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 Response Page - Jesson  Interview -      


These comments are responses to the questions listed below,
which were generated in regard to the
Lucinda Jesson Interview of
04-14-2011.
 

Overview

Lucinda Jesson, Commissioner of the Minnesota Department of Human Services, describes the challenges facing the agency due to potential budget cuts. Health care comprises the majority of DHS spending, and half of that spending is funded by federal sources. The state needs to rework its payment schemes so that people may assume more self-direction of their care without the state foregoing its responsibility to protect and provide services to those who need them.  Commissioner Jesson calls for more effort at prevention in controlling health care costs. She believes paying providers based on outcomes should be considered and contends that families should assume some of the risks of care for vulnerable individuals. She suggests that the state should explore whether counties should be given more flexibility--while being held accountable for results--in the delivery of human services. 

For the complete interview summary see:  http://bit.ly/ip7Hk3

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 Commissioner Jesson. Average response ratings shown below are simply the mean of all readersí zero-to-ten responses to the ideas proposed and should not be considered an accurate reflection of a scientifically structured poll.

1. Prevention. (8.9 average response) It is essential in controlling health care costs that major efforts be directed at prevention, particularly in the high cost areas of heart disease and diabetes.

2. Outputs. (6.9 average response) Payment to health care providers should relate to whether or not treatment is successful (outputs) and not relate only to the amount of service provided (inputs).

3. Risk-sharing. (7.3 average response) Instead of assuming exclusive responsibility for protection of some vulnerable populations, the state should allow some risk-sharing with individuals and families.

4. Counties. (6.9 average response) Instead of the state making all decisions, county governments should be given more flexibility to decide how human services are delivered, while being held accountable for results.

 

Response Distribution:

Strongly disagree

Moderately disagree

Neutral

Moderately agree

Strongly agree

Total Responses

1. Prevention.

0%

11%

0%

24%

66%

38

2. Outputs.

13%

5%

11%

39%

32%

38

3. Risk-sharing.

8%

3%

8%

61%

21%

38

4. Counties.

5%

13%

11%

53%

18%

38

Individual Responses:

Ray Ayotte  (10)  (10)  (10)  (10)

Peter Hennessey  (2.5)  (0)  (7.5)  (7.5)

1. Prevention. This is an example of "sounds good in theory." But how do you propose to implement it? I can just see the food police and the exercise police knocking on your door every day (heck, three times a day). A doctor can only tell you how to change your habits, and give you medicines to treat your symptoms and consequences of your conditions. He can't make you change. And we all die of something in the end. What do you propose to do about the ravages of old age, such as immune deficiency, heart and kidney failure? Parts simply wear out.

2. Outputs. I wonder what the reaction would be if the same idea were applied to government. We've had a "war on poverty" since LBJ in 1965, a "war of organized crime" since the 1950's, a "war on drugs" since the 1980's, a "war on terror" since 2001 -- have any of them been won yet? What if we paid government for successful outcomes? Seriously, how do you propose to pay doctors and hospitals for the care of patients who are not going to get well, no matter what? Will government pay their office staff, malpractice insurance, tuition loans, leases and mortgages, etc.? Of course not. Doctors are among the filthy rich who have to be taxed higher and pressed harder in the name of social justice.

3. Risk-sharing. Case history. When my mother reached retirement age, and was separated from my father, she was pressed by a social worker to apply for SSI. I went with her to apply. The clerk at that time demanded to know about my finances, insisting that it is first and foremost my responsibility as her son to help her. This was in 1974. Just seven years later another social worker was absolutely furious with her for her refusal to apply for the whole package of SSI, food stamps, MediCAL, etc. By that time she was back with my father and did not need the extra assistance. I don't know why we changed the old-fashioned rules about family having the responsibility to help.

4. Counties. I am all for pushing all decision-making as far down to the local level as possible; but again, there is that phrase, "accountable for results." What does that mean? Success in getting people back on their own feet? Getting rid of federal mandates? Weaning our local governments off the federal funds for all these programs? Or convincing the old and the sick that it is their responsibility to die before they run up their bills too high?    Let's get serious. Social programs are expensive and a bottomless pit. The more we try to help, the more we feed only the neediness, not the self reliance, in the people we try to help. We only foster dependency and gamesmanship, not decency. Politicians respond to reforms by demagoguing them to death. It is only the politicians who don't understand that no matter what you call it, local taxes or federal taxes, it is the same people whose pockets are being picked. Most people don't even understand "family values" anymore, or only see then as intrusion on their "privacy" or as "cramping their style." Everything we tried so far has only made the problem worse, and in fact destroyed entire classes and generations of people. Just look at how statistics have exploded since the 1960's in the categories of promiscuity, divorce, illegitimate birth, addiction, single parenthood and other social ills, even as, or more correctly, because of all the money and programs we've thrown up against them.    Only a return to the understanding and appreciation of traditional values will lead us out of the mess we are in now. But government is exclusively about the use of power. So the only way government can use its power to help -- that is, reduce the cost of social programs - is by revising its rules for providing assistance, by means testing it against the applicant's extended family. However, this only raises the level of intrusion into everybody's lives to draconian levels. The other extreme is no government assistance at all; let every family fend for itself. I don't know where the reasonable middle ground is, except official and cultural insistence on self-reliance and self-determination first.

