Featured Guest Commentary
The essay by Senator John Marty provided below is from a post first published by Bill Moyers on March 4, 2017, on BillMoyers.com. Re-published here with permission from the author.
In a Special Report entitled “Is Health Care Doomed?” journalist Bill Moyers examines the current state of health care reform in the US and profiles various efforts by state legislators to offer alternatives to widespread loss of access to affordable health care under the new Republican plan to demolish the ACA (“Obamacare”). In particular, he spotlights Senator John Marty’s plan to reform health care and notes:
“We are at a stalemate. Opponents of the ACA have no viable replacement and supporters have no power to stave off the Republican bulldozer.
Is the situation hopeless? In Washington, probably — at least for now. But there are alternatives. As I noted above, two longtime advocates for universal health care, Drs. Woolhandler and Himmelstein, have renewed their campaign for single-payer reform, which candidate Barack Obama applauded when he was campaigning and then rejected after his election as part of those compromises he made to win support from conservative Democrats and the medical and insurance industries. In their Annals article, the two reformist physicians offer evidence that single-payer reform could provide “comprehensive coverage within the current budgetary envelope” because of huge savings on health care bureaucracy. It’s worth reading.
So is a plan put forth by Minnesota State Sen. John Marty. Often described as “the conscience of the Minnesota Senate,” Marty has been an advocate for universal health care since he was elected 30 years ago. He has served as chairman of the Senate Health Committee and now serves as the ranking minority member of the Senate Energy Committee. Often ahead of his times, Marty introduced and eventually secured passage of the country’s first ban on smoking in hospitals and health care facilities. Long before public support had materialized, he worked to ban mercury in consumer products, create a legal structure for public benefit corporations and bring about a “living wage” for workers. In 2008, when he introduced legislation proposing marriage equality for LGBT couples and predicted it could pass in five years, colleagues dismissed him as a Don Quixote. Five years later Minnesota passed marriage equality legislation.
So this lifelong progressive has earned the right to chide his fellow progressives for “merely tinkering” with problems. He writes that “If 21st-century progressives had been leading the 19th-century abolition movement, we would still have slavery, but we would have limited slavery to a 40-hour work week, and we would be congratulating each other on the progress we had made.”
This timidity, Marty acknowledges, might be partially explained by decades of defeat at the hands of powerful financial interests and politicians beholden to those interests. But as a result, many politicians who espouse progressive change have retreated from a “politics of principle” to a “politics of pragmatism.”
Sen. Marty crisscrossed Minnesota to talk directly with citizens about what they need and want in health care. He has now proposed a universal health care system which he calls the Minnesota Health Plan. He’s distilled it into a small paperback book — Healing Health Care: The Case for a Commonsense Universal Health System. I asked him to write an essay for us summing up the plan’s basic principles and the case for it.” — Bill Moyers
A CALL TO ACTION
By John Marty
Our health care system is broken.
We have some of the best health care available in the world, but one of the worst systems for accessing that care. We squander outstanding health care resources — providers, clinics and hospitals, medical research and technology — on a broken system that makes it difficult and expensive for many people to get the care they need.
President Obama provided hope during his 2008 campaign, saying health care “should be a right for every American.” Unfortunately, he never proposed universal health care, though the Affordable Care Act (ACA) was a big step forward. It reduced the number of people without health coverage by almost half. It made a (in some cases, literally) lifesaving difference for millions of Americans.
However, even if the ACA were beefed up, it would always leave some people without coverage. In addition, health insurance does not equate to health care — millions of Americans who have insurance still cannot afford the care they need due to exclusions in coverage, copays and deductibles. And because it added even more complexity to our already convoluted insurance system, the ACA is easy to attack.
Republican attacks during the 2016 campaign were wrong; the ACA is not the cause of the problems in the system. Nor is it the solution, despite the good it did for many people.
Now that President Trump has blurted out that “nobody knew that health care could be so complicated,” we will watch the ironic efforts of Republicans to replace the Affordable Care Act — an insurance-based plan, largely modeled on former Massachusetts Republican Gov. Mitt Romney’s “Romneycare,” which, in turn, was largely based on ideas from the conservative Heritage Foundation. We have Republicans attacking a Republican concept. It might be bizarre to watch, but lives are at stake.
We are Headed in the Wrong Direction
Most of the health care “reforms” in recent decades aimed at saving money by making sure people don’t overuse health care, putting barriers in their way. These reforms included use of restrictive “networks” of providers, requiring “prior authorization” by the insurance company before treatments could be provided, copays and higher and higher deductibles. The Republican proposals this year head further down that path of adding barriers to care, especially when they cut Medicare and Medicaid.
After four decades of putting barriers between people and medical care, we do make fewer visits to the doctor than people in most other countries.
But it is hard to call this a success. About a third of Americans report that they fail to get the care they need, because they cannot afford to pay for it. Yet even after all those “reforms,” we are spending nearly twice as much as people in most other countries spend. That raises both an ethical and an economic question:
Why would any society make it difficult for its people to access health care? And, if our attempts to make health care less expensive through barriers to care isn’t working, shouldn’t we try a new approach?
Fixing these problems requires fundamental changes in our health care system. We need a new model.
Health Care Should be Covered like Police and Fire
We could start by looking at other public services. Nobody goes without police and fire protection — nobody has to apply for new “police and fire coverage” each year, nobody has to worry that they may no longer be qualified, nobody has to worry about a $3,000 deductible before the fire department will come. Nobody has to worry that the local sheriff won’t accept their “police insurance” plan. And nobody gets a letter informing them that their police or fire coverage is being terminated, for any reason.
