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 Response Page - Gilchrist  Interview -      


These comments are responses to the questions listed below,
which were generated in regard to the
Lauren Gilchrist Interview of
09-21-2012.
 

OVERVIEW

Lauren Gilchrist, Special Advisor to the Governor for Health Reform, distinguishes between three main healthcare issues: access to health care, quality of health care, and management of health factors external to the health care system. She cites the difficult challenges of increasing numbers of uninsured, variation in quality of care, and rising costs. The administration advocates a "triple aim" of better care, better health and lower costs. That goal will be advanced, she believes, both through the continued development of the state's health exchange and with enactment of several key recommendations of the Governor's health reform task force. Those recommendations include measures to increase access, support accountable care organizations and prevention efforts, broaden the use of electronic healthcare records, make more effective use of all levels of health care professionals and increase the ranks of primary care providers.

For the complete interview summary see:  http://bit.ly/Y1L0AJ

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 Lauren Gilchrist. 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. Health costs unsustainable. (7.8 average response) Health care is on an unsustainable trajectory, consuming an ever-growing share of our state and national economy.

2. Cost and quality not apparent. (7.7 average response) Most Minnesotans are unaware of how their healthcare providers rank in terms of cost and quality.

3. Pay for outcomes. (5.2 average response) Payments to physicians, hospitals and other providers should be based on expected outcomes from patient care, not on services rendered, and providers should receive some of any savings realized when outcomes are met.

4. Curb expensive procedures. (5.2 average response) Physicians and other providers should be restrained from prescribing expensive diagnostic procedures of questionable value.

5. Each must assume responsibility. (8.5 average response) Individuals must assume more responsibility for their own health and health care, including being aware of the costs, risks and benefits of health services and health behaviors.

6. Prevention trumps treatment.  (5.9 average response) Preventing pre-diabetics from developing diabetes is more important than assuring optimal diabetes care for people with diabetes.

7. Use a public/private model. (3.9 average response) Minnesota's developing health insurance exchange should be run as a public-private partnership, like the Minnesota Zoo.

8. Forgive loans to primary care physicians. (5.0 average response) Medical school student loans should be forgiven for physicians who go into primary care.

9. Health care changes not needed. (2.2 average response) Don't tamper with the existing health care system. Concerns over access, quality and rapidly growing expenses are overstated.

 

Response Distribution:

Strongly disagree

Moderately disagree

Neutral

Moderately agree

Strongly agree

Total Responses

1. Health costs unsustainable.

6%

6%

6%

32%

48%

31

2. Cost and quality not apparent.

3%

6%

10%

48%

32%

31

3. Pay for outcomes.

26%

16%

13%

19%

26%

31

4. Curb expensive procedures.

26%

10%

16%

32%

16%

31

5. Each must assume responsibility.

0%

0%

10%

42%

48%

31

6. Prevention trumps treatment.

19%

0%

23%

35%

23%

31

7. Use a public/private model.

26%

26%

16%

26%

6%

31

8. Forgive loans to primary care physicians.

13%

23%

19%

39%

6%

31

9. Health care changes not needed.

52%

26%

6%

10%

6%

31

Individual Responses:

Peter Benner  (10)  (10)  (10)  (7.5)  (7.5)  (5)  (7.5)  (7.5)  (0)

R. C. Angevine  (10)  (7.5)  (7.5)  (7.5)  (10)  (10)  (10)  (7.5)  (0)

3. Pay for outcomes. While I agree this is the desirable course to follow I am unclear on exactly how such a system can be implemented.

Ray Ayotte  (7.5)  (10)  (10)  (10)  (10)  (10)  (10)  (7.5)  (0)

Paul Hauge  (10)  (7.5)  (10)  (7.5)  (10)  (7.5)  (5)  (7.5)  (0)

Randy Lawson  (5)  (10)  (0)  (0)  (10)  (0)  (0)  (0)  (0)

1. Health costs unsustainable. Government control of health is the problem.  Get out of Medicare, Medicaid and Affordable Care Act.  Medicine will be affordable again.

2. Cost and quality not apparent. So are most hospitals and insurance companies.  So stop trying to do it.

3. Pay for outcomes. Payment should be a free exchange between the patient and the doctor.

4. Curb expensive procedures. Lawyers should be restrained from suing MDs without having to be responsible for the court costs of both litigant and defendant.

