Senator John Marty
Appearances
Health Chatter
The Politics of Health Care
But our hospital systems, most of them are nonprofit, and they're supposed to be doing it, but their CEOs are all making multimillion-dollar salaries. They're all very heavy bureaucratic things, top-heavy administratively. Because we can make money doing this. And even though they're not profit-making entities, there are a lot of people who are making a lot of profit off of it.
Health Chatter
The Politics of Health Care
And more and more of them are partnering with for-profit groups. And they share board memberships of them. And so everybody's got their own niche. Ten years ago or so, there was some new entity came into Minnesota. Great idea. And they were saying they were selling a product to employers saying, you know, we will scrutinize the bills, the health care bills of all your employees.
Health Chatter
The Politics of Health Care
We'll charge like I think it was like 500 bucks per employee. And we will basically guarantee you we'll save you more money than that because there's so many errors on the on the bills and everything else that you and your employees are paying a lot more than 500 or more than you should per year because of that.
Health Chatter
The Politics of Health Care
So the only thing they do is scrutinize the bills in a logical way and figure out where the errors are. That's all they did. It was a multimillion-dollar business, and their entire business is a logical business. They are saving employers and employees money, but how do they improve health care? They don't provide one penny's worth of health care. Correct.
Health Chatter
The Politics of Health Care
And hospitals now are all big hospital systems. The hospital systems, Mayo, Essentia, Fairview, M Health Fairview, Health Partners, they're all health systems. But Abbott Northwestern Hospital – It is a healthcare provider. It provides healthcare to people, but it's part of a line of healthcare system. What does a line add to? Oh, administrative stuff.
Health Chatter
The Politics of Health Care
We're going to do things more efficiently, more bureaucratically, more, I'd argue, less humanely. So a lot of people making a lot of money off it. Pharmaceutical industry, everybody's got their own cut of it. And pharmaceutical industry used to be just the manufacturers. Then it became... the pharmacy benefit managers, and everybody's got their own cut. The system gets more bureaucratic.
Health Chatter
The Politics of Health Care
So that's why people make a lot of money on it, and they like to keep what they're doing.
Health Chatter
The Politics of Health Care
Absolutely. I couldn't agree more. Green is what shapes a lot of stuff. And we can't act as if it doesn't exist or isn't an important part of the economy. That's important. Again, my focus when I say I didn't design Minnesota Health Plan is a way to save money. I designed it because I think I want to have the best health care system in the world.
Health Chatter
The Politics of Health Care
So people are healthier and they don't need to go to the doctor. And when they do, they get the care they need. But it will save money too.
Health Chatter
The Politics of Health Care
Sure. A couple of responses that the first one of which is which noodles would you pull out? Well, I spend a lot of my time and what we're talking about today is the big picture, how we need a different logical healthcare system. And I think we absolutely have to work on that.
Health Chatter
The Politics of Health Care
And part of the trouble is because of this noodle bowl, you're in your analogy, pulling one out is really a sticky, slippery mess. And yeah, And it's not easy to do. And so I would say let's not lose focus on let's fix the big picture. But in 36 years in the legislature, I spent an awful lot of time on the incremental things, the one noodle at a time, one noodle at a time and so on.
Health Chatter
The Politics of Health Care
And I would like to make the case that arguing that working on the big picture is I think we need to do and we haven't been doing. is critically important. We cannot stop doing that. That should be our number one focus. But that does not excuse one from not saying, hey, we could make this change and make people's lives better now and improve the health care system now.
Health Chatter
The Politics of Health Care
There is no excuse for not doing that. Most of my time on health care has been on those incremental changes. And I would make the same argument on others, and that is that those who are working on incremental changes because we want to accomplish something, That's very important. But that does not excuse you from looking at the big picture. So we don't have this messy bowl of noodles.
Health Chatter
The Politics of Health Care
Yeah. And part of the thing, when you talk about mental health, we have a huge shortage of mental health practitioners across the board. And Fairview... mHealth, Fairviews are now called. They keep changing their names, but every health system, their marketing plans, somebody's making a lot of money changing names all the time.
