • dave

        Scotland is about to leave. Wales won’t be far behind, as far as I’m concerned the Republic can f-ing have Northern Ireland with its Catholic/Prod loony tunes. Without all the bloody layabout Celts to support the Angles and Saxons can get back to doing what they do best, kicking ass and taking names.

        • jefe68

          You’re kidding, right? You might want to look into the history of GB a little and would learn that the “layabout” Celts have the lion-share of ingenuity in engineering and science and have been responsible for such inventions as the telegraph, telephone,TV, color TV, not to mention a huge amount of inventions and engineering developments that made the industrial revolution possible. They are today one of the world leaders in medical research in the fields of AIDS and stem cells.

          By the way you’re juvenile comment speaks volumes to one English contribution to the world, the lout.

  • Berkshire_Boy

    It seems to me that any Governor of the Commonwealth would have a fiduciary obligation to study the options that might be available to improve the existing system,contain costs and improve outcomes. if the result of such a study indicates moving to a single-payer system, that option should be fully vetted by the General Court. What is the harm in exploring it?

  • bomber

    I say go for it! That way it will creep its way into a national policy!