THE BEST MEDICINE
Loretta McLaughlin

No less a bastion of conservatism than the Massachusetts Medical Society has paid $100,000 for studies -- Are you ready for this? -- of a single, unified system to finance comprehensive health care for everyone in the Commonwealth, all 6.1million of us.

Best of all, the studies find that a far broader range of coverage, including prescription drugs and many elements of long-term care at home and in nursing homes, could be delivered for millions of dollars less than is now spent for the patch work system of health care here. Further, there would be few to no co-payments or deductibles.

A single-payer approach to health care, according to the analyses sponsored by the Medical Society, provides far more care for many more people for far less than the complex  multi-payer system in the state and country.

Of course, Canadians who have long known the savings and worth of single-payer health care,  along with multitudes of Americans who want the same system, have tried for decades to convince  the politically hidebound among physicians of this medical economic truth. So it is to the credit of
the Massachusetts Medical Society that it set up a task force to seek comparisons of single-and- multi-payer approaches and approved "informational" studies of them.

Through an odd set of circumstances, the project has become an open secret in the state Legislature. Since last December, summaries of the studies have been in the hands of the state Senate Ways and Means Committee. In 1997, to avoid the expense of similar studies, the Senate agreed to accept the data from the society's funded analyses.

And the core findings from the studies, plus a little historic perspective, have appeared for weeks on the MMS Web site on Internet in a place accessible only to members.  The work was done by the Lewin Group of Washington, D.C., and Solutions for Progress of Philadelphia in association with professor Alan Sager and research analyst Deborah Socolar of the Boston University School of Public Health.

Meanwhile, monitoring the by play between the Legislature and Medical Society are the health care reformers and members of the political action committee Mass-Care, which originally persuaded the Senate to explore a single-payer system. In view of the potential for huge tax savings and in health premiums for business and workers, these health-care reform advocates want the Senate to release the analyses now.

"Will we continue to waste money on a bloated multi-payer system while the Ways and Means Committee sits on the results of the studies?'"  Mass-Care asks in a memo to its members across the state.

The hitch at this point is that all sorts of "stipulations'" have been placed on the studies in an effort to protect the privacy of the contents as copyrighted material. The Medical Society feels it would be  impolitic to reveal the details before the annual meeting of the full membership in May. That would sully the process by which such "internal" matters are handled, says a spokesman.

However,  trying to remain quiet about the analyses until next May has little appeal for the Senate Ways and Means Committee, particularly when the material concerns taxpayer-paid health costs and the prospect of covering all the state's residents. After all, the state had intended to do the same studies two years ago.

Those who have seen the studies know they are thorough, well done, rich in detail, and coming to largely similar conclusions, even though the timetable varies modestly for implementing coverage, phasing in current state and federal programs and their funds, and realizing savings.

The studies envision giant reductions -- in the neighborhood of $1.5 billion to $2.2 billion a year within Massachusetts for the total of all public, private, and personally paid health care. In 1999 that overall health care cost is expected to add up to $36 billion.  Understandably, the bulk of savings under a single-payer system would come from giant reductions in corporate health insurance expense, the cost of administering coverage (sorting out claims from thousands of different plans, billing, and collecting co-payments and deductibles).

Enormous savings could result from bulk purchasing of prescription drugs. There would be an end to the costly cost-shifting that saddles workers and employers who responsibly buy health insurance with the bill for free care for the uninsured and underinsured. One possibility is to set up a state-authorized trust fund to collect, hold, and disburse the health care funds. At issue in large part is how "pluralistic"  the reimbursement of physicians can be under a single-payer system.

An insistence upon pluralism is the political ground upon which the Massachusetts Medical Society has always stood in the face of any proposal for universal health care -- even in this case, where the  proposals were ordered and paid for with its own funds. Yet Medical Society policy nowadays is conditionally receptive to universal coverage. Possibly some form of single- payer system may ultimately be acceptable as well.

As never before, doctors struggle daily with serious limitations on how much time, testing, and treatment they are allowed to give patients under managed- care insurance plans.  By and large, doctors fought President Clinton's proposal for national health care coverage, seeing it as more big
government intrusion.

But many doctors now regret that they have been left to the mercy of health insurance companies without counter balancing government protections so doctors can remain the primary makers of medical decisions.  Nevertheless, no one doubts that a lot of wiggle room will be needed for negotiating the shoals of coverage -- and control -- if a single-payer system is to come to
pass in Massachusetts.

McLaughlin is former editorial page editor of the Boston Globe.