Health Chatter
The Politics of Health Care
And it's good for their business model, but it's not necessarily a change in healthcare. But when they bought out HealthEast, another health system in the past, Metro HealthEast was East Metro. When Fairview announced that they were buying that out a few years ago, They talk about they will enhance and improve services in the East Metro area. Look at their press releases. They promise that.
Health Chatter
The Politics of Health Care
First, one of the first things, major things they do is to close Bethesda and St. Joe's Hospital. I'll focus on St. Joe's Hospital, which tended to deal with mental health, tended to deal with addictions, substance use disorder, tended to deal with mental health, those kind of what some call behavioral health issues. Why do they want to shut it down? They were losing money on it.
Health Chatter
The Politics of Health Care
There are other systems, and they're struggling as an overall system, they say, and I'll take them at their word for it. I would do some things different than they do. But they shut this hospital down. And I am thinking, how does that expand healthcare coverage? And they say, oh, we're doing this and this instead, and this will be much better.
Health Chatter
The Politics of Health Care
Well, I'll say that some of the things they're doing are good things to be doing, but is it better overall? Do we really... Can we get by with less inpatient mental health and substance use beds? Not necessarily. So what we, why, what I wrote the CEO and the board several times when they were announcing they were closing this down, kind of angry because they shouldn't be doing this.
Health Chatter
The Politics of Health Care
And I understand when they say they're losing money on it, but why don't they then tell the state, because the state pays a lot of mental health and substance use costs through our public programs. And why don't you, fight the state and say, look, because we're doing more mental health stuff than other health systems are. And we're not getting paid enough for that.
Health Chatter
The Politics of Health Care
And maybe you pay too much for orthopedic surgery. And why don't you as a state negotiate with us, pay a little more for this and a little less for this. You know, I'm told, and I'm not sure this is accurate, but if I go see my family practice doctor and go to see her about some mental health challenge, some medication or something,
Health Chatter
The Politics of Health Care
That she's paid more for my visit than if I visit a psychiatrist who is more training and most specialists get paid more. Well, I understand that's the way we bill for mental health and so on, but there's something amiss there. And so using the mental health illustration is we should be paying more for mental health, less for other things.
Health Chatter
The Politics of Health Care
Well, OK, that's going to then it's just there's a zero sum game. You're not doing better. But, you know, if the other thing is, if we have a logical system where the health care providers and the health care systems, everybody have fewer costs, administrative, bureaucratic costs, if you cut a third of their costs away.
Health Chatter
The Politics of Health Care
You can cut their compensation overall by 25%, and still they're much better off. So one of the things we have to do is we have to get out a lot of the bureaucracy, and that's why we need the bigger change. The second one I'll mention is the mental health one. There are huge gaps in coverage there, and I think we have to be addressing that.
Health Chatter
The Politics of Health Care
And those two, I mean, to me, it's the pricing because we don't have any logical system for negotiating prices. We have all this bureaucracy. And I'm going to relate one third issue to this because it relates to the bureaucracy. And that is, and it's partly the Affordable Care Act to blame for this. but it's been an ongoing thing for 30, 40 years.
Health Chatter
The Politics of Health Care
And that is, we figure, you know, when they're saying how we're not just trying to save money, we're trying to improve quality, the triple whatever measure they're trying to do. They want to improve quality too. So we're going to measure quality. And we tried the same thing with schools a number of years ago. It was a bad mistake.
Health Chatter
The Politics of Health Care
Unfortunately, people backed off of it, but we're further into it in healthcare. And that is you try and evaluate teachers, right? And how do you do it? Okay. Each principal goes and evaluates. Each teacher will pay them for their performance, pay for performance, value-based care, pay quality measures. All those things are designed.
Health Chatter
The Politics of Health Care
If we do the same thing in education, which we were trying, some people were trying for a number of years, we're going to measure teachers. Well, there's no, objective way to do so. You have the principal come in and measure what, well, principals have their favorite teachers and they, different people are evaluating every way. So how do you measure it?
Health Chatter
The Politics of Health Care
So how are you going to pay some more because of that? So instead we do think, oh, we'll use standardized tests. When teachers quickly figure it out is if we're going to do standardized tests, I'm going to take the senior teachers who may be the most qualified and best ones. I'm not going to take the troubled kids. I'm going to take the good kids.
