In final days of Minnesota governor’s race, a focus on three issues: health care, health care and health care

An August poll by Suffolk University of 500 likely voters in Minnesota put health care as the top issue in the U.S. Senate and governor races.
An August poll by Suffolk University of 500 likely voters in Minnesota put health care as the top issue in the U.S. Senate and governor races.

Jeff Johnson and Tim Walz know where to focus their attention in the closing days of their 2018 campaign.

Thanks to polling results — and their own conversations with voters throughout the state — the two governor candidates are well aware that health care is the top issue on voters’ minds.

“This is the most-important issue in this election,” said Republican Johnson during a recent press conference on the issue. “No matter where we travel, it is the No. 1 issue that comes up. Nothing is even close. People are scared to death about their insurance in this state.”

“This should be the issue that unites us,” DFL nominee Walz said at a health-care focused event at which he joined 2nd Congressional District candidate Angie Craig. “I want to say it until I’m blue in the face; it’s always about people. If we bring it back to people and their lives then we’re gonna find solutions.”

Polling has shown that the issue has remained important throughout the election. An August poll by Suffolk University of 500 likely voters in Minnesota put health care as the top issue in the U.S. Senate and governor races, while a September Star Tribune/MPR poll of 800 voters found that health care was mentioned as a priority by 25 percent of voters, more than any other issue. More importantly, 20 percent of undecided voters list it as their No. 1 issue.

The latter poll asked two questions on some specifics related to the issue. Some 52 percent of likely voters polled in the MPR/Star Tribune survey said they thought the federal government had a responsibility to make sure all Americans have health insurance, though there was a pronounced partisan split on the question: 84 percent of Democrats agreed with the sentiment, but only 23 percent of Republicans did. Voters identifying themselves as independent were divided evenly on the issue, with 43 percent saying yes and 45 percent saying no.

There was far less of a gap — partisan or otherwise — on a second question related to health care: did voters support letting residents buy their insurance through a public insurance program such as Medicare or MinnesotaCare, an option advocated by some DFLers? Of those polled, 70 percent supported the concept while 11 percent opposed, and there were supermajorities among Democrats, Republicans and independents, as well as among all age groups and all regions of the state.

Medicare for all or Medicare for some?

The polling explains why health care is showing up in so much campaign advertising. An analysis of political ads by the Wesleyan Media Project (based on data gathered by Kantar Media) found that 46 percent of ads aired between Sept. 18 and October 15 for federal races throughout the country mentioned health care. During the same time period, just over 30 percent of ads in governor races were on that issue.

The themes that run through the advertising are simple, and sometimes simplistic. Democrats say Republicans want to complete the repeal of the Affordable Care Act, including its protections for pre-existing conditions, and their ads often feature testimonials from people who describe the financial and health impacts of losing coverage.

Republicans, meanwhile, say “Medicare for all” equates to a government takeover of health care. One mailer, targeted against a DFL state House candidate, pictures a mother on the phone with a sick child in the bed next to her, and claims the DFL candidate “thinks you should call bureaucrats — not your doctor — when your child is sick.”

Tim Walz on a single-payer system: “I have said I think it is probably inevitable, because in every other industrialized nation, that’s what they have.”
MinnPost photo by Annabelle Marcovici
Tim Walz on a single-payer system: “I have said I think it is probably inevitable, because in every other industrialized nation, that’s what they have.”
Those campaigns have required both Johnson and Walz to respond. At their debate in Willmar Oct. 9, for example, Walz was asked about his support for a single-payer system. “I have said I think it is probably inevitable, because in every other industrialized nation, that’s what they have,” he said. “But I’m open to what that looks like.”

When pressed as to whether he supports such a system, which has taken off among some Democrats after it was a centerpiece of the Bernie Sanders campaign in 2016, Walz responded with a lengthy answer. “This nation spends twice as much on health care as any other nation, and we rank about 37th in results,” he said. “I simply believe we can achieve outcomes better than anyone else.”

He praised the concepts behind the Affordable Care Act to spread the risk pool over as many people as possible. “Don’t pretend that prior to 2009 that rates were going down,” he said of the year the ACA passed. “They were skyrocketing.”

When pressed by Johnson to give his views on single payer, Walz said, “I don’t care what that payer looks like as long as we’re getting value for our dollars, we are improving that care receiver’s health and adequately compensating those care providers. There are many different models that have been tried. Most of the countries that get better outcomes with cheaper price have ended up cutting the payer out of that.”

More than 120 members of Congress are co-sponsors of the Expanded and Improved Medicare for All Act, which would open Medicare — a program created to provide health care for Americans over the age of 65 — to every resident. There is a 70-person Medicare for All Caucus, of which U.S. Rep. Keith Ellison, the DFL nominee for attorney general, is a co-chair. Walz is neither a sponsor of the bill nor a member of the caucus.

But he did answer a questionnaire for a group called Main Street Alliance, which advocates on issues important to “socially responsible” small businesses.“We need to enact a single-payer system, and as governor I will put us on a path toward single payer,” he told the group.

Johnson accuses Walz of shifting his support on single-payer to something short of that for political reasons, since single-payer was more popular among DFL primary voters than it might be in a general election, Johnson said.

A national debate

Democrats nationally are having their own debate on the issue. Some support enhancements of the ACA, including providing a public insurance option, such as Gov. Mark Dayton’s MinnesotaCare buy-in proposal. Others fully embrace single payer through Medicare for all. There also are differences in what candidates — and voters — mean when they speak about “single payer” and “Medicare for all.”

A recent national poll by Reuters-Ipsos found that 70 percent said they supported “Medicare for all.” But when the question was rephrased to gauge opinions about “single payer” health care, support dropped to 41 percent. Other polls have seen support drop when respondents are told taxes might increase to cover increased costs for Medicare or that the government would gain “too much control” over care decisions.

There also is disagreement over projected costs of a national Medical-for-all program, with both supporters and opponents picking numbers from the most-comprehensive analysis of costs, which said that unless reimbursements to providers remain low, costs will increase by trillions of dollars. Minnesota-based Growth & Justice has also analysed the issue are concluded there could be savings for the insured.

Democratic candidates are united, however, when it comes to a campaign strategy: warning voters that the GOP could remove protections for pre-existing conditions as they continue pushing to end the ACA. Aiding that narrative is a pending lawsuit filed by Republican state attorneys general with the support of the Trump Administration, a suit that argues that when Congress ended the mandate for people to purchase insurance, the constitutional underpinnings of the ACA disappeared.

Alliance for a Better Minnesota, a DFL-aligned independent expenditure group, has been hammering Johnson on the threat of losing coverage for pre-existing conditions. While specifics are few, the gist of the claim is that letting healthier residents purchase “skinny” plans that might have higher deductibles and not cover preexisting conditions will make the high-risk pools too expensive: for government and for premium-payers.

The criticism also questions Johnson’s recollection of how the pools worked before the ACA made them unnecessary.

Johnson: help the private market make insurance more affordable

The normally unflappable Johnson bristles when talking about the ABM ads. “I have said from the start of this campaign that we will continue to guarantee affordable coverage to people with pre-existing conditions,” Johnson said.

He does favor reestablishing the pre-ACA concept of high-risk pools. When that pool existed before the ACA, there were 23,000 Minnesotans enrolled, at a cost of $178 million a year. Johnson said he didn’t know how many might be on that system in the future, but it was cheaper than the reinsurance program adopted in 2017 to help private insurance companies with their highest-cost policy-holders.

“There’s been heavy subsidizing of health insurance in Minnesota for many years and there will be going forward because it’s a value we have in this state,” he said, while noting that he wants to spend that money in ways that doesn’t harm the insurance markets, which he claims Obamacare did.

In his owns ads and in his public statements, Johnson criticizes the idea of a single-payer system. Last week, he stood with a Canadian radiologist who is a critic of Canada’s version of single payer, claiming it leads to long waits and delayed care.

“Single payer means there isn’t private insurance anymore,” Johnson said. “We all lose our insurance and we’re all forced on one government plan. I think we need to move in exactly the opposite direction.”

