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In the midst of a rancorous health care debate, don’t forget these three lessons Minnesota has learned

It’s easy to lose sight of the big picture — which is very big.

We know change is coming.

We are all exhausted by the back and forth of health care news. It’s hard for even those of us who work in in the field to keep up. Proposals for sweeping change create a gnawing worry about how — or whether — our medical bills will get paid next year, or next month.

Jim Schowalter

It’s easy to lose sight of the big picture, which is very big. Right now, we are in the process of reinventing how we get and pay for care, in Minnesota and nationwide.

We know change is coming. We said it in a State Budget Trends report and pretty much every Task Force of the last decade. Fortunately, working on health care isn’t new for Minnesotans. We’ve tried ideas that worked and others that failed. In the process, we have learned a thing or two about ourselves. These are lessons we can’t ignore.

1. The more of us who have health insurance, the better off we all are.

As a state, we have made immense progress toward making health care available to everyone. The number of Minnesotans without health insurance has dropped by about 200,000 since 2013, saving hospitals more than $50 million in charity care. We’ve brought in about $2 billion of federal health funding, which works directly to keep our friends and neighbors well.

Right now, policymakers are working on a number of urgent problems: how to stabilize the market for individual health insurance, how to ensure that people can get care where they live and how to tame the soaring cost of prescription drugs. These issues are important and need attention. But remember that to get care or prescription drugs, Minnesotans need health insurance. It’s not perfect, but insurance is step one in getting everyone the care they need.

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2. Health care is more expensive than Minnesotans can afford.

The debate is so heated because nobody — government, business, household — can really afford to pay more for care. Nine out of ten Minnesotans have health insurance through their employers, or through government programs like Medicare or Medicaid. For years, most of us never thought about how much an X-ray or a course of antibiotics would cost, because we weren’t paying for it — not directly. For many years our employers, government and insurance companies pretty much took care of things for us.

That’s changed and continues to change quickly. We all have been asked to foot the bill for a growing share of our medical bills. We’re paying higher premiums, higher deductibles and higher co-pays.

When one person’s medical bills can increase everyone’s premiums by $5 a month, we can easily see the need to share expensive care broadly. Yet at the same time, lawmakers are hearing proposals that would raise costs. It still has not sunk in that high medical bills were the problem before the ACA, are the problem under the ACA and would still be under the ACA replacement bill just released by the U.S. House of Representatives. Long-term, settling on the financing is just an initial step that gives us all a chance to examine health care expenses and figure out how to lower the bills.

3. Get the incentives right.

Big questions defy easy answers. Even though we’re tempted to look for a silver bullet or a painless solution, no single change will solve our health care problems. None of us are that smart or can think of all the “what if” scenarios that take place in the real world. As a result, we have to focus on setting up the right incentives and let everyone do their job.

This is especially true in health care, where lives are at stake and we want to get the best care. But “best” means balancing many things including our individual preferences along with the science, cost and uncertainty of treatment.  Rather than laying out ambitious ideas and assuming all the complicated moving parts will fall into place — as we did with MNsure systems — it’s vital to plan thoughtfully for the complexities of any change, and to promise only what we’re sure we can deliver.

There is a virtue to thinking big. But in health care, there’s a greater virtue in careful planning. Let’s not subject Minnesotans to the pain of repeating old mistakes.

Jim Schowalter, former commissioner of Minnesota Management and Budget, is president of the Minnesota Council of Health Plans.


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