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 Response Page - Knudson  Interview -      

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


Sue Knudson, vice president for informatics for HealthPartners, describes how that company has used its integrated structure as both payer and provider of health care to provide better relative quality at lower costs than competitors. She discusses the opportunities and challenges of Minnesota's implementing such a structure statewide.  

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 Sue Knudson. 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. Incentives now result in higher costs. (8.7 average response) Because existing incentives don't reward efficiency, health care is far less cost-effective and more expensive than it should be.

2. Change market to get better value. (9.2 average response) The health care market should be changed to enable people to buy better care at lower cost.

3. Provide information to consumers. (9.5 average response) Advance information on the cost and quality of health care providers should be available to consumers.

4. Give consumers incentives. (8.8 average response) Consumers should be given incentives, such as lower co-pays, to choose cost-effective providers.

5. Overhaul of health care pricing not warranted. (1.8 average response) The growing expense of heath care is not so great as to require big changes in how consumers select providers and how providers are paid.

Response Distribution:

Strongly disagree

Moderately disagree


Moderately agree

Strongly agree

Total Responses

1. Incentives now result in higher costs.







2. Change market to get better value.







3. Provide information to consumers.







4. Give consumers incentives.







5. Overhaul of health care pricing not warranted.







Individual Responses:

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

4. Give consumers incentives. As long as the cost-effective providers are in the high quality tier.

Roy Thompson (8) (5) (8) (7) (5)

Terry Stone (10) (10) (10) (10) (0)

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

Bert LeMunyon (10) (10) (10) (10) (0)

Peter Hennessey (10) (10) (7.5) (2.5) (0)

1. Incentives now result in higher costs. And the problem will only get worse as long as we are still trying everything under the sun except a free market solution.

2. Change market to get better value. I don't see any mention of, or advocacy for, returning to a free market in health care. Yet time and again we see that only free market competition is able to achieve the seemingly mutually exclusive goals of better service at lower cost. It is never explained (why) free market works in every other area of the economy, but is not allowed to operate in the health care industry. Every problem we are facing now is the direct result of government interference, since the New Deal and especially since the Great Society, and about to be made far worse under Obamacare. There won't be any successful reform as long as we are operating under the assumption that we only need to tinker with the government's dictatorial role in this field, within the existing pseudo-fascist / pseudo-socialist framework and the coming hugely more intrusive and destructive provisions forced on the industry by Obamacare.

3. Provide information to consumers. I don't see a proposal for a Consumer Reports type of survey to compile the experiences of patients with a specific doctor or clinic or hospital. Even if we did have something like that, the doctor-patient relationship is highly unique to every specific case. Yes, somehow patients must be better educated, about their illnesses and the cures, a specific doctor's / clinic's / hospital's / lab's expertise, and their costs. What is never addressed is how you do that across all levels of education, intelligence, motivation, income, etc., to make sure patients can fully participate in their own care.

4. Give consumers incentives. The problem is third-party payer, whether it's an insurance company or the government. People pay far less attention to cost as long as they think it's someone else paying for it. If anything, co-pays should be higher to make patients more cost conscious, and thereby use and abuse the system less. If an insurance company is to be the payer, maybe it should be owned by the policy holders like a mutual company, so that periodically they would get a refund for premiums not spent. In any case, we must establish health care savings accounts out of which to pay out of pocket incidentals, office visits or co-pays, premiums for catastrophic coverage, etc. And as long as we still have an income tax, all contributions to health care savings accounts and all medical expenses must be fully deductible, without caps and limits.

5. Overhaul of health care pricing not warranted. We must get government out of the health care industry and out of the health insurance industry. This is not one of the enumerated powers of the federal government, and we've seen how tinkering with such ideas at the state level has also only made the problem worse. Let the industry go back into the free market, with doctors and patients setting their own terms.

Ken Smart (10) (10) (10) (10) (0)

1. Incentives now result in higher costs. I believe primary reason for this is that cost has been shifted to third parties. There has been far more efficient and cost effectiveness, for instance, in vision care, where the consumer is the primary payer of services.

2. Change market to get better value. Need to take government out of the equation and allow individuals to purchase their own insurance without mandated government coverage - then consumers can choose the coverage that meets their needs.

3. Provide information to consumers. Again - this is only meaningful if consumers are paying the cost directly - if a third party pays the cost, then providing such information is irrelevant and a waste of resources.

