What Do I need to know… about the Minnesota Health Plan?
Compiled by GMHC, MUHCC and PNHP-MN | October 2008
- Why the “free market” does not work for health care delivery:
The current health care industry does not fit two essential criteria required for free markets to work:
- Complete freedom of patient choice in provider
- Numerous sellers (ie: insurance companies, hospitals, specialists, drug companies) Further, costs are entirely unpredictable and frequently catastrophic Our society regulates those services needed for public safety and good (such as utilities) – health care falls into this category. A system, like ours today, in which the taxpayer foots half the bill (through Medicare, Medical Assistance, insurance for public employees) cannot be considered a free market.
- The MHP is not “socialized medicine”
Socialized medicine means that government employs health care providers and owns health facilities Privately owned clinics and privately employed providers will exist just as they do now. The health care delivery system will look just like it does now. A single-payer financing system is similar to Medicare. Medicare is not socialized medicine.
- Myths about rationing
Definition: denial of necessary medical care
We already ration care and the level of rationing is worse than in other countries
Under the MHP, there will be less rationing. More services will be available to more people.
- Myths about waiting lines
What is our the current average of “wait time” for an appointment? The MHP provides a structure to make sure resources match (and don’t exceed!) need in all areas of the state. There will be coordination in the distribution of resources. Without universal access to primary care, we have contributed to “wait lines” in Emergency Rooms that occasionally cause them to literally shut their doors and “divert” patients to other hospitals. Examples of wait times in other countries is not helpful because we spend about twice as much on health care as nearly any other country. No one is proposing that we cut our spending down to the level of other countries.
- Myths about overuse of system
Medical care is not like groceries. The vast majority of people will not demand the most expensive medical procedures (surgery, medications, procedures) just because they are perceived as “free.” Guaranteed access to a primary care provider will enhance appropriate, efficient use of the system This doesn’t seem to be a problem in other countries which manage to provide universal access to quality health care for about half the cost that we do.
- Expectation that high risk people “should” pay more for health care (occasionally phrased as unwillingness to pay for “fat people,” tobacco-related illnesses, etc.).
Erecting cost barriers to health care for those with unhealthy lifestyles will simply make their conditions worse and be more of a long-term drain on the system We should seek to alter behaviors that contribute to disease through education – in our schools, clinics and other ways.
- How the MHP addresses the potential for influx of people into the state for “free” care
An important question addressed in line 15.29 which authorizes the MN Health Board to “implement eligibility standards for the MHP, including standards to prevent an influx of persons to the state for the purpose of obtaining medical care.”
- Points about loss of administrative health care jobs with institution of MHP
When more efficient systems are developed we should adopt them. Single-payer financing is a very efficient, cost-saving system, open and transparent to the public. There are many opportunities to retrain administrative workers for positions in the new health care system (ie: nurses in administrative roles can return to patient care). Though not specified in this bill, it is reasonable to consider a subsidized “retraining program” for displaced administrative health care workers This “job loss” needs to be balanced with the potential for “job creation” that will occur when businesses are no longer burdened with steadily increasing, unpredictable health care costs.
- Detrimental features of high co-pays and deductibles (or, why there are no out-of-pocket expenses in the MHP). High co-pays and deductibles discourage the use of the timely, primary care – exactly the care needed for health and to decrease long-term costs. They do not impact the biggest part of the health care cost pie – those incurred by the most ill 20% of the population.
- Cost of a single-payer system
Numerous studies have been done at the state and national level, which consistently show significant savings when multiple payers are replaced with one payer. Savings would be greatest if this were instituted at the national level. Savings at the state level are smaller, but still significant. There is no state study done which can be directly applied to Minnesota in 2008. Nonetheless, there is enough consistency in the studies done to date to suggest that:
- A single-payer system cuts total health costs by at least 15%.
- Providing universal access to health care, without any co-pays or deductibles, increases total health costs by about 10%.
- This is a NET savings of about 5%. The money we are paying now can be used to provide us with more benefits AND cover all Minnesotans.
- Myth that the “fee-for-service” method of provider payment means that no one will be controlling spending or promoting quality
Providers are paid for each service rendered.
Capitation: Providers are paid a lump sum for the care of a patient. This is the method of payment classically associated with “managed care.” Yes, there is an incentive in the fee-for-service method of payment to overuse resources. There is an incentive in the capitated form of payment to underuse resources. There is no evidence that managed care improves quality of care Essential components of quality care provided by the MHP access to care and continuity of care.