6. Prevention trumps treatment.  Are you serious?  Are you a diabetes specialist?  I'm not and I should not be making this decision.

7. Use a public/private model. The health insurance exchange should go the way of the dodo bird.

8. Forgive loans to primary care physicians. There should be no student loans.  Student loans without schools’ reducing tuition is tyranny.

9. Health care changes not needed. Get the government out of healthcare.  Get government out of insurance regulation.  Let the people buy Major Medical and pay the rest out of pocket.

Pat Barnum  (10)  (7.5)  (0)  (0)  (7.5)  (5)  (0)  (0)  (7.5)

2. Cost and quality not apparent. Minnesotans certainly are capable of determining if the health care they are receiving from providers meets their needs. And most are capable of selecting someone else, if they don't think they are getting the best care. They don't need a government agency to tell them that. But I do agree that most do not "shop" their care for price, and therefore don't realize that they might be able to get identical services at different net prices.

3. Pay for outcomes. Because bureaucrats are so much better at determining whether an outcome is "expected" and therefore payable. It doesn't take much imagination to come up with very bad unintended consequences of that practice.

4. Curb expensive procedures. This is a decision to be made between doctor and patient. Period.

6. Prevention trumps treatment.  What kind of a question is this? Waste of time to ask and collect.

8. Forgive loans to primary care physicians. And then who pays? The taxpayer? No thanks.

9. Health care changes not needed. Where is the question about whether MN should be creating an exchange? That is the REAL question, is it not? If the government wasn't already so meddling in what has to be covered, by whom, and for whom we wouldn't have gotten into this mess in the first place.

Ralph Brauer  (2.5)  (5)  (0)  (0)  (5)  (0)  (0)  (5)  (2.5)

1. Health costs unsustainable. There is a bit of “crying wolf” about this. We have been warned the heath care crisis is on an "unsustainable trajectory" for over two decades. In a systemic sense each attempt to "fix" it has made things worse. A classic case is HMOs. They were the fix of choice two decades ago. Instead they have raised costs and lowered quality. Minnesota's drop in rank is testimony to that as is the unconscionable increase in costs and the salaries of the MBAs who now run the system.

2. Cost and quality not apparent. Without a definition of quality I can't answer this. Providers supposedly rated high in quality were just disciplined by Medicare for offenses that don't show up in measures currently being used.

3. Pay for outcomes. What is the "expected outcome" of a patient with a chronic rare disease that has no cure? It is one thing to rate outcomes on simple surgical procedures and the use of screening tests it is another to rate diagnostic outcomes. The "right" diagnostic outcome is to make the optimal diagnosis. Sometimes that takes time and money.

4. Curb expensive procedures. Of questionable value to whom? Is this going to be a triage judgment where a procedure might help a handful of people, but be costly? Or to put the question another way: the system is now set up to pay for mass screenings of questionable value, but which are big profit makers for physicians and clinics. The other dimension of this is who is going to make this decision and how? My father, a surgeon, used to say that statistics are not applicable in individual medical cases. Is some MBA sitting at a computer screen going to do this or a physician sitting in the office with an actual patient? It is counter-intuitive, but the system no longer trusts health professionals. That is the essence of this comment and some of the other points made. The counter-intuitive part is perhaps if we trusted physicians more rather than less it might go a long way to solving the problem.

5. Each must assume responsibility. A great many so-called "high risk" behaviors are the result of addictions--smoking and obesity are two prime examples. Do we go after the person who is obese because they guzzle too many Cokes with high fructose corn syrup or after the people who (are) responsible for using this substance, whose addictive qualities are becoming more apparent with each new study.

6. Prevention trumps treatment. This is a very dangerous triage statement. Are we going to shift dollars from a person who needs a kidney transplant to prevention? This is morally irresponsible.

7. Use a public/private model. A zoo is what we have now. To those of us who are system dynamics modelers if you are going to create a "public/private" model then you need to put your money where your generalizations are and actual model the solution.

