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Sanford Withdrawing from Avera’s DakotaCare—Time for Public Option!

Because Avera and Sanford can’t get along, going to the doctor is about to become a bigger pain the keester for thousands of South Dakotans. Sanford is pulling out of the DakotaCare network, meaning that, as of January 1, 2017, folks with DakotaCare (including 12,000+ state employees) will have to put up their own cash to visit Sanford hospitals and clinics.

Right now, DakotaCare and Wellmark are the only health insurance providers that includes the two market-dominating hospital chains, Avera and Sanford, in their coverage networks. Both Avera and Sanford offer additional insurance plans, but Avera’s plans don’t include Sanford providers in their network and vice versa.

Last year, Avera bought DakotaCare. So right now, Avera owns a plan that provides coverage at Sanford facilities. Free-market tension ensued:

Earlier this year, Sanford officials say they approached Avera about extending access to Sanford Health Plans to Avera physicians, a move that would have created a third broad network plan in the state and one that would have put Sanford on an equal footing with Avera’s DakotaCare plan. But Avera countered with a proposal that Sanford buy an equity share in DakotaCare.

Paul Hanson, the executive vice president of Sanford Health, said Sanford balked at Avera’s proposal based on philosophical and regulatory concerns. Hanson said he didn’t think it was realistic for two competing health systems to own an insurance company, and he said the move might have raised anti-trust problems with the two owning a single insurer [Jonathan Ellis, “Sanford to Leave DakotaCare After Negotiations with Avera Fall Through,” that Sioux Falls paper, 2016.08.23].

Hmm… maybe it’s not realistic for any health system in South Dakota’s sparse health care market to own any insurance company. If two oligopolizing health care providers are going to leave us with only one broad health insurance network, the market is failing us. The public option—the recommendation from President Obama and candidate Clinton that we offer Medicare to citizens under 65—is now all the more warranted in underserved South Dakota.


  1. Rorschach 2016-08-24 07:52

    More proof that Sanford Health doesn’t play well with others. They don’t want to cooperate. They want to dominate. It’s a non-stop arms race with Sanford Health. Don’t buy into an established network – Dakotacare. Create your own, and leave Dakotacare customers without doctors in your network. Going back a few years, doctors used to have privileges in both Avera McKennan Hospital and Sanford Hospital. It was Sanford Health that did away with that cooperation by requiring its doctors to work exclusively at its hospital.

  2. jerry 2016-08-24 08:19

    Maybe this is the way to get Dakotacare out of being able to insure the state workers. 12,000 employees is a whole lot of belly buttons that will complain to the powers to be for a change. Sanford cannot give them the access but Wellmark can. Think of it this way, Wellmark has never been denied a rate increase (30 per cent rate hike for this year, 45% last year), so why not let yet another out of state company take over? According to what I have read on this blog site, South Dakota gets its ballots printed out of state apparently because we here cannot spell. The more government money that you can send out of state from a few prying eyes, the better.

  3. Troy Jones 2016-08-24 08:31


    You do realize all the changes in the industry, defections from participating in exchanges, and rate hikes can be directly to the faults in the design of Obamacare don’t you?

    Assuming you grasp this, I have two questions:

    1) Will you admit Obamacare was designed to fail, either intentionally or unintentionally?
    2) If intentionally, was it designed to make the public option the default option?

    Your post seems to indicate #2 with your quickness and zeal to advocate the public option as the answer (vs. reform of Obamacare or its repeal and replacement).

  4. Snaillady 2016-08-24 08:50

    Troy Jones, since the ACA was crafted using the Heritage Foundation’s model and following Mitt Romney’s use of the plan when he was governor, do you really believe that conservatives formatted a national healthcare model to fail? Where’s the profit in that?

  5. Greg 2016-08-24 08:57

    Sanford Health is more about control and profits than healthcare.

  6. Craig 2016-08-24 09:01

    Of course the only answer from the Republicans must be “blame Obamacare”.

    Troy did you even bother to read this story? This has nothing to do with Obamacare and everything to do with one health system not wanting to play well with another health system. There is no law that precludes them from continuing the status quo and allowing DacotaCare insurance to cover Sanford practitioners.

    Bu… bu… bu thanks Obama.

