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These comments are responses to the statements listed below,
which were generated in regard to the
Tony Lourey  Interview of

Act now to ensure a Minnesota-based health insurance exchange

State Sen. Tony Lourey is chief author of Senate File (SF) 1, the Minnesota Insurance Marketplace Act. It creates the Minnesota Insurance Marketplace as a state health insurance exchange under the federal Patient Protection and Affordable Care Act (ACA). The bill must be passed by the end of March to meet federal timelines for establishing an exchange. Lourey contends that a Minnesota-based exchange will be a better model and less expensive than a federally designed exchange. Lourey says key components of the bill include: (1) Setting up a seven-member board in the executive branch that will run the exchange;  (2) Setting a clear prohibition of direct conflict-of-interest for board members governing the exchange; (3) Providing, through the exchange, side-by-side comparisons of health insurance plans, so consumers can choose plans based on cost and quality; (4) Giving the board the ability to select only health insurance plans for the exchange that are in the interest of consumers to ensure better value; (5) Providing clear tools for preventing adverse selection and ensuring a stable marketplace for consumers; and (6) Providing for payment to navigators and assisters to better serve the uninsured and underserved populations using the exchange. Estimates are that 1.3 million Minnesotans will seek coverage through the exchange by 2016.

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 Senator Lourey. 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. Focus is health insurance reform. (7.7 average response) Health exchanges are meant to accomplish health insurance reform, not health care reform.

2. Lower health costs may result. (6.1 average response) However, the cost and quality information provided to consumers by Minnesota’s health insurance exchange will have a positive effect on health costs in Minnesota because insurers will compete to offer better insurance products and providers will compete to offer higher quality, lower cost health services.

3. Many uninsured will benefit. (6.1 average response) The exchange will allow a very significant number of heretofore-uninsured people to obtain health insurance and access needed care.

4. Conflict-of-interest rules essential. (7.5 average response) Strict conflict-of-interest rules for the exchange board members are essential to consumer confidence in the operation of the exchange.

5. Products must be judged, approved. (6.1 average response) The exchange board should be allowed to exclude insurance products from the exchange that are not in consumers’ best interests.

6. A Minnesota exchange preferred. (8.0average response) It is better for Minnesota to design and build its own health insurance exchange rather than opt for the federal exchange, which attempts to be a "one-size-fits-all" model.

7. Exchange is a needless expense. (4.4 average response) Most people will still depend on employers or insurance agents to choose their health insurance; a health insurance exchange is simply going to add to the cost of state government without providing a benefit to most citizens.

Response Distribution:

Strongly disagree

Moderately disagree


Moderately agree

Strongly agree

Total Responses

1. Focus is health insurance reform.







2. Lower health costs may result.







3. Many uninsured will benefit.







4. Conflict-of-interest rules essential.







5. Products must be judged, approved.







6. A Minnesota exchange preferred.







7. Exchange is a needless expense.







Individual Responses:

Bert LeMunyon (7.5) (5) (5) (5) (2.5) (5) (7.5)

5. Products must be judged, approved. Aren't consumers capable of determining what is in their best interest?

7. Exchange is a needless expense. I would like to know which plan, federal or state is less burdensome to the taxpayers?

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

Dave Broden (7.5) (10) (2.5) (2.5) (7.5) (10) (2.5)

1. Focus is health insurance reform. While the focus may be on health insurance, the goal of improved insurance and the link to health care must be recognized and a key element of the plan. As the Health exchange moves ahead and is implemented it must be shown to have an impact on both insurance and care reform or it will likely fail to [be] accepted and used by the public.

2. Lower health costs may result. The statement is true and critical to the establishment of the health exchange. The real issue is however is the cost and particularly the quality information defined and prepared in a form and content that really addresses the quality. Quality in itself is a term that is so broad that it may not mean anything. Some expanded use of the term and with other terminology would be beneficial.

