Category Archives: MinnesotaCare buy-in option

Dean Phillips isn’t Close to Being MN’s Strongest Presidential Candidate

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U.S. Rep. Dean Phillips (DFL-Edina) seems to be relishing the national attention that comes with his months of hemming and hawing about a long-shot potential challenge of Joe Biden for the Democratic presidential nomination. To be clear, Phillips is far from the best Democrat in the nation to serve as an alternative to Joe Biden. In fact, Phillips is not even close to being the best presidential candidate in little old Minnesota.

Phillips is fine. The former CEO of Phillips Distributing, his step-father’s inherited business, is thoughtful and decent, if also sometimes dull and self-righteous, as centrist politicicans tend to be. His bipartisan instincts have made him a good fit to represent the purple-ish 3rd congressional district, which is anchored by Minnesota’s most affluent western suburbs.

However, it’s time for Phillips to come out of the TV studios and return to representing his district. As Rep. Annie Kuster (D-NH) said in today’s Star Tribune:


There’s no path. There’s no outcry. Personally, I think it’s a vanity project by Mr. Phillips, and I think it could do serious damage by emboldening the Trump Republicans.”

To be clear, the most talented politician in Minnesota isn’t Phillips. It’s DFL Senator Amy Klobuchar, and it’s not even close.  Reports about Klobuchar’s erratic behind-the-scenes behavior are concerning when it comes to the world’s most pressure-packed job. Still, no Minnesota politician is better than Klobuchar at doing what presidential candidates must do well – sell progressive ideas and positions in both wholesale and retail settings to a wide variety of audiences. Whether on big or small stages, Klobuchar consistently comes across as warm, sincere, tough, bright, thoughtful, prepared, nimble, and persuasive. As such, Minnesota’s senior senator would be a much more compelling presidential candidate than Phillips.

While Klobuchar is Minnesota’s most skilled politician, DFL Governor Tim Walz ranks second. At the same time, Walz has more marketable policy accomplishments than Kloubachar or any other Minnesota pol. 

In a purple state with a slim one-vote DFL advantage in the state Senate, Walz can boast on national stages that he signed many state laws that national Democrats want to see on a national level, such as legislation creating a family and medical leave system, securing abortion rights, legalizing marijuana, expanding child care access, creating new gun violence protections, making voting more accessible, providing free school lunches for all, investing much more in public education, building a public option for health insurance, and requiring disclosure for dark money donors. 

All the while, the Minnesota economy has outpaced a relatively strong national economy, with a lower rate of inflation and unemployment than the nation as a whole.

Walz’s long list of significant policy accomplishments would be popular among the national Democrats he would need to win over in a primary challenge against Biden. Importantly, it also would be popular among the swing voters a Democratic nominee will need to win over in a 2024 presidential general election.  Politically speaking, Walz is well poised to make a “we will do for America what we did for Minnesota” pitch to Democrats clutching their pearls about Biden’s electoral viability.

State Capitol insiders are quick to point out that Walz’s myriad policy wins had more to do with House Speaker Melissa Hortman, Senate Majority Leader Kari Dziedzic, and a number of very capable DFLers chairing key committees. But that kind of inside baseball would largely be ignored by national pundits and reporters if Walz ran for President. Walz vocally supported those progressive changes and signed them into law. Therefore, it would be fair for him to tout them in early Democratic primary states.

But Klobuchar and Walz aren’t going to be in those states, not as candidates anyway. They have enough political sense to understand that they’re never going to defeat an accomplished, albeit ancient, incumbent, and that trying to do so at this late hour would irreparably ruin their reputation with the leaders and activists they need in order to be effective.

Phillips, for all his strengths, appears incapable of understanding that part.

Dueling Visions for Minnesota: Scandinavia or South Dakota?

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Elections in a purple state can give you whiplash. 

After red wave elections, we’re led by Republicans like Tim Pawlenty who push for low taxes, poor services, and culture wars.

After blue wave elections, we’re led by DFLers like Tim Walz who push for higher taxes, better services, and cultural tolerance. 

After elections with more mixed results, legislative stalemates cause us to keep the prevailing status quo frozen in place.

That makes every election cycle extremely consequential.

The South Dakota Vision for Minnesota

In 2022, a decidedly purple Minnesota – at the time, it was the only state in the nation with one chamber of the state Legislature controlled by Democrats and the other controlled by Republicans – held a particularly high-stakes election. 

If Minnesota voters had elected ultra-conservative former physician gubernatorial candidate Scott Jensen and a Republican Legislature dominated by far-right Trumpers, Minnesota would have become a conservative promised land, much like its neighbor to the west, South Dakota. 

During the campaign, Jensen and other Republicans proposed a race-to-the-bottom on taxes, including eliminating the state income tax, which would have led to dramatically worse services.  Republican spinmeisters prefer to say “smaller government,” but the reality is that it would have meant much worse services. The anti-vaxxer Doc Jensen also pledged a South Dakota-like war on public health and culture war initiatives to force conservatives’ thinking on gays, guns, God, and gynecology on all Minnesotans. 

