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John Marty, Minnesota State
Civic Caucus, 8301
Creekside Circle #920, Bloomington, MN 55437
David Broden, Janis Clay, Marianne Curry, Paul Gilje, Jim Hetland (phone),
Verne Johnson (chair), Sallie Kemper, Dan Loritz, Tim McDonald, Jim Olson
(phone), Wayne Popham (phone), Clarence Shallbetter, Bob White
Summary of meeting:
As part of its on-going examination of proposed remedies for soaring
healthcare costs, the Caucus visits with State Senator John Marty who
outlines his recommendation for a universal health plan for
The statewide Minnesota Health Plan (MHP)
would pay providers for the care of all residents, and would cover all
medical services including dental care, prescription drugs, optometry,
mental health, chemical dependency, and home care and nursing services.
The plan would be prohibited from denying medically necessary care to save
money. Premiums, based upon ability to pay, would be paid directly to the
Minnesota Health Fund, which would operate independently of legislative
appropriation. The governing board of the fund would be democratically
elected by regional health boards, which are elected locally by elected
Welcome and introductions
Marty has been a state senator for 24 years. The son of a minister and
theologian, Marty grew up in a home engaged in the civil rights and
anti-poverty movements. He attended St. Olaf College in Northfield and
received a B.A. in Ethics in 1978.
Marty was elected to
the state Senate in 1986. He is the former chair of the Senate Environment
Committee; and the Health, Housing and Family Security Committee. He and
his wife Connie have raised two children, Elsa and Micah.
Comments and discussion
Sometimes cutting costs make a problem worse
With a growth rate of
about 9 percent annually, health care is far and away the fastest growing
portion of the state budget. There are many compounding factors, primarily
escalating costs and an aging population that will, under present
conditions, lead to increased consumption of services.
"In some cases,
cutting costs exacerbates problems. If you think health care is too
expensive, and you decide to buy less of it, you risk worsening a health
condition. Governor Pawlenty's 'unallotment' of General Assistance
Medical Care did not, as purported, save $380 million, because the very
sick people in the program didn't stop getting sick when they lost their
health care coverage. HCMC (Hennepin
alone estimated that their additional costs when GAMC disappeared would be
$100 million. When care is cut, these people get sicker, and sicker people
eventually cost more to treat.
Saving up to 20 percent
"My health care plan,
which I'll describe later, covers chemical dependency and mental illness.
If we treat people for mental health and chemical dependency, we'll
decrease our prison population. The majority of people in prison have
untreated mental illness and/or chemical dependency, which often leads to
"We think this health
plan would generate a net savings of about 20 percent from the total
currently spent on health care (Minnesotans spend over $40 billion per
year). The savings are not just in health care; there are savings in
other parts of the economy as well - there would be a reduction in human
services costs, reduction in crime, reduction in litigation over health
"Colorado appointed a
commission to address the huge problem of people without access to health
care. They asked for reform proposals and whittled down 24 plans to the
four that showed the most promise. They hired the Lewin Group (a health
economics firm not particularly sympathetic to a single-payer approach -
Lewin is now owned by United Health Group) to analyze the cost of each
proposal, and how many people would remain uninsured under each. The
single-payer plan was the only plan that didn't leave hundreds of
thousands of people without coverage. It was also the only plan that
didn't cost more than current spending - Lewin projected that it would
actually cost significantly less."
While there has not
been a formal fiscal analysis of Marty's plan yet, a Harvard study of a
single payer proposal in
found that it would immediately reduce health care costs by 8-12%, and the
total savings would exceed 20% over time.
biggest cost drivers of our system are under-consumption and
inappropriate-consumption, not over-consumption.
"The number of health
care visits per year in the United States is half that of many nations.
Our problem is more with under-consumption, and
inappropriate-consumption. Are there people that overuse doctors, and
doctors that over-prescribe? Yes. But that is a relatively small problem
here. In America, we love our doctors; we just don't like to visit them.
