Middleboro Review 2: Affordable health care for all is the easiest problem to solve in Massachusetts

Sunday, September 28, 2025

Affordable health care for all is the easiest problem to solve in Massachusetts

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Affordable health care for all is the easiest problem to solve in Massachusetts

September 28, 2025

By alan sager

Health care spending in Massachusetts is just about the highest in the world. It is enough to finance health security for all of us. Health security means that we get care that’s effective, competent, quick, and kind—with no more than tiny co-payments and no worry about medical debt. To redeem the promise of plastic insurance cards, health security requires having enough good doctors, dentists, nurses, hospitals, and other caregivers where we need them.

That doesn’t make health security for all easy to win—just easier than housing, education and job training, global warming, personal and national security, decent living standards, or the other huge challenges we face. Because we already spend enough on health care to get the job done.

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Unfortunately, we won’t get even one step closer to affordable health security for all by nibbling around the edges of the problem. That includes following the well-intentioned but deeply flawed recommendations that the CEO of Blue Cross Blue Shield of Massachusetts, Sarah Iselin, set out in a recent CommonWealth Beacon commentary.

Her proposed remedies are modest. Even so, they are not likely to be implemented. If they were, they would do little good because they don’t attack—or even identify—the causes of high costs, weak access, and caregiver shortages. How can a problem be successfully treated if it isn’t correctly diagnosed?

Blue Cross’s imaginary world

Iselin asserts that “Our state has a chance to make big changes in our health care system right now—the kind of transformation that can only come about in a crisis.”

But who in our state will take that chance? Most politicians mean well but none yet face strong political pressure to fix health care. Our governor wasn’t elected because she knew a lot about health care. Our legislative leadership knows less—apart from a few terrific committee chairs. And the Health Policy Commission’s two new members are the head of the state hospital association and a drug company executive, each an informed insider who seeks not transformation but simply higher revenue for their sector.

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Many citizens and caregivers are suffering already, but their crisis hasn’t translated into political pressure for serious change.

When it comes to lobbying in Massachusetts, it’s no surprise that health insurers, hospitals, and others in health care are eight of the top 12 spenders, as reported earlier this year.

Iselin claims that “We have an excellent track record in our state of collaboration between health plans, clinicians, business, labor, and policymakers.” Sure, but that happy harmony has been lubricated by ever more money each year for business as usual. The throats of that harmonious chorus will go dry after the last remaining dollar is pumped out of the financial aquifer.

State government has for decades refused to put its arms around health care and understand our cost or access or caregiver problems—or their causes. It did pass a law in 2012 requiring an assessment of needed hospitals and other caregivers, but then simply walked away from implementing that law. So state government still doesn’t know which hospitals are needed, or how many doctors we need or even have. And it has refused to forge the financial and legal tools to sustain needed caregivers.

Still, it’s encouraging that so many smart and knowledgeable and dedicated people already work in health care in state government and elsewhere. They will be able to help fix our health care, once the people at the top face political pressure to get serious.