Ray Ayotte (10) (10) (10) (10) (0)
R. C. Angevine (7.5) (10) (7.5) (10) (0)
3. Offer incentives to choose value.
Would need to see details -- generally would like to see lower overall
Ralph Brauer (7.5) (7.5) (0) (5) (2.5)
1. Create a MN health exchange. I agree
Minnesotans should choose a plan reflective of their community and
their values, but the devil is in the details. As a disabled
Minnesotan I have seen those like myself--especially those with
chronic conditions-- thrown under the bus in the name of "quality" and
"outcomes." The so-called exchange should be designed by all
stakeholders and should contain two inalienable rights: the right to
choose your own physician and treatment and the right not to be denied
health care because of income or preexisting condition.
2. Include quality and price data. The
problem with this is there are too many vague statements and a
profound misunderstanding of system behavior and modern medicine. Two
examples will suffice. Hospitals "save" money by sending patients home
before they are ready. This recently resulted in fines on several
Minnesota hospitals being levied by Medicare--the plan Brunner seems
to find most objectionable. Second, it has long been pointed out that
ratings fail to take into account "cherry picking" by hospitals and
providers. Hennepin County must treat all who enter its doors;
Fairview Southdale can send them elsewhere. This is also true for
physicians. They can refuse to serve as primary care providers for
more difficult patients. In fact, health care is now developing a
system eerily familiar to public education where clinics located in
low income areas rate lower than those in high income areas, just as
do schools. The systemic result is that doctors with more seniority
and experience can pick better assignments just as can teachers. This
creates a nice little reinforcing feedback loop.
3. Offer incentives to choose value.
Consumers should be offered incentives to choose their own provider
and the best quality care they can find. For example, the Mayo Clinic
is a world leader in many types of care, but the current system makes
it extremely difficult for members of HMOs, especially in the Twin
Cities, to go to Mayo. It is interesting Brunner cites Consumer
Reports car tests as an analogy, for she does not realize how much she
stuck her foot in her mouth. The highest quality cars--those with the
best safety ratings, best repair records, longest ownership--are also
some of the most expensive. While we may not be able to afford
Mercedes or Lexus quality care we also do not want cheap care. As
anyone familiar with quality knows, it costs.
4. Reward preventive measures. Many
so-called preventive measures such as smoking and obesity are being
shown to have complex addictive systemic causes. You cannot blame
either the victim or the provider for this. Again the analogy with
education is striking. It is the health care version of NCLB, where
"low performing" schools are given less money when in fact they have a
5. Health exchange not needed. When
America places in WHO (World Health Organization) rankings somewhere
near Cuba, something is clearly wrong. Start with an inordinate amount
of funds (the highest in the world) being spent not on health care but
administration of HMOs and other providers. The MBAs, not the
physicians, are the real winners in the American system. Second it is
time that so-called advocates of quality and cost-effectiveness define
what they mean. The human body is a complex organism where Patient A
may respond quickly to treatment and Patient B baffle the experts. My
father and mother, both physicians, used to say there are no
statistics in medicine. Both used that as their answer to patients who
asked how long they had to live or whether a treatment would work. My
father performed the first surgical amputation of the lower half a
patient's body. It was extremely complex technically and promised
little chance of success, but he felt he had to try it. The patient
went on to live to be 83. Would an HMO today authorize such a
procedure? I was the fourth person in the world to undergo a complex
new procedure that saved my live. My HMO refused to allow me to go to
Mayo to have it done. I went anyway. I was fortunate in that I could
afford the extra charge, but what of those who cannot? Are we going to
decide who lives and who dies by how much money they make?
Unfortunately we already are--and the results put us 37th in the world
in quality of care largely because some people in this country--and
this state--receive health care worse than in the most
resource-deprived areas of the world.
Scott Halstead (10) (10) (10) (10) (0)
4. Reward preventive measures. There
needs to be incentives for consumers that maintain healthy lifestyles
and utilize less health services.
5. Health exchange not needed.
Minnesota's health care reform needs to analyze and report the health
care screening and resulting, often-costly (and) not successful
medical services being provided. Our health care is often driven by
the pharmaceutical and medical device providers and many consumers’
outcomes are quite poor.
Pat Barnum (5) (0) (0) (0) (10)
1. Create a MN health exchange. MN
should refuse to participate in ACA. States rights. And it should not
set up a health exchange.
