Last Thursday night at the Northfield Community Resource Center, DFL state Senator John Marty argued that the current state and federal health care system was simply “not good enough,” and elaborated on the key principles of a new state health care proposal that he said would provide better care and cut costs in the long run.
Marty has been a member of the Senate for 23 years, and is currently running a campaign for Minnesota governor. Also in attendance at the forum were state Representative David Bly and Senator Kevin Dahle, both of whom Marty noted were co-authors of the Minnesota Health Plan in the House and the Senate, respectively.
Marty, who was introduced as the “chief author of the Minnesota Health Plan in the Senate,” spoke of providing “common sense solutions” to the health care crisis, and said that “most people want something that works for them,” regardless of their political stance.
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Marty began his speech by noting that many public figures who support “universal” health care actually define “universal” coverage as insuring only about ninety-four percent of the population. Marty, in contrast, says he wants to see truly universal health care coverage.
The proposed plan would be one of single-payer plan coverage, using a mix of private and public care. Marty asserted that although the emphasis would be on “public and preventative care,” Minnesota has “a good mix of public and private care, and we’re going to keep it that way.” He said that individuals ought to be able to choose who their doctor is under the plan.
The Minnesota Health Plan would set premiums based on ability to pay. Despite concerns raised during the question and answer session, Marty said that this plan will ultimately save money “by taking care of people in an orderly, efficient way.”
He cited several studies suggesting that single payer plans could save money in the long run.
Marty also said that negotiating the price of services can greatly reduce costs across the system. Negotiating, Marty said, “can save about forty percent on drug costs.” Marty argued that hospitals should also be allowed to “negotiate a budget.”
In terms of rationing care, Marty said, “I don’t think insurance companies should ration care, and frankly I don’t think government should ration care.” Instead, Marty says, he believes care should be rationed “by doctors and patients.”
He also said that costs could be cut by decreasing overuse or misuse of the health care system. Marty acknowledged that “people do overuse health care under our current system, and people also underuse it and misuse it, but we think we’d overuse it less under the new system.”
In a humorous aside, Marty suggested that generally people don’t want to spend more time in the doctor’s office than they have to, saying “people don’t generally go for an extra colonoscopy on their day off.”
The proposed new plan would be administered by a 15-member board, eight of whom would be elected from county boards. The state would be broken into six regions, five of them rural, and one metro area. Each rural region would send one representative, and the metro area would send three. These would all be paid positions.
Although Marty provided some information on the financing and administration of the proposed plan, he devoted most of his time at the forum to addressing the plan’s core principles.
Firstly, Marty said, the Minnesota Health Plan is one of true universal coverage.
“You wouldn’t be fighting to qualify. You’d be covered, period,” he said.
He made a humorous comparison to police and fire services, saying, “when your home is being burglarized” or “you need police protection, you don’t have to qualify.” To Marty, health coverage is just as essential and urgent as universal access to the fire brigade or local police squad.
All “medically needed” care, including dental, optical, mental health, hospice, and long-term care would be covered under the plan.
The only service that Marty said is “explicitly not covered” under the Minnesota Health Plan is “purely cosmetic care,” but reconstructive surgery, he later said, would be covered.
The plan would also not cover drugs that are heavily marketed in Minnesota, via television and internet advertisements because, according to Marty, these ads heavily contribute to overutilization of drugs that people more people “don’t really need.” He cited Lipitor and Viagra as heavily advertised and frequently over-utilized drugs.
Although generally a strong supporter of President Obama, Marty criticized the President for deciding that it is “politically unsalable” to include undocumented workers under health care coverage.
Marty provided a dramatic image when he described the child of immigrant parents seriously injuring himself in an accident. Marty turned to the audience and asked, “are we going to let that child bleed to death?”
Many in the audience began visibly shaking their heads. Marty says that it is the “federal government’s responsibility to fix immigration problems,” but “in the meantime, I don’t want my kids going to school with infectious diseases.” He said that it was important that workers in the food industry be treated for infectious diseases as a public health precaution regardless of the workers’ citizenship.
The most important function of the plan, said Marty, would be “to make people healthy. If it saves money, in my mind, that’s a bonus.”