Health Chatter
The Politics of Health Care
I talked to one teacher who said, you know, years ago, I felt I thrived with the most troubled kids. They're more challenging, but I think I did better with them than other kids, with other teachers, comparatively me compared to other teachers, he said.
Health Chatter
The Politics of Health Care
And to me, I thought, when you're measuring that, you find out that the ones who have the sickest patients, or in the school case, the struggling students, you know, you're discriminating, you're making disparities worse.
Health Chatter
The Politics of Health Care
And so to me, one of the things we have to do is recognize that all these quality measures, which are designed to save money and improve health, maybe are costing money and arguably are making care worse. Why do I say that? There was a, one of the measures they often use to prove how good this stuff is, is a hospital readmissions reduction project or whatever it's called.
Health Chatter
The Politics of Health Care
Medicaid and Medicare, the federal government was pushing this. And there was actually one study out in 2017 that suggested that this quality measure that for cardiac patients, it was having the impact. Hospitals would be penalized if a patient came in, was readmitted within 30 days or something when they last left.
Health Chatter
The Politics of Health Care
And hospitals, they also penalized a little bit of somebody for mortality kind of thing. So Actually, the incentive, if you look at it carefully, the incentive was actually kick people out of the hospital. And if you don't readmit them, well, they might die.
Health Chatter
The Politics of Health Care
But anyway, there was one study suggested there may be a University of Michigan study suggesting as many as 5,000 more fatalities from this quality measure. Well, if a quality measure is killing people, instead of trying to tweak the quality measure, maybe the first thing we should do is get away from the quality measure. So in real short, that's a long story to say.
Health Chatter
The Politics of Health Care
One of the things is that the bureaucracy, a lot of the bureaucracy is well-intended. We're going to measure quality. We're going to pay for quality. And the fact that it may cost 10 times as much and take hours and hours of doctor and medical staff time to evaluate and bill and everything else, maybe That's counterproductive.
Health Chatter
The Politics of Health Care
And maybe what we should be doing is trying to focus on having doctors and nurses and others be well-trained, have them have peer pressure and their own personal pride that makes them want to do a better job and not a little more. So, all right.
Health Chatter
The Politics of Health Care
Sure. Yes and no. First of all, on technology, technology has in some ways saved huge amounts of money. In other ways, much of the way we use the technology is not on patient records and so on. Absolutely. If they did not have to report what we're doing and why we're doing it and how much we're charging for each thing. I agree.
Health Chatter
The Politics of Health Care
If you took out the billing side of it, you would cut the cost, bureaucratic cost by half. Huge, more than half. And the technology stuff. Because if doctors and medical providers and in hospitals and so on were sharing all the medical stuff.
Health Chatter
The Politics of Health Care
The medical stuff, the health records for patients, without sharing the cost and the billing, if they were using it for medical care and not for that, it would be a huge plus. But anyhow, we're using technology to make it more expensive, unfortunately. But that's not good. The studies.
Health Chatter
The Politics of Health Care
Right. I would say that some of the studies, there's one I've been pushing for for 10 years. We finally got it. And that's to do a cost analysis of a logical, universal health care system using as a proxy for that proposed Minnesota health plan. Compare that, the cost to everyone, the cost, economic and health costs and benefits, cost benefit analysis.
Health Chatter
The Politics of Health Care
a logical universal healthcare system to what we're doing now. Not government costs, not employer costs, not patient costs, not anybody costs, but the whole system, all the costs. And that includes things like, you know, when we figure out medical care costs, a lot of the costs I would argue that they call as medical costs
Health Chatter
The Politics of Health Care
prior authorization where a doctor has to approve, I mean, where an insurance company has to approve the care your doctor wants to give you, that to me is not improved medical care. There's no purpose. The insurance company has not interviewed the patient. They have not
Health Chatter
The Politics of Health Care
treated the patient they have not examined the patient they're making decisions based on some chart and what they think makes sense right and that's hugely that's purely administrative burden meant to save money and to me um that's what we have to look at everything and another type of cost we don't ever figure it out but the time you spend trying to figure out your co-pays and your bills
Health Chatter
The Politics of Health Care
What's your time worth? No kidding. Nobody thinks that's fun. What are you paid at work? How many hours are you spending a month doing that?
