Extending health care coverage to Americans neglected by the current system also sounds good. Yet it could result in building a publicly funded alternative health plan—a possibility that perturbs private health insurers and many physicians. Compared with the federally funded Medicare and Medicaid programs, private insurers have higher administrative costs—2 percent and 13 percent, respectively. Physicians, already dismayed by the lower reimbursements paid by federal programs, fear more of the same. Private insurers and their defenders claim a public program would undermine the higher-cost and, they would argue, higher-value health care offered by private insurers and physicians. Moreover, they assert, it could be the first step to a single-payer system, which could mean rationing of care and a lack of useful competition.
In any case, the Obama administration takes a distinctly different approach from President Bill Clinton’s in the early 1990s, which critics say failed to engage Congress and the public. Obama and his team are providing only high-level guidance to members of the House and Senate. Details will be ironed out in the legislative process. To achieve a bill that can pass with 60 votes in the Senate, a bipartisan group of leaders is crafting the chief components. In the House, only a simple majority will be needed to pass major reform legislation.
At the same time, industry groups including the National Priorities Partnership (which includes Bloomington-based insurer HealthPartners) and Health Reform Dialogue issued white papers demonstrating consensus among a diverse set of stakeholders. These unusual acts of political teamwork are being tested as the House and Senate debate legislative fine print: the size of businesses mandated to provide insurance, which tax breaks to eliminate to pay for the increased number of insured, and rewarding clinicians for delivering care with better outcomes.
To achieve affordable, high-quality health care for all Americans, most policymakers agree that everyone should carry health insurance, employers should continue to help pay for it, and a variety of health plans should be offered to all Americans. The tough decisions come when determining the best way to pay for the new program, how to wring out inefficiencies in the current system, what services to cover in the benefit package, and what government’s role should be.
Even in this complex environment, there is real optimism that legislation will pass this year and the president will sign it. If it happens, the resulting federal legislation would likely extend coverage to more Americans, put information technology in more hospitals and medical offices, and increase the transparency of costs and quality. The Obama administration also wants to promote health and prevent disease in order to lower the costs of chronic disease.
In Minnesota, local health care and business leaders say, we could combine these impending national reforms with unique elements in our culture and health care industry to actually transform the health of our state.
As it responds to the new reforms, Minnesota is positioned to go beyond where most other states will land once the law is passed. We asked 37 Minnesota health-care and business leaders: What are the most promising unexploited opportunities to transform health and health care in our state? They spoke of our strengths—innovation and collaboration—and possible approaches, which include engaging the public in owning their healthy futures.