2. Include quality and price data. It is
ridiculous to think that "quality" care could ever be measured and
reported accurately - too many factors; humans aren't cars. In which
case people will be using garbage data to help make health care
decisions. This is a set up for fraud and manipulation, and someone,
but probably not doctors, to make a lot of money.
3. Offer incentives to choose value. The
quality of care rubrics are bound to be totally laden with bad data,
driving consumers to be driven to what will absolutely become Crony
4. Reward preventive measures. No
Anonymous (10) (10) (10) (5) (2.5)
Don Anderson (10) (7.5) (5) (7.5) (0)
1. Create a MN health exchange. It seems
like we are already on track to design our own health exchange.
2. Include quality and price data. The
only problem is having a health provider that doesn't provide the
services that another adjacent provider provides, and you can't make a
readily available switch.
5. Health exchange not needed. Consumers
should have the information so they can compare their present provider
with adjacent providers. Providers can change as time goes by.
Peter Hennessey (2.5) (2.5) (2.5) (2.5) (10)
1. Create a MN health exchange. Yea,
state's rights and all that. From a socialist state, no less. Why
don't you do something really radical and tell the feds to (go away).
Will the exchange allow competition, or is it just a cover for a bunch
of fat cats already in the game to divvy up the market like a cartel?
Will there be room for new players with a better plan? What is this
pathetic and pathological obsession with "designing" and "regulating"
everything? Ever hear of the free market? That is the only mechanism
that delivers both high quality and low price.
2. Include quality and price data. That
is a great goal in theory, but the guest offered nothing specific
about how this is done.
3. Offer incentives to choose value.
That is a great goal in theory, but the guest offered nothing specific
about how this is done. Here is a radical idea -- how about letting
the free market work, take government completely out of it?
4. Reward preventive measures. That is a
great goal in theory, but the guest offered nothing specific about how
this is done. Pray tell, what are preventative measures? What if you
already diet, exercise, don't smoke or drink or nothing, don't have a
hazardous job or hobbies, and you still have chronic conditions? Is
that then the doctor's fault? It may be news to these great reformers,
but people go to a doctor because they are sick, not because they are
well. We don't need doctors to keep us well, but to detect and apply
corrective measures when something goes wrong.
5. Health exchange not needed. In a free
country people take responsibility for their own welfare; they don't
wait for government bureaucrats to save them from themselves. But the
fundamental assumption in all social welfare schemes is that the
target population is too stupid to know what's good for them, and it
takes government "experts" to care. If someone really does have an
idea for evaluating the quality of care delivered by a doctor, clinic
or hospital, and somehow it really works, then they can either offer
their service for a fee or post it on-line for free. But the fact is
that quality of service is highly individual and therefore my
experience is most likely irrelevant to other people. For example, I
have gone to Kaiser just once; I like to choose my own doctor, thank
you, and I bother to inform myself so I can talk intelligently about
my condition. I switch doctors when (s)he is not comfortable with
that. Some may be good but are pompous asses; some have great bedside
manners but are incompetent. Only I can tell and only from actual
experience, for myself alone. As we can tell from the way clinics,
Kaiser or the VA is run, nothing in a government-standardized system
allows for anything like this. Patients are like cattle in a feedlot,
or like parts on an assembly line. Had enough of that on "sick call."
Robert Freeman (7.5) (10) (10) (10) (2.5)
1. Create a MN health exchange. Assuming
key decisions are made in a transparent way that gives the public and
other stakeholders a chance for input.
5. Health exchange not needed. The
exchange exists as a mechanism to distribute the federal subsidies,
not to help consumers compare products. Without it there would need to
be some other way of connecting people with the federal subsidy they
qualify for under the ACA.
Dave Broden (10) (10) (10) (10) (7.5)
1. Create a MN health exchange.
Minnesota must do its own thing regarding Health Exchanges-- because
Minnesota is a leader (or was) and innovator in medical care. We need
to do the same and innovate in Health Exchanges. We should do this as
a partnership of public private organizations not focused only on
building a government built approach.
2. Include quality and price data. Yes,
with a condition that it is recognized that quality has two
components: a) doing the health care well and effectively and b)
avoiding barriers to entry of new medical techniques and procedures as
well as pharmaceuticals. Far too often quality is a simple measure or
where a technology, service, or product is today, not a look at how
improved capability is addressed. Also need to be careful about
outcomes-based decisions: OK if applied to common and standard
procedures, but what about unique diseases or situations for which
outcomes may be high risk? Do we forget to care for these folks
because outcomes are expected to be low in terms of success rates?
