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 Response Page - Brunner  Interview -      

These comments are responses to the questions listed below,
which were generated in regard to the
Julie Brunner Interview of


Julie Brunner, Executive Director, Minnesota Council of Health Plans, describes her organization's view of state and federal reforms now underway. She supports Minnesota's designing its own health insurance exchange rather than accepting a uniform federal approach. She cites the extensive work already accomplished here in the areas of provider quality measurement and payment reforms. She stresses that the state's exchange should provide reliable information to consumers on the quality of health providers' outcomes and their related prices. The exchange should also, she believes, highlight health plans' incentives for consumers to select providers with a record of better quality outcomes for lower prices.

For the complete interview summary see:

Response Summary: Readers have been asked to rate, on a scale of (0) most disagreement, to (5) neutral, to (10) most agreement, the following points discussed by Brunner. Average response ratings shown below are simply the mean of all readers’ zero-to-ten responses to the ideas proposed and should not be considered an accurate reflection of a scientifically structured poll.

1. Create a MN health exchange. (8.6 average response) Rather than accepting a uniform federal approach, Minnesota should take the opportunity to design its own health exchange--a vehicle to assist consumers in selecting health care insurance.

2. Include quality and price data. (8.4 average response) A Minnesota health exchange should provide thorough, understandable, information on quality delivered and prices charged by doctors, hospitals and other health care providers.

3. Offer incentives to choose value. (7.3 average response) Consumers should be offered incentives--such as lower co-pays and deductibles--to select providers that have higher quality rankings and lower prices.

4. Reward preventive measures. (7.8 average response) A health exchange should also build in insurance reforms that reward preventive measures by providers and consumers.

5. Health exchange not needed. (3.3 average response) Consumers know who the quality, price-conscious, providers are and can find suitable health insurance plans on their own. There's no need for health exchanges.

Response Distribution:

Strongly disagree

Moderately disagree


Moderately agree

Strongly agree

Total Responses

1. Create a MN health exchange.







2. Include quality and price data.







3. Offer incentives to choose value.







4. Reward preventive measures.







5. Health exchange not needed.







Individual Responses:

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 pricing.

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 resource shortage.

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 Medical Care.

4. Reward preventive measures. No exchanges.

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 backward.

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 nearly lost.

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 motor vehicles.

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 care providers.

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 providers!

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 objective.

Tom Spitznagle (9) (9) (9) (9) (5)

Wayne Jennings (5) (10) (8) (8) (1)


The Civic Caucus   is a non-partisan, tax-exempt educational organization.   The Core participants include persons of varying political persuasions, reflecting years of leadership in politics and business. Click here  to see a short personal background of each.

   Verne C. Johnson, chair;  David Broden, Charles Clay,  Bill Frenzel, Paul Gilje,  Jim Hetland,  Marina Lyon,
Joe Mansky,  John Mooty,  Jim Olson,  and  Wayne Popham 

The Civic Caucus, 01-01-2008
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Verne C. Johnson, chair, 952-835-4549,       Paul A. Gilje, coordinator, 952-890-5220.

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