    Secondly, we have actual proof that the recent withdrawal of Aetna from the Obamacare system in numerous states is simply a retaliatory strike against the DOJ due to the lawsuit to prevent the Aetna / Humana merger. We even have documentation from Aetna threatening the pull out if the government didn’t allow the merger even while they had previously indicated (in early 2016) they were in support of Obamacare and had plans to expand. Where I come from that sounds a lot like blackmail.

    This is not a failure of Obamacare – it is simply a move to pressure the government into giving them what they want.

    It seems clear at this point that the private market isn’t willing or able to get the job done. They are too concerned with profits and too concerned with enriching themselves via golden parachutes and multi-million dollar annual bonus payments to executives. Did I mention the CEO of Aetna paid himself $28MM last year? I know we should feel sorry for him because a few years earlier in 2013 he made over $30MM. I was probably hard for him to deal with a pay cut.

    It is time we admit that healthcare will continue to suffer as long as we allow for-profit industries to call the shots, because these companies will always put profit ahead of patients.

    Medicare for all is the answer. The private market has proven it via their own actions.

  7. jerry 2016-08-24 09:06

    In light of the record profits of the insurance companies, show how those “flaws” play into a failure of Obamacare Mr. Troy.–PR_301891

    Why was the public option ever taken completely from the table, to get the insurance company’s approval for their greedy little hands. They have proven that they cannot help themselves by running the program without raiding the program. So then, Cory is correct, we need the Public Option. What the hell is that? Here ya go

  8. Don Coyote 2016-08-24 09:07

    The solution to an oligopoly would be to allow cross state sales of health insurance policies. It would not only increase competition but increase the size of risk pools and reduce administrative costs.

  9. David Newquist 2016-08-24 09:08

    The salient point is that the delivery of healthcare is not a consideration in the negotiations between two allegedly non-profit corporations. Corporate power and control is the only concern reflected. It shows the failure of corporations in providing for the general welfare of the people and makes a strong case for single-payer insurance. For the people, healthcare is the objective, not just an incidental issue in the corporate culture.

  10. Troy Jones 2016-08-24 09:18


    1). DAKOTACARE was forced to sell itself directly because of Obamacare.

    2). Aetna was leaving no matter whether the merger was approved or not. They were losing money because Obamacare violated simple actuarial soundness (which was really why we had to pass it to find out what is in it, as Gruber admitted it wouldn’t withstand basic financial soundness examination). Their threat was only to delay the inevitable- leaving the exchanges. It was so obvious that the threat probably impacted the merger rejection (a rejection warranted on its face).

    3). Profit is what invests in the future. Your knee-jerk response only belies your bias to have the public option prevail which supports my point. Obamacare was never designed to work but have the government take over health care from cradle to grave.

  11. Don Coyote 2016-08-24 09:29

    @Snaillady: “… since the ACA was crafted using the Heritage Foundation’s model and following Mitt Romney’s use of the plan when he was governor …”

    That’s not true. Under the Heritage health care model the “individual mandate” provided for only catastrophic health insurance coverage not comprehensive. The Heritage model used the loss of tax credits rather than the tax penalty that Obamacare uses. Under the Heritage model Medicare would have become a voucher program and the federal role in Medicaid would have been reduced not expanded.

    Also “Romneycare” was nothing more than Mitt Romney acquiescing to legislation developed and passed by a Massachusetts Legislature where Democrats possessed a super majority in both houses and overrode 8 Romney vetoes. Romney really had no choice. Just like with Obamacare, the Democrats own in it’s entirety the whole bag of krazy kat healthcare legislation.

  12. Don Coyote 2016-08-24 09:35

    I see the esteemed Professor demonstrates his ignorance of the term “non-profit” with his use of the qualifier “allegedly”.

  13. Craig 2016-08-24 09:41


    1) Sounds like that is an accusation worthy of a citation. I assume you have a source? I read the stories when DakotaCare was sold and it mentioned to such requirement.

    2) I’m glad you know what Aetna’s plans were even though earlier in the year they had indicated they were in support of Obamacare. Again – sounds like a claim worthy of a source. If find it interesting that so many companies are still in the exchanges, but others claim they can’t make it work. Sounds a lot like poor management to me… or perhaps it has more to do with them not being able to make enough profit from the exchanges so they leave to focus on other sectors known for being more profitable.

    3) Why is that so many are quick to equate profit with investing in the future when it is a private company, but when the government wishes to invest in the people, we are told the cost is too high? Pick a lane perhaps?