"We have a good system
with poor access. There were 22,000 emergency room visits in Minnesota
last year for dental care. These are dental problems that can be
prevented at a relatively low cost, but instead are neglected until they
become significant. Under-consumption of preventive dental care leads to
the inappropriate-consumption of costly emergency room dental care. Many
countries that have universal health care-and are comparable to us in
outcomes-spend less than half of what we spend - they don't waste money on
inappropriate care because they have access to care at the appropriate
federal health care reform is bold tinkering
"We spend more money
on health care than all but a few industrialized nations. In just seven
health care spending is growing from $35 billion to $55 billion - that's
an increase of $20 billion on top of a budget that we already can't
"Obama's health plan
could be categorized as 'bold tinkering,' not true systemic reform. It is
bold in that it will cover 40 million people who don't have insurance
now. However, it is tinkering, because by the end of the decade,
according to the Congressional Budget Office, there will still be 32
million people without health insurance, and a third of the nation will
have insurance but still be unable to afford needed health care, because
of very high deductibles and lack of coverage for needed care, such as
Progressives are not being bold on health care
movement has become timid-Democratic politicians say they support
universal health care, but they really don't.
If the progressive
movement of today were in charge of the abolitionist movement we'd still
have slavery, but slaves would be working only 40-hour workweeks. We'd be
so proud of that progress that we'd forget we still had slavery.
If this were the Great
Depression, with seniors living in poverty, instead of establishing Social
Security for everyone, we'd propose doing it as a pilot program.
Health care is the
number one cause of bankruptcy in this country - in fact it is the cause
of more bankruptcies than all other causes combined. And the gaps in our
health care system are fatal to tens of thousands of Americans each year -
we could fill another Vietnam Wall - 58,000 dead - every year and a
quarter with the names of Americans who die from a lack of health care.
We are the only industrialized country on the planet that has
people going bankrupt, and people dying from a lack of health care, yet
the federal government didn't even consider a proposal to cover everyone.
This is a moral issue, and we need to address it.
Components of the
Health Plan proposal
The Minnesota Health
Plan (MHP) would be a statewide plan to cover everyone, for all
medical services including dental care, prescription drugs, optometry,
mental health, chemical dependency, home care and medical supplies and
equipment. The plan would be prohibited from saving money by restricting,
delaying, or denying care.
Premiums would be paid
directly to the Minnesota Health Fund, which would operate independently
of legislative appropriation. The governing board of the fund would be
democratically elected by regional health boards, which are elected
locally by elected county commissioners. . Since the revenues and
operation of the plan are independent of the state, you could describe it
as a 'quasi-public' plan.
The essence of the
plan is outlined in nine principles, which would be legal requirements for
the plan. They are:
all Minnesotans receive high quality health care, regardless of their
2. Do 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
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 any Minnesota resident;
6. Focus on
preventive care and early intervention to improve the health of all
Minnesota residents and reduce costs from untreated illnesses and
7. Ensure an
adequate number of qualified health care professionals and facilitates to
guarantee availability of, and timely access to quality care throughout
leadership in medical education, training, research, and technology; and
adequate and timely payments to providers.
"The bottom line is
that I don't care if a health care system is designed by Republicans or
Democrats - it won't be a good system if it doesn't meet these nine
principles. I don't use the term 'single-payer' to describe the
proposal, because that term isn't very descriptive. A lot of people
'know' they support or oppose 'single payer' even though they aren't sure
what it means. The Minnesota Health Plan is a single plan, which
has a single administrator, and a single health fund that
pays all the bills to all of the providers for all of
"I'm not insistent on
this plan - I'm willing to support any plan that meets all nine of these
Distribution of specialties not aligned with needs
"We have great
shortages of general practice doctors, certain specialists such as
psychiatrists, and shortages in other medical professions, such as
advanced-practice nurses. Nobody is in charge of ensuring an adequate
number of providers. The
turns out twice as many specialists each year as general practitioners
even though we need far more of the latter.
"Somebody has to be in
charge of making it happen-you can't force students into a particular
field, but you can add incentives that will affect their choices. The MHP
would be required to work with higher education institutions to ensure
that there are enough providers to meet the public's needs.
state should treat health care like a public utility
"Right now about half
of our health care dollars are paid by government-Medicaid, Medicare,
MinnesotaCare, public employee care, etc. Employers pay a little less
than a quarter and individuals pay a little more than a quarter of our
total health care costs. In the MN Health Plan, we would keep close to
this current allocation of funding responsibility, because we are trying
to minimize the economic disruption from implementation of the plan.