Jeff Johnson favors reestablishing the pre-ACA concept of high-risk pools.
MinnPost photo by Craig Lassig
Jeff Johnson favors reestablishing the pre-ACA concept of high-risk pools.
That means enhancing the private markets to make it more affordable, Johnson says, and his health care plan includes allowing small businesses, farmers or groups of churches to purchase group plans; forming regional partnerships with neighboring states to allow residents to buy plans across state lines; and a tax exemption for deposits into health care benefit accounts and health savings accounts.

More controversially, Johnson supports reducing the state coverage mandates: the 62 conditions and treatments that must be covered by plans sold in the state. Such reductions require waivers from the federal government, but the Trump Administration is more accepting of state requests.

Johnson, however, said he isn’t yet willing to list which mandates should be removed, saying that should come after a conversation with health care recipients, providers and policy makers. “I fully recognize how unbelievably politically difficult that is because if you eliminate that mandate the attack ads come out saying you don’t care about people with that particular condition,” he said. But adding more mandates “raises the cost of insurance for everybody.”

MinnesotaCare and ‘market fantasies’

Johnson’s lack of specifics on the mandates has opened him to a Walz attack: that he won’t be specific until after the election, denying voters the information to judge the proposals.

For his part, Walz has endorsed a MinnesotaCare buy-in. MinnesotaCare is the state-subsidized health insurance program for working people who make too much to be eligible for Medicaid but can’t afford private insurance. The program covers families earning between 138 percent and 200 percent of the federal poverty rate.

Republican have rebuffed the effort to expand access to MinnesotaCare, citing concerns by hospitals and medical providers that they already struggle with the amounts that MinnesotaCare pays in reimbursements. The Minnesota Hospital Association opposes the expansion, saying members accept lower reimbursements that are significantly below commercial insurance payments because of the vulnerability of the population using MinnesotaCare. If people moved from those commercial policies to MinnesotaCare, hospitals would see revenue declines.

Walz considers the buy-in plan as a step toward a single-payer system, which Johnson says worries him. “Even this step is a disaster for Minnesotans, and particularly for struggling hospitals and clinics all over the state,” Johnson said. “I know he was a geography teacher, but his math is really bad.”

Walz responds by saying Johnson is putting his faith in a private insurance market that doesn’t act like a real marketplace and hasn’t been doing a very good job holding down costs.

“Pretending that the market’s going to make all that happen, that’s simply fantasy,” Walz said. “If you’re running for governor and your plan is to scream single payer at me, you ain’t getting anything done.”

Of revenue and reinsurance

The candidates disagree on a significant source of money for state health care programs. Johnson supports allowing the so-called provider tax — a 2 percent tax on health care services — to expire at the end of 2019. That money currently is the dedicated source of funding for MinnesotaCare (and for former MinnesotaCare enrollees who moved to Medicaid under the ACA’s Medicaid expansion program). That’s nearly 1.5 million people in the state.

The hospital association, which Johnson quotes in opposing MinnesotaCare expansion, disagrees with Johnson on letting the provider tax expire until an alternative is crafted.

Walz would like to maintain the tax, which raises $500 million a year. Next year’s sunset was part of the compromise between Dayton and legislative Republicans to end the government shutdown in 2011. Without it, however, the next governor and Legislature will have to find money from other sources to pay for health care subsidies, and to continue a controversial reinsurance program to help insurance companies with the highest-cost policyholders.

Democrats voted against reinsurance and Dayton let it become law without his signature. It is now being touted by the GOP as the primary reason that the individual insurance market not only stabilized this year but saw rate cuts, and even Dayton’s Commerce Department credited reinsurance as one reason. About 155,000 residents get insurance from the individual market in Minnesota, while another 303,000 get benefits from the small group market for employers who have fewer than 50 workers. The two programs cover less than 9 percent of the state.

Both Johnson and Walz support stabilizing the insurance system until other changes can be made. Says Johnson of the reinsurance bill: “I likely would have signed it as governor but it’s a band-aid,” said Johnson. “It’s not sustainable to keep doing this year after year after year. ”

Comments (66)

  1. Submitted by Joel Stegner on 10/29/2018 - 01:10 pm.

    Bottom line. Johnson does not think that all Minnesotans have a right to access to comprehensive health insurance at a cost they can afford. One of the best things about Minnesota is our cost effective, high quality. Why should some have to settle for less because Republicans who have never gone without health insurance think they deserve lower taxes? Not even financially smart as neglected illnesses can have astronomical costs – just so focused on personal pocket book issue that certainly is not One Minnesota thinking.

    • Submitted by Ron Gotzman on 10/29/2018 - 02:49 pm.

      “Bottom line. Johnson does not think that all Minnesotans have a right to access to comprehensive health insurance at a cost they can afford.” – wrong – read the article.

      Why should some have to settle for less because Republicans who have never gone without health insurance think they deserve lower taxes? wrong – read the article.

      Mr. Joel sounds like he is listening to the old – tired – DFL campaign commercials. When Tim wins – we will see if he will hold Gov. Tim accountable.

      • Submitted by John Evans on 10/29/2018 - 06:42 pm.

        Mmmm … Sorry, but any conservative will tell you that there is no such thing as “a right to buy comprehensive health insurance at a cost they can afford.” The market is supposed to set prices and any government policy that interferes with that process is, per se, a drag on efficiency and also a big step down the road to serfdom.

        Jeff Johnson is a conservative, if we take him at his word. And he seems to believe that an unfettered private insurance market results in lower rates, despite all experience and evidence to the contrary.

        All his dodges about the risk pool and reinsurance should be ignored.

      • Submitted by Elizabeth Frost on 10/30/2018 - 08:57 am.

        Hello Ron –

        Johnson wants to eliminate some required covered conditions. Doesn’t’ that sound like he is saying that all Minnesotans don’t have the right to comprehensive health insurance at a cost they can afford?

        Healthcare is so unjust it is crazy. It is bad enough to have a crippling illness, why do we as a society have to penalize the sick and ill by bankrupting them? How do we make it more fair? Ask people to pay a percentage of their income instead of premiums to insurance companies.
        It is very simple. Just like Medicare.

        • Submitted by Bob Barnes on 10/30/2018 - 01:20 pm.

          Elizabeth,

          “Healthcare is so unjust it is crazy. It is bad enough to have a crippling illness, why do we as a society have to penalize the sick and ill by bankrupting them? How do we make it more fair? Ask people to pay a percentage of their income instead of premiums to insurance companies.
          It is very simple. Just like Medicare.”

          Let me point out a few issues here.
          1. How is it fair to steal MY income to pay for YOUR bad habits? That’s what universal coverage/single payer amount to. Your choice to eat poorly and get Diabetes shouldn’t be a reason to tax me to pay for it. There’s no fairness in your solution at all.. other than everyone is equally poor and miserable.
          2. Do you know why healthcare and health insurance (2 very different things) are so expensive in the US? I doubt it but I’ll explain. The government refuses to enforce 15 USC 1 (Sherman Anti Trust Act among others) against the entire section of the US economy (actually against anyone really). They did it to Standard Oil back in the early 1900s and broke them up. The current system allows hundreds of monopolistic practices to go on every day. Your doctors charge you a fee based on what type of insurance you have. Akin to you being charged 10 times as much at Walmart or Target as the person ahead of you in the same line with the same item(s). The govt forbids you to import drugs from overseas where they get them cheaper. The drug companies are exempt from lawsuits over vaccines etc. If you were bit by a rattlesnake… the treatment would cost you upwards of $50,000 yet the anti venom is purchased by the doctors/hospitals for a few hundred dollars per dose (at most). Why are they allowed to run the fee up by thousands of percent? Why are prices never posted for the end users to see?
          3. Let’s talk pre existing conditions. If YOU ran an insurance company, would you write a policy for a home owner that had just set his own house on fire and wanted insurance after the fact? Not likely. You’d be charging that home owner a hefty premium because you’d be guaranteed to have to pay that claim. People are going to have serious illnesses. Those who do will always have to pay more for insurance because of it. But in a free market system, even their costs would be low enough that they could afford the premiums quite easily (mainly due to competition and a large risk pool where insurance companies would not have to be paying out for every little thing). Which is going to result in higher premiums: A. charging every medical visit and illness to insurance that they have to then pay claims on? or B. Paying most of your expenses out of pocket so insurance companies only pay out on larger claims that you couldn’t afford out of pocket? Clearly B would result in lower premiums. The way you get there is you reduce the costs of care so that the extreme majority of medical issues would be affordable out of pocket. You do that by ending the anti trust and monopolistic practices and get govt out of the markets so competition and capitalism can take over.