In other words, think Kristi Noem, with a stethoscope prop.

The Scandinavia Vision for Minnesota

Fortunately, 192,408 more Minnesotans voted for incumbent Governor Tim Walz than Jensen. More surprisingly, since it was predicted to be a historically horrible year for Democrats, Minnesotans also elected narrow DFL majorities in the state House and Senate.  The all-important Senate majority is especially razor-thin at 34-33.

Walz and the DFL-controlled Legislatures are armed with a $17.5 billion budget surplus and are offering a vision that is more like a social democratic-led Scandinavian country in the 1970s than South Dakota in the 2020s:

  • Paid family and medical leave;
  • An enormous funding increase for public schools;
  • A targeted child tax credit to dramatically reduce childhood poverty;
  • Free school lunches for all students;
  • An opportunity for people without employer-based health insurance to buy into public health insurance (MinnesotaCare/Medicaid), instead of only being able to choose private insurance;
  • Down payment assistance for first-time home buyers, homelessness prevention, affordable housing, and rent vouchers;
  • A huge package to save the beleaguered childcare sector and make child care free for poor families and more affordable for middle-class families;
  • Large subsidies for weatherization, electric vehicle infrastructure, and solar energy expansion to combat climate change;
  • A range of gun violence prevention reforms, such as universal background checks, red flag laws to prevent people who could be perceived as a threat to themselves or others from getting guns, raising the legal age for obtaining military-style rifles to 21, and banning high-capacity magazines;
  • Legalized marijuana and expunged records for past offenders;
  • Driver’s licenses for undocumented immigrants;
  • Automatic voter registration;
  • Enfranchising felons who have served their time; and
  • A capital gains tax hike for the wealthiest Minnesotans.

The list goes on. Overall, think Bernie Sanders, with a Fargo accent.

This is the most dramatic swing of state policy in my lifetime, and perhaps in the history of the state. And if somebody you may have never heard of, Judy Seeberger (DFL-Afton), had received just 322 fewer votes in her state Senate race, most of those changes would never have been possible. Without Seeberger’s handful of votes in the eastern suburbs of the Twin Cities metropolitan area, Minnesota would still be stuck in limbo between the South Dakota vision and the Scandinavia vision. 322 votes.

Does Walz Care About ONECare?

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So far, Minnesota Governor Tim Walz has largely been a responsive caretaker governor, responding to the crises du jour rather than than actively pushing a progressive agenda and building a legacy for himself.

Governor Walz’s legacy is essentially “pissed off all sides while consumed with thankless pandemic management.” I think he did a reasonably good job managing the pandemic, but he definitely had to make enemies doing it.

One partial break from caretaker mode was his poorly named “ONECare” proposal, which would give Minnesotans the option to buy into MinnesotaCare. MinnesotaCare is a longstanding program serving low-income individuals and families who can’t get employee-sponsored health insurance and don’t quality for Medicaid, which is called Medical Assistance (MA) in Minnesota.

Giving Minnesota health insurance consumers of all income levels this additional option would ensure that every Minnesotan in every county had at least one health insurance option available to them. That’s a big deal. It also would bring more competition to an individual market that sorely needs more competition. Over time, this could result in lower premiums for consumers.

Walz has not pushed his proposal particularly hard. Meanwhile, other states’ Governors are leading their states forward.

Colorado and Nevada this year passed public option plans—government-run health insurance plans—that are set to launch in 2023 and 2026, respectively. They join Washington state, which enacted its law in 2019 and went live with its public option in January.

The early results from Washington state’s experiment are disappointing. In many parts of the state, premiums for the public option plans cost more than premiums for comparable commercial plans.

Many of the state’s hospitals have refused to take part in the public option, prompting lawmakers to introduce more legislation this year to force participation if there aren’t sufficient health insurance options in a geographic area. And consumer buy-in is also meager. In its first year of operation, the state health insurance exchange sold only 1,443 public option plans, representing fewer than 1% of all exchange policies.

Michael Marchand, chief marketing officer for the Washington Health Benefit Exchange, the state’s health insurance marketplace, said it’s premature to judge the program by its first year.

During the earlier years of Obamacare, the premiums for many commercial plans were high, he pointed out. Eventually, as insurers became more knowledgeable about the markets, prices dropped, he said.

If Governor Walz would get re-engaged in this issue and actively market his plan, they could learn from the experiences of Washington and avoid it’s mistakes. For instance, in areas where there is insufficient health insurance competition, Walz could require hospitals to participate.

A MinnesotaCare buy-in option is extremely popular — only 11% oppose it, according to a Minnesota Public Radio survey. This is probably in part because it is an option. Any Minnesotan who opposes buying into MinnesotaCare — because of conservative ideology or because MinnesotaCare turns out to be expensive or poor quality — they can vote with their feet, as consumers in the state of Washington are doing.

Fighting for a MinnesotaCare buy-in option makes sense for Walz. The polls consistently show that health care is a top issue for voters, and huge majorities consistently trust Democrats over Republicans on that issue.