Health Chatter
The Politics of Health Care
Right. And for that matter, employers, the same thing. How much time they spend shopping for health care each year for their employees and then teaching their employees what's covered and helping them through the mess. That's a huge thing. If they just had, here, health care coverage. It'd be so much simpler. But all those costs, figure that in.
Health Chatter
The Politics of Health Care
So one cost analysis, Minnesota health plan versus current law, what it would cost, what it would save, what it would do. And I'm talking both medical health costs and benefits and economic costs and benefits, because my premise is it's cheaper and far better health wise. But that's a study. I'm really thrilled we're doing it. Some of the other studies I'm really troubled by.
Health Chatter
The Politics of Health Care
They had a study which is getting better, which got better along the way because a lot of people objected to it. But it was a health care affordability board. And in the health department, others were going to calculate For entities, they defined them as entities. They didn't define them, but they basically meant health systems or insurance plans or whatever.
Health Chatter
The Politics of Health Care
That these entities, they were going to analyze how much, not only how much they're spending now, but how much their costs should be growing per year and what should be the expected growth and are they keeping above it or below it.
Health Chatter
The Politics of Health Care
Everybody wants to get rid of unproductive stuff, but much of the stuff they're doing is adding to bureaucratic stuff. The bill originally had a thing in there that They would estimate what these were. And if the plans, if the entities, which are, again, bureaucratic entities who are part of the cause of this, were giving them a taste of their own medicine.
Health Chatter
The Politics of Health Care
But if they didn't meet the cost stuff, they would have to come in with a corrective plan. And if not, they could be fined.
Health Chatter
The Politics of Health Care
um fines of up to i think half million dollars which is not substantial in terms of multi-billion dollar entities but you know it's a fine and i that was supposed to do something my question is first of all how is the health department able to calculate what costs are and what they should be because they can say hey i got sicker patients than i had in the past we have sicker patients in your hospital severity it's it's all severity adjustment yeah
Health Chatter
The Politics of Health Care
And trying to analyze that, again, it's the grading. We're going to spend 10 times as much on grading as we're going to improve anything out of it. But so they were going to do that. And what would the impact be? How would that bring down affordability? If I'm, say, I'm mega health system, I can name any of them.
Health Chatter
The Politics of Health Care
But if I'm a mega health system and I'm being told our costs went faster up than they should, what am I going to do? I'm going to hire more people to figure out to write a corrective plan, which we have to write a corrective plan. I'm going to make sure it is the best corrective plan you've ever seen.
Health Chatter
The Politics of Health Care
And it's going to cost us thousands and thousands of bucks of time of very high paid executives to figure out this clever plan. That doesn't save any money. That's more paperwork. Where are we going to save money then? Well, we're going to cut back on the number of people staffing our clinics, going to have your hold times on the phone be longer, your wait time for appointments longer.
Health Chatter
The Politics of Health Care
We're going to tighten up the health care. spending and increase the bureaucratic spending to bring down the cost. So to me, that's a very more data is good. So I don't have a gripe about what we've changed it to that we're going to try and measure it. But I'm afraid this is going to be used in a way that doesn't get to the big problem. We're all concerned about it.
Health Chatter
The Politics of Health Care
Right. The prevention aspects are critically important. And unfortunately, it's always a sort of a stepchild or an afterthought in terms of dealing with prevention. And the trouble is, if we're going to put money into that, oh, we've got to take money for other things because we don't have the money to do this.
Health Chatter
The Politics of Health Care
And that's why a logical health system, that's why a Minnesota health plan proposal has changed. its own decision-making authority and the legislature doesn't set the budgets for it. It would, well, the legislature has to approve the premium rates that they'd be charging, but the premium is based on ability to pay.
Health Chatter
The Politics of Health Care
And basically what we would have is trying to have them in setting up the health policy for the state is... A logical way to do that might be we deliver health care in a public health manner. Every school should have a health care clinic. Every school have a health care clinic. We'd invest in the prevention efforts instead. Or we give grants to do this. We have this local public health grant.
Health Chatter
The Politics of Health Care
That's a great idea. But, you know, it's just kind of extra money. We're spending like one tenth of one percent of our health care dollars on prevention.