8. Forgive loans to primary care physicians. Why primary care physicians only?

9. Health care changes not needed. The elephant in the room no one wants to confront is the corporatization of health care in Minnesota. We need to break up these HMOs before they gobble up every hospital and clinic in the state and leave us all dealing with the health care equivalent of Enron.

Chris Brazelton  (10)  (10)  (10)  (7.5)  (10)  (10)  (7.5)  (10)  (0)

4. Curb expensive procedures. Sensible standards must be set regarding value.

5. Each must assume responsibility. The system must be designed to be user friendly.  Also, trying to strike a balance between profit and what is good for consumers is tricky.  Consumers trying to make healthy choices are at a disadvantage in our economy.  We have a financial culture that is at odds with some of our goals.  Businesses can make more money by cutting corners or providing goods and services that are less healthy, especially in a climate where the need to improve the economy results in demands for less regulation. Petro chemicals and carbon based energy are unhealthy.  Factory farms with rampant use of antibiotics and growth hormones are unhealthy.  Even efforts to improve school lunches sometimes get bogged down in politics, supporting certain food producers that provide less healthy choices. Sedentary office work or repetitive factory work for companies that discourage frequent breaks leave workers with fewer options.

6. Prevention trumps treatment.  Obviously both are important.  The thing about investing in prevention is to spend extra money wisely and efficiently now to reduce costs in the future.  Conversely, what we failed to prevent yesterday is costing us dearly today, and this only gets worse as time goes on and we fail to make key investments.  This principle is relevant in many areas beyond the health care we are talking about, including mental health, education, infrastructure, alternative energy, peace on Earth…

7. Use a public/private model. Success will depend on many factors.  Buy in from key stakeholders is critical.  It is also important to be able to filter out the lobbying efforts of those who don't add value to the mission and goals.

8. Forgive loans to primary care physicians. There are ways of structuring this to bring more primary care physicians into markets that are underserved, especially in outstate Minnesota's rural communities.  Forgiveness must be tied to a minimum number of years of service.

David Dillon  (10)  (10)  (0)  (0)  (10)  (7.5)  (0)  (5)  (0)

2. Cost and quality not apparent. Why would they?  The consumer has been pushed to the curb in the modern "employer pays" health care system.

4. Curb expensive procedures. I presume this means some outside third party.

5. Each must assume responsibility. Many of the guidelines seemed phrased as political pabulum, so as not to offend.  So, you want consumers to be "aware" of costs and quality.  Well, how does that work in all the other normally functioning markets?

Tom Kujawa  (2.5)  (7.5)  (2.5)  (2.5)  (7.5)  (5)  (2.5)  (7.5)  (2.5)

1. Health costs unsustainable. Minnesota's healthcare is some of the best in the world. Is one’s access to healthcare a right? Who is responsible to provide that right?

2. Cost and quality not apparent. (This) is now available on the web, if people have the tools to access such.

3. Pay for outcomes. Compliance to taking care of oneself is a personal responsibility that has an impact on clinical outcomes. For example, you have an obese patient with hypertension and type-two diabetes. Patient cannot afford or (does not) have access to recreational facilities and or money to help pay for medications and other preventative care. Who is at fault when outcomes cannot be met due to socio-economical restrictions?

4. Curb expensive procedures. Most physicians order tests based on needs for obtaining diagnosis.  Empirically, when a dianosis is easy to obtain, we can treat cost effectively. Until the tools are available to assist in proper diagnosing, that are a benchmark procedural standard of care, sometimes we need to pay for advances in technology, costs, to assure advances in quality medical care.

5. Each must assume responsibility. See #3 comment above

6. Prevention trumps treatment.  Prevention is as important as is optimal care regardless.

7. Use a public/private model. I am not familiar with the business model of the zoo.

8. Forgive loans to primary care physicians. Education should be affordable for all regardless of one’s chosen profession.

9. Health care changes not needed. One can always improve the efficiency of the health care delivery model.

Scott Halstead  (10)  (10)  (10)  (10)  (10)  (0)  (2.5)  (7.5)  (0)

4. Curb expensive procedures. Restraints should be reasonable.  Excessive restraints may be more costly in the long run and delay proper treatment to their detriment.

6. Prevention trumps treatment.  They are of equal importance.  We need both done well.

7. Use a public/private model. I'm not certain the health insurance industry and health providers will be good partners in operating a health exchange.  Based upon past performance many have placed their financial interest before the needs of the public.