Moreover, in the 2022 gubernatorial general election campaign Walz may very well be running against a physician, Scott Jensen. This will ensure that health care is high profile in the race. Therefore, candidate Walz needs to be seen fighting for better health care, and this proposal gives him that platform.

If a MinnesotaCare buy-in option passes, Walz finally has a legacy beyond pandemic management. If Senate Republicans kill it, which seems likely, Walz has a great political argument to make while running for reelection and trying to retake the Senate: “I worked my ass off to give you another health insurance option and bring you some price competition, but Republicans like Scott Jensen opposed it on orders from private insurance lobbyists. If you want to more options and more price competition, vote for me and change the Senate leadership.”

Pushing a public option is a great political option for Walz. So why is he so damn cautious about it?

Walz’s Pandemic Leadership Showcases A Politically Courageous Side

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I’ve come to realize that I’ve been partially wrong about Governor Tim Walz.  Based on what I had seen pre-pandemic, I had him pegged as a politically cautious guy who inevitably gravitated towards a relatively modest “split-the-difference” caretaker agenda.  From a progressive’s standpoint, he seemed like a competent Governor, but far from a bold one.

Often Cautious

After all, prior to the coronavirus pandemic, Walz had exhibited an abundance of caution that wasn’t comforting to progressives. For instance, Walz came into office proposing an exciting MinnesotaCare Buy-In Option for Minnesotans who can’t get health coverage from employers or the government. Progressives cheered.  But Walz didn’t seem to fight particularly visibly or hard for it. 

Likewise, Walz has expressed support for legalization of marijuana for adults. Again, progressives cheered. But Walz rarely uses anything close to the full measure of his powerful “bully pulpit” and political influence to move public opinion on that key social justice issue. 

In the 2019 session, Walz wanted to raise much more revenue to deliver improved services.  Instead, he ended up with lower overall revenue. He caved relatively quickly to Republican demands and walked away without one penny of the gas tax increase he sought, while giving Republicans an income tax cut and a 10% cut in the provider tax, which is needed to fund health care programs.

At a time when DFLers controlled the House and the Governor’s office, the GOP-controlled Senate somehow was given a”no new taxes” outcome that would make Tim Pawlenty proud, and Governor Walz declared victory.

Why has Walz been so cautious? My theory is that he is so infatuated with his “One Minnesota” sloganeering from his 2018 campaign that he has been afraid to challenge conservatives and moderates in rural areas of the state.

Bold On Pandemic Response

However, lately Walz has been under heavy fire from those rural Minnesotans about his wise decision to close bars and restaurants statewide.  Since most Minnesota counties still have few or no coronavirus cases, the bar and restaurant closures strike short-sighted rural Minnesotans as overkill, and Republican politicians are always all too happy to encourage rural victimhood and resentment. 

“While we understand the necessity of Governor Walz to lead in this time of crisis, that leadership should not be unilateral and unchecked,” (Republican Senate Majority Leader Paul) Gazelka said in a statement.

Gazelka’s statement came amid growing signs of GOP discontent with Walz’s previous ex­ec­u­tive ord­ers temporarily closing bars, res­tau­rants and oth­er busi­nes­ses. It also comes as the administration mulls new safety measures, including requiring Minnesotans to shelter in place.

Several lawmakers, all Republicans, have expressed concerns about the impact of Walz’s orders on small businesses in their towns in Greater Minnesota.

“The gov­er­nor’s ord­er puts these small busi­nes­ses in an im­pos­si­ble po­si­tion,” state Sen. Scott New­man, R-Hutch­in­son, said in a state­ment addressing the closings in the hospitality industry. “These small busi­nes­ses, and their many hour­ly wage earn­ers, will un­doubt­ed­ly suf­fer be­cause of this ord­er. I urge the gov­er­nor to re­con­sid­er the fi­nan­cial im­pact of his ord­er on small busi­ness own­ers that con­cur­rent­ly has the po­ten­tial to make them crimi­nals for sim­ply try­ing to earn a liv­ing.”­

To his credit, on pandemic response issues Walz has consistently put public health above politics.  He understood that ordering closures on a partial county-by-county basis would be unfair and ineffective.  After all, irresponsible citizens in counties were restaurants and bars were closed would simply travel across county borders to eat and drink out, which would create new pandemic hot-spots in previously uncontaminated Minnesota counties.

Thanks to Walz’s leadership, on March 24 Minnesota ranked in the top ten of states with the most aggressive policies for limiting the rapid spread of coronavirus.  A lot has changed since these rankings came out, but Walz seems very likely to issue a shelter-in-place order sometime this week, which should keep Minnesota relatively high in the rankings.

It would be tempting for Walz to view restaurant and bar closing through a short-term political lens, as the Governors in red states such as Wyoming, Mississippi, Texas, Nevada, Oklahoma, and Missouri seem to be doing.   It would be easier to keep some or all of Minnesota’s bars and restaurants open, and let other states leaders do the heavy lifting when it comes to pandemic management. 

