Why Massachusetts must lead on health care

By Henry Mallett

When the CEO of UnitedHealthcare is shot in broad daylight and many assume that the alleged shooter, or someone they loved, must have been denied care, you know the system is broken. This reflexive assumption says it all: Americans have come to expect austerity from their health insurance rather than actual care.

America remains the only wealthy democracy without a universal public health option. Here in Massachusetts, we’re fortunate to have MassHealth. But let’s be honest, it’s a compromise that satisfies no one. It provides essential coverage for our most vulnerable while offering subpar, unaffordable products to many middle-class residents, and it funnels enormous sums of public money into private insurance companies. That makes corporations very happy while leaving patients and providers frustrated.

According to the Massachusetts Budget and Policy Center, the state allocated about $19.8 billion to MassHealth in 2024 — nearly two out of every five dollars in the entire state budget — most of it flowing to private insurers contracted to manage care for low-income and working-class residents. These insurers employ utilization review managers, often without specialized medical training, who decide which treatments, medications or hospital stays get approved. In effect, public money funds a private bureaucracy that rations care. Meanwhile, top executives collect multimillion-dollar compensation packages while hospitals struggle to stay open. Andrew Dreyfus, the CEO of Blue Cross Blue Shield of Massachusetts, earned about $5.6 million in 2023, and a predecessor received $8.6 million in a single year, according to HealthLeaders Media.

When the state’s health budget enriches insurers while limiting access for patients, it’s fair to ask who this system really serves. We’re already paying for health care through our taxes, premiums and hospital subsidies, but too much of the return goes to corporate salaries as opposed to community health.

Live experience

I write this as someone who has seen these failures firsthand. I’ve worked on inpatient psychiatric units through the pandemic, in child welfare, at Boston hospitals and in private practice. I’ve watched insurers pressure clinicians to discharge patients a day after a suicide attempt or deny coverage that could mean the difference between stability and crisis. These decisions are made miles away from the bedside, leaving both patients and providers powerless.

Waltham’s own history tells a similar story. Waltham Hospital, which had served this city for more than a century, closed its doors in 2003 after a Boston-based nonprofit deemed it unprofitable. Since then, residents have had to travel to Boston, Burlington or Newton for hospital care even as the population has grown. For a city once known as “Watch City” for its innovation, the loss remains a painful reminder of how fragile our health system really is.

Critics say a single-payer system would eliminate insurance industry jobs. Maybe so, but we have ended other industries once we recognized they harmed the public good. We banned lead paint, outlawed child labor and stopped dumping toxic waste into rivers. Jobs that exist to ration care should not be the jobs we fight to preserve.

Others claim a single-payer system would reduce choice. But who really gets to choose now? Our employers pick our insurance plans, and those plans dictate our doctors, medications and hospitals. The illusion of choice is one of the cruelest features of the current system.

Health care is a public good

Massachusetts may be small, but it has always led — in education, health care and civil rights. Yet on this front we are lagging behind the world.

That’s why the Mass-Care single-payer bill (H. 1405 / S. 860) matters. It would guarantee health coverage for every Massachusetts resident without premiums, deductibles or copays, thereby removing the stranglehold private insurers have over who gets care, when and how much it costs. Health care isn’t free, but it’s a public good, and we already spend enough to make it universal if we stopped subsidizing inefficiency and profit.

The bill is in committee, and the coming months will determine whether it moves forward. Massachusetts legislators will review and vote on a committee recommendation before any full-floor vote. That means residents can make a real difference now.

Our representatives aren’t up for election this year, but they are making decisions right now that determine the future of health care in Massachusetts. A few calls and emails can help move this bill from committee to the floor and finally make health care in our commonwealth worthy of the people who live here.

Upcoming event: Solving the Health Care Crisis

MassCare Town Hall – Oct. 29 at 6:30 p.m. at the Waltham Public Library, 735 Main St.

Sponsored by MassCare, a coalition of more than 100 member organizations advocating for a universal single-payer system in Massachusetts, this event will explore how we can move from an inequitable, profit-driven model to one that is sustainable, compassionate and equitable.

Speakers include

• Dr. Don Berwick, former administrator for Medicare and Medicaid under President Obama.
• Heather Clark, Smith College alum and founding member of South Shore Medicare for All.
• Katie Murphy, president of the Massachusetts Nurses Association and critical care nurse at Brigham and Women’s Hospital.

Take action

Contact Waltham’s legislators today and urge them to support a favorable “ought to pass” recommendation for H. 1405/S. 860

• Sen. Mike Barrett (3rd Middlesex) at 617-722-1572 and Mike.Barrett@masenate.gov
• Rep. Carmine Gentile (13th Middlesex, co-sponsor) at 617-722-2810 and Carmine.Gentile@mahouse.gov
• Rep. Thomas Stanley (9th Middlesex) at 617-722-2810 and Thomas.Stanley@mahouse.gov

Henry Mallett is a clinical social worker who lives in Waltham.