Serving Northern St. Louis County, Minnesota

Health care debate

Unpopular GOP plan and failures of the ACA, make the case for single-payer


As the health care debate continues in Washington, one fact has become increasingly apparent. Americans don’t want to go back to the bad old days being proposed by Republicans. They don’t want to live in a country where one-in-six citizens lack health coverage, where rural hospitals struggle to survive, and where insurance companies routinely deny coverage for pre-existing conditions.

By the same token, Democrats can hardly take comfort in the Affordable Care Act. It’s a half-measure at best, that only got us halfway to the goal of universal coverage, and failed to get America’s unprecedented health care cost spiral in check.

We can do better, by taking the most successful aspect of the ACA— the Medicaid expansion— and extending it to the entire population under age 65. Medicaid is the most efficient health insurance system in the country, costing about 22 percent less per beneficiary than private insurance. And its cost per beneficiary has increased at an average annual rate of just 4.1 percent over the past 30 years, compared to 6.9 percent under the private insurance system. At the same time, Medicaid provides comprehensive coverage with much lower deductibles than is typical of private insurance.

And Medicaid is a well-run and well-established program, providing health care benefits to more than one-in-five Americans already.

Extending Medicaid to the 29 million Americans who remain uninsured as well as the approximately 160 million Americans currently covered by employer-based or other forms of private insurance, would cost a lot of money— likely close to one trillion dollars per year. But before dismissing the idea as too costly, consider that we currently spend a combined $1.125 trillion a year for Medicare, Medicaid, and veterans hospitals. Indeed, nearly half of all Americans are already covered by a government-run health insurance program, and those Americans express high satisfaction with the experience. To suggest that covering the other half of Americans, who are mostly working age and reasonably healthy, would create some kind of implosion of the health care system is nothing more than scare tactics by special interests that benefit from the inefficiencies in the current system.

The move to a single-payer system, such as Medicaid, would be a boon to most U.S. businesses, which have increasingly struggled to fund health insurance for their employees and are forced to compete with foreign companies that benefit from the low cost of funding similar single-payer systems in their own countries. Such a transition would certainly be a boon to the 29 million Americans who currently lack health insurance coverage. And it would provide better coverage than all but the most generous of employer-based insurance policies. In other words, the benefits would be enormous and widely shared.

Certainly, such a transition would require a funding mechanism, but the new taxes needed to pay for a full Medicaid expansion would be significantly less than what a huge majority of Americans currently pay for private insurance premiums, big deductibles, and other out-of-pocket health expenses. A modest payroll tax, similar to the funding mechanism for Medicare, would cover the bulk of the cost.

Medicaid would provide an excellent system of basic coverage, which Americans could supplement if they desired, just as many Medicare recipients do.

Keep in mind, a transition to a single-payer system does not mean that your doctor will work for the government or that some government bureaucrat will decide what care you receive. The only change for health care providers is who they bill for their services, and single-payer will save them considerably on administrative overhead because they won’t have to deal with dozens of different private insurance companies and their byzantine billing practices.

Imagine no longer having to worry about going without health coverage if you lose your job. Imagine having the freedom to start your own business without worrying how you’ll pay for health insurance.

Would there be complications? No doubt. Some health care providers would resist the lower reimbursement rates offered by Medicaid. Some critical access hospitals and clinics, such as those in Cook and Ely, would probably need additional funding, just as they currently receive under Medicare. Health care is complicated to be sure, but a single-payer system could significantly reduce the complication, provide significant efficiencies, and provide universal coverage in the U.S. for the first time. If there’s one thing that the current debate over health care has demonstrated, it’s that the alternatives currently being offered in Washington don’t measure up to the benefits of single-payer.


6 comments on this story | Please log in to comment by clicking here
Please log in or register to add your comment
Bill Hansen

There are many examples of universal health care around the world that we can study to implement the best system for Americans. Here in Cook County, our federally qualified Sawtooth Mountain Clinic provides comprehensive and quality care using a modest federal subsidy that makes it affordable for all. As you point out, health care is complicated, but this is a solvable problem.

Thursday, July 6, 2017
Steve Jacobson

But what is a modest federal subsidy? I am in favor of good affordable health care but everyone needs to remember that is not and cannot be free. I work in one of the mines and I have given up pay raises in to keep my health care premiums lower. I believe too many people just want the health care to be free. The question I am asking is who pays for it? The government? How do they get the money to pay for it but by raising taxes on the working individuals. I have recently heard of two cases where a person was billed a certain amount because the hospital/clinic assumed he had good insurance. When the person explained that he was going to pay out of his pocket the bill was lowered substantially.

Monday, July 10, 2017

Try to find a highly developed, industrialized wealthy country in the world that has adopted the US private insurance backed healthcare system. You won't find one.

US healthcare system costs $9, 237 per person, UK $3,749 per person. Per capita spending is much higher in US and we have shorter from birth life expectancy, higher infant mortality and fewer doctors. Americans spend far more of their hard-earned tax dollars on health care than in any other developed country and face a very real risk of bankruptcy due to serious and/or long term health issues.

