On MinnesotaCare Buy-In Option, Legislators Must Put Patients Over Lobbyists

Why can’t the Minnesota Legislature give consumers a MinnesotaCare buy-in option so that they have a guaranteed health insurance coverage option, more doctor choices, and much better price competition?  An army of corporate lobbyists say it’s because reimbursements to the health care industry would be lower under that approach, an argument that froze legislators into inaction during the 2019 legislative session. 

To be clear, if that argument prevails, Minnesota lawmakers will never contain health care costs.

To contain costs, policymakers have to lower the amount of money going to the major cost drivers — insurance overhead, doctors, nurses, medical devices and pharmaceuticals.  If politicians reject a reform every time lobbyists for those cost-drivers object about getting lower reimbursements, they will never contain consumer costs.

Let’s look at one of those cost-drivers, physicians.  Politicians like to complain about insurance overhead and pharmaceuticals, for very good reasons, but that’s too easy.  Let’s look at the most sacred of health care’s sacred cows.  Doctors have an abundance of fans, campaign donating power, and lobbyists, so politicians are especially afraid to direct cost-control efforts at them. 

When you look at the long list of developed nations where physicians are paid less than in the U.S., paying less for doctors seems reasonable and doable.  For example, the average specialist in the U.S. earns $230,000 per year, while the average specialist in other industrialized nations receives less than half that amount, $107,000 per year. 

Remember that the next time you hear physicians and their lobbyists complaining about reimbursements being too low.

Oh and by the way, the health outcomes in those developed countries with modestly paid physicians are better than in the U.S. So don’t buy the claim or inference that better pay automatically leads to better care.  It doesn’t.

And about those pharmaceuticals.  American patients pay much more for pharmaceuticals than patients in many other developed nations around the world.  Remember that the next time you hear lobbyists complaining about Medicare and Medicaid reimbursements being too low.

(On this front, the Minnesota Legislature needs to pass legislation to allow importation of Canadian pharmaceuticals, as I argued a while back.  Florida recently passed such a bill, but Minnesota politicians remain frozen by health care lobbyists.)

A Minnesota Care buy-in option — branded as “ONECare” in Minnesota by Governor Tim “One Minnesota™” Walz — would ensure that every Minnesotan always has at least one health insurance option available to them, which is particularly important in remote rural areas.  It would give them broader networks of caregivers, which again is important to Greater Minnesota residents.  It would provide comprehensive benefits and a service that gets good consumer reviews. It would bring better price competition to hold down the health insurance costs.  Those all would be huge benefits for hundreds of thousands of Minnesotans.

But not if Minnesota politicians get cowed into inaction every time corporate health care industry lobbyists complain about receiving lower reimbursement rates. If this group of legislators won’t do the right thing on a MinnesotaCare buy-in option, we should elect a new group who will.

Bernie v. Reality

Lambert_to_the_SlaughterFor the past week the trending buzzword for Bernie Sanders has been “reality”. As in: “Is Bernie out of touch with reality?” “Bernie’s ability to win is not connected to reality.” And, “Revolution in 2016 America is not a concept rooted in reality.”

If he weren’t about to throw a serious scare into Hillary Clinton, who is sort of Reality-Plus, or Reality-Minus, depending on your enthusiasm for her, no one would bother to think too long about Bernie Sanders setting up as Our Guy. I mean, Bernie as the one sent out to do battle with all the massed forces of the Wall St. kleptocracy, Big Pharma, UnitedHealth and all the other richer-than-Croesus “managed care insurers”? Not to mention chilling out every panicked authoritarian convinced “total war” with someone now is the only way to keep rabid jihadis from stepping off the 7 bus and cutting all our heads off. Until recently not too many of us actually stopped and considered Bernie Sanders being that guy.

Like a lot of the people I hang around with, I get a big smile on my face whenever I hear Bernie laying into the 1%, which as he is quick to point out is really the .1%.

“[Bleeping]-A right, Bern!”, I yell back at the TV, scaring the dog.