          • Submitted by Paul Udstrand on 10/30/2018 - 01:58 pm.

            “1. How is it fair to steal MY income to pay for YOUR bad habits? That’s what universal coverage/single payer amount to. Your choice to eat poorly and get Diabetes shouldn’t be a reason to tax me to pay for it. There’s no fairness in your solution at all.. other than everyone is equally poor and miserable.”

            Dude, you don’t pay for YOUR own health care right now unless you pay for everything out of your own pocket. So are you complaining about the fact that your insurance company pays for other people’s health care? Where do you think the money private insurance uses to pay for your health care some from? This is no different than medicare and it’s no more or less “fair”.

            Why don’t you send me all of YOUR medical records and those of your family members so I can decide whether or not YOUR morally competent enough to receive the health care the rest of us are paying for. And if your daughter ends up the ER after a car accident we better stop and not treat her until we find out whether or not she was responsible for the accident eh?

            • Submitted by Bob Barnes on 10/30/2018 - 05:30 pm.

              “Dude, you don’t pay for YOUR own health care right now ” – False claim. I have my own insurance policy which covers what I need/want. I pay the premium for that. That’s what private insurance does. My insurance company carries policies for others for their own medical needs.

              “I merely note that your comparing Type II diabetes to arson.

              Yes, the problem is we have a business model instead of a health care system. Your “arguments” make that perfectly clear.” — (this last line is beyond laughable. Go look up the list of the top hospitals in the world… almost all of the top 20 are here).

              there is no real difference.. both require the insurance company to pay out on claims. You can actually cure your own Type 2 btw just by eating properly. The point is pre-existing conditions will always exist and will require higher premiums due to the guaranteed claims to be paid out. In your system, everyone is taxed to pay for that and at much higher costs. In my proposed system, only YOU pay that premium and the premium would be at least 80% less than it is right now.

              My proposal is to bring healthcare spending back down to 4% of GDP or less where it was traditionally before we got the boondoggle known as Medicare crammed down our throats. Today we are spending closer to 20% of GDP and that cost is increasing steadily every year. Within 4 or 5 years, our economy will simply collapse because there won’t be enough money to pay for it all. Single payer doesn’t fix that either. Single payer will just drive good doctors out of the business and you’ll be left with the scrubs that barely made it thru medical school, just like other places that already have such systems. On top of that, your own care will be delayed in most cases or even outright denied.

              • Submitted by Paul Udstrand on 10/31/2018 - 08:54 am.

                “False claim. I have my own insurance policy which covers what I need/want. I pay the premium for that. That’s what private insurance does. My insurance company carries policies for others for their own medical needs.”

                I’m afraid you don’t know how your own insurance works, nor do you understand the business model, which is kind of ironic given the fact that you’re pretending to defend the business model!

                The insurance money that pays your medical bills comes from all the other people who also have insurance policies with your company, they don’t just give you your own money back. You’re describing a savings account, not an insurance policy. The business model is to take ALL of the money collected from ALL of the policy holders and use to pay individual bills. If you paid your own bills you wouldn’t need an insurance policy in the first place. This is no different than medicare, it’s the same model without the profit and shareholders and multi-gazillion dollar executives.

              • Submitted by Matt Haas on 11/02/2018 - 10:56 pm.

                Hey Bob, so am I to surmise my five year old should cure the hole in his heart too? Or perhaps my niece with CF. The problem your having is that health insurance is not analogous to property insurance at all. It functions both as insurance (ie external forces acting up ones health like injuries and infectious disease) as well as like a warranty, (protecting against breakdown or defect). To use your line of reasoning, should an insurance company deny a new homeowner the ability to buy insurance because their previous home was destroyed by a tornado? Should they refuse to pay a claim if the foundation collapses after 10 years due to faulty concrete? Here’s an idea, perhaps the best way to think about single payer is to consider it not insurance, but a warranty, with coverage limited only to that which is specified, just like your 3 year 36000 mile coverage on your powertrain will pay for your motor blowing up. You’ll still have the option to pay for any additional coverage you think you’ll need, ie collision, glass, or wheels, but the cost for those will be greatly lessened, and the important bits that keep the “car” in motion (and contribute the greatest amount to premiums) will be tacked onto the “payment”, in this case your income tax. Not that I expect to sway you, but hopefully it makes things a bit clearer for others.

          • Submitted by Paul Udstrand on 10/30/2018 - 02:03 pm.

            ” Let’s talk pre existing conditions. If YOU ran an insurance company, would you write a policy for a home owner that had just set his own house on fire and wanted insurance after the fact? Not likely. ”

            I merely note that your comparing Type II diabetes to arson.

            Yes, the problem is we have a business model instead of a health care system. Your “arguments” make that perfectly clear.

          • Submitted by Frank Phelan on 10/31/2018 - 07:47 am.

            Yes! I’ve been waiting for conservative to get on board with enforcing anti-trust law for a long time.

            Should we start with healthcare or just go straight to breaking up the monster mega banks?

  2. Submitted by Hiram Foster on 10/29/2018 - 02:36 pm.

    Why do Democrats always fail and Republicans always succeed? It’s because the Democratic Party is the party that believes in doing something, and the Republican Party believes in doing nothing, and it is always the case that doing something is much harder than doing nothing. For Republicans, doing nothing often takes the form of saying “the market will solve the problem”. And if the market doesn’t solve the problem, which is the case in the area of health care for reasons that have been well understood by economists for decade, the Republicans can do the other thing they are good at, blame regulation.

    • Submitted by Frank Phelan on 10/29/2018 - 05:33 pm.

      Many Republicans profess fealty to Christianity, but faith in the free market borders on idolatry.

    • Submitted by Paul Udstrand on 10/30/2018 - 10:59 am.

      Yes but the problem is that the failure of the health care markets has obvious for decades, not just in the last decades. Democrat’s have just finally managed to recognize the bloody obvious after decades of practicing Republican magical thinking.

      We could say better late than never but Democrat’s still don’t have their act together on this, far too many are still labeling common sense as a: “pipe dream” of some kind. Another problem is that we’re stuck with poor champions in many ways because the same neoliberals who denounced single payer for decades are now trying to be it’s champions. So Republicans get to say: “Hey, aren’t you the guys who decided all this stuff was a bunch of pipe dreaming two years ago when you put Clinton on the ballot instead of Sanders?” I mean, it’s doable, but this would all have been a lot easier if Democrats had put expanding Medicare on the agenda back in the 90’s instead of pulling a Heritage Foundation health care plan off the shelf.

  3. Submitted by Bob Barnes on 10/29/2018 - 07:49 pm.

    Single payer is a disaster. What Walz fails to mention is that single payer nations ration care (rich get immediate care while everyone else waits or is outright denied certain treatments). Those nations are going broke almost as fast as the US. Walz is also lying… premiums went up roughly 10% annually before ACA, since they have gone up in many cases over 100%. Without the subsidies (which 80+% get) no one could afford premiums now. Neither candidate will admit the real problem (just as Trump has refused to do anything about it) and that is the monopolistic practices in the system. Enforce 15 USC 1 and you’ll see healthcare and health insurance costs drop 80% almost overnight. That would put the US well below every other industrialized nation for cost .. by a large margin. Go look at the Surgery Center of Oklahoma website for an example of the free market in action at 20% of the normal cost.

    As for pre-existing conditions, would you give insurance to someone who set their house on fire after the fact and not charge them a LOT? Yes, some people have serious illnesses .. that is just luck of the draw. Those people will always have to pay more for insurance. But having a free market would make their insurance premiums easily affordable, just not as cheap as those who are healthy.

