Published November 10, 2003
Minneapolis Star and Tribune
People invited to a conference last week on achieving universal health insurance in Minnesota might have found the timing a bit curious. Minnesota has just faced its worst budget crisis in a generation — as have most states — and the 2003 legislature made cuts, not expansions, in the state’s health-care programs.
Yet for just these reasons, the two-day conference couldn’t have been more timely. Even though it ranks No. 1 or No. 2 nationally in reaching the uninsured, Minnesota is about to get a good, ugly look at what happens when a state reduces health coverage for vulnerable populations. Some 37,000 Minnesotans are expected to lose eligibility for subsidized coverage in the next four years. Data presented at the conference suggest that these patients will lose regular doctor care, contract what should be preventable diseases and wind up in hospital emergency rooms with catastrophic conditions that could have been avoided. It’s the perfect time to think about reversing that trend, and Minnesotans should credit the ambition of the conference organizers — the Children’s Defense Fund, the Minnesota Nurses Association and the Minnesota Council of Health Plans.
The organizers also deserve credit for ingenuity. Months ago they circulated a request for proposals, urging any public expert to submit a plan to expand health coverage. They then had the proposals graded by a panel of experts including former Minnesota Health Commissioners Jan Malcolm and Mary Jo O’Brien and Minnesota Health Economist Scott Leitz.
They received nine proposals covering a broad spectrum. The Minnesota Chamber of Commerce and the Minnesota Business Partnership submitted plans emphasizing cost-containment and consumer accountability, presumably to avoid retrenchment by private employers, who now provide insurance for about 68 percent of Minnesotans. Sen. Sheila Kiscaden, I-Rochester, submitted a plan that would require every Minnesotan to buy health insurance, but then provide means-tested subsidies. The Children’s Defense Fund itself submitted a plan that would have the state guarantee coverage for every child, but then relieve employers from the cost of providing dependent coverage.
Perhaps the most ambitious proposal came from Dr. Edward Ehlinger, director of the Boynton Health Service at the University of Minnesota. His blueprint, developed by The Physicians’ Working Group for Single-Payer National Health Insurance, would move the nation toward national, universal health care. Single-payer proposals have been around for some time, and many observers think they’re outside the political mainstream. But it’s worth remembering that every other developed nation now offers national health insurance, and many studies have shown that these other countries spend less per capita than the United States while achieving better health outcomes. And the closest existing American model, Medicare, actually outperforms most private insurance plans in customer satisfaction and cost containment.
The panel of experts rated Ehlinger’s plan high for coverage and quality, but said it was politically “unrealistic.” That might be true, given that Washington and St. Paul have been moving in the opposite direction this year. But it doesn’t mean that the nation’s current direction is right — or wise.