How Libby, Montana Got Medicare for All

By Kay Tillow –

In 2009 when the Washington beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table–except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single payer healthcare system, Medicare, to solve the problem.

Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos killing hundreds and sickening thousands in Libby and northwest Montana. The W. R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all law suits and legal avenues failed, Baucus turned to our country’s single payer plan, Medicare.

The single payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, Montana, not just the former miners but the whole community—all covered by Medicare.

They don’t have to be 65 years old or more.
They don’t have to wait until 2014 for the state exchanges.
No ten year roll out—it’s immediate.
They don’t have to purchase a plan—this is not a buy-in to Medicare—it’s free.
They don’t have to be disabled for two years before they apply.
They don’t have to go without care for three years until Medicaid expands.
They don’t have to meet income tests.
They don’t have to apply for a subsidy.
They don’t have to pay a fine for failure to buy insurance.
They don’t have to hope that the market will make a plan affordable.
They don’t have to hide their pre-existing conditions.
They don’t have to find a job that provides coverage.

Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.

Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people. “This is a new thing,” Berryhill told the Missoulian. “No other group like this has ever been selected to receive Medicare.” Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility. She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day. She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.

Berryhill said she did not know how much the care would cost. That kind of analysis was beyond her directive to sign the people up. There have been no reports of competition from the private for-profit Medicare Advantage plans. The sick are not profitable.

No one should begrudge the people of Lincoln County. The mine wastes were used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought the carcinogens home on their clothes. The W. R. Grace Company dumped much of the clean up costs onto the federal government. A June 17, 2009, order by the Environmental Protection Agency, the first of its kind, declared Lincoln County a public health disaster. The Libby Medicare provision in the health reform law is based on the area covered by that EPA order.

Baucus gave his reasons to the New York Times for its only story on this unique benefit: “The People of Libby have been poisoned and have been dying for a decade. New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”

Health tragedies are happening in every town. Over 51 million have no insurance. Over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans. Nothing in last year’s reform law will mitigate the skyrocketing costs. Most insurance is threadbare and doesn’t cover. More than 50% of us now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.

Bill Clinton recently stated that the U. S. could give coverage to all for one trillion dollars a year less than we now pay if we adopted the system of any other advanced nation. (Unfortunately, he did not say this when it would have mattered most during the 1993 and 2009 health care reform debates.)

Other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies. Congressman John Conyers has reintroduced HR 676, the Expanded and Improved Medicare for All Act, which does exactly that. There are 60 cosponsors. It would cover all medically necessary care for everyone including dental and drugs by cutting out the 30% waste and profits caused by the private insurers.

So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest cuts in its benefits, let us counter with the Libby prescription to clean up the whole mess. Only a single payer, improved Medicare for All, can save and protect Medicare, rein in the costs, and give us universal coverage.

Medicare will celebrate its 46th birthday on July 30, 2011, and all are invited to join in the festivities. Medicare was passed in 1965 and implemented within less than a year. When we pass HR 676, this single payer bill, we can all be enrolled in the twinkling of an eye.

All Unions Committee for Single Payer Health Care–HR 676


  1. Usha Abramovitz on June 16, 2011 at 9:11 am

    This just gave me an idea; open Medicare at the Federal level NOW, to all those who are sick / have pre-existing conditions and will not / cannot (except at huge personal expense), be accepted by private insurance plans. Voila! Private Insurance is happy, the sick are happy and over time the well will stop paying for insurance as they know that they will be covered if they do fall seriously ill AND private insurance will wither away.

    • know_then_do on June 17, 2011 at 1:13 pm

      This is a joke, right? Why on earth would the private system “wither away” if it never had to pay medical expenses? No, ALL Americans need to be in ONE pool for single-payer to work. It’s just that simple. “ALL for ONE and ONE for ALL!”

