Viewpoint
A Net, Not a Sieve
Once again, the latest report ranking states by their health status shows Minnesota first. This is not by divine right or dumb luck. It’s due to a number of factors, including high-quality health care, our long history of progressive employers providing good insurance, and a state government that has gone beyond the minimum in providing coverage for our needier residents. Minnesota also has the lowest percentage of uninsured. There is a connection. But other factors jeopardize our state’s good health and health care. As our population ages, the cost of delivering care increases. When the economy is slow to recover, businesses, individuals, and government are all financially squeezed. As the new Legislature convenes, the health of Minnesotans is threatened. Confronting a large budget deficit, many of our “leaders” are unwilling to face the reality of needed tax increases. The governor’s cabinet has proposed changes in purchasing that contain possibly helpful ideas but seem to contain a lot of unhelpful cost shifting as well.
The MMA is, of course, concerned with the situation. The MMA Task Force on Health Care Reform has been looking at real solutions. Its report, focusing on long-range reform, goes to the board this month. The MMA committees on Legislation and on Medical Practice and Planning have met jointly, as well, to discuss more short-term actions. It is important to the health of all Minnesotans to preserve the state’s safety net and not allow it to become a sieve. The following principles are critical:
- All Minnesotans must be insured. We cannot have a repeat of 2003, when thousands of people lost their coverage.
- We cannot have funds dedicated to health care diverted to the general fund. This is backwards! The general fund should provide for our societal responsibilities. Sick people shouldn’t be funding the state.
- We must increase the tobacco tax $1/pack. Even if the increase didn’t net a cent in increased revenue, it is the most effective way to reduce underage smoking. But it is estimated to raise an additional $260 million.
- Any additional revenues from the tobacco tax should be used for health care. Sure, we would like it to replace the sick tax. Blue Cross would like it to replace their premium taxes (surprise). Given the state’s current fiscal problem, nobody’s taxes are going to be cut. This revenue should be used to keep the safety net from being cut open.
- Eliminate the co-pays for MinnesotaCare, Medical Assistance, and General Assistance Medical Care, which were instituted in 2003. A RAND study shows that these co-pays don’t prevent unneeded costs. They create a barrier for needed care. They are rarely collected; they are simply a dishonest way of reducing payments to providers and shifting costs to actual payers. The cost shifting of government to the private sector makes the acknowledged sick tax look like a rounding error!
- If there still are not adequate funds to fully cover everyone and there is still no political courage to provide them, the state should cover everyone to the extent possible rather than eliminate coverage for some people entirely. Although care is available to anyone, the uninsured tend not to seek it. When they finally do, their illnesses are often more difficult and expensive to treat.
- Physicians must look for ways to increase efficiency. A basic cause of increasing health care costs is our inability to increase our productivity. This is true for other labor-intensive professions such as education and police. We can support use of appropriate clinical guidelines and pathways and try new, cost-effective models of care. We are smart, creative people; we can do better.
Minnesota has been known for health for well over a century. This generation has been given a legacy of good health, good health care, and good health insurance. Let us not be “The Worst Generation” that frittered it away for a tax break!