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health care demonstration

Last week, Daily Kos asked Governor Brian Schweitzer about his plan to pursue a single payer health system for the state, modeled on the system pioneered by Saskatchewan Province in Canada.
"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."[...]

"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's plan requires waivers from the federal government primarily for Medicaid, but potentially for all federal health systems. Schweitzer wants to include Medicare, Medicaid, Indian Health Services, SCHIP, VA—all federal health systems—to pool that $4 billion to set up a public option. He'd like to implement this program as soon as possible, so he is not waiting to see what the outcome of the various legal challenges to the Affordable Care Act will be, or for the provision of the law that allows states to apply for waivers to set up their own systems rather than the standard ACA exchange. Since Montana's Republican-controlled legislature refused to pass legislation to set up the exchange, as required by the law, Schweitzer's plan could be the kernel of a federal-state partnership under the law.

Two other states have innovative single-payer plans that are well-developed, while a handful are in the "still talking about it" stage, and one has abandoned its efforts. Vermont and California are the furthest along, and Connecticut has backed off a public option plan that had been in the works for years.

Vermont has established Green Mountain Care, a bill actually signed into law. There are still critical details, like how the program would be financed, to be worked out. This is where the Schweitzer model might come into play, and could be a sort of ideological reversal of the Republican answer for all programs—a block grant. Using all federal health care dollars spent in Vermont, or Montana, as a lump sum to finance a public health system, with the option for people with private insurance to buy in, is a smart solution.

They're looking at using the funds offered in the ACA to assist states in building the health insurance exchanges. Vermont is seeking a waiver to pursue the single payer system and not have to run a separate exchange. As the law stands now, they can't get that waiver until 2017. Democrats in both chambers of Congress have introduced legislation to move that date up to 2014, legislation which President Obama supports, and in fact has included in his jobs plan. For Vermont, the big question is whether there's any leeway for the administration to grant waivers ahead of what's allowed in the ACA for the system to be implemented. Vermont's success in this, in turn, could help clear a path for Montana.

California has made substantial legislative progress toward setting up its own single payer program, with a block of "two-year" bills that will both ready the state for the 2014 implementation of the ACA, and lay groundwork for a single payer system, a bill which is also slated to be considered next session.

Originally posted to Joan McCarter on Tue Oct 04, 2011 at 03:27 PM PDT.

Also republished by Single Payer California, Global Expats, ClassWarfare Newsletter: WallStreet VS Working Class Global Occupy movement, DKOMA, Progressive Hippie, These Green Mountains, and Daily Kos.

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Comment Preferences

  •  It's like using a toothpick to break an iceberg... (5+ / 0-)
    Recommended by:
    Anne Elk, Pluto, BYw, laborish, DontTaseMeBro

    But the fact that there are those out there continuing to try makes me feel that there is at least hope.

    “And in the end, it's not the years in your life that count. It's the life in your years.” ~ Abraham Lincoln

    by JMoore on Tue Oct 04, 2011 at 03:44:11 PM PDT

    •  But if one state gets a single-payer system (1+ / 0-)
      Recommended by:

      it would immediately be something that people in other states want.  

      Imagine what happens when health care costs are the lowest nationwide in the one state with the "socialist" healthcare system.  It's harder to argue against, right?

      At least harder to argue against in the second state.  

      I imagine that in Vermont it will be easiest to achieve and probably happen there first.  

      Then, California alone has 12 percent of the U.S. population. If Democrats were able to push a public option there, that's a lot of people whose lives are improved in itself.  But in the bigger and more diverse state it would be even more evidence that the system can work.   Then New York, Massachusetts, Rhode Island...

      I think this works in a way similar to same-sex marriage; it's main obstacle is prejudice and fear, and it's sort of a wedge issue.  Does the political power of insurance companies parallel the political power of Evangelical Christianity?  It might even exceed it, but I think it's somewhat similar.  Similarly I think a public option somewhat parallels the idea of civil unions as a sort of half-step.

      So single-payer starts in the states where the electorate is most favorable to it...the sky doesn't becomes something more Americans want.  I think you get maybe a third of the total U.S. population covered by single-payer systems in states where it is established, then the whole country finally establishes it at once.  

      Could happen...might not happen...but if the U.S. ever gets a single-payer system, I think it will happen like that.