However, according to Marty, the proposed Minnesota Health Plan will also save money in the long run. He said that in Minnesota, the average individual is paying $7,000 annually for health care. That cost, under the proposed plan, is “going to go down,” Marty said.
He imagines an ultimate savings of up to twenty percent of the 35 billion dollar budget for health care in Minnesota.
Marty said the plan could even function to stimulate the economy by ensuring universal coverage, allowing small business owners and entrepreneurs to work independently or from home, rather than working for a given institution simply to ensure that they receive health insurance benefits.
The plan will also save money not by cutting services or coverage, but through “efficiency,” avoiding “excess use of costly equipment,” and minimizing bureaucratic costs.
Currently, according to Marty, bureaucratic spending in the health care system is extremely high. He stated that “31 cents on the dollar” of health care costs are paperwork, and that many nurses complain about spending large parts of their workdays filling out forms. Marty said he believed the Minnesota Health Plan would reduce paperwork costs.
“Early and preventative care” emerged as one of the defining themes of Marty’s speech. As an example of the lack of preventative care under the current system, Marty stated that there are “22,000 emergency room visits in Minnesota for dental care each year resulting from basic tooth decay that wasn’t detected or treated.
Furthermore, Marty said, “we want to have appropriate care.” Marty said that services such as an urgent care room and a 24/7 nurse helpline can diminish the numbers of people who crowd emergency rooms.
During the question and answer session following his speech, Marty said that a program that “invests in prevention,” by emphasizing basic lifestyle changes or such as “diet, exercise, and nutrition” will save money over time by “changing behavior.”
Marty argued that “prevention is the biggest thing that brings down the cost of health care.” He said The Minnesota Health Plan promotes “health and good behavior,” and is a plan “that’s charged with looking at the whole picture.”
Marty cited new estimates claiming that 45,000 Americans every year are dying because of lack of health care, a figure which Marty exclaimed is “like a third world country!”
Marty then held up several print-outs of charts which demonstrated that among developed nations, Americans generally go to the doctor’s office relatively infrequently each year, but are still spending more on average than individuals in most other countries.
Two other charts also demonstrated that life expectancy and infant mortality rates in the U.S. are fairly poor relative to other developed nations. These kinds of data, according to Marty, demonstrate that “we’re spending a lot more and getting less. We’re not getting the best results.”
Part of the problem, as Marty sees it, are significant shortages in the numbers of general care practitioners in the U.S. “We produce about twice as many specialists as general practitioners,” in large part, Marty said, because many medical school students are graduating with debts as large as $200,000, and specialists generally have higher salaries than general care physicians.
He proposed solutions to this shortage through forgiving student loans, negotiating higher pay for general practitioners, or partially subsidizing medical school costs.
Marty also provided several anecdotes about families and individuals who have suffered under the current health care coverage system. He spoke of a family whose income was based on farming, who paid $500 out of pocket for a sick child. They felt that the next time one of their children was sick they would not be able to afford medical care.
Under the current system, Marty said, this type of dilemma is not uncommon: “Parents gamble, they have to make these choices.”
He spoke of meeting a woman whose sister had been a nurse who was 48 years old when she lost her job and the health insurance that had been provided by her employer. This woman was then diagnosed with, and died from, what Marty was told was a “totally treatable thyroid disease.” She was unable to afford the health care that could have saved her life. These kinds of stories, for Marty, demonstrate that the health care system as it now stands is simply “not good enough.”
The Minnesota Health Plan bill, drafted by 71 co-authors, has been a work in progress for the past two years, and Marty imagines it will take between three and four more years to have it enacted.
Ultimately, Marty said, enacting the bill will be a question of willpower and vision. “We’ve lost a lot of our vision in health care. We’ve lost our faith. I think we have to develop a political vision.” The public must answer the larger question, Marty said, of “what kind of society do we want?”
The Minnesota Health Plan is supported by 36 organizations including the League of Women Voters, the Minnesota Nurses’ Association, and the Minnesota Health Care Coalition. Despite this, Marty said when it comes to obtaining the necessary federal permission for the plan to be enacted, “we realize it’s a hard sell.”
More advocacy is needed, particularly on the grassroots level. Local support is key for Marty, who says that if everyone who thinks they like the Minnesota Health Plan supported it, “it would pass overnight.”