Star Tribune article 7/6/17, State Stands to Lose Billions Under GOP Health Bill

MN would lose about $2 billion in federal dollars for medical assistance, state version of Medicaid and MinnesotaCare in just 18 months estimated by DHS and those losses would multiply in subsequent years with projected loss of $10.4 billion by 2025, $31 billion by 2030. More than a million Minnesotans rely on these programs, 2/3 of cuts to elderly and people with disabilities. How is a state supposed to fund healthcare plus infrastructure, education and on and on?

Add the federal fund losses to the rest of the 49 states, medicaid expanded or not, and the future looks pretty bleak for the entire US not just in a lot more people sick, dying, bankruptcies, clinic/hospital closings and job losses but our whole economy will plummet.

We are being fed a crock of baldfaced lies. Paul Ryan said "Freedom is the ability to buy what you want to fit what you need". Pence said "Obamacare repealed with something that actually works---bringing freedom and personal responsibility back to American Health Care". Obamacare is in a "death spiral" and makes your premiums skyrocket. All bogus statements to obfuscate the goal of massive transfer of $800 billion to top 1% and leave states and average Americans holding the bag. Not my idea of freedom.

Anu Partanen moved from Finland to the US eight years ago and learned how stressful and terrifying it is to get health insurance in this country. Partanen wrote an article March 18, "Fake Freedom of American Healthcare" and a book, "The Nordic Theory of Everything: In Search of a Better Life", both recommended reading. Partanen said, despite stereotypes, her income taxes in Finland were about the same as she pays in Federal, state and local taxes in NY City.

I also recommend reading about Wendell Potter, a former health insurance company executive who resigned after visiting an annual touring free clinic at a fairground in Virginia, 2007. What he saw, long lines of hundreds of people waiting for hours, desperate for healthcare, being treated in animal stalls, outside on gurneys left him stunned, "more than I could possibly have imagined happening in America". The interview Bill Moyers did with Potter on why he resigned and since then Potter has written many articles for newspapers, his blog, books and media tv appearances. He was an insider who knows exactly how much money influence health insurance companies and pharmaceutical companies have over on our legislators. Many, many Senate and House staffers who work on health care bills for legislators are "revolvers". They leave their government jobs and go work/lobby for the health insurance and drug companies. No conflicts of interest there!

Medicare Part D is prohibited from negotiating for lower drug prices due to Medicare Modernization Act 2003 bulldozed through by Republicans and signed by George Bush. The strong-arming during the vote process is a huge story by itself. On the other hand, VHA and Medicaid has government mandate to hold down drug prices. "This Is Why Your Drug Prescriptions Are So High" article reports Medicare Part D prescriptions cost 80% more than VHA, 73% more than Medicaid. Doesn't make any any rational sense to bar one but not others from negotiating drug costs but crony capitalism rules. Dems have introduced many bills to allow Medicare to negotiate drug prices but no go from Republicans. They have introduced no such bills themselves.

Premiums have gone up but who in the world thinks premiums wouldn't have risen if ACA hadn't come into being. Things can be fixed if there is a will to do it. Medicare has had many changes over the years, some to fix flaws, some not good for Americans such as raising eligibility age and drug prices. One big reason premiums are higher now is that Marco Rubio threw monkey wrench into the "risk corridors" which created a pool of funds that profitable insurance companies put into to prop up insurers who lost money in the first 3 years. If the amount insurers lost was greater than what profitable insurers put in, the government would make up the difference. What Rubio called "taxpayer bailout to insurance companies" was just a way to chip away at ACA and regular Americans got higher premiums.

I don't believe that the US can't do much better for us but the top 1% want those big tax cuts at the expense and suffering of the rest of us. The GOP has made it clear they don't want us to have health care. They don't seem to care much what happens as a consequence to the whole US either.

Tuesday, July 11, 2017
Steve Jacobson

I guess I was hoping for some responses that were not copied and pasted.

Wednesday, July 12, 2017

Steve, what sources do you believe on GOP House and Senate so-called health care bills? Feel free to "copy & paste".

All the major health care advocacy groups and industry including AMA are very much against the Senate tax cut bill masquerading as a health care bill.

An unusually rare letter by presidents and ceos of health insurers, America's Health Plans (largest health industry lobbying group) and Blue Cross Blue Shield Association to Mitch McConnell and GOP Senate on Friday to drop Cruz proposal stating it is "unworkable in any form" and will lead to "widespread terminations of coverage".

Saturday, July 15, 2017
Shaking my head

Curious as to why when the left-wing had the house, the senate, and the Oval Office, they did not demand drug prices similar to what the rest of the world pays. Whenever government buys a lot of something, the price is substantially increased. Similar to what has happened to the price of higher education. Government backed anything in the swamp that is Washington will never get cheaper.

Friday, August 4, 2017