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 Response Page - Nelson  Interview -      

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


Connie Nelson, a consultant with Public Strategies Group says that people expecting every possible health care treatment don't realize that higher spending isn't correlated with improved health.  She asserts that state and local government in Minnesota currently have enormous potential to affect the health care market, purchasing as they do health coverage for more than 30 percent of the state's population. Nelson believes that such purchasing power could save the state $1 billion a year if the state began “buying health and wellness”, rather than simply paying for specific services. In addition, Nelson recommends that to highlight the true cost of health care and increase revenue, the state should reduce or remove the tax-exempt status now given to employer-provided health coverage.

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 Nelson. 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.  Demand is strong. (7.1 average response) People want access to every medical test, every procedure, every specialist–-without realizing that higher spending is not correlated with improved health.

2. Use purchasing power. (7.9 average response) State and local government in Minnesota now purchase health care for about two million people. That purchasing power should be channeled to buy health and wellness, not just to treat illness.

3. $1B savings possible. (6.0 average response) Such an approach could save state and local government in Minnesota about $1 billion a year.

4. Solicit competitive bids. (7.6 average response) Minnesota should move aggressively--obtaining waivers as possible under new federal health legislation--and design a system that features competitive bids from providers, based on health outcomes and price.

5. End tax-exemption. (5.7 average response) To help expose the true cost of health care to consumers and put greater pressure on providers and consumers to contain costs, Minnesota should reduce or remove the tax-exempt status now provided for employer-paid health care coverage. 


Response Distribution:

Strongly disagree

Moderately disagree


Moderately agree

Strongly agree

Total Responses

1.  Demand is strong.







2. Use purchasing power.







3. $1B savings possible.







4. Solicit competitive bids.







5. End tax-exemption.







Individual Responses:

Jack Evert  (10)  (10)  (7.5)  (10)  (7.5)

3. $1B savings possible. I can believe the savings, but we have been "taken down the primrose path" so many times with unrealized claims, that I am very skeptical.  I would think a pilot program to prove the concept would be a very good idea. If it is proven, then it could be expanded.  I expect the medical community to fight every attempt to do this because ultimately if health care costs go down, the medical community will make less.

Dave Broden  (2.5)  (7.5)  (5)  (10)  (5)

1.  Demand is strong. People do want access but that does not mean use of the procedure or specialist --it means choice. I give people more credit in understanding that there are associated costs with each item. Choice and access must be maintained and the needed addition to the discussion is ensuring that the value of the procedure is understood so a test to do a test vs. test to obtain data to improve patient condition is the focus.

 2. Use purchasing power. I strongly agree but there must be a simple and clear definition of what health and wellness is or the taxpayer will be paying for gym classes, bicycles, tennis shoes etc. Increasing focus on health and welfare has been a need and attention point of many in the health areas for some time.

3. $1B savings possible. There is likely a savings. How to measure and quantify the savings is a good question. I do not like to jump to support a number without solid evidence and supporting data.

4. Solicit competitive bids. The idea and objective is the correct one. The discussion of this approach however must continue to include the opportunity for all participating to have choice of their doctor and types of service, not to (be) forced to (have) a particular service etc.

5. End tax-exemption. This topic should be part of a tax policy review as well as included in the health care debate. Without more understanding of the cost and implications of this change it is difficult to take a side.

W.D.(Bill) Hamm  (0)  (7.5)  (5)  (5)  (0)

1.  Demand is strong. This is an attempt to blame the milking of the system by system-insiders on the victims. Many of our elderly are steadily milked with procedures they don't need. Reducing the availability of these procedures does absolutely nothing to reduce the incentive behind the scamming.

2. Use purchasing power. While the goal is admirable, I am far from convinced of the direction being promoted here. Far too heavy on top-down Socialist overtones.

3. $1B savings possible. "Could save", those are the key words here. We haven't seen anything near real legislative language here yet. It's all just pie in the sky until we see how the "enemies within" in our two party system mess it up.

