Massachusetts Joint Comittee on Public Health

October 20, 2009

Boston, MA

Thank you, Madame Chair and Members of the Committee for the opportunity to testify this morning. My name is Iyah Romm, and I am a medical student at Boston University School of Medicine. I also serve as a national leader of the American Medical Student Association (AMSA), where I am the New England Regional Director and Co-Chair of the Health Care for All Steering Committee.

In my capacity as a medical student and AMSA leader, I am here today to offer the perspective of a large cohort of physicians-in-training regarding the broken health care system in which we are training, and which we will inherit. With respect to this system, AMSA believes the following:

1. Health care is a fundamental human right and is the single greatest moral imperative for our generation. We, even in the Commonwealth, are woefully failing to ensure quality, affordable, health care to all of our residents.

2. Medicine and the entire health care sector must serve the public good over private industry profits.

3. The best solution to our health care crisis is a single-payer system of publicly funded, publicly accountable, privately delivered, quality, affordable health care for all.

With 62,000 members, AMSA is the oldest and largest independent association of physicians-intraining in the US and has a rich history of advocacy on issues affecting our current and future patients. In fact, AMSA was borne from a seminal moment in the history of our health care system – the establishment of America’s own single payer system, Medicare. As an organization of future physicians, AMSA is committed to advancing a legislative agenda that reflects this history and basic principles.

While Chapter 58 reform has resulted in modest improvements in health insurance coverage, health care costs are spiraling out of control – even in Massachusetts.1 Despite a health insurance market dominated by not-for-profit insurers, premiums are expected to increase by 7-12 percent next year. In 2008, Massachusetts had the highest family coverage premiums in the country – $13,788 on average. These costs are being deflected onto the residents of the Commonwealth and are overwhelming state, municipal, family, and individual budgets and livelihoods. Public services are being slashed resulting in difficult choices and erosions of coverage.2 The long-term sustainability of “universal coverage” in Massachusetts is in peril. Clearly we cannot allow this trend of misprojection to continue at the expense of our patients and our friends, our neighbors, our sisters, and our fathers.

The individual mandate is a unique element of Chapter 58; many other components have been implemented previously in other states on differing scales. As we have seen in those other states, including but not limited to Maine, Minnesota, and Oregon, coverage has increased following reform. But these expansions in coverage have fallen short of the elusive goal of universality and true access for all3 – each time sabotaged by lack of financial sustainability. The culprit? Continued reliance upon commercial insurance markets as the gateway to care and the false hope of competition as a means of “bending the cost curve.”

By definition, incremental reforms explicitly limit access if not decrease the quality of coverage through many ‘crowd-out’ mechanisms to prevent the collapse of the private insurance sector – a necessary sequela of universal health care. Three years after implementation of Chapter 58, we have yet to see anticipated significant gains in coverage or affordability. In 1987, 7% of Massachusetts residents were uninsured – today, the sum is 3%, at best. Moreover, many Bay State residents struggle with skyrocketing premiums seemingly unhindered by the enhanced “competition” fostered by Chapter 58 and the Connector. And without comprehensive reform, the number of uninsured – and number of individuals qualifying for hardship exemption – will continue to rise unchecked. If I were to lose my university-provided insurance, I would be forced to spend exorbitant sums for minimal coverage.

Incremental reforms have focused on the crisis of uninsurance rather than the ultimate goal of ensuring access to quality, affordable health care. Expansions in health insurance coverage do not guarantee concurrent expansions in access. Through high deductibles and other cost-sharing mechanisms, commercial insurers continue to erect financial barriers to care. Indeed, despite purported universal coverage, one in six Massachusetts residents was unable to pay his or her medical bills last year. The result? Many Commonwealth residents are still forced to forego medically necessary care. Such practices by private insurance companies render expansions in coverage meaningless – and ultimately more costly. These are the patients that my peers and I do not see on our primary care rotations; rather, they still present unnecessarily in the Emergency Department with preventable conditions.

Recent funding cuts have torn gaping holes in our ‘safety net,’ with those clinics and hospitals committed to the underserved suffering under massive budget shortfalls – including Boston Medical Center where I study. In the hospital, I see how these shortfalls have resulted in staff reductions that ultimately threaten the quality and availability of care. And we have begun down the slippery slope of tiering coverage with, for example, the recent benefit restrictions imposed on legal immigrants.

Single payer is the only responsible health care reform option. The vast majority of our seniors are satisfied with Medicare; in fact, many patients anxiously await Medicare eligibility because of the program’s guarantee of both coverage and access. Labor unions and advocacy organizations across the Commonwealth support a single payer system, as do the majority of health care providers.4 These groups — these constituencies — recognize that single payer is the best system in which to guarantee quality, affordable, health care for all. Across the country, politicians, policy-makers, and citizens are looking to Massachusetts as a beacon of hope on health care reform. The private insurance industry has had eight decades to lead change, to shift from a world predicated upon a race to the bottom to culture of innovation and care. But their time has passed. Your Committee has the opportunity to truly provide that light. I hope you will offer the leadership necessary to reform our system and to address one of our greatest moral failures of the last fifty years. Only a single payer system can provide the change we need – simplifying payment, eliminating unnecessary bureaucracy, and investing the subsequent savings into a solitary goal, providing care to all. The math is simple, the morality pure, and the passion indefatigable. As a future physician, this is the type of system in which I aspire to practice medicine.

Thank you very much for the opportunity to share this perspective.

1. Steinbrook, R. Health Care Reform in Massachusetts — Expanding Coverage, Escalating Costs. N Engl J Med 2008 358: 2757-2760

2. Sack K. Massachussetts Faces Costs of Big Health Care Plan. NYT, 2009.

3. Long S, Masi P. An update on health reform in Massachusetts, fall 2008. Health Aff (Millwood). 2009;28(4):w578–87

4. McCormick D et al. Single-Payer National Health Insurance: Physicians’ Views Arch Intern Med. 2004;164(3):300-304.