3. Many uninsured will benefit. This the big question. Even with the exchange, how will the uninsured connect with the exchange? To insure the uninsured there will likely be a need for the state or non-profits, etc. or for-profit organizations to set up offices or consultants to connect and help uninsured to be involved. This link will be key to the success, not the exchange itself.

4. Conflict-of-interest rules essential. This is debatable. It is difficult to exclude expertise in favor of generalists who are not experienced in the field. Some method of connecting the experienced and linked individuals must be enabled either directly or indirectly. Why not trust people to do an objective view and decision process regardless of how they are involved?

5. Products must be judged, approved. The statement is reasonable if an objective criteria can be established regarding what is in the consumer’s best interest.

6. A Minnesota exchange preferred. The Minnesota health experience is a leader; we do not nor should not lower to the other general national standards. Minnesota must build on our strengths to make this successful.

7. Exchange is a needless expense. Providing informed choices via the exchange will offer the citizens the opportunity to compare plans, cost, quality etc. and thus impact [the] recommendation of agents or employers. If well done, the exchange should be a change agent in how all citizens select and use health insurance and health care options.

Mark Kulda (10) (0) (5) (0) (0) (7.5) (10)

1. Focus is health insurance reform. Exchange won't help with pricing because it will be more expensive. They will make it easier but definitely not cheaper.

2. Lower health costs may result. There is no incentive to lower prices. As more and more companies drop out of the exchange because they can't match the price of the lowest health plan. Once the rest of the plans drop out or go out of business, then the plan that is left will have no competitive forces in place to try to control costs. It is then that costs will really start to rise. Or the government will reach in to take over and we'll have full single payer, which would be devastating.

3. Many uninsured will benefit. While it will be easier to see what plans are available, they will be much more expensive and harder to afford. If the subsidy isn't high enough, then all the exchanges in the world won't get more people to buy something they already can't afford. Those people will just drop out of the system and pay the penalty rather than buy insurance. This will make the pool of insured smaller and thus even more expensive to cover.

4. Conflict-of-interest rules essential. It is foolish to have a Board that has no insurance experience at all. Consumers are not going to be affected if one of the seven board members happens to have insurance experience. Do the supporters of the conflict rules really think that one person who has a clue about how to sell insurance is somehow going to game the system so that somehow insurers are going to make more money and [cheat] consumers? That's just idiocy. Instead you are going to have a clueless board enacting stupid rules that is going to force more insurers out of the system and consumers will lose out.

5. Products must be judged, approved. So a board of non-insurance experts is going to get to pick and choose winners and losers.... based on what? They are all political appointees. They will choose plans from companies they agree with politically. Pre-approving plans is going to allow them to implement their political position and will not be in the best interests of consumers. Allowing any plan in that meets certain guidelines ensures that many more diverse products serving everybody will be in, not just the plans that fit the political correctness of the Board.

6. A Minnesota exchange preferred. While I agree Minnesota could do a better job with an exchange than the Feds, the fact is we've already spent about $100-million and still have nothing to show for it yet. I fear our control of our own exchange is going to be massive waste of state money. Our exchange will only be slightly better than the federal exchange and we'll have [spent] hundreds of millions of dollars to have only a marginally better exchange.

7. Exchange is a needless expense. An exchange will make it easier to shop for insurance but most people won't even use it, so it is going to be a waste. The money could have been better spent just giving the money directly to people and let them buy their own policy on the open market that already exists. A government trying to force itself upon an already existing marketplace is a recipe for waste, fraud and disaster.

David G Dillon (10) (0) (0) (0) (0) (0) (10)

1. Focus is health insurance reform. Exactly right and confounding at the same time. The single biggest problem in health is cost. Senator Lourey is leading the charge to spend millions and millions of dollars, every year, in a state run effort that will do nothing, as he rightly points out, to reform health care.

2. Lower health costs may result. The better information will lead to lower cost argument doesn't hold up. There is a very long list of real issues that are driving health care cost and lack of information or competition between insurance companies doesn't even make the list. Ironically, the state has put up barriers to more insurance companies competing in Minnesota and then spends millions to "fix" the problem.