    As far as bias… yes I have a bias. That bias is developed from years of watching the industry try to manage itself while seeing what our peers in other nations experience with their healthcare. It is seeing people go without healthcare due to cost. It is seeing an infant mortality rate in the US that puts us behind Slovakia, Hungary, Poland and about 25 other nations and one which is three times as worse as nations like Japan. It is from seeing insurance companies deny life saving treatments and drug companies increasing the costs of drugs by hundreds or even thousands of percent not because the cost of production has increased, but because they wish to increase their profits.

    We have tried privatized healthcare for the past 100 years. It clearly hasn’t worked. When preventative care is avoided due to the cost, and when citizens are denied such care simply because they lost a job or have to choose between making rent or paying for health insurance this month then clearly the system is broken. How many more opportunities do we give to the private insurers to clean up the mess?

    When something doesn’t work as we had hoped it isn’t always our fault, but when we continue to do the same things year after year and decade after decade while knowing they still don’t work then yes it is very much our fault. Single payer is the best alternative I’ve seen presented. If others have ideas I’m open to them, but aside from the Republicans voting to defund Obamacare every other week for the past two years I’ve yet to see any concrete solutions to a problem we clearly know exists.

  14. Donald Pay 2016-08-24 09:49

    Troy says, “Profit is what invests in the future.” Interesting theoretical idea that sometimes applies, but not always, especially not in health insurance. What “future” is being considered? Are we talking quarterly profit numbers, or the long-term health of the people covered under the insurance plan?

  15. Eve Fisher 2016-08-24 10:00

    As long as health care is considered the same as, for example, auto repair, i.e., a for-profit business, in which every health care provider, drug manufacturer, and insurance company can charge what the market will bear, we’re going to be screwed. Because it doesn’t take a rocket scientist to know that when your loved one is desperately ill, you’ll pay anything and everything you have to save them. When my husband had his heart attack, I didn’t shop around to see if there was a cheaper way to get him to Sioux Falls than by helicopter. Instead, save his life! Now! And so prices go up – the epi-pen costs are a classic example – and up and up… And everyone just sighs and says it’s one more price for freedom. Bull. It’s greed. Give me single payer. I want every American on Medicare. We can make it work.

  16. Troy Jones 2016-08-24 10:56


    1) The Sioux Falls business community is not that big. Maybe the best confirmation is both Hospital systems supported passing Obamacare and Dakotacare opposed it. They all knew what the effect was going to be on this insurance business model.

    2) I guess it is in the eyes of the beholder on what is good business practice and management. Personally, an insurance company staying in a business segment that is actuarially unsound would be poor management.

    3) Your confusion belies your lack of basic micro-economics with regard to rhetorically equating business profit/investment with government spending/subsidy/investment.

  17. Dicta 2016-08-24 11:14

    “Hmm… maybe it’s not realistic for any health system in South Dakota’s sparse health care market to own any insurance company.”

    Meta-analysis of peer reviewed research indicates the vast majority of studies show integrated delivery systems have a positive impact on quality of care. I think it is plenty realistic as well as effective.

  18. Craig 2016-08-24 11:16

    So Troy – that’s a long way of saying you don’t have any sources to back up your claims then?

    Duly noted.

  19. Jenny 2016-08-24 11:23

    I think blaming all of this entirely on Obamacare is a copout. As if Healthcare corporations were not playing games like this before.
    Should profiting off of sick people be ‘good business practice and management, Troy”?
    The most popular healthcare program by far to Americans is Medicare.
    Until Medicare is expanded for all and the Corporate giants quit playing corporation games, Americans will continue to get screwed.

  20. Rorschach 2016-08-24 13:14

    This story isn’t about Obamacare. It’s about one health system that’s trying to gobble up the world to the detriment of South Dakota citizens who will now have their access to doctors of their choice limited or curtailed entirely. One health system has a white hat here, and being the uber-Catholic that he is I expected Troy to make note of that fact. Instead he tried to change the subject. Are you on the Sanford payroll, Troy?

