Former Senator David Durenberger has been involved in health care policy for decades, first as a proponent of HMOs in the 1970s, and more recently as a advocate for national health care reform. He is currently a senior health policy fellow at the National Institute of Health Policy at the University of St. Thomas, and recently spoke to the TC Daily Planet about health care reform and access to health care.
You’ve been involved in the health care debate for a long time. Why are you so interested in the topic?
I used to work for a large employer in St. Paul, which, along with another dozen large employers in the Twin Cities decided that the only way to reduce the costs of employee benefits was to deal with the costs of health care, which were out of control. The only way to do this was to introduce into the employment marketplace a choice of health plans. When I got started with this in the 1970s, one of those choices was called an HMO (or now a similar thing is an accountable care health organization).
What are the major problems with the current health care system?
It costs too much for the value it delivers. That’s it in a nutshell.
Well, that’s really it, but one other big thing is that it only insures about 52 percent of us on a consistent basis. There’s only 52 percent of us that always have insurance, and then 20 some percent usually have it, and then another 20 percent never or rarely has it. So compare this to other countries where everyone has access to health care.
So what’s the best solution to increasing access?
All the best solutions are in the Affordable Care Act in 2010 because it established national goals of healthy people in healthy communities, universal access, and reform to the way health care providers are paid.
The federal legislation sets up a system of insurance exchanges. You are a proponent of this?
Yes, because a majority of people get their insurance through their employers. There’s a majority of employers that are not capable of providing their employees with a choice of health benefits. So if we’re going to rely on private insurance, we need another mechanism by which people can make comparisons between qualified health insurance providers. If you’re lucky the employer will self-insure and hire some one to pay your bills, or they’ll hire one insurance company for every one in the company. And that doesn’t introduce the kind of choice that makes competition work in insurance.
You see competition as the crucial part of insurance reform?
Yeah, you need competition in order to give people choices and you need information in order to give people those choices. And that’s where it’s critical to get insurance companies to play by the rules, via a uniform set of rules, and get providers to be more forthcoming about the prices and the outcomes.
What do you think of the federal Affordable Care Act (ACA)?
What we need as a country as policy goals are all incorporated in the Affordable Care Act. But we need to acknowledge that the government in Washington can’t accomplish those goals by itself. The only way that people begin to improve their health is by taking advantage of opportunities they have to stay healthy and be rewarded for doing so financially. Communities have to do that themselves.
We practice health care differently in different places. We probably have 70 to 100 different ways of practicing health care across the country. The way it’s practiced in Rochester and International Falls is different, and it’s different than the Twin Cities. National insurance companies, both public and private, are providing the same service in different parts of the country and the outcomes and cost and are different. Medicare programs, for instance, operate differently in different parts of the country. So ACA introduces more accountability to those different health care practices and costs.
Are there some things ACA doesn’t address? Why not advocate for universal, single payer to cover those gaps?
The only thing that single payer would do is perpetuate some of the ills of the current system. Medicare, for example, is single payer and Medicare will pay two or three times the cost in Miami or Los Angeles than in Minnesota for the very same outcome.
And it also doesn’t allow for innovation, it doesn’t allow for people who run creative, accountable care organizations (the kind we have in the Twin Cities for example) to get rewarded for being innovative. That’s the danger with the single payer, is that you settle for everyone being covered but nobody getting the quality of care that you could be getting if you adopted practices in communities like ours.