Health Chatter
The Politics of Health Care
Maybe we ought to be spending 5% or 10%. No kidding. I don't know. But the only way to do it is a logical way. But that's the way we've come at this piecemeal. We have a shortage of providers in greater Minnesota. Oh, we have a $3 million program to provide more family practice practitioners in greater Minnesota. The number is made up there. I don't know exactly what it is.
Health Chatter
The Politics of Health Care
But we put a few million dollars in to get more practitioners. That's not going to get a lot of practitioners and we have shortages across the board and so on. So we need to have a logical system. Who's in charge of making sure we have enough health care providers? Nobody. University of Minnesota is in charge of providing. They do most of the doctors. We graduate in this state.
Health Chatter
The Politics of Health Care
They're the vast majority or graduated through there. Is anybody making sure that they we provide if the need is for more general practitioners and less specialists?
Health Chatter
The Politics of Health Care
And they say in my pitches, do you want to tell med students? Do you want to tell them, oh, you've got to go into general practice? Well, a lot of them want to go into general practice, but they find out they're compensated more here. So they do that.
Health Chatter
The Politics of Health Care
But we have nobody in charge of saying, you know, maybe if we've got a shortage of this kind of practitioners, like I used mental health earlier or general practice, maybe we should pay more for them. Maybe we should pay off their med school debts. Maybe we shouldn't have med school tuition for those incentivize, incentivize the threat or use the economy to do it.
Health Chatter
The Politics of Health Care
But nobody's in charge of making sure we have enough practitioners. Nobody's in charge of making sure we do public health and health departments. I've been fighting health department for years, trying to get commissioners to say we need more money, whether it's for sexually transmitted infections or whatever.
Health Chatter
The Politics of Health Care
getting the health department commissioners to say it because they say, oh, no, we're not. And I asked several of them because I was chair of health committee at one point confirming the commissioners that were saying, you know, I want to know if you think there's a need for something, would you speak up? Oh, yes, I would. But no, they present their budget to the governor.
Health Chatter
The Politics of Health Care
The governor says, here's what you can do. And that's what they're for. And I'm saying, but you're a medical professional. I want to know your judgment. Do we need more money for prevention? And but that's what we need a logical system for. We don't have
Health Chatter
The Politics of Health Care
There's also- And trying to do the broader one. One of the 10 principles behind our bill is that it must focus on preventive health. Thank you, thank you.
Health Chatter
The Politics of Health Care
The healthcare system, in designing the bill, it has 10 Minnesota health planners, 10 principles designed to make sure
Health Chatter
The Politics of Health Care
um that it's a logical healthcare it has to cover everyone for all their medical needs patients get to choose their medical providers and patients and doctors make the decisions not government or insurance companies or business nobody else does patients and doctors do we focus on preventive health things like that providers have to be paid in a timely and fair manner um 10 principles that would be legally binding on the health plan and you need them all
Health Chatter
The Politics of Health Care
I think you need to focus on public health. We don't want to have more money on health care. We want to have less money on health care and more on keeping people healthy. But that's all tied into it. So we need the whole package. That's why the piecemeal thing is very important to work on. But we can't forget the big picture.
Health Chatter
The Politics of Health Care
Sure. Well, first of all, I think there were some very significant improvements, little piece by piece things in terms of pharmaceutical price gouging types of things. Lots of good little steps forward. But I also want to keep focusing this cost analysis of the Minnesota health plan or a logical universal health care system versus what we have now is a two and a half year study.
Health Chatter
The Politics of Health Care
And I want to be preparing for that. But one of the other things I wanted, we have, we have roughly almost 20% of our population in Minnesota is on public programs, Medicaid, medical assistance, we call it, and Minnesota care. Roughly over a million people out of less than 6 million people in the state are on those programs. And those are public programs.
Health Chatter
The Politics of Health Care
but they are run by private insurance companies. If I'm on, if I qualify for Medicaid or Minnesota care, I get my care through one of the health plans, Blue Cross or Health Partners or whatever. And it's an extra bureaucratic step that costs a lot more money and it's resulting in bad outcomes, worse outcomes, not better outcomes.