8. Forgive loans to primary care physicians. There need to be limits, perhaps higher limits for serving in areas (where) there are an insufficient quantity of providers and consideration should be (given to) other (areas) with insufficient numbers of providers.

9. Health care changes not needed. The existing health care system is broken and band-aids and gum won't fix it.

Peter Hennessey, PhD.  (10)  (2.5)  (0)  (0)  (7.5)  (7.5)  (0)  (0)  (0)

1. Health costs unsustainable. Which is precisely why government must get …out of this industry and let it go back to true free market principles.  The historical trend in medical costs correlates directly with the deepening involvement in and take-over of this industry by the federal government.

2. Cost and quality not apparent. I don't now about MN, but I think it is fair to say most people manage to find ways to evaluate their doctors on a basis other than just their bedside manner.

3. Pay for outcomes. Doctors are not auto mechanics and people are not cars. Healing is not 100% and exclusively up to the doctor. Medicine is not absolute science; it is art. Outcomes cannot be guaranteed, but in the meantime the patient has used the doctor's time and expertise, for which he deserves to be paid.

4. Curb expensive procedures. How quickly we forget that all those "expensive diagnostic procedures of questionable value" —can you even name just one? — had replaced a truly dangerous, hazardous and expensive practice called exploratory surgery. Is anything like that even talked about anymore, let alone practiced?

5. Each must assume responsibility. Yes, and the best way to do that is to pay for the services yourself; pay at least a significant part of the bill. Otherwise, who cares if the doctor sent the insurance company or Medicare a bill for $200, insurance/Medicare approved $30, paid $24, and it is my responsibility to pay nothing. This sure will not deter me from running to my doctor with every stupid little ache and pain. And if I were a doctor, I would have no choice but to refuse to treat patients with insurance or Medicare. How is a doctor supposed to pay his bills, with reimbursement rates like that?

6. Prevention trumps treatment.  There is nothing new in this idea. People under regular care would be caught in time by any doctor. Still, many do progress to full diabetes, because the doctor alone is not responsible for the course of the disease.

7. Use a public/private model. The exchange should be run like a zoo? You do know that comparing any operation or enterprise to a zoo is a derogatory comment, right?  But the Freudian slip is right on the mark. Only a fascist or socialist theory of government would accommodate a public/private partnership in anything. A free market theory puts up a strict separation between business and state.

8. Forgive loans to primary care physicians. How … are medical schools supposed to pay their bills?

9. Health care changes not needed. The government must get … out of this and all other businesses and industries.  We are the United States of America, not Nazi Germany, Fascist Italy, Soviet Russia, Communist China, socialist European Union, etc.

Don Anderson  (7.5)  (7.5)  (5)  (10)  (10)  (7.5)  (7.5)  (7.5)  (10)

1. Health costs unsustainable. As more medical treatments and procedures are developed, it’s going to increase people's need to get health care.

8. Forgive loans to primary care physicians. Primary care is preventive medicine in that ailments are detected before they require other specialized physicians.

RW Geist, M.D.  (0)  (0)  (0)  (0)  (10)  (0)  (0)  (5)  (0)

1. Health costs unsustainable. This is the fate of all managed care systems whether corporate here or nationalized abroad.

2. Cost and quality not apparent. Patients are able to judge personalization, continuity, and timeliness of care and rightly trust their doctors now, but will not when the ACO doctor is paid by the corporation to restrict care--splitting the ACO capitation fee profits from bedside gatekeeping is called "gain sharing".

3. Pay for outcomes. "Value" payments are the smoke screen intended to hide basing provider pay on the clinic's "cost of care index". Remember, the equation is "value"="quality"/cost. The only thing that counts in the HMO corporate and government agency counting houses is what they can count--money.

4. Curb expensive procedures. Does this mean that some computer algorithm or MBA should make professional decisions for what is 'necessary" for a patient they never see? "Questionable value" is one of favorite bits of sophistry to cover-up barriers to care by blunt corporate or government tools used for regulation of access.

5. Each must assume responsibility. The cost of care will never be controlled until folks know the real prices of the services (they) want.