But Walz isn’t taking that politically expedient approach, and the economic and political fallout from all of this could potentially cost him his political career.

I certainly hope that doesn’t happen, but if it does, it’s a relatively small price to pay to prevent Minnesota hospital patients from suffering the kind of horrific meltdowns being seen in Italy, where physicians are reportedly forced to deny care to suffocating people over 60 because of lack of medical capacity. 

Trying to avoid scenes like that are well worth whatever political price Walz pays. Here’s hoping that the newly self-quarantined Governor stays healthy, and that a plurality of Minnesotans will eventually appreciate his impressive display of political courage at this crucial moment in Minnesota history.

Washington Passed A Public Option That is NOT a Model For Minnesota

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Give leaders in the state of Washington a lot of credit.  Governor Jay Inslee and the Washington Legislature recently passed legislation to create a public health insurance option that will save Washingtonians an estimated 5 percent to 10 percent compared to private health plans.   Starting in 2021, the privately administered “CascadeCare” plan will be available to Washingtonians in the “individual market,” those under age 65 who can’t get insurance through their employers or another public insurance plan.

That’s significant progress, much more progress than Minnesota Governor Walz and the Minnesota Legislature made during the 2019 session when they failed to even seriously consider a plan to give Minnesotans in the individual market the option of buying into MinnesotaCare.  President Trump and his followers are working overtime to sabotage and try to repeal popular Affordable Care Act (ACA) health protections, while Inslee is strengthening the ACA.

We need that kind of leadership in Minnesota.  In the 2020 session, champions of the popular MinnesotaCare buy-in option should hold critics accountable for trying to block an initiative that could save consumers at least 10 percent of their health insurance costs. 

The Fatal Flaw With Washington’s Law

I say “at least 10 percent,” because Washington leaders caved to medical lobbyists in order to get the law enacted. In the process, they sacrificed significant consumer cost-savings.

One of the primary reasons to give consumers a public option is because public health insurance programs with a huge pool of patients are in a relatively strong position to leverage lower medical costs.  You know, like Medicare does. Here’s what a recent Urban Institute study found about Medicare’s ability to control medical costs.

 “…average spending on private health insurance per enrollee grew 4.4% per year between 2006 and 2017—faster than the growth of spending per enrollee in Medicaid and Medicare, and faster than the growth of the gross domestic product per capita, which grew an average 2.4% each year.

Per-enrollee spending in Medicare grew an average 2.4% per year while per-enrollee spending in Medicaid grew 1.6% each year. Holahan said Medicare and Medicaid experienced slower spending growth than private insurance because public programs have more leverage over provider payment rates, helping them to keep costs down. Private payers end up paying higher hospital and physician prices.”

In the face of such findings, what do Washington leaders do?  They guarantee reimbursements at a rate that is much higher than Medicare.  The Seattle Times explains:

The (Washington) law will require health plans to reimburse medical providers and facilities at up to 160% of the federal Medicare rate. That is a higher rate than the original version of the bill, which capped the reimbursement at the Medicare rate.

CascadeCare champions had it right in their original bill.  The reimbursement rate for the MinnesotaCare buy-in option should be set at the Medicare rate to allow savings to be passed on to Minnesotans.  Washington leaders apparently were spooked by lobbyist threats that caregivers would deny care to patients if they got paid Medicare reimbursement rates.

Physicians Can’t Be Sacred Cows

We will never be able to significantly control health care costs until we demand savings from every part of the healthcare system — pharmaceuticals, medical devices, unnecessary procedures, administrative overhead, and, yes, caregiver reimbursements.  American physicians, particularly specialists, are being paid more than physicians around the world, so controlling that cost-driver also must be in the mix.  American doctors can no longer be treated like political sacred cows.

As long as lobbyist-cowed legislators keep carving out these kinds of special interest exceptions, medical inflation will continue to skyrocket and keep Americans from accessing health care.  Minnesota legislators need to pass the MinnesotaCare buy-in option in 2020, and they should do it without caving to any of the interests driving medical costs making health care unaffordable and inaccessible for millions.

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Drop the “ONECare” Branding of the MinnesotaCare Buy-in Option

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I’m a big fan of Governor Walz’s proposal to give Minnesotans a new MinnesotaCare (MNCare) buy-in option.  If it passes, it would be a signature part of his legacy as Governor. But he has a lot of work to do before he gets it passed, and he should start by wiping the slate clean and dropping the name “ONECare.”

To be clear, the name ONECare is hardly the biggest problem Walz faces.  The much bigger problem is an army of well-connected health care lobbyists and industry-employed donors pushing legislators to stick with a status quo that reimburses the industry at higher rates than MinnesotaCare, an argument that legislators who are serious about cost-containment must reject. 

To pass this proposal, the Governor is going to need to use his political capital and get a lot more personally engaged in the fight than he has been so far.

But the name ONECare certainly doesn’t help the cause, a cause I’ve been supporting over and over, and it’s easy and painless to fix.