      • Usha Abramovitz on June 21, 2011 at 9:28 am

        @know-then-do : If public health insurance were to be made comprehensive and self sufficient by reforming i.e. taking out the private for-profit components (Part D) and restoring its negotiating power, then there would be few takers for an alternative and much more expensive system. With no takers, private insurance would wither away – it does after all need insurees to actually make a profit. We would be forcing pvt. ins. to compete with a public system, which is what a public option is all about. So let us find more groups of people to whom we can open up Medicare and let us start “drying out” Medicare (reforming it).

  2. Eric Straatsma on June 17, 2011 at 11:36 am

    Regular health insurance is like free groceries for life. If we sold grocery insurance, and allowed people to buy any food they wanted, at any time, grocery insurance would get more expensive than just buying the food needed. Only the rich could afford grocery insurance. That is exactly what is happening now. Only the rich can afford private payer insurance.

    Single payer systems that include everyone and come out of taxes, (not separate insurance payments) work in other countries by limiting care to what is ‘necessary’, and by not allowing people or doctors to ‘buy caviar’ when all they need is hamburger. Most doctors in single payer systems are on salary, not on a cost plus profit making (greed oriented) basis as in this country. The US has the most expensive disease care system in the world, with the worst outcome and the highest number of uninsured per capita. Prisoners in jail get single payer, the military gets single payer, US Congressmen get single payer, but the US citizen; NOPE, it is evil and socialistic.

    Some people call the single payer system a ‘death panel’. Well, why not look at this issue? Many seniors do not want one million dollars spent on them in the last two years of their life. Many do not want life support or extraordinary measures to keep them alive. What is wrong with that?

    Why not have a single payer system, put doctors on salary and encourage living wills, healthcare directives, etc, so that the taxpayer does not waste money on greedy doctors who find out what your insurance will pay for, so that they can do lots of surgeries, tests and expensive procedures, just to try and milk the system and pay for their mansion, yacht and/or Mercedes?

  3. David Mintz on June 17, 2011 at 1:22 pm

    Baucus’ slick move benefits the population of the afflicted zone, but unfortunately it is an abuse of the Medicare system because he was essentially reverse-cherrypicking, loading the system with people who definitely had a lot of medical needs. This is quintessential right-wing hypocrisy: feed at the public trough when it suits your interests, preach free-market and self-reliance the rest of the time.

    Health care is a human right. I will never, ever, ever give up the fight and I know you won’t either.

  4. Jeff on June 17, 2011 at 4:13 pm

    Before any of us move to Libby Montana to get health care, you should be aware that Medicare is only expanded to those who come down with disease due to asbestos.

  5. dougo on June 17, 2011 at 4:24 pm

    Oh Max,Max Max, Where are your precious private insurance companies when the citizens of Libby need them? They all abandoned these poor souls in their time of need didn’t they. Too expensive for them to turn as profit. I’m sure many had insurance through their employer W.R. Grace and others but what happened when they reached the limits of their policies? Claims denied. Profits restored at the expense of the lives of Libby but Senator Max Baucus stepped in and gave the citizens of this county what he denied the rest of the nation. He should be ashamed of himself but shame would mean you have a conscience. Rather,he has a self serving interest in giving the people of Libby MT. the coverage they needed,probable the only way this joke of a man could save face in the eyes of his constituents and maintain his seat. His buddies in the insurance industry will contribute mightly for his offloading the sick and dying people of Libby onto the government.Thanks buddy.

  6. Dr.Stephen Keister on June 18, 2011 at 10:20 am

    It was Sen. Baucus that had representatives of Physicians For A National Health Program arrested and handcuffed when they attempted to testify re a single payer plan before his Senate Committee during the health care debate….this man is the ultimate two faced politician.

    The nation still requires single payer, but first we must rescue Medicare and Social Security. See my June 2 and June 16 articles on the Rag Blog.

  7. NOT-so-entitled-ALL on June 27, 2011 at 5:13 pm

    Since when is health care a human right? The only rights we really have are to die, because since abortion was made legal, we don’t even have the right to live, so how is health care a human right?

    Our entitled-mindedness is our undoing, and our personal choice as such!

    And by the way, I grew up in Libby, Mt.

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