Health Chatter
The Politics of Health Care
One of the health plans is prohibiting its doctors at its public hospital to from treating prenatal treatment for visits for women who are on Medicaid. And that's a public program. They're telling people, they're telling their doctors not to treat certain Medicaid patients until they come in the hospital for a childbirth. And these are often low income at risk women who have more complications.
Health Chatter
The Politics of Health Care
Why are we doing it? Well, because we have a public program is being administered by people trying to make money off of it. And to me, one of the hopes I have next year is that we can move to just say, let's go back to, let's kick out this pilot project we've been doing with no evaluation for 30 years.
Health Chatter
The Politics of Health Care
kick out the private insurance companies from the public programs, because then we could start fixing some of the things like the disparities where mental health is paid less. We could make sure patients aren't being denied care because they're not in the right health plan. These are public programs. Public is spending literally billions, billions and billions of dollars a year on
Health Chatter
The Politics of Health Care
And why are we turning that over to private plans to do nothing more than administer and allegedly save money? But basically, they save money by denying care. Right.
Health Chatter
The Politics of Health Care
Sure. Well, I think as the medical profession and our knowledge of medicine has grown, we've learned, we've gone from ancient times or even much closer to ancient times than we want to think where we had really harmful medical practices like bleeding was going to solve illnesses until a hundred years ago.
Health Chatter
The Politics of Health Care
Yes. And politics affects how we govern ourselves as a people, how we relate to each other as a society. And because some people can make more money doing certain things their way, they may not be bad people. I don't think they are. I talked to a woman who worked for one of the large companies. HMO plans in the state. And she said, John, what do you think? Why?
Health Chatter
The Politics of Health Care
I've been spending my whole career trying to make sure more kids get Medicaid, medical assistance, so they get care. What's wrong with that? I said, nothing's wrong with that. But why do we have to have some insurance plan trying to help people get coverage? Why don't we just say you're all covered, period?
Health Chatter
The Politics of Health Care
And so it's not bad people, but their jobs depend on it. And to me, making that change, we want to treat them fairly. I want to make sure if we're replacing, if we're displacing people in insurance and billing and collections and those jobs, if we're going to displace people, we want to make sure they get good jobs elsewhere because we got to be concerned about them.
Health Chatter
The Politics of Health Care
They're our fellow human beings. But we also don't want to have, we'd be better off, I think we'd actually save money We took everybody working in health insurance in Minnesota and had them sit at their desks and do nothing. And then just provide health care in a logical, cheaper way. It would be cheaper in my mind. But that's the trouble.
Health Chatter
The Politics of Health Care
The reason it's so slow to change is people all have their vested interest in it. And we never take a look. That's why I'm saying we work it. Tinkering on each of these is important. Tinkering is important. sounds tiny, but big tinkering things that are good things to do. We've got to keep working on that. But at the same time, let's look at the big picture. Why do we do it this way?
Health Chatter
The Politics of Health Care
I mean, it's literally modern medicine is relatively new and we've done incredible things, life expectancy getting much better, everything else. And I think here in the United States, we've got some of the best providers in the world and so on. Minnesota, particularly, we've got some of the best medical professionals, doctors, nurses, researchers.
Health Chatter
The Politics of Health Care
And how would we do it if we wanted to have a logical system that addresses healthcare disparities, that addresses the lack of access to care, that addresses the high costs of care, and has people focus on how we keep people healthy and make sure they get the care they need? To me, that's a simple question, but it's a big question and it's a huge challenge, which is why
Health Chatter
The Politics of Health Care
medical providers have got to be involved. And I'm thrilled that med students at the U of M are more engaged in health policy than I think med students were 20, 30 years ago. Because they see it's going to affect their practice.
Health Chatter
The Politics of Health Care
It's got some of the best facilities in the world, some of the best technology in the world. We've got wonderful things. And overall, mainly more from public health than from individual technologies and so on. Life expectancy, as you know, has been growing and growing and growing until, oops,
Health Chatter
The Politics of Health Care
last few years, it's been shrinking, which points to one of the problems we have that the healthcare system, we think we have the best in the world.
Health Chatter
The Politics of Health Care
And I would argue we in many ways have some of the best facilities, research, training, technology, professionals, some of the best in the world, but our healthcare system is one of the most, it's certainly probably the most dysfunctional of any developed nation. And we've been doing because there are problems. Healthcare is getting more expensive.
