In the health reform debate, the Senate is split between “public option,” and “private only.” It’s reminiscent of the mid-19th century, when the split was “slave” versus “free,” and the Senate ultimately landed on middle ground, the Missouri Compromise of 1850.

In the waning days of 2009, the Senate is once again desperately searching for middle ground. For instance, some Democratic compromisers propose dropping the public option in favor of expanding eligibility of Medicare and Medicaid.

But as Minnesota Democrats look for that elusive middle ground, they, like Kansas’s Dorothy, are effectively arguing that “there’s no place like home.” Call it the Minnesota Compromise of 2010. Minnesota Senator Al Franken and Congressman Keith Ellison are pressing an amendment mandating that all health plans emulate Minnesota health plans and spend 90% of consumers’ premiums on care costs, rather than administrative and salary costs.

The Minnesota Compromise – my term, not theirs — is ideological middle ground that would require any health plan to match the efficiency of the nation’s most efficient plans. According to Minnpost:

Non-profit health plans in Minnesota spend an average of 91 percent of premium costs directly on health care. Franken’s office said the national average is around 70 percent, with large plans spending considerably more percentage-wise on average, and individual plans less.

Under this Minnesota Compromise, corporate health plans would have to get as administratively lean as the nation’s leanest plans. Business-as-usual wouldn’t be tolerated, but there would still be a way to do business.

This move is interesting from a strategic communications standpoint. The Ellison-Franken amendment is framed around hard-headed efficiency, rather than soft-hearted ideology. It will be very uncomfortable for elected officials to explain to consumers why they oppose making sure that 90% of consumers’ premiums go for direct health care.

The Minnesota Compromise probably won’t pass. Franken and Ellison are not powerful players, and there is simply too much corporate health insurance money on the table. But Minnesota’s congressional backbenchers are offering an intriguing approach that should get more consideration than it probably will.

– Loveland

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