6. Prevention trumps treatment.  Prevention is not a magic (way) to cost control nor improving population costs and medical statistics. Vaccinations and prenatal care are about they only real cost savers. The various "preventions" and screenings are nice and of aid to individual patients but tend to make medical care more costly in over 4 decades worth of peer reviewed studies.

7. Use a public/private model. If you want a financial and quality disaster create a utility system for a microeconomic sector where millions of people make millions of transactions daily baseed on the real, not subsidized prices of goods and services. ObamaCare is a cartel creation system to fix prices and to franchise insurance and provision of medical care. Too bad the monopoly-nationalized cartels abroad don't work and neither will the corporate-state cartels here. They make fixed budgets "work" by caring for the many well ("well care") while queuing the few ill ("sick care").

8. Forgive loans to primary care physicians. This is government determining winners and losers without understanding what drives demand inflation and without understanding that shifting to primary care docs is no panacea for cost control. The percentage of GDP spent abroad on medical care has everything to do with national wealth and and variance of population demographics--not because primary care makes some magical difference.

9. Health care changes not needed. The current system cost problems began abruptly after 1965 when 85% of the population suddenly had taxed-subsidized insurance. Paying for care with tax-free insurance dollars makes care appear "free". Decades of trying to ration access to supply (HMOs, CON, DRGs, and price fixing) have failed, because the problem of medical inflation is caused by "free" care demand. The only way out is to get control of medical dollars back into the hands of families from the managed care barons--more on that another time.

Lynn Bartness  (7.5)  (7.5)  (5)  (5)  (10)  (5)  (0)  (5)  (5)

Anonymous 1  (7.5)  (2.5)  (7.5)  (2.5)  (10)  (7.5)  (2.5)  (2.5)  (7.5)

Paul Daugs  (0)  (10)  (0)  (0)  (10)  (0)  (0)  (0)  (10)

1. Health costs unsustainable. If the Government would get … out of the individual market and let consumers buy the health care they want and stop the class action law suits from coming the health care system would be an actual market again. The problem is the government and the problems would be solved on their own if the government would get … out of business decisions.

2. Cost and quality not apparent. Most Minnesotans are unaware because our system today does not involve them in the cost decisions. Typically, the clinic works with the insurance company and thus the clinic can charge higher prices. Consumers should have to stand in between the clinic and insurance carrier so the clinic can't charge such outrageous rates for basic health care check ups.

3. Pay for outcomes. The very definition of a market is based on consumers paying for services rendered.

4. Curb expensive procedures. Until the government makes tort reforms so lawyers cannot (file) suit for the punitive damages within class action suits doctors need to do all of these diagnostic procedures to make sure they will not be sued.

5. Each must assume responsibility. And they should have pay for their health care and be reimbursed by insurance carrier.

6. Prevention trumps treatment.  We cannot nanny our way to cheaper costs; each person must understand their health care risks and needs and should be responsible for paying for their needs. This way the individual will stay healthier because they have the right incentive to not become sick. No more free health care.

7. Use a public/private model. Government's purpose is to protect private property, get … out of my health care decisions.

8. Forgive loans to primary care physicians. If people want to become doctors then they need to pay the price for becoming a doctor not be rewarded with no debt and a big fat paycheck that they can do with what they want.

9. Health care changes not needed. (There) are concerns with the health care system but you are going at fixing it with the worst possible ideas. We need to restore a true market place not regulate … it.

Dave Racer  (10)  (5)  (0)  (0)  (10)  (5)  (2.5)  (2.5)  (0)

1. Health costs unsustainable. The primary cost-driver is government interference with private markets - politics vs. policy.

2. Cost and quality not apparent. Most Minnesotans do not care how their doctor ranks against others. They care only about whether they are receiving good care.

3. Pay for outcomes. This establishes the rule makers as the arbiters of quality care. Patients should decide directly with their physicians when care is needed. There is nothing inherently wrong with fee-for-service. What you are promoting is externally dictated formulaic healthcare.

4. Curb expensive procedures. Physicians should negotiate with patients about what is necessary, and patients should have financial risk. Questionable value is in the eye of the beholder and subject to the golden rule.

