The Nov. 7 editorial argues it is better to continue building on the Affordable Care Act (ACA) than implement a Medicare for All universal health care system (“Warren health plan is the wrong remedy”). However, that depends on our goal. If we want health care for everyone, the ACA won’t get us there.

Certainly, the ACA covered more people. However, only about half of the uninsured got coverage, and it did not help those who already have insurance afford dental care or pay for long-term care. It also failed to adequately address high deductibles and other out-of-pocket payments that drive people into bankruptcy.

On top of that, because the cost is such a problem, we are going to need to dump the dysfunctional health care financing model that the ACA made even more convoluted.

If we want all people to have health care that addresses all their needs, including things like dental, mental health, prescriptions and long-term care, we need a comprehensive universal approach, not more patches on the current patchwork system.

The editorial suggests that patients are beginning to understand the complexities of the subsidies of the ACA and the glitches in the insurance exchange are being ironed out. That’s true for some, but in such a confusing system there will always be people with mental health or other physical or intellectual challenges that prevent them from successfully enrolling and re-enrolling every year.

Contrast this bureaucratic model with the simplicity of enrolling a five-year-old in kindergarten: the child doesn’t need to qualify, and their parents don’t need to have the right “school insurance” plan. Why such a simple system for schools? Because we want every child to get an education. Elementary schools are available to all because parents don’t need to worry about whether they can afford the premiums, copays and deductibles for school, and they know they won’t be hit with surprise bills because some of the teachers are “out of network.”

The editorial says there are other options for moving forward. If so, why hasn’t anyone, of either party, proposed an alternative plan that covers everyone? The Democratic presidential candidates who don’t support Medicare for All recognize the popularity of a universal system, so they offer similar-sounding plans like “Medicare for All Who Want It,” but none of their plans would cover everyone, and none would save money.

While some other countries deliver universal health care through multiple insurance plans, the governments in those countries tightly regulate insurance company behavior. In the U.S., it doesn’t work that way. Insurance companies effectively set the rules: The Senate author of the Affordable Care Act singled out a former insurance company VP as the designer of the ACA. Not surprisingly, insurance company profits have been sharply up since the ACA’s passage.

Not only is our current insurance-based model unable to deliver universal health care, but we will never get control of spending without a universal single-payer system. Why? Because only a Medicare for All single-payer approach allows for real price negotiations and only it will eliminate the bureaucratic financing system that is bankrupting us.

The U.S. spends almost twice what other industrialized nations spend for health care, yet we have worse outcomes. This is driven by our complicated insurance and billing system, and by the lack of any rational price negotiations. When some hospitals charge 16 times as much as other hospitals for the same procedure, we need fair price negotiations. Our unreasonable prices are obvious when you compare prescription drugs. Other countries negotiate drug prices, but we don’t have a good system for doing so. As a result, price gouging by Big Pharma is hurting and sometimes killing people.

The editorial mentions concerns about the loss of “choice” of insurance plans. Insurance plans put barriers up to deny us choice — networks that deny provider choice and prior authorization requirements that deny the care our doctors recommend. With a single payer, people have a full choice of doctors and hospitals and they get the treatments their doctors suggest. Most people want to choose their doctors; not a “choice” of insurance companies that deny them access.

Politically, passage of a universal health care system would be difficult, as was passage of the ACA. But as an elected official, I’d rather fight for a system that makes sense — one that covers everyone for all their medical needs, saves money, gives patients the choice of doctors, and leaves medical decisions to doctors and their patients instead of insurance companies and government.

That’s an easier political sell than the ACA, which covered more people, but made the system even more bureaucratic and didn’t fix the cost and access problems faced by millions of Americans.

Make no mistake. Many of us who advocate for universal health care have been working on incremental improvements as well. I’ve never believed that advocating for a solution that fixes our access and affordability problems excuses me from ignoring incremental changes to make the system better in the interim. I’ve been fighting for an end to pharmaceutical price gouging, for less insurance company interference in medical treatment, and have passed numerous bills to improve the system. I strongly supported the passage of MinnesotaCare many years ago and pushed for implementation of the Affordable Care Act and expansion of Medicaid more recently.

But when we as a nation fail to treat people with serious mental illness, housing them in our local jails instead, when we have young adults dying because they cannot afford insulin, when we have workers with “good” health insurance plans facing bankruptcy over medical bills, incremental changes are not enough.


John Marty, DFL-Roseville, is a member of the Minnesota Senate.