4. Solicit competitive bids. More pie in the sky that does nothing to bring power and control back to the local level.

5. End tax-exemption. We on the poorer end of the stick need all medical costs directly deducted from our taxable income. Taxing our healthcare cost is just more regressive attacks upon the working class.

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

1.  Demand is strong. Wrong on all counts.   a. People may want access to services they don't really need, but it is your doctor who explains, advises, recommends and provides the appropriate referrals, without which you will not have access.   b. People as consumers of services have a choice and a responsibility to know their own needs and do their own cost-benefit analysis.  c. The reason there are people who do not do this is that they are told that (i) health care is a right, (ii) health care is free, and that (iii) we only have to tax the filthy rich a little more and then it will remain free.  Well, it is just basic economics that people want more of anything if they think it's free.

2. Use purchasing power. a. No, the purchasing power should be returned to the people. The State has no business being in the health care business either as a provider or as a single payer. Of course costs go up as the demand goes up and there is a bunch of … politicians throwing more and more money at the limited number of suppliers. Where is the incentive to compete, to keep costs down? In normal business it's called "leaving money on the table;" meaning that you are stupid not to take it if it's being thrown at you. If the state feels they need to help some people with their health care costs, they can do it in such a way that the consumer has a proprietary incentive to pay as little as necessary and keep as much of that money for themselves as possible. Then you will have competition among suppliers to keep costs down and quality up.  b. Stop this (talk) about "wellness." What is this … about "buying health, not sickness"? You go to the doctor to buy sickness? Our bodies are designed to heal themselves in all sorts of ways from all sorts of harm and injuries and conditions. Even under the worst of circumstances the only thing a doctor does is help your body heal itself. People go to a doctor because they need help with a problem. A doctor can't keep you well; a doctor can't be responsible for your health, especially not in spite of yourself, any more than the gas station attendant is responsible for keeping your car running. You might as well demand that the grocery store assume the responsibility for your diet.   c. Refusing to pay a doctor for his services, either in the form of inadequate reimbursement rates (in the face of rapidly increasing bureaucratic burdens) or refusal to approve procedures, will only drive more doctors out of at least the state-supported programs, if not the profession itself. With reduced supply, you can only expect increased prices. That's just basic economics.

3. $1B savings possible. Where is the study and the analysis to prove such an allegation?  Indeed, Minnesota could save the entire cost of state-run or state-paid services just by getting out of the business altogether, and letting people fend for themselves, according to their own best judgment.

4. Solicit competitive bids. a. Yes, Minnesota should move aggressively to do anything and everything to stop Obama care.  b. No, Minnesota does not need to design a new system. It needs to end the system and get out of private business.  c. No, you can't pay "based on outcomes." So if a patient dies on the table, you refuse to pay the doctor? The doctor and his support staff are supposed to work for free? Even slaves are fed and housed.

5. End tax-exemption. Fringe benefits and their tax-exempt status are an invention from World War II era wage and price controls, whereby the government simply has forbidden companies to compete for workers by offering more pay.  Yes, do away with all company-paid benefits. To the employer it's all part of the cost of labor; they don't care how it's divided up. Give the equivalent amount of money to the workers; let them buy what they want. Make the expenses deductible to the workers.  Better yet, stop using the tax code for social engineering, do away with all income taxes, and replace them with a simple retail sales tax. Then sit back and watch the economy grow; watch all these social ills go away as people have the resources to solve their own problems without government interference.

Don Anderson  (7.5)  (5)  (5)  (7.5)  (7.5)

1.  Demand is strong. We're constantly being bombarded with ads that encourage us to have such and such a procedure done, get such and such a test, et al. As a result society wants the access.

5. End tax-exemption. This might help the economy and the consumer, as well as the employers. But what about the "no new tax" element? How would they respond?

Chris Brazelton  (7.5)  (10)  (5)  (10)  (7.5)

3. $1B savings possible. Costs savings not detailed in summary.