When selling ideas and policies, words matter a lot. Think “estate tax” versus “death tax.” “Tort reform” versus “lawsuit abuse reform.”  “Medicare-for-all” versus “single payer.”  We’ve seen it over and over: Words impact clarity and emotions, and clarity and emotions impact voting behavior.

For three primary reasons, the brand ONECare doesn’t help Walz to convince anyone to enact perhaps the most important policy proposal on his agenda, and instead inadvertently hurts it a bit. 

ONECare DOESN’T DESCRIBE, OR DISARM MOST DAMAGING CRITICISM.  I prefer the very boring, literal name “MinnesotaCare buy-in option.” I know, I know, it obviously isn’t very lyrical or concise, but it instantly explains the patient benefit, and that’s the most important advocacy need. 

This is a concept that almost no one understands, so they need a concise description.  ONEcare is not the least bit descriptive. If a Minnesotan heard ONECare come up in a shorthand way, they would have no idea what is being discussed, and very likely would assume you were talking about a corporate health plan. 

After 27 years in existence, “Minnesota Care” has a bit of brand equity, and “buy-in option” explains the concept much more clearly than “ONEcare.” 

Even more importantly, “MNCare buy-in option” also shines a bright spotlight on that key word “option.”  The word “option” disarms the most potent critique of the proposal, the false claim that Minnesotans will be forced to use “government-run health care” against their will. 

In a year when Medicare-for-All is being lambasted on the national stage for being mandatory and coercive, it’s critically important to be repeatedly stressing the disarming key message that this is merely another “option” for Minnesotans to take or leave. Stressing that selling point in the name is the best way to achieve that kind of repetition.

ONECare SOUNDS VERY CORPORATE, WHEN IT’S THE ANTITHESIS OF CORPORATE.  Also, ONEcare sounds very much like a corporate health care brand.  In fact, if you search the internet for “onecare,” numerous private health ventures pop up. 

Adopting a corporate-sounding brand name confuses and sullies an initiative that’s actually all about providing an option for relief from corporate insurance.  That makes no sense.

ONECare IS TOO WALZ-CENTRIC AND PARTISAN IN TONE.  Finally, ONEcare politicizes the proposal by using a derivative of Walz’s 2018 campaign theme “One Minnesota.”  ONEcare comes across like a partisan advertisement, as opposed to a sincere effort to help Minnesotans get cheaper and better health care coverage. 

Governor Walz likely intended ONEcare to be unifying – “we’re ‘one Minnesota’ and this gives everyone the same option in all parts of the state, including areas where there are few options.” I get that. But the fact that the “One Minnesota” sloganeering was so central to Walz’s recent election campaign makes ONEplan feel like it belongs to one political tribe only, instead of something that people of all political stripes should support.

Again, dropping the ONECare name obviously isn’t going to guarantee passage.  For that to happen, legislators are going to need to have more courage, and Governor Walz is going to need to really use his political capital to fight for this.  But dropping “ONECare” will help make their explanation of this excellent idea feel a bit more clear, direct, disarming, and apolitical.

Championing Both Medicare-for-All and Buy-in Option

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During last night’s Part I of the Democratic Presidential debate, moderators and candidates acted as if candidates must make a choice between advocating for Medicare-for-All and a Medicare buy-in option.  It was one of the few areas of division among the progressive candidates

Why?  Progressives should be simultaneously advocating for both policies. 

Stop Bashing Buy-In Option

Medicare-for-All advocates like Sanders and Warren need to stop taking cheap shots at a Medicare buy-in option. 

The reality is, without a filibuster-proof Senate majority, Medicare-for-All simply can’t pass for a while.  Therefore, progressives need a Plan B that helps as many Americans as possible, shows that Democrats can deliver on their health care rhetoric, and advances the cause of Medicare-for-All. 

That’s what a Medicare buy-in option does. 

It helps more Americans in the short-run by bringing much more price competition to the marketplace and ensuring every American has at least one comprehensive coverage option available to them, even in poorly served areas. 

Beyond helping Americans in the short-term, a buy-in option also advances the cause of Medicare-for-All. Americans have been brainwashed by decades of conservatives’ vilifying of “government run health care,” but a buy-in option will give younger generations of Americans first-hand evidence showing that Medicare is not to be feared. It will show millions of Americans that Medicare is cheaper and better than conservatives’ vaunted corporate health plans.

And that will help disarm conservatives’ red-faced criticisms of “government run health care” and Medicare-for-All.

Stop Bashing Medicare-for-All

At the same time, champions of a Medicare buy-in option like Biden and Buttigieg need to stop railing on a Medicare-for-All. 

Even though Medicare-for-All can’t pass right away, progressives need to keep explaining what the world’s other developed nations figured out a long time ago, that a single payer government-run is the only real solution for any nation that hopes to control costs, cover everyone, and improve health outcomes.

For far too long, progressives have been afraid to educate Americans about why a single-payer system is needed.  When fearful progressives sensor themselves from explaining why Medicare-for-All is needed, they leave the stage to conservative and corporate demagogues relentlessly spreading myths about the evils of “government-run health care.” 

