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 Response Page - Todd-Malmlov  Interview -      

These comments are responses to the questions listed below,
which were generated in regard to the
April Todd-Malmlov  Interview of


April Todd-Malmlov, Exchange Executive Director at the Minnesota Department of Commerce, argues that getting better health care quality and value information to consumers through the state's developing health insurance exchange will drive competition in the health care marketplace, lowering costs, increasing innovation and improving quality. She describes the process Minnesota is using to develop its exchange and the significant challenge of the short time frame available for doing that. She explores the impact the Affordable Care Act and the exchange should have on health care choices and coverage in the individual and small-group markets. In closing she contends that health reforms enacted in Minnesota in 2008 will allow Minnesota to build a far better health exchange than those developed in other states or by the Federal government.  

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 Todd-Malmlov. 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. Create a MN health exchange. (8.9 average response) ather than accepting a uniform federal approach, Minnesota should take the opportunity to design its own health exchange--a vehicle to assist consumers in selecting health care insurance.

2. Include quality and price data. (9.2 average response) A Minnesota health exchange should provide thorough, understandable, information on quality delivered and prices charged by doctors, hospitals and other health care providers.

3. Offer incentives to choose value. (8.1 average response) Consumers should be offered incentives--such as lower co-pays and deductibles--to select providers that have higher quality rankings and lower prices.

4. Reward preventative measures. (7.9 average response) A health exchange should also build in insurance reforms that reward preventative measures by providers and consumers.

5. Health exchange not needed. (1.9 average response) Consumers know who the quality, price-conscious, providers are and can find suitable health insurance plans on their own. There's no need for health exchanges.

Response Distribution:

Strongly disagree

Moderately disagree


Moderately agree

Strongly agree

Total Responses

1. Create a MN health exchange.







2. Include quality and price data.







3. Offer incentives to choose value.







4. Reward preventative measures.







5. Health exchange not needed.







Individual Responses:

R. C. Angevine (10) (7.5) (7.5) (10) (0)

2. Include quality and price data. While I agree with the information provided in the question I am curious as to why there is no mention of the services provided by the insurance plan.

Bruce Montplaisir (10) (10) (10) (10) (0)

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

5. Health exchange not needed. In states that fail to properly regulate health insurance and leave it up to the consumers and market, many people get ripped off by poor plans that fail to provide the coverage promised, and the consumer does not find out until it is too late. While Minnesota has done a far better job of regulating insurance providers, the exchanges should drive quality among providers as well, improving efficiency and lowering cost.

Anonymous (10) (10) (10) (0) (2.5)

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

Anonymous (7.5) (5) (7.5) (2.5) (2.5)

1. Create a MN health exchange. Without knowing what the administration's plans are for a Minnesotan exchange, it's hard to know if a federal exchange is better or worse.

2. Include quality and price data. Not clear that the Exchange should do this. Surely it should be the role of the Department of Health or a non-profit entity that doesn't have a conflict of interest. If the Exchange is offering insurance options then it seems they have a vested interest.

3. Offer incentives to choose value. Plans are already doing this on their own.

4. Reward preventative measures. Again, why is this the role of a health exchange? Surely it is supposed to be an online marketplace. These questions make it sound like the exchange is going to be the one buying the insurance and doling it out to people, like a government program.

5. Health exchange not needed. The exchange is supposed to be an online marketplace to compare options and connect them with subsidies. Additional responsibilities beyond those required by federal law (that are not added through the legislative process) should make consumers very nervous.

Bert LeMunyon (10) (10) (10) (7.5) (0)

Scott Halstead (10) (10) (10) (10) (0)

Don Anderson (10) (10) (10) (10) (0)

1. Create a MN health exchange. It is better to have our own rather than accept a uniform federal approach because we can offer a better system than a federal approach, which has to cater to the lowest state.

2. Include quality and price data. Quality delivered is the best criteria to follow; price should follow quality in importance.

5. Health exchange not needed. How many people now insured have been able to pick their own plan on their own. Most are probably on company prescribed plans?

Peter Hennessey (2.5) (5) (5) (2.5) (7.5)

1. Create a MN health exchange. Rather than accepting a uniform federal approach—yes. Design its own health exchange—no. This just adds a yet another very expensive layer of bureaucracy that has nothing to do with delivering actual care to a patient. Somebody sure had a sense of humor naming that monstrosity "Affordable" Care Act. The truth is rather different: Obamacare (is) a drastic tax increase on working people, a drastic tax increase on the middle class, a drastic tax increase on small businesses, a drastic tax increase on all employers. Obamacare (is) free to no one; (it means) rationing for all (and) death panels for seniors. Obamacare (is) designed to kill private insurance, designed to kill private health care, designed to kill costly patients, designed to kill the economy, (and) designed to kill free enterprise.

2. Include quality and price data. It would be nice if government bureaucrats could and would limit their activities to such a limited scope. But we all know that it can't and won't end there. Why do people always choose to ignore the obvious fact that we got into this mess precisely and only because of government interference in the market, beginning with The Great Society and Medicare, and all the "reforms" and mandates forced on providers and insurers every since?

