Gubernatorial candidates discuss health care in online debate

The online gubernatorial e-debate hosted by E-democracy.org continues this week with responses from the candidates on major issues facing the state. Today’s theme is health care. Each candidate was asked to respond to the following questions: “Please detail what initiatives you will undertake to make quality health care more accessible and affordable for all Minnesotans. Share your vision and detail at least three goals with specific targets your Administration will seek to meet within the next four years. In your rebuttal, you are encouraged to contrast your approaches with the proposals of other candidates. What makes your plan better?”

Tim Pawlenty
Minnesota continues to have the healthiest people in the nation and the lowest rate of uninsured. However, America’s health care delivery system is broken. Rising health care costs are pinching families, businesses and government, and relief is urgently needed. We have begun nation-leading health care reform during my term. This last year, health care premium increases slowed to their lowest rate of growth in decades. Still more needs to be done.

Mike Hatch wants a government-run system. I believe we should put patients and doctors in charge.

Our nation-leading efforts forcing price disclosure and quality measurements, paying for better care rather than just the volume of procedures, reducing administrative overhead and bureaucracy, expanding electronic medical records, taking on the prescription drug companies and holding down costs, have all had a positive impact.

My first goal in this area will be to expand those efforts during my second term with additional transparency in the health care system. We’ve made good progress with efforts such as our nation-leading RxPrice Compare website which allows Minnesotans to comparison shop for prescriptions by city or zip code. Since the program started, prices have dropped on 77% of generics and 54% on brand name drugs. By using the market and price transparency we are seeing results.

An example of cost transparency is in the field of lasik eye surgery. Here the cost has dropped because consumers can discover the cost of the procedure and “shop” based on cost and quality. This doesn’t work for all aspects of health care, but it provides insight into how we can improve a portion of the system.

My second goal is to continue to maintain Minnesota’s ranking as the state with the lowest number of uninsured and to work to reduce that number.

A third goal will be to transform and realign health care payments to reward results and outcomes and maximize the proportion of spending that goes to effective care. Our QCare (Quality Care And Rewarding Excellence) system, implemented by executive order this year, helps empower consumers and rewards providers for results. This means establishing high standards for outcomes in areas such as diabetic and cardiovascular care, which together are estimated to save $153 million a year.

Our efforts are being noticed. Just this summer, the federal government established efforts to control health care costs which are modeled after Minnesota’s plan.

Walt Brown
Minnesotans enjoy some the best health care of any state in the union.

For that we should all be grateful. Healthcare can be more accessible and more affordable for many Minnesotans by more fairly and accurately determining the costs of premiums according to ability as well as need.

Every decision I make will be sincerely based on the premise that taxes will not be raised. By standing on my promise to Quit Raising Taxes, you can be sure that my administration will find solutions and not rely on buying excuses with your tax dollars.

Three goals I have that I wish to share with you include (1) Taxes of any kind shall not be raised to further health care needs, (2) State assistance to the needy will not be forsaken as reasonable premiums will be properly established, and (3) The private and charitable sectors of our state will be encouraged by my administration to continue generous programs and to increase efforts.

Leslie Davis
Everyone in Minnesota should get decent cost effective medical or health care. There is no one size fits all to health care and I offer two arrows for the quiver of solutions and three benefits that could arise.

One is to reduce the cost of medical care and two is to expand the range of solutions to medical treatment to areas such as homeopathy, massage, acupuncture and the entire range of alternative medicines and medical procedures.

However, the age old saying that an ounce of prevention is worth a pound of cure is even more valid today in the era of skyrocketing costs. Prevention and education on personal responsibility is the first line of medical and health care defense.

Allow qualified nurses, physician assistants, paramedics and others to staff offices and perform many medical procedures now relegated to doctors only. Most medical tasks do not require expensive doctor attention. This would reduce medical costs because routine tasks would be billed out at the much cheaper rate, doctor salaries would fall since they wouldn’t have to handle the same case load and competition would increase, which always leads to lower prices and better quality.