    The only thing relevant to note about Obamacare is that both hospitals want the governor to expand medicaid so they can recover some costs from treating the working poor. I know an individual who works full time who does not qualify for medicaid and does not make enough to qualify for and pay for Obamacare either. The only way for him and his family to get coverage would be if the state expands medicaid eligibility as contemplated by Obamacare. Thus he and his large family are uninsured. If anyone needs to go to the emergency room the family is at risk of being bankrupted. They go without routine healthcare, which will catch up to them eventually. Also if they go to the emergency room – the hospital will shift the costs of that to paying customers. If for-profit insurance companies are too set on paying executives exorbitantly and flooding the airwaves with advertising – all while claiming they can’t make a profit on Obamacare, then perhaps there ought to be an option for people that has lower overhead costs – like medicare.

  21. Jenny 2016-08-24 13:30

    Troy needs to listen more to the Catholic church’s support of Single Payer Healthcare.

  22. Dicta 2016-08-24 13:46

    “The most popular healthcare program by far to Americans is Medicare.”

    The program’s own trustees expect it to be insolvent by 2030. Popular or not, it has serious problems.

  23. Jerry 2016-08-24 14:02

    Don is correct on across state line product sales, and as luck would have it, the platform already is here. We call it Medicare. Ask any old duffer or dufferette how they like it, they will tell you that they love it.

  24. Jerry 2016-08-24 14:05

    Medicare, as we know it’s nuts and bolts today, may be insolvent if we do not make adjustments to it to increase the amount paid in. Not to difficult to do.

  25. Troy Jones 2016-08-24 14:36


    The Catholic Church has no binding position on single payer health insurance. It is a matter of prudential judgment and its advocacy by some in the Church (regardless of position) is neither binding as a matter of Faith and Morals nor is their position de facto of any greater credibility of Catholics who disagree.

  26. Troy Jones 2016-08-24 15:12


    You are absolutely correct that we must always have a preferential option for the poor. However, it is up to our prudential judgment (combination of our life experiences, education, and faith) to discern best how to implement/accomplish such preferential options. Based on my experience, general and fairly recent expansion of government programs worsens the condition of the poor long-term and thus in many cases, I discern we need greater economic growth to improve the condition of the poor and more regulations and higher taxes and greater reliance on the government actually worsens their condition.

    I’m called to follow what my conscience guides me to do in matters of prudential judgment while always pursuing a better formation of my conscience, expanded life experiences, and being open to changing my mind as both my experiences and conscience develop.

  27. Darin Larson 2016-08-24 15:38

    I will translate what Troy is saying here: If we try to help the poor, we will end up hurting the poor. You see, when the poor get regular meals, decent housing and an education, that is preferential treatment and they will come to expect it. The poor don’t need alms; they need a job. That was what Jesus was getting at when He said we will always have the poor with us, but we will not always have Jesus.

  28. jerry 2016-08-24 15:57

    Clinton just put the drug cmpany’s on notice that she plans on regulating their sorry behinds.

  29. jerry 2016-08-24 16:17

    For the record, the maker of EpiPen is the daughter of a Democratic senator, Clinton is going after those tax dodgers and price gougers.

  30. Craig 2016-08-24 17:28

    “Based on my experience, general and fairly recent expansion of government programs worsens the condition of the poor long-term”

    You may want to look up the impact of welfare reform which was signed by Bill Clinton in the 1990s and see what impact it has had. Here is a hint – a lot fewer people on welfare and a lot more people in poverty.

    Facts have a pesky way of shattering biases don’t they?

    “Go get a job you lazy bum and stop trying to mooch from Ceasar” ~ Jesus

  31. bearcreekbat 2016-08-24 17:49

    Troy, ah, “the condition of the poor.” But which conditions? Hunger? The need for shelter? Medical care? Clothing? Education? Transportation? Heat in the winter? Some other condition that Jesus addressed in the Bible?

    Which of these conditions do you believe are worsened in the long term by providing government programs and assistance intended to help the poor with food, shelter, medical care, education, transportation and the like?

    And what about the Catholic position in the link concerning treatment of the poor that states:

    “It demands fair international trading policies, decent treatment of refugees, support for the UN and control of the arms trade. Solidarity with our neighbour is also about the promotion of equality of rights and equality of opportunities; hence we must oppose all forms of discrimination and racism.”

    Which candidate’s public statements and historical behavior do you believe is most consistent with these specific goals Troy – Trump or Hillary? You sure have the right to support Trump and oppose Hillary, but you might be engaging is some sort of self-deception if you believe such a position is consistent with Catholic teachings on how we should treat each other, strangers (immigrants and refugees) and the poor.

