Health Care for All, Before the Decade is Out
by Senator John Marty
September 25, 2003

Four decades ago, when no person had ever traveled more than 200 miles from earth, President Kennedy committed to sending a man to the moon, a quarter million miles away, "before the decade is out." A tough challenge, but one that we met. We need the same commitment to providing all Americans with health care.

How important is it that everyone receives health insurance coverage? The Universal Declaration of Human Rights, adopted by the United Nations with U.S. support, declares that all people have a right to medical care. A 2003 Harris Poll indicates the public, by more than a 2 to 1 margin, believes "government should do whatever is necessary" to ensure that people get the medical care they need.

Yet American political debate over health care has deteriorated to the point that few politicians pay anything more than lip service to the idea of providing health care for all. Why? The lobbying of insurance companies, the pharmaceutical industry, and other medical interests along with their big campaign contributions, crush any politician willing to shake up the status quo.

If JFK could deliver on a commitment to put a man on the moon, we can certainly deliver universal health care before this decade is out. It is a grand vision, but unlike Kennedy's bold pledge, this would not be a first. All of the west European countries, Canada, and Japan have already achieved universal coverage.

Apologists for the status quo will argue about cost, but look at the facts: In 2000, Americans, their employers, and government combined to spend an average of $4631 per person on healthcare, even while 40 million people had no coverage! Our health care spending is 44% higher than in Switzerland, the next most costly country. We spend a whopping 83% more than the $2535 Canadians spend per person. But despite our high expenditures, the US does worse on basic health indicators such as infant mortality and life expectancy than virtually all of the west European countries, Japan and Canada.

Providing universal coverage will cost less, not more. While this may seem counterintuitive, it is understandable when you recognize that when people without health insurance eventually do get care it is in emergency rooms, or through hospitalization and other costly treatments that are ultimately paid by cost-shifting onto government and those with health coverage. And, with all of the cost shifting and disputes about who is responsible for which costs, health plans and providers spend almost a third (31%) of our health care dollars on administration.

To jumpstart the process, we need a new approach. Instead of simply trying to restrain costs within the current system, or even proposing a specific new health plan, we should begin by laying out the goals or requirements that the new system must meet -- things like universal coverage and giving the patient the choice of provider. Only after spelling out the parameters of the system is it time to design and implement changes to meet the goals.

Last March, I introduced Senate File 979, spelling out criteria for a healthcare system that delivers affordable access to high-quality medical care for all Minnesotans. The legislation directs the Commissioner of Health to develop a plan to present to the legislature so the state will reach that goal by 2010. My legislation would require the system to provide comprehensive benefits, including mental health, chemical dependency, and dental coverage. It calls for reducing costs through prevention and early intervention, efficiency, and elimination of bureaucracy. The legislation spells out nine specific requirements for the system, but would give the administration broad flexibility in how to meet them.

Governor Pawlenty has recently appointed a task force to respond to rapidly rising healthcare costs. The panel, to be chaired by former Senator Dave Durenberger, includes many distinguished community and political leaders. With private sector medical costs rising by 16% in 2002, the panel has an important task.

But, if the task force takes the traditional route and suggests saving money by reducing the services covered, or excluding more people from coverage, they will only make our system worse. And they will not succeed if they only look at the healthcare costs of those currently insured. There are more than moral reasons for addressing the problems of the uninsured, such as the cost to the system from often preventable and very expensive emergency treatment.

The governor's task force has an opportunity to step back and take a broad look at what we should expect from our health care system. They could start with a look at the nine standards in SF 979 -- including the commitment to continuing Minnesota's leadership in medical education, research, and technology, and the focus on preventive care, efficiency, and reduction of bureaucracy to save money.

If there is broad agreement with the goals in the bill, the governor's task force should start developing a plan that will implement them as part of their cost-saving directive.

The federal government is unwilling to deliver on universal coverage. Let's make a commitment here. We will provide health care to all Minnesotans before the decade is out. It may be difficult, but it's easier than putting a man on the moon.

To see the text of Senate File 979, click here

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