By having new medical training levels and specialties many more students would be drawn to medicine without having to devote the time and money to becoming a full fledged physician.

There are millions of potential students out there who have the intelligence to do the work but can’t go all the way through medical school because of financial, work, or family obligations. Or maybe they’re part of the more than ninety percent of applicants that are denied entrance to medical school because of the requirements or the number of admissions.

We should allow certain tasks to be handled by these lesser-trained, but qualified, individuals. If people are concerned that more mistakes may be made they have the choice of seeking a full fledged licensed physician. If they want to save some money they might choose a nurse practitioner or other alternative. In reality, choosing a nurse might even get them better attention and better medical care than a busy doctor. Besides, many doctors regularly refer many of their patients to their specialist friends anyway.

If a complex problem were to arise a person could always seek a fully-licensed physician. In other words, take the mystery out of medicine.

Ken Pentel
I will establish a single payer healthcare system that is universal. This would eliminate the multi-payers, advertising and marketing. A state hospital board would be established to distribute technologies and expertise fairly in MN. And we will set fees on a menu for hospitals, doctors and drugs.

The first and second year we would establish a single payer healthcare board that sets fee’s for drugs, doctors and hospitals.

In the third year we would cover all the uninsured children.

The forth and fifth year we would phase-in coverage for all.

All Minnesotans would have a health card, go into the doctor or hospital, following their procedure, their card would be swiped. The bill would go to the State, the State would pay. Simple and easy.

Overhead would go from 30% in the existing system to 2%.

Single-payer would take the weight of health coverage off the shoulders of employers, schools and farmers and others.

We would pay for the system from the saving in overhead and administrative costs, as well as a progressive income tax and pollution tax.

Every other democracy in the world has healthcare for all. It’s unacceptable that we tolerate the existing condition. Universal Single-Payer is way overdue.

Peter Hutchinson
Can you imagine:

* WORLD CLASS HEALTH for Minnesotans at a world competitive cost per person – a system that delivers best health and best care -at the best price- for every Minnesotan?

* STAYING IN YOUR JOB because it matches your talents and lifestyle and not just because it offers health care insurance?

* TAKING CARE OF A HEALTH CONDITION when it’s a small problem – before it becomes a really big and really expensive problem?

Solving the health care crisis is not only critical for the state budget, but also for every business and family in Minnesota. Health care inflation is literally drowning our state and local governments. The flood of spiraling health care costs now soaks up all new revenue– all of it, and then some. Unless your governor does something about this, we can’t make key investments in any other important areas… transportation, education, environment. We just won’t have the money.

Will this be easy? Absolutely not. But, ignoring this crisis is not an alternative. The only comprehensive plan for health care reform you can find this year is at www.TeamMN.com. I encourage you to read the full report; we project that it can save Minnesota governments about $1.7 billion with which we can improve education, assure health insurance for all, get transportation systems moving and clean up our waters and habitat.

You’ll hear from Tim Pawlenty that our revenues are growing at a nice clip. What he doesn’t tell you is that health care costs are growing at an even greater clip. You need to ask him, “How can you call your budget responsible if you don’t effectively deal with the key cost factor?”

Health care reform must not be optional. I think Minnesotans know this. The methods may be negotiable, but the ends are not. Here’s how we’ll save Minnesota governments $1.7 billion per year and improve the quality of health outcomes:

* Improve quality of care (quality costs less)
* Pay for prevention (costs less than treatment)
* Cut the cost of bureaucracy/overhead by half
* Mandate Minnesotans have basic health and long-term care insurance/provide help to those who can’t afford insurance
* Put Minnesotans in charge of cost and quality choices (and increase real choices)
* Encourage Minnesotans to take responsibility for their own health care decisions. Most of our most expensive and widespread health problems are due to our own personal lifestyle decisions.

Mike Hatch
We must stem the meteoric rise of health care costs and improve accessibility for all Minnesotans.