A civilized, humane society that takes care of its people with universal police and fire coverage needs to do the same with health and dental care.
Designing a New System
Before leaving on a trip it is important to know where you are going: Focus on your goals and where you are headed. The same is true for designing a health care system.
Here are some basic principles that need to be followed if a health care system is to serve the public well. The health care system must:
• ensure all people are covered;
• cover all types of care, including dental, vision and hearing, mental health, chemical dependency treatment, prescription drugs, medical equipment, long-term care and home care;
• allow patients to choose their providers;
• reduce costs by cutting administrative bureaucracy, not by restricting or denying care;
• set premiums based on ability to pay;
• focus on preventive care and early intervention to improve health;
• ensure there are enough health care providers to guarantee timely access to care; and
• provide adequate and timely payments to providers.
These principles offer an entirely different approach to health care reform. Instead of trying to design a health care system that restricts care, we design a system that keeps people healthy and helps them get care when needed.
Perhaps counterintuitively, that logical health system actually saves money. To illustrate why a system focused on health is less expensive than one based on insurance, consider an analogy between schools and hospitals:
If schools were funded the way we fund hospitals, each teacher would need to spend a half hour or more each day calculating and reporting how much time was spent with each student, along with the amount of supplies each student consumed. Those calculations would be forwarded to the school’s billing office, where a portion of janitorial costs, facility costs, and administrative overhead would be allocated to each student.
The billing office would bill each student’s “education insurance plan,” at a highly inflated price (Hospitals call it a “chargemaster” rate.). Each education insurance plan would negotiate with the school, ultimately reducing their cost by about two thirds. Those families who don’t have any “education insurance” would be liable for the full, inflated “chargemaster” price. Many families would struggle to pay. As a result, the school would also need a collections office.
Would this improve education? No. It would make it worse, shifting teacher and administrator time from education to billing.
Would it save money? No. It would cost much more, adding these significant administrative duties.
We would never want to fund schools the way we fund hospitals.
Our Proposal — A Minnesota Health Plan
I have introduced legislation to create a Minnesota Health Plan (MHP), a proposal designed to meet all of the principles mentioned above. The MHP would be governed by those principles, setting it apart from other health systems in its focus on public health and well-being instead of profit or politics. While this plan is designed for Minnesota, a similar model could be used in other states.
The MHP would be a single, statewide plan that would cover all Minnesotans for all their medical needs. Equally important, it would reduce the need for costly medical care through public health, education, prevention and early intervention. It would be governed by a democratically selected board that would be legally bound to those governing principles.
Under the plan, patients would be able to see the medical providers of their choice without network restrictions, 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, optometry, mental health services, chemical dependency treatment, medical equipment and supplies would all be covered, as well as home care services and nursing home care. Consumers 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.
There would be no filling out of complex application forms, no worrying whether a provider is “in network” or not, no worrying about whether the treatment was covered or how you are going to pay for the drugs.
The MHP would be prohibited from restricting or denying care to save money, but would lower health care spending through efficiency, the elimination of billing and insurance paperwork, and through public health prevention.
The MHP would restore medical decision-making to the doctor and patient, removing health insurance companies from making treatment decisions. The plan would end not only access problems caused by cost, but also access problems caused by an inadequate number of health professionals and facilities around the state, because the health plan would be required to ensure sufficient providers to meet medical needs around the state.
The plan would be funded by all people, with premiums based on the ability to pay, and a payroll tax on employers, along with existing state and federal funds that have been committed to health care. Those payments would replace all premiums currently paid by employees and employers, as well as all copayments, deductibles and all costs of government health care programs. The premiums paid by all but the wealthiest would be less than the premiums, copays and deductibles they currently pay.
Although the MHP is not cheap, it is significantly less expensive than our current system, and it would provide a full range of health care services to everyone, improving the health of Minnesotans.
The politics of health care reform in 2017
Republican gains in recent years show that progressives need to spell out solutions that would actually fix our problems. We cannot win policy battles by negative attacks against the other side. We will win when the public realizes that our solutions will improve their lives. Thus, when fighting against Republican efforts to eviscerate Medicare, Medicaid and the ACA, saying “no” isn’t enough. We need to articulate a solution.
Republicans typically describe health reform proposals they don’t like as “government health care.” But that is not an accurate description of this plan. The MHP is a patient-directed health plan. It lets people choose the providers they trust, and medical decisions are made by patients and their doctors, not government or insurance companies.
The MHP is publicly governed, which means that it is more accountable to patients than insurance companies. It encourages competition and innovation among doctors and hospitals based on an efficient financing system in the background.
Finally, let’s not forget the ethical dimension. What does it say about a society that allows some of its people to suffer from untreated health crises? Should profit and individual wealth continue to determine who gets care, or should health care be available to everyone?
The proposed Minnesota Health Plan and the principles that underlie it are nothing more than what any caring society would desire in order to ensure good health for all of its people. It is time to replace health insurance for some with health care for all.
John Marty has been a Minnesota state senator since 1987. He is former chair of Minnesota’s Senate Health Committee and is currently the ranking member of the Energy Committee. He is a strong advocate for government ethics, campaign finance reform, environmental protection and universal health care. Marty also supports public investments in education, health and employment to enable all people to reach their full potential. He is a graduate of St. Olaf College with a BA in ethics; he and and his wife, Connie, live in Roseville, Minnesota. Follow him on Twitter: @JohnMarty.