And when progressives leave the stage to conservative demagogues — surprise, surprise – progressives lose the debate.

Start Pushing Both

What would it sound like to advocate these two positions simultaneously? It could sound something like this:

Ultimately, we must cover everyone, control skyrocketing costs, and improve health outcomes. And you know what? Ultimately, the only way to do that is Medicare-for-All. 

In America, Medicare has proven effective and is popular with those who use it. In developed nations around the world using government-run systems like Medicare, everyone is covered, costs are much lower and health outcomes are much better. 

So Medicare-for-All must to be our ultimate goal. We have to keep our eyes on that prize. We need it as soon as possible.

At the same time, the Republican-controlled Senate won’t pass Medicare-for-All.  That’s reality folks.

Given that reality, what can Democrats do right now to both help the American people and pave the way for Medicare-for-All in the long-run?  A Medicare buy-in option.  A buy-in option has lots of public support among Republican voters, so it has a much better chance of passing the Senate than Medicare-for-All.

Let Americans choose between corporate care and Medicare. If they want to keep their private health insurance, they can. But given them another option.

President Trump is afraid to give Americans make that choice. I’m not. He knows Americans will like Medicare better, and doesn’t want to give them that option. I’m not afraid, because I know that a Medicare plan that isn’t required to profit off of patients will be cheaper and better that corporate care. So let Americans choose.

Enacting a buy-in option now will show more Americans that they have nothing to fear from Medicare coverage. And that will help us move the American people towards embracing Medicare-for-All.

Pols and pundits keep framing this issue as if it must be a battle to the death for progressives. But Medicare-for-All versus a Medicare Buy-in Option is a false choice.  Progressives should be advocating for both, and stop savaging each other on the issue.

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

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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.

Medicare Buy-In Option: The Next Span in the Bridge to Medicare-for-All

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Democratic presidential candidates are lining up in support of Medicare-for-All, and I’m glad they’re making that case to Americans.  Around the world, single payer systems like Medicare-for-All are delivering better and cheaper health care than Americans are getting, and we need to adopt such a system as soon as possible.  As William Hsiao, Ph.D., professor of economics at the Harvard School of Public Health puts it:

“You can have universal coverage and good quality health care, while still managing to control costs. But you have to have a single-payer system to do it.”

But for reasons I’ll explain below, I don’t believe Medicare-for-All can pass in 2020, even if Democrats control Congress and the White House.  So, we need to extend a meaningful bridge to Medicare-for-All.

So what could Democrats pass to make Medicare-for-All possible in the relatively near future?

The 74-Year Battle

Before we get to that, let’s back up to reflect on how we got here.   In 1945, Harry Truman wanted what we today would call Medicare-for-All.  For 20 years, it went nowhere.  What was dubbed “socialized medicine” by Ronald Reagan and other Republicans just didn’t prove to be politically feasible.

In 1965, Lyndon Johnson had a partial breakthrough. He passed Medicare for 65 and older, but it wasn’t as comprehensive as today’s Medicare. As support for Medicare grew, improvements were made.  In 1972, Republican Richard Nixon agreed to expand coverage. In the Reagan years, home health care, hospice services, and a limited prescription drug benefit were added.  In the George H.W. Bush era, the prescription drug benefit was expanded.

The historical lesson:  Health care reform in a nation dominated by powerful private health insurance companies has been supremely arduous, and therefore incremental.  This is true even though Medicare has proven popular and efficient.

Medicare-for-All Next?

Unfortunately, three-quarters of a century after Truman started advocating for Medicare for All, the debate still is treacherous. In 2019, the Medicare expansion debate boils down to essentially this:  Should progressives push for 1) publicly financed, mandated Medicare-for-All; 2) voluntary, consumer-financed Medicare buy-in option; or 3) a publicly financed, mandated “Medicare at 50.”

Many progressives, myself included, point to the polls showing strong support for Medicare-for-All, and say now is the time to push for it.

Indeed, progressives should continue to make the case for making Medicare-for-All the goal. At the same time, we have to recognize that in the current political environment, Medicare-for-All has much less popular support than a Medicare buy-in option.  A January 2019 Kaiser Family Foundation (KFF) poll finds that  56% of Americans support Medicare-for-All, while 77% support a Medicare buy-in option.  So when conservatives and insurance companies start attacking, the buy-in option would be much more politically bullet-proof than Medicare-for-All.

Moreover, as the debate heats up Medicare-for-All and Medicare-at-50 will be vulnerable to two of the most deadly attacks in all of American politics.  First, opponents will say they’re “massively expensive.” Second, they will say consumers would be “forced to give up your current coverage.”

We shouldn’t discount the political power of those two critiques.  When it comes to taxpayer expense and mandated change, American voters have historically been very easily spooked. Those two attacks, which would be greatly amplified via hundreds of millions of dollars worth of the most intensive political and special interest propaganda the nation has ever seen, will be very effective at eroding support.

