Health care in Minnesota: The answers get easier with the right questions

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With the start of the 2024 legislative session, there have been multiple articles in the Star Tribune about health care, all indicative of a failure to effectively manage it in Minnesota. We should ask “What do we need?” then build it. Despite the Star Tribune Editorial Board saying that “[n]one of these questions have easy answers” (“A public option? In Minn.? Well … maybe?” Feb. 13), it is a fact the answers are well-known but are being opposed by the health care industry, since the answers will decrease profits.

Let’s start with “What do we need?” Sooner or later, everyone needs care. So:

Should Minnesota have a public option? The public options mentioned by the Milliman consulting report referred to in the editorial would expand coverage, but the state needs to be looking at a comprehensive approach that gets to the heart of the issue, the cost of health care, not just premiums and out-of-pocket costs.

Should Minnesota deal with medical debt? Yes, but we need to move beyond so we are not burdening people with medical debt in the first place.

Should the city of Fosston have obstetric care? You bet it should, and we need to have effective statewide planning to accomplish that.

Markets are complex. The term “free market” is nonsensical. Markets are not “free.” Markets are structured to produce desired outcomes.

If one looks at the health care marketplace, it is a failure for many people (buyers — i.e., patients), but works pretty well for most of the sellers. A satisfactory health care marketplace would provide all people with excellent health care, have enough doctors and other health care providers, and have costs that are affordable for society. Just look at other industrialized countries and you will see we are behind.

The health care market is unique. Health care consumers are driven by need, not by want. Put yourself in the patients’ shoes. You get chest pain. You go to the nearest ER. No price shopping, no Yelp reviews. You simply need care now.

What about competition? Health care businesses avoid competition. Hospital companies create regional monopolies. Allina hospitals are never across the street from Essentia hospitals. Pharmaceutical companies never post ads saying their insulin is cheaper than the other guy’s insulin.

Another market issue should be examined. Since the 1970s we have seen a series of insurance schemes: HMOs, ACOs, Medicare Advantage, Value Based Care. Each has claimed to be the answer to controlling cost. Each one is based on the flawed idea that people need to be prevented from getting too much health care. We know people are not going to their doctor and saying, “How about an extra colonoscopy?” During the 50 years the U.S. has been fiddling with these schemes, our health care costs have steadily grown faster than the costs in other modern countries. The U.S. now pays almost twice as much per year for medical care than these other countries, while having a lower life expectancy. As a result of ignoring other countries’ experiences and listening to the medical industry resist sensible reform, we now have a health care situation with a super-premium price producing an inferior product. Is it wise to have the fox design the chicken coop?

The 2023 Legislature passed a bill to fund a study of a health care system for Minnesota. The study is due to be delivered in 2026. It will show the ability to achieve better outcomes for less expense.

The question for Minnesotans will be: Is the goal of health care to provide large profits for health care businesses or to provide excellent affordable care for patients? We can have affordable health care for patients and society and still have thriving health care businesses. Other countries have proven it works. Be prepared to support the change that serves patients best.