Montana Gov. Brian Schweitzer has always been something of a renegade on health care, leading busloads of seniors to Canada to buy drugs and asking the federal government to give drug discounts to Montana’s residents. Those aren’t the only fights the Democrat has picked with Washington. He once asked the federal government to bring Montana’s National Guard troops back from Iraq so they could fight wildfires. He’s a liberal in a libertarian state, but he’s also Montana’s most popular politician. Now he’s proposing to overhaul the state’s health care system and calling for a government-run system to provide care for about a quarter of the state’s population. Schweitzer discussed the idea, and his own plans for the future, with National Journal. Edited excerpts from the interview follow.
NJ In crafting your plan, you’ve compared Montana to Saskatchewan, a Canadian province with a similar population. Why is that a good model?
SCHWEITZER They have 1,000,050 people, and we have 990,000 people. They’re about 10 percent Indian, and we’re about 7.5 percent Indian. The same Ukrainians and Irish and Scandinavians that settled in Saskatchewan settled in Montana. So, ethnically, we’re a pretty good match. They are farmers and miners and loggers and energy producers, like we are in Montana. But I thought it was curious that they live two years longer and have a lower infant-mortality rate. When I contacted their premier to find out more about their health care system, I found out it costs a little less than $4,000 per person. In Montana, we’re close to $8,000 per person. So I asked them, how does your system work?
NJ Trying to emulate a Canadian system—that doesn’t always play well in this country.
SCHWEITZER Those are your words, ma’am: emulating a Canadian system. I’m proposing a system that would cover about a quarter of Montana, about 250,000 people who are on Medicaid and the state employees. If other people wanted to buy into the system, they could, just like BlueCross BlueShield. The story is what we’re actually doing, not what somebody says we’re doing.
NJ But is that something you’re concerned about? The analogy you made between the two localities may make a lot of sense, but it invites that kind of sound bite.
SCHWEITZER You know, in Washington, D.C., they don’t actually want to know what the facts are out here. [The Saskatchewan] system isn’t perfect, but the community health care system seems to
work. They pay their doctors more than we pay ours in Montana, too. So, you know, they’re able to cut costs, deliver health care, live longer, have a lower infant-mortality rate.
People say right away, you’re just using somebody else’s system. But we’re using somebody else’s knowledge. If the federal government is going to tell me that I’ve got to cover all these new patients in Medicaid, then the least they can do is give us the ability to set up a system that’s efficient. And, hey, I’ve got a neighbor that has a system that is working pretty good. So I figure we ought to lift some of their ideas.
NJ What is your view of the federal health care reform law that passed last year?
SCHWEITZER They attempted to do some good things. I was disappointed that they didn’t challenge the underlying costs of health care in this country, and that means challenging pharmaceutical companies, challenging the medical-device companies. You know this discussion of insurance companies? We just said, well, we’ll trust them to become more efficient. And I don’t necessarily see that happening.
NJ You’re nearing the end of your final term as governor. Some people are saying that you might run for the Senate in 2014.
SCHWEITZER Who said that?
NJ I’ve been hearing that.
SCHWEITZER Blah blah blah blah blah. I’ll fish in the morning. And maybe drink beer in the afternoon. And if someone calls and complains about their road or schools, I’ll give them the phone number of someone over at the state government. This is the only thing I’ve ever been elected to. I was elected governor, and I can serve two terms. And I had a lot of things going before I did this, and I may have a lot of things going after.
NJ Health care is an issue that you’ve been talking about for a long time. And now you have this splashy idea. Do you think, after you leave office, you’re going to want to be an advocate for this issue?
SCHWEITZER Maybe, maybe not. I’ve still got some ranches. Maybe I’ll just run cows, fix fences.
NJ Do you think your proposal is one that other states should consider?
SCHWEITZER They always say the states are the laboratories for democracy. So the states can do what they want to do, and what we’ll do in Montana may work someplace else. Or maybe they’ll try something else. But if they don’t approve some of these waivers [from federal requirements under the new health care law] and allow states some room, I don’t think we’ll ever find out.
This article appears in the October 15, 2011 edition of National Journal Magazine.