Montana Looks North for Health Care That Works

To create universal care, Governor Brian Schweitzer is taking a hint from Saskatchewan—where the people live longer and it costs less, too.
Montana road photo by Zach Den Adel

Photo by Zach Den Adel.

A little over a decade ago he was busing Montana senior citizens to Canada to fill their prescriptions at reasonable prices—a way of protesting the American pharmaceutical industry. Now, Montana governor Brian Schweitzer is planning to establish a state-wide universal health care system modeled after that of the state's Canadian neighbor, Saskatchewan.

The governor, a Democrat, announced last month he will seek a waiver from the federal government to design his own health care system in Montana rather than implement all the regulations set by the Patient Protection and Affordable Care Act (PPACA), the federal health care reform package signed into law last year. His goal is simple: better care, for more people and less money.

Schweitzer follows in the footsteps of Vermont governor Peter Schumlin, who signed a bill earlier this year to move toward a single-payer health care system in that state. Vermont's system will also require a federal government waiver, an option included in a provision of the PPACA to allow states to pursue their own approaches to health care reform. The waiver won't be available until 2017, but legislation has been introduced to move that date up to 2014, when many of the PPACA mandates take effect.

Montana is one of just a few states in the nation that has maintained a budget surplus throughout the recession, and the governor doesn't plan on letting disappointing aspects of the federal program get in the way of that.

Schweitzer says about 50 percent of Montana's health care patients are enrolled in one of four government programs: Medicare, Medicaid, Indian Health Services, and the Veteran's Administration. While three of the programs are federally run, Medicaid, which provides care to low-income people, is the one government health care program the governor has some authority over, with 35 percent of its funding coming from the state.

In 2014, when the PPACA kicks in, many of the uninsured will be given the opportunity to enroll in Medicaid. With this change, Schweitzer expects the state's Medicaid population to double, creating a huge financial burden on the state of Montana under the current health care system. But the straightforward rancher-turned-governor isn't afraid to challenge policies he doesn't think make sense, no matter how established they are.

"Here's what I know," he says firmly, "that unless we challenge the underlying costs of health care ... it will bankrupt the states because there's no way of decreasing the cost of health care under the current system."

Like many, Schweitzer became frustrated with the health care debate in Washington, D.C., especially because lawmakers weren't looking to systems already working in other countries. Instead, they remained centered around American insurance industry interests. Montana is one of just a few states in the nation that has maintained a budget surplus throughout the recession, and the governor doesn't plan on letting disappointing aspects of the federal program get in the way of that:

There are similar demographics between his state and the province to the north, but Saskatchewans live two years longer on average and have a lower infant mortality rate than in Montana.

"I thought, 'My gosh, if I'm going to have to double my patient load and run the risk of bankrupting Montana, why wouldn't I look at a system that a neighbor is using for those people that are in the Medicaid population?"

Schweitzer points out the similar demographics between his state and the province to the north: Montana has a population of about 990,000, while Saskatchewan's is just over 1 million; the average age is just two months different; the ethnic make-up is about the same; and the economies of both are centered around farming, mining, logging, and energy production. Yet with the universal health care system in place, Saskatchewans live two years longer on average and have a lower infant mortality rate than in Montana.

After working through the numbers to compare health care systems with Brad Wall, the conservative premier of Saskatchewan, Schweitzer discovered the province spends about $4,000 per person per year to provide care to all citizens—that's half what Montana currently spends per person to provide care to only a portion of the population.

And while providing better service to more people for half the cost, Saskatchewan's health care providers are rewarded more generously than those in Montana. "The beauty of this system is that the general practitioners of Saskatchewan actually make $220,000 a year," Schweitzer says. "And, uh, general practitioners in Montana make far less than that."

There seems to be little opposition to the proposal, as it addresses both liberal and conservative concerns and exercises states' rights.

The difference, he says, is that Saskatchewan's health care program is not centered around profits. The province's health care is about 70 percent public and 30 percent private, while Montana's is about 50/50; in Saskatchewan, 87 percent of care takes place at community health clinics set up across the province, with contracted specialized services accounting for 13 percent, according to the governor.

Schweitzer says time and money are wasted on unnecessary procedures and equipment under the U.S. health care system because patients pay through third party insurance companies. With indecipherable medical bills and prices for every procedure pre-negotiated between health care providers and insurance companies, patients leave without knowing what they bought or how much they paid for it.

Contrary to rhetoric about "socialized medicine" coming out of Washington, Schweitzer argues Canadian health care providers are actually better capitalists because they negotiate prices with medical device and pharmaceutical companies. "Whatever pill it is that they're peddling, if that pill doesn't provide a better health outcome than a pill that's already available at a lower price, [health care providers] don't even buy the pill."

And eliminating insurance companies saves immense administrative time and money, allowing health care providers to focus on doing what they're meant to do: provide quality care.

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Schweitzer plans to emulate Saskatchewan's system by setting up community health centers across the state, employing physicians, nurses and nurse practitioners to provide almost all the care needed. For more advanced or specialized procedures, patients will be sent to contracted service providers.

The governor isn't confident that the waiver will be approved by the federal government, which recently denied his request to sell prescription drugs at Medicaid prices to all Montana citizens. Still, there seems to be little opposition to the proposal so far, as it addresses both liberal and conservative concerns with the Affordable Care Act and exercises states' rights.

State senator Jason Priest, a Republican from Red Lodge who has been involved in crafting GOP measures to undermine the PPACA, said, "I don't want to reject it before I see the details. I am just glad he is thinking about it."

While his ultimate goal is to provide care to everyone in the state, Schweitzer plans to start out with those he's responsible for insuring: Medicaid patients, government employees, and university faculty and students. For others interested in the program, the governor says they'll calculate the cost for citizens to buy into the program.

"And we'll say to the federal government, 'We have a better system than your Medicaid, your Indian Health Services," Schweitzer says. "If you want your patients to have better care, you can just bring them on over."



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