In “Why single-payer is not likely our path forward” (Sept. 17), Prof. Lynn A. Blewett said that she would support a Medicare-for-all type single-payer health plan but that she believes obstacles make it unlikely to pass. She suggests we give up on achieving the best solution and settle for covering more people by focusing on certain population segments.
Blewett was on the mark when she said, “The U.S. health care system is unique.” That’s true, but not always in a good way. We squander the talents of our excellent doctors and nurses, clinics and hospitals, medical research and technology on a dysfunctional system for accessing care. We are unique in our high costs — spending twice as much as other industrialized countries, while delivering worse health outcomes. We are also unique in being the only industrialized country that doesn’t provide health care for all of its people.
Expanding our current system is not the right approach. The cost of American health care is one-sixth of our entire economy; competing nations spend only a tenth of theirs on health care. Warren Buffett recently described medical costs as “the tapeworm of American economic competitiveness.”
Whether it is the national legislation introduced by Sen. Bernie Sanders with 16 of his colleagues or our proposed Minnesota Health Plan (mnhealthplan.org), we want to reduce costs while providing better care.
I don’t want “government-run” health care or “insurance-run” health care, where government or insurance companies or employers tell us which doctors we can see or what care we receive.
The Minnesota Health Plan (MHP) would be a patient-directed system where people choose their doctors and where medical decisions are made by patients and their doctors. It would replace the health insurance system, covering dental, mental health, prescriptions and all medical needs. The MHP would ensure sufficient medical capacity to keep rural hospitals open and prevent waiting lines.
Wouldn’t a universal system cost more? Economic studies in the U.S. and real-world empirical evidence from other countries consistently show that a universal system costs less, not more.
To understand why a logical health system costs less than our “unique” system, contrast the way we fund schools vs. hospitals. If public schools were financed like hospitals:
• Teachers would spend a half-hour or more each day calculating the time spent with each student, along with supplies consumed. The school would allocate facility costs and administrative overhead.
• The school’s billing office would bill families and their “education insurance plans.” Employers would offer “school coverage” for employees’ children. Parents without employer coverage might not be able to afford coverage, and other parents might not be able to afford the copays and deductibles. The school would need a collection agency.
• If the parent switched jobs and got a different plan, the school might be out-of-network, forcing children to switch schools.
• Government would subsidize school coverage for those buying in the individual market, but some students would fall through the cracks. They would be denied an education unless the schools provide “uncompensated” education and cost-shift unpaid expenses to other students.
Education is already very expensive, but funding schools like this would add enormous additional costs. Schools would be uncertain which bills would be paid, and insurance plans would negotiate different rates for various services, so schools would hike up their charges, meaning that some parents would face bills far higher than others. Everyone would pay more.
In addition to higher costs, it would hurt outcomes by shifting resources from teaching into administering a convoluted financing system.
That would be a terrible system for funding education. It is a terrible system for funding health care. Tinkering with it is not a solution.
The four obstacles that Blewett sees to the adoption of a universal system can and must be overcome. Her concern about the Employee Retirement Income Security Act would be addressed in the design of the MHP. The legislation doesn’t limit employer rights in any way, but few would choose to continue offering a plan when their employees are given better coverage through the MHP.
Blewett assumes that there would be unstable funding if the health system were competing with other items in the state budget. This concern is addressed in our legislation by keeping the MHP separate from the state budget. Premiums people pay would go directly to the health plan, not the state treasury, and could only be spent on health care.
Her other obstacles relate to the need to obtain waivers from the federal government. Certainly, those waivers would face challenges due to the political clout of the insurance lobby and Big Pharma. Passing the legislation would face similar hurdles. But the cost of surrender is too great. The failure of incremental changes in our broken system added to the economic fears that elected Donald Trump.
Ironically, the efforts of Trump and the Republican Congress to take away access to health care may have multiplied our chances of getting a Medicare-for-all system. For both economic and moral reasons, it is time to cover all people, for all their medical needs.
John Marty, DFL-Roseville, is a member of the Minnesota Senate.