Well, someone's gotta take on health care for Minnesotans

As President Trump very belatedly is learning, health care is complicated. It's also politically brutal. Trump is the third president since Bill Clinton who sought to change the American health insurance system early in his term and saw his approval rating slide as a result. It's an issue candidates for statewide office are well-advised to dodge and duck if they can.

So I was a mite surprised to see St. Paul Rep. Erin Murphy — a hard-running candidate for governor — in the lead on March 13 when a House DFL minority contingent briefed us scribes on the GOP health bill du jour, a fat $384 million reinsurance subsidy for Minnesota health insurance providers.

The DFLers had come to the Capitol basement to tout their preferred addition and/or alternative: the expansion of MinnesotaCare into a true public option for at least some Minnesotans. Murphy functioned as the emcee as folks who've been hammered by high premiums on the MNsure exchange pleaded to be allowed to buy coverage from MinnesotaCare, a state-subsidized health insurance program now reserved for low-income people. Later that day, Murphy brought their message to the House floor and issued a statement to underscore it.

Didn't some hotshot campaign consultant tell you to stay away from this thicket? I asked Murphy a few days later, after the House's Republican majority had rejected the DFLers' idea and heaped scorn on their zeal for "government health care."

Her response: "My experience as a nurse taught me that you can't walk away from a patient that needs your help and attention."

Murphy is — not "was" — a nurse. She keeps her practice license current and teaches in the nursing doctoral program at St. Catherine University. Before running for the Legislature in 2006, the Wisconsin native was executive director of the Minnesota Nurses Association; before that, she was a lead nurse on a surgical transplant team at the University of Minnesota, where skill, responsibility and teamwork were matters of life or death.

That background made Murphy a natural DFL health policy successor to the legendary Sen. Linda Berglin — or so I thought as I watched her apply her professional expertise to policy debates as a new legislator. She also spoke with the banked anger that comes from watching a loved one — her mom — battle both insurance companies and cancer in the final months of her life.

"I came here wanting to fix health care. I wanted to make this work for people," she recalled.

But she opted not to become the House's health care maven. She was drawn to caucus leadership instead. By 2013, she was House majority leader. Back in the minority two years later, her yen for leadership found another outlet. In November, she was the first DFLer to stride onto what's bound to be a crowded 2018 gubernatorial field, given Gov. Mark Dayton's intention to retire.

Republicans pounced on her candidacy announcement with an attempt to tie her to Obamacare. It had become a word dirty in enough Minnesota voters' minds last fall to help enlarge the House Republican majority, something that had not happened in this state in a presidential election year since 1984. Murphy was on notice that running as "the health care candidate" is a perilous trek.

Yet there she was on March 13, leading the charge for expanded MinnesotaCare eligibility.

"Minnesotans can't walk away from this issue, so neither can I," she told me. It's too important to personal and community well-being — not to mention the state's economy — for Minnesota politicians to cede to the federal government. "The nurse in me" won't let her watch from the sidelines as other politicians get bloodied by the health care issue, she said. (That includes U.S. House Speaker Paul Ryan, her sister's classmate at the high school in Janesville, Wis., from which they all graduated.)

The health insurance remedy she favors is not one magical pill. She's in sympathy with those who call for Medicare for all but does not think Minnesota should try a single-payer approach on its own.

Rather, she wants state government to use MinnesotaCare as one of several tools to drive down the cost of both insurance and medical care itself. Her ideas range from the nitty-gritty of state Medicaid contracting, to the public health value of better transit, housing and education, to the transformative potential of medical research at the University of Minnesota.

She's a fan of the work done by then-Gov. Tim Pawlenty's bipartisan task force in 2008 to reorient the practice of medicine to keeping chronically ill people out of the hospital. "That's under the radar, but it's intuitively right to me. We can do much more of that kind of reform," she said.

Those aren't ideas that lend themselves to a rev-'em-up stump speech before DFL audiences. But they may distinguish Murphy as uncommonly knowledgeable and common-sensical about an issue that looks likely to stay front-of-mind through 2018 and beyond. Her announced rivals in the DFL field are State Auditor Rebecca Otto and St. Paul Mayor Chris Coleman, neither of whom seems likely to challenge Murphy for renown as the health care candidate. Other candidates are surely on the way, encouraged by Lt. Gov. Tina Smith's surprise announcement that she won't run.

Permit two observations. One: While the reputations of many health-related professions have been sullied by America's long-running health care cost crisis, nurses retain high regard. And two: No other potential candidate for Minnesota governor, in either major party, is a nurse.

Lori Sturdevant is a Star Tribune editorial writer and columnist. She is at lsturdevant@startribune.com.