Every Minnesotan could be covered under a state administered healthcare
plan within the coming year if legislators can overcome opposition
from a powerful healthcare insurance industry and a governor who
publicly opposes the type of “single-payer,” government-run
system that a growing alliance of lawmakers, physicians, professionals,
labor unions and business and community groups endorse.
Legislation introduced by State Senator John Marty (DFL-Roseville)
in the last hours of this year’s legislative session is the
latest hope that universal, single-payer health care can be achieved
“My goal is to make sure we get the best health care for
the state,” said Marty. “The best primary care, public
health care and preventive care,” he said.
“Single-payer” health care, according to a January 2003
edition of The American Journal of Public Health, is the only such
coverage that ensures universal healthcare access.
Single-payer offers no out-of-pocket payments—no co-payments
or deductibles. A bare-bones single-payer system in Minnesota would
have the state pay licensed healthcare providers (with monies collected
according to ability to pay) on a fee-for-service basis.
With single-payer, patients are free to seek care from any licensed
healthcare provider with the encumbrance of financial incentives
or penalties removed. Medical decisions are made by patients and
providers rather than dictated from afar.
And with the purchasing power controlled by statewide funding,
prices for drugs and medical services could be bargained for and
at least partially controlled.
“Single-payer systems reduce excessive administrative costs
by not wasting money on managing care, marketing, underwriting,
lobbying, and profit,” wrote Kip Sullivan, former member of
the steering committee of the Minnesota Universal Health Care Coalition
(MUHCC) and author of “The Health Care Mess.”
Marty’s bill, SF 2324—the “Minnesota Health
Care Act,” had only time to be sent off to the Senate’s
Health, Housing and Family Security Committee before the sand in
the session’s hour glass ran out. But as of this week, one
quarter of the Senate and one third of the House had signed on as
“We are supporting this bill,” said Eileen Weber,
program coordinator for the MUHCC. “This bill is going to
be a great starting point,” she said.
“Especially since we have a governor who doesn’t seem
to care about health care,” Weber said yesterday via cell
phone from the steps of the Capitol. Weber had just left a hearing
for Minnesota Health Commissioner Dianne Mandernach concerning her
decision to hold back research from March 2006 showing 35 Iron Range
miners had contracted mesothelioma, a rare form of cancer.
“There was some pretty frightening testimony coming from
health department staffers,” said Weber.
Staffers testified that they had been instructed by Mandernach
not to discuss the cancer data even within their own department.
The testimony has called into question not only health department
policy, but what type of communication the governor has with his
As one who has worked shoulder to shoulder with state legislators
trying to initiate universal healthcare reform for the state, Weber
sounded summarily strained. “Governor Pawlenty has an apparent
disregard for health care in Minnesota,” she said.
Proposals exhorting universal health care and a single-payer system
have been floated in the Legislature since 1991. Only this year,
a bill written by Sen. Leo Foley (DFL-Coon Rapids), and introduced
at the beginning to the session, was stripped of most of its language
pertinent to single payer.
“It didn’t get a hearing,” said Foley. “It
just wasn’t appropriate at the time,” he said.
“The thing now seems to be that we’re moving forward
this year,” Foley said. “Frankly, I’m not an opponent
of Sen. Marty’s bill. I have high hopes for [it],” he
But some who have walked the walk for the single-payer plan are
not as pleased with Marty’s last-minute proposal. A letter
sent out last week from the Greater Minnesota Health Care Coalition
(GMHCC) to co-sponsors of the bill says that the proposal, as currently
written, has a serious language flaw that could undermine its intent
to create a single-payer system.
Charlotte Fisher, GMHCC President, tells legislators in her letter
that, “the bill has language [that] clearly describe[s] administrative
middlemen entities such as HMOs, even though HMOs are not specifically
named in the bill … This would end up working much the same
way as the current privatized operation by HMOs.”
“There is a problem there,” said Sen. Foley about SF
2324’s language. “His bill is less definite [on the
single-payer issue]. It delays the administration of single payer
over the next few years,” Foley said.
“You can’t have private healthcare insurers remain
in a single-payer state health system,” said Sen. Marty yesterday,
claiming his single- payer ground. “If they are going to continue
doing business here, they can’t do it as an insurance company,”
“What we’re trying to figure out is the best fit for
Minnesota,” said Marty in defense of his measure. “I
think we’re on our way to doing that,” he said.
“I campaigned primarily on healthcare reform,” said
Senator Mary Olson (DFL-Bemidji), a co-author with Marty on SF 2324.
“In my 15 years of practicing law, I represented many people
who were trying to redress grievances against their healthcare providers,”
“Until I ran for state Senate, I wasn’t involved at
all in politics,” Sen. Olson said. “It all started for
me when I sent a letter to (then State Attorney General) Mike Hatch
because I admired what he was doing as an advocate for consumers.
I asked what I could do to help improve our state’s healthcare
system,” she said.
“Right now we have people sitting very far removed from what
would be in the best interest of the patient,” said Olson.
“Our current system is run primarily for the benefit of the
healthcare industry,” she said.
“You just can’t trust private healthcare insurance
providers to be beneficial to patients when they’re making
healthcare decisions based on the market,” Olson concluded.
And about the governor’s opposition to a single-payer plan,
she said, “Ultimately, it’s the voters who make the
decision: A lot of people, especially in rural Minnesota, are fed
up with the ways things are.”
“I think he has to come to the light,” Sen. Foley
said about Governor Pawlenty’s position. “Without the
commitment to find a way to finance and implement these things you
end up with inadequate health care, inadequate transportation,”
“I think that the Legislature has been in a crisis mode
in dealing with healthcare reform in Minnesota,” MUHCC’s
Eileen Weber said. “But we have to start looking five years
down the road,” she said.
“We want to be clear that there will be one universal payer
for this plan,” Weber said. “I do think we should remove
the ‘healthcare delivery systems’ language from the
bill,” she said.
But shutting out the private health insurer industry with a single
payer system, even the most zealous of single payer advocates admit,
will be “times that try men’s souls”—and,
according to health reformer Kip Sullivan, “Given the enormous
power of the interests which oppose price controls and a single-payer
system, it might seem like wishful thinking to predict that America
will adopt price controls and a single-payer system.”
“Being a realist, there will be a large employment transition,”
said State Representative Alice Hausman (DFL-St. Paul), who began
tinkering with the idea of a new way to approach a single-payer
system late last year based on a California healthcare model that
includes private healthcare insurers in the mix.
“A single-payer health program would eliminate the jobs of
thousands of healthcare and insurance workers who currently perform
billing, advertising, eligibility determination, and other superfluous
tasks,” says the American Journal of Public Health article
quoted at the beginning of this piece. “These workers must
be guaranteed retraining and placement in meaningful jobs,”
“It’ll be a long road with the Health Care Act going
through a lot of changes before we get something we can get passed,”
said Sen. Marty.
“I’m willing to take the slow process if it gets things
done,” said Sen. Leo Foley.
Said State Rep. Hausman, “My hope is that we’ll all
trust one another as we start having these hearings, because there
is a common enemy out there, which is the status quo.”