5. Each must assume responsibility. This is key. Individual responsibility, for most of us, is all that will reduce spending. But government or even healthcare professionals are very poor at convincing individuals to care for themselves. That decision rests in the spirit of the person.

6. Prevention trumps treatment.  Prevention is vitally important. And individuals that care for themselves by their own volition will tend to avoid Type 2 Diabetes. Of course. But what you are promoting is screening for early stage of disease. That is a different animal.

7. Use a public/private model. What a horrible comparison: Zoo to an Exchange. Surely you didn't mean to call humans animals, or did you? The only reason for an exchange is to use taxpayer dollars to subsidize insurance premiums and because the Affordable Care Act demands it. The governing form it takes is important, and a private corporation more like MCHA is a better choice than one run by a government department. But in the long run, the Exchange will fail to deliver because it cannot financially sustain what it promises.

8. Forgive loans to primary care physicians. No. Not unless the student trades dollars for time. If the physician is willing to work at the mean family income of his/her community until the loan is paid off, out of fees forgone, then okay.

9. Health care changes not needed. We have no choice but to find solutions. Medicare and Medicaid, the primary culprits, are destroying our economy. The concern about quality is grossly overstated, and access is partially overstated. Cost of care and volume of spending is a major concern.

Michael O'Brien  (7.5)  (10)  (10)  (10)  (7.5)  (7.5)  (5)  (2.5)  (0)

1. Health costs unsustainable. Health care has become to expensive. Obama care is not the answer but I do believe a more concerned effort should be made to control the excess billing by doctors and hospitals.

2. Cost and quality not apparent. Most people, not just Minnesotans, don't care as long as the bills are paid. They should be holding the physicians and hospitals accountable. I check my mom’s bills and find billing errors from Medicare and Medicaid. Very few do this. Insurance companies because of these errors and the extremely high cost of medicine has to charge high premiums— a catch 22.

3. Pay for outcomes. In any business you have to know your budget to be successful; not knowing what a surgery will cost makes it impossible for an individual or an insurance company to plan accordingly. Not rocket science; just common sense.

4. Curb expensive procedures. Diagnostic procedures are way out of control, again how can you plan a business strategy with these prices. If medicine was a business and we could shop around these prices, (we) would put them out of business. They would not be competitive in this free market society. Each facet of medicine from the beginning to the end should have a price tag. All doctors get the same pay; of course, surgeons and specialists would be at a different pay scale just like in the free market but manageable.

5. Each must assume responsibility. Many people are understanding if they want to enjoy life they must take care of themselves, but until it touches their pocketbook or life style, many won't do anything to help their own health. If there were financial reward for good health, proper weight etc. then maybe more would work at it. But there will always be people who will smoke, drink, and eat themselves right into medical care.

6. Prevention trumps treatment.  I know of people with type-2 diabetes and I know of people with their eyesight being affected and organs shutting down, amputations. All need care but much of this can be controlled by diet. Until more people eat good foods and pop is poured into the ground there will always be this problem; sugar and substitutes must be controlled in a diet.

7. Use a public/private model. This question is hard to understand. If you mean should be run like a business with fair and competitive prices where you can shop around for care, I would agree, if it keeps prices down and (service) isn't compromised.

8. Forgive loans to primary care physicians. The same argument is now being heard for math and science teachers. I have spent 13 years on a school board and forever I have heard about rising costs of colleges. Now that the government has control and charges our kids 7.5 % interest, the costs are higher. We need to award all of our kids with college free tuition no matter what the field. If medicine needs good doctors let the hospitals and their agencies pay for their student college and the same (goes) for any other field.

9. Health care changes not needed. Health care is a disaster. Obama care would be the biggest mistake we could make as a society. Someone needs to come up with a good responsible plan. We don't have one and if Obamacare gets in heaven help us. Everyone I have talked to in medicine agrees.

Anonymous   (7.5)  (7.5)  (2.5)  (5)  (5)  (10)  (2.5)  (2.5)  (0)

Anonymous   (7.5)  (7.5)  (2.5)  (5)  (5)  (10)  (2.5)  (2.5)  (0)

Anonymous  (10)  (8)  (4)  (8)  (7)  (0)  (8)  (5)  (0)

Until we move our health care system from a procedure-based system to a market-based system, we will continue to see costs escalate causing more state and federal assets to be tied up in these programs that should and could cost much less.