"Under my plan there
will be a payroll tax on employers, and individuals will pay premiums
based on income. Premiums might be collected through the department of
revenue, although the funds would not go to the state treasury, but
directly to the health plan. We would seek federal authority (it would
require extensive federal waivers) to keep the money Minnesota receives
from the federal government (Medicaid, Medicare, etc.) but fold it into
"The MN Health Plan
would be run by the plan's board, not the governor or legislature, and the
funds would be totally separate from the state. You cannot operate a
health care system if politicians are able to take money from the plan to
help balance the budget.
treat health care like a utility-like police and fire, like education,
like clean water. This health plan is a public utility in the sense that
citizens do not need to qualify for it. When you call 911 to report a
home burglary, the police do not ask if you have police insurance; they
don't ask if you qualify for their help. Under this plan, everybody pays
and everybody is covered.
"Unless we treat
health care that way, we will never cover everyone. If people have to
qualify for their coverage, if they have fight with an insurance company
over a claim, the mentally ill, the disabled, the most vulnerable people
will be the first ones who fall through the cracks."
This is health care, not health insurance
People often point to
Massachusetts as an example of universal health care.
doesn't have universal health care, but instead requires everyone to buy
health care insurance, providing a subsidy for those who cannot afford it.
"Massachusetts is very
similar to the federal plan - it was the model for the federal reform. The
RomneyCare/ObamaCare plans are basically more of what we're doing now - we
already cover most people with a wide variety of public and private
insurance plans that cover varying amounts of medical services - both
and Washington expanded the number of people able to access those multiple
The MHP differs from
those plans in that it provides health care for all, not health insurance
through multiple plans that may or may not cover one's medical needs.
role for health insurance companies in MHP
"Under this plan there
will be no insurance companies in health care. Some of Minnesota's current
health plans provide both health care and insurance-Health Partners, for
example-they run Regions hospital and numerous medical and dental clinics,
so they would continue as providers, but not as insurers.
"There are people in
the health insurance business who would lose their jobs due to the MHP.
This is not a minor matter, and one that we take very seriously. The
legislation requires the MHP to provide job retraining and other
dislocated worker benefits. And, unlike the thousands of other Minnesota
workers who lost their jobs under the current recession, they would,
because of the MHP, have their health care taken care of."
Other benefits will result
One of the greatest
contributors to the cost of auto insurance and workers comp is the medical
component. So as a result of the adoption of universal health care, the
costs of these forms of insurance would go way down. There would also be
a significant reduction in litigation -universal health coverage
eliminates the disputes over medical costs for injuries related to
employment, auto accidents, medical malpractice, etc.
There would be big
reductions in human services costs of government by covering everyone,
including mental health and chemical dependency (e.g., sharp drop in need
for out-of-home placement of abused or neglected children) and significant
reductions in violent crime with resulting savings in law enforcement,
courts, and corrections.
"When I introduced the
four years ago, people said we didn't have a chance. Last year, we had 74
co-authors-a third of the legislature. But we didn't have support of the
governor. Now we have support of the governor but don't have the
legislature. The way politics are now, the bill will never have a hearing
in a Republican legislature or get a Republican vote. But things would
change if DFLers were to reclaim the legislature.
"This year we're
working to build support, hoping to have better prospects in two years.
If there is a change
in the next election, and if Governor Dayton is willing to make an
aggressive push for truly universal health care, I believe we could pass
the bill in 2014. It might take a long special session, like back in
1971, but it could be done.
"This plan is not
perfection, but it would be an enormous improvement. We don't have a
health care system now - what we have are a lot of excellent medical
providers, and a patchwork of ways that people access, or don't access,
those providers. We are trying to do is set up a health care system
- a system that makes sense. When we have a crisis this big, we need to
address it, and need to address it now.
plan may be more politically realistic than people think
Why didn't the
Colorado health care commission adopt the one proposal that solved the
problem of health care access - and that saved money at the same time?
Because they said it wasn't 'politically realistic.' That's the same
thing they told the women fighting for suffrage a hundred years ago - but
the suffragettes didn't give up.
"We have hundreds of
thousands of Minnesotans who cannot afford medical care - with people
literally dying from a lack of access to care. We have the cost of health
care bankrupting families, businesses, schools, and state government.
When there is a plan -
the Minnesota Health Plan - that provides health care to all and saves
money at the same time, it is time to tell those who dismiss it as
'politically unrealistic' that we aren't going to propose a half-baked
plan that doesn't solve the problem. We're going to change what is