Health premiums and out of pocket expenses have soared, with the rate increases slowing only because the insured pay higher co-payments and deductibles. As a result, fewer employers offer health insurance and 77,000 more Minnesotans are uninsured.

The cost of health care is the largest tax on business and the most common cause of family bankruptcy.

This is unconscionable. Here’s what we can do:

• The State should negotiate lower prices for prescription drug medication on behalf of all Minnesota consumers. Prescription drugs compose 20 percent of the health dollar and is the fastest growing sector in health care.

• Reduce the size of our uninsured population. The larger the uninsured population, the higher the premium increases on people who are insured. This effect is due to cost shifting. There are three groups who represent the uninsured and underinsured population in Minnesota:
+ Working Poor - currently, there is a $100 million surplus in the Health Care Access Fund. This surplus should be applied to the MinnesotaCare program to cover more of our “working poor”.
+ Young Adults - Minnesota law mandates that students between the ages of 18 and 25 be covered under their parent’s policy. Many states have removed the education requirement and Minnesota should do this as well.
+ Small Employers -should be able to stabilize their premiums by being able to purchase coverage for high-risk employees from the Minnesota Comprehensive Health Association (MCHA).

• Our Attorney General (AG) audits of the three largest HMOs and two largest hospital systems revealed that up to 40 percent of the health dollar is spent on administration costs. By changing the governance of these institutions, we hopefully can dramatically reduce administrative costs. Some states now appoint members of such institutions in order to make them more accountable. We should consider this option.

• Adopt the 75 recommendations from our AG audit report to the Pawlenty Administration. These recommendations range from pension rules to better financial accounting to placing caps on net worth (our HMOs and BCBSM have the highest net worth to premium ratio in the country).

• Adopt a false claims act and whistleblower law.

• Review the concept of Centers of Excellence as it relates to diagnostic centers and health provider clinics.

Containing health care costs will help preserve and build a middle class in Minnesota—under a Hatch Administration we will get results.

Hutchinson rebuttal
First, I want to thank everybody for participating, this is an important part of what it’s going to take to move Minnesota forward. Secondly, I want to begin by acknowledging ideas I found in the other, at least in the Hatch and the Pawlenty presentations, but I thought it made some sense.

Mike Hatch talks about lowering prices during negotiations for prescription drugs, that makes sense to me, and he also talks about removing the education requirement from the way in which we structure health insurance for young people. I also think that makes some sense.

Tim Pawlenty, for his part, talks about increasing what he calls, transparency. That means getting the right information for people so they can use it, and he also introduced this year, the election year, his Q care idea which is really about paying for the right thing done right the first time. I think it’s a good idea. I’ll talk a little bit more in a second about how I think it can go much, much further.

Let me step back though from those initial reactions and share the following: I think what’s important here is that for candidates to know where they are going, how they are going to get there, and how they are going to pay for it. And, frankly, on those three measures, neither the presentations from Tim Pawlenty or Mike Hatch really measure up. Both claim that healthcare is a top priority, but if you watch Tim Pawlenty’s sixty second ad which he used for his opening statement, you won’t even see healthcare mentioned.

Mike Hatch, on the other hand mentions it, but certainly doesn’t make it his top priority. If you click over and watch my opening statement, I think they’ll be no question in your mind, that healthcare is the most important thing from our point of view. It is so expensive, it is rising so fast, it is threatening so many Minnesotans that any leader that doesn’t take the time to go after healthcare, isn’t really taking the time to do what matters most to Minnesotans. That’s why we made it so important from our overall, in terms of our overall campaign.

Secondly, I think you got to look for specific targets. If you go to our website www.teammn.com, you can see a lot about the targets we’ve set for healthcare. Overall, we want to reduce costs by 20%. That’s not going to be easy, but it can be done if we are willing to cut the cost of bueracracy, on overhead, administrative systems that are not standardized, forms, codes, and computer software that really aren’t compatible with one another. There’s a tremendous overhead cost. Mike Hatch refers to this, but really doesn’t give us very much specifics about how he’d go after it.

