Without federal assistance in funding or policy leadership, many states have been cornered into difficult budget positions, forcing local leadership to invent new creative ways to manage money -- or simply go without. Unfortunately for Minnesota, the actions and rhetoric of our Republican governor makes the state's situation even worse.
In the last few years, most public discussion around the state budget has been a numbers game where facts and figures float away from any sort of context or situational examples (the same can be said for the national; take Social Security, for example). It's for a well-intentioned reason: un-connected dots usually hide bigger problems.
Minnesota's budget from last year's gridlocked session produced funding shortfalls that now require $25 million worth of fixes. Legislative spokesmen optimistically think this session's "deficiency bill" will provide coverage by Thursday -- since everyone this time around is now working so hard on civility. So who almost didn't get paid? Believe it of not, public defenders and emergency flood relief for the southeast part of the state. While that sounds bad, it gets worse.
There's no better example of playing with numbers than in Minnesota's healthcare discussions. First, the numbers. The projections from the Pawlenty Administration claim that in 12 years, at a growth rate around 27%, healthcare funding will make up 85% of the state budget, in spite of reports that claim healthcare costs are slowing down (currently education makes up the largest percentage, but with the slash and burn attitude on public education, a major shift could occur).
Those projections may be skewered, but I doubt by much -- healthcare costs are expanding radically. However, this is usually where the exposition with numbers stops and the punditry begins.
To take it a step further, the Governor characterizes the situation in terms of a bloated welfare state. But if one goes any further in laying out Minnesota's health care situation, such as asking why costs are rising so sharply, a dramatic change in the discussion occurs. Overhead costs for private insurances in Minnesota are around 14% (mostly because of head official's pay, name brand drug prices, office paperwork, malpractice insurance, and new technology costs), while other country's public insurance overhead costs around 2%. Even spending for Minnesota's GAMC program for low income recipients who earn less than $600 a month will go up 37% in this budget cycle.
So it's not a question of our programs, it's a question of the business of healthcare. For progressives, the point comes up over and over, certainly. But so do the specific ineffective responses to the problem. To attack the rate increase, the Governor wants to switch GAMC recipients over to MinnesotaCare, a different public program requiring premiums.
Since more individuals and small businesses are unable to afford or qualify for private insurance, people are now switching from money saturated private insurances to under-funded public programs. But instead of addressing why the rates are going through the roof, the Governor is looking for nicely presentable quick fixes by playing the numbers game. The bottom line? Big bad business continues, healthcare quality decreases, and people go without.
I mentioned the national social security debate earlier because the "it's an immediately threatening crisis that needs radical reform" rhetoric has been effectively tested on Minnesota's public programs by the Pawlenty Administration. We need new ideas on fixing health care, ones which begin from informed assessments and focus on not just the numbers but situations.