Over the past few weeks I have written to you about two of the costs crushing families across Massachusetts: housing, where I laid out how we could build 100,000 permanently affordable homes with public financing, and utility bills, where I showed how we could build toward publicly owned energy rather than writing blank checks to giant utility companies. Today I want to talk about the third pillar of the affordability crisis, because health care costs in Massachusetts are the highest in the country. And just like with housing and energy, this is a problem the State House has the power to solve directly and has chosen not to.

Nowhere is the cost more consequential than for our older neighbors. Massachusetts is now the most expensive state in the nation for older adults to cover their basic needs, according to the UMass Boston Elder Index, which measures the cost of housing, food, health care, and transportation county by county. Sixty percent of Massachusetts residents over 65 who live alone do not have enough income to cover those basics, one of the highest rates of elder economic insecurity anywhere in the country. In Somerville, older residents on fixed incomes have to get by on roughly $30,000 a year while the cost of remaining in the community they built has climbed past $37,000 for a single older renter, and it keeps rising. When rent, utilities, and health care all hit record highs at once, the people who spent their working lives making our communities what they are get priced out of them, and that is exactly what is happening across Massachusetts right now.

As a state, we spend $128.57 billion a year on health care, which works out to more than $18,000 for every person in Massachusetts, yet the State House refuses to take action. And over 42 percent of that spending goes to things that have nothing to do with keeping you healthy: insurance company administrative fees, the armies of billing staff hospitals hire to fight with insurers over what gets covered or doesn't, and prices inflated by hospital systems and drug companies with the market power to drive up costs. I spent my career before the legislature as an antitrust economist, and this is what a broken market looks like when nobody in power is willing to confront the corporations profiting from it.

There is a bill sitting in the State House right now that confronts our broken healthcare system. The Medicare for All bill, which I proudly cosponsor, would create a single public payer system covering every Massachusetts resident for everything medically necessary: doctors, hospitals, prescriptions, mental health, dental, vision, hearing, and long-term care without premiums, deductibles, or copays. You get to keep the doctors you have and gain the freedom to see any licensed provider in Massachusetts, because when everyone carries the same public coverage there is no such thing as “out of network.” And if you are on Medicare today, you keep everything you already have and gain dental, vision, hearing, and long-term care, and the supplemental plans you pay premiums for today become unnecessary.

The independent economic analysis, updated this January by economists at UMass Amherst, shows that we would save nearly $30 billion with Massachusetts Medicare for All and shows exactly where the savings come from. The two biggest sources are the ones the insurance industry least wants you to look at: administrative waste and monopoly pricing. Cutting insurance administration to Medicare's levels and freeing doctors and hospitals from the billing bureaucracy saves $23.75 billion a year all by itself. Further, using the bargaining power of a single agency negotiating for seven million residents, the same way the VA already negotiates, brings hospital prices, physician prices, and drug and medical device prices down. Because every hospital gets paid the same fair rate for every patient, with nobody uninsured and nobody underpaid, all hospitals can afford to stay open.

Here is how we pay for it: the Massachusetts Health Care Trust starts with the $63.09 billion in federal and state money already flowing through Medicare, Medicaid, and other public programs, and replaces everything you currently pay in premiums, deductibles, copays, and out-of-pocket costs with four taxes that add up to far less:

For a worker earning $60,000, that 2.5 percent comes to $1,000 a year, in place of premiums, deductibles, and copays that routinely run five to ten times that amount.

Over 98 percent of Massachusetts households will pay less than they do now, with the biggest savings going to households earning under $75,000, and the small share who pay more are the highest earners and those living on capital gains and dividends. For union members who gave up raises at the bargaining table, contract after contract, to hold onto health benefits, every dollar your local chapter no longer has to spend defending coverage becomes a dollar on the table for wages. This is why nurses and unions across Massachusetts have championed this bill for years. And for employers, 7.5 percent of payroll replaces family-coverage costs that routinely run far higher, while the small businesses that could never afford to offer benefits at all gain the power to compete for workers with the largest companies in the state.

Those four taxes raise $46.01 billion, bringing total revenue to $109.1 billion against a $98.7 billion system cost, leaving a $10.4 billion cushion for contingencies in the very first year. My partner is a nurse, and I have watched what our current system does to the people who deliver care and the people who need it, so when the numbers say we can cover everyone, save money, and still bank a surplus, the only remaining question is political will.

When Medicare for All was on the ballot as a non-binding public opinion question in 2024, it won all eleven districts where voters weighed in, averaging 64 percent support, including in districts that voted for Trump. For decades this bill was quietly killed in committee without a recorded vote and without anyone having to answer for it. But this session, for the first time in 30 years, it advanced out of committee. That movement was only possible because we organized and won the fight to put every single committee vote on the record, and legislators can no longer bury it anonymously while premiums climb and older neighbors leave the state.

Now we build on that momentum and refuse to settle for half measures or incremental fixes around the edges. I have no interest in trading the real thing for a study commission or a pilot program when 64 percent of the voters and an answer for funding are already sitting on the table. It's true that the full system will need federal waivers that today's Washington will not grant, but that is an argument for moving now rather than waiting; building the architecture today is how Massachusetts stands first in line the moment Washington is ready, exactly as our 2006 health reform positioned us when the Affordable Care Act arrived.

I am running for State Senate because these fights connect. The same inside-outside organizing that banned broker fees, stopped the utility blank check, and just pried this bill out of committee is how we win the whole thing. We can build the coalition that makes protecting insurance industry profits politically impossible. Fearless, not reckless: the numbers are on our side, the voters are on our side, and what is missing is leadership willing to push our own party to do the right thing the first time, not after it is already safe.

The primary is September 1, and the way we win it is the same way we win everything else, by talking to our neighbors. Please join my team for a canvass shift or a phone bank in these final two weeks, because every door we knock is a conversation about the Massachusetts we can actually build together.

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Paid for by Committee to Elect Erika Uyterhoeven · Somerville, MA
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