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State single-payer bill passes its second test in Senate

BY KIP SULLIVAN Southside Pride, Minneapolis Feb. 16, 2009
If livin' were a thing that money could buy, You know the rich would live and the poor would die. --"All My Trials," traditional folk song

SF 118, the Minnesota Health Act, which would guarantee health insurance for all Minnesotans under a program called the Minnesota Health Plan, passed out of the Senate Commerce and Consumer Protection Committee by a party-line vote of 7 to 3 on Feb. 10. The lopsided vote was a sign of the growing support for the single-payer approach. This is the first year since 1991, the year single-payer legislation was first introduced in the Minnesota Legislature, that a single-payer bill has cleared two committees in the Senate. The bill has never been heard in the House. It will get its first hearing in the House on Feb. 25.

The Feb.10 hearing was just one of many battles that remain to be fought over the next several years before the Minnesota Health Act is enacted. But the lopsided vote, the large crowd, the concise and persuasive testimony presented by proponents of the bill, the superficial arguments of the opposing witnesses, and the subdued tone of the Republican senators who voted against it were signs of a change in the way Minnesota talks about health care reform these days. The single-payer approach, long kept off the table by leaders of both parties, is definitely on the table.

The early-afternoon hearing began at 12:40 and ended at 2:45. Sen. Linda Scheid (DFL-Brooklyn Park) began by noting how many people had come (she said people needed tickets to get into the room and others were outside watching on TV monitors). She said she knew people "had strong feelings for this bill" but she wanted the crowd to remain quiet.

Sen. Marty (speaking from the witness table) spoke for 35 minutes, then introduced his three witnesses: Lisa Sherman, the mother of an autistic boy from Stillwater representing Take Action Minnesota; Ann Settgast, a doctor representing Physicians for a National Health Program and the Minnesota Universal Health Care Coalition; and Nancy Breymeier, a financial advisor and president of the Metropolitan Independent Business Alliance which represents over a hundred small businesses. Then opponents of the bill (the insurance industry and three business groups) made brief statements criticizing the bill.

The following five statements illustrate the issues raised by this hearing:

* Sen. Schied's remarks to Sen. Marty about how helpful he has been in helping her understand the Minnesota Health Plan (MHP);

* Dr. Ann Settgast's remarks about the insurance industry;

* The remarks by Julie Brunner, the director of the Minnesota Council of Health Plans, implicitly blaming doctors and patients for the health care crisis and deflecting blame from the insurance industry;

* Sen. Mary Olson's (DFL-Bemidji) reply to Ms. Brunner; and

* Sen. Scheid's response to a remark by Mike Burress who spoke against SF 118 on behalf of the Minnesota Association of Health Underwriters.

At some point after Sen. Marty had described the bill, Sen. Schied gave him a big smile and said she appreciated all the work he had done to educate her about the bill. "Now I get it," she said. Sen. Scheid has been in the Legislature since 1976. Single-payer bills have been introduced every year in the Senate and the House since 1991. So for Sen. Scheid to say now, in 2009, she understands why the Minnesota Health Plan is a good plan tells you (a) Sen. Marty is doing a good job as the chief author talking to other senators and (b) change can happen relatively quickly once a single-payer bill begins to move through the Legislature (and of course that happens only if it is backed by a strong movement within and outside the Legislature).

Dr. Ann Settgast's testimony was effective not only because she's a doctor, but because she speaks clearly and persuasively while referring to her notes only infrequently. She speaks without notes in part because she speaks about her daily life as a doctor, and in part because she's a very serious student of health policy and she knows the case for the MHP very well.

The point Dr. Settgast drove home was that she sees mostly insured people, and it's precisely because she works with mostly insured people that she has come to oppose proposals that leave insurance companies in the mix. Her actual words were something like, "Working daily with a mostly insured population has made me wary of proposals that merely expand coverage." She made that point again when she reminded the committee that half of all personal bankruptcies are caused by medical bills, and three-fourths of those people had insurance when their medical bills arrived. She said when the MHP becomes law the only thing that will look different will be "the billing department at your clinic." She cited two surveys that indicate 60 to 65 percent of doctors support single-payer. She closed observing that she didn't grow up in Minnesota but now wants to stay here, in part because our uninsured rate is low and medicine is done well here, and in part because we're a state that tends to act before other states do and she looks forward to helping Minnesota lead the nation in health care reform. "I'm thrilled to be here and to be part of this movement," she said with a smile at the end. "I urge you to support this bill."