  32. Jenny 2016-08-24 21:18

    Troy, your unempathetic robotic answers to Catholic teachings do not fool anyone.
    You know darn well that Pope Francis supports universal healthcare and has spoken on it recently and who knows a Catholic nun that is against universal payer? That nun would be waayyyy in the minority.
    Profitting off the poor and sick is so far against the teachings of the Catholic church. You need to admit to yourself that you are a supporter of an institution that clearly favors socialism. Once you can come to terms of that you’ll be a better man. Denial is never good.

  33. Troy Jones 2016-08-24 21:50


    The specific policies of government to pursue the preferential option to the poor is a matter of prudential judgment of each individual Catholic. The Pope’s prudential judgment to be respectfully considered but are not required to be accepted.

    That said, there has not been an encyclical against capitalism to the degree there has been one which condemns capitalism as inherently unjust while socialism has been so condemned. All papal encyclicals which criticize capitalism highlight its weaknesses and issue a call for us to mitigate those weaknesses by individual and collective action (the specifics which are given to the discernment of the individual). Additionally, the Church has never condemned profits, only unjust profits which opens up what is unjust to further prudential judgment.

    With regard to your comment my position is a minority, I have no idea if my position is in the minority of Catholics in the US or world and neither do you know. But, matters of prudential judgment are individual matters whereby being in the minority or majority is not a consideration for one to violate their prudential judgement.

    Finally, whether my comments are “empathetic” or not is irrelevant . With regard to matters of Faith, Morals, and Prudential Judgement, we are called to use our mind and conscience on such matters and dismiss “feelings” or emotion because emotions can only confuse and distract us. So I guess I should thank you for the compliment you find my commentary without emotion or feeling.

  34. Troy Jones 2016-08-24 21:54

    “is a NOT consideration for one to violate their prudential judgement.”


  35. grudznick 2016-08-24 22:08

    Ms. Jenny, this is not unlike how the Catholic Church is renaming Harney Peak, is Sanfording everything else, in fact I would not be surprised to find out that way back, before the Lakota were even in the Black Hills, there was a fellow named Sanford who had pre-dated the Thoen Stone, discovered gold way back then and climbed that hill and we now need to name it Sanford Peak.

    Could the Forest Service be talked into naming rights? The carving of a third giant head to deface the rocks of the general area? Crazy Horse is rolling in his grave.

  36. Troy Jones 2016-08-24 22:36

    Bear and Jenny,

    By the way, reading the definitive guide from the United State Conference of Catholic Bishops “Forming Consciences for Faithful Citizenship” gives me greater coverage to support Trump over Clinton than I “feel” comfortable because I think they both embody a plethora of positions which I oppose.

    Frankly, your counsel on what I should do as a good Catholic has absolutely no standing with me. Your not the Pope, my Bishop or my Pastor and I’m called to discern their teaching and admonitions and confident in my ability to do so without the help of people who I only have acquaintance through a blog and no knowledge of your interior life.

  37. grudznick 2016-08-24 22:49

    Mr. Jones, do you see your church backing away from the naming of things, like hills or buildings, as something that will happen over the next couple of years, or over the next couple of hundred years?

  38. Jenny 2016-08-25 02:11

    Keep at those Catholic Social Doctrines, Troy.
    Avera is not Catholic anymore since it’s going against the Common Good.

  39. Jana 2016-08-25 08:03

    “Based on my experience, general and fairly recent expansion of government programs worsens the condition of the poor long-term”

    Does the same hold true for Ag and Business welfare?

    Just wondering.

  40. Dicta 2016-08-25 08:30

    “Medicare, as we know it’s nuts and bolts today, may be insolvent if we do not make adjustments to it to increase the amount paid in. Not to difficult to do.”

    Increasing revenues to the tune of 100s of billions of dollars ain’t exactly easy without shifting money around elsewhere. I always chuckle when I hear “it’s so simple!” in regards to programs like these because it rarely is.

    Also, for what it’s worth, I think Sanford comes across looking like the bad guys here. Consider what they did. Avera spent oodles of cash to obtain Dakotacare, at least in part because those covered lives had in network access to Sanford docs. Sanford, in an act of corporate chutzpah, demands that Avera just give Sanford Health Plan members the same benefit. Avera PAID to get access. And when Avera doesn’t just hand it over, despite being offered buy in to Dakotacare the same way Avera did, Sanford walks.

