MinnPost photo illustration by Corey Anderson
Single-Payer Six: from left, Thissen, Kelliher, Marty, Bakk, Rukavina, Dayton.
It is reasonably likely that single-payer health care will be on the ballot in Minnesota in 2010.
Sound crazy? Maybe it is crazy.
Although single-payer is popular on the left, the common political wisdom is that a plan that could (and would) be labeled socialized medicine is a political impossibility in America. Barack Obama, who used to favor single-payer, dropped it when he ran for president.
As a Senate candidate, Al Franken took the position that although single-payer would be the best approach, it was not possible in today's political environment. John Dingell of Michigan, the longest-serving member of the U.S. House, has introduced a single-payer bill in every congressional session since he was elected in 1955. But it has never gone anywhere.
When Senate Finance Committee Chairman Max Baucus set out this year to create a bill to provide health care to all Americans, he started saying that representatives of all points of view on health care reform — except single-payer advocates — were welcome at the negotiating table.
So perhaps you will be surprised to know that at least six of the 10 DFL candidates for governor not only support single-payer but support a plan that would make Minnesota a first-in-the-nation, one-state-only, single-payer state.
It starts with state Sen. John Marty of Roseville. In 2007, Marty introduced a bill that would end private for-profit health insurance in Minnesota and replace it with a plan of taxpayer-financed public health care that would cover every Minnesota resident, from cradle to grave (Marty actually uses the term "cradle to grave" when he describes it) for all of their health care needs, including mental health parity, chemical dependency treatments, pharmaceutical coverage and even dental. The plan would have no co-pays or deductibles.
Of course, Marty is known more as a visionary liberal than as a pragmatic politician. But his bill has now acquired 71 co-sponsors in the Legislature and has been passed by two Senate committees. You'll find more on the plan, which Marty named The Minnesota Health Plan, here. Legislative support for the plan is definitely growing. It's crazy, but not completely crazy, to think that such a bill could pass.
(It is important to note that there is no specific plan at present for raising the revenue to pay for the plan. Marty argues that the revenue should not be called "taxes" but "premiums." But they will look and feel a lot like taxes. He argues that most Minnesotans will end up paying less than they pay now in health insurance premiums.)
Support for Marty's bill
Of course, if such a bill ever did pass, I assume it would have little chance of being signed into law by a Republican governor. To be honest, before the last few weeks, I would have said that it was unlikely that even a DFL governor would sign such a bill. And I would have predicted that no candidate from any of the parties would think they could get elected on a single-payer platform. And maybe that's true, but a lot of this year's DFL candidates apparently don't think so.
As I've listened to the DFL field talk about health care, I've been surprised at the number that explicitly endorse Marty's bill.
State Sen. Tom Bakk of Cook and state Rep. Tom Rukavina of Virginia are co-sponsors of the Minnesota Health Plan.
Speaker of the House Margaret Anderson Kelliher of Minneapolis took everyone (including Marty) by surprise at a Hopkins debate in November by announcing that she supported Marty's bill. Marty asked her why she was not a co-sponsor, and she quickly replied that she would sign up.
Although that announcement seemed to come out of the blue, the next time I caught the DFL guv candidates — Dec. 7 at Macalester College — she repeated her support for the Marty bill and said that he had arrived at that position after much thought and study. Kelliher is generally considered one of the front-runners for the DFL endorsement. And, as speaker, it's unlikely that her thinking is way out of line with mainstream DFLers in the House.
Former U.S. Sen. Mark Dayton, also considered a serious contender for the DFL nomination, said at Macalester that Marty's bill represented his preferred approach and that, as governor, he would ask the Legislature to pass the bill and he would sign it.
Rep. Paul Thissen of Minneapolis, who chairs the Health Committee of the House, said that he wanted to commend Marty for his bill. I wondered about that word choice (he could commend the senator for his work on the bill without actually favoring it), so I called Thissen, whose expertise on health care is a key part of his pitch to become governor.
Thissen said Marty's bill had come up before his committee in 2009 without coming to a vote. I asked him why not. He said he hadn't brought it to a vote because he wasn't sure it had the support to pass. But his own position, Thissen said, is that he would have voted for the bill in committee and, "if that's the bill that the Legislature passes," he would sign it as governor.
Based on his answer, you'd have to add Thissen to the list of six DFL guv candidates who would sign the single-payer bill, but the "if-that's-the-bill-the-Legislature-passes" language suggests that the Marty bill is not Thissen's personal favorite.
The whole conversation reinforced that feeling. Thissen, who has already played a key role in legislation that expanded health coverage for Minnesota kids, went on to say: "My bottom line is that we need to get to a place in Minnesota where you can see a doctor no matter where you live, your employment status or your pre-existing conditions. The Minnesota Health Plan is one path to that. I commended Sen. Marty because he has taken that goal seriously. But there are real issues in the way of getting there and we need someone who will address those issues."
