A plan for better health, universal care
06 02 08 - 10:42
Governor's task force presents ambitious recommendations for fast-paced reform
BY JEREMY OLSON
Pioneer Press
Article Last Updated: 02/05/2008 11:13:42 PM CST
A governor's task force is challenging Minnesota to get healthy by 2011, and the report it released Tuesday doles out responsibility to everyone.
It challenges Minnesotans to halt the state's obesity rate this year and reduce smoking and binge drinking. It recommends paying doctors based on the outcomes of patients, not their numbers of procedures and office visits. It proposes saving money by cutting inefficiencies and insurers' administrative costs and then using the savings to extend health coverage to the state's 374,000 uninsured residents.
"If this report makes everybody happy, we've not done our job," said Sean Kershaw, a task force member and director of the Citizens League. "There is something for everybody to despise in this."
Turns out that's true even for Gov. Tim Pawlenty, who created the task force last summer and asked it to create a single plan to address the separate but connected flaws in the health care system.
On Tuesday, Pawlenty commended the group for the "comprehensive fashion" of its reforms but didn't agree with all of them.
He opposed a state mandate requiring that all Minnesotans have insurance. And he opposed further financial penalties to discourage smoking, saying "we've hit the smokers hard enough" with recent cost increases.
Pawlenty said the plan is nonetheless a "framework" for an improved health care system. The task force estimates its reforms could cut Minnesota's projected health care expenses by 14 percent in 2011 and by almost 20 percent in 2015 - and that's after extending health coverage to the uninsured. The projection is based on progress in four areas:
-- Prevention: Investments in tobacco prevention, school nutrition, public recreation, workplace fitness and other health programs would more than pay for themselves by reducing the prevalence of diseases such as diabetes and the need for medical care.
-- Payment: Clinics would be rewarded for keeping patients in good health and would be paid special fees to provide more oversight of patients with chronic diseases. Insurers would also create a bidding system to steer patients to the most efficient clinics.
-- Quality: All doctors would switch to electronic medical records before 2010. Their performance would be measured against accepted standards of care and publicized so that patients could choose the best doctors.
-- Costs: Electronic medical records and other efficiencies would reduce administrative costs for insurers. Insurers wouldn't pay for obsolete medical services. An advisory group would scrutinize new technology and inform insurers whether it was worth covering.
The question now is whether Minnesota is ready to take this medicine. The report's timetable is ambitious. Halting the state's rising obesity rate in one year would require overnight lifestyle changes for some people.
It also raises some tricky political issues - as shown by Pawlenty's objection to the insurance mandate. Several task force members said the mandate was important and that a sliding scale of state subsidies would help Minnesotans afford their required premiums.
Pawlenty countered that a mandate would simply raise fines or even criminal penalties against the low-income people who couldn't pay for insurance.
Plans have come and gone before. There was enthusiasm in 2005, when the Minnesota Medical Association announced a similar health reform agenda, and in 2004, when a citizens forum led by former U.S. Sen. David Durenberger proposed cost-saving changes.
Task force members were nonetheless optimistic that real change is ahead.
Kershaw said Minnesota's uninsured rate is among the lowest in the nation and that its health systems and employers are unique in their existing cooperation around health care reforms. The state also ranks high for overall health and longer life expectancy.
"If we can't do this, nobody can," he said, "and I take that as a good sign."
Several interest groups have objections, particularly those groups wanting a single-payer system to replace the existing market-based system with competing insurance companies. A local privacy group also opposes the move toward electronic records, and the requirement that doctors conform to "cookbook medicine" standards.
The state medical association also is concerned with the proposed bidding system for paying doctors that could create financial risks if the doctors bid too low.
One key lawmaker was optimistic, though she was disappointed at the governor's objections to the insurance mandate.
The task force report recommends many of the same ideas that were recommended last month by a group of legislators, said State Sen. Linda Berglin, D-Minneapolis, who served on both groups.
Lawmakers appear to agree on the need to reform the health system all at once, she said. The state can't afford to increase access for the uninsured, Berglin said, until it saves money by eliminating waste and unnecessary medical procedures. It can't expect doctors to raise the quality of their care without a payment system that gives them better incentives.
"I think there's urgency," Berglin said. "Each year that we don't move forward with cost containment, we pay dearly."
Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583.