The rising cost of health care continues to be a primary issue in modern America, and many people feel that the federal and state governments are not doing enough to combat the problem.

In response, organizations, communities and public officials across New England are working toward a solution of their own: pushing for a single-payer health care system, town-by-town.

The problem

According to a University of Massachusetts Amherst economics expert, health care in America costs too much for the average person.

“The United States, as a country, consistently underperforms comparable countries in both health outcomes and the cost of care,” said Auden Cote-L’Heureux, a UMass Amherst graduate who is now a master’s student in economics at the University of Bonn in Germany. “If you look at comparable countries, we pay way more per capita for health care, and we have worse health outcomes, including lower life expectancy.”

In 2024, for example, the United States spent nearly $15,000 per person on health care, resulting in an average life expectancy of about 79 years, according to the Peterson-KFF Health System Tracker. By comparison, Germany, considered a global leader in health care, spent around $9,400 per capita in 2024, with an average life expectancy of 81 years. The United Kingdom, where the average life expectancy is also 81 years, spent less than $7,000 per person.

At a Joint Committee on Ways and Means hearing in March, the rising cost of health care became the focal point. Educators, teachers unions and school administrators pleaded with lawmakers for help. At that hearing, Sen. Jacob Oliveira, D-Ludlow, said, “The rising cost of health care [is] crippling our cities and towns. It’s crippling our state.” Oliveira noted that while the state provides extra dollars for many expenses that districts struggle to fund, there is no such account to help pay for rising health care costs stemming from labor negotiations.

Against this backdrop — and the federal government’s failure to extend Affordable Care Act (ACA) subsidies — individual communities in Massachusetts are now formally supporting a single-payer health care system. At least 23 municipal councils across the state, including Springfield, Northampton and all of Barnstable County, have passed resolutions supporting an “An Act Establishing Medicare for All” in the state Legislature. These communities represent approximately half a million residents.

“The cost of health insurance is kind of insane. In the last few years since I’ve been on council, it’s gone up about 10% per year for each city employee that’s covered,” said Deborah Klemer, vice president of the Northampton City Council. “It’s just adding so much cost to our budgets.”

Klemer worked in the health care system for years, and has witnessed firsthand the shifting trajectory of health care costs in America.

“When I first started working in radiology in 1983, I had great health care. No co-pays. I just went to a doctor and got covered and got everything paid,” Klemer said. “I remember in the ’90s, it started changing, and there were co-pays and less care. It got worse and worse. … You have to jump through all these hoops, and you know you’re not getting good care, either, for the money you pay for health insurance.”

Klemer noted that employer-based health insurance often leaves people feeling stuck in jobs they didn’t enjoy, and argued that a single-payer system would give people more freedom to pursue work they are passionate about without worrying about losing coverage.

The idea of implementing single-payer health care “does seem to be gaining momentum, and I think now we’re at this tipping point where it’s just so unaffordable for so many, and people are starting to wake up about it and fight for it,” Klemer said.

Farther north, Greenfield, which passed its single-payer resolution in 2025, is also experiencing the harsh economic effects of rising health care costs.

The resolution was proposed by the Greenfield Human Rights Commission “because of the belief that health care is a universal human right and need for people,” said City Council President Lora Wondolowski.

“If you look at Greenfield, our health insurance costs went up by more than 15% last fiscal year. The next fiscal year, the proposed increase was another 19%. It’s crippling our town budget,” Wondolowski said. She said a single-payer system “would decrease our costs by like $6 million.”

Wondolowski expressed a similar sentiment to Klemer, saying that the momentum for establishing a single-payer system in Massachusetts “gives me hope.”

“Frankly, communities all across this area and across the state are facing huge health insurance costs at the same time as people are getting kicked off of insurance,” she said.

Affordable health care is nonpartisan

In addition to broad community support, establishing a single-payer health care system is popular on the individual level, even in traditionally conservative districts. In 2024, the Massachusetts Campaign for Single Payer Health Care, known as Mass-Care, ran a nonbinding public policy question in 11 districts.

