Update on the Single Payer Issue

The single payer amendment came to a vote this afternoon during the first day of debate on the Senate health care bill. After a vigorous debate, the Senate voted it down in a roll call with 15 voting yes (including me) and 22 voting no. This was a much stronger showing than had previously been expected.

As outlined in my post yesterday, I had reservations about the self-executing trigger language in the amendment — language that purported to automatically start a process of implementing a single payer system based on bureaucratic findings without further legislative intervention. Yesterday, I filed an amendment to the amendment to remove the trigger language. This morning, I worked with Senator Eldridge to develop a compromise version that had no self-executing trigger, but which preserved the language requiring a thorough airing of a single payer option in 2015 and 2016.

It turned out that a number of other senators shared my reservations about the trigger. The change in the language led to several additional people choosing to vote for the amendment and also allowed a number of people who did plan to vote for it anyway feel more comfortable with their votes.

I feel that the amendment as redrafted would have kept the single payer conversation alive in a useful way and that was the sentiment of those voting yes. In the long run, a shift to single payer — in the right form — would be very good for Massachusetts businesses (who would no longer pay directly for health care) and would also make it easier for business to hire low wage workers. The great bargaining power of a single payer entity would reinforce the strong cost control pressures created by the legislation.

Those voting no expressed concerns that keeping that conversation alive would add uncertainty to a situation that is already very confusing for providers and distract them from the challenge of meeting the new cost control targets in the bill.

While disappointed with this loss, I remain enthusiastic about the bill that we will pass on Thursday. I think that it addresses the most important issues in the short and medium term — creating pressure to hold down costs and speeding the transition away from fee-for-service medicine. It also includes a number of positive reform elements.