Bruce A. Lundeen  (7.5)  (5)  (2.5)  (2.5)

4. Counties. I am skeptical local governments can be fair without oversight.

W. D. (Bill) Hamm  (7.5)  (5)  (7.5)  (7.5)

1. Prevention. This is a thinly veiled statement in support of Governmental attacks on smokers and the obese and will do little to go after the industries pushing this garbage at us. Instead this effort is about legislatively attacking these individuals, which is much easier. This is the clearest reason why we need to get government out of the healthcare fix.

2. Outputs. By whose determinations? Instead of promoting a patient based healthcare system this proposal will bring about the same kind of institutional failure as "Outcome Based education" which moved us from child centered education to state mandated top down education. Same mechanism of control with no guaranteed outcomes for the patient, only outcomes for the system.

3. Risk-sharing. Helping organizations like LSS is much more cost effective than any state run program.

4. Counties. While I tentatively support this direction, the proof  along with my support is in the final details.

Dennis L. Johnson  (10)  (7.5)  (10)  (10)

4. Counties. The general approach outlined by the speaker is commendable; the question is how it is to be accomplished. The record in prevention is not strong when administered through the state, or even through public education programs.  Much of the need for health care is brought about through poor life-style choices, with a smaller percentage through inherited genes and just plain luck. My guess is about 75% the former and 25% the latter. Alcoholism, smoking, lack of moderate exercise, high stress occupations, overweight and related factors (are) the most obvious life-style factors. Regrettably, persuasion rarely leads to improved life-styles; another method must be found. One likely approach would be through rating health insurance costs according to lifestyles, just as auto insurance now is. Safe drivers with no violations get the best rates; others pay more.  Health insurance could be rated the same way, at least in the private market. The state or federal government could never do this, politically. The hard part is how to get health care to the indigent or those who refuse to purchase health insurance.  If the state picks up their costs, the numbers will increase greatly as people learn "why pay when you can get it free". Some formula of limited or only partial payment must be devised to create the incentive for all to purchase some form of insurance, regardless. States and Counties must be free to experiment with their use of funds to create a formula that works effectively and reasonably fairly for all.

Pat Barnum  (2.5)  (0)  (7.5)  (7.5)

1. Prevention. You can't legislate behavior to protect oneself, no matter how hard you try. Not to mention that it is not the role of government to try.

2. Outputs. Doctors and patients are the only ones that are in a position to judge the proper treatment and successful results. I simply cannot imagine having a government bureaucrat deciding what outputs are successful - we already have enough interference with insurance companies trying to make health care decisions.

3. Risk-sharing. There really is not enough information in the recap about what "some" we are talking about, both in populations and risk, to adequately answer this question. In general individuals should be responsible for their own decisions and expenses. Government should provide for a safety net for those truly incapable of providing for themselves. But more often than not, it works against the disabled by requiring totally dependency on the government when perhaps only partial assistance is needed (i.e., take a look at the rules regarding Social Security Disability).

Don Anderson  (10)  (5)  (7.5)  (2.5)

1. Prevention. Prevention also touches on the topic of fat and fast foods. How can we work with the food industry when their profits depend on fat and fast foods?

2. Outputs. Sometimes the treatment isn't successful, not because of the health care providerís treatment, but because of the patientís own condition.

3. Risk-sharing. Persons, a lot of times, become patients because of their own behavior.

4. Counties. Are we a State or a collection of Counties with their own ideas?

Ray Schmitz  (10)  (7.5)  (5)  (2.5)

1. Prevention. Curse the devil, etc.  How does the system really work on prevention? Most of what I have seen involves a discussion and filling out a form, but there are not services of follow up

3. Risk-sharing. If the individual/family is capable of doing this why is the person listed as vulnerable.

4. Counties. This assumes the will and ability of 87 counties to do so. My experience suggests that this is not true.  Why not centralize or regionalize the systems?

Dave Broden  (10)  (10)  (10)  (10)

1. Prevention. The key is to get people to take ownership of their own health issues particularly related to these two problems. In the case of heart and diabetes much of the problem is cultural and the related life style and diet. So just dwelling on health is not the answer that makes this issue as tough as it is (but the)need to make a life style change is some meaningful way without changing the culture impact.

2. Outputs. We must move to outcome-based measurements but without the complex system that may be needed to implement. This will drive both better health and better health care delivery.

3. Risk-sharing. A risk sharing approach must be core to the solution. Challenges are how should risk be defined, who is not part of the risk pool (i.e., chronic diseases, mental health, disabled?) and who defines? Most medical organizations agree that far too many people believe that the state will care for all, for all causes, and personal responsibility is not a factor--this is a cultural change without establishing a class war.

4. Counties. Moving from state to county or even city level should provide both flexibility and better direct attention to the specific need. The one concern that needs to be addressed is that all areas of the state or cities do not have the same services and some links and sharing must be established to ensure uniformity.