Robert J. Brown  (10)  (10)  (10)  (8)  (7)  (6)  (5)  (10)  (0)

5. Each must assume responsibility.  This is fine for individuals who have the education and time, but there is need for support through community education and other means for some people to understand this responsibility.

8. Forgive loans to primary care physicians. Some reasonable program such as where loan is 10% (forgiven) for each year served in primary care.

Mary Jo Kreitzer  (10)  (8)  (5)  (7)  (7)  (5)  (2)  (7)  (1)

Expand essential benefit set to include evidence-based integrative medicine. Has potential to improve outcomes and lower costs.

Tim Hall  (na)  (na)  (na)  (na)  (na)  (na)  (na)  (na)  (na)

We have a representative government. It is the responsibility of elected officials to be our purchasing agents. I know they don't want this responsibility since there will be conflict between those receiving the money, and those receiving services. If our elected officials are unwilling to manage the taxes they collect, then it is time for new elected officials. To bring down cost we need to look at tort reform first, then ask Hospital owners what compromises they would be willing to make for this reform. Second insurance companies invest and leverage the money they bring in. One idea would be to mandate insurance company's that a certain percentage of investment money would be put into a safe account to lower leverage. That money would be tax-free since it would be a rainy day fund.

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

Ellie Skelton  (7)  (9)  (5)  (8)  (7)  (5)  (7)  (6)  (2)

Tom Spitznagle  (5)  (5)  (7)  (5)  (9)  (7)  (7)  (1)  (6)

During my time as a Minnesota health care company executive, I was impressed by how focused the industry, along with its group plan customers, are on the issues of health care quality and cost.  This probably helps explain why Minnesota has been ranked at the top in health care for so many years.  With some regulatory guidance, the free market system works very effectively.
 
Providing more information to consumers about how to best maintain their health along with health plan financial incentives to follow a healthy lifestyle is a good idea.  Providing concise information to consumers about where the best health care can be obtained is another good idea and will promote competition in the marketplace, which can lead to better overall health care.
 
Much is said about the benefits of electronic health records and they are substantial.  But, the industry has been moving in this direction on its own since the late 80’s (I developed a proposal that AT&T presented to the Mayo Clinic for electronic records back in 1987).  Today, major providers like Park Nicollet and the VA system have systems that have been in place for years.  I’m not sure what public policy involvement in this issue would achieve other than to promote standardization.
 
I didn’t notice any mention about dealing with some of the cost drivers that impact health care such as 1) government health programs that artificially cap reimbursement rates and the effect that this has on passing unreimbursed costs on to drive ever-rising health insurance premiums along with reducing access to care; 2) the costs of litigation and associated malpractice insurance;  3) the costs associated with care provided to those without insurance or the ability to pay.
 
I’m not convinced that a great deal of government involvement in the health care industry is a good idea when one looks at how well the state and federal government are doing managing their own affairs.  That includes the highly unpopular Affordable Care Act.  Having said that, any task force should heavily involve health care industry experts so that the potential ramifications of any new state programs can be identified and addressed.
 
Observation:  if anything, the state should first have in place a comprehensive task force to analyze its own operations and make recommendations for much-needed operational and financial improvements.  After succeeding at this, then maybe the state may have some credibility when it comes to guiding other industries on matters of cost and quality.

William Kuisle  (9)  (9)  (9)  (5)  (8)  (8)  (1)  (4)  (2)

Carolyn Ring  (10)  (8)  (4)  (4)  (10)  (10)  (6)  (5)  (5)

Who will make the decisions in questions 3 and 4?  There must be reform of malpractice suits before there can be any change in determining unnecessary procedures.

Chuck Lutz  (10)  (9)  (9)  (8)  (9)  (7)  (8)  (8)  (2)

Roy Thompson  (7)  (8)  (7)  (8)  (8)  (6)  (5)  (7)  (3)

    

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 


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The Civic Caucus, 01-01-2008
2104 Girard Avenue South, Minneapolis, MN 55405.  civiccaucus@comcast.net
Verne C. Johnson, chair, 952-835-4549,       Paul A. Gilje, coordinator, 952-890-5220.

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