Monday, December 26, 2005

The Minnesota Universal Health Care Coalition (MUHCC)

Real change often requires not only top-down leadership but bottom-up activism. The Minnesota Universal Health Care Coalition (MUHCC) began in coffee houses, community centers, and union halls with a series of discussions, presentations and lectures about the state of the health care delivery system in both Minnesota and the nation at large. It currently consists of 13 organizations committed to both incremental change in MN and comprehensive reform legislation for the entire state.

Discussions about the rising cost of health care and the growing number of uninsured Americans are replete with policy proposals ranging from "single payer" to "personal health savings accounts" - from tort reform to "patient incentives" (deductibles). To keep things straight, it's helpful to understand that there are three basic models for delivering health care.

  1. Medicare's "fee for service" model.
  2. The Managed Care/Managed Competition (HMO) model.
  3. The high deductible, "defined contribution", libertarian model advanced by the Bush Administration.
Options two and three are based on the premise that the health care delivery system is "overused". In general, managed care advocates believe that doctors "abuse" the system by perscribing more treatment than is necessary which leads to ever increasing health care costs.

"High deductible" advocates believe that the rising cost of health care is due to "over insurance" which encourages over use on the part of patients. This later is referred to in insurance and ecconomics terms as Moral Hazard risk.

"Fee for Service" advocates, which include the proponents of single payer health care believe that the rising cost of health care is due to waste in the system which includes
  • Excessive administration costs.
  • Excessive oversight of doctors by the insurance arms of the HMOs.
  • Under-participation in funding health care represented in part by the uninsured.
  • Un-negotiated equipment and drug prices.
to enumerate a few. The cost of these inefficienies are estimated at anywhere from 15% to 30%. MUHCC estimates that if even 15% of these costs are recaptured, it is enough to fund $-1 benefits ($0 deductible), universal coverage to all citizens of MN plus provide long term care benefits to everyone in the state.

There are both moral and economic arguments for reforming the current health care delivery system. Democrats have done well historically at advocating for broad access to health care and they have done well at articulating the moral argument for universal coverage.

Democrats have done less well at articulating the economic argument. A 1999 KPMG study titled: The Competitive Alternative: A Comparison of Business Costs in North America, Europe, and Japan points out that Canadian-based firms enjoy a 7.8% cost advantage over U.S. based firms measured across nine key industries largely due to Canada's publically funded health care system. It costs U.S. automobile manufacturers, $1,200 more per unit on average to produce a vehicle than it does their counterparts in Canada - largely due to health care costs. And in fact, Ontario now produces and sells as many vehicles in North America as does Detroit.

I'm going to make neither a moral argument nor an economic argument for a publically funded health care system - I'm going to make the case for freedom.

Freedom for a middle-aged couple to pursue a dream of opening their own bed and breakfast in the Redwing Valley of Minnesota without fear of their business being swamped by health care costs.

Freedom for a young cellist to pursue a life of music knowing she can put out a shingle anywhere in the country and have access to affordable health care.

Freedom for a newly married pair of college graduates to work with ex-gang members in Detroit's inner city knowing they won't be bankrupted by medical costs.

Freedom for an engaged Christian to open a ranch in central California that offers a place where kids from LA can spend part of their summer caring for and riding horses without pricing out the people he wants to serve in order to cover health expenses.

I don't accept that freedom's just another word for nothing left to lose, I believe it's why we all love this place.

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