In terms of isolating and drawing big, bold neon-colored circles around the fundamental issues, no one comes close to Bernie. He’s absolutely right. Income inequality in the USA is off the charts, at least for an alleged democracy. The system is rigged. Big money has bought off not just Congress but most of the conglomerate media as well, to the point that at this moment, there is, truly and genuinely, no effective resistance or counter-narrative to the most affluent forces in the country accumulating even greater control over our supposedly free markets, government and culture.

Other than the issue of how to best achieve effective gun control, which has to be a federal system, I don’t really disagree with Bernie on anything. Medicare for all. Check. Free tuition for higher education. Check. And on and on.

My problem — my “reality” dilemma — is that I haven’t believed in the one-man revolution theory in a long, long time. Every empirical piece of data you can gather and pretty much every historical touchstone you can summon tells us it It is a physical, sociological, intellectual impossibility for one man (or woman) to make sweeping, radical, revolutionary change in the way the United States does business.

Can one person crank the rudder another 5 or 6 points starboard or port? Maybe. But even that’s easier if it’s a conservative “trimming big government” and cutting taxes for big donors than a Democratic Socialist handing the fat cats a big new tax bill and adding to the authority of government.

But come on. Pulling the control, the profits, the share-holder value out from under UnitedHealth and Cigna and the others? Essentially dismantling them? And not just “breaking up the big banks” but larding them with serious levels of unavoidable taxation to fund free-tuition and infrastructure repair? Am I really supposed to wonder if one guy, and in this case a cranky 74 year-old, can pull this off in four years? A 180-degree financial revolution? In the United States as it is today, if it took less than 100 years without a counter-revolutionary firestorm it be would be a miracle.

I just don’t see it. I wish I did. But I don’t. Life doesn’t work that way. It never has. Anywhere.

The “primal forces of nature”, as Mr. Jensen explained to Howard Beale in “Network” are simply so big, so vastly more influential and, as public-companies, so deeply integrated into middle-class dreams for an RV and a few winters in Florida, that President Bernie Sanders would first have to have a Congress as progressive as he is to achieve even his most modest proposal, like improving veterans health care or some small beer like that.

And that’s the key to “Bernie reality.” As it is currently elected and convened, Congress has one overriding goal, and that is to hustle and shill for enough money to stay in office. Anything it ever does for middle class voters is strictly a happy, residual accident. Bernie’s entirely admirable progressive agenda, his fervid revolutionary dream, requires that that equally progressive Congress to be there when he arrives, and that ain’t going to happen. Citizens United and gerrymandering are years if not decades away from being gutted and replaced with something, you know, democratic.

Further, many of the people most eager for Bernie’s revolution have a bad habit of taking Congressional elections off. They get whipped up every eight to twelve years, and then fade off when the one-man revolution fails to single-handedly dethrone the royal families in the first couple weeks. And this crowd isn’t all dewy-eyed college kids. It was striking to listen to adults my age grumbling and throwing up their hands over Barack Obama within a year of his first election. The naivete, from allegedly intelligent adults, that one guy could swiftly transform everything they despised into gems of unblemished purity was startling to behold.

Startling, but utterly familiar to any student of human nature.

So what then? Cautious, triangulating, incremental Hillary Clinton?

Well, I gotta tell ya, when you look at Mitch McConnell controlling the Senate and Tea Party holding the House hostage and the banks and corporations controlling controlling all of the above, not to mention the banks and corporations controlling most every other Democrat too, (including Clinton), there’s something to be said for a couple more rounds of Obama-style pragmatism. Something to be said for someone who is (way) smarter than the raving Tea Party lunatics and wily enough about how the game works to balance the feudal greed of JP Morgan Chase, K Street and UnitedHealth with the goals of progressives, labor, women and minorities.

The reality of Bernie’s revolution is pitched warfare, which is fine and righteous and noble, but a lot better idea when you have a good chance of victory.

I wish it were different. But right now Bernie doesn’t have enough firepower on the front line.