By Jean Ruzicka
Park Rapids Enterprise
Published Wednesday, December 10, 2008
When the Legislature convenes Tuesday, Jan. 6, health care reform will be on the docket and Sen. Mary Olson, DFL-Bemidji, will be advocating restructuring the current “business commodity.”
Olson, addressing a recent meeting of the League of Women Voters, shared her history as an attorney that shaped her views on the issue, including serving as an Air Force hospital’s legal advisor.
In 1989, moving to the Brainerd area, she began representing people who were injured in accidents, working with insurance companies to get medical bills paid.
“It became more and more difficult to hold insurance companies accountable,” she said. “I saw a lot of waste, a complicated, convoluted system with more money being spent on administration and denying claims, as opposed to the patient.
“I wanted to be a voice for consumers,” she said of her decision to seek a seat in the Legislature.
Health insurance is a business, she said. “The commodity is health care.”
Insurance companies have two ways to profit: charge more for the product or deliver less of a product.
“In the health care system we’re seeing both. And as long as we treat it as a commodity, it will continue. There is no cost motivation to save patients money.”
Twenty to 30 years ago, the concept of “managed health care” was accepted as a means of controlling costs, Olson explained. Gone were the days of submitting a bill for payment after seeing a physician.
Health care costs were often reduced by “putting up roadblocks,” proving non-beneficial to the patient “if you look at infant mortality and longevity.”
The advent of managed care has not kept costs down and has reduced access to care, Olson said.
In 2006, the Minnesota Department of Health estimated 383,000 Minnesotans were living without health insurance, 66,000 of the uninsured children.
“Thirty other countries are ahead of us” in health care, Olson said. “We spend twice as much on average as other countries on a per capita basis. The residents in foreign ports receive greater coverage at less cost.
“And the situation will get worse,” Olson cautioned. “We are at the very beginning of the Ć¢ā¬Ėretirement years.’ Most health care costs occur after people retireĆ¢ā¬Ā¦ If nothing is done, by 2030 health care costs could consume the entire state budget.”
And rural Minnesota will soon begin to hurt, she predicts. “As the number of people who can’t afford health care grows, costs will grow exponentially.”
Attempts to reform health care have proven relatively unsuccessful, she said, citing Massachusetts’ plan requiring everyone to buy insurance, taxpayers subsidizing those who cannot afford to pay.
Forcing everyone to have coverage is good, she said, “but nothing has been done to tackle wasteful spending or denying access to needed care.”
More than half of bankruptcies are health care cost-related, she said — and many of them have coverage.
Some legislators are pushing pay-for-performance health care, she said, similar to No Child Behind. “But it adds administrative costs. And it’s very predictable in outcomes; affluent outperforms the less affluent.”
Rural Minnesota hospitals have a more difficult time keeping their doors open, Olson said, attributing the higher number of older and poorer people. Medicare and Medicaid do not reimburse at the cost of coverage, she said.
If the cost of service is underpaid, hospitals are forced to charge more to paying consumers — or offer service providing more reimbursement, she said.
A recent survey shows 70 percent of the medical profession is not happy with the way health care insurance is being handled, Olson said.
The single payer system, “run by the people using the system,” is being studied in the Legislature.
Principles of the reform call for people paying for health care based on their ability to pay.
Everyone in the state would be covered. This, she said, may call for more stringent residency requirements than are currently in place.
The plan would allow a choice of providers. And it covers everything comprehensively — no co-pays.
Premiums would be collected like Social Security, she explained, which would be administered by a separate, member-run group. An actuary would determine costs. Doctors and hospitals would remain private, a distinction from socialized medicine.
An estimated 20 to 40 percent savings should be achieved, Olson said, as opposed to the current system.
“Canada spends tremendously less than we do, with good outcomes,” she said of a recent fact-finding trip to the neighbor to the north.
“Bankruptcy, losing a home to long-term care costs in Canada is inconceivable,” she said. The government negotiates with doctors and hospitals, who are paid as well as those in the U.S.
If a doctor goes into a remote area, where he or she will see fewer patients, the physician receives a salary commensurate with those in urban areas.
“There is no more middle man standing between you and the doctor in determining the care you need. That’s a decision for the doctor.”
A Colorado study comparing models fund the single payer approach achieves the most savings, she told League members.
Rep. Brita Sailer, DFL-Park Rapids, said there is considerable focus on preventive care in the House.
But Olson said from time spent in health care committees she’s learned preventive medicine does not always save money. Money is spent to treat a whole population, for the one or two who may contract an illness.
A rally and lobby day for the Minnesota Health Plan has been scheduled Monday, Jan. 5.