Now that the government shutdown is over, Congress will need to figure out what to do about an impending spike in health insurance premiums for Americans (including tens of thousands of North Dakotans) who purchase individual plans through the Affordable Care Act exchanges.

Those premiums currently enjoy heavy subsidies that are set to expire at the end of the year unless Congress renews them, which would mean dramatic cost increases for the insured. On the other side of that coin is that years of fiscal profligacy, which has become particularly acute under the terms of Presidents Donald Trump and Joe Biden, has left our nation with little capacity to continue them.

We are already $38 trillion in debt, and adding a couple of trillion dollars more every year.

But the debate over the subsidies is beside the point Marvin Lein said on this episode of Plain Talk.

Lein is a retired healthcare professional with 30 years of senior healthcare administrative and CEO experience, including managing large multi-entity, private, for-profit physician practices. He served as CEO of Mid Dakota Clinic in Bismarck from 2013 to 2022. According to him, moving Americans to a single-payer system for delivering health care is the only sustainable path forward.

"We've run the current model, the free market model, to the point where we can no longer bury, redistribute, hide systemwide costs," he said, and while we can have a debate about whether the status quo, where most Americans get their health insurance through a third party, is truly a "free market," he has a point.

He recalled that when he started in 1994, the industry reacted strongly to the Centers for Medicare & Medicaid Services setting price controls, fearing it would be "socialized healthcare" and "the end of healthcare."

"Well, that didn't happen," he said, arguing that a Medicare-for-all plan could bring spiking prices under control. "Medicare is price setting. Medicare is managed delivery. Right? Medicare is much more like the European model than the insurance products that you and I purchase on the commercial marketplace. which is the old model that is failing has failed."

Also on this episode, guest co-host Pat Finken and I discussed my story about a stalker in North Dakota's state house and the City of Fargo's ongoing efforts to annex a proposed AI data center despite objections from just about everybody else.

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