Health Chatter
The Politics of Health Care
In the early 1960s, I believe it was 4% of the economy. Maybe it was 5% of the economy. Now we're almost up to 20%. We're at 18 some percent of the economy now. And so it's not just inflation adjusted, but it's kind of quadrupled. It's quadrupled what percent of the fast growing economy is. And so we are spending a lot. And
Health Chatter
The Politics of Health Care
And we also have never in this country made sure that everybody has access to healthcare. And so we have, unfortunately, when you look at how things go, you hear so many politicians and others, oh, we've got the best healthcare system in the world.
Health Chatter
The Politics of Health Care
But we are now, we spend a lot more than others do, our life expectancy, infant mortality rates, all of which have been getting more negative the last few years. They were never near the top. I mean, they were not nearly as good as they should have been. I think one WHO, World Health Organization, I think they've rated us like 37th best in the world.
Health Chatter
The Politics of Health Care
And when you count how many developed nations there are, it's not that good. And so I'd say it's been getting worse. And part of the reason it's getting worse is because of health policy. Because each individual practitioner using the knowledge they have, they make mistakes. And we have lacks of knowledge. And we've got all that.
Health Chatter
The Politics of Health Care
But aside from that, the system, the way we put it together and make it work has been getting worse. And it never was a system. It was sort of a non-system patchwork quilt of how we cover people and everything else. And unfortunately, again, as you said, this is my 37th year in the state senate.
Health Chatter
The Politics of Health Care
And I didn't plan to be there that long, but I'm not willingly going to leave until we pass universal health care and have a logical health care system. That doesn't mean I'll make that, but I'm committed to doing everything in my power to try.
Health Chatter
The Politics of Health Care
But one of the problems I've seen has been throughout my career and started probably in the 70s is that policymakers say we've got several problems with our health care system. One, not everybody's covered. And two, it costs too much. So In the economic world, if something costs too much, you buy less of it. That's just supplying them. That's the way the market works. So we buy less of it.
Health Chatter
The Politics of Health Care
And so healthcare professionals are saying, or the health policymakers have been saying, well, it's too expensive. And so let's make it harder for people to get so they don't use as much of it. Because obviously, if we're spending so much, it's because people are using too much healthcare. And you know, and I know that as new technologies and new things more expensive happen, but
Health Chatter
The Politics of Health Care
The last 30 or 40 years, most of the health reforms, the reforms designed to make it more affordable and cover more people, Affordable Care Act was one of those. I would argue it did nothing to make it more affordable. It probably made it less affordable. But nevertheless, it cut the uninsurance rate. The people who have no coverage, it cut it by half. And that's a huge benefit to people.
Health Chatter
The Politics of Health Care
So it's done a lot of those things. But all these reforms... making healthcare more difficult to get, probably contribute to health inequities, probably contribute to declining overall health. And they haven't worked to save much money.
Health Chatter
The Politics of Health Care
Because now after those 30, 40, 50 years of these healthcare reforms designed to save money and cover people, we still have in Minnesota, it's only about three, four, 5% of the public that has no coverage.
Health Chatter
The Politics of Health Care
but arguably about half the public doesn't have the coverage they need because they don't go to the dentist because they can't afford it or they can't afford the co-pays or deductibles, so they, whatever. But we haven't covered everybody, which is pretty essential for a good public health system. And the other thing is we haven't really done a very good job of saving money.
Health Chatter
The Politics of Health Care
Matter of fact, we spend literally two times what anybody else in the world spends per person on healthcare with about 10 or 12 exceptions. Other countries, All but 10 or 12 spend half per person or less than we do. And many of those have better outcomes and so on. So our healthcare reforms have been going the wrong direction. Real quickly, what the summary of what I'd like to have
Health Chatter
The Politics of Health Care
I'd like to have a logical healthcare system. I don't care what I was telling people. I got a system. I proposed one 12, 15 years ago that I think makes good sense. I think it would be the best healthcare system in the world, frankly. It's not very modest, but I really think that's not a very high mark to meet because, frankly, nobody's doing a wonderful job of it.
