Ray Ayotte (7.5) (10) (10) (10) (0)
Chris Brazelton (10) (10) (10) (10) (0)
3. Fee basis rewards spending.
Information will be the key, helping more patients become partners in
their care, training them to make more informed choices.
4. Require new incentives. We have to be
careful not to incentivize providers who accept only healthier
patients and avoid the chronically ill patients whose prognoses are
Bruce A. Lundeen (10) (7.5) (10) (7.5) (0)
4. Require new incentives. (Given) the
cost of health care and the incomes of, in particular, inner-city
people, co-pays are not an option, and deductible for having no
5. Don't change incentives. The current
system is going toward excluding a substantial number of people from
health care altogether.
Anonymous (7.5) (5) (7.5) (5) (2.5)
Dave Broden (7.5) (2.5) (5) (7.5) (2.5)
1. Health care will dominate budget.
This is the party line of each party and those forcing health care
into government. Good fiscal management may not result in this
situation. (We n)eed to be objective but also sensitive to the fact
(that) health care is increasing in cost and the demographics are
driving the costs.
2. Provide outcome and price data. While
making the information public will help the quality of the information
and also making the information have some specific actionable status
is much more important. Metrics must be accurate and common across all
systems and must be kept current. We also must be cautious about too
much focus on cost without attention to services and quality.
3. Fee basis rewards spending. The issue
of payment based on fee for services has become a buzzword and may not
be as real an issue as some suggest. There needs to be a realistic
study of which approach provides the best health care quality and
expertise as needed by the patient.
4. Require new incentives. A very good
idea and approach if and only if the metrics can be made effective
otherwise this is a gimmick.
5. Don't change incentives. Cost and
quality need to be continuously addressed
David Dillon (10) (0) (0) (10) (0)
1. Health care will dominate budget. How
can anyone not see this?
2. Provide outcome and price data.
Essential? No, that's optimistic. It might help but it misses the
larger opportunity of savings to be had from real consumer engagement.
Individuals should buy their insurance and deduct the costs. Getting
the consumer involved has more promise than any other move. And, this
scares the dickens out of both insurance companies and health care
Robert Freeman (10) (10) (10) (2.5) (2.5)
Pat Barnum (10) (0) (2.5) (2.5) (7.5)
1. Health care will dominate budget.
However, I challenge the "rightness" of whether the State should be
providing so much care for so many people. Is that really the proper
role for the government/taxpayer? Except for those most vulnerable I
don't agree that it is.
2. Provide outcome and price data. I
have absolutely no trust in a government determined rating of whether
care was worthy of a good rating or not.
4. Require new incentives. A *private*
health insurance plan certainly has the right to limit the network
their subscribers may visit. Equally, an individual should have the
right to purchase any plan they want (or chose none) from a free
market, competitive environment. However when the state strangleholds
competition and completely regulates and controls revenue, and accepts
responsibility for paying for so many people, I would disagree that
they should further be allowed to what amounts to winners and losers
in the public feeding trough of health care providers.
Rosemary Froehle (10) (10) (10) (7.5) (0)
3. Fee basis rewards spending. I have
worked in the health care system for years and seen this effect over
and over. I have been one of those people who provided coordination of
services as a social worker and program coordinator. We couldn't get
reimbursed for the time/cost of the coordination yet we saved money by
helping to reduce unnecessarily scheduled doctor/clinic visits,
(providing) education and referring patients to most appropriate
medical personnel, referral and support to other holistic types of
treatment, support systems, etc. We had a small version of "medical
home" and I believe this is one of the stellar components for
improving quality while reducing costs.
Ralph Brauer (2.5) (0) (0) (0) (5)
1. Health care will dominate budget.
Leitz should be ashamed of himself. This is the equivalent of saying
we have a warm July because it's summer. The issue is which costs for
what are rising. Several studies have shown one reason costs are
rising (is) because of HMOs and the outcomes piece. The percentage of
health care dollars going to administration is considerably higher as
a percentage of total health care costs than it was 20 years ago. A
second reason is that all this monitoring costs something. God help us
if this is what passes for expertise in the Health Department.
