Saturday, December 4, 2010

Massachusetts Voters Appear Ready to Embrace Single Payer

By FireDogLake's Jon Walker

Massachusetts is considered one of the most liberal states in the country. It has already adopted a private insurance-based, near-universal health insurance system under Republican Governor Mitt Romney. Given that, it should come as no surprise that, in a large swath of the state, voters signaled their willingness to adopt a universal single-payer health care system, similar to “Medicare for all.”

Massachusetts allows for citizens to place non-binding, local “public policy questions” on the ballot. In precincts containing around 10 percent of the state’s population, the Massachusetts Campaign for Health Care Justice put on the ballot a question asking voters whether or not to instruct their local representative to “support legislation establishing health care as a human right regardless of age, state of health, or employment status, by creating a single-payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?” As of today, in the precincts reporting 62 percent voted yes.

How would this 62 percent support in these local precincts translate to the level of support statewide?

As done previously for the marijuana legalization public policy question, I did, where possible, a town-by-town analysis comparing the results for the single-payer question to the results of the 2010 governor’s race and the 2008 presidential contest. (Note: precincts not fully reported, and a few towns that are split between two state House districts, had to be dropped from the analysis.)

In the towns compared, the voters were only very slightly more liberal-leaning than the entire state. This year, in the towns examined, the liberal-leaning gubernatorial candidates, Democrat Deval Patrick and Green Jill Stein, combined for a total that was roughly only three percentage points higher than their share of the vote statewide. Compared to the 2008 presidential election, the towns examined only supported Barack Obama and the liberal third-party candidates by roughly two percentage points compared to voters statewide.

A projected 59 percent support for single payer

By comparing the samples, I conclude that the towns I examined in my analysis are fairly representative, and if the single-payer question had appeared on the ballot across the whole state this year, it would have received a Yes vote of roughly 59 percent, just slightly less than it did in the local precincts.

That is a strong majority for a state single payer system, especially given that this midterm election saw a big Republican wave with unusually high conservative turnout.

I did the same analysis based on the results of a near-identical single-payer public policy question placed on the ballot in several districts in 2008. While the districts where it was on the ballot were significantly more liberal than the state as a whole, my analysis leads me to believe that roughly 69 percent of the 2008 electorate supported single payer. 2008, of course, was a Democratic wave year, and showed unusually high liberal and youth turnout.

This swing on a liberal issue is similar to the generic ballot swing from Democrat to Republican that we saw in the last two elections. I suspect in a more normal election, with a more normal turnout, demographic support would fall somewhere in between.


It appears the voters of Massachusetts are open to embracing universal single-payer health insurance, which would be substantially more progressive and cost effective than their current private-insurance-based system. With the state struggling to pay for their inefficient, subsidized private system It is a reform the state should seriously consider.

I would hope to see that if there were broad support among the electorate for single payer, the Democrat-dominated Massachusetts state government would choose to implement this better policy. Unfortunately, as we have seen at the national level, the health care industry has a powerful ability to crush smart reform. If the elected officials refuse to act, single-payer activists should keep in mind that there is at least potential majority support for taking the issue directly to the voters through the initiative process. Something the state of Massachusetts allows.

Some Caveats– Most of the caveats of my marijuana legalization analysis also apply. There is a fair amount of vote drop-off down the ballot. For example, it is likely supporters of single payer were slightly more likely to indicate their support for this non-binding question, while those mildly opposed chose to just skip it.

Most importantly with an issue like this: details are critical. Many of those who in general support single payer might oppose a specific proposal based on how it is paid for and how it affects their current insurance. If single payer activists do try to advance the issue through a binding initiative, getting the details right politically and policy-wise could prove a very complicated task.