The measure won in all 11 districts with an average “Yes” vote of 64%. In two of the districts — the 3rd Hampden and 4th Hampden — Medicare for All won even as the districts voted for Donald Trump, Mass-Care notes.

“We ran the ballot question in (Nicholas) Boldyga’s district. He’s a Republican, he’s MAGA. We won in the 50s when we ran it in those kinds of districts,” said Jon Weissman, a member of Mass-Care’s board of directors serving western Massachusetts.

“The average [support] over the years is two-thirds. I say to myself, ‘Two-thirds, oh that’s kind of low,’ because I’m used to what we got in Amherst, or what we got in Leverett, or even in Granby, certainly in Northampton, where they’re up in the 70s and 80s,” Weissman continued.

Some proponents of a single-payer health care have argued for a regional system modeled after the European drug-price-negotiation system. Such regional health care coalitions are not novel to the United States; in 2025, California, Oregon, Washington and Hawaii formed the West Coast Health Alliance to “uphold the integrity of effective public health strategies.”

According to an official with Maine AllCare — an organization advocating for publicly funded health care coverage in Maine — regionalization of the single-payer effort could prevent smaller states from being taken advantage of by insurance companies and medicine suppliers. The organization contends that regional cooperation should initially focus on groups of smaller states working together to negotiate and purchase prescription drugs. He added that broader interstate regulation of health care and financial systems would likely be too complex to manage.

Opponents make case

Despite the positive economic outcomes of implementing a single-payer health care system demonstrated by Mass-Care’s economic analysis, some institutions remain opposed to the idea.

In a March interview, Bill Rennie, senior vice president of the Retailers Association of Massachusetts, said the increased tax rates necessitated by such a system “would have a very devastating, kind of killing, effect on the economy, and it would be something that would incentivize businesses and employees to bleed the state.”

Rennie identified drug providers, rather than insurers, as a major factor in rising health care prices.

“Cost is still the primary concern that we really need to try and get a hold of,” Rennie said. “And from our point of view, a lot of it’s on market control of certain providers.”

Wondolowski identified insurers as a significant part of the problem, saying that “we have an insurance lobby that’s really strong in the state, and so there’s a lot of money and lobbying that comes from the insurance industry.”

In a 2025 statement to the State House News Service, Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, which represents insurers, said that “mandating a one-size-fits-all, government-run health care system would eliminate meaningful health care choices for patients and require dramatic tax increases on residents and employers across the commonwealth.”

Pellegrini also identified providers as a core issue, stating that implementing a single-payer system would “divert attention from the urgent work needed to control the actual drivers of rising health care costs, namely, unchecked provider prices and the skyrocketing cost of prescription drugs.”

Massachusetts at vanguard

Many Massachusetts residents remember the passage of “Romneycare” 20 years ago, which provided a strong model for the federal Affordable Care Act of 2010. Even though Romneycare helped provide health insurance to nearly every person in the state, some people say it wasn’t enough.

According to Weissman, the constant Republican attacks on the ACA precluded further progress in reforming the health care system.

“Every session of Congress, you’re defending it against the right wing,” Weissman said. “It just means everyone in the Legislature, in Massachusetts in particular and in Congress especially, they get to say, ‘Oh, we can’t touch this thing. We have to defend it as is.’

“We’re not asking them to tinker with it or touch it or improve it at all. We’re talking about going back to the Medicare system and improving that,” Weissman continued. “We never said we were working to improve the ACA. We were working to improve Medicare.

“No matter how you think you’re going to pass single-payer, you have to have the largest grassroots movement Massachusetts has ever experienced,” Weissman said. “You can propose halfway measures — the public option for instance — but in order to get that out of this Legislature, you need the same size movement that you need for the whole shebang. So why not just go for the whole shebang?”

The current Massachusetts single-payer bill, co-sponsored by Rep. Lindsay Sabadosa, D-Northampton, is still in the Joint Committee on Health Care Financing. The reporting date was extended to June 15.

“We are working with the committee to see if we can find a path forward,” Sabadosa said in an email. “I’m keeping my fingers crossed.”

James Noyes writes for the Greenfield Recorder as part of the Boston University Statehouse Program.

Original source: us