Single-payer health care in Minnesota: Notes from a community forum

by Erica Mauter | February 22, 2009 • Yesterday afternoon I attended a health care forum sponsored by SD62 DFL. U.S. Congressman Keith Ellison, State Senator John Marty, health care advocate and community organizer Kip Sullivan, and PNHP-MN member Dr. Elizabeth Frost all spoke on what single-payer health care is and how we might get there, both in Minnesota and nationally.

The speakers began with prepared remarks.

Kip Sullivan went through a whole bunch of statistics about health care spending vs health in various developed nations. Of course we spend the most but don’t have the healthiest people. He included a brief explanation of why our costs are so high. One of the biggest problems is administrative costs, much of which is attributed to trying to get payers (i.e., insurance companies) to pay. Another part of the problem is on the supply side which includes prescribing unnecessary services, the high cost of drugs, and spending a lot on perhaps unnecessary infrastructure like having a spendy MRI machine in every clinic in Minneapolis (as an example, this is not actually the case).

So we spend so much on health care because our health care is so expensive and Kip suggested that any new system will be attacked because of cost, even though it’s already inherent in the current system.

Dr. Frost followed with examples of patients she has encountered being negatively impacted by lack of insurance or by the structure of our current health care system. She also, finally, in case anyone wasn’t sure, explained exactly what single-payer health care is. It’s basically Medicare for everyone. Each person pays into a government health care fund, and that health care fund pays providers. The fund is the only entity paying money to the providers, hence the term “single-payer.” This is in contrast to hundreds of different insurance companies paying the same providers for different patients: “multi-payer.”

John Marty talked about the bill he has sponsored, the Minnesota Health Act (SF 118/HF 135). The nine principles of health care reform in the Minnesota Health Plan are stated as the requirements of the bill. This is the meat and potatoes of this whole thing, so at least read the nine principles and the plan summary. He mentioned that a common concern that he hears is that people want to be able to retain their choice of insurance, but what people really mean is they want to retain their choice of providers. Under this plan, everyone would be free to choose from every health care provider in the state. I know I don’t have much choice in my insurance. That people are possibly making this mistake says to me that this is a key aspect of our health care system that people simply do not understand. That’s pretty screwed up.

Keith Ellison finally moved the conversation toward what I wanted to hear, which was how we plan to accomplish switching to a single-payer health care system. He said that there is significant disinterest in this issue in Congress. Often there is a more pressing issue (e.g., Iraq, the economy), but health care always seems to be #2. He pointed out that the single biggest stimulus we could give to General Motors would be the severe reduction in health costs that single-payer health care would bring. He said that Starbucks spends more money on health care than on coffee beans. And then he basically said that there are plenty of great reasons to make this change and plenty of organizations on board with it, but our political system is the chief barrier. He also put a Minnesota plan in a national context by pointing out that leading the way on this issue would be a huge incentive for businesses to (re)locate here and help build momentum for a federal plan. (And it would make us Minnesotans feel good about ourselves.)

The question and answer session is where a lot more and more interesting details of the plan came out.

Some Features of the Proposed Program

* The Minnesota Health Plan would replace Medicare, Medicaid, worker’s comp, etc. Maintaining those other plans would mean maintaining multiple payers which defeats the purpose. We’d need a federal exemption to do this.

* Dental would be included.

*“Residents” would be covered with no distinction between legal/illegal. If you’re not a resident your home state or country will be billed (I’d need some more info on this). It’s both a moral and a public health issue to exclude anyone including undocumented folks. Someone also asked how this plan ties in with our immigration policy. Keith Ellison basically referred back to the moral and public health issues, and said that the cost of treating undocumented folks is way less than the administrative bloat.

* Premiums are based on the ability of individuals to pay. This system turns our currently regressive health care costs into progressive costs.

* The plan could include a student loan forgiveness option to attract providers. The plan does mandate having enough service providers. They spoke to some of the complexities of providers actually getting paid, doctors choosing specialties because they command more dollars and speed up the loan payoff process, and the possibility of specialists still being relatively scarce in less populated areas.

* Alternative and holistic medicine would be covered. According to Dr. Frost, “medically necessary care” is covered, is evidence-based, and the provider must be licensed. Acupuncture is an example of alternative medical care for which there is provider licensing and evidence of positive outcomes.

* This is not a comprehensive list of the plan’s features, just what came up in the Q&A.

Other Nuggets of Information

* Per capita health care spending in the U.S. last year was approximately $7,000. Minnesotans, at $7k per capita spending, spent $35 billion on health care last year. The state budget was $18 billion.

* We don’t have to go whole hog on this. Stepping stones to a single-payer system could be lowering the age of Medicare eligibility to 55 or including kids aged 0 to 18.

* Insurance companies have overhead upwards of 30%. Medicare’s overhead is approximately 2%. The difference is (claimed to be) in executive salaries, underwriting (i.e., the process of determining if someone is insurable and how much it would cost), and marketing.

* “Single-payer health care” should not be confused with “universal health coverage.” Massachusetts mandated universal coverage which requires everyone to be insured, but insurance doesn’t necessitate health care and mandating insurance perpetuates the current problem.

* Someone asked about our societal litigiousness and the impact of a lawsuit-averse mindset on the part of providers. According to Kip, what we spend on malpractice suits is relatively little and the vast majority of cases never even see a day in court (because lawyers won’t even take them).

My Thoughts

* There were some conflicting examples given that alluded to businesses also paying premiums based on their ability to pay/profitability. I’d think the only cost to a business would would be the business owner’s personal premiums. I thought the point was to cut businesses out of the equation all together. Need some clarification here.

* I’d like to see some math on the cost to implement the plan, the magnitude of the projected cost savings, and a risk assessment of underfunding the program. This has got to be out there somewhere, but I haven’t found it yet.

* Seems to me like many really will be voting on this as a moral issue because so many people (myself included) haven’t had a problem due to lack of insurance, maybe can’t see concretely what the impact on their wallet is, and have had decent experiences with the current system and quality of care. The insurance that I have right now provides me with pretty good coverage and practically no premium. I’m 100% certain that my ability to pay would mean I’d be paying a lot more under this system. I’m not opposed to that because I believe in the system.

* The single-payer concept seems obvious. The chief arguments against it that I can see would be how it’s funded adequately, the administrative structure, and whether it’s appropriate for the government to be involved in in the first place.

* I wonder about this: If more socially conservative folks are so inclined to legislate their morals, the moral stance of providing health care for everyone seems at odds with the fiscally conservative free market, capitalistic position of making private health insurers compete for your business.

* Someone asked about the mechanics of the actual shift in money flow and what happens to the insurance companies. I didn’t really hear a good answer. John Marty did suggest that many health plan/insurance company employees do have a medical background and could be retrained and redeployed in the new system.

Further Reading

* fresh.mn: The Minnesota Health Plan
* mnhealthplan.org

* Wikipedia: Single-payer health care

* Minnesota Universal Health Care Coalition – includes upcoming events that you can attend to hear more on this issue

* Commonwealth Club podcast with Zeke Emanuel [web] [iTunes] on “the ins and outs of creating a new health care system” in which he discusses various options, one of which is single-payer, and the pros and cons of each. Totally worth an hour of your life.

* MnIndy: “Minnesota Health Plan advances in Senate, opponents grilled” – Great comments.

* Kip Sullivan’s book: The Health Care Mess: How We Got Into It and How We’ll Get Out of It