    Free markets (without heavy regulation or monopolistic practices) are the only workable solution. Those markets brought you 4k ultra high def. tvs for a few hundred dollars, smartphones that are more powerful than personal computers of just 5 or 6 years ago at very cheap prices… why would you not want free market competition to bring you the cheapest costs of care and the best outcomes for the most important thing in your life?

    • Submitted by Paul Udstrand on 10/30/2018 - 10:39 am.

      Private insurance rations care to a much greater extent than any single payer system in the world. We have the most “rationed” health system on the planet. If you don’t believe your health care is currently rationed try stepping outside your provider network to get treatment or expertise they don’t offer or don’t cover.

      Republican’s flood the discourse with false information regarding other nation’s health care systems. No one has a perfect system but single payer would improve our system dramatically. We pay more, get less, and have the worse outcomes of any developed nation. And we’re STILL leaving tens of millions of American’s without any coverage at all.

      • Submitted by Bob Barnes on 10/30/2018 - 12:05 pm.

        “Private insurance rations care to a much greater extent than any single payer system in the world.” — this is an outrageous lie. In the US, you can get any treatment you want… in the UK for example, you cannot. The govt run system there deems certain drugs and procedures too expensive to be worth using (unless you have private insurance that will pay for it). Single payer systems MUST ration care because it’s the only means of cost control they have. Whenever everyone sees the system as “free” it gets abused. Thus the only way to control costs is to ration care… either by denying certain treatments outright or making the patient wait months for the treatment. Even the LA Times proved this to be true when they did a big story on Canada’s single payer system where the rich people get immediate care while those that couldn’t afford the supplemental insurance are told to wait ..many times months. A hernia operation takes months of waiting to get… whereas in the US you can have it literally tomorrow.

        “We pay more, get less, and have the worse outcomes of any developed nation.” — this too is yet another bald faced lie. Yes, we pay more but we have better outcomes than anyone. That’s why we have so much medical tourism. People from all over the world come to America for treatment. It’s also why we have 18 of the top 20 hospitals in the world located in the US!

        The problem with those of you on that are Democrats/left wingers is that you run around pushing a false narrative using propaganda put up by other left wing organizations.

        If you took the time to read my comment above, you’d see that what I propose would drop ALL costs across the board by 80% or more literally overnight. The US would be below Mexico in terms of money spent on healthcare (costs)…. which is well below EVERY 1st world nation on the planet by a large margin. Go to the website for the Surgery Center of Oklahoma and have a gander at their prices. They actually list the cost of any procedure they perform online so you know what your total cost will be before you ever set foot in the door. Their prices are 20% of most every major hospital in America. That’s because they use a free market system.

        • Submitted by Paul Udstrand on 10/30/2018 - 01:35 pm.

          “In the US, you can get any treatment you want…” No, THIS is an outrageous lie.

          In the US you can only get the treatment your insurer will cover, or you can afford to pay for yourself. This is simply fact, and if you’re not aware of it, you have no business pretending to represent the nature of health care in the US.

          Tens of thousands of Americans are denied treatments and coverage every year in the US. On a daily basis insurers refuse to cover prescribed medications for just one example. Sure, you can get the medication you Doc actually prescribed, as long as you can pay for it on your own.

          And then there’s de facto rationing that occurs when even people who have insurance of some kind have to choose whether or not they can afford their medication or buy food and pay their rent. Millions of American’s dial their dosages down so they can spread out their costs, assuming that taking some of their medication is better than not taking any at all.

          One of the reasons insurance administrative costs are so high it that they spend so much money employing so many people who sit around figuring out how to deny coverage, or order less expensive procedures and treatment.

          So yeah, you could get any treatment you want in the US… if you don’t need insurance to pay for it. That means we’re rationing to all but the top 5%.

        • Submitted by Paul Udstrand on 10/30/2018 - 01:47 pm.

          “Yes, we pay more but we have better outcomes than anyone.”

          This is completely false. Several studies and comparisons have repeatedly shown the US delivers some of the worse health care treatment outcomes in the world, not even just the “developed” world. We’re ranked 37th according to the WHO (behind Costa Rica). Anyone even make a casual attempt to find out how our outcomes and quality compare will quickly discover that we pay more and get worse. You sir have clearly NOT made such an attempt.

          Even our basic mortality rates are increasing.

          • Submitted by Mark Kulda on 10/30/2018 - 10:09 pm.

            You reasoning is flawed because you assume that the only factor that affects health outcomes are those dictated by the delivery of the health care system, when health outcomes by your metric are determined by far more than just the care given.

            • Submitted by Paul Udstrand on 10/31/2018 - 09:21 am.

              Health care outcomes are a product of health care delivery. Sure, it’s a complex system, but the metrics are clear and reliable measurements of health care delivery. You can talk about something else if you want, but you’re just changing the subject.

              • Submitted by Mark Kulda on 11/01/2018 - 10:18 am.

                Health care outcome is NOT just determined by the delivery of the care. Yes its’ probably one of the most determinant factors but not the sole factor. Also included is how much follow up there is and whether any lifestyle changes are encouraged and made. If someone who is obese and had diabetes is treated by the health care system with meds and told to eat better and exercise and they don’t but then they have a heart attack and die. How is it the health care system’s fault for not preventing the heart attack? Under your metric, that’s a bad outcome that’s on the provider. Other countries with better so-called outcomes have OTHER factors than just the health care system that help. We do a terrible job with the other factors in the US. Getting better outcomes is not just about blowing up the payment system so that we can get more care to poorer people, which is what single payer is all about. We can get more care and cheaper care using better, smarter alternatives than destroying the quality of our system which will certainly happen under single payer.

                • Submitted by Paul Udstrand on 11/04/2018 - 09:35 am.

                  Once again, you really need to make a better effort to understand the subject matter:

                  “Health care outcome is NOT just determined by the delivery of the care. Yes its’ probably one of the most determinant factors but not the sole factor. Also included is how much follow up there is and whether any lifestyle changes are encouraged and made.”

                  ALL of those issues and observations flow out of our health system and are by definition the “outcomes” we currently measure. These are all metrics and data we collect and use to quantify and qualify our health care quality. The fact that you seem think your talking about something OTHER than outcomes simply betray’s lack of understanding.

      • Submitted by Mark Kulda on 10/30/2018 - 10:16 pm.

        The greatest amount of ‘rationing’ of the American health care system is done by Medicare. Medicare for all doesn’t mean people get as much care as they want. The fact is that a single-payer system will have to ration care, period. The government does not reimburse providers enough to actually pay for the care provided. So if EVERYBODY would now get their care at the government’s rate, then the providers will have to cut corners in order to make the numbers work. Guess what that means, Paul? Rationed care and care with the corners cut. Not world class health care like we have now. Outcomes are based on more than just what the heath care system delivers. And our society is terrible at following through and making people make different, healthier choices. It’s not just the delivery system that leads to bad outcomes. Advocating for single payer because of a flawed payment system is not a good enough reason to destroy the nation’s best medical system. A good solution would be to empower consumers with their own money to shop for high quality care using quality and price transparency so the best, most economic choices can be made…using HSA like accounts. Too many advocates of single payer simply want to get all the health care they can consume and have somebody else pay for it. That just won’t work.

        • Submitted by Paul Udstrand on 10/31/2018 - 11:13 am.

          “So if EVERYBODY would now get their care at the government’s rate, then the providers will have to cut corners in order to make the numbers work. ”

          No. You’re making the false assumption that providers work with narrow margins. Our providers charge hundreds of times more for comparable services and treatments than anyone else in the world. You could cut reimbursement rates by 50%-70% and they still wouldn’t have to cut any corners to make ends meet, not even close. However, no one is actually talking about cutting reimbursements that much, most of the initial savings (about a trillion dollars) from reduced administrative costs for both Medicare AND providers.

          Providers would save hundreds of millions in administrative costs by having a single payer to bill instead of dozens or hundreds all with different rates and coverages.

          • Submitted by Mark Kulda on 11/01/2018 - 10:28 am.