2. Provide outcome and price data. This
is very dangerous data. Health care is not building widgets. Every
patient is different. This answer and most solutions to the health
care crisis show a total lack of systemic understanding. For example,
HMOs require doctors to see so many patients per day. This figure is
based on some dubious number crunching and a great example of why you
don't want MBAs running our health care system---which they are now.
The only way to really determine this and other health care issues is
to use system modeling. For starters that model would use time not
money as its main variable. Why? Take the patient issue--some patients
might take a few minutes others might require considerable time. We
built an experimental model of nursing staffing that shows the current
system is too rigid because of MBAs setting staffing criteria so that
the system finds it difficult to respond to crises. The issue of time
allocation on a single unit in a hospital is the entire problem in
miniature. Making public outcomes tells us nothing. (A) misdiagnosis
because of the time thing can cost millions and I say this from
personal experience. Rigid HMO rules would not allow for the right
tests to be done or the right therapies to be undertaken. The bottom
line is that HMO rules in my case cost them over a million dollars
that would have been saved by one simple x-ray and proper drug
therapy. As for prices, health care is not a car. What is needed is to
put the system back in the hands of doctors. There is a reason the
Mayo Clinic is the best hospital in the world--it is run by doctors,
3. Fee basis rewards spending. This is
patently ridiculous. Don't we pay everyone from auto mechanics to CEOs
on a fee for service basis? Are we going to provide better care for
our cars than we do for our people? Not to belabor (pun intended) the
issue but you and I can both bring our cars into a mechanic to be
fixed. In both cases the car won't start. In one it is a simple
problem--the battery is dead. In another it is more complex---the
battery is dead because of some bad wiring it takes time to find. Do
both drivers get identical bills? No. Are both outcomes equal? If we
treated the mechanics like we do doctors they would have fifteen
minutes to figure out the cause. The one with the bad battery would
get fixes right away. The one with the bad battery due to wiring costs
might get a new battery and then be back in the shop in a few days
because there wasn't time to diagnose the problem.
4. Require new incentives. Forgive my
feistiness, but this is also patently stupid. Patients are not health
care professionals. They have no way to make health care decisions.
What every patient wants to know is who is the best at what they do,
not if they are the cheapest. There is a reason that patient errors
are the third leading cause of death in the this country and that we
rank on a par with Cuba in WHO rankings of care even though we spend
more than any other country. It is because people like Leitz are
micromanaging the system even though they lack any training in health
care. Note: Leitz has absolutely no training in health care; judging
by his resume not even a simple course in anatomy, but he is making
decisions about your treatment and mine. That is truly scary. It's
like letting Homer Simpson run the nuclear power plant.
5. Don't change incentives. I honestly
do not understand this question. What is meant by changes in
incentives? Again, health care is not producing widgets. To inject the
"incentives" into any health care discussion
is dangerous. Health care professionals have an incentive--it is
called the Hippocratic oath.
Don Anderson (10) (5) (5) (7.5) (0)
Mina Harrigan (8) (8) (10) (8) (0)
Robert J. Brown (10) (10) (10) (10) (0)
1. Health care will dominate budget.
This was forecast by the Brandl-Weber report for Arne Carlson, but as
long as things were going well people ignored that warning. Are they
going to ignore it again if the economy and the state budget improve?
Wayne Jennings (10) (10) (5) (8) (4)
Assuming that testimony was valid, it is
encouraging to hear that Minnesota health care leads the nation and
that further efforts for prevention and determining quality are
underway. Much work remains to be done before the goal of universal
healthcare is assured for all at reasonable costs.
Carolyn Ring (8) (4) (8) (7) (3)
Until there is reform on malpractice suits
doctors will continue to administer tests and other safeguards that
have a minimal outcome for patients.