Our proposal is laid out on our website. It’s pretty darn clear that since the state of Minnesota, with local government as well, spends $8 billion a year, we certainly can reduce these costs by simply refusing to pay for the stuff that doesn’t pay produce anything. The same applies for improving the quality of care. We know that up to 30% of all the care that’s delivered in Minnesota, is stuff that needs to be redone, it wasn’t done the first time, it needs to be fixed. We shouldn’t be paying for care that isn’t the very best, and we do call it best care. They out to get the right care, the right time, the right way, the first time. This is what Tim Pawlenty is driving at with his Qcare proposal, but it’s way too timid. We think you can save up to $900 million by simply pursuing quality care, and that’s the important thing. We can get better care, but it can also be less expensive. That combination makes a huge difference, and that’s what leads us to be able to assure that every Minnesotan is covered by health insurance.

Our first two proposals, driving administrative costs down and driving quality up, save up to $1.7 billion. That money at hand, we can make healthcare available to everyone. That doesn’t have to be a good intention. It can be the result we actually want to achieve, so we’re pushing really hard on getting those three things to happen, cut the cost, improve the quality which also saves, and make sure that healthcare is available to everyone in Minnesota. We don’t see any excuse for why that wouldn’t occur.

Now when you look at the proposals, made by both Mike Hatch and Tim Pawlenty, you can’t find goals like this anywhere. You can’t find the kind of specificity that we think it’s going to take to really make this happen. Here is how somebody put it to me one day after we were talking about the importance of healthcare reform. They said, if you couldn’t get healthcare reform, it really wouldn’t be worth being governor. And that’s the truth, I think the healthcare reform is so essential to what we need to achieve, that if we don’t get reform now, we are going to paralyze everything that goes on in government.

And I’m discouraged that neither Tim Pawlenty or Mike Hatch are really willing to make this a top priority by staking their reputations on specific goals with specific strategies to achieve them and specific financial results. Without that sort of thing, how can we hold a leader accountable for getting the real work done, and achieving the kind of goals that we all have in mind.

Now let me say just a word about three other parts of our healthcare plan, one has to do with public health, that is attacking the two big epidemics that we face, the epidemic of smoking which was the epidemic of the 20th century, and the epidemic of obesity which is going to be the epidemic of the 21st century. We’ve been uninvesting in this sort of thing and we out to get reinvested and soon.

Secondly, everything in our healthcare reform effort counts on straight talk about personal responsibility. Look, if you do what you’re supposed to do, you lead a good life you don’t smoke, you don’t get obese, you don’t eat the wrong things, why should you pay for the people who choose to do otherwise? We need to put incentives in to the healthcare system so that everyone gets reminded that not smoking, maintaining a good body weight, going to the gym, getting your preventive services really are valuable. So we are going to encourage everyone through premium deductions …

Hatch rebuttal
I am the only candidate for Governor who has a proven track record of taking significant steps to reform our State’s health care system.

Unfortunately, Governor Pawlenty has done nothing to reduce health care costs.

While I believe that everyone has a right to health care, I don’t believe that the solution lies in a system run by state government.

While Governor Pawlenty talks about consumer-driven health care (which has no proven track record of making health care more affordable or reducing costs), the reality is:

_ Governor Pawlenty has driven approximately 36,000 Minnesotans off the health care rolls.

_ Had Governor Pawlenty gotten his way in 2005, an additional 40,000 working Minnesotans would have been thrown off the health care rolls.

_ Regrettably, Governor Pawlenty’s Administration has done nothing to keep health insurance premium costs down.

According to the Minnesota Department of Health, in 2006:

_ There are approximately 383,000 uninsured people in our state, which is an increase of 40,000 people since 2005.