In her comments explaining why the Minnesota Council of Health Plans opposes SF 118, Julie Brunner made two points: That single-payer systems in other countries are not "problem free," and that the insurance industry is part of the solution, not part of the problem. (SF 118, like all single-payer systems, would give to the MHP nearly all of the functions now carried out by the insurance industry.) Ms. Brunner began her testimony by describing the MHP as a "government-run health care system." She then quoted a statement she pulled off the internet by some woman who claimed to be an American ex-patriot living in France. This alleged ex-pat said she was paying more now out of pocket than she had been paying in dear old America. It is impossible to know if this was a true anecdote. Brunner was obviously scraping the bottom of the barrel if the best she could do was appear before a state legislative committee and read from some anonymous statement posted on the internet. Brunner went on to say Canada does not cover prescription drugs taken outside a hospital (this is true for some Canadians and not others). She said some cancer treatments are not covered in the United Kingdom. (She must have been referring to a breast cancer drug that extends life by four or five months and has such punishing side effects that it was not approved by the American FDA until just a few months ago. The FDA's approval was over the objections of many consumer groups in this country and the FDA's own advisory body. There has been some controversy in the UK in the last year over the UK's refusal to pay for this drug.) "The MHP won't be problem-free," Ms. Brunner concluded.

Sen. Mary Olson, a member of the committee and an active member within the Minnesota Health Reform Caucus (the caucus within the Legislature that represents the single-payer point of view), made a very effective five-minute retort to these comments. She told the committee about a trip she took to Canada with Sen. Sharon Erickson Ropes (DFL-Winona) last summer. Looking at Brunner she said, "I have to tell you, there is no such thing as a perfect system anywhere in the world, but some work better than others. We went to Thunder Bay and then to Winnipeg. We heard an overwhelming message: No one in that country would trade their system for ours. They thought it was outrageous that people in this country can be bankrupted by medical bills. Canadian doctors said they wouldn't tolerate third parties interfering in their relations with patients the way insurance companies in this country interfere in the doctor-patient relationship. Other countries have problems, but they have better ways of coping with them than we do." She closed by criticizing Brunner for referring to the MHP as a "government-run health care system." She said doctors in Canada are free to practice medicine without interference from the government, whereas in this country we have a system run by health insurance companies.

Brunner's other point was that Minnesota needs health insurance companies to do the unpleasant work of forcing health care costs down. Even after the MHP is created, Ms. Brunner said, "The work of the health plans must still be done. Health care is not expensive because of health insurance. Health insurance is expensive because of health care." In other words, we have a health care crisis because doctors and patients are making dumb decisions that lead to overuse of the health care system and we need insurance companies to help doctors and patients figure out how to use less health care. There is a kernel of truth to the claim that doctors and patients overuse the health care system, but it is only a kernel and it is only about one-tenth of the truth. The rest of the truth is that underuse of the health care system is far worse than overuse (thanks in large part to the behavior of the health insurance industry), and the health insurance industry, in its relentless crusade to wipe out the relatively small amount of overuse, harms patients and generates enormous administrative costs that drive up overall costs.

My final highlight: One of the opposition witnesses was a white-haired man named Mike Burress who said he was representing "450 of the state's brokers, as well as carriers" (which presumably means health insurance companies). He began by saying he approved of the current system in which people who work hard can buy more health care than people who don't work hard. He said he didn't approve of the fact that "government has a program for everyone," regardless of whether they have made any effort to buy health insurance. "People should have the freedom to choose innovative health insuance products," he said, and SF 118 would take that "freedom" away.

When Mr. Burress was done, Sen. Scheid asked, "I don't think I heard you correctly. Did you say that wealthier people should be able to have better access to health care?" Burress replied, "Yes, that's what I said, just like they can buy better cars and housing. This is America." Sen. Schied replied, "Well, I guess I did hear you correctly." The audience laughed.

After the vote was taken, Sen. Schied announced the 7 to 3 outcome, and then she thanked the crowd for remaining quiet. They erupted in applause at that. Sen. Schied smiled another big smile, banged the gavel and said, "Meeting adjourned."