5. Products must be judged, approved. How nice that they know what is best for us and will limit our choices to protect us. I can hear the champagne classes clinking among the insurance lobbyists from here. The State puts in place programs and rules (to help us) that drive up costs making health care almost unaffordable. The State then puts in place programs that cost millions to make health care affordable.

6. A Minnesota exchange preferred. This is simply an assertion with no argument to support it. Why are our needs different than the needs in, say, Iowa or Connecticut? We all want lower cost, we all want better quality, we all want greater availability. This is classic case of bureaucratic conceit. They want to tap the federal money and spend it because they believe they are so wise and will find other wise people to oversee this project that will help the people.

7. Exchange is a needless expense. Millions of dollars will be spent. Unelected commissioners will limit our choices. Low information voters will be told the government has once again protected them. Please look at what this kind of thinking has done for Europe, or if you don't want to look so far away, look at what this kind of thinking has done for cities like Detroit. Our best chance to have a functioning market with real feedback mechanisms and consumers with power has been lost taking our chances for lower cost with it and the leftists are taking a victory lap by building an exchange. At the very least, Senator Lourey, let your people have choice. Make the exchange open. We need a wide range of options for consumers. Restrict the choices for your own family but give us the freedom to choose in an open market.

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

Don Anderson (7.5) (5) (7.5) (10) (7.5) (7.5) (2.5)

Ralph Brauer (0) (0) (0) (5) (0) (7.5) (0)

1. Focus is health insurance reform. This survey could not have been more timely. I just returned from an emergency visit to the Mayo Clinic in which due to HMO intransigence I had to give them my credit card and a blank check in order to get care. I will be going back to Mayo this week after three weeks of wrestling with the HMO. This is the second time I have had a life-threatening emergency in which Mayo was the only provider who could save my life. In the first case my physician literally had to tell the HMO my death would be on their hands if they did not approve my getting care at Mayo. In the second case a different HMO was more responsive, but through no fault of the case manager handling my care, had to wend its way through the HMO bureaucracy. Given all this, the notion that insurance reform and health care reform are not related is patently absurd. It shows little understanding of systems or system behavior.

2. Lower health costs may result. It is time to admit there is no such thing as high quality and low cost any more than you can get a Mercedes for the price of a used Yugo. Good heath care does cost. The procedure I underwent at Mayo in 1998 was experimental (I was the second person it had been tried on) and involved high tech, expensive technology which only they and four other hospitals possessed, along with a medical [staff member] who had been trained in that procedure. The problem with cost is that in the HMO system every HMO wants to keep their patients in network. They can pay for expensive equipment by making sure all their patients are referred to their [HMO] specialists even though on average they are not as experienced or well-trained as those at Mayo. What the state needs to do is to label Mayo a Center for special care and insure all patients have access to their expertise. Then it should limit the excess money spent on technology that Mayo already has and is not needed by everyone. Right now in the HMO system a patient in rural Minnesota has access to better care than in the Metro because rural physicians are freer to send patients to Mayo. A great example of the myth of low cost/high quality is what has happened to the University of Minnesota. After selling its hospital to Fairview, the quality of care has consistently declined because of Fairview's cost cutting to the point [that] it ranks dead last in the number of reportable incidents of all hospitals in the state. This, by the way, includes a criminal sexual assault on a patient. Would you consent to be cared for at a facility that cannot even protect its patients?

