Tuesday, April 1, 2008

Minnesota - The Minnesota Health Reform Dream

Minnesota considers itself a state that works. I know. I lived and practiced there for 25 years. The mix and success of its liberal politics and conservative business practices always astonished me.

Minnesota believes you can do good and do well at the same time with the right top-down, bottom-up alignments. In the current health care scene, with public-private sectors cooperating, Minnesota legislators believe you can cover the state’s 374,000 uninsured, shave 20% off the state’s health bill, improve health, ease disease burdens , and small and big businesses will still do well, all in a state that consistently ranks number one among the 50 states in its citizens’ health status.

A pipe dream? An An April Fool Joke? Perhaps, if no financial mishaps or budget overruns occur. In Minnesota with its highly educated, mostly white but shrinking populace, and its relatively small but growing underclass, it could work.

It probably won’t. But it might. Minnesota, after all a state of 5.2 million people, has the lowest rate of uninsured, 7.2 %, in the nation, and that will help cut the state’s looming budgetary shortfall. As one cynic remarked, “There’s always gloom for improvement.”

The Minnesota Senate is considering passing health reform bill, which has yet to pass the House and withstand a possible Governor’s veto. The bill contains some of these elements.

• Hospitals and doctors fees will be made public ( lack of transparency is considered errancy).

• Primary care doctors will be paid more for creating 24/7 medical homes where care will be coordinated( the compulsion to coordinate may be inordinate)

• Standard benefit sets for common care will permit consumers to compare care and prices ( standardization trumps individualization)

• The state will mandate tracking of childhood obesity levels (The body mass index is more important than exercise during gym class or recess)

• Chronic disease will be managed through nurse phone calls, not through doctor office visits ( home visits will supplement frequent doctor re-visits)

• Small businesses and individuals will be able to purchase private health plans with tax-free dollars ( the desire is to level the health care playing fields , i.e. require big and small employers to act the same).

Some of these things sound sensible – transparency of fees, chronic disease management by nurses, tax credits for all – but others – tracking childhood obesity – do not. The latter smacks of government invading private lives. What will be next – monitoring diets, randomly checking blood alcohol and nicotine levels, surveillance of smoking in the home?

Can government cut health costs? The failed Medicare precedent is evident. Nevertheless, that’s the central strut of Minnesota’s health bill and Democratic presidential candidates’ health proposals. The proof will be in the pudding (fittingly, a sweet dessert with a creamy texture), but the pudding will take a long time to cook.

Can government save money by forcing all to buy health insurance? Individual mandates, liberals claim, will lower premiums for all. It will compel young “invincibles,” who deem themselves immortal and who prefer to spend money on other life style choices, to buy insurance and help carry the load for the old. Unfortunately, here the Law of Unintended Consequences kicks in. In mandate-enforced Boston, health premiums for the young cost five times more than in mandate-free Tucson. It may also be why health costs are so high in Minnesota. It has a nation-leading number of 64 mandates premiums must cover.

But I’m off track. The Minnesota legislature doesn’t propose individual mandates. Instead, it’s saying , among other things, that making fees public and allowing consumers to compare care and prices will allow private competition to thrive. To the governor, it’s a market based bill.

On a national level, there are sensible basic steps that could be taken to lower prices and improve care.

• Allow national health plans to compete across state lines, another way of saying, make health plans portable.
• Reduce mandates in states, the main reason state premiums vary so much.

• Post prices for insured – and uninsured.

• Reform malpractice.

• Repeal state laws limiting retail clinics

• Scrap employer health plan deductibility and introduce health care tax credits for every individual.

These steps may never be taken. They are too sensible for the Wise Wizards, dubbed the Bungling Bureaucrats by some, of Washington and state capitols. These technocrats believe they and only they, not consumers, have the wisdom to bring about affordable health care.


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