Some shortcomings
This, of course, implies some shortcomings in the Marty plan. Thissen mentioned three:
1. Thousands of Minnesota families make their livings working for private-health insurance companies. Many of those jobs would disappear and others would be dramatically changed if Minnesota banned private insurance. We need a plan to deal with that level of economic disruption.
2. Thissen agrees with Marty that on a total basis, a single-payer system would cost less than the current inefficient mixed public-private system. But moving all health expenditures into the public sector would be the biggest increase ever in the public portion of economic activity. "We have work to do to convince Minnesotans to double the size of the state budget," Thissen said, which I took to be a reference to the scary rhetoric opponents of the plan would surely use to describe single-payer as socialized medicine that would place government bureaucrats in the middle of every family's health care.
3. "We can't just have the conversation about who pays for health care," Thissen said. We also have to talk about how we pay for it." I took that to be the start of a whole additional discussion of the perverse incentives that make U.S. health care so expensive and ideas for payment reforms that would bend the cost curve while improving long-term health outcomes. Thissen is deep into those issues, and I hope to deal with them another day.
At Hopkins and Macalester, when so many of the others were endorsing the Marty plan at Macalester, former DFL House Leader Matt Entenza of St. Paul took his turn without mentioning Marty or single payer. Entenza instead referred to his approach as "Minnesota Medicare." Since Medicare is pretty much a single-payer system (with the federal government as the payer and Americans over 65 as the insured), I thought at first that this was just Entenza's term for single-payerism. But that's not so.
Entenza wants a combination state-federal program under which Minnesotans younger than 65 could get access to Medicare coverage, but would pay the premiums themselves. This is very close to the idea that briefly streaked across the U.S. Senate (but has since been pulled down), except the senators were talking about doing it nationwide, offering an early Medicare buy in to 55- to 64-year-olds.
Entenza's approach
Unlike the Marty plan, Entenza's approach would not guarantee coverage for all. It would be optional and it would not do away with the existing private health insurers. But, if it could happen, it would give some Minnesotans with no coverage or poor coverage the ability to buy into a big proven plan with plenty of benefits.
Entenza said it would require a waiver from the feds, but he believes that is feasible. It theoretically wouldn't cost the federal budget anything since the under-65 Minnesotans would pay premiums to cover their costs. If possible, he would try to provide state subsidies, on a sliding scale linked to income, for Minnesotans that couldn't afford the full cost of the Medicare buy-in.
Entenza was more critical of the Marty plan than any of the candidates with whom I spoke. He said there is no concrete plan to raise the revenue to pay for Marty's plan, and "I worry that all of us, as Democrats, have fiscal issues to sort out first" about how to pay for programs that already exist.
"In an environment of a $7 billion deficit, there's no money there for brand-new entitlements," Entenza said. "It's easy to make promises that you can't necessarily pay for."
He gave Marty's bill the classic Minnesota back-handed compliment, calling it "interesting," but worried that voters will find it frightening and unimaginable. Entenza feels his own idea taps into the pre-existing reputation of Medicare.
"Heading into an election, it sure is helpful to point to something that people know works," he said.
Minneapolis Mayor R.T. Rybak missed the Macalester debate and doesn't have much of a health care discussion on his website yet. I tracked him down at a TakeAction Minnesota meeting last week about health care issues and asked him explicitly about Marty's plan. He was noncommittal, saying that he likes the idea but doesn't think it makes sense to focus on a bill that was written in advance of the big coming federal health care bill. It makes sense to him, he said, to wait and see the landscape after the federal bill is done, focus on the key goals of "universal, affordable, access and coverage," without necessarily wanting that to be accomplished by a single-payer system.
At Macalester, Ramsey County Attorney Susan Gaertner didn't comment directly on single-payer. On her website, she promises to "provide the leadership to develop a modern universal health care system based on a public/private enterprise that recognizes our changing workforce, provides for the mandate of private and portable insurance and finds a way to pay for it that is acceptable to both individuals and businesses." Her health care program is not fully developed, but there are enough clues in that sentence to rule out a government single-payer plan.
Former state Sen. Steve Kelley also didn't comment directly on Marty's bill but he isn't proposing single-payer. He says that as governor he would work with President Obama to strengthen the new federal program now taking shape, and spoke favorably about including a strong public option in that plan.
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Comments (75)
There's nothing surprising about single payer. It's the most logical, simple, efficient, and economical way to structure a health care system. What's surprising is that the health care industry has managed to block it's creation for so long. Well, I guess it's really not surprising given the corporate patronage of our political parties. It's nice to see that some Democrats are finally recognizing the bloody obvious and apparently moved by their conscience to fight for the right thing. It would be nice if our state does something to be proud of at least one more time in my lifetime.