_ This statistic masks the total number of uninsured, however, because the 383,000 figure only includes those people who did not have coverage for the entire year.

_ According to national studies, when Medicare and Medicaid are excluded, almost 40% of Americans did not have coverage at one time or another in 2004.

_ These figures do not include the growing number of underinsured Americans who fail to get access to the health system because of high deductibles, high co-pays, and low limits of coverage (e.g., many private insurance or HMO plans, Health Savings Accounts, MinnesotaCare, etc.).

_ In 2006, the number of uninsured kids grew by 8,000 to a total of 68,000 children without health insurance, and Minnesota is lagging behind forty other states that have decreased the number of their uninsured children.

I was honored to be recognized nationally as a leader for exposing excessive waste in our health care system when Senator Charles Grassley (R – Iowa) invited me to testify before Congress on my office’s audits exposing excessive waste by our state’s hospitals.

Based on these audits, my office made 75 specific remedial recommendations to the state administrative agencies that regulate these institutions: the Department of Health, the Department of Commerce, the Department of Humans Services, and the Department of Revenue. Remarkably, none of Governor Pawlenty’s agencies followed or even responded to our recommendations.

I was the first public official in the country to get hospitals to sign an agreement (the Minnesota Agreement) not to price-gouge the uninsured, whose ranks are growing everyday due to serious illness and businesses dropping coverage.

The Minnesota Agreement, which is a binding agreement filed in court, has been executed by every hospital in Minnesota, including the Mayo Clinic, Allina Health System, Fairview Health Services, as well as our public facilities, such as the Hennepin County Medical Center. That’s a real result that benefits thousands of Minnesota families.

I have also tackled the problem of helping Minnesotans get the mental health coverage they deserve when I negotiated an alternative “mental health court” with Blue Cross and Blue Shield, Medica and HealthPartners.

Below are a number of steps that I will take as Governor to reduce skyrocketing health care costs and work towards more accessible and quality health care:

* The State should negotiate lower prices for prescription drug medication on behalf of all Minnesota consumers. Prescription drugs comprise 20 percent of the health dollar and is the fastest growing sector in health care.

* Reduce the size of our uninsured population. The larger the uninsured population, the higher the premium increases on people who are insured. This effect is due to cost shifting. There are three groups who represent the uninsured and underinsured population in Minnesota:

+ Working Poor_currently, there is a $100 million surplus in the Health Care Access Fund. This surplus should be applied to the MinnesotaCare program to cover more of our “working poor”.
+ Young Adults_Minnesota law mandates that students between the ages of 18 and 25 be covered under their parent’s policy. Many states have removed the education requirement and Minnesota should do this as well.
+ Small Employers_should be able to stabilize their premiums by being able to purchase coverage for high-risk employees from the Minnesota Comprehensive Health Association (MCHA).

* Our Attorney General (AG) audits of the three largest HMOs and two largest hospital systems revealed that up to 40 percent of the health dollar is spent on administration costs. By changing the governance of these institutions, we hopefully can dramatically reduce administrative costs. Some states now appoint members of such institutions in order to make them more accountable. We should consider this option.

* Adopt the 75 recommendations from our AG audit report to the Pawlenty Administration. These recommendations range from pension rules to better financial accounting to placing caps on net worth (our HMOs and BCBSM have the highest net worth to premium ratio in the country).

* Adopt a false claims act and whistleblower law.

* Review the concept of Centers of Excellence as it relates to diagnostic centers and
health provider clinics.

I have a proven track record of working on behalf of consumers for affordable and quality health care. Minnesotans can count on me to continue to get results that matter.

Pawlenty rebuttal
While my opponents like to talk tough about health care reform, I’m the only person in this race who has actually implemented it.

Our first success came through the state health insurance program, which delivered a zero percent premium increase to tens of thousands of Minnesota state employees. The Minnesota Advantage program brought national recognition to our efforts, but we didn’t stop there.