3. Offer incentives to choose value. Yes, but the people offering the incentives should be the providers and the insurance companies competing against each other in a free market. But by definition, any state or federal exchange takes away the very concept of "free" in relation to the market. The combination of higher quality and lower cost is possible to achieve, and has been achieved, only in a free market. Government cannot force it into existence; it only makes things more expensive because government regulation only stifles initiative, motivation and innovation, it only creates monopolies, and it only imposes ever more expensive and wasteful bureaucracies on all participants. As recently as the early 1970’s, Blue Cross was advertising that they pay to providers 97 cents out of every dollar they take in as premiums. A few years ago Congress passed a law requiring that this amount be no less than 80 cents. That is what government interference does. If you really want to "drive competition in the health-care marketplace, lowering costs, increasing innovation and improving quality" then your path is clear: Step 1 -- repeal Obamacare and refuse all attempts at its implementation at any level in any form. Step 2 -- repeal all regulatory mandates imposed on providers, health insurers and policies. Step 3 -- remove all barriers that prevent consumers from buying only the coverage they want and can afford. Step 4 -- open the market to in-state and out-of-state competition.

4. Reward preventative measures. No, people do not go to the doctor for preventative measures. They go because they are sick. They go to the doctor for advice on how to manage their condition, and think of preventive measures only on their doctor's advice.

5. Health exchange not needed. Consumers should know and make the effort to learn who the quality (providers are...)—yes. That is called personal responsibility and looking out for your own best interest. There's no need for health exchanges—yes.

Anonymous (7.5) (10) (7.5) (10) (0)

Fred Morrison (10) (10) (5) (8) (0)

The statement in the first sentence of item 5 ("Consumers know who the quality, price-conscious, providers are and can find suitable health insurance plans on their own.") is true, but other consumers are not so knowledgeable, so we need the exchange to provide them with the consumer education. More information never hurts.

Fred Zimmerman (8) (9) (9) (9) (5)

Our 28-year-old son has battled cancer since he was 23 months old. We have visited hospitals in several states and he received a five-organ transplant at the University of Pittsburgh which required a 171 day hospitalization and many follow-up appointments at the Mayo Clinic, University of Minnesota, and the University of Nebraska. Better data collection, if it is not filtered by invested professionals, should be able to help consumers decide on more cost-effective health care. For instance, after seeing these institutions close up and for extended periods, I would rate Mayo and the University of Nebraska at the top of the list. Pittsburgh would be at the bottom in terms of both cost-effectiveness and quality of care. After a hospitalization charge of around $5 million, the institution transplanted defected organs, which now require another expensive and life-threatening replacement transplant. I mention this not to complain, but to suggest that there are enough quality and cost gaps in the present system that accurately gathered data should help consumers cooperate in lowering cost. We do need much more disclosure on healthcare costs, quality, and outcomes.

On the other hand, I would not want to see the Minnesota Department of Commerce involved with the process. This negligent and aloof department was supposed to review long term care insurance premium increases sought by insurance companies. The Department of Commerce approved premium increases of 40 to 70 to 90 percent in a single year. Many separate analyses were submitted by highly qualified analysts, at least two with PhDs, along with many other complaints from Minnesota citizens. The Department of Commerce ignored all of this input -- even after appeals to Governor Dayton. The Department of Commerce cannot be trusted to carry any responsibility that will address the matter of cost to consumers. They don't do anything.

Al Quie (10) (10) (8) (10) (0)

Tom Spitznagle (8) (9) (2) (2) (7)

Tim Hall (na) (na) (na) (na) (na)

In the United States we have 4 workers to every one patient compared to Australia and Canada. (In those countries) health care is also paid for by a national sales tax. In the Obama plan anyone who is suppose to pay for it has an exemption. In Croatia they have a national health care plan that cost 50 dollars and has no mandate to buy it. All have a basic heath care plan but you can also pay for additional insurance. The European Union isn't stupid enough to have a health plan run by them for every country. Governor Carlson has already set up the framework for a state plan with private companies with Minnesota Care. Neither Party will ask for productivity studies to find out who the nonessential people working in health care are. For a state plan to work they would have to be fazed out as they retire.

Tort reform is the most important though. Without it in some cases we are paying doctors to do nothing. They are scared to death to do anything but run tests. If they try to do anything and something goes wrong then they get sued. That is why John Edwards sued doctors delivering babies. They have to be delivered. Doctors can't keep the baby in there until they retire.

If we can put together a state plan that includes senior citizens, and people in the military we can get rid of any Federal health care plan. These are our citizens, our state our responsibility.

Paul and Ruth Hauge (8) (8) (9) (7) (3)

It's encouraging to hear that Minnesota is a front-runner in the area of health insurance reform and with people like April Todd-Malmlov leading the way, it will happen.

Charles and Hertha Lutz (9) (10) (10) (10) (0)

Carolyn Ring (10) (10) (8) (9) (5)

There is no doubt we are going to get exchanges, so let's keep them in state control and not federal.

Leonard Wozniak (10) (10) (6) (10) (0)

Shirley Heaton (10) (10) (10) (10) (5)

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,  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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