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April 28, 2014 / stacieshap

Don Berwick : Medicare for all speech

Town Hall Meeting – Boston University – April 16, 2014

“Thanks so much to Liat, Jawad, and Boston University School of Medicine, and thanks, all of you, for coming here tonight. I’m excited that so many of you are here, advocating for Medicare for all. With your hard work and your commitment we can finally make single payer a reality in this Commonwealth.

I’m Don Berwick. I’m running for Governor, and I’m asking you to join me. Join me in working to make Massachusetts the progressive beacon that this nation so badly needs. Join me in fighting for social justice, equality, and compassion. And in working for an economy that gives everyone the chance to thrive.

Health care is a human right…  period!  For far too long, we have been the only western democracy that has failed to make good on that promise.

But now, we are on route.  Don’t let the lies trick you – with the Affordable Care Act – Obamacare – we are at last on the pathway toward promising every American man, woman, and child that they no longer need to be afraid that they won’t have care when they need it – that they won’t face bankruptcy from getting care when they do need it.  Bravo!

And Bravo Massachusetts!  We got there first.  In 2006 – eight years before the rest of the nation, we made health care a human right.  And we will never go back. Never!

Now, we can lead again – forward.  We can again be a beacon for the nation.  You see, when it comes to health care, we are not done.  Coverage, alone, isn’t enough.  We need a bigger promise – better Care when we need it, better Health for the population, and lower Cost – costs we can afford without devastating our public resources, working and middle-class families, or the vitality of our businesses, large and small. I call that promise the Triple Aim.  You can have better care, better health, and lower cost.  I’ve worked for three decades on that.

That takes a new health care system – one that directs every ounce of its energy and every nickel of its money toward meeting the needs of people – our needs – relieving the burden of illness, injury, and disability, and not waiting for trouble but keeping us healthy.  We need that guarantee for every person, and most urgently – most importantly – for the least advantaged among us – children, elders, and those in or near poverty.  Liberty and justice for all means health care for all.  All means all.

This nation has one health care insurance system that actually does that, but only for elders.  It’s Medicare.  It’s the step we took in 1965 that ended for our seniors the fear that they will not have health insurance, and, more than that, that established a publicly accountable, transparent system of insurance to serve them.  For 17 months as President Obama’s Administrator for Medicare and Medicaid, I got to lead that system – Medicare. I got to fight every single day for the interests and wellbeing of nearly 50 million people.  And I did that with an administrative budget – overhead – of 1% of what we spent on their care.  Of every Medicare dollar we spent, 99 cents – 99% went for care, itself. 

Elders have that now in America, and just you try to take it away from them.  If anyone made a move to end Medicare now, 50 years after it began, there would be a public outcry so fierce, that the idea would be drowned out instantly.  “Don’t you touch my Medicare,” they would say.  50 million would say that.

But, what about the rest of us?  Who’s got our backs – or, more accurately, who’s got your backs? Because I qualify for Medicare now, and don’t you think of touching it!

The politicians in Washington backed away from the next, logical step toward publicly accountable health care coverage for all when it rejected a single payer plan – or even a public option – in the heat of the Affordable Care Act debate.  The vested interests of the status quo – insurers and others – put up a fight to preserve the complex, unaccountable, opaque system of payment that we have today.

The result?  Waste, confusion, complexity, and opacity. 

  • Waste, because the private sector insurers spend over 10% of your premium dollar on overhead, not 1% of your money, like Medicare does. That wastes your money – that comes right out of your pocket.
  • Confusion and complexity, because your doctor, your nurse, your hospital administrator and you spend hours of time and billions of dollars sorting out varying coding systems and billing rules and approval processes and coverage determinations.  They don’t get to ask, first, “What do you need?” but rather, “What is your coverage and who insures you?”   Just try to understand it, and see how far you get.  Try it… give your insurance company a call and ask how they decide – and who decides – that you can have Test A, but not B, or Drug X, but not Y.

And then, once you do have the coverage, who stands up for your interests?  Who goes to the mat to make sure that your care is safe, and world-class, and available?  That it respects your choices and your culture and preferences? 

Medicare does.  By law, it has to.  When I ran Medicare, I spent days and days implementing and overseeing the surveys and studies of care that Congress required us to do, to make sure the care was as good as it could be.  I helped develop and launch the largest patient safety program in the history of the world – the “Partnership for Patients,” it was called – to help hospitals reduce injuries and errors in care all over America.

  • And opacity – the lack of transparency.  Who can see into the windows of today’s health care coverage industry?  Only one system of coverage in our nation is required by law to release data on health care’s performance, to explain in detail how it arrives at coverage decisions, and to tell everyone how much it is paying and to whom:  Medicare!

They say it can’t be done: Medicare for All.  I say they are wrong.  They said we couldn’t cover everyone, and we did it – in 2006.  Now we can prove the naysayers wrong again.  We can create and manage a simplified, transparent, efficient, and fully accountable single health care payment system in Massachusetts.  And we can make it work for the people.

Critics – those who are benefitting from the status quo – will mouth words about a government takeover of health care.  Don’t you believe them!  Under a Massachusetts single payer system, we can and we should keep the exciting and productive pluralism of health care provision that we have today – hospitals, clinics, doctors, and integrated systems of care can and should continue to be independent, some public and some private, and, when it is useful, they can and should compete with each other. 

What will be new with single payer is that now you – the people – have a potent way to speak with those who give care about what we need, what we want, and what we will pay for.  You can say that mental health services are deficient in this state, and you want it fixed.  You can say that we need health care to defeat the epidemic of substance abuse that is killing our people.  You can say that you want energy and money devoted to prevention – real prevention.  You can say that you expect safe care, and care that respects the cultural and linguistic diversity of our communities.  You can say that you want home care, and better respect for home care workers.

And we can say that we want every nickel and dime of our hard-won wages that we spend on health care to buy health care and health  – not paperwork, billboards, corporate headquarters, or confusion.

Let’s lead, Massachusetts!  We can show this nation a pathway to health and victory over illness, and a pathway to respect what health care really should be for patients, families, doctors, nurses, hospitals, clinics, and the hundreds of thousands of Massachusetts health care professionals who want to be able to do the work that adds meaning to their lives.

People often ask me if I’m a one-issue candidate, whether I have ideas for the future of our Commonwealth beyond health care. My answer: Of course I do. I want our education system to be the envy of the world. I want to end child poverty and chronic homelessness. I want us to have the most ambitious energy and environmental agenda in the nation.  And I want jobs and an economy that gives everyone the opportunity to thrive.

But, I will tell you this:  If you care about education, if you care about transportation, if you care about ending hunger, and homeless, and poverty – then you have to care about health care.  If you think that “all” means “all,” as I do, then we had better have in that corner office a Governor who understands what great health care looks like. 

Health care is now 42% of our state budget, and it has gone up 59% in the past decade.  Without reform – serious reform – bold reform – health care in Massachusetts, like health care in the nation, will continue to erode possibilities and investments in the public and private sector alike.

We can have better care, better health, and lower cost all at the same time if – and only if – we commit to shaping a system of care that focuses every step of the way on the needs of the people it serves. 

And the front door to that change – a crucial step on the way to health – is a financing system, at last, that makes sense: single payer.  Medicare for all. It’s right; it’s possible; and it’s time.

Join me. If I am your Governor, we will go to that better place.  We will make Medicare for all a reality. And we will be, as we have been before, an example of reason and compassion and justice for this troubled nation.”


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