Therefore, today’s poll numbers for Medicare-for-All and Medicare-at-50 will not hold up, and when they shrink, congressional votes will disappear.

Advantages Of A Medicare Buy-In Bridge 

A Medicare buy-in option, however, is much more politically durable, and not just because it has 21 points more support in the KFF survey than Medicare-for-All.

Not Expensive. First, a Medicare buy-in option wouldn’t have a big taxpayer price tag like Medicare-for-All or Medicare-at-50, because consumers under age 65 would be paying premiums, not taxpayers.

Not A Mandate.  Second, a buy-in option wouldn’t force any consumer to give up their current coverage, which they would need to do with either Medicare-for-All or Medicare-at-50.  Under the buy-in option, consumers who want to continue to pay more to keep their private coverage could still choose to do so.

The fact that a Medicare buy-in option is voluntary and self-financing would largely disarm the most potent political attacks that have been working since 1945.

A Bridge To Medicare-for-All. But make no mistake, passing a Medicare buy-in option would constitute dramatic progress that would make Medicare for All much more likely in the future.  Let me count the ways:

  • More Affordable for Millions.  Because Medicare has much lower overhead than private health insurance, it would give millions of Americans more affordable coverage than they have today. By the way, if private insurance somehow turns out to be cheaper and/or better than the Medicare option, as conservatives have long claimed, consumers obviously will choose it.  If that happens, Republicans will be proven correct. So let patients decide, not politicians. Conservatives should have nothing to fear from giving this option to consumers.
  • Aid Cost Control.  A Medicare buy-in option would give Medicare a bigger pool of consumers, which would give Medicare officials much more leverage to negotiate cost control with hospitals, doctors, device makers and pharmaceutical companies. “Medicare-for-more” would not be as effective at leveraging lower costs as “Medicare-for-All” will be, but it will bring important progress.
  • Deepen Medicare Support. As more Americans voluntarily switch from private insurance to the cheaper Medicare buy-in option without experiencing worse service and coverage, it will show Americans that this “government-run health care” is not the horrific bogeyman Republicans have made it out to be.
  • Broaden Generational Support. Finally, while Medicare currently mostly only has senior citizen champions, newly converted believers in Medicare would be in their 20s, 30s, 40s, 50s, and early 60s. This would dramatically strengthen the Medicare-for-All base of support.

So, a Medicare buy-in option would be much more politically feasible than Medicare-for-All or Medicare-at-50, and it is the next logical span of the bridge to Medicare-for-All to add. Progressives shouldn’t be hesitant to build it.

If You Like TrumpCare, You’ll Love JohnsonCare

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Minnesota gubernatorial candidate Jeff Johnson (R-Plymouth) is crying foul over an Alliance for Better Minnesota television ad that says Johnson’s health care proposals would take health care away from Minnesotans who need it.

But the Alliance’s ad is accurate. Without question, the health care “reform” approach candidate Johnson is promoting during his campaign would take health care away from Minnesotans who need it.

Let’s break down the proposed JohnsonCare plan, piece-by-piece.

Johnson Eliminating ACA Protections

Johnson wants to make the Affordable Care Act (ACA) a thing of the past in Minnesota, via a federal waiver granted by the Trump Administration. More specifically, Johnson wants to eliminate the ACA approach that has:

  • Protected Record Numbers of Minnesotans. Under the ACA framework, Minnesota achieved the highest rate of health care coverage in state history.
  • Made Previously Unaffordable Protections Affordable. For lower and middle-income Minnesotans who don’t get coverage through their employer, the ACA has provided hundreds of millions in financial assistance to reduce or eliminate premium costs.
  • Strengthened Minnesotans’ Protections. The ACA also banned the hated preexisting condition denials, insurance payment limits, and dangerous junk coverage.  Because fewer Americans are no longer living one illness or injury away from being crushed by a mountain of bankrupting medical bills, personal bankruptcies have decreased by 50 percent during the time the ACA has existed.

If Johnson eliminates the increasingly popular ACA protections in Minnesota, that all goes away.  So yes, in several different and dramatic ways, Johnson absolutely would take health care away from Minnesotans who need it. The ad is correct about that.

Johnson’s False Claims

Johnson’s criticism of his opponent’s health care proposal is also utterly ridiculous.  Johnson says claims opponent Tim Walz “wants to eliminate private health insurance and force all Minnesotans onto one government program.”

The reality is, Walz supports a MinnesotaCare buy-in option. Under that approach, Minnesotans would have the option of either buying private plans or buying into the MinnesotaCare program, which is a government program operated by private health insurance programs.

In other words, Johnson’s claims that Walz wants to “eliminate private health insurance” and “force all Minnesotans onto one government program” are flat wrong.

If Walz is proposing a government-run single payer plan in the short-term, I’m not aware of it. Even if that were true, Johnson’s inference that eliminating private insurance in favor of government run health care would hurt Minnesotans is also wrong.  After all, Medicare, a government-run health plan, is popular and effective.  Medicare is helping Minnesotans, not hurting them.

