In response the article “Health costs, cost trends serving double whammy,” [Gazette, Nov. 17], the most noticeable observation I made from this excellent summary of the recent annual Health Policy Commission (HPC) hearing in Massachusetts, was the glaringly noticeable omission of even the mention of the single payer/Massachusetts Medicare for All bill (S860/H1405) in that discussion, which included providers, health system leaders, insurers, and state agencies but did not include single payer advocates. According to a letter included in the hearing program from HPC Executive Director David Seltz and Board Chair Deborah Devaux in 2024, “Massachusetts now posts the highest family health insurance premiums in the country,” and “the highest cost of health care for a family exceeded $31,000, including out-of-pocket spending.”
How would Medicare for All be paid for? The Medicare for All bill proposes a 2.5% payroll tax, (the first $20k is exempt) for employees, and a 7.5% payroll tax (first 20K is exempt) for employers. Those who are self-employed would pay a 10% payroll tax (first 20k is exempt). Social security, pensions, unemployment benefits: would not be taxed. The payroll tax would replace and eliminate premiums, copays, coinsurance, and all out-of-pocket costs.
The article showed that for the vast majority (98%) of one- and two-earner families at different income levels, Massachusetts residents would save money while receiving comprehensive coverage. Municipalities would save vast sums of money on the cost of insuring their employees. For example, using the municipal calculator, Northampton would save up to $7 million on health care, (which could be used instead to fund essential services such as schools). For this reason, I was proud to draft the resolution that passed unanimously in June 2025 in Northampton’s City Council in support of passing the Medicare for All bill in Massachusetts. Comprehensive care would include all medically necessary inpatient, outpatient, rehabilitation (SNF) care, prescriptions, labs, X-rays, as well as dental, vision and hearing care. In the article Seltz says employers are shifting costs onto their workers. “While one in five people with commercial coverage was enrolled in a high-deductible plan in 2014, that figure approached 50% in 2023, he said, adding that survey results tell us that patients and residents who have high-deductible health plans are much more likely to have medical debt.
Medical debt, and subsequent bankruptcy is essentially nonexistent outside of the U.S., and is a leading cause of homelessness. Trump’s “Big Beautiful Bill Act “is projected to double the rate of uninsurance” in the commonwealth via the loss of the mandate causing the loss of Medicaid coverage and subsequent loss of funding of Community Health Centers, (since around 43% of their patients are on Medicaid, and they also serve 66% of the state’s uninsured population).
Health care in the U.S. is the most expensive in the world, claiming 18% of our GDP. We pay more than twice per capita than any other wealthy nation, even though they provide universal coverage. Massachusetts has among the highest medical costs in the nation. Massachusetts spends one third of its budget on health care. Total annual health care spending per capita in Massachusetts in 2023 exceeded $11,150 per person (an 8.6% increase from 2022) and has risen since. This is one of the highest cost burdens in the nation, yet the state does not rank at the top in quality (#14 in one study).
Private insurance is highly inefficient yet highly profitable, with as much as 15%, totaling billions, going to administration, advertising, lobbying, excessive CEO salaries, stock buybacks, shareholder dividends, and other non-care expenses. In contrast, traditional Medicare has less than 3% overhead. Medical charges are opaque and highly variable, with some hospitals charging more than 10 times what others charge for the same treatment in the same geographic area. The same goes for prescription drug pricing. The consolidation of large medical centers is creating regional monopolies that drive up prices. U.S. medical costs are rising faster than in other wealthy countries. Massachusetts has failed to meet its own benchmark cost controls.
By contrast, here are a few examples of what the cost of health care under Medicare for All in Massachusetts would be for wage and salary earners: If your annual earned income is $50,000 with one earner, you pay $750 per year (not per month) to cover you and your family. If you earn $75,000 (one earner), you pay $1,375 per year. It may shock you to see that a double-income wage earning family with combined income of $250,000 can save $463,500 over 18 years — money that could pay for children’s college education.
Health care is not an option, it is a necessity. It is the right to life. Massachusetts must put our lives first. Simply put, those who oppose Medicare for All in their actions are unequivocally serving the insurance industry.
Shelly Berkowitz, MD, lives in Northampton.