Matt Entenza's campaign is being bankrolled by his wife's tens of millions of dollars in UnitedHealth stock options. It's no surprise that he's not a fan of Marty's bill. And while Entenza claims the state's looming budget deficits stand in the way of paying for such a program, those same deficits haven't stood in the way of Entenza's support for a taxpayer-financed Vikings stadium.
"Although single-payer is popular on the left, the common political wisdom is that a plan that could (and would) be labeled socialized medicine is a political impossibility in America."
The reason "socialized medicine," the belief that tax cuts are the cure for all economic ills, and other tenets of the right are "political impossibilities" is that Democrats rarely have the courage to openly challenge them with unity, vigor and persistence. At some point these ideas must be challenged openly or it will take years for them to die out on their own. Single-payer is the perfect issue on which to begin the reeducation effort and now is the perfect time to start the process.
Three reasons:
1) Health care is front and center on the national stage and polls have consistently shown strong support for single-payer or public option plans. In recent months, the public has been exposed to a lot of new information about the costs and dangers of continuing with what we have.
2) Cost comparisons of single-payer vs. private insurance heavily favor single-payer and are easily understood when clearly explained.
3) Most importantly, the basic concepts of single-payer are dirt-simple: maximum risk pool size for minimum cost; no middle man; no administrative overhead for businesses; no employer obstacles to hiring and no employee obstacles to leaving or changing jobs; and no pre-existing conditions, denials, pre-approvals or other artificial obstacles to receiving care.
All this is just begging for an in-depth analysis of how the federal bill affects the state funding of Medicaid and MNCare. I have not seen much on how health care reform impacts the long-term state budget.
So, the state is billions of dollars in the red, we've got 10% unemployment and an undetermined underemployment. Government's income from employment taxes is sinking faster than Mark Dayton's manic phase, but the Democrat party thinks there's still room in there for socialized medicine.
Sounds like a plan.
U.S. healthcare will be like Soviet bread. Dirt cheap if you can find it.
If you want incredibly high health care costs, get rid of copays, coinsurance, and deductibles.
People will then go to the MD for every little sniffle. You have to have some sort of cost sharing in order for it to be effective. That's why copays and the like came into existence.
Good luck getting this through.
There's nothing crazy about single payer, it sells itself. Are you a human being? If yes, your covered, go to the doctor. What doctor? Anyone you want, you have complete choice. What's my copay? Zero, and you never see another medical bill for the rest of your life. How much will this cost? Less than your paying right now. Administrative costs are reduced because there's no marketing, and no fighting over coverage. Provider costs are reduced because they send out the same bill to the same people, and know exactly how much they'll get paid. You can also finally get a handle on the actual cost of procedures and treatment, and drug expenses. A simplified system allows you to much more easily do whatever studies you want to do to figure out where your inefficiencies, quality health care, and waste are. What about this sounds crazy?
Mr. Udstrand,
How much are these providers going to be paid? Since there would only be one payer, does that mean the state would dictate how much they are going to pay for particular services? Providers nationwide are already dropping out of Medicare (including Mayo Clinic) because they cannot afford the government reimbursement rates.
Also, if everything is "free", what's going to prevent providers from ordering every possible test since it won't cost the patient anything.
Medicare learned that you can't cover everyone and make it free. They have a $1000 deductible every time you go to the hospital. You also have a $155 deductible on office visits and then must pay 20% of every bill for the remainder of the year. There has to be some sort of cost sharing.
Mr. Swift, I think it goes without saying that to support a single-payer system, some of the money people are now spending on premiums has to be diverted to the single-payer system in the form of taxes. The total cost at the end of the day would be lower - we know this, because the government-run programs both in this country and every other one are more efficient than the private ones; they spend significantly less on overhead and of course nothing on profits.
If you're against it on ideological grounds that's one thing, but no point in being intentionally disingenuous about it - nobody is suggesting it will be free, only that it will be less at the end of the day, overall.
Single payer sounds like a great way to win the DFL primary & lose the general election.
//People will then go to the MD for every little sniffle.
Uh, no, they won't. Do YOU like to make extra visits to the doctor? This is a long standing canard. In fact, there is an actual medical term for the disorder of seeking too much medicine: Munchhausen's. And btw - Munchhausen's is extremely rare (.2 % of hospital inpatients).
