Saying “health care is a right,” state Sen. Julian Cyr, D-Provincetown, has submitted a bill calling for a study that would determine whether Massachusetts could establish a single-payer health care system that outperforms the current model.
Cyr’s proposal would require the Center for Health Information and Analysis to develop a benchmark for a system that provides publicly financed, universal access to health care for the population through a unified public health care plan.
If a study determines that benchmark outperformed the actual total health care expenditures over a three-year period, the Health Policy Commission would be required to draft a bill within one year that would implement a single-payer health care system that offers “continuous, comprehensive and affordable coverage for all residents regardless of income, assets, health status or availability of other health coverage.”
“We should really start to consider alternative solutions. We need a roadmap to get there. I think the broader single-payer bills would be quite ambitious for us to implement, particularly given the very uncertain federal environment,” he said.
This initiative comes amid rapidly rising insurance costs, with the Massachusetts Division of Insurance approving an average premium increase of 7.9% for 2025, although Alan Sager, a professor of health policy and management at Boston University, questions the accuracy of state-published health care costs:
“Our chair wrote a report last year stating that in 2022, health care spending in the state was $71.7 billion, but that figure leaves out a lot. In reality, total health care expenditures in 2022 were well over $100 billion in Massachusetts.”
The Wellfleet Select Board is in favor of any way to reduce the town’s health care costs.
“These increases have resulted in serious challenges for Massachusetts residents, including those here in Wellfleet.” said Select Board member Ryan Curley.
Dr. Brian O’Malley, who retired and closed his practice in Provincetown in 2017, said the current system is designed to generate profit rather than provide the best care. He said the lack of large employers in the region means many residents lack strong insurance coverage, making the need for reform even more urgent.
“Any system that still relies on making a profit is not going to solve the myriad of issues that we face,” he said.
O’Malley identified access and administrative complexity as the two biggest problems in the current system.
“This is a matter of health care equity. I believe that health care is a fundamental human right that should be available to every single person equally. We should all have the same access to the same care.”
The burden of private insurance on both patients and doctors forced O’Malley to spend most of his day handling paperwork instead of seeing patients. The limited time for patient care was one of the reasons he closed his practice, Provincetown Medical Group, saying at the time their the “mom-and-pop doesn’t work anymore.”
“We see a variety of patients covered by a variety of plans, each of which has its own strategy for making a profit. And I have to be a tool to that from the moment I’m seeing the patient in the room.”
Sager agreed, explaining that profit-driven health care only makes sense in a competitive free market — where innovation, lower costs, and efficiency are driven by competition.
However, “in health care, we don’t come close to meeting any of the seven requirements for a functional free market,” he said. “That’s why profit-making has no place in health care — it becomes a smokescreen for bad behavior.”
Universal health care aims to solve these issues by offering comprehensive benefits, including behavioral health, substance abuse treatment, prenatal services, and eliminating deductibles, co-payments, co-insurance, or other cost-sharing. It also ensures that patients have the freedom to choose their providers.
But Sager admitted it is unrealistic for Massachusetts to implement universal coverage, citing the state’s lack of capacity to implement it.
“I’ve always had great affection for single-payer, but I don’t think we should waste time pursuing fatal ideas, however good they are. It will never pass the Legislature unless there’s a crisis.”
He argued that if single-payer were implemented, it would require doubling the federal income tax to replace private insurance payments and out-of-pocket costs.
“Politically, under any conceivable president or Congress, doubling the federal income tax is not in the cards.” Instead, he suggests an all-payer model, where existing revenue streams — private insurance payments and government funding — are combined into a single pool while freezing private insurance payments at current levels.
Cyr said he takes the pragmatic approach recognizing the complexity of transitioning to a single-payer system.
“I think we need to be honest about the complexity of the current health care system and what it would take to actually move towards single-payer health care.”