Tom Triplett  (10)  (7.5)  (7.5)  (2.5)

Anonymous  (10)  (7.5)  (7.5)  (7.5)

2. Outputs. Patients, however, do not always follow their doctor's advice. How would the state put responsibility on patients who don't pay for their own care to follow through on treatment...by denying future care? If so, how would that be done? I envision a bunch of appeals if care is denied.

3. Risk-sharing. Good idea, but how to actually implement...Choice is great, but hindsight is better than foresight when it comes to things like elder abuse.

Will Shapira  (10)  (0)  (0)  (0)

2. Outputs. I urge you to give serious consideration to a single payer system, similar to what is being proposed in Vermont. I want insurance companies out of the equation. Government can and should be responsible for wise spending of out health care dollars.

3. Risk-sharing. I am a socialist who favors good, big government. People cannot afford this wrongheaded idea.

4. Counties. Why should county governments be involved? One layer of government properly managed should be enough.

David F. Durenberger  (10)  (10)  (10)  (10)

This is my 40th year on this subject, and suggestions for policy change remain the same. Execution requires a kind of leadership that apparently doesn't exist in our community. Unfortunately. I wish her and Mark well.

Richard McGuire  (10)  (10)  (8)  (8)

Any discussion, debate, program restructuring that deals with medical care that fails to deal with the underlying costs of medical care [not merely how it gets paid for, i.e., insurance vouchers v. Medicare] is doomed to failure because it does not address the real issue.

John Milton  (10)  (10)  (0)  (5)

Alan Miller  (9)  (5)  (8)  (3)

Until we finally adopt some form of single payer, we will continue to remain as a third world provider when it comes to health care.  While corporations and their executives reap in the profits, 47 million Americans go without health care.  Absurd.

Don Fraser  (9)  (9)  (6)  (8)

Al Quie  (10)  (0)  (10)  (5)

Assuming there are inputs, activities, outputs and outcomes. Outcomes ought to be the determinant. Second, third party payers will always be a fiscal problem. If there were none, the decisions would be solely between the physicians and the patients. Any way that the patient has more responsibility and the physician has less worries about lawsuits, the less costly healthcare will be.

Mina Harrigan  (10)  (10)  (9)  (8)

Robert J. Brown  (10)  (10)  (10)  (10)

Chuck Lutz  (10)  (9)  (8)  (9)

Paul and Ruth Hauge  (9)  (8)  (8)  (8)

John Adams  (10)  (8)  (8)  (10)

Bert Press  (10)  (0)  (0)  (0)

Shirley Heaton  (10)  (10)  (10)  (10)

Christine Brazelton  (10)  (7)  (7)  (8)

2. We must make sure that we don't punish providers that care for people with chronic, incurable illnesses.

3. To the degree that those families are able to take responsibility.  Many families are not physically, mentally or emotionally able to care for vulnerable members of the family.   

Wayne Jennings  (10)  (8)  (8)  (9)

Program redesign comes up again as it should. I would like to see more active projects and less talk. The compliance orientation of the state agencies, important as that is, puts a real dampener on innovation. Plus creating and implementing new designs has to be done on the fly, like changing tires while the car is moving. Nonetheless, it must be done and encouraged by state agencies.

Scott and Nancy Halstead  (10)  (10)  (5)  (5)

How do you get individuals that have very little income and assets to be more responsible for their health and reducing the cost of health care?  We have sin taxes, but we don't connect the income brought by the sin tax in with the services provided.

Arvonne Fraser  (10)  (8)  (7)  (5)

Focus on prevention and, frankly, overuse of health care facilities; too much spent on last six months of peoples' lives (and I'm an old woman!).  More use of health care directives--maybe even sanctions against health care workers who disobey them.  More and better public education about hospice services.  Doctors can't fix everything; shouldn't have that mentality and neither should the public.  And more use of technology in health care so that tests aren't duplicated and health care costs cut with efficiency in record keeping and billing.  Cut administration and give teachers the same status as doctors.  They are equally important.

David Detert  (4)  (4)  (10)  (8)

Prevention is a good idea but it will be decades before it results in cost reduction and we need cost reduction now.  A big improvement would be to make people much more accountable for their own health as question three starts to suggest.  Most of what passes as health care reform now is way to late or the potential benefits are too far in the future to be of any practical good.  Health care reform as we are doing now is what we do to keep busy while we wait for the health care system to go bankrupt and take the rest of the economy with it.

Lyall Schwarzkopf  (8)  (6)  (8)  (8)

Clarence Shallbetter  (4)  (8)  (8)  (7)

Bright Dornblaser  (10)  (10)  (8)  (8)

Terry Stone  (8)  (6)  (8)  (8)

Carolyn Ring  (10)  (4)  (8)  (8)

2. Outputs.  Who is going to make the decisions as to what the outputs should be?

Tom Spitznagle  (9)  (9)  (9)  (9)

Leanne Kunze  (8)  (10)  (5)  (7)

Tom Swain  (10)  (10)  (7)  (8)

    

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, Marianne Curry, Bill Frenzel, Paul Gilje,  Jim Hetland,  Marina Lyon, Joe Mansky, John Mooty,  Jim Olson,  and Wayne Popham 


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