Simplot,
Payments are negotiated, and it's a lot easier for two parties to negotiate payments than it is for dozens of parties to negotiate payments. There's not a single country in the world where a single payer, or national system has wiped out health care providers. Not only do Germany, France, and Canada have plenty of providers, they deliver better health care than we do. Providers are terrified of an expansion of Medicare because of it's reimbursement rates. You can't have it both ways, you can complain that Medicare will drive providers out of business and at the same suggest providers will get rich because everything is "free". Fraud is illegal. You protect yourself against fraud and inflation the same way we do now, you audit them. And Medicare and the VA do a much better job of controlling costs than the private sector does.
Yeah, providers would eventually take a financial hit that's why their dead set against single payer, it actually controls costs. The fact is we're overpaying right now, the reason our health care is so expensive is because too many people are making too much money. Logic dictates that has to change in order to make the system more affordable and control costs. Are we gonna drive the health industry out of business? Not even close.
A single payer system may not be perfect, but it is MILES ahead of the Republican plans of "Don't get sick; die quickly" or "import medicine from socialized countries, but don't call us socialists."
The biggest irony for the Party of Irony (formerly known as the Republican Party) is that despite its costs, a single-payer health care system would create more jobs, business and economy as more and more people threw off the yoke of corporate serfdom and started their own businesses.
Mr. Black:
It is apparent from your article that Paul Thissen has thought deeply about these issues and has been far more engaged than most of the other Democrats.
Sometimes I wonder whether I am living on the same planet as John Marty. In the first place, for-profit health insurance can't be sold in Minnesota. Ever wonder why United HealthCare DOESN'T sell health insurance in Minnesota?? It's because they can't. Now, you might want to argue that Minnesota's insurance companies are inefficient and a state-run insurance company would be more efficient, but you'd better bring some evidence to back up your bluster. Minnesota has one of the most efficient health care systems in the country. The problems here are ones of a)the cost of insurance is too high for the working class and b) unfair Medicare reimbursement rates for both providers and insurers.
The biggest objection to a Minnesota-only single-payer plan is, national health insurance is coming. Don't you guys read the friggin newspaper?? What, you think Congress is going to give Minnesota permission to spend the expanded federal funds on an entirely new Minnesota-only system?
I direct a small nonprofit with 31 employees and dependents on our health plan.
Our renewal quote was for an 18% increase.
The increase included the following facts.
For the sample claims period provided, the insurer -- (one of the "nonprofit" HMOs) -- collected $59,308.54. They used $10,082.45 on adminisrative fees. They paid $33,938.61 in claims.
Requiring 17% in administrative fees is highly inefficient, and that does not even account for the additional administrative costs that insurers impose on medical practices.
Raising the rate 18% in non-inflationary times upon only needing 57% of my billed charges to pay for medical expenses tells me we need a new system.
Love Corey Anderson's illustration! What a great looking team in scrubs and lab coats.
Wishing you all happy holidays and a Healthy New Year.
Dave Thomson:
re: Your comment that "you might want to argue that Minnesota's insurance companies are inefficient and a state-run insurance company would be more efficient"
One would assume that you're familiar with the features of the MHP and therefore should be aware that there is no provision for a state-run insurance company in the plan. Doctors and medical groups are perfectly capable of negotiating procedures and rates directly with the state. There's no reason to believe that inserting any insurance company into the negotiating process would result in a more efficient or cost-effective outcome.
On the other hand, the efficiences that would result by eliminating massive insurance company bureacracies (as in retraining them for more productive work) and by standardizing records and paperwork would be enormous.
Mr. Udstrand (as opposed to just "Udstrand".
In a single payer system it may be easier for the State to negotiate a contract but certainly isn't for the provider. What option does the provider have if they don't want in?
There are already providers in MN that don't take Medical Assistance because they just can't afford the reimbursements. They lose money on those patients.
Some additional questions for you:
1. Who would be eligible for this? Would recipients have to live in the state for a specified period of time? How do you prevent people from moving here just for the "free" medical care?
2. How about when you travel? The state would likely not have agreements with providers in other states?
3. If you cut payments to providers it stands to reason that they won't be able to attract the best and brightest doctors and the latest technology because they wouldn't be able to afford them.
4. How exactly will single payer control costs? If you give people and providers an open checkbook, that will do nothing to control costs.
None of the health care reform ideas I have read do anything to address personal responsibility. They want changes to the providers and to the insurance companies but make the patients responsible for nothing.
Yes, I work in the insurance industry. The 3 major health plans in MN on average have 10% admin rates. 90 cents of every dollar goes right to paying claims. The rest goes to admin. When looking for a charity, experts suggest you look for those with 20% admin rate so the health plans are actually better than good charities. What is wrong with that?
By the way, MN insurance companies do not make money on premiums. They make their money on the investments they make with their state mandated cash reserves.
This story demonstrates why I dig Paul Thissen. He's smart, goes beyond sound bites and actually knows and grooves on the heavy lifting needed to tackle big issues.