My administration began QCare - Quality Care and Rewarding Excellence - a new quality standard that rewards top performing providers while saving millions of dollars in health care costs. Through executive order we’ve directed state government to apply QCare standards and align payments and incentives for all state-purchased health care.

This program will save money and lives by rewarding quality, rather than just quantity. The Department of Health estimates that if QCare standards are met, more than $153 million in health care costs can be saved every year.

QCare also transforms the way health care is purchased in Minnesota by shifting focus from solely on the costs charged by providers to the quality of their care. The program identifies quality measures, sets aggressive targets for health care providers, makes measures available to the public online, and changes the payment system to reward quality rather than quantity.

Health care costs are not going to be restrained through constant litigation or having the Governor appoint health care company board members. Recall that after Mike Hatch appointed Medica board members in 2001, he then sued the board and tried to continue his control. In 2005, a judge said that Hatch had “unfairly accused” the board members of wrongdoing when Hatch claimed they “hijacked the company.”

Hatch also promised that under his watch at Medica premiums would go down. As you can imagine, that never happened.

Peter Hutchinson’s goals have some merit and he’s focused on many of the same areas as my administration. However, it is unlikely that there is $1.7 billion in savings in the health care portion of our state budget. Also, much of his prescription for health care is already being undertaken.

In addition to QCare, we have received national recognition for our Smart Buy Alliance. In November 2004, we brought together the state and several other private health care purchasing coalitions representing large and small business as well as union groups - potentially representing nearly 3/5 of the state’s population.

The Alliance’s goal is to work together to drive reform in the health care market. This approach is much different from Hatch’s big government takeover of health care or a big new risk pool that just shifts costs rather than reducing them. The Smart Buy Alliance uses the strength of these health care purchasers to demand common purchasing strategies and promoting and rewarding greater quality and value.

The following entities have agreed to participate in the Alliance:
. Labor/Management Health Care Coalition of the Upper Midwest
. Minnesota Association of Professional Employees (MAPE)
. Employers Association
. Minnesota Chamber of Commerce, representing employers of all sizes from across the state
. Minnesota Business Partnership, representing Minnesota’s largest employers
. The State of Minnesota (including the Departments of Employee Relations and Human Services)
. Buyer’s Health Care Action Group (BHCAG)
. Advocates for Market Place Options for Mainstreet (AMOM).

Working cooperatively, we will be able to increase access, improve quality and hold down rising health care costs.

Davis rebuttal
Now that the candidates (alphabetical order) Brown, Hatch, Hutchinson, Pawlenty and Pentel have had a chance to ponder my suggestions for health care I bet they wish they emphasized personal responsibility more. Mr. Hutchinson in particular sounds more and more like his idol Jesse Ventura who had a lot to say about others but no specifics that made real sense. And Hutchinson’s attack on Pawlenty is not the way to solve the health care funding situation. Hutchinson’s financial maneuvering smacks of his abject failure leading, or misleading, the Minneapolis public school system when he was its superintendant. Lots of wishful thinking but little substance.

All the candidates basically missed THE most crucial component to any health care program or plan and that is patient involvement in their own care as pointed out in my health care statement. If the responsiblity and role of the patient or care seeker is not pinned down then there won’t be enough money in the world to care for them all no matter what the funding mechanism is. It is clear from the candidate responses, especially Governor Pawlenty’s, that they do not understand where money comes from and how it gets into circulation. Without that knowledge they can’t properly manage the financial affairs of Minnesota adequately and they should be rejected for the position of Governor.

In the case of the Governor Pawlenty, his financial incompetence has been demonstrated by the billions of dollars of borrowing at inflationary interest during, hopefully, his final term in elected office that has put us in enormous debt. A paradigm shift is essential in health maintenance, health care, and personal responsiblity for all Minnesotans. New cost effective methods of alternative treatments and medicines are lacking in all the other candidate responses and therefore they should be rejected until my suggestions are incorporated at the beginning of their rhetoric.

Wednesday: Competitive Minnesotans