    •  No, it's like using a Vermont to break a Texas! (1+ / 0-)
      Recommended by:

      It'd work. Vermont is pretty well shaped to grab onto despite its small size. It would be quite easy to jab a Vermont into a Texas! Many Texans will welcome the Vermont-jabbing, simplifying things.

      And, that is what we shall do with single payer and the like over the next several years. I hope.

  •  Inspiring. (1+ / 0-)
    Recommended by:

    This is the "good" America at work.

  •  Its very important (1+ / 0-)
    Recommended by:

    that the states push the envelope to do good things here.  Even if they don't go as far as schweitzer, they should be working to be active purchasers.  There's a paper on it from the Georgetown University Health PolicyInstitute that gives some background on other steps. .

    But this is the brass ring.

  •  peter shumlin (0+ / 0-)

    Is very positive that they can get a waiver in 2014. He really feels sincereity in Obama and sebelius.

    A couple of bloggers like Carnet have been poo poo ing the thought that Vermont will successful because Obama wanted the 2017 date and not 2014.  

    Bernie sanders himself said the cbo was being a complication for the 2014 waiver date. NOT OBAMA.

    Peter shumlin wanted a waiver from NCLB from Duncan and the administration delivered. :)  obama might bypass congress and grant the aca waiver for 2014 anyway.  They bypassed congress for education.

    •  Its in the president's interest (1+ / 0-)
      Recommended by:

      to deliver in VT.  The only way he loses is if single payer isn't tried there.   If it succeeds, it happenned because of his law.  If it fails, hey, that's why we didn't push for it.

      I also think he sincerely believes in the laboratory of democracy concept, having been a state legislator.

  •  How is this single payer? (1+ / 0-)
    Recommended by:

    The Schweitzer plan is simply a public option into which anyone can buy.

    Alternatively, people can continue using other insurers.

    In fact, though Vermont seems somewhat closer it is not single payer either.

    I don't know what the California proposal is, but given that the other two are not single payer I'd be surprised if California really is either.

    •  I'm convinced that once 2017 rolls around (0+ / 0-)

      even if a state wants to implement real single-payer, they'll be forced by the president to change it to a weak public option before being granted a waiver. Unfortunately it's at the president's discretion, and every year money's going to play more and more of an extreme role in Washington.

      "Only idiots believe the earth is getting warmer. Besides, they've proven it's only getting warmer because of sunspots."

      by Carnet on Tue Oct 04, 2011 at 05:32:11 PM PDT

      [ Parent ]

    •  he is doing sasakchewan's plan (0+ / 0-)

      In his state.

    •  From a California fact sheet (3+ / 0-)
      Recommended by:
      elfling, KenBee, wsexson

      prepared by State Senator Mark Leno:

      SB 810 (Leno) is the solution to rising health care costs and declining quality. SB 810 is a “Medicare-For-All” style single-payer health care reform plan.  It combines public financing with competitive private health care delivery and provides:

      Truly Universal Health Care - Eligibility is based on residency, instead of on employment or income. No California resident will ever again lose his or her access to health care because of unaffordable premiums, changing or losing a job, their age, divorce, or a pre-existing medical condition.

      Affordable Coverage – SB 810 requires NO NEW SPENDING because California already spends plenty of money to cover every resident with better coverage than what most Californians have currently.  This plan is paid for with federal, state and county monies already spent on health care and with premiums that are based on a percentage of income (for families) or payroll (for employers) that eliminate the premiums, deductibles, and co-pays now paid by employers and consumers....

      Many more details at the link such as "Freedom to Choose Your Providers," "Fair Reimbursements," Cost Containment through Efficiency," etc.

      The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

      by ybruti on Sat Oct 08, 2011 at 06:15:41 PM PDT

      [ Parent ]

  •  I think Brian Schweitzer has the political skills (1+ / 0-)
    Recommended by:

    to get the public to support this....I think he's right..

    I'm rooting for Vermont, California, and any other state that wants to try. If a couple states can successfully implement single payer, and people learn it saves money and helps the local economy, it could have a gradual domino effect.

  •  Here's hoping everything stays on track in Vermont (6+ / 0-)

    If Vermont can gets it waivers, and especially if they can get them early, then I imagine we will see more states becoming VERY interested.

    People can't seem to comprehend that other countries spend far less yet have better healthcare. Maybe when an actual US state does it (yeah yeah, it's not quite single payer, etc), people will start to pay more attention.

