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Serving Northern St. Louis County, Minnesota

Minnesota Health Plan

New book outlines transition from the MNsure mess to a single-payer system


A new book by Minnesota state Sen. John Marty offers something that few politicians have ever provided to the public before— a straightforward plan to transition to a single-payer health care system in the state.

If there’s one thing, above all else, that passage of the Affordable Care Act has demonstrated, it is that any health care reform that maintains the existing private health insurance system is doomed to fail. While the ACA provided a brief respite in the spiraling cost of health care, premiums are now making up for lost time. Health officials here in Minnesota are already warning consumers that they are in for sticker shock when new MNsure rates are announced in a few weeks. Most plans are expected to see increases approaching 35-50 percent.

Despite skyrocketing premiums, Minnesotans are increasingly getting less in terms of coverage. To keep premium increases to a minimum, Minnesotans are opting for high deductible plans that require families to pay thousands of dollars before real insurance coverage kicks in. Even then, they still have co-pays and other charges. And many of the plans provide no dental coverage and only limited coverage for mental health care.

The problems inherent in the ACA are no justification for going back to the bad old days, when insurance companies could simply refuse to insure those in poor health, or when they were allowed to pocket huge profits by simply denying care even to those they had agreed to insure. In those days, we had 50 million uninsured Americans and our health care costs were spiraling out of control.

That leaves the obvious question. Where do we go from here?

Sen. Marty, in his new book, released at no charge in digital format this week, lays out a road map for the implementation of what he calls the Minnesota Health Plan, a comprehensive, single-payer health insurance proposal that he argues will provide significantly enhanced medical access for all Minnesotans, without spending any more than the $50 billion that Minnesotans and their employers currently pay for health care premiums and medical services every year.

The single-payer system would direct far more money towards actual care, however, since it would save the 15 cents on every health care dollar that goes to administering what is without a doubt the most inefficient health insurance system on the planet. That 15 percent amounts to seven billion dollars a year that Minnesotans and their employers spend on bureaucracy, whether it is administrative staff at hospitals, insurance companies, or in the government.

Complexity breeds inefficiency, as those who have struggled with the MNsure process are well aware. Yet it doesn’t have to be that way. As Sen. Marty notes, the cost of signing up seniors for Medicare is just a tiny fraction of the cost of getting Minnesotans signed up for coverage through MNsure. It’s not that government is inherently inefficient. Indeed, the Medicare system is far more efficient than any private insurance company. It’s that when government systems are set up to benefit special interests— like the insurance industry in the case of the ACA—that common sense and efficiency regularly disappear out the window.

The transition to a statewide single-payer system may well be possible, since the ACA does allow for waivers, which would essentially allow states to utilize federal health care dollars to develop alternatives to the current system, as long as they meet certain standards, which the Minnesota Health Plan, as envisioned by Sen. Marty, certainly would. In addition to federal funding, the cost of care under the Minnesota Health Plan would be paid for primarily by a payroll tax and individual premiums, similar to the way that Medicare is funded today.

Those who say a single-payer system isn’t viable are deploying mere rhetoric in place of reality. Many other developed countries manage to provide a successful single-payer system for their citizens, and so do we. Medicare, after all, is a single-payer health care system, and it’s one of the two most popular programs (the other being Social Security) run by the government.

Would the Minnesota Health Plan face political opposition? Without a doubt. Many politicians maintain their office by defending powerful special interests, and few are more powerful than the insurance lobby.

But one thing is certain. You don’t win if you don’t try. We ended up with the Affordable Care Act, with all its flaws, because the Obama administration opted to avoid a battle with the insurance industry, not because the administration could argue that theirs’ was a better plan.

Perhaps it took the misfire of the Affordable Care Act to open the door to something better. If so, Sen. Marty’s new book is pointing a way forward. It’s definitely worth a read.


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