Reforming Our Cobbled Healthcare System

Photo via Daniel Lobo/Flickr (CC-BY)

by Catherine DeLorey

Originally posted in DigBoston on August 9th, 2021.

For those who did not already realize what a dysfunctional health care system we have, the Covid pandemic has exposed just how vulnerable the US healthcare system is. While more and more people become aware of its defects and inequities, our legislators continue to cobble together incremental changes that just leaves us with a larger patchwork quilt of an inappropriate and inefficient system.

But, there is one beacon on the horizon that can address this. Single Payer health care, also known as Medicare for All, is the way to make health care affordable and equitable for everyone. 

Even though more than 70% of US residents support a single payer system, the fact that we do not yet have it indicates that this is a political more than scientific issue. The United States is the only developed country in the world that does not offer its residents universal health care.

In a single payer system, the dysfunctional attributes of poor access, and the high costs of the current system will be eliminated. With a single payer health care system many current dysfunctions would be resolved.

“Everybody In, Nobody Out,” a popular chant of health care advocates, highlights a primary characteristic of the single payer system, which is that everyone has access to health care services. Health care is not based on income, or what the insurance company considers appropriate. It is a medical decision between the care providers and the patient. In addition to everyone being eligible, single payer health care is portable, that is, it is not dependent on place of employment, marriage, or residence.

In this single payer reformed system there are uniform benefits for everyone. Which health services are offered does not depend on how much money a person has or how expensive an insurance plan they have. Benefits are determined by medical need. The interference of the health insurance company determining services would be eliminated.

Within Medicare for All, prevention and health education are an integral function of any individual health care plan. Health insurers do not pay for prevention because, although it may save money in the long run, it does not always save money in the short term. Since individual policyholders often change insurance companies, an individual health insurer would not reap the benefits of preventive care they had paid for.

Another advantage of a single payer system, is that each person selects their own physician. One does not need to be concerned if the provider or specialist is in the plan or not, there are no hidden costs from seeing a physician who is “out of plan”, since there is no “out of plan.”

Currently, the United States has the most expensive health care system in the world. We pay more than twice the cost of health care of other developed countries, costing more than $11,000 for every person in the country. By not needing to pay premiums, copays or deductibles, single payer will save money for individuals and the entire health care system. There are a number of different payment plans offered to pay for a new single payer health care system, but in all of them, more than 95% of individuals would save money.

Although a single payer system is necessary, it is not sufficient. Once we have health care access for everyone, we can begin to address the structural problems with the system. Knowing that 70% of the population supports single payer, shows us how much single payer is political. As a political issue, constituents have a responsibility to inform their elected representatives that a single payer system is an idea whose time has come and we should join the rest of the developed world in having a system that is universal, affordable and equitable.

Boston has always been an epicenter for health advocacy and health care reform. It is home to two major health activist organizations. Health Care Now ( ) which is fighting to win a national single-payer healthcare system because access to healthcare is basic to human dignity, and Mass-Care (, the pre-eminent Massachusetts organization working to establish a single payer health care system in Massachusetts.

The following is the Massachusetts state legislation supporting single payer / Medicare for All:

  • An Act establishing Medicare for all in Massachusetts. H 1267
    • filed by Denise C. Garlick and Lindsay N. Sabadosa, supported by more than 60 legislators
  • An Act establishing Medicare for all in Massachusetts. S 766
    • filed by Sen. James Eldridge, supported by 25 state senators.

If we are not satisfied with our current dysfunctional health care system it is up to us to support and work with the organizations and legislation that will change it.

—Catherine DeLorey is a longtime community health advocate. She is president of Women’s Health Institute and a member of Massachusetts Peace Action’s Fund Healthcare not Warfare working group.