    The information we’ve been able to obtain sure makes Sanford look like the bad guys here, and it’s not inconsistent with the way they’ve done business in the past. I think this was the death knell for me seeking medical care from them ever again.

  41. caheidelberger Post author | 2016-08-25 09:34

    Hey, Dicta: do you have some links on that claim about integrated delivery systems? Does “intergrated delivery system” include the insurance system? How does having the hospitals own the insurance program improve care? Does it lower costs?

  42. leslie 2016-08-25 09:42

    THE CONSCIENCE OF A REPUBLICAN. not something to entrust our future too, certainly, troy. your words…”basic financial soundness ” are spun as hard as any obstruction you have thus far foisted on the American public, and the world economy for that matter.

    “The Sioux Falls business community is not that big.” you say, despite SD’s aggressive courting of the world economic/financial industry making a hidden largest economic engine in the state over AG.

    finally, “Obamacare was never designed to work but have the government take over health care from cradle to grave.” is their meta data or micro data or metrics or even a citation you may wish to share with us?

  43. leslie 2016-08-25 09:46

    “to”… and “there”. cripes:(

  44. caheidelberger Post author | 2016-08-25 09:47

    Medicare is not going bankrupt. We’ve given it eleven more years of solvency with the Affordable Care Act. Baby boomer die-off will give it more. And allowing us young healthy folks to sign up for it and kick in our premiums would make its funding even more solid and make this whole network squabble between Sanford and Avera far less relevant to most South Dakotans’ lives.

  45. Dicta 2016-08-25 09:49

    Here is a link regarding IDS and outcomes and a meta-analysis of the studies surrounding them:

    You ask good questions on what the studies showed, so I’ll reproduce them here:

    1. Quality of care improved across the board in almost all studies
    2. A few showed lower utilization rates
    3. One study showed cost savings

    More often than not, integrated delivery systems have their own insurance wing, but this is not a necessary condition to be defined as an IDS. The two best examples in the US of IDS are Kaiser Permanente and Mayo, both of which provide plans. The idea behind the integration is that in increases transparency across the continuum of care, allowing the payor and provider an opportunity to work in a cooperative manner, rather than the competitive one they generally did under a fee for services model. These models are frequently capitated, where the payor provides capital on a per member/month. This encourages the provider to avoid unnecessary procedures and also preventing readmissions. It forces creativity in changing lifestyles, improving medication adherence, monitoring of chronic conditions outside clinic walls, etc.

    Let me know if that answers your questions.

  46. bearcreekbat 2016-08-25 11:05

    Troy, far be it from me to tell you how to believe or practice your religion. I perceive substantial differences in what I read online about the purported nature of the Catholic faith in how they should treat the poor and your unsupported statements that the poor are somehow worse off when we have public policies aimed at making food, shelter, heath care, education, and other necessities of modern life available to the poor.

    The unfortunate contrast between these public statements purporting to be church doctrine and the apparent freedom of committed Catholics like yourself to adopt completely contrary views provides a compelling reason for rejecting religious doctrine and accepting atheism as a significantly more morally consistent and compassionate belief system. Thank you for that, I guess, as this contrast really undermines any attempt to view religions like Catholicism as anything other than scams aimed at separating people from their money and giving them a moral freedom to disregard the needs of the poorest among us.

  47. Don Coyote 2016-08-25 13:12

    @cah: “Medicare is not going bankrupt. We’ve given it eleven more years of solvency with the Affordable Care Act. Baby boomer die-off will give it more.”

    The eleven years additional solvency only applies to Medicare Part A (hospitalization) and is conditional on whether the future hospital payment price constraints imposed on Medicare by the ACA become unworkable (they will) and that Congress won’t override them (they will).

    Solvency would also be affected by how the economy grows or doesn’t and the labor participation rate which is declining partly due to the anemic recovery but also because of the increasing numbers of baby boomers going into retirement. Both of these affect how much revenue is collected by the payroll Medicare taxes of the employee and employer.

    Keep in mind also that the $700B in Medicare savings that were used to help pay for ACA will blow yet another hole in the debt when the Medicare bonds are cashed in. The CBO estimates that by 2029, 1 in 5 dollars of the federal budget will be spent on Medicare and by 2041 it will increase to 1 in 4 dollars.

    Current Medicare funding is sketchy at best. Future funding is peppered with unfunded liability land mines. A single payer system with another 200M patients is totally unsustainable.

