Learning To Lose With MnSure

Bunyan_woodpeckerIn case you haven’t heard, Republicans hate health insurance exchanges like MnSure. While the conservative Heritage Foundation developed the approach, conservative leaders like Bob Dole, Newt Gingrich and Orrin Hatch endorsed it, and conservative standard bearer Mitt Romney pioneered it, contemporary conservatives have come to despise it since it was adopted by President Obama.

Conservatives now prefer to allow insurance companies to compete across state lines governed by federal regulations, instead of the current system of state-by-state regulation of insurance products.  But there isn’t sufficient political support to enact the conservatives’ preferred interstate competition approach.

I feel my conservative friends’ pain, because my preferred approach also doesn’t have enough political support to become law, and I also don’t love insurance exchanges like MnSure.  I’d much rather have a single payer system — the system that delivers the best care and value in other industrialized nations — than this competitive private sector exchange model.  However, since there wasn’t sufficient political support for my first choice, my fallback preference was to authorize a “public option”—a Medicare-for-All — competing against private options to test which model is more efficient and effective.

But alas, after a long, fair and considered congressional debate, I lost on both my first and second choices.  Now I and all Americans have to accept the private competitive exchange model that prevailed in the democratic arena.

Memo to my Republican friends:  That’s how losing works in a democracy.  You have to accept the outcome of the democratic process, and move on like an adult.

While insurance exchanges like MnSure were far from my preferred option, there are things I like about them.  For the first time, they require products to be directly comparable, so that a lightly informed consumer like me can actually do apples-to-apples shopping, or silver plan-to-silver plan shopping.

That represents a significant improvement that will reshape the marketplace in a somewhat more consumer-friendly way. With private and non-profit insurers required to create directly comparable products, insurers now know that many consumers are going to buy the more affordable apple over the comparatively expensive apple.  That puts consumer demand pressure on insurers to offer the most affordable apple possible, just as airlines have constant demand pressure to offer the most affordable ticket to New York City via online marketplaces like Kayak, Orbitz and Travelocity.

Whether we’re talking about Kayak or MnSure, the widespread availability and use of the Internet makes this kind of comparison shopping possible.  Social media and advertising guru Simon Mainwaring is among those those who have written about how the Internet changes modern marketplaces:

“More than ever before, consumers have the ability to unify their voices and coalesce their buying power to influence corporate behaviors.”

So far, this type of “coalesced buying power” is showing promise.  In Minnesota’s competitive exchange, we are seeing among the lowest premium prices in the nation.  That’s a tribute to Minnesota’s non-profit health insurance companies, the state health care model that Republican Governor Arne Carlson significantly shaped and the exchange model that Republicans developed, supported and pioneered.

In life and in policy making, sometimes we don’t get our first choice, or even our second choice.   Liberals like me certainly didn’t get our first or second choice in the 2010 federal health reform debate.  But that doesn’t mean that some good can’t come from the third choice, if we’re adult enough to give it a chance, instead of working overtime to sabotage it.

So my conservative friends, on the launch day for MnSure, join me in belting out those healing Stephen Stills lyrics:  “If you can’t be with the one you love, honey, love the one you’re with.”

– Loveland

Note:  This post was also featured in Politics in Minnesota’s Best of the Blogs.

Time for Obamacare Supporters To Let Their Light Shine

insurance_denialObamacare is easy to misunderstand.  It’s complex, confusing and heavily demagogued, and those things all plant seeds of doubt in a lightly informed citizenry.  Given the barrage of lies flying around, it astounds me that a majority either still want to keep it or make it stronger.

But as Senator Ted Cruz and many others can tell you, it is very easy to whip about a third of the population into a fervor over Obamacare.  Listening to Cruz, Boehner and the boys discuss Obamacare, you’d think the End Times are nigh.

One of their favorite tactics is the ritualistic burning of the Obamacare Card.   Though there is no such thing as an Obamacare Card, a conservative group called Freedomworks printed up a batch of faux cards so they could burn them in the public square.

The minority intent on repealing Obamacare has created a good visual with the card burnings.  Now, the majority of Americans who either want to maintain or strengthen Obamacare need to create a memorable counter visual.

I nominate burning insurance rejection documents.  For decades, insurance companies have been denying health coverage for seriously ill Americans, because seriously ill people are expensive and unprofitable to cover.   I’m not blaming insurance companies for doing this, because we have built a system that effectively requires them to deny coverage to those with expensive medical needs.  After all, any insurance company that started covering the most sick, expensive patients would be run out of business, because they wouldn’t be able to compete against competitors who reject the most sick, expensive patients.  Unless all insurance companies are mandated to cover these folks, none will.

Everyone agrees that these denials have tragic consequences for an enormous group of ailing Americans.    According to research by the Commonweath Fund:

An estimated 9 million were turned down or charged a higher price because of a health problem, or had a preexisting condition excluded from their coverage.

The tragedies that stem from such denials are widespread.  Non-treatment.  Under-treatment. Inefficient and ineffective treatment.  Bankruptcies driven by mountains of unpayable medical bills.  Cost-shifting to the rest of us.

No more.  Starting with the insurance policies going on sale  October 1, 2013, Obamacare makes it illegal for any insurance company to ever again deny coverage based on a preexisting condition.  As a result, 9 million of some of the sickest Americans finally will be eligible for coverage, and if you get sick or hurt in the future, so will you.

