Against Our Will
Ninety-one percent of Minnesotans feel health care should be made available to all citizens, regardless of their income or employment status. And 80 percent would endorse raising taxes to achieve that goal. Those are just two of many revelations in a statewide survey commissioned by the Minnesota Citizens Forum on Health Care Costs, an 18-member group formed by Governor Tim Pawlenty last September to devise new strategies on how to contain the rapid growth in health care spending.
The survey indicates that Pawlenty acted against the overwhelming will of the people during the last legislative session, when he rammed through a budget that deprived an estimated 38,000 Minnesotans of access to health care in order to forego a tax hike. (And only a last-minute infusion of federal money and the tenacity of DFL Sen. Linda Berglin prevented that number from climbing over 60,000.) Confronted with this stark disconnect between public opinion and the policies enacted by his party at the behest of the governor, Republican Rep. Fran Bradley, chair of the Health and Human Services Finance Committee in the house, has chosen to discredit the survey.
"I'm skeptical of the methodology used," Bradley argues, saying the results don't make for a "mandate majority." "It is almost nothing asking if people want everybody to have health insurance--it's an apple pie question. It doesn't have any specific context raised to it. Usually what people mean is raise taxes on other people, like for tobacco. Also, people have a general misunderstanding of what kind of money we're talking about. They may understand it to be 10 dollars a year, but what about a thousand dollars a year? Because [to provide universal access] you are talking about lots of money."
Bradley's spin job is woefully weak on a number of fronts. If 80 percent isn't a mandate, then Pawlenty, who was elected with just a little more than half that percentage, certainly had no mandate to balance a $4.2 billion state deficit without raising taxes. And even if we accept Bradley's contention that what the survey respondents really meant to say was that they favored a 10-dollar hike on tobacco taxes to support public access to health care, well, Pawlenty not only eschewed that option, but wiped out the state's $490 million tobacco settlement fund endowment, formerly dedicated to health-related issues, to balance the deficit.
Citizens Forum Project Director Michael Scandrett notes that an experienced firm was commissioned to conduct the survey, and that the 800 people surveyed were a "representative sample of Minnesotans both demographically and geographically." And far from what Bradley infers, respondents had a nuanced view of how health care should be delivered in this state.
Only a slight majority, 56 percent, supports a "single-payer" system operated by the government instead of the private sector. Eighty-two percent would rather have private sector involvement than a system completely run by the government. Yet 76 percent believe government has a responsibility to ensure safe, high-quality medical care for its citizens.
These views are fairly consonant with the way the state operates MinnesotaCare--using public dollars to enable those who can't afford health insurance to contract for services with private health care providers. In short, the survey clearly indicates that Minnesotans would rather have the access provided by programs like MnCare expanded, rather than cut back, as Pawlenty and the Republicans did in the last session.
But that was last year. After releasing the results of their survey last month, the forum members are expected to deliver their recommendations on health care reform to Pawlenty any day now. The Republican and DFL caucuses have already released their legislative agendas on health care for the current session, which began Monday.
In broad strokes, the DFL is proposing ways to significantly increase access to health care and prescription drugs--and can do so, Berglin contends, without raising taxes. The Republican plan concentrates on cutting costs by going to a more free-market, unregulated system that places greater responsibility for health care decisions on the consumer.
More specifically, the DFL proposes bringing the employees of small businesses (employing a maximum of 50 people) into MnCare, at a cost that would be subsidized by both the state and the business. Because many current MnCare applicants are actually eligible for Medical Assistance, a program partially funded at the federal level, Berglin believes there is room in MnCare's budget to encompass uninsured workers without raising taxes. The DFL would cut costs by promoting electronic record-keeping instead of paperwork, and by capping the overall rise in health care prices at approximately 6 percent annually, as compared to the 15 percent increase in 2002.
Meanwhile, the Republicans propose a moratorium on all health care mandates (such as specific treatments and services health insurers must cover), a limit on medical malpractice awards, a tax cut for health care providers, and an open market that would lift the ban on for-profit health insurers operating in the state. In other words, providers have fewer overhead costs from regulations and malpractice insurance, along with less government oversight and a greater freedom to pursue profits.
Further, Republicans argue that free-market competition would limit administrative fat and price gouging. But it bears noting that for-profit providers would be exempt from HMO audits conducted by Attorney General Mike Hatch, which have uncovered numerous instances of corporate mismanagement of resources. In any case, there is nothing in the Republican reforms that would directly increase access to health care for state residents. But that's what the people want--and are willing to pay for.
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