  48. Rorschach 2016-08-25 13:42

    Yet … Canada sustains. Canada sustains. Are they just smarter than us?

  49. Don Coyote 2016-08-25 14:16

    The Canadian health care system is plagued by doctor shortages, overcrowded clinics and clogged ERs. Canadian wait times for treatment have increased to twice as long as they were in 1993. Access to doctors has suffered so badly that many Canadians are now crossing the border to find treatment in the US. Costs continue increasing in a never ending spiral. By 2017, six provinces (including the most populous ones of Quebec and Ontario) will be spending 50% of their revenues on healthcare. Doesn’t sound very sustainable to me.

  50. Dicta 2016-08-25 14:39

    “Access to doctors has suffered so badly that many Canadians are now crossing the border to find treatment in the US.”

    This isn’t really true and never has been.
    Some, particularly those with susbtantial assets, do. The vast majority do not.

  51. jerry 2016-08-25 14:57

    Medical tourism is very lucrative with savings up to 90 per cent, as my daddy used to say, “that ain’t hay”. Don seems to think that our health system is the best in the world, easy to say when your world does not exist. Try dental work in Mexico or europe, it will pay for your trip

  52. Craig 2016-08-25 14:59

    Canada spends 11.4% of their GDP on healthcare… the US spends over 17%. According to Gallup, Canadians are also twice as likely to be satisfied with their healthcare than Americans are (52% vs. 25%). It isn’t a perfect system, but the results show it is effective, less expensive than what we have, and the citizens have a higher opinion of it.

    I’m pretty sure Canada is doing just fine. As are the dozens of nations which continue to have universal healthcare. For all the scare tactics we hear from the right…. when is the last time we heard of a nation which switched from universal healthcare to anything else? Yet we keep thinking if we just give the big drug companies and private insurers a few more decades… maybe they can get it right eventually.

    Time to try something new. Ask anyone on Medicare if they are happy with their coverage and you’ll likely hear positive news. Thus, perhaps it is time to change.

    I realize we cannot just flip a switch and migrate everyone onto Medicare overnight. However, we could change the age people can go to Medicare and adjust that age over time. We start at 60, and in a couple of years we drop the age to 55. Then we drop it to 50 and so on until everyone is covered. This gives the private insurance companies time to modify their businesses and gives the healthcare industry time to adapt to the new model since it comes in waves and not all at once.

    I’m sure we can do it and I’m sure it will cost us less than the current solution.

  53. jerry 2016-08-25 15:47

    Craig, you actually could switch to Medicare in about 1 month’s time. As long as you have a social security number, simple and fast.

  54. Troy Jones 2016-08-25 15:50


    What you are conflating are distinct matters of Church Teaching on a hierarchy. I’m summarizing these in laymen’s terms and in summary certain complexity and nuance is lost. Plus, my examples aren’t perfect as to some degree they have application or tangential pieces covered somewhere else. Don’t beat me up on the examples or argue them. I selected them as simple to list.

    Dogma, Doctrine, and Infallible Teaching are Teachings which must be believed by the faithful. Failure to accept theses Teachings are grave matter and failure to believe them are a separation from God and His Church. I’m not going explain how they aren’t necessarily de facto separation but it goes to knowledge, will and intent. These are to be accepted as an assent of faith.

    Then there are Teachings which are considered Authoritative (a compendium (not all inclusive) of such Authoritative Teaching is found in the Catechism. While lower on the hierarchy than mentioned below, it is not to be taken less seriously by the lay Catholic and failure to accept may be just as grave. But these are matters to be accepted to be as an assent of the will and intellect.

    All of the Teachings which are among the above are Teachings to one is to hold or, if one is struggling to hold by reason of will or intellect to be sincerely and actively aspiring to reconcile/hold by living the sacramental life, learning and understanding the teaching, and prayer.

    Everything else are matters where one is the listen to the heart of the Church, contemplate through prayer and learning, and listen to one’s conscience. These are those matters where Prudential Judgment come into play and good faithful Catholics may hold differing positions so long as the rationale and judgement is formed based on one’s honest understanding and listening to one’s conscience as opposed to being formed based on secular pressures, self-interest, and/or laziness. And, only God and the individual know whether one’s judgment is rightly formed or not.

