The Gordon Rosenmeier Center for State and Local Government forum took aim at the most prominent topic on the collective political agenda this year — health care.
A sizable crowd of attendees gathered the evening of Thursday, Sept. 12, in Chalberg Theatre in Central Lakes College to hear two lawmakers with distinguished records in health care policy give their takes on the hot button topic — and this, despite competing with a Democratic presidential debate and a Thursday night NFL game.
That’s not surprising, said state Sen. John Marty, a DFLer with a long track record with health care reform and implementation. Health care is always a topic that weighs heavily on people’s minds, he said, particularly in recent years when the current model has degenerated into a dysfunctional shell of what it should be.
“I think our health care system is sick,” Marty said. Then later: “While we have some of the best health care providers in the world, we have one of the most dysfunctional systems for how to access and pay for care.”
Joining him was Dave Durenberger, a former Republican senator who now aligns himself as an independent. At 85, boasting a distinguished career of public service at the local, statewide and national level of governance, Durenberger spoke from decades of experience that stretched back to the ‘60s.
While ideologically different from Marty, his prognosis was also bleak.
“As a nation as well as a state, we have found it so difficult to deal with what was — when I got started — a $250 billion a year system, which is now approaching a $4 trillion system,” Durenberger said. “And it sure isn’t because of population changes. There’s no other way to explain it than as a systemic failure.”
Durenberger said the primary goal of the forum taking input from two health care-minded lawmakers as a former Republican and a sitting Democrat, is to find a solution and not cast blame. In that vein, the forum brought together a lifelong moderate conservative who favors free-market principles -- which is to say, Durenberger emphasized the value of self-autonomy, possibly implemented via a system where people can invest into health care systems that work and buy five-year memberships to hospitals they prefer.
This, in contrast to government paid, mandated and controlled forms of health care, he said. You risk stunting the system as a whole when you place mandates and restrictions to create even outcomes across the board, he said.
“The problem is that you start penalizing the people in the system who might charge just a little bit more, but get much better results,” he said. “In your heart, you want the medical system to change itself. You want to build the incentives inside the profession they seek to change the system and be naturally rewarded for consistently doing that.”
While government-run programs like Medicare have been a significant improvement for the well-being and care of vulnerable populations, there are flaws in the mechanism. He noted — beyond the difficulties of creating positive change in a political climate colored with self-interest and greed — sometimes good intentions, if they’re badly implemented, ultimately hurt people.
“Medicare and Medicaid was a great thing for the elderly and low-income Americans,” Durenberger said. “But, it was a disaster for the health system because part of the deal was they use the hospital, the doctor and insurance companies — Blue Cross and Blue Shield — to pay for it.”
“What did that mean?” he added. “It meant payment of ‘reasonable and customary fees for services.’ And what did that mean? It meant you charge however much you want to charge as a hospital, it means you can charge however much you want as a doctor. … That's at the heart of the problem that has generated the situation we’re in today.”
Marty -- who contrasted himself as a left-leaning progressive — said he favors a single-payer model of health care. That, he said, is a taxpayer system mandated by the government, but a patient’s choices — where they receive care, the caliber of that care and the nature of that care — remain in their and their physician’s hands.
Marty said there’s an ongoing struggle between two philosophical interpretations of the state of health care and how it’s supposed to function — namely, the abundance model, and the scarcity model.
The former — which Marty said he subscribes to — states that a developed state is able and morally obligated to provide competent health care to every one of its citizens. The latter, he said, believes health care is something of a limited resource that has to be carefully executed in its quality and scope.
As such, Marty iterated his support for a single-payer model of government-mandated health care, or — in the meantime — a gradual implementation of reforms that improves the current system and leads to that end goal.
“I believe we can do this. If everyone has access to affordable health care, then we’re all better off,” said Marty, who made comparisons to other taxpayer-funded socialized programs — such as police and fire departments, public schools and state highways.
He cited studies by the Mercatus Center — a libertarian policy think tank — that stated Medicare for All would decrease health care costs by $2 trillion over the next 10 years, while countries across the globe have been able to implement a single-payer or a single-payer option dominated system at half the costs of the American system.
In the end, the argument against or for socialized health care is warped, Marty said. Often it’s framed in whether or not it’s feasible, but it’s evident the current system is infeasible and single-payer may be the most realistic option going forward.
“I believe we should find a way to get single-payer health care,” he said. “I don’t think we can afford not to.”