While governors of most states are deciding whether to implement or resist President Obama’s health care law, Montana Gov. Brian Schweitzer is looking to do something completely different: bringing a Canadian-style single-payer system on his state.
The details of the Democrat Schweitzer’s plan are not clear, and he has not submitted a formal proposal yet. However, in media appearances he has stated he wants to copy the health care system of Saskatchewan, a Canadian province directly north of Montana.
The prospects for this ambitious health care overhaul are dim, however, something even Schweitzer recognizes.
“We’re pretty similar: Montana has 990,000 residents and Saskatchewan has just over 1 million. They’re 10 percent Indian, we’re 7 percent. Their average age is just two months different than ours,” Schweitzer stated in an extensive interview with the Washington Post. “But they have a health-care system where they live two years longer and have lower infant mortality rates.”
Mark Rovere, associate director of the Centre for Health Policy Studies at Canada’s Fraser Institute, says such comparisons are off-base.
“A variety of research has shown that differences in population health statistics have little to do with health care systems,” Rovere says.
He says implementing a Canadian-style health care system in Montana would be a “big mistake.”
Carl Graham, president of the Montana Policy Institute, agrees.
“I don’t believe his proposals will bring down costs or improve quality and access,” he says. “Universal, single payer, or whatever label someone wants to use for government-run health care has been tried before and always results in longer waiting times and less access to quality care.”
Single Payer Problems
Rovere says Canadians have indeed experienced access problems, including significant wait times, and a variety of cost-control measures have reduced quality. He notes Canada’s health spending may be lower on a per-person basis than the United States’, but such spending only captures part of the cost of that country’s system.
And even with the lower per-person spending, the government devotes significant resources to funding Canadian health care.
“In 6 out of 10 provinces, half of all provincial revenue goes to health [care],” says Rovere.
Medicaid as Substitute
Schweitzer’s proposal would not result in a mandatory single-payer system in the state. Instead, he envisions something like “Medicaid for all,” where state employees would be placed in the Medicaid system and private employers could buy into it. He also proposes revamping the state’s Medicaid program to offer care through community health clinics instead of the traditional fee-for-service program.
Such a change would require a waiver from the federal government, which Schweitzer has acknowledged is unlikely to be granted.
Even if it’s approved by the federal government, Graham doesn’t give this plan much chance in the Montana legislature.
“I think there might be some room to work together around the edges, especially with the idea of removing federal strings from Medicaid through block grants or whatever. But the idea of a single payer system is anathema to the independent spirit of most Montanans, whether run by Washington or Helena,” Graham said.
Cost Control as Chief Aim
Schweitzer’s impetus to seek this radical change in Montana’s health care system is cost control. In his view, Obama’s law did not give states enough flexibility nor will it do enough to control overall health care costs.
In a March 2011 interview, Schweitzer said the law is “not going to work in the State of Montana or any other state for that matter.”
Graham agrees with Schweitzer’s criticism of the federal law, though not his proposed health care plan. He suggests alternate measures could drive market forces to lower costs.
“At the Montana Policy Institute, we’d like to see a do-over,” say Graham. “Get rid of ACA and instead address the valid problems with our health care system by focusing on empowering consumers instead of bureaucracies. That means a payment system that connects the consumer to the cost and encourages patients to be responsible customers—for example, HSAs, high-deductible plans, and things like that. We’ll also be rolling out a Medicaid reform plan that does this with low-income health care support plans.”