Montana Governor Brian Schweitzer, not willing to wait for the Affordable Care Act to kick in in two or three years, is challenging the federal government to start having a dialogue about real health care reform now by allowing Montana to set up a system modeled on "SaskCare," the Saskatchewan health system, the first universal health care system among the Canadian provinces.
In an interview with Daily Kos Friday, Schweitzer talked about his rationale for the plan. It builds on a request he made last year for a Medicaid waiver for his state to set up a "Medicaid Part D" program, as he called it, a prescription benefit plan for all Montanans. That proposal, intended to hit at the heart of a long-time Schweitzer foe—the pharmaceutical industry—would have allowed the state to offer a prescription drug program to all Montana citizens that would provide the drugs at Medicaid prices.
That waiver request was denied.
Building on that, and taking Saskatchewan as his model, Schweitzer will request a waiver from HHS for not just Medicaid, but Medicare, Veterans Administration and Indian Health Services funds that are provided to the state. He wants a block grant of those moneys to set up a single payer system. And he's using Saskatchewan as his model because of the similarities between that province and his state.
"Montana has a population of 990,000 people," he explains. "Saskatchewan has a population of 1,050,000. Their average age is about the same average age of Montana. They're about 10 percent Indian, we're about 7 and a half percent Indian. The other ethnic groups—they're a mirror image of us ... So we have the same ethnic population, we're farmers, we're loggers, we're miners, we're oil developers ... They, in Saskatchewan, live two years longer and have lower infant mortality."
Looking at those basic elements, Schweitzer asked province Premier Brad Wall for details on their health system. He discovered that the province spends about $4 billion a year on universal health care, about $4,000 per person. In Montana, all systems—public and private, state and federal—it's a little more than $8 billion, and about twice as much per person.
"So they're living longer, less infant mortality, and they're paying half as much," said Schweitzer. "Unlike Washington, D.C., that piqued my interest. This is maybe a system that I want to look into."
Schweitzer talked about all of the factors at work in the high cost of care in the United States, factors that are well-known to anyone who has followed the health care reform debate: high costs in pharmaceuticals, in medical devices, in the number of services provided, in the fractured and divergent system providing care.
"In Saskatchewan," he explained, "they have five MRIs for the entire province. We have three in Helena for 35,000 people and a couple of dozen for Montana. Why? Because they cost $3 million and you can make $500,000 a year on them."
"We have an $8 billion health care industry in Montana right now, and 50 percent of it, or $4 billion, is coming directly from the federal government," he continued. "That may be enough so that we can get the rest of Montana in it. We turn to the rest of Montana and say to them we've got this $4 billion, and we're taking care of all these people, and now we've run the rates and if you want to pay into this system, here's how much it's going to be. If you don't want to buy into that system, you don't have to."
"If you want to pay twice as much for Blue Cross and Blue Shield and have their accountants lie to you," the governor said, "you just stay right where you're at. But I think they'll knock our door down."
Schweitzer is not too optimistic about the chances of this broad waiver being granted, but wants the health care reform discussion to continue. He's also not sure that in the intervening years between now and when the major provisions of the Affordable Care Act are implemented, that the core of the law will actually be maintained.
"The Affordable Care Act is probably not going to be implemented," he argued. "And most of it isn't going to be implemented until '14, and by that time it's going to have changed a great deal. We have people who continue to live lives, and they have children who get sick and there's elderly people who get sick and sometimes people get in accidents—we can't wait around for Congress."