Moreover, government run health plans are used in many other developed nations. Compared to the United States, consumers in those nations have 1) universal comprehensive coverage, 2) lower overall health costs and 3)  better overall health outcomes.

JohnsonCare and TrumpCare

Instead of the ACA, Johnson wants to back a high risk pool program that was very expensive for both consumers and taxpayers when it was used pre-ACA. Minnesota Public Radio reported:

Craig Britton of Plymouth, Minn., once had a plan through the state’s high-risk pool. It cost him $18,000 a year in premiums.

Britton was forced to buy the expensive MCHA coverage because of a pancreatitis diagnosis. He calls the idea that high-risk pools are good for consumers “a lot of baloney.”

“That is catastrophic cost,” Britton says. “You have to have a good living just to pay for insurance.”

And that’s the problem with high-risk pools, says Stefan Gildemeister, an economist with Minnesota’s health department.

“It’s not cheap coverage to the individual, and it’s not cheap coverage to the system,” Gildemeister says.

MCHA’s monthly premiums cost policy holders 25 percent more than conventional coverage, Gildemeister points out, and that left many people uninsured in Minnesota.

Johnson also wants to promote “junk,” “short-term,” or “skinny” plans, which are cheap because they don’t cover basic protections.  Promoting junk plans to reduce health care costs is like promoting cheaper cars lacking seat belts, airbags, crumple zones, safety glass, and anti-lock brakes. They look good if you’re only considering the price tag, but they’re a disaster when you and your family are in dangerous situations and desperately need those life-saving protections.

On health care, as with so most other issues, Jeff Johnson is aping Trump. President Trump is obsessed with eliminating Americans’ ACA protections in favor of a skimpy TrumpCare replacement. Trump insists that TrumpCare will cover everyone and cut costs, while the nonpartisan Congressional Budget Office finds that 23 million Americans would lose their protections, and millions more would pay higher premiums.

So Minnesotans, if you like TrumpCare – and only 17% of Americans do – you’re going to love JohnsonCare.

MN GOPers Aren’t the Health Care Saviors They Claim To Be

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Exuberant Minnesota Republicans seem to think they have a winning health care issue for the 2018 election season–reinsurance. And they do deserve a great deal of credit for helping to enact a state reinsurance program that is reducing premiums for Minnesotans in the individual market. The individual market is for the 162,000 Minnesotans who can’t get insurance from their employer or the government.

While their claim that premium increases in 2016 and 2017 were due to DFL policies is ridiculous, it is true that the Minnesota reinsurance program they helped pass is helping those consumers. As the Star Tribune reported:

Jim McManus, a Blue Cross spokesman, said that were it not for the state’s reinsurance program, the carrier’s Blue Plus HMO would be seeking an average individual market premium increase of 4.8 percent as opposed to the 11.8 percent decrease cited Friday by Commerce

Impressive, and Republicans deserve credit for this.

The Rest of the Story

But as Ricky Ricardo would say, before Minnesota Republicans can credibly brand themselves health coverage saviors, they still have some splainin to do.

Why Not National Reinsurance? First, they need to explain why their party – in complete control of the U.S. Senate, U.S. House and the Presidency and entire U.S. Executive Branch of the federal government – doesn’t enact reinsurance to help all Americans. Because of economies of scale and the need for market consistency, a national reinsurance program makes much more sense than a hodgepodge of variable state programs.

Moreover, if stabilizing the market and helping consumers pay less is good for Minnesotans, wouldn’t it be even more awesome to do that for all Americans?  That’s likely why 75% of Americans support enacting reinsurance at the national level.

Why Sabotage the ACA?  So why aren’t Rep. Erik Paulsen, Rep. Jason Lewis, Rep. Tom Emmer, Jeff Johnson or former Governor Tim Pawlenty pressing for reinsurance at a national level? Because they and their White House puppet master would rather sabotage the remarkably effective Affordable Care Act (ACA) than improve the ACA to help American families.

The list of things Trump and his congressional Trumpbulicans are doing to irresponsibly sabotage American families benefiting from ACA protections is long and breathtakingly irresponsible.  This is hurting tens of millions of struggling Americans.  Republicans are ignoring the 71% of Americans who say the Administration should do all it can to make the the ACA work, compared to just 21% who support efforts to make the ACA fail and replace it later.

Why Oppose Adding A MinnesotaCare Buy-in Option?  The other thing Republicans boasting about the state reinsurance bill need to explain is this: Why aren’t they supporting giving the 162,000 Minnesotans in the individual market a MinnesotaCare buy-in option?

The MinnesotaCare buy-in option would achieve much of what Republicans profess to support — more plan and doctor choices for consumers in sparsely populated areas, guaranteed coverage for all Minnesotans in sparsely populated areas, and more competition to control prices.

The fact that Minnesota Republicans won’t support the common sensical MinnesotaCare buy-in option proposal, won’t push for a national reinsurance program, and continue to actively sabotage the ACA makes their gloating about being health care saviors ring very hollow.