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Health care: Minnesota can and must do better

Ensuring that all Minnesotans have health care security is a New Year’s resolution worthy of our shared effort.

Rebecca Otto

As we rang in the New Year, many of us gave thanks for family, friends, and our health.

But health care insecurity remains a reality for too many of us: the farmer in Redwood Falls choosing between a $30,000 annual family policy and seed for next spring; the St. Paul couple delaying retirement four more years to ensure their 22-year-old has health coverage; the Beltrami County woman on Medicaid who can’t find a dentist willing to treat her abscessed tooth; the young woman in Minneapolis avoiding getting tested for a genetic marker for cancer for fear that a pre-existing condition could make it impossible to get health coverage in the future.

These decisions are making people sick. We must do better.

In 2013, Americans spent $8,713 per person on health care, 2½ times the average spent by OECD nations. The Minnesota Department of Health projects that spending will more than double by 2023. This growth outpaces state economic output, and will cut into all other things we care about – including education, environmental protection, and economic growth.

Worse, we’re not getting good value for our money. A 2017 Commonwealth Fund study found that the U.S. health care system ranked last on overall performance among 11 high-income developed nations.

I asked my governor campaign’s policy team to research how we can create a health care system that guarantees care to every Minnesotan, delivers a comprehensive standard benefit set, lowers costs, and encourages continuous quality improvement in health outcomes. Here’s what we found. 

What doesn’t work

Bill after GOP bill to repeal or destroy the Affordable Care Act has been scored by the Congressional Budget Office as leading to millions of people losing health coverage.

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The GOP’s recently passed federal tax bill is projected to increase premiums for individuals and small businesses and increase the number of uninsured by 13 million, while raising the national debt and increasing pressure to cut Medicare and Medicaid. 

In Minnesota, Republican legislators recently passed stop-gaps to stabilize the individual market, including state-funded discounts for those not receiving federal tax subsidies, as well as subsidies to insurance companies in hopes they will remain in the market and restrain rate increases. Republicans passed these measures while letting a less expensive and more effective proposal — a MinnesotaCare buy-in — flounder without a committee hearing. 

What works

Our analysis found that nations with lower health care costs and comparable or better quality share certain characteristics: 

  • Health care is universal, and is usually publicly financed through general tax revenues instead of insurance premiums.

  • They have a guaranteed, standard, comprehensive benefit set.

  • Private nonprofit providers compete for patients.

  • The focus is on primary care and population health.

We reviewed universal health care systems as well as the research literature on value-driving payment reforms in the U.S. and abroad, and developed my Healthy Minnesota Plan based on what has been shown to work. You choose your health care provider.  There are no premiums or deductibles. Every Minnesotan receives a standard comprehensive benefit set, including mental health and substance abuse treatment, reproductive health and family planning, maternity, and vision and dental care. 

The Healthy Minnesota Plan focuses on the importance of a stable primary-care provider-patient relationship and on obtaining value for our health care dollar. Under the plan, payment systems will be designed to encourage private providers — whether they are part of care delivery groups, independent practitioners, or institutionally based — to be efficient and innovative, and to coordinate care. For most providers, gone will be the pay-per-visit or procedure system that encourages quantity over value, and gone will be the time-consuming coding and billing and pre-authorizations. Providers can focus on their core mission: keeping us healthy.

Paying for it

How do we pay for it? By some measures, as much as 64 percent of health care spending is already public under Medicare, Medicaid, workers comp, the VA, local, state, and federal government employee plans, and military Tri-care. We will seek federal waivers and redirect all current public health care spending into a single protected state fund. We will eliminate the skyrocketing health insurance premiums paid by individuals and employers. Instead, we will create a system of broad-based and fair taxation agreed to with the Legislature.

Decades of research indicate that this kind of approach will save the vast majority of Minnesota families money while providing comparable or better quality health care. The evidence we have conservatively suggests that, after an initial period of transition, savings could exceed 15 percent, curbing spending growth into the future while covering all Minnesotans and greatly reducing the inequities that currently exist in health care.

Government’s purpose is to improve the common good. Ensuring that all Minnesotans have health care security is a New Year’s resolution worthy of our shared effort.

Rebecca Otto is Minnesota’s state auditor and a 2018 candidate for governor.

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