            If you were a provider or a payer, instead of a lawyer, you’d probably understand the medical payment system better. Lawyers are smart people and you are very bright and I always appreciate your intelligence but this is one area where you’re not quite on the right page. Yes reducing the administrative costs will be helpful on both sides. Providers will be able to save money not having to deal with as much billing issues but they will still have to bill the government and their medical records and billing will still take administrative costs to be able to continue to deliver care. Provision of the actual care is still the overwhelming bulk of health care costs. Keeping the quality of care high will require a larger reimbursement rate than what providers currently get. While that’s doable the problem is it also balloons the expected costs and pushes the system into the probably unaffordable category. Single payer in and of itself doesn’t control the cost problem because it doesn’t adequately factor in what the actual cost of procedures should be. Right now
            CMS does use a system called RBRVS to help determine reimbursement rates, but that system will be totally upended if all care had to be paid for by the government because the system now assumes that they can provide a lower rate knowing other payers will be able to make up for it. There will have to be longer and much more serious analytical discussions by CMS using much more robust determinants and in my experience I don’t trust the public sector to do that right.

    • Submitted by Pat Terry on 10/30/2018 - 11:04 am.

      The problem is that there has never been a case where an unrestricted free market provides a workable healthcare system. Ever. Anywhere. Because healthcare is nothing like TVs and smartphones.

      Single payer, and other versions of unviversal healthcare, are used all over the world, and provide better care for less money than the United States does.

      • Submitted by Bob Barnes on 10/30/2018 - 12:13 pm.

        “The problem is that there has never been a case where an unrestricted free market provides a workable healthcare system. Ever. Anywhere. Because healthcare is nothing like TVs and smartphones.” — only because people can’t stop voting for big govt. Healthcare is exactly like TVs and Smartphones and any other product you care to buy. You want the best quality for the lowest cost. That means it must be a free market system. Competition brings quality and lower prices. Govt mandates bring lousy quality and higher costs. Go look at the disease / illness problems in places like the UK.. where you’re more likely to get sick from being in their dirty hospitals than being at home.

        “Single payer, and other versions of unviversal healthcare, are used all over the world, and provide better care for less money than the United States does.” — Again this is an outright bald faced lie. They ration care to keep costs down and their outcomes are worse than those in the US. Not only that, they get drugs from US companies far cheaper because WE are paying all the R&D costs. IF they actually paid their “fair share” of the costs, their systems would cost just about as much as ours and still have worse outcomes than us.

        I just gave you a solution that would drive costs down 80% for both care and insurance. A solution that would put the US below Mexico in terms of cost of healthcare and well below every 1st world nation on Earth by a very large margin. It’s a proven system that has worked time and again and has brought more people out of poverty than every other system combined. Free market capitalism is the only solution that is workable. Everything else is a disaster that enslaves the population with taxation and crappy care.

        • Submitted by RB Holbrook on 10/30/2018 - 02:45 pm.

          “Healthcare is exactly like TVs and Smartphones and any other product you care to buy.”

          It is possible to live without a TV or smartphone, believe it or not. Can you say the same thing about medical care?

          Can you make a response that doesn’t rely on “I, me, my?”

          • Submitted by Bob Barnes on 10/30/2018 - 05:42 pm.

            RB, that is a logical fallacy. No one in America is EVER denied healthcare. You can walk into any ER and be cared for 24/7. Here is a little comparison for you:

            Would you rather have a 1980s brick mobile phone that cost $3500 or an Iphone/Galaxy that costs a few hundred dollars? The free market brought you that change. The free market (as heavily regulated as it is) took you from the old tube console tvs to a 100+ inch LED tv that can hang on your wall with 4k High def picture. Why would you NOT want the same free market involved in the most important thing in your life (your healthcare)?

            Yes, I can live without a tv or smartphone. But if I have a health issue, I want the very best care I can get at the very lowest price. That only happens in a free market system where competition controls the markets.

            • Submitted by RB Holbrook on 10/31/2018 - 09:11 am.

              “No one in America is EVER denied healthcare. You can walk into any ER and be cared for 24/7. ” Well, now . . .

              First, according to the US Department of Health and Human Services, “Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs.” The ER treatment is something imposed by big government, not the free market.

              Second, the ER is not obligated to provide routine or preventive care. You know, that boring stuff that keeps people from needing more expensiove care.

              Third, who do you think pays for the ER care? That’s right: You, with your taxes, or with the insurance that you bought. You’re subsidizing the care of the looter class whether you like it or not.

              “Why would you NOT want the same free market involved in the most important thing in your life (your healthcare)?” Because the free market does not necessarily reflect my needs or wishes. It is a compendium of mass choices. For another thing, I am not always equipped to decide what I need or want. I can make a free decision to agree with the marketing and decide I want a new phone or TV. I am not capable of diagnosing my need for a particular treatment.

              That’s why doctors go to medical school, in case you were wondering.

            • Submitted by Paul Udstrand on 10/31/2018 - 09:15 am.

              “RB, that is a logical fallacy. No one in America is EVER denied healthcare. You can walk into any ER and be cared for 24/7. Here is a little comparison for you:”

              Again, you’re simply wrong. The required treatment in ER’s is limited to emergency treatment. You can’t walk into the Abbot Northwestern ER and get an annual physical or have that lump on your neck examined. You’re not going get chemo or routine prescriptions in an ER.

              Furthermore part of the rationing we’ve been discussing started emerging back in the late 90’s when a lot of private for profit hospital simply stopped building ERs into their hospitals. That’s what the Urgent Care’s are all about. Sure, you can walk into an ER and the law requires emergency treatment, but if walk into Park Nicollet’s urgent care… they’ll call an ambulance to take you an ER somewhere.

              And of course the idea that you can “get” health care by walking into an ER even if it’s emergency treatment assumes that cost is no factor. Sure, if you afford a $20k+ bill, but people who can’t afford those bills simply forgo medical treatment.

              And by the way, ER care is one of the most expensive types of care in our system, and you actually WANT people to go there for routine health care? THAT’S your solution for people who have no insurance? And you think you have a plan to “reduce” our health care costs?

      • Submitted by Mark Kulda on 10/30/2018 - 10:19 pm.

        What you are essentially saying is that you don’t trust yourself to make your own medical decisions and you trust government bureaucrats to make those decisions for you. You might trust that, but I and many, many others don’t. There’s just not a good track record there.

        • Submitted by Paul Udstrand on 10/31/2018 - 10:16 am.

          “What you are essentially saying is that you don’t trust yourself to make your own medical decisions and you trust government bureaucrats to make those decisions for you. You might trust that, but I and many, many others don’t. There’s just not a good track record there.”

          I’m not sure who this is directed at but it’s common myth among “free market” defenders of private health care so I’ll respond.

          To being with, those who claim that Medicare for All is a government takeover of the health care system don’t understand how the health cares system works. We have “payers” who pay the bills, and “providers” who actually perform medical procedures and prescribe treatment. Medicare is a “payer” not a “provider”.

          Your actual medical treatment regardless of insurance or lack thereof is primarily determined by the provider, not the payer. Medicare doesn’t tell Docs how to treat your high blood pressure or brain tumor. So the question of “trusting” the government to make your health care decisions is simply facile. Medicare doesn’t and won’t make your health care decisions.

          Now payers DO sometimes interfere with treatment recommendations and deny treatment, but that’s a product of the business model not “big government”. MFA actually decreases that interference because once everyone is enrolled it brings everyone under a common insurance umbrella that doesn’t have to compete for profits. It also expands your treatment options and availability substantially because it essentially creates one of the largest “networks” of providers in the world. No matter where you live, or who you work for (or don’t work for) you go to the doc of your choice, that Doc makes treatment decisions and recommendation, and they send the bill to Medicare.

          As for Trust… right now when your insurance interfere’s with your treatment they do so for profit. So yes, I’d trust a government workers who’s just doing their job over a private insurance bureaucrat who gets paid to save money by denying coverage or opting for cheaper medical care any day. If you have private insurance and you think you have more control over your health care because of that… you don’t understand your situation.

