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.”
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.
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.