4. Give consumers incentives. This should also be priced into the insurance premiums consumers pay.

5. Overhaul of health care pricing not warranted. Health care cost is clearly growing at an unsustainable rate.

W. D. (Bill) Hamm (10) (10) (10) (5) (0)

1. Incentives now result in higher costs. The system now exists to serve the system not the patient. We need locally controlled coop structures connected to a central data and buying center that are structured (to) provide patient centered healthcare, the model used by the Basque industrial Coops. What your offering us here is more top down system centered over expensive (waste).

2. Change market to get better value. The system needs to be changed to allow the people to participate in the decision as to the type of healthcare they want and need. I tire of this elitist game of telling us what Ö we must choose from.

3. Provide information to consumers. Only if it is available for all options, including the Coop structures I spoke of.

4. Give consumers incentives. This constitutes a defeatist attitude, there should be no co-pays or base pays either; all are the result of greed within the system.

5. Overhaul of health care pricing not warranted. These thieves are taking us for double the inflation rate or better ever year. Insurance companies must be driven out of the market by coop competition. At the same time Government and public employee unionism must also be taken out of the equation. The only structures on the planet that have successfully achieved this and provide cheap quality healthcare that is patient based are the Mondragon Industrial Coops.

Dave Broden (7.5) (7.5) (10) (10) (0)

1. Incentives now result in higher costs. Metrics can be set for any answer desired. While the improved metrics will add information there is no assurance that the metrics with stated incentives will add to the cost effectiveness.

2. Change market to get better value. The statement is valid and the overall objective but what is the level and what are the criteria that say lower is lower and quality increases. Metrics are as good as those who wrote them and very dependent on how they are used.

3. Provide information to consumers. Some for relative ranking on a common basis should be available but the approach must be uniform and the cost of developing and maintaining the data base must very low or it becomes a hidden cost that has no direct health care value.

4. Give consumers incentives. The concept of variable co-pays is one that may have some value and should be applied as a prototype to see if the concept works.

5. Overhaul of health care pricing not warranted. One factor in health care cost will be the impact of competition on cost as long as competition does not begin to compromise the availability of the quality and type of care an individual desires.

Bob Olson (10) (10) (10) (10) (0)

David G. Dillon (10) (10) (10) (10) (10)

Clarence Shallbetter (na) (7) (8) (7) (3)

Bright Dornblaser (10) (10) (10) (10) (0)

Mina Harrigan (10) (10) (10) (10) (0)

John Milton (na) (na) (na) (na) (na)

Here is my response to yet another dance-on-the-head-of-a-pin: if we're serious about having a healthcare system that is available and affordable for all, we'll need to go back and expand Medicare to all citizens, with a single payment mechanism designed for access, quality and control of unnecessary costs. This means the health insurance companies will have to find something else to insure, and we take the 25+% of total costs that are going to the health plans and operate the system on approximately 5% administrative costs, just like the present Medicare. No more dancing.

Kevin Edberg (9) (9) (9) (10) (3)

Alan Miller (na) (na) (na) (na) (na)

A single payer system like the rest of the civilized world would eliminate the absurd costs, be more efficient, and get the vultures away from feeding on the carrion (us, the consumers).

Arvonne Fraser (8) (10) (10) (7) (4)

Lydia Howell (0) (10) (10) (10) (0)

The U.S. should have universal single payer health care---like every other western democracy does. Currently--including ACA--it's all about insurance corps & big "pharma" getting more and more money!

Bert Press (5) (10) (10) (10) (5)

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

Iím way out of my league on this one, hence the manner of responding to the questions. But it appears that the block lies with our political leaders and until the voter recognizes that he/she are the ones sending the reps to govern, there will always be the dead-lock.

Robert J. Brown (10) (10) (10) (10) (0)

Lyall Schwarzkopf (7) (7) (7) (7) (4)

Virginia Eernisse (10) (10) (10) (10) (0)

A complex subject made clearer. Thanks

Wayne Jennings (10) (10) (10) (10) (5)

I believe in universal health care as a matter of right. HealthPartners is moving in the right direction even though a giant organization, which it itself can be a barrier (or an advantage). I appreciate this effort.

Tom Spitznagle (8) (9) (9) (8) (2)

Roger A. Wacek (5) (5) (10) (5) (0)

The big changes required: drugs & surgery are not health care! After 20 years of fighting with health care companies I dropped my health insurance. I did not want anything the health insurance companies covered!

Jerry Fruin (9) (10) (10) (10) (2)

Chuck Lutz (10) (9) (10) (9) (1)

Paul and Ruth Hauge (8) (9) (8) (8) (7)

Tom Swain (10) (9) (9) (10) (0)

Excellent Presentation. Overdue


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.

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