Health Care for All

It is time to deliver health care for everyone. Minnesota and the U.S. already spend twice as much on health care as people in other nations. Yet we have health outcomes that are much worse than comparable countries.

Senator Marty has long supported efforts to cover more people, including Minnesota Care and the Affordable Care Act in Washington. However, it is time to stop trying to help more people qualify for care and start ensuring that everyone receives care.

He authored the proposed Minnesota health Plan (Senate File 2740) which would cover everyone for all their medical needs – including dental, prescription drugs, vision and hearing care, mental health services, chemical dependency treatment, home care services, and nursing home care. Patients would choose their doctors, and there would be no co-pays, deductibles, or other barriers to care.

The obstacles to its passage? Republicans work alongside the insurance industry, pharmaceutical lobby, and other powerful interests to block it – even though we would have healthier people; even though the plan would cost less than our current dysfunctional system.

The biggest reason that some Democrats won’t fight for it? Persuaded by those powerful interests, they say it isn’t politically realistic. What is actually unrealistic is the notion that we continue to pay double for a bureaucratic system that leaves many sick people without care and burns out doctors by forcing them to spend their time on insurance paperwork rather than caring for patients.

Under the plan, patients would be able to see the medical providers of their choice when they need care, and their coverage by the health plan would not end when they lose their job or switch to a new employer.

Dental care, prescription drugs, vision & hearing, mental health, chemical dependency treatment, medical equipment and supplies would all be covered, as well as home care services, and nursing home care. Patients would use the same doctors and medical professionals, the same hospitals and clinics, but all the payments, covering all of the costs, would be made by the MHP, and everyone would be covered.

The Minnesota Health Plan (MHP) would be a single, statewide plan that would cover all Minnesotans for all their medical needs.

There are currently about 250,000 Minnesotans without any health insurance, and at least a million more who have insurance, but still cannot afford their medical bills due to co-payments, deductibles, and care not covered by their insurance, even after they pay high premiums. The MN Health Plan would eliminate the problem of un-insurance and under-insurance. It would replace our costly insurance system with healthcare for all. Equally important, it would reduce the need for costly medical care through public health, education, prevention, and early intervention.

No need to fill out complex application forms, no worrying whether a provider is “in network” or not, no worrying about whether a treatment is covered or how to pay for the drugs.

The Minnesota Health Plan would be prohibited from restricting, delaying, or denying care, or reducing the quality of care to save money. Instead, it would reduce healthcare spending through fair pricing, efficiency, and the elimination of paperwork. MHP would restore medical decision-making to the doctor and patient, removing insurance companies from interfering with treatment decisions. The plan would address both access problems caused by cost and those caused by a shortage of health professionals and facilities around the state.

Healthcare would be funded by all Minnesotans, based on our ability to pay, replacing all government and private insurance plans and it would end all co-pays, deductibles, and other out-of-pocket expenses.

Although the Minnesota Health Plan is not cheap, it is less expensive than our current system, while providing a full range of health care services to everyone, greatly improving the health of Minnesotans.

Why the Minnesota Health Plan would cost less, despite covering everyone

Universal coverage is actually less expensive than our current patchwork system. The Minnesota Health Plan would be financed from the same sources as our current system:

More than half of all health-care spending is currently paid by the state and federal government (e.g., Medicare, Medicaid, VA, Advanced Premium Tax Credit, public employee health care, MinnesotaCare, etc.), and we would continue to use those dollars.

Individuals and families would continue to pay premiums, but instead of paying them to Blue Cross or some other insurer, they would be paid to the Minnesota Health Plan. Those payments would replace all current premiums, as well as all copays, deductibles, and out-of-pocket expenses for dental and other care that currently bankrupt many. However, the premiums would be based on ability to pay, not based on age or medical condition—most people would pay much less, though some would pay more—and it would be affordable to all.

Instead of an employer mandate, and instead of the annual burden of shopping for an insurance plan, employers would pay a tax that would, for most employers, cost less than their current coverage, even though their employees would have comprehensive benefits, including dental and long-term care. And employers would no longer have to worry that hiring an older worker will drive up their premiums.

To briefly explain why an efficient universal health-care system is less expensive than our current dysfunctional mess, we look at two of the biggest cost drivers in medicine. First, our current system overpays because of completely irrational pricing. As reported in the New York Times, a national comparison of hospitals showed pricing for the simplest form of knee replacement ranged from about $3,400 to about $55,800. Hospitals charging the low-end prices are not undercharging; they set prices sufficient to cover their costs. Those radical price disparities—unrelated to costs or benefits—show that some purchasers of health care are being charged as much as ten to fifteen times what is reasonable. A logical single-payer system negotiates prices, resulting in rational costs.

Second, our current system is bloated with enormous administrative waste. To understand the significance of the administrative savings under single payer, consider an analogy. If public schools were funded the way we fund hospitals, each teacher would spend time each day calculating the time and resources they devote to each student. The school would allocate janitorial costs, facility costs, and administrative overhead to students. The school would bill each family and their “education insurance plans.” Those insurance plans would pay for different services at different rates, with different copayments. Because education is expensive, employers would offer “school coverage” for their employees’ children. Those without employer coverage would shop for school insurance on the individual market. Because of the high cost of individual policies, the government would step in to subsidize coverage. Even so, not all families would have “education coverage” and many families would struggle to pay. As a result, schools would spend additional resources to collect payments and cost-shift unpaid expenses to other students. Setting aside additional complications such as teachers or schools being “out-of-network,” this would still be a costly, bureaucratic nightmare. It would harm education outcomes by shifting resources from teaching to billing and insurance. Financially, it would cost a fortune to pay for the billing clerks, accountants, and price negotiators for the schools, plus all the operating costs for the “school insurance” companies. Eliminating this billing and insurance bureaucracy from our health-care system would result in huge savings.

From Senator Marty’s 1/29/2018 Commonweal commentary “Speed Up on Single Payer: Our First Concern Should Be Health Care For All:

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