Jerry Fruin (7) (10) (8) (9) (0)
Chuck Lutz (8) (10) (10) (9) (0)
Amy Wilde (10) (9) (10) (9) (1)
The Welfare Reform 2.0 bill currently going
thru the Minnesota Legislature would do little or nothing to impact
the true cost drivers of human services costs. How we pay doctors,
transparency on where Medicaid money actually goes (how much pays for
actual care), paying for outcomes instead of just fees for service,
early intervention, and incentives to individuals to prepare/plan for
aging and practice evidence-based prevention habits, etc., will do
much more to reduce Medicaid costs than trying to disqualify a handful
of drug-using applicants by giving everyone costly drug tests.
Arvonne Fraser (5) (7) (10) (8) (4)
We also need more and continuous public
education about living more healthy lives and join other states in not
making doctors do everything possible to save lives of the
terminally-ill aged or those with health care directives that forbid
resuscitation or those who are brain dead.
Bright Dornblaser (10) (10) (10) (10) (0)
Tom Spitznagle (5) (7) (4) (5) (4)
Minnesota has been a leader in health care
creativity thanks to smart, motivated people combined with incentives
provided by a free market. Government can provide some standards so as
to ensure consumer fairness but attempts by government to micromanage
the health care market generally serve to screw things up for the
majority, unless, of course, there is some other political objective
in mind besides improving the nation's health care.
For example, attempts by government to use its bargaining power to
reduce costs only serve to distort costs for those covered by private
health insurance. Mandates to provide health services to the uninsured
further distort private insurance costs. Government further distorts
the market by reimbursing providers at much higher rates in some
states and by not adequately monitoring costs incurred by its health
plans for legitimacy.
My experience with the health care industry indicates that competition
between insurance companies, HMO's and PPO's to provide quality health
care coverage at a reasonable cost to their group and individual
customers, combined with competition between providers to be one of a
health plan's preferred provider, go a long way towards insuring that
health care quality remains high and costs are competitive.
Perhaps the major drivers of rapidly rising health care costs are
conditions like those noted above and demographic shifts that are not
under the health care industry's control. Perhaps increased
competition, such as the government allowing out-of-state health plans
to compete, would provide an even stronger market-based incentive for
insurance companies and providers to keep costs and quality in line
than would government micromanagement.
Lyall Schwarzkopf (9) (7) (6) (8) (9)
David Detert (10) (2) (7) (10) (10)
As a family physician this topic has always
been a top concern for me and I could write a book in response. First
I believe that the basis of all present reforms, which is that
improved quality will lead to reduced costs, is false. The truth is
the opposite and is shown by the crisis in funding social security. As
we improve quality, the cost for the individual or for the particular
procedure may go down but the composite cost goes up because the
individual lives longer, develops other medical problems, which
require additional care and treatment and thus cost.
To control costs we need to completely revamp the system, include a
discussion of what we can afford as a society, decide how we include
everyone in paying for health care and hold people responsible for
their own health.
The current efforts to improve health care
are all worth doing but are 30 years too late and not nearly
comprehensive enough to deal with our problems. My attitude about the
present reforms discussed in this issue is that they are what we do to
stay busy while we wait for the system to collapse.
Paul and Ruth Hauge (7) (7) (7) (8) (3)
Tom Swain (9) (8) (8) (7) (0)
Roger A. Wacek (10) (0) (5) (5) (5)
5. Don't change incentives. This discussion is like shuffling
deck chairs on the Titanic. The biggest cause of sickness & death is
the sickness care industry (lets quit calling what we have “health
care”); policed by the FDA. Obamacare will (probably) collapse this
Bert LeMunyon (7.5) (7.5) (7.5) (5) (2.5)
4. Require new incentives. Variable co-pays and deductibles do
not lower costs, they just shift the costs from insurer to patient.