          Finally, this idea that we make our heath care decisions in any event is based on the mythical notion that health care is just another consumer choice we make. This is simply absurd. When your in pain, or unconscious, or in the middle of a heart attack, the idea that you can go “shopping” for health care options will likely get you killed… literally. Even in an emergency the ambulance is required by law to take you to the nearest ER, not the one of your choice, assuming you’d be conscious enough to even make a choice. Being sick or injured is NOT the same as looking for a new pair of shoes or a set of golf clubs, or even a house. Medical expertise simply can’t be “googled” or even compiled on some kind of consumer “best of” list.

          And if you really want the greatest level of “choice” and options Medicare for All creates that because it creates the largest provider “network” the nation has ever had. Almost every Doc and hospital and clinic and nursing home in the country would be in the “network”. You’d have more control over your own health care than American’s have EVER had.

          • Submitted by Mark Kulda on 11/01/2018 - 10:10 am.

            You are really showing your lack of how the medical payment works. Of course the provider is going to dictate the individual care that gets provided. But when the reimbursement rate is so low, the providers are going to begin to be guided more by what rate brings them the most money so they can try to continue to operate. This means that the bureaucrats who are artificially determining rates are de facto going to be dictating treatment. Not individually as you point out and we both agree on, but by their determination on payment structure. With such low reimbursements, you will get cutbacks in treatment, which is what happens in other countries with single payer. You can’t deny there are not waiting lines in single payer countries and treatment sought but not provided. It definitely happens in single payer countries. You will get to choose providers, of course, but the care you get will be absolutely and directly affected by how much the government is going to pay for it.

            • Submitted by Matt Haas on 11/02/2018 - 11:05 pm.

              Or, of course, the providers just make less money. Lack of demand for currently overpriced medical skill and technology drives down cost, until the system reaches a point of stability. I’d imagine this will happen around about the time the boomer generation “ages out” of the need for health care.

            • Submitted by Paul Udstrand on 11/04/2018 - 09:39 am.

              “You are really showing your lack of how the medical payment works. Of course the provider is going to dictate the individual care that gets provided.”

              Actually your just displaying your lack of knowledge regarding how much we have bouncing around in our health care system.

        • Submitted by Frank Phelan on 10/31/2018 - 10:29 am.

          Are insurance company bureaucrats trust worthy?

          • Submitted by Mark Kulda on 11/01/2018 - 10:03 am.

            At least they can be fired if they make mistakes.

            • Submitted by RB Holbrook on 11/01/2018 - 04:46 pm.

              Or, if their “mistake” saves the company money, they can get promoted.

              My wife used to handle claims for a medical insurer. Her specialty, in fact, was pre-existing conditions. Denying claims was how the company made money. If she denied one “by mistake,” there were no consequences. If she paid one that the company thought she shouldn’t, that was a very, very bad thing.

    • Submitted by John Evans on 10/30/2018 - 11:46 am.

      Our uniquely American experiment with private health insurance has proven one thing: that the insurance market is absolutely incapable of controlling health care costs.

      • Submitted by Bob Barnes on 10/30/2018 - 12:20 pm.

        “Our uniquely American experiment with private health insurance has proven one thing: that the insurance market is absolutely incapable of controlling health care costs.” — No, it has proven that govt intervention in free markets is what drives up costs and makes a total disaster out of the system.

        If you and I went to Walmart and there were no prices listed for anything.. would you shop there? And if so, would you be ok with them charging me $100 for a 50 inch 4k tv but then charging you $2,000 for the exact same tv that I got? No on both counts. Yet you do that with your healthcare every single day. Would you be ok going to the gas station and not only not see the price of gas at the pump but you get charged based on which insurance you have? Your 10 gallons of gas might cost you $500 while the person at the next pump only pays $50 for 10 gallons of gas. That is the system we have now because of monopolistic practices that the govt refuses to deal with. Medicare patients are charged far less than privately insured patients for the same exact care… done anywhere else and those in charge would be arrested and jailed for anti trust behavior.

        As usual, pretty much everyone commmenting here doesn’t have the first clue of why prices are so high and why healthcare is such a mess in the first place. All you want to argue about is which political party is worse and how much better Socialism and Communism are to free markets (while walking around with electronics brought to you by those very same free markets for costs you can easily afford).

  4. Submitted by Roy Everson on 10/30/2018 - 04:32 am.

    The industrialized world has considered health care a basic right for generations now — with the exception of these United States (see social democracy, lack of). Any population reasonably well informed will adopt it slam dunk. One reason Americans are poorly informed is scare tactic bunkum like this from Johnson: “Single payer means there isn’t private insurance anymore,” Johnson said. “We all lose our insurance and we’re all forced on one government plan. I think we need to move in exactly the opposite direction.”

    Well, betcha your last forkful of lutefisk that Johnson has Scandinavian relatives somewhere in the old country and that those kin can tell him there is a private insurance market coinciding with the public system and that here in Norway where I’m staying some employers choose to get their folks ahead of the line health-wise so to speak to boost productivity and enhance worker’s well-being. Privately. Not that people entirely within the public system are dissatisfied — how else would they be the happiest people in the world (even if they don’t show it so much, then)?

    • Submitted by Bob Barnes on 10/30/2018 - 12:58 pm.

      “The industrialized world has considered health care a basic right for generations now” — that’s a serious problem. A right would imply that you have the right to force a doctor to treat you. Healthcare is not a right because it requires someone else to provide it for you. It’s like the old saying… if everyone else walked off a cliff, would you walk off it as well? Those systems have much higher overall taxes than we do and have lower quality outcomes. How is it any better having the govt take even more of your hard earned income to pay for the irresponsible behavior of others? Also, those private companies are lowering your wages to pay for that health insurance. They aren’t going to eat that cost .. they just reduce the rate of pay for each position to cover it. Sounds a lot like slavery to me.. or at least indentured servitude.

      In a free market capitalist system, I’ll pay for my own care and the costs will be much, much lower so that everyone can afford their own care and their own insurance policies based on what they need.

      • Submitted by Roy Everson on 11/01/2018 - 01:03 am.

        Reminds me of those popular utopian novels in the 19th century which today can be read as fantasy and tor their very limited basis in reality. The fact is there is no representative democracy in the world that would ever choose your model of health care. Period. But because there are several approaches of universal coverage and many of them incorporate private insurance options there are conservatives the world over who get this. They are conservatives, not reactionaries. American Exceptionalism means having one of the few major parties on the planet that relies on utopian capitalism and the lies of pols like Johnson for policy positions.

  5. Submitted by Frank Phelan on 10/30/2018 - 05:48 am.

    Does this mean that Johnson will stop playing on peoples’ Islamophobia and fear of immigrants? Or is that still playing well with the base?

    • Submitted by RB Holbrook on 10/30/2018 - 11:44 am.

      Of course not. Why do you think the Republicans are running the ads with scary Nancy Pelosi and those two “near” fellows, Ellison and Kaepernick?

  6. Submitted by Paul Udstrand on 10/30/2018 - 09:28 am.

    Johnson doesn’t have a clue, and single payer isn’t a tired old DFL plan, the Democrats have been fighting single payer for decades, that’s why we don’t have already. The neoliberal grip on Republican AND Democrat mentalities has been rock solid for decades, both parties have been practicing mental gymnastics and magical thinking regarding health care for decades.

    The limitations placed on your health care and cost of being healthy by the private insurance industry dwarf those that would exist under a Medicare for All plan. If you think you currently have “choice” and “freedom” and affordability, you haven’t really needed to use you health insurance yet and you don’t understand your coverage. If you think the “market” provided all of these things before Obamacare you’re connection with reality is tenuous.

    Republicans proved that when it comes to health care (and most other problems) they got nothing to offer but magical thinking. Remove all requirements and let the market do it’s magic. That’s how millions of people end up with out insurance and tens of thousands with insurance end up bankrupt if they ever really need health care. And this isn’t just an economic problem, millions of American’s have suffered and died because we have a market but no system for health care.

    But really, the most important part of this story, and the one that no news media in Minnesota is reporting… is the duplicity and dishonesty of the Republican campaigns and plans. We actually saw the Republican “plan” when they tried to repeal “Obamacare” and THAT’S same plan these guys are running on today… yet they deny it.

