Columnist Richard Fein: Medicare for All? Questions legislators need to answer

  • Richard Fein

Published: 1/28/2019 9:05:42 AM

The new state legislative session will almost certainly include some discussion of a state-sponsored Medicare for All for Massachusetts residents.

Legislation to that effect was submitted last session, and elected representatives from Hampshire County apparently already support the concept. We should ask them to consider these questions and then give the state’s citizens some specific, fact-based answers:

How much will it cost and how will you pay for it? At a minimum, Medicare for All, or M4A, would need to replace the amount currently being paid by commercial insurers, plus the amount paid by Massachusetts residents in co-pays. According to the 2018 annual report of the Center for Health Information and Analysis, that amount was $22.8 billion in 2017. As a point of comparison, the fiscal 2019 budget of our state government is $41.2 billion.

Vermont already passed but decided not to implement a M4A program (Green Mountain Care). Why? The program would have necessitated a huge increase in taxes. The administration of former Gov. Peter Shumlin estimated it would need to increase payroll taxes to 11.5 percent and income tax of up to 9.5 percent, to be assessed on a sliding scale.

Over 1 million Massachusetts residents are enrolled in federally funded Medicare. If you have Medicare now, can you keep it? If not, will the state give a tax credit of some kind to seniors who have been subject to Medicare taxes since 1965?

 Over 4 million residents are covered by commercial health insurance. Will they be better off financially with M4A? Will their quality of their heath care improve? If so, how? If you like your current health insurance, can you keep it? If so, are you exempt from the added taxes associated with M4A?

What will be the reimbursement rate for health care providers? At present, the Medicare reimbursement rate is much lower than that of commercial market insurance.

Will health care providers be required to accept M4A? According to a Kaiser Family Foundation report in 2015, 21 percent of respondents in their National Survey of Primary Care Physicians do not accept new patients covered by Medicare. For Medicaid, the figure is 22 percent for new patients. In addition to that, 32 percent will not accept Medicaid at all.

Will all medical expenses be covered automatically? If not, will the limitations and restrictions be like those imposed by the commercial insurers? By Medicare? By Mass Health? If a claim is rejected, wouldn’t an M4A be like a huge insurance company in terms of customer and health care providers who want to fight for their prescriptions to be filled as written (not generics), PET scans, etc.?

What is the plan to roll private insurance, Medicare, Medicaid, federal employee health insurance, state employee insurance into one M4A program? How many new state employees will have to be hired?

Do proponents of M4A really expect that private employers who now provide company-financed health insurance will raise their employee's wages to compensate for the increased tax burden their employees will bear under M4A?

If the person utilizing a medical service is not paying anything for it out of their own pocket, will they make medical appointments more frivolously? Will wait times to see a doctor or have an operation increase? Will it be necessary to recruit more doctors to practice in Massachusetts?

Will people living in Massachusetts while being in the United States illegally be covered by M4A? In California, the Legislature is already considering such a proposal.  

Some proponents of M4A apparently believe that there will be billions of dollars saved from reducing provider and funder administrative costs, lowering drug prices, reducing fraud and reducing hospital and provider pricing. Do our legislators accept the premises and calculations upon which that proposition is based?

It seems to me that any state M4A will simply shift health care insurance costs from Massachusetts residents as individuals and employers to individuals and employers as taxpayers. Further, health care per se will not improve and could get worse.

It may be that legislators will simply refer M4A to a commission for study. If that happens, it will give legislators more time to do their fact-based research and give citizens their answers.

Gazette readers may want to compile their own set of questions. If you would like a copy of this column with links to the information cited, please email

Richard Fein lives in Amherst. This is his debut as a regular columnist for the Gazette. His column will appear the fourth Monday of every month. Reach him at


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