Liberal in the Land of Conservative

Why the Minnesota Health Plan?

Health care is bankrupting many families, even those with health insurance. People ask what good it is to have the best doctors if they cannot afford to go to them. Politicians of both parties have been tinkering with health-insurance reforms for years, but that's not solving the problem.

Before deciding how to move ahead, we should recognize that there is a big philosophical divide about how to proceed: Is health care a commodity or a community need?

Many politicians view it as a commodity -- something that is bought and sold in the marketplace. "Bought," that is, to the extent you can afford it. However, if you believe that all people deserve access to affordable health care, as two-thirds of Americans do believe, then there is a problem. Many people don't earn enough to buy health care.

Most health proposals from politicians reflect this commodity approach. They reason that if people cannot afford health care, government should subsidize the coverage or allow insurance plans to cover fewer medical services to save money. To achieve universal health coverage, these proposals would require residents to buy insurance. In Massachusetts, this proposal has become law, but even with that requirement, Massachusetts has a target of only 95 percent insured.

Equally troubling, Minnesotans who have insurance still face astronomical health costs, and they would get little relief from this type of reform.

As an alternative, we could treat health care as a community need, something everybody needs and everyone gets -- just like police and fire protection.

If you call the police because your home is being burglarized, the police dispatcher doesn't ask whether you have police insurance and what plan you have. He or she doesn't waste time and money having you fill out forms so your insurance company can be billed. The police response does not depend on your insurance status. Everyone is treated equally. It's the American way.

If health care were treated as a community need, when you were sick you would get the care you needed. And you would get sick less often, because you would receive preventive care and health education to assist you in taking responsibility for your health. As with police and fire protection, we all would pay for it, and we all would benefit from it.

Our current commodity health-care system leaves many people without access to needed care. In contrast, other western, industrialized nations cover everyone for all medical needs. That's why people in those countries have longer life expectancies and lower infant mortality rates.

In reality, everyone in Minnesota eventually gets health care. If people can't afford treatment, we wait until they are really sick, then we pay for more costly hospitalization and emergency-room care. We end up paying more because people don't have health care up front. We don't focus on prevention. And with our incredibly complex insurance system, about 30 cents of every health-care dollar we spend goes to administrative costs. That is why Americans pay at least 50 percent more for health care than those other nations pay.

Many middle-income families have insurance but are still only one serious illness away from bankruptcy. Our businesses, schools and government face skyrocketing health-care costs.

It is time for Minnesota to make sure that every Minnesotan has access to the health care that they need. By treating health care as a community need, not as an optional commodity, we will live healthier lives and save money, too.

In Minnesota, managed care has been implemented in a way that offers several advantages over fee-for-service. For example, state contracts with health plans provide a mechanism for leveraging improvements in access, accountability, and quality that has been lacking in fee-for service. Also, managed care (in contrast to fee-for-service) limits the state’s financial risk to predetermined payment levels. In addition, managed care enrollees generally have more recourse when problems arise than do enrollees in fee-for-service care. This is one reason that our report recommends that the Legislature consider expanding the duties of the state’s managed care ombudsman to encompass fee-for-service enrollees. Finally, health plans’ efforts to engage enrollees in health improvement activities contrast with the more passive and uncoordinated approaches that have characterized fee-for-service care.

In order to keep Minnesotans healthy and provide the best quality of health care, our health care system must:

(1) Ensure all Minnesotans receive high quality health care, regardless of their income;

(2) Not restrict, delay, or deny care or reduce the quality of care to hold down costs, but instead reduce costs through prevention, efficiency, and reduction of bureaucracy;

(3) Cover all necessary care, including all coverage currently required by law, complete mental health services, chemical dependency treatment, prescription drugs, medical equipment and supplies, dental care, long term care, and home care services;

(4) Allow patients to choose their own providers;

(5) Be funded through premiums and other payments based on the person's ability to pay, so as not to deny full access to all Minnesotans;

(6) Focus on preventative care and early intervention to improve the health of all Minnesotans and reduce costs from untreated illnesses and diseases;

(7) Ensure and adequate number of qualified health care professionals and facilities to guarantee availability of, and timely access to quality care throughout the state;

(8) Continue Minnesota's leadership in medical education, training, research, and technology; and

(9) Provide adequate and timely payments to providers.