    All the things you have been mentioning fall under this later matter which not only allows but encourages different positions as it recognizes the differences of each individual and their own experiences/learning, etc. Thus, it is how it is permissible for Catholics to differ not only among themselves but with the Pope. His prudential judgment isn’t defacto better than anyone else’s because his experiences are different (not better or worse but different).

  55. jerry 2016-08-25 15:59

    Thanks Troy for making it clear that the difference is how big the check is.

  56. Jon H 2016-08-25 17:16

    I personally think our governor has been stalling on having more medicare in the state because he is watching closely a very historical vote that will be taking place in Colorado. Amendment 69 will create the first single payer state plan in the country and the latest polls say it is going to pass. I am sure our legislature in Pierre will be ready to put out a similar plan of their own!

  57. bearcreekbat 2016-08-25 18:01

    Troy, your comments are a bit abstruse for someone without the funds to feed their children or provide them with shelter, utilities and health care, to fully comprehend. But if these comments and ideas give you comfort in supporting people like Trump, who have no meaningful history of trying to help people in need, in contrast to Hillary, who has spent her entire career attempting to better the circumstances of the poor, then I have no legitimate complaint. Vote for the politician who best represents what you believe in! For me, that is the politician with a demonstrable record of trying to help the poor – and in this election that is Hillary.

  58. Troy Jones 2016-08-26 08:46


    We are not arguing the merits of a particular position. Because there was an assertion one couldn’t be a good Catholic without either having a liberal economic ideology or not agreeing with every utterance of the Pope, I was explaining the theological difference with regard to Church Teaching on Faith and Morals, Infallible and Authoritative Teaching and then its application in matters of Prudential Judgment.

  59. Rorschach 2016-08-26 10:30

    bear, what Troy is talking about without saying it is canon law, which is the Catholic Church’s version of sharia law. What you need to understand is: canon law good/sharia law bad. Troy is an expert on both, apparently.

  60. bearcreekbat 2016-08-26 10:39

    Troy, I appreciate your unique insight into papal thinking. Not being a Catholic I have no standing to argue that a good Catholic would only support a candidate who has shown a past concern for the poor and advocates future policies intended to help the poor.

    I do find it a bit intriguing, however, to try to wrap my mind around the idea that a good Catholic can reject such a candidate in good faith and support in her place someone like Donald Trump, who seems to have violated virtually every religious principle or command that I thought (erroneously thanks to your clarification) that the Catholic Church stood for.

  61. Troy Jones 2016-08-26 10:41


    Nothing I said had a thing to do with Canon Law. All I was doing was responding to something specifically directed at me and related to a misunderstanding about being a lay Catholic in the public square. If this is a blog only for liberals or non-Catholics, just let me know and I’ll stay away.

  62. Darin Larson 2016-08-26 18:46

    We need single payer universal healthcare with competition between medical providers. This combines bargaining power and competition to reduce costs and drive innovation in how services are provided.

    This is the next step after Obamacare which was a compromise that did not contain effective mechanisms to control costs and foster competition.

  63. Rorschach 2016-08-26 18:47

    If you think you are the only Catholic here you are mistaken, Troy. If you want to label everybody but yourself a liberal you are not paying attention. When you come here and make assertions expect to be challenged. Many of the assertions you make here are generalizations and not supported by evidence – often contrary to evidence.

    My experience with this blog is that only trolls are unwelcome, unlike Dakotawarcollege where many more are unwelcome.

  64. Troy 2016-08-26 23:34


    You didn’t and don’t challenge me intellectually. You gave up intellectually and resorted to an insult in the comfort of those who will defend you just because you all agree. It’s ok. I am used to it.

    The reason you don’t feel welcome elsewhere is they don’t suffer fools very well and it hurts your feelings.

  65. Adam 2016-08-27 00:15

    Obama ran on bringing America single payer health care in 2008, and he pert near decapitated poor John McCain and Sarah Palin in the final vote… And then the GOP House of Rep. neutered the fruition of public consensus.

    When EVERYONE is in the insurance pool, the rates are cheaper. It’s just how the math works. I really believe God wants the cheapest and best health care for EVERYONE. Single payer, in the US, is the current will of God – in my view. The only question conservatives have to ask themselves is, “Do all poor people deserve some form of basic health care?” I also ask them, “What would Jesus say if He were alive in today?”

  66. Adam 2016-08-27 00:35

    The Lord, Troy, wants His people to have single payer one day. Go argue with Him if you have any questions.

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