Co-pays aren't that bad. Here in Norway we pay about 25 USD per visit, with a maximum each year of around 250 USD. Isn't going to break anybody.
BTW, wasn't a single-payer pilot project the thrust of Sen. Sanders' amendment that was withdrawn during its lengthy reading on the Senate floor?
T.J. Simplot--
Here's what I would say: At this point, the MHP is basically a conceptual framework (although one based on several well-functioning systems in place in the world today) with little defined detail. For a person such as yourself who may have questions or reservations, you can go either of two ways:
1) As we've just seen at the national level, you could assume the worst possible implementation at every level of detail and therefore oppose anything that is proposed on the basis that you might not like the end product, or...
2) You could learn as much about the plan as you can, talk to both proponents and opponents, and gradually form your own opinions about what might work and what might not. Then, when it gets to the actual process of considering outlines and details, you can participate in the dicussions on what should or should not be included, how it should be implemented, etc.
One would hope that here in Minnesota we could engage in a much more collaborative process, regardless of the outcome, than what we've been seeing at the national level. But the final question at this point is: what is a good argument against seriously considering the single-payer option?
Mr. Simplot,
??In a single payer system it may be easier for the State to negotiate a contract but certainly isn't for the provider. What option does the provider have if they don't want in?
There is no opt out, that's why single payer controls costs. Don't pretend you don't understand how that works, it's very simple, the state negotiates the best prices. You either provide health care or you don't. I think it's funny all the sudden the insurance industry is the providers new best friend by the way. You guys spend millions fighting payments but now your all about the poor providers. No ones losing money with Medicare, they just don't make as much as they do with other insurers. The reason health care costs, the cost for procedures, have gone up is because providers jack up the prices so they make money even though they're negotiating discounts. That's why no one actually knows how much anything really costs. I think providers collect sixty cents on the dollar from medicare and what eighty cents from some private insurance, but they charge everyone at least twice cost, even if they're supposed to be nonprofit.
Again make up your mind, is medicare going to drive providers out of business or make them rich with free money? You can't have it both ways.
As far as the rest of your questions go, you'd have to ask the candidates about their specific plans. If it was up to me I'd make it simple, if you live in MN your covered, if you have to leave the state because something isn't available here, your covered. Emergency care is covered even if your just driving through. If you live in another state and you want to come to the Mayo or the U. nothing changes, work it out with your insurance company you poor bastard without a single payer system. Providers wouldn't be prohibited from taking other insurance, just required to take the state insurance. Of course if we had a national single payer system the issue would be moot. As far as people moving here is concerned, you seem to confused about some basic economics here. Single payer doesn't make health care "free", it simply pays for it collectively. The premiums are collected as taxes, so whoever lives here pays. So it doesn't matter who moves here, if they live here they still pay. Besides, I thought you guys are always arguing that taxes drive people out of the state, not lure them in. It that scenario develops it will mean our system is working and the pressure to take it national will be on.
As for co-pays, some plans I've seen call for a $25.00 copay for the first year to offset start-up costs and then nothing after that. But if you want to tweak the system with small copays like Mr. Everson describes, and a yearly limit of some kind be my guest. It's still a lot cheaper than what people are paying now. My co-pay went from $25.00 to $125.00 last year.
Agree with Nancy Gertner's comment. Great illustration Corey!
Are you suggesting that MinnRoast 2010 have a Doctor's Hospital sketch?
Paul Udstrand writes
"Single payer doesn't make health care "free", it simply pays for it collectively."
This point is often missed in the heated discourse. Health care costs money. The discussion really comes down to deciding to whom you want to write the check.
In the existing system, the checks are typically written to private insurance companies (though sometimes nonprofit); those checks are often written on our behalf by employers. For single-payer, the checks go to the gov't.
The way insurance works is the risk is shared by a pool of insured. We're all betting that our payments will total less than the health care we need. When you can spread the costs over a larger pool, the amount each insured has to kick in drops. Therefore the ideal pool is the one that everybody is in, where costs are shared over everybody. That means the ideal system is an insurance monopoly. If its run by a private company, a percentage of premiums will go towards profit, which implies that the theoretically best pool is a gov't run, universal, mandated participation insurance plan: single payer.
Calling universal health care "unrealistic" is a piece of right-wing propaganda used to keep it from being enacted at the federal level. EVEN THOUGH we would save $400 billion per year while assuring health care for every American.
Re: Candidates. Entenza, Thissen, and Gaertner have all said they would sign the Minnesota Health Plan if the legislature enacts it. Steve Kelley has said he would veto it, even though he supports the general idea of universal health care.
Re: "State run" program. Premiums and/or taxes collected to support the program would be managed by an independent body, as would the program itself.
