Montana sets up single payer. Guess what happens…

August 9th, 2013 by Sylvia Moore Leave a reply »

In one of the most conservative states in America, a revolution in health care is quietly happening. People under the age of 65 are actually getting access to affordable health care without relying on health insurance. It’s happening in Montana. Last year, the state’s then-Democratic governor, Brian Schweitzer, went around the state legislature and established the nation’s first free publicly-run medical clinic for state employees and retirees. There are no co-pays or deductibles. Physicians are paid hourly, so there’s no financial incentive for them to give patients costly treatments. Participants can still use their private insurance, so the clinics are really a form of public option. So did the sky fall in the Big Sky state? To the contrary:

The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it’s actually costing the state $1,500,000 less for healthcare than before the clinic opened.

“Because there’s no markup, our cost per visit is lower than in a private fee-for-service environment,” Hill says.

Schweitzer, a single payer proponent, didn’t need any more studies or commissions or hearings to start this healthcare revolution. He just went ahead and did it. Sure, the state’s Republicans grumbled, but even some of them are admitting that the the state-run model is showing results. Now, there are plans for more clinics. However, the Montana experiment still isn’t universal. It would be even better if all Montanans could use the free clinics. It would save the state even more money. But, opening the clinics to every resident may have run afoul of federal preemption laws. Schweitzer unsuccessfully sought a federal waiver to establish a more inclusive system. Under the Affordable Care Act, states won’t be able to opt out of the law and create alternative healthcare models until 2017.

Since it’s unlikely California will get another single payer bill introduced at the state level anytime soon, perhaps what Schweitzer did in Montana can be replicated at the local level (San Francisco has Healthy San Francisco, a city-run, near-universal program where most participants pay a fee on a sliding scale). At least Californians would be exposed to another positive example of a publicly-run model in action.

In the meantime, it would be nice if Schweitzer had a little chat with Gov. Jerry Brown. Just saying.


  1. Michelle Klein-Hass says:

    The person who created Healthy San Francisco is now the head of the LA County Department of Public Health, and he created Healthy Way Los Angeles here. Perhaps he might want to look at Montana’s clinics, and look at ways of beefing up the County healthcare system in a similar fashion. We desperately need it. There are no Urgent Care clinics in the San Fernando Valley…the closest is in South LA. So here, when one has a problem that could be solved at an Urgent Care, like, say, an ingrown toenail, you have to go to the ER to get it taken care of. This is wasteful!

  2. Darryl Cherness says:


    That was a very interesting article. If a Republican state like Montana can create a single payer system, why can’t we in Democratic California?

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  4. bob wilkin says:

    Bernie Sanders needs to mention this on his stump speach

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