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 Response Page - Leitz  Interview -      

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


Scott Leitz, Assistant Commissioner, Minnesota Department of Human Services, cautions that for the interest of the state - government, business, and individuals alike - the rapid growth in cost of health care must be contained. Aging is a particular challenge as is the hard reality of decreased fiscal resources available to meet rapidly increasing costs. "When you pair information on the quality and the total cost of care with incentives for consumers to make choices based on that information," Leitz contends, "you begin to see the elements of a solution."

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 Scott Leitz. 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 care will dominate budget. (8.5 average response) Health care expenses are rising so fast that they threaten to eat up every dollar of increase in the Minnesota state budget.

2. Provide outcome and price data. (6.5 average response) An essential element to improve health care and lower its costs is to make public the outcomes of care and the prices charged by doctors and hospitals.

3. Fee basis rewards spending. (7.2 average response) Even with information on cost and quality, the system will continue to reward spending if hospitals and doctors continue to be paid on a fee for service basis.

4. Require new incentives. (7.3 average response) Health plans should be required to include incentives that reward patients who choose better quality at lower cost via such means as variable co-pays and deductibles.

5. Don't change incentives. (2.4 average response) The problems of cost and quality in health care are nowhere near the point where changes in incentives are needed.

Response Distribution:

Strongly disagree

Moderately disagree


Moderately agree

Strongly agree

Total Responses

1. Health care will dominate budget.







2. Provide outcome and price data.







3. Fee basis rewards spending.







4. Require new incentives.







5. Don't change incentives.







Individual Responses:

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 poor.

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 insurance moot.

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 providers.

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, not MBAs.

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 word

"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 system.

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.



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 

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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