This Obamacare-mandated change is revolutionary for those who have been rejected in the past, and for any of us who could be denied in the future, which is all of us.  It is a vastly under-appreciated aspect of Obamacare.

bonfire_celebrationSo to celebrate this momentous occasion, let’s burn some insurance company rejection documents.  Since there are 9 million lives impacted, let’s burn 9 million denial documents. Just as fake Obamacare Cards needed to be produced for theatrical effect, symbolic rejection documents would have to be recreated.  (Most people don’t save their rejection letters to put into their baby books.)

Imagine what that blaze would represent.  Coverage denial for victims of all types of cancer, diabetes, hepatitis C, multiple sclerosis, schizophrenia, quadriplegia, Parkinson’s disease, AIDS/HIV and countless other ailments?  Up in smoke.  Coverage denial for patients in desperate need of doctor-recommended medications?  Burn, baby, burn.

Think about it.  Never again will any of your desperately ill family members, friends, co-workers and neighbors receive a coverage rejection letter again.  The banning of pre-existing condition denials is now a reality, thanks to Obamacare.  Let’s tell that story.  Let’s create that visual.  Let’s have that celebration.  Supporters of Obamacare should quit cowering in the shadows of the Obamacare Card burnings, and let that light shine brightly.

– Loveland

Note:  This post was featured as a “best of the best” in MinnPost’s Blog Cabin.

South Dakota Guv’s Fiscal Race-to-the Bottom Not A Selling Point for Minnesotans With Dakota Roots

Dear South Dakota Governor Dennis Daugaard:

I’ve been pondering your recent “Dakota Roots” visits to Minnesota’s Mall of America to recruit South Dakota expatriates to return to their native state to strengthen South Dakota’s economy.    As the Star Tribune explains:

Dakota Roots was first launched under Daugaard’s predecessor (Republican Governor Mike Rounds) to address the state’s vexing problem. South Dakota needs more workers to take full advantage of its low unemployment rate (4.3 percent) and 10,000 unfilled jobs statewide, according to the governor’s staff.

As the name suggests, Dakota Roots is designed to lure people who perhaps grew up in South Dakota and had moved away, or went to college there, or had parents or grandparents from the state.

As a native South Dakotan living in the Twin Cities, I’ve been giving your pitch some thought.  There’s a lot of what you are selling that is attractive to me.  I have treasured family and friends in South Dakota.  I miss the expansive prairie skies framing breathtakingly beautiful fields of sunflowers or bison.  I love many of the changes that have happened since I left Sioux Falls about 30 years ago, such as the Washington Pavillion, Parker’s Bistro, Josiah’s Coffee, Spezia, Zanbroz and the rejuvenated Falls Park.  I admire the populist spirit of South Dakotans, and the pride they have in a place and culture that too few Americans have taken the time to understand and appreciate. Continue reading

Minnesota Health System Needs Obamacare Too

On a weekly basis, Garrison Keillor reminds Minnesotans that we are above average.  But we didn’t need him to tell us that.  We’re a pretty innately smug bunch when it comes to our state.  Call it “Minnesota Exceptionalism.”

We’re especially smug about our health care system.  Therefore, some of us were not all that sure we needed Obamacare’s private health insurance mandate, which is presently the only politically feasible way of improving health insurance coverage and banning pre-existing condition restrictions.

But we do.

It is true that Minnesota is better off than the rest of the nation. Nine percent of Minnesotans lack health insurance coverage, and that’s much better than the nation as a whole, where 16% are uninsured.

We can rest assured that we aren’t suffering nearly as much as many other states, such as Texas (27% uninsured), Mississippi (24% uninsured), Louisiana (22% uninsured), Nevada (22% uninsured), and Oklahoma (22% uninsured). These GOP strongholds are suffering more at the hand of the GOP’s shameless health reform stonewalling than we are.

But let’s not delude our exceptional selves.  Minnesota needs the private insurance mandate too.   After all, using the same kind of health insurance mandate the Supreme Court just upheld, Massachusets has a much better record than Minnesota.  Under ArneCare in Minnesota, we have 9% uninsured, which is better than average.   But under ObamneyCare in Massachusetts, they have only 5% uninsured.

Moreover, we self-congratulatory Minnesotans should never forget that in the shadows of Minnesota’s overall 9% uninsured rate are pockets of much deeper health care despair. For instance, more than a quarter (27%) of low income adult Minnesotans are uninsured. That’s a little bit of Texas in our midst.

No, 9% is not good enough. That’s 463,100 of our Minnesota friends, neighbors, and coworkers who are just one metastasized cell or black ice sheet away from a mountain of medical bills, and the bankruptcy that so often goes with it.

That’s 463,100 Minnesotans delaying medical care until medical care becomes much more expensive, and often much less effective.

That’s 463,100 Minnesotans who obviously don’t stop getting hurt or ill, and therefore are forced to shift their enormous medical expenses to the rest of us, which in turn forces more of us to drop our own coverage.

That’s 463,100 Minnesotans — the population of Rochester, Duluth, St. Cloud, Eagan, Plymouth, Lino Lakes, Willmar and Ramsey, combined.

That can’t be ignored.  Minnesota needs the insurance mandate, and the rest of Obamacare too.  So thank you Heritage Foundation, Newt Gingrich, Don Nickles, Mitt Romney and, now, John Roberts for giving it to us.

– Loveland

Note:  This post also was featured as a “best of the best” on Minnpost’s Blog Cabin feature.