  •  YAY Sanity is fighting and moving beyond (3+ / 0-)

    PPACA. People are speaking up against wall street and insanity.

  •  Republished in Single Payer California (6+ / 0-)

    We'll get it done by 2014.

    SB 810 should be on Jerry Brown's desk in Feb 2012.

    Photobucket; an oasis of truth. Truth that leads to action 48forEastAfrica - Donate to Oxfam

    by Shockwave on Sat Oct 08, 2011 at 06:15:22 PM PDT

  •  Go gov... (3+ / 0-)

    Brian is the best argument against term limits I've ever seen.  He has been a smart, pragmatic and generally progressive governor for the last 7 years and the state is much better off for having him.  I don't always agree with him, but if he could run again I'd vote for him in a New York minute.

  •  Schweitzer 2016 (2+ / 0-)
    Recommended by:
    KenBee, historys mysteries

    Here's a guy that would make a great president.

  •  It's slow, but it's basically inevitable. (4+ / 0-)
    Recommended by:
    ChadmanFL, CrissieP, KenBee, supercereal

    Makes me think of the cause of marriage equality, or equality for lbgt military members.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Sat Oct 08, 2011 at 06:22:04 PM PDT

  •  This is the way to do it (0+ / 0-)

    ...on a State by State basis so that it reflects the needs and desire of the local population.  

    The Affordable Care Act is fundamentally flawed (along with being unconstitutional) because it pumps up the current health insurance system and subsidizes it.  For some States, the current insurance system is the way to go when coupled with high risk pools.  For other States like Vermont and Montana, they should give the federal government a raspberry and go their own way.

  •  Go California, Montana, and Vermont (4+ / 0-)

    We are very proud of you. you will take the lead from here and lead us to sanity.

    Vermont- Bernie Sanders
    California- Nancy Pelosi
    Montana- Brian Schweitzer

  •  Schweitzer 2016! (1+ / 0-)
    Recommended by:
    historys mysteries

    I hope he pulls this off and it is beloved by Montanans and decreases morbidity and mortality!

    Corporations are driven by the bottom line, not by concerns for health, safety or the environment. This is why we need government regulations.

    by the dogs sockpuppet on Sat Oct 08, 2011 at 06:34:07 PM PDT

  •  They will knock his door down and (6+ / 0-)

    they will revere him for decades to come if he puts single player in place for Montana. Tommy Douglas, the then-Premier of Saskatchewan is considered by many here to be the greatest Canadian ever.

    We have only just begun and none too soon.

    by global citizen on Sat Oct 08, 2011 at 06:35:30 PM PDT

  •  Booze & smokes cost more in Sask? (3+ / 0-)
    Recommended by:
    stolen water, psykos, Matt Z

    I'm too lazy to look it up but I think that alcohol and tobacco cost more in Saskatchewan than in Montana?

    That would explain the extra 2 years that people live north of the 49th.

    •  the cold keeps things fresh. (6+ / 0-)
    •  Interesting theory...would have to see the rates (1+ / 0-)
      Recommended by:

      of alcohol and tobacco use. I'm sure they're available somewhere, I'm just too lazy to go digging at the moment. Perhaps later...

    •  Montana - A Little Bit South of Saskatoon (1+ / 0-)
      Recommended by:

      "now this is not the end, it is not even the beginning of the end. But it is, perhaps, the end of the beginning." W. Churchill

      by Thor Heyerdahl on Sat Oct 08, 2011 at 07:45:14 PM PDT

      [ Parent ]

    •  It's only 2 years longer..... (1+ / 0-)
      Recommended by:
      historys mysteries

      It's only 2 years longer when you compare the lifespan of Canadians to Americans (including those with DVA and military health care and other government provided health care - including federal employees and Congress). If you compare Canadian lifespan to only those with American insurance-run health care, it is nearer a 4 year difference.

      Polls show that 91% of Canadians and 45% of Americans consider Canadian health care to be far superior to American insurance-run health care, and numerous polls and studies bear that out to be true.

      A metastudy of the ten most statistically significant studies regarding Canada and the United States, 5 demonstrate that Canada has the better medical outcomes, 3 are equal, and only 2 suggest medical outcomes are better in the United States. The cumulative result of those studies is that Canada's death rate for medically treatable conditions is 5% lower than analogous deaths in the United States on a per capita basis.