No governor or legislature could again cut off from health care tens of thousands of our poorest citizens, many of whom are mentally or physically ill or disabled and thus unable to work, and none of whom earn more than about $8,000 per year.
Is your comment of political feasibility based on what people want or what health insurance corporations want?
This is great news!!!! I will definitely support only a candidate who promises to support single-payer in Minnesota and who promises to make such a plan a priority. Having a single payer system and universal coverage in Minnesota would unleash entrepreneurial spirits who are currently trapped by health insurance needs.
Long live single payer and freedom!
Minnesota is not the only state where single-payer is gaining steam. There are parallel efforts in other states.
I think that once people see what a steaming pile of corporate welfare the current House/Senate bill is and how little it will help those most in need, they'll be demanding single payer.
Many of you may not know that Canada's single-payer system was developed province-by-province, starting in Saskatchewan in the early 1960s. Once people in other provinces saw how it worked in Saskatachewan, they demanded it for themselves, too,
None of the above have supporters with the kind of money that the gubernatorial campaign will require. I wonder how Mayor Rybak leans on this issue?
Senator Franken says that MN is a model for everyone else with over 90% of premiums going for medical care. I suppose the government could improve on that. It may not be too late for one of our Senators to get us the same deal as Hawaii--our own State plan.
Realistically, we don't pay for health insurance, we are prepaying for healthcare. We pay premiums in advance, and then use up the money we pay in. For most people, just paying for the healthcare would be cheaper than paying for the "insurance". A real option would be genuine insurance, cheap but only covering big ticket items. It might cost a couple of hundred bucks per year, but then we could use the rest of the 8 grand to pay for those office visits and pocket what is left over.
If we have a chance to elect a Governor who (a.)has the courage and vision to institute a proven remedy for our broken health care system and
(b.) is the ONLY DFL candidate refusing to indenture him/herself to lobbyist and PAC donations,
why the heck would we consider anybody else for the office?
It sure looks like John Marty would be best for the job.
Joel Clemmer
I must be dreaming!
If dems at both the national and state level want to jump off the precipice in 2010, I certainly won't try to stop them
...so long as their plans don't take effect until 2011!
Note that most of the population of Massachusetts (80% in one poll) want to keep the current program (the closest thing to single payer in the US).
It's only the insurance companies and their flunkies who don't like it.
It's not perfect, but it seems to be better than the alternatives.
And note again that one can have functional single payer systems with private insurance companies and health care providers (see France, Germany, Japan).
America spends double the second highest costs per capita on health care of any nation on Earth. Over fifty percent of that spending comes from federal, state, and local governments. Based on those two facts alone, we can already say today that America has the most socialist health care system on Earth. A single payer system would actually decrease public taxpayer costs while lowering health premiums. No nation's health system has anywhere close to the level of overhead that ours does.
Several commenters have pointed out that we have a multi-billion dollar deficit and then almost implicitly blamed the DFL for it. However, every non-partisan state and federal economist agrees that the greatest single cause of government spending growth is skyrocketing health care costs. According to the Bureau of Labor Statistics, the number of health administrators has increased twenty-six times between 1970 and today! We wonder why health care costs are increasing ten percent per year with overhead growth like this?
Our state and nation is headed toward bankruptcy. Even Republican Presidential candidate John McCain emphasized the importance of health care reform in his campaign last year. No one denies that health care is the most significant fiscal problem facing our state and nation today. That is exactly why we cannot allow partisan idealogues from either party to safeguard an industry that now exists only to get rich by denying care and bankrupting taxpayers and businesses. The private, for-profit health insurance industry has become the greatest Ponzi scheme this nation has ever faced. They can only get rich until they run out of other people's money.
Paul B (#35, #36). More people in Massachusetts may be covered, but those who were poor enough to receive free health care now get help with their premiums BUT must pay co-pays and deductibles.
The MassPlan is hundreds of millions of dollars over budget because -- like the Senate plan -- it does nothing to stop ever-rising (as in every year) insurance premiums and profits. They also underestimated the number of people who'd be signing up. To save money, the state recently cut off 30,000 legal immigrants from access to the insurance exchange, which equals NO health care except what they can pay for in cash. One of Boston's largest hospitals sued the state a few months ago because the state's payments to it are so low it soon will be unable to serve the poor.
The difference between the MassPlan/the Senate plan and those countries that have private systems is that those countries treat insurance as a public utility instead of letting it manage the system to its own advantage no matter how much it hurts their customers (patients). All insurers must be non-profits.
Those countries review care costs and premium prices each year and only allow premium price increases that cover real costs. All forbid insurers to refuse to pay any claim for any reason except provable fraud. Competition is on the quality of their customer service rather than price. Patients pay no co-pays or deductibles. Health care is funded by, I believe, a mix of employer-furnished coverage and government-funded care.
