In the Feb. 18 Dispatch, Rep. Josh Heintzeman alleges that Governor Dayton's recommendation of a "Buy-in" option to MinnesotaCare for low income Minnesotans is actually a "pivoting towards a single-payer system."
This charge is not credible. It is no secret that a Democratic sponsored single-payer Minnesota health plan has been on the table for years. I spoke to Josh in his office on behalf of this plan last year and reported on it in the Dispatch. An independent reviewer (Lewin Group) estimated such a plan would save the state over $150 billion in its first 10 years. But Republicans will have none of it. That plan is practically dead for now, so whether or not Gov. Dayton is for that proposal is irrelevant. Therefore the governor is logically dealing with the cards available on the table to get lower cost health plans to more Minnesotans.
As Governor Dayton stated in his Dispatch article, MinnesotaCare is an insurance program that Governor Arnie Carlson and both parties created in 1992. It initially had a 3 percent annual overhead, less than one-fifth of those entities Representative Heintzeman labels as "for profit insurance companies."
MinnesotaCare is funded mostly by taxes on medical providers and funds available from the federal government. But four years after its inception it was "privatized" by turning its subscribers over to HMOs. These providers are paid through our state government similar to contractors for road construction, but unlike road contracts, my understanding is that the HMOs are not accountable for reporting profits. If Representative Heintzeman wants some substantive reform, he should get the HMOs out of that market or reform their transparency.
What "for-profit" insurance companies do to the health cost market is demonstrated in the many large Minnesota corporations such as Cargill and General Mills that have dropped employee health insurance. Instead, they pay providers directly. Their savings from this "self-insurance" averages 10 percent. Self-insurance is not possible for small businesses.
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Representative Heintzeman claims that the programs Democrats support "will cost Minnesota taxpayers an arm and a leg," implying that this is true for MNsure/Obamacare, the Minnesota Health Plan and MinnesotaCare. But highlighting only the taxpayer cost for any of these plans conveniently omits half of the economic reality. The dairy farmer that Governor Dayton cited whose premium jumped to $26,000 last year can be used as an example.
For this example one might assume that this farmer's annual state taxes were $10,000, which gives a total tax plus insurance total cost of $36,000. If he then obtained a health plan that doubles his taxes to $20,000, Josh could label this a "Chernobyl" disaster. But the "for profit" insurance bill would disappear, for a net combined cost to the farmer of $20,000 for a net $16,000 savings. The tax numbers may be arguable, but the lower outcome is not. Representative Heintzeman does not want to display the full picture.
The comparatively large jump in premiums in the individual insurance market is due mostly to the small pool of buyers that the insurance companies limit them to. These buyers need to get into a larger pool. The best pool for the whole state would be the whole state, such as with single-payer. Medicare, the Canadian system, and most of the health care systems in the world's other 20 most developed countries are universal coverage single-payer. It is deceptively false to bad-mouth all these systems as "Chernobyl" disasters.
No matter what is intended, the practical outcome of actions on health care by Representative Heintzeman and his party has been to keep "for profit" insurance companies in the market instead of working toward affordable universal coverage. These profits come at the expense of best possible care reaching all Minnesotans.
Peterson, Bloomington resident and formerly of Nisswa, is retired from internal medicine practice at Park Nicollet Clinic.