  •  The state route is the way to go (2+ / 0-)
    Recommended by:
    Eric Blair, historys mysteries

    My guess is part or all of the Affordable Healthcare Act are stricken by SCOTUS, if not all of it.  Single-Payer healthcare initiated by the states is the way we're ultimately going to get true healthcare reform.  Some parts of AHCA are a good idea, but on the whole it does little to actually control costs and leaves failed private insurers running the system.  Vermont is only the start.  Once is succeeds there it'll spread like wildfire.

    I'm guessing this goes nowhere in Montana, but I'm very happy to see Schweitzer at least pushing it.

  •  This is a brilliant approach in Montana... (2+ / 0-)
    Recommended by:
    Matt Z, mashed potatoes

    ...and should be the model pursued on a state level and nationally. Combine all the programs (huge admin savings there alone) and put everyone into the same pool. Very efficient and very fair.

    This is what Mass should have pursued and hopefully what Vermont does go to.

  •  From a Governor, yet! (4+ / 0-)
    Recommended by:
    Matt Z, Odysseus, mcmom, mashed potatoes

    "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."

    We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

    by david78209 on Sat Oct 08, 2011 at 07:15:26 PM PDT

  •  The way we're gonna get single (3+ / 0-)

    payer is thru the states. Period. Congress is unable to get it done. And, the Red State governators will do everything they can to kill Obama's Affordable Care. That pretty much leaves it up to the Blue States. And, when the Blue States pass Single Payer their Red State neighbors will be pressured to join their more enlightened blue neighbors. Eventually that pressure yields.

  •  Stupid question - how does optional bit work? (1+ / 0-)
    Recommended by:

    This is awesome news and I hope it works out and that we're drug inexorably into the 20th century.

    Maybe I'm dumb but how does it work being optional ? Won't private companies just tweak their rates so th at they can give away high deductible plans like candy and steal all the twenty-somethings?  The state end s up with a shitty risk pool and crumbles...  How big a loss do you think they're willing to take in a small state like MT in order to show that their huge industry serves a purpose? They'll want this plan dead if they have to sell to montanans with a huge discount, especially to twenty and thirty year olds.

    But of course we have to let them rate state by state--that's the whole "sell across state lines" thing the right keeps talking about, the better to let the states race against each other in a bid to buy an industry like SD did with credit cards...

    No matter how cynical you become, it's impossible to keep up; no matter how cynical you are, you have no idea...

    by ChristopherMays on Sat Oct 08, 2011 at 08:11:59 PM PDT

  •  The right idea (1+ / 0-)
    Recommended by:

    Schweitzer has the right idea. The fragmented nature of American health care makes it impossible to hold down costs, facilitates cost shifting, and inhibits the gathering of meaningful outcome data.

    "I want real loyalty. I want someone who will kiss my ass in Macy's window, and say it smells like roses." Lyndon Johnson

    by pkgoode on Sun Oct 09, 2011 at 12:54:29 AM PDT

  •  And Montana is a "red" state (1+ / 0-)
    Recommended by:
    mashed potatoes

    It's great to see that Governor Brian Schweitzer is working on single payer health care for Montana.  This is a state that George W. Bush carried by at least 20 percentage points twice and that has been carried by the Democratic nominee just once since 1964 (and only with the help of Ross Perot).  If single payer health care is a winning issue in Montana, then it should be a winning issue in many "bluer" states.

    Not only is Montana a "red" state, it's also considered a libertarian haven.  This is the state that had the "reasonable and prudent" daytime speed limit on Interstate highways in 1995-1999.  This is a state where supporting gun control is automatic political suicide.

    Governor Brian Schweitzer is a model for "red" state Democrats.  He has his share of differences from the national party (or he wouldn't be a 2-term governor), but he's no obstructionist Blue Dog.  He is by far one of the most popular governors in the entire country.  The country and the world would be in much better shape if we had more people like Brian Schweitzer and fewer like Joe Loserman, Blanche Lincoln, Ben Nelson, Evan Bayh, Mary Landrieu, etc.

    You might be a Rethug if you join forces with the tobacco lobbyists but condemn abortion, birth control, and gay marriage as crimes against humanity.

    by jhsu on Sun Oct 09, 2011 at 09:04:43 AM PDT

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