    Republicans voted what? over 50 times to repeal Obamacare? And one of the integral parts of THAT repeal was ALWAYS to scrap the pre-existing condition coverage mandate. These “cheap” plans the Republicans promise can only exist in a “market” where insurance companies can deny coverage.

    It’s complex industry but a very simple business model, the more health care insurance actually has to pay for, the more they have to charge to pay for health care, and we have the most expensive health care in the world. Insurance companies make profits by collecting more than they pay out. They don’t lower health care costs, they just pay less either in the form of denied coverage, or higher premiums and deductibles.

    The thing is we’re not talking about cheap car insurance plans that make you “legal” on the road, we’re talking about peoples lives and financial survival. Cheap coverage is a boon for the industry and a disaster for people who need health care… but THAT’S the Republican plan. And it’s not really any different with expensive insurance plans, you think the bonanza of revenue that flows out of the ability to deny coverage will be limited to the cheap insurers? Do you really think they’re going to leave all that money on the table for someone else?

    Single payer lowers insurance costs because it creates a nationwide “network” with the greatest possible leverage to negotiate reasonable prices with providers. It also lower costs because the administrative costs of a non-profit government entity are a fraction of those in the private for-profit sector. Medicare administrative cost are something like 3%-5% compared to 20% in the private sector. For one thing there’s no need for hundreds of millions of dollars in marketing. Finally MFA lowers costs by creating the largest possible pool of contributors, the largest possible divisor. Your premium is replaced by a tax, but that tax is in most cases about half of the cost of your premium because your sharing costs with 300 million people, one of the largest insurance pools on the planet.

    Obamacare IS the market solution Republicans dreamed of, that’s why their attempt to repeal it failed… when they had to produce a replacement plan they found out they were trying to replace their own plan.

    Those of us who demanded a public option, and have been demanding single payer for decades always knew that Obamacare couldn’t and wouldn’t control costs. And we told you so. But you can’t trust Republicans.

    They’re lying when they NOW claim that they’ll protect pre-existing coverage. And a guy like Johnson may say he’s suddenly come to support high risk pools… but those are financed by tax dollars that Republicans are always and forever trying to reduce and eliminate. The problem with Johnson’s support of HRP’s is that you KNOW Republicans will slash those dollars whenever they get a chance and accuse those using the program of being overly dependent on government. So yeah, he’s for it… just like he’s for food stamps “when people REALLY need them”

    The United States has clung to the “market” model longer than any other developed nation in the world. Our health care “market” makes trillions of dollars a year because we pay more for less than anyone else. And we get the poorest over-all health care. All Republicans want to do is go back and double down on the market magic… if they tell you anything else, they’re lying.

    • Submitted by Mark Kulda on 10/30/2018 - 10:30 pm.

      The one factor you are not including in your recitation of how great you think it would be for everybody under single payer, is that you (wrongly) assume that providers are going to continue to provide the same care we get now but just do it for far less than they make now. You assume you can just force them to take the lowball rate the government is going to offer. They won’t because they can’t. Many will go out of business or will cut back on hours and the quality and availability of care will go down. Greater Minnesota already has a care provider crisis on its hands now at the current reimbursement rates. Providers now ONLY take Medicare patients because they know they can make up their losses by treating private insurance patients. By removing the private insurance patients payments and replacing them all with the government reimbursement rates, you will seriously degrade the quality of care. So how is that better. It may be cheaper out of pocket for many Americans but it also may not be and nobody will know because now the costs will be hidden in the tax system and it will be nearly impossible to know exactly how much the system will cost. Smaller countries may be able to do single payer in an acceptable way because consumers there really don’t know what its like to get care on demand like we do here. Waiting lists for treatment are ok for them but in the US, it won’t be tolerated. Your idea that the system will remain just as good as it is now under single payer is the fatal flaw in your reasoning and exactly why people should toss the single payer idea in the trash can where it belongs.

      • Submitted by Paul Udstrand on 10/31/2018 - 11:02 am.

        Once again you’re making a lot of ill-informed assumptions.

        To begin with, your assuming that providers are running a shoe-string budget of some and can’t afford to provide care for less than they’re currently charging. This is completely false. We pay more for health than anybody because our “market” allows our providers to charge hundred and thousands of time more than their costs.

        We pay around $11,000 for colonoscopy’s for instance, it’s the same procedure that costs around $6,000 in Germany. Colonoscopy’s don’t actually cost MORE to do in MN than they do in Germany, they just charge more. I can go down the list on everything from MRI’s to the tooth brushes you get in the hospital. Sure if bring prices down providers won’t make as much but they won’t go broke by any means. You also have to look at what private sector providers spend their money on, they have outrageous administrative costs and executive pay packages. And no, none of that is giving us better health care… again we pay more for less and worse.

        Most Minnesota provider are already technically not-for-profit providers so while they still make a lot of bucks and charge a lot, they’re not going to run off in search of better profit elsewhere.

        I hate to tell you this but the reason private insurance reimbursement rates are higher than medicare is because the premiums and co-pays for private insurance are so much higher, not because medicare doesn’t pay a fair rate.

        You do know by the way that Medicare in MN is administered by Blue Cross Blue Shield right?

        • Submitted by Mark Kulda on 11/01/2018 - 10:39 am.

          Of course I know Medicare is administered by private third-parties. Its why it actually is administered well and efficiently. I’d take a moment to point out that you are assuming providers will all be willing to take a pretty enormous pay cut and that our quality won’t go down. I differ. I think right now many smart people choose the medical profession because they can make a lot of money. Doctors can specialize here and make $400,000 a year with easy hours. Do you think you’ll still get the best and brightest in Medicine if you tell the same people they have to work harder and make only $137,500 or whatever the government is going to say they can make? (Obviously they won’t directly dictate that but with the reimbursement rates they set, they will do this de facto). I coached soccer with a guy from England who’s sister is an NHS nurse and he confirmed this theory that in systems where pay is limited you get workers who take the job because they need the money, not necessarily because they can get paid very well to do the job. He said his sister is not really the smartest lady and she doesn’t really do a good job nor does she care to do so. When you don’t get the best working in the system, the delivery suffers. I don’t think Americans would be happy with the system that emerges under single payer.

          • Submitted by Matt Haas on 11/02/2018 - 11:10 pm.

            That’s strange, most doctor’s state the reason for their career choice, at least in public, as a desire to help other’s. Are you saying doctor’s, nurse’s and all the other support staff that go into our health care system will simply walk off the job if we don’t compensate them obscenely to do so? That’s silly. What good are doctors if no one can afford their services. Who will be paying their salaries then?

          • Submitted by Paul Udstrand on 11/04/2018 - 09:48 am.

            Again, YOUR the one making all kinds of bizarre and unsubstantiated assumptions. YOUR assuming that providers would be forced to endure unacceptable pay cuts. You’re basically declaring that affordable health is economically unfeasible. You’re telling us that profits are more important that health. I would point out that we have NOT seen a huge influx of refugee providers fleeing the poverty forced upon them in Europe and Canada. They still have plenty of hospitals and healthcare professional in countries that deliver better and universal health care that we do. The idea that providers would flee MN for better pay elsewhere is simply fatuous.

  7. Submitted by Paul Udstrand on 10/30/2018 - 09:34 am.

    It’s actually very simple: Republican’s have filed over a dozen lawsuits claiming the the pre-existing condition coverage mandate under Obamacare is illegal or unconstitutional. Are these Republicans who promise to protect that coverage telling us they denounce their own lawsuits? Why don’t we ask them? Just ask them whether or not they support the lawsuits to strip pre-existing condition mandates from the health care regime?

    • Submitted by Mark Kulda on 10/30/2018 - 10:37 pm.

