Single-payer healthcare needs more Democratic support to move ahead

Editor’s note: This story is part of a six-part series covering bills that have historically failed in the state Legislature but are still reintroduced year after year.

Single-payer bills proposing to overhaul the existing health insurance system, a mix of privately and publicly financed care, and replace it with a single, publicly funded health plan that would cover everyone, have been kicking around the Minnesota Legislature since 1991. Considered politically unrealistic, the bills have failed to get even enough DFL support to make any legislative progress until recently. If it moves forward, the current proposal will face resistance from special interest lobbies and those favoring use of the free-market to control costs. But for now it still needs more Democratic backing to continue progressing. The Minnesota Health Act was heard in one House committee and passed two Senate committees before its authors set it aside for the rest of this year. It proposes to fund a single, comprehensive plan with a special income-based tax on individuals and businesses that would go directly into a health fund. Sen. John Marty, DFL-Roseville , author of the bill, said it would theoretically be less expensive than the current system, even though it would fully cover everybodyâÄôs medical care, because it would cut administrative costs and provide preventive care. Marty also chairs the Senate health committee, one of the two that passed the bill this year. The health fund would be controlled by a state health board, composed of county commissioners from throughout the state along with appointed individuals. The boardâÄôs duties would include hiring and overseeing health plan administrators and negotiating provider pay rates. Marty said he sees passing the bill as a three or four year effort, in part because people think itâÄôs politically unrealistic due to strong insurance and pharmaceutical lobby opposition. Marty thinks itâÄôs doable but âÄúan extremely uphill battle,âÄù he said. The bill proposes a comprehensive overhaul of the current health care system, which means âÄúreshaping one sixth of our entire state economy,âÄù he said. Knowing Gov. Tim Pawlenty would never sign it, he said theyâÄôre focused on building public support, educating legislators about the bill and having a âÄúgood debateâÄù about how it relates to the issues with which various committees are concerned. Next year, he said he might try to pass it through one or two more committees. After that, he said, âÄúwe hope the governor is not in office anymore and we push hard to make it a reality.âÄù But itâÄôs still not clear exactly how much money it would end up costing or saving. Rep. David Bly, DFL-Northfield, introduced the bill in the house this year, where it got its first-ever hearing, and he said some legislators still have a lot of questions about those details. A cost study of the bill was vetoed by Pawlenty last year, Bly said, and now theyâÄôre fundraising for one to be done by the nonprofit Wilder Foundation . âÄúWeâÄôre hoping that in about six monthsâĦweâÄôll have a lot of the answers to questions people have,âÄù Bly said. Now, he said, theyâÄôve got support from about half of the Senate Democrats and are approaching that portion of the House. More still need to be convinced itâÄôs doable. âÄúMany, many people say, âÄòItâÄôs not politically feasible,âÄôâÄù Bly said, or they feel threatened by what insurance companies have done to previous reform attempts. Kip Sullivan , author and longtime single-payer advocate, was part of a group that helped get single-payer legislation introduced in Minnesota in 1991. ItâÄôs been given little attention until now, he said, because the DFL leadership favored a more politically realistic option, managed care legislation, thinking it would effectively lower costs. Managed care insurance plans are meant to cut costs by controlling things like hospital admissions and length of stay, and giving financial incentives to patients who see providers within a certain network or choose less costly care. The idea behind it, Sullivan said, is that healthcare costs are driven by overuse of the system by doctors, who are paid a fee for each service. Indeed, Marty said most of the solutions around the capitals, both here and in Washington, have been, âÄúâÄòLetâÄôs try and have people use less of it.âÄôâÄù But Sullivan argues cost is driven up by things like administrative waste and some overcharging by specialist and pharmaceutical companies âÄî which the single-payer system aims to avoid. He said single-payer momentum began to gather in 2000 after a backlash against managed care. But in the Legislature, it took until 2007 to get a committee to pass a bill. The big change, Sullivan said, occurred with the 2006 election of several new democrats, including Bly, who didnâÄôt want to do âÄúDFL leadership healthcare as usual.âÄù Around the same time, Marty was selected to chair the Senate health committee and collaborated with that group, introducing an early draft of this bill at the end of the 2007 session and working during the next summer and fall to refine it. While he said previous single-payer bills were âÄújust kind of template bills,âÄù this was designed particularly for Minnesota. University health policy professor Lynn Blewett said itâÄôs a nice idea in the grand scheme of things, but the complexity of moving the existing system âÄî composed of hundreds of insurance companies all regulated and financed differently âÄî into one makes it almost impossible to implement. For example, she said, one difficulty would be getting the federal government to funnel Medicare and Medicaid funding to the stateâÄôs program instead of the federal programs. Managing the waivers associated with that would add a layer of bureaucracy, she said. And like other efforts to expand government-financed healthcare, it will likely encounter resistance from Republicans, including Sen. David Hann , R-Eden Prairie, who heard the bill when it passed the health committee this year. âÄúI thought it was a terrible idea,âÄù he said. One immediate problem with it, he said, is it would eliminate the entire insurance industry in Minnesota, thereby terminating the employment of thousands. But the larger issue for him is that the constitution doesnâÄôt justify publicly financed healthcare, and he wants to see advocates address that. Though itâÄôs not a big legislative threat, Hann said, it is hugely problematic that a lot of people seem to see it as a good thing.