Making single-payer health care happen in Minnesota

Every Minnesotan could be covered under a state administered healthcare plan within the coming year if legislators can overcome opposition from a powerful healthcare insurance industry and a governor who publicly opposes the type of “single-payer,” government-run system that a growing alliance of lawmakers, physicians, professionals, labor unions and business and community groups endorse.

Legislation introduced by State Senator John Marty (DFL-Roseville) in the last hours of this year’s legislative session is the latest hope that universal, single payer health care can be achieved in Minnesota.

“My goal is to make sure we get the best health care for the state,” said Marty. “The best primary care, public health care and preventive care,” he said.

“Single-payer” health care, according to a January 2003 edition of The American Journal of Public Health, is the only such coverage that ensures universal healthcare access.

Single payer offers no out-of-pocket payments—no co-payments or deductibles. A bare-bones single-payer system in Minnesota would have the state pay licensed health care providers (with monies collected according to ability to pay) on a fee-for-service basis.

With single payer, patients are free to seek care from any licensed health care provider with the encumbrance of financial incentives or penalties removed. Medical decisions are made by patients and providers rather than dictated from afar.

And with the purchasing power controlled by statewide funding, prices for drugs and medical services could be bargained for and at least partially controlled.

“Single-payer systems reduce excessive administrative costs by not wasting money on managing care, marketing, underwriting, lobbying, and profit,” wrote Kip Sullivan, former member of the steering committee of the Minnesota Universal Health Care Coalition (MUHCC) and author of “The Health Care Mess.”

Marty’s bill, SF 2324—the “Minnesota Health Care Act,” had only time to be sent off to the Senate’s Health, Housing and Family Security Committee before the sand in the session’s hourglass ran out. But as of this week, one quarter of the Senate and one third of the House had signed on as co-sponsors.

“We are supporting this bill,” said Eileen Weber, program coordinator for the MUHCC, “This bill is going to be a great starting point,” she said.

“Especially since we have a governor who doesn’t seem to care about health care,” Weber said in late June via cell phone from the steps of the Capitol. Weber had just left a hearing for Minnesota Health Commissioner Dianne Mandernach concerning her decision to hold back research from March 2006 showing 35 Iron Range miners had contracted mesothelioma, a rare form of cancer.

“There was some pretty frightening testimony coming from health department staffers,” said Weber.

Staffers testified that they had been instructed by Mandernach not to discuss the cancer data even within their own department. The testimony has called into question not only health department policy, but what type of communication the governor has with his own cabinet.

As one who has worked shoulder to shoulder with state legislators trying to initiate universal healthcare reform for the state, Weber sounded similarly strained. “Governor Pawlenty has an apparent disregard for health care in Minnesota,” she said.

Proposals exhorting universal health care and a single payer system have been floated in the Legislature since 1991. Only this year, a bill written by Sen. Leo Foley (DFL-Coon Rapids), and introduced at the beginning to the session, was stripped of most of its language pertinent to single payer.

“It didn’t get a hearing,” said Foley. “It just wasn’t appropriate at the time,” he said.

“The thing now seems to be that we’re moving forward this year,” Foley said. “Frankly, I’m not an opponent of Sen. Marty’s bill. I have high hopes for [it],” he said.

But some who have walked the walk for the single payer plan are not as pleased with Marty’s last-minute proposal. A letter sent out last week from the Greater Minnesota Health Care Coalition (GMHCC) to co-sponsors of the bill says that the proposal, as currently written, has a serious language flaw that could undermine its intent to create a single-payer system.

Charlotte Fisher, GMHCC President, tells legislators in her letter that, “the bill has language [that] clearly describe[s] administrative middlemen entities such as HMOs, even though HMOs are not specifically named in the bill … This would end up working much the same way as the current privatized operation by HMOs,” Fisher wrote.

“There is a problem there,” said Sen. Foley about SF 2324’s language. “His bill is less definite [on the single-payer issue]. It delays the administration of single payer over the next few years,” Foley said.

“You can’t have private healthcare insurers remain in a single-payer state health system,” said Sen. Marty yesterday, claiming his single payer ground. “If they are going to continue doing business here, they can’t do it as an insurance company,” he said.

“What we’re trying to figure out is the best fit for Minnesota,” said Marty in defense of his measure. “I think we’re on our way to doing that,” he said.

“I campaigned primarily on healthcare reform,” said Senator Mary Olson (DFL-Bemidji), a co-author with Marty on SF 2324. “In my 15 years of practicing law, I represented many people who were trying to redress grievances against their healthcare providers,” she said.

“Until I ran for state Senate, I wasn’t involved at all in politics,” Sen. Olson said. “It all started for me when I sent a letter to (then State Attorney General) Mike Hatch because I admired what he was doing as an advocate for consumers. I asked what I could do to help improve our state’s healthcare system,” she said.

“Right now we have people sitting very far removed from what would be in the best interest of the patient,” said Olson. “Our current system is run primarily for the benefit of the healthcare industry,” she said.

“You just can’t trust private healthcare insurance providers to be beneficial to patients when they’re making healthcare decisions based on the market,” Olson concluded.

And about the governor’s opposition to a single-payer plan—

“Ultimately, it’s the voters who make the decision,” Sen. Olson said. “A lot of people, especially in rural Minnesota, are fed up with the ways things are.”

“I think he has to come to the light,” Sen. Foley assented as to Governor Pawlenty’s position. “Without the commitment to find a way to finance and implement these things you end up with inadequate healthcare, inadequate transportation,” he said.

“I think that the legislature has been in a crisis mode in dealing with health care reform in Minnesota,” MUHCC’s Eileen Weber said. “But we have to start looking five years down the road,” she said.

“We want to be clear that there will be one universal payer for this plan,” Weber said. “I do think we should remove the ‘healthcare delivery systems’ language from the bill,” she said.

But shutting out the private health insurer industry with a single payer system, even the most zealous of single payer advocates admit, will be “times that try men’s souls”—and, according to health reformer Kip Sullivan, “Given the enormous power of the interests which oppose price controls and a single-payer system, it might seem like wishful thinking to predict that America will adopt price controls and a single-payer system.”

“Being a realist, there will be a large employment transition,” said Representative Alice Hausman (DFL-St. Paul), who began tinkering with the idea of a new way to approach a single payer system late last year based on a California healthcare model that includes private healthcare insurers in the mix.

“A single-payer health program would eliminate the jobs of thousands of healthcare and insurance workers who currently perform billing, advertising, eligibility determination, and other superfluous tasks,” says the American Journal of Public Health article quoted at the beginning of this piece. “These workers must be guaranteed retraining and placement in meaningful jobs,” it says.

“It’ll be a long road with the Health Care Act going through a lot of changes before we get something we can get passed,” said Sen. Marty.

“I’m willing to take the slow process if it gets things done,” said Sen. Leo Foley.

Said Representative Hausman, “My hope is that we’ll all trust one another as we start having these hearings, because there is a common enemy out there, which is the status quo.”