3. Many uninsured will benefit. This is again overly simplistic. The uninsured are not a monolithic bloc, but instead are made up of several different groups. Some are those with chronic illnesses who have been essentially driven out of the market, others are healthy young people who gamble that they don't need insurance, a third group are those whose employers do not provide insurance, a fourth are those with high drug costs (one of my prescriptions right now costs $1700 per two-week supply), and the final group are those who cannot afford insurance. It is unclear how an exchange will help all these people, especially without additional government costs. Right now America ranks 37th in the world in heath care--in the same range as Cuba and Eastern European countries. Contrary to the Senator's assertion of the quality of Minnesota care, the Agency for Health Care Research and Quality ranks us 44th in childhood vaccinations, 43rd in home health care, 22nd in care of pneumonia and 21st in mammograms. Many of these low rankings are due to the same disparity of care for whites vs. people of color and rich vs. poor that plague our education system.

4. Conflict-of-interest rules essential. Despite my criticisms of the current system, providers need to be at the table. They just don't need to dominate it.

5. Products must be judged, approved. This is absurd. If it is not in the patient's (please do not call us consumers; buying health care is not the same as buying vegetables) interest, why approve it? What happens is inferior care ends up costing more, just as does inferior education. I estimate the bungling in my case fourteen years ago cost the HMO a quarter of a million dollars that would have been saved had doctors, not bureaucrats made the decisions.

6. A Minnesota exchange preferred. That is only if it is better than the federal model. Given the make-up of the group planning the Minnesota exchange that is questionable, since Minnesota is now totally dominated by HMOs. Under the original Sherman Act, the current HMO policies would have been considered illegal because they in essence are a cartel.

7. Exchange is a needless expense. Until we give control of the patient back to the patient and his/her physician we will continue to have mixed health care. Allow physicians in consultation with their patients to send them anywhere they need to go. Get rid of networks. Like education reform, health care reform suffers from lack of systemic thinking. Both are prime illustrations of the Law of Unintended Consequences because we did not understand the nature of systemic feedbacks.

Bill Brandt (10) (10) (7.5) (10) (5) (10) (10)

1. Focus is health insurance reform. This is what needs to be done first.

2. Lower health costs may result. Everyone needs to [do] their jobs, but a system needs to be in place that rewards honesty and sincere responsibility/accountability rather than easier lying/cover-up of problems.

6. A Minnesota exchange preferred. It is hard to get to the right people when things go haywire and Washington D.C. is just too far away. St. Paul can be [at] a distance [for] getting justice many a time as well. But this is a good start and one that is in the right direction.

Bill Hilty (10) (5) (5) (10) (10) (10) (0)

Universal single-payer anyone?

Chuck Lutz (10) (9) (9) (10) (9) (8) (1)

John Milton (5) (8) (8) (10) (10) (9) (0)

David Detert (9) (4) (8) (10) (9) (10) (9)

Al Quie (8) (5) (8) (10) (8) (10) (5)

Tom Spitznagle (4) (5) (4) (7) (2) (5) (9)

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

With the government using tax dollars to suppress health care (see the cases documented in the DVD "Burysynski"; we're talking millions of dollars) all the activity in the survey is like shuffling deck chairs on the Titanic.

As someone who attributes my good health to drinking raw milk as a child I find the terrorist strike on the Minneapolis food coop to protect the health of our children to be particularly asinine. Sally Fallon concludes from CDC data that you are hundreds of times more likely to get sick from pasteurized dairy products than raw dairy products. (Watch the DVD 'Farmageddon') Minnesota [had] one of the biggest food poisonings from pasteurized dairy products.

Lyall Schwarzkopf (5) (6) (4) (8) (6) (8) (7)

Tom Swain (10) (6) (7) (10) (9) (10) (5)

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

1. Focus is health insurance reform. Hopefully, down the road, reform of insurance will lead to reform of health care.  The conflict between generating profits and generating quality health care requires oversight to keep unscrupulous providers out of the market.  Minnesota has done a better job than most other states in this regard.

3. Many uninsured will benefit. My uninsured husband is looking forward to having access to this information.

7. Exchange is a needless expense. My employer uses a broker who discourages innovative, cost-saving approaches. Our costs are rising by double digit percentage increases each year.  I wonder how many other employers depend on the same poor system.


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reflecting years of leadership in politics and business. Click here  to see a short personal background of each.

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