3. Offer incentives to choose value.
This is definitely required but the word "quality" is again very much
off base and must be separated into a) management and outcomes of
common health issues; b) addressing serious diseases such as some
heart issues, cancer, etc. c) consideration of advancements in
medicine. If only situation "a", health care will take a serious step
4. Reward preventive measures. Yes, that
is happening and is an effective approach. Need to be very innovative
in the definition of incentives, such as linking years of no problems
to cost, confirmation of regular check-ups, etc., not only reduced
costs for sports clubs, etc.
5. Health exchange not needed. This is
an issue that should have been debated more effectively including who
should establish the health exchange and who should provide oversight.
Private insurance companies and health care organizations have worked
to establish components of a plan in some states. Why not use or
integrate this into the government plan or have industry or a separate
industry run it and government provide oversight only. Which will be
more effective and less costly?
Rosemary Schultz (10) (10) (10) (10) (0)
David Dillon (10) (0) (0) (0) (10)
1. Create a MN health exchange. Better
federal than United Nations. Better state than federal. Better county
than state. Best for the individual to shop choices.
2. Include quality and price data.
Prices? Certainly. The notion that such an exchange could provide
thorough and understandable information on quality is laughable and
dangerous if believed.
3. Offer incentives to choose value. How
will providers come to be known to have higher quality outcomes? Is
this compared to how sick their patients were to start with? Or maybe
the extent to which they can, belatedly, convince them to make more
healthy choices after becoming a patient? The opportunity for the
power of economic freedom to drive improvement in health care is
4. Reward preventive measures.
Absolutely. More costs for consumers for smoking, drinking and potato
chips. Not sure what providers should do. Less money if they don't say
‘bend over and cough’?
5. Health exchange not needed. Minute
Clinic was a Minnesota created national success story. What did they
do and why did consumers choose them? Hint, it wasn't from a high
quality rating from the bureau of health rating systems.
Anonymous (10) (10) (10) (10) (2.5)
Jim Olson (10) (10) (10) (10) (1)
Terry Stone (10) (10) (10) (7) (3)
While the state (the common, the taxpayers,
the global community) has a compelling interest in preventive
healthcare, there is little appetite for nanny-state manipulation of
our exercise or dietary regimen. This compelling interest will remain
so long as our culture refuses to allow citizens who make long chains
of bad judgment calls to escape personal responsibility for their
actions. Currently taxpayers pick up the tab for a good deal of poor
judgment including dietary judgments that cause or augment diabetes,
healthcare for families to whom recreation is (valued) more than
healthcare insurance and (Pell) grants to pay for education for
families to whom new guns and hunting shacks were of more value than a
college savings fund for the kids.
Government efforts to impose behavior are
generally unwelcome. In Minnesota, perhaps more than elsewhere, we
have a cultural expectation of freedom. There is good history on
resistance to nanny-state rules and regulations, without regard to the
wisdom of such behavior modification. Examples are the 25˘ big game
license of 1860, flotation devices (controversial in the 1950’s),
child seats in cars, helmets for motor cyclists and seatbelts for
A health exchange with insurance reforms
that reward preventive measures by providers and consumers will need a
long time horizon, perhaps (a) generational (one).
Chuck Lutz (9) (10) (10) (9) (0)
Lyall Schwarzkopf (7) (7) (7) (7) (5)
Paul Hauge (7) (8) (8) (8) (5)
Roger A. Wacek (10) (10) (0) (10) (0)
Any Health Exchange should include all
health care providers: By all; I mean dentists, eye doctors,
chiropractors, osteopaths, acupuncturists etc. It is a continuing
waste of money to compile a Health Exchange (directory) of sickness
After 20 years of arguing with insurance
companies to get them to cover some of my health care expenses I
cancelled my insurance. Obamacare will force me to subsidize sickness
care so please don't waste more money on a directory of sickness care
Bright Dornblaser (10) (10) (10) (10) (2)
Robert J. Brown (10) (10) (10) (10) (2)
Carolyn Ring (10) (10) (8) (10) (7)
No matter how it is structured, assessing
quality of providers’ care is likely to be subjective rather than
Tom Spitznagle (9) (9) (9) (9) (5)
Wayne Jennings (5) (10) (8) (8) (1)