5. End tax-exemption. This makes sense.

R. C. Angevine  (5)  (7.5)  (5)  (5)  (2.5)

1.  Demand is strong. While I generally agree that most of us fall into this category I also think that medical staff and the medical insurance providers are a large part of the problem.  Most of us would probably back off on some of these items if we had a bigger part to play in paying for them.

5. End tax-exemption. I would need to know more about this approach.  In part it sounds like we are passing additional costs to workers without providing them any option to make choices.

John Sievert  (10)  (10)  (7.5)  (10)  (5)

4. Solicit competitive bids. Agree.  Minnesota has often led the way in innovation in healthcare and healthcare insurance. Don't stop now - we know more about this any other state and certainly more than the incompetence one sees from the Federal government.

5. End tax-exemption. I'm uncertain how this works and I'm not sure I understand how this would work.  Right now, the last thing we need to do is pile more tax expense on struggling families during this recession.

David Dillon  (10)  (0)  (0)  (5)  (10)

5. End tax-exemption. This is a much bigger issue than most people know.  It is the core reason companies, rather than individuals are buying health care coverage.  And, as your question points out, it is the first crucial step in consumers’ being insulated and disengaged from being active economic participants in health care.   This step should also include a tax decrease fully equal to the lost deduction.

Willard Shapira  (2.5)  (10)  (5)  (10)  (5)

1.  Demand is strong. Who says higher spending is correlated with improved health? I don't believe that is necessarily true across the board. Each case is different and must be considered individually.

2. Use purchasing power. It could be a major first step toward single payer. We should be better informed by Civic Caucus on the new system in Vermont and how it can be established in Minnesota. There is nothing wrong with socialized medicine, especially if it gets the greedy insurance companies out of the loop.

3. $1B savings possible. Tell me how.  Another way is to veto a new billion-dollar stadium for the Vikings. See my letter to the Pioneer Press, July 5.

4. Solicit competitive bids. Long overdue.  Can proponents beat high-powered lobbyists in opposition?   Do we even know who they are?

5. End tax-exemption. If this would cause employers to eliminate or reduce coverage for workers, the net result could be detrimental to workers and public health care coverage overall. But, if it paves the way to single payer, government-provided health care, I am all for it.

Ralph Brauer  (2)  (0)  (4)  (2)  (1)

Jackie Underferth   (6)  (9)  (8)  (7)  (4)

Leanne Kunze  (10)  (10)  (10)  (10)  (3)

5. End tax-exemption. Don't eliminate; a reasonable cap makes sense. Must also address the impact of treating employer health insurance as income on pensions.  This is a great opportunity for We the People to grab hold of our seat at the table to balance the power of the health insurance lobby.

Tom Spitznagle  (5)  (8)  (5)  (8)  (3)

Rick Bishop  (8)  (10)  (10)  (8)  (5)

Robert J. Brown  (9)  (10)  (5)  (8)  (7)

Fred Senn  (10)  (10)  (8)  (10)  (7)

Wayne Jennings  (8)  (10)  (8)  (10)  (7)

I love this talk of redesign though the specifics need to be carefully thought through. If mistakes occur, they can be corrected. Current forces of status quo create gridlock and nothing is done. Healthcare, K-12 schooling and higher education are great candidates for redesign.

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

Austin Chapman  (10)  (10)  (6)  (8)  (10)

Who is the "Champion" to make this happen?

Arvonne Fraser  (10)  (10)  (5)  (5)  (8)

William Kuisle  (7)  (5)  (3)  (5)  (0)

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

This presentation tends to be way beyond my comprehension. Folks like me require better scenarios to get the gist of what is being offered. Hence I did not participate in the review

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

State and Local level Government employees’ health premiums should be reduced for being healthy.

Chuck Lutz  (10)  (10)  (9)  (9)  (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 

The Civic Caucus, 01-01-2008
8301 Creekside Circle #920,   Bloomington, MN 55437.
Verne C. Johnson, chair, 952-835-4549,       Paul A. Gilje, coordinator, 952-890-5220.

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