Cape Care advances single-payer health care system

By Cynthia McCormick
Cape Cod Times' Staff Writer
July 02, 2007

In "Sicko," the new Michael Moore movie that opened Friday, the iconoclastic director proposes to replace private health insurance with a single-payer system.

Moore isn't the only one with that idea.

A group of activists known as Cape Care wants to make Barnstable County one of the first places in the country to put a single-payer system into practice.

The group says the Massachusetts health reform act signed into law by former Gov. Mitt Romney doesn't go far enough in providing universal health coverage.

Cape Care recently hired its first paid employee - part-timer Candace Perry - and plans to blanket the Cape this fall with a series of public hearings on what people would like to see covered by a single-payer system.

"We think we've done the political science groundwork," said Brian O'Malley, a Provincetown physician and a member of the Cape Care steering committee. "We believe we have strongly broken the myth the single-payer system is too weird to fly."

Approved in theory

Last year 11 communities on the Cape passed a nonbinding referendum in support of Cape Care. Next year Cape Care hopes to put the single-payer system to a binding referendum.

There's a difference, of course, between voters thinking something is a good idea and actually voting for some sort of levy or tax to make it a reality.

So far, the cost of bringing universal health care to Barnstable County via a single-payer system is a big unknown.

"At this point those numbers have not been run," Perry said.

Under a single-payer system, every resident of Barnstable County would be entitled to comprehensive health care coverage, in the same way that all residents are entitled to municipal police protection or public school education.

The county would have its own insurance product and pay for coverage by assessing residents a certain amount, the mechanics of which have yet to be worked out.

Barnstable County commissioners haven't bought into the plan yet, nor do they know much about it. "We haven't heard any details on how much it would cost or how it would work," Commissioner Bill Doherty said.

Would families need a second insurance policy to pay for care off-Cape? Will it be a tax or something else? "That's another thing that would have to be worked out," Doherty said.

Health care for less

O'Malley said universal coverage would contain costs in part by eliminating marketing and administrative costs associated with private health insurance plans.

"Taxes might be higher, but overall (health care) spending - we expect to do it for less," O'Malley said.

He criticized the state health care reform act as too complicated, expensive and narrow.

The reform law requires most residents of Massachusetts to have health insurance, but many plans and premiums are still out of the reach of poor and middle-class families, O'Malley said.

"What we want is a true universal health care system where everybody is covered," said Dr. Patricia Berger, co-chairwoman of Mass-Care, the parent organization for Cape Care. Mass-Care is sponsoring a Health Care Trust Bill that would bring a single-payer system to Massachusetts, but Berger said her organization supports Cape Care's efforts to pilot a similar program in Barnstable County first.

"All the other industrialized countries have some type of single-payer system," Berger said. "Every citizen has some basic coverage guaranteed. That's not true here."