Massachusetts, and now the Senate, is sort of using this model but without the important part: taking us out from under the control of an industry that puts profit first and our welfare last.
Bernice--
My point was not that the MA plan is perfect -- far from it, but that (contrary to some claims) the citizens feel that it is an improvement and want to keep it.
Most people do want health care reform that involves more government involvement; the only question is the details.
I have agreed with you before on the superiority of the Western European (and increasingly Asian) model of health care as a basic right -- the right to life as stated in the D of I as the first of the three basic rights.
@ 36 Paul, It's just so much simpler. There's one set of rules. So those systems really work. That's what they're for, and the reason for that is those countries have all decided that there's a basic conflict between making a profit for investors and covering people's health.
In Germany, for example, there are about 200 insurance companies. It's not single-payer. I want to make that point, 200 insurance companies. Anybody in Germany can buy any of the 200 company plans. If you don't like your insurance, guess what: You can drop it, shift to the next guy, and the new guy can't raise your premium. Now, that's more choice than anybody in America has.
One of my criticisms would be of our multi-tiered health care system, it's a really expensive system to maintain because there's so many different systems within it. There's so many different forms of billing. There's so many different prices. It's just vastly simpler if there's one set of rules and one set of forms and one price or one regional price for the whole country.
You go to the doctor in France and that doctor, by law, is required to post on the wall the price she's going to charge you for the hundred most common procedures that she does. No doctor in America could do that because they don't know what they're getting paid. They get 30 different fees for the same procedure in the same week because of all the different plans.
The result is enormous administrative complexity. The American health insurance industry - you know, it's free enterprise, it's competitive, those guys make huge salaries - it's the least efficient payment system in the world. So we are just pouring tons of money into stuff that doesn't buy anybody health care largely because we have this hugely complicated overlapping set of systems and that's one of the reasons all the other countries went to a single system. Japan has 3,000 payers but it's a coordinated system with one set of rules.
So again, I would suggest that the administrative complexity with it multi- layered and overlapping set of systems is one of many needed fixes. A single system of rules and billing would help to resolve what is currently a highly dysfunctional and inefficient system.
Building on Mr. Shulze's post; I'll explian why I support a basic expansion of medicare- single payer in this country instead of the multiple insurance company system in Germany, or the French system. Basically, I think our system is just so screwed up, and our political system is corrupted at this point that implementing a French or German system would be impossible. Any attempt to use the existing private sector in this country would simply result in watered market reforms. Even the non-profits in this country tend to behave like for-profits and you just end up with an overly complex and inefficient patchwork, like the bill that just passed. The other problem is we just don't do regulation very well in this country. In German and France they have and enforce regulations. In this country our regulatory agencies tend to get captured by the industries they're supposed to be regulating, the financial sector being the latest example. So in order to make a those other systems actually work, we'd have to over hall our regulatory approach as well.
I think the fasted and simplest way would be to just make medicare available to everyone. It already exists, the infrastructure just has to be expanded. Auditing and regulation of medicare and the VA is already more efficient because they have to vested interest in defeating regulation. Efficiency is simply a matter of auditing and innovation. I just don't think you're ever going to coral the private sector in this country into behaving like the ones in France or Germany. In fact, I think to the extent that Medicare is inefficient, it's because we use private sector companies to administer it. I think that's probably the real reason you see these regional and state differences in medicare costs. If we just consolidated it, like the VA, it would be fast and simple. And remember, the process of improving the system is ongoing, it doesn't have to be perfect out of the gate, but even an imperfect national system would be a huge improvement over what we have.
Just one more comment: we constantly hear the statement that Minnesota small businesses need a better "business climate," and the usual prescription for such is lower taxes. It's hard to imagine any tax cut or any other action state government could take that would improve economic conditions for small businesses more than establishing single-payer health care.
The benefits would be enormous: much lower premium costs (in the form of a uniform, published tax schedule); elimination of all insurance-related overhead, including the need to evaluate competing policies at the end of every year; elimination of the medical component of any liability insurance; elimination of any health-related hiring or employment issues for either employer or employee; would-be entrepreneurs could quit their day job to work full-time on building a new business without worries about health insurance for self, family or prospective employees.
Seems to me that if small business owners started becoming aware of the benefits, support for single-payer amongst small businesses would likely reach critical mass very quickly.
//Just one more comment: we constantly hear the statement that Minnesota small businesses need a better "business climate,"
You have to remember, a lot of these so-called chambers and associations have become defacto political (as in party promoting) organization. The various chambers of commerce, small business associations etc. have been aligned themselves along Republican lines for a couple decades now. They don't really speak for a majority of whoever they claim to be speaking for. A lot of companies large and small have realized that health care is killing them, and they want it fixed.