      Well then they can put preexisting conditions back where they belong in a high risk pool like MCHA which can better manage the claims and spread the risk in the greatest possible way. Instead of spreading it to other policyholders of the same company, it can be spread to all taxpayers (for example). MCHA was a model of a great concept with a minor, easily fixable funding flaw. MCHA should have been used as a national example of exactly how to deal with the relatively few people with pre-existing conditions and instead the ACA forced MCHA to dissolve, which was a huge mistake. And just to be clear about what the argument over pre-existing conditions is all about….consider what people with pre-existing conditions are asking….they want to pay a small amount of money and then consume an enormous amount of very expensive medical care, but they want everybody else to pay for it. So when 5% of the people consume 80% of the medical costs in a system, the people paying for that 80% ought to have the right to say something about that.

      • Submitted by Paul Udstrand on 10/31/2018 - 10:29 am.

        Let someone else make your health care decisions for you just because they help pay your bills? Dude, you people always assume that you’re going to control someone else’s health care… you realize that in your scenario I get to control YOUR health care right? After all I pay your bills don’t I? Sure, make your health care records public and we’ll all decide whether or not we want to pay your bill.

        This is basic civics- no… being a citizen or a voter or a taxpayer does NOT give you veto authority, that’s NOT how democracy works. And the fact that you want to step into someone else’s health care and make treatment decisions tells us all we need know about your concept of “choice” in health care.

      • Submitted by Paul Udstrand on 10/31/2018 - 12:57 pm.

        By the way high risk pools don’t work, and they were never meant to be anything more than stop-gap measures in the place. We’re way past that kind of strategy at this point.

        For one thing you end up in endless debates about who belongs in them and who “really” qualifies. They don’t “save” any money because no matter the risk, the actual health care costs the same, so they don’t reduce cost in any way. All HRP’s really end up doing is protecting private sector profits by putting more burden on taxpayers.

        And as I’ve already pointed out, if you think these guys that don’t believe taxpayers should pay for anyone’s medical bills without having a: “say” in health care or subjecting recipients to some kind of “moral” test are going to make sure the HRP has a stable and ample revenue stream and budget… I got a bridge for sale.. give me a call. You KNOW the same guys pitching HRP’s today are the same guys who be attacking it as a boondoggle and untenable burden on taxpayers the day after it goes live.

        The only reason your hearing about HRP’s from Republicans now is they got nothing else to offer, and they’re taking a beating on pre-existing conditions. But I gotta say if you trust them on this, you’re probably being foolish. No matter what they promise today, during their campaigns, I guarantee you the reality of any HRP they come with AFTER the election will be a far cry from anything they’re promising now. But of course that’s my opinion.

      • Submitted by Matt Haas on 11/02/2018 - 11:26 pm.

        No, they are asking (or in my son’s case, will be asking) not to have a congenital condition, outside of their control, limit THEIR choices as to what they can accomplish in life. Like my college friend, who beat cancer, they’d like to start their business secure in the knowledge they can purchase insurance to cover their health care and provide for their family. Like my niece, they’d like to be able to have independence to literally keep breathing, to make something out of what life they have. Apparently, in your mind, the 80%’s response should be “too bad, I’ve got mine”.

  8. Submitted by Paul Udstrand on 10/30/2018 - 10:06 am.

    Correction, my earlier statement that Republicans have filed over a dozen lawsuits to repeal scrap pre-existing condition coverage was mistaken, I apologize. There are actually just one or two widely supported lawsuits representing 20 States, and those suits seek to repeal Obamacare in it’s entirety, including the pre-exsiting coverage mandate. However my question remains, Are Johnson and Lewis and Paulson saying they don’t support those lawsuits? Are these guys who literally voted to repeal Obamacare in it’s entirety with no replacement on the table NOW telling us they wouldn’t vote to repeal it again unless the PEC mandate were left in place?

  9. Submitted by Paul Udstrand on 10/30/2018 - 11:19 am.

    It’s also important to remember that even a state wide single payer would look very different than anything you see now. Even just a state-wide single payer (in lieu of a nationwide system) would provide far more universal coverage and access to providers and treatment. Many of the financial constraints and treatment limitations currently seen in Medicare are a product of the private sector competition.

    For instance, in order to qualify for Medicare now, in some cases you have to spend down to less than $2,000 in assets. Those income requirements are a product of limiting medicare to the elderly and a few others. When you expand it to everyone regardless of age, you no longer need those restrictions because the revenue for coverage is sufficient to cover the costs regardless. Just as there are no wealth restrictions on Social Security where would be no need for them in Medicare. And coverage is universal, nearly EVERY provider is the “network’ so the financial restraints that currently limit coverage would be largely eliminated.

    So yeah, we can all point to problems with the current Medicare coverage, (and most of us can point to far MORE problems with private sector coverage) but you have to remember that if that coverage is universal most of those problems and complaints disappear. This is why the Health Care industry has spent billions of dollars keeping public options off the table for decades. A lot of the problems you see with current Medicare regime are actually built in so that the private sector can remain “competitive”.

    • Submitted by Mark Kulda on 10/30/2018 - 10:42 pm.

      That’s right, a statewide single payer system would have rationed, poor quality care and waiting lines that they don’t have in other states. And many providers would actually leave Minnesota to go to states where they would be reimbursed at a much higher rate than the very low public reimbursement rate is. The only reason why we even have such good quality care here is because there is a private insurance system here to make up for the losses the public system makes the medical system incur. Single payer would be a disaster for high quality care in favor of cheap low quality care that other people will pay for.

      • Submitted by Paul Udstrand on 10/31/2018 - 10:40 am.

        You know it’s really funny to see the avalanche of ignorance that flows out of Republican’s and “free market” market champions when talk about health care.

        Dude, MN hasn’t allowed for-profit health providers for decades. Technically almost all of our providers are not-for-profit, that was the whole big deal about our HMO’s back in the 80s. So no… they’re not going to go in search of bigger profit elsewhere. You may recall that a few years ago the MN Attorney General (I think it was Mike Hatch at the time) actually sued ( I think it was Alina) for collecting too much profit? They were forced to return millions of dollars and redirect more money into patient care.

        • Submitted by Mark Kulda on 11/01/2018 - 10:01 am.

          Private health insurers have still and continue to this day to sell health insurance in Minnesota. You talk about ignorance and then don’t realize that you are confusing true health insurance and the state’s non-profit managed care plans (the HMO’s). Minnesota has a law requiring all managed care plans or HMOs to be non-profit. But private health insurance (non-HMO) is still here but is not price competitive because HMOs have such a big market share. Regardless, health insurer profit is but a tiny part of the health care cost problem. The bigger problem as you well know is the excessive profiteering by the health care providers. And under the current government dictated reimbursement of public plans, the providers cost shift (squeeze the balloon) so that private insurers and HMOs make up for the losses incurred when treating publicly paid patients. Paying every patient at the artificially dictated public rate, like single payer will require, will mean cutbacks of care. And I’m very certain Americans will not go for that.

          • Submitted by Paul Udstrand on 11/04/2018 - 11:28 am.

            OK, so profiteering among providers is the big problem, but you don’t want to reduce those profits because providers will flee the State or the Country if for greener grass elsewhere if reduce their profits?

            By the way, private insurers are also profiteering, their problem is it that it’s difficult to make profits AND provide competitive coverage. This is why Medicare for All is so much less expensive, all they have to do is pay the medical bills and cover their own much lower expenses.

  10. Submitted by Dana Dickson on 10/31/2018 - 02:37 am.

    Let’s run the experiment. Tattoo Republican’s foreheads with a Red “R” and let them have all the cash in advance healthcare they can afford.

  11. Submitted by Paul Udstrand on 11/04/2018 - 10:10 am.

    To the moderator- this is a corrected version of an earlier submission.

    Mr. Kulda says:

    “If you were a provider or a payer, instead of a lawyer, you’d probably understand the medical payment system better. Lawyers are smart people and you are very bright and I always appreciate your intelligence but this is one area where you’re not quite on the right page. ”

    I’m not a lawyer, I’m a photographer who spent over a decade working in on psych units in residential and inpatient hospital units.

    I must say however that as the Vice President of Public Affairs for the Insurance Federation of Minnesota; YOU might be more familiar with the perspective of those who need to make money from health.care rather than those who need health care. If you weren’t an industry representative your information might more reliable and your economic arguments more reality based.

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