Health Chatter
The Politics of Health Care
But have a healthcare system that covers everybody for all their medical needs and doesn't put barriers in their way. And so the analogy of what I'd like to see is with education. In Minnesota, our constitution says we are supposed to provide a quality education system for all kids. So how do we do it?
Health Chatter
The Politics of Health Care
Well, when you turn five years, now when you turn four years old, you are basically able to get an education. You don't have to have, your parents don't have to have the right insurance plan, school insurance plan. They don't have to worry about co-pays or deductibles. You don't have to worry about if the local, if some of the teachers are going to be out of network.
Health Chatter
The Politics of Health Care
You don't have to worry about any of those things. Why? You turn four years old, you get to go pre-K. You turn five years old, you go to kindergarten. You get to go. You are qualified. Why? Because you're a human being and you live in Minnesota and you're that age and it's school age. Why do we do that? Because we want every kid to get a good education.
Health Chatter
The Politics of Health Care
If we care about public health, as pandemics and epidemics and infectious diseases show us, We don't want to cover, oh, 80% of the public. We want to cover 100% of the public. We want everybody covered. So my vision is let's have a healthcare system and the reform, the policy I'm looking for is not one that tries to save money. I'm not trying, we're twice as expensive as anybody else, as I said.
Health Chatter
The Politics of Health Care
I'm not trying to save money. I'm saying, why don't we try and design a healthcare system that does what a healthcare system should, tries to keep people healthy, when they need care, help them get care. Very simple. And I would argue, and we're actually working on a, the state funded a study this year at last of it.
Health Chatter
The Politics of Health Care
I would argue that making a logical healthcare system that focuses on health and public health and wellbeing, not focused on saving money, ironically actually does save money because we get rid of all the crud that's putting up all these barriers that in the end don't get around the need for healthcare. They do that.
Health Chatter
The Politics of Health Care
So my, my ideal, what I want us to do, and you never hit your ideal, but why can't we cover everyone? Why can't we do, again, you can find fault with the schools. I can too. And we could certainly improve them and we're working at that. And I, And I think you can fight all we want about that. But the bottom line is the idea that every child gets an education is pretty important.
Health Chatter
The Politics of Health Care
There's a common denominator. Yeah. Everybody has it. I think we ought to do it. So that's my vision for what we ought to do is have a health care system. And I can go into more about the barriers to care. But just one more philosophical thing for the discussion. And that is Stephen Covey, the author, about 40 years ago, proposed two world mindsets, one of which is one of scarcity.
Health Chatter
The Politics of Health Care
One is a model of abundance. The abundance model, there's enough for everyone. We take care of each other. We all do better, that sort of thing. And the scarcity one is there's not enough to go around. If you get more healthcare or you get more of whatever, I get less of it. And you're fighting among each other. You're doing all this.
Health Chatter
The Politics of Health Care
You're making sure nobody gets something they don't absolutely deserve. And I would argue in the healthcare world, the American model has been Clearly, the scarcity one.
Health Chatter
The Politics of Health Care
If somebody is getting any care they don't absolutely need, especially if we're paying their bill and they're lazy people and we're going to take care of them, but only the minimum they need and we're going to make them jump through all these hurdles to do it and everything else. That scarcity mindset is ironically making health care scarce and too expensive and unaffordable.
Health Chatter
The Politics of Health Care
And the broader mindset, which I think a number of countries actually do. And that is your healthcare matters to me and mine matters to you while we all take care of each other. Let's assume there's enough to go around because frankly, there is when you do it that way. So I would say let's get the abundance mindset, which is a whole different way of looking at healthcare.
Health Chatter
The Politics of Health Care
And I can give you examples of why that matters so much. But with that, I would say that's the past, present and future for what I'd like to see.
Health Chatter
The Politics of Health Care
Sure, and I'll say that that gets to one of the big problems we have. We have a system that puts, as the Minnesota nurses often say, it puts profits before patients. And everybody's got their own niche on how they're going to do it. It's the, quote, non-profit health care systems in the state.
Health Chatter
The Politics of Health Care
Our insurance companies until a couple of years ago that sold health policies were all, quote, non-profit. We changed the law because we didn't want to be the only state that didn't allow for profits in because somehow that was going to make health care cheaper.