The thing is, this debate we've been having here is just taking place here, there's never been a clear public debate about a national single payer plan. The Democrats literally blocked it. When you explain what it is, and how it works, most people want it and want it yesterday. That's what's so frustrating about this; there's this false consensus that it's not realistic, but it sells itself and if you vote something it'll pass.
Anyone who proposed expanding Medicare as a panacea for health insurance does not know Medicare.
I've been on Medicare Part A for years, and am still waiting for them to pay dollar one.
Paul,
//My point was not that the MA plan is perfect -- far from it, but that (contrary to some claims) the citizens feel that it is an improvement and want to keep it.
I see what your saying, but the Mass plan has failed to provide 100% coverage or contain costs. To the extent that folks there see it as an improvement and want to keep it; I think that tells you more about how crappy our existing system is than it does about how good the Mass plan is. Almost anything is an improvement on our existing system in the short term, and people are literally desperate.
It's like some people keep pointing out about the new health care bill, and they're right, in the short term it does some good. My worry is that it perpetuates the systemic issues that causing so much pain and suffering and economic damage. The reason I say it may be worse than nothing is while it doesn't just fail, it creates a new framework that will actually be an obstacle to real fixes in the future.
The promise of the public option was not that it would be the great solution, but it would start creating a framework that could be expanded in the future. I think the deal the Democrats cut, (and this is why I think incrementalists are going to be disappointed) is that any kind of public option or expanded medicare is OFF the table permanently. And that's worse than no deal at all because it effectively prohibits real health care reform.
John,
My folks have been on Medicare for almost fiften years, and like millions of other people, Medicare has paid thousands.
No one is talking about any panaceas, just a health care system that works, if affordable, and doesn't crash the economy, you know, like the almost any other developed country in the world. The assumption is that it won't be perfect out of the box but we'll improve it as we go along.
John:
Medicare A is hospitalization; I assume that you haven't been hospitalized since you've been eligible.
It paid for my mother's hip replacement revision, and will pay for mine sometime in the next few years.
@#s 40-43; 45-46: aGreed.
Paul and Paul:
I HAVE been hospitalized -- to the tune of some $43,000.00. Despite my having Part A coverage, Medicare paid not one penny.
And if "Medicare" paid thousands and thousands, it would be interesting to see how much of those payments were made by Medicare, how much by personally bought Medicare supplemental insurance policies, and how much by other policies.
If one has only Medicare Parts A and B (which latter costs about $100.00 per month premium) most people are one misfortune away from economic disaster. I have seen this in acute and long term care patients over and over.
Mr. Iacono,
Obviously we can't debate your personal medical expense issues for a variety of reasons.
I will say however that with the system I'm advocating you wouldn't be looking at any medical bills much less $43,000. You have remember the national single payer medicare/medicaid would be significantly different in many respects. It would be nationwide, and all inclusive, and everyone would be enrolled unless they opted out. You medical bills, whatever they may be, would be paid. Whatever problems your experiencing, are the result of a medicare program being run like a private plan in competition with other plans rather than a national plan thats sole purpose is to pay everyone's medical bills. With the system I'm describing there are no grounds for any kind of denial, and no way anyone could get stuck with medical bills. The medicare your dealing with part of a hodgpodge of competing interests that are part of a health care market. I'm saying let's scrap that and create a health care system. In the new system, you just go wherever you want to go and get whatever treatment you need, and the national insurance plan pays the bills. Everyone's covered, no matter where they are, no what treatment they receive. It'll be cheaper and more efficient than what we have now.
Democrats: "Lets just mandate everyone gets insurance without making any meaningful cost/incentive reform! Woo-hoo!"
Republicans: "Rabble rabble rabble!"
Independents: "Check please."
If Republican were really so hell-bent on saving money, why didn't they look to what works in the rest of the world (they're ALL cheaper), pick the one that was most ideologically pure to them (many are private systems) and propose THAT? If Democrats were really so hell-bent on universal coverage, ditto, there are dozens on the rack to choose from.
I'll answer my own question on this one: we don't have a government of, for, and by the people. We have a government of, for, and by the corporate interests with the deepest pockets. Or at the very least, "the best democracy money can buy".
The only thing this debate has proven to me is that it's impossible to deal seriously with costs until everyone has health care and is invested in the system. It's a necessary first step. Otherwise, there always seems to be an illusory way out since the option of denying care as a cost control measure seems possible, though it doesn't seem to happen in reality. Instead we just provide everyone with more expensive, less effective care when it's too late to do anything useful.
There was always going to be some expansion, but reform was far more important. I just wish the Republicans had realized that, and done something about it, when they were in power. We might be in a much better place, and they would've avoided some damage to their brand.