Category: Health Care

by Dave Mindeman

When I talk about health care, I generally deal with health care the way it is....not the way I would like it to be. Over the years we have locked ourselves into a juggernaut.

When Dwight Eisenhower left the Presidency, he warned us about the coming Military Industrial Complex. A system of defense that protected itself and developed a type of self-sustainment that transcended logic.

We have the same thing in Health Care....a Health Care Industrial Complex if you will. It has promoted itself as a "growth" industry when the reality is that it is a consuming parasite that cannot be controlled.

The numbers are daunting. Health Care consumes 15.3% of the national GDP. 11% of all employment is in health care. We spend $7,498 health care dollars annually on every man, woman and child in the US. Even during the recession (since 2007), healthcare jobs have increased by 559,000.

Of the Fortune 500 companies, 58 are health care related (over 10%). 12 involve Pharmaceuticals (Pfizer #40), 11 in Medical Insurance (United Health is #22), 8 are Medical facilities, 6 are in Pharmacy or other Health Care (Medco #36), 5 are Health Care Wholesalers (McKesson is #14), and 10 are Food and Drug Retailers (CVS is #18).

Healthcare is ingrained as an institution and efforts to reform or change it only happen on the margins. Health Care Industrial Complex is an economic leviathan.

Our efforts at reform bump into this monstrosity whenever we make the attempt. The Clinton administration looked like it might have had a chance back in the 1990's, but was beaten back by massive and intense lobbying. The Obama administration took the approach of working from within the sytem. The ACA was the result....but it really is just a hybrid of the same system with marginal reforms.

Single payer is the logical solution, but going up agains this type of industrial complex makes that type of radical change nearly impossible. Obama's ACA could have given us a true opening to real reform if the public option had been allowed to be in the mix. But the Health Care Industrial Complex (let's just call it the HCIC), sent in their big lobbying guns to squelch that possibility.

When the Republicans attack the ACA, they are largely attacking an entity that they had a large hand in formulating. They forced it to merge with existing industries. They forced slow implementation that has been inefficient and burdensome. And they have attacked the revenue streams that would keep it from adding to the deficit.

And we continue to depend on an employer based system with which we have this love-hate relationship. Employers find it burdensome but don't want to hand it off to the government either. It is grossly inefficient in costs, but they refuse to take the chance of any big changes outside of their control.

And the HCIC itself fights change at every turn. It is a big, ugly business with deep entrenchment.

Another annoying aspect is this Republican insistence that we need more competition in this system while at the same time they fight to protect the barriers to real competition.

The Health Insurace industry defines competition in health care as finding the best ways to NOT cover sick people; and to control the items and procedures they have to pay for.

That is not competition and it sure as hell isn't healthcare.

I can't give you a solution because the status quo is a powerful entity. But there would be one thing that Minnesota could do to at least point the way. We have the single payer, Minnesota Health Plan, sitting in the legislature waiting for action. I'm not sure, but I assume with a Federal waiver, Minnesota could enact this legislation and show the country a new way. A more logical way. A more cost effective way.

Of course, that means butting heads with the HCIC -- but shouldn't we at least try?

Category: Health Care

by Dave Mindeman

Rep. Jim Abeler wrote an op-ed in the Strib to criticize the new Minnesota Health Exchange.

He doesn't like it.

Even though Rep. Abeler voted for the preliminary bill (voted against the final bill - surprise!) in order to make him the lone Republican on the conference committee, and that in the past, Abeler has been shown to be relatively astute on health policy, let's be perfectly clear.

Abeler and all of his Republican colleagues abdicated any relevance on the health care exchange long ago.

Their party has fought the Obamacare initiative from the beginning. They still contend they should repeal it all. The Minnesota Republican majority legislature of the last biennium refused to move on this policy in any way....even though the Supreme Court ruled it to be Constitutional and the law of the land. They did nothing, helped with nothing, and they criticized incessantly. And now, Rep. Abeler is trying to tell us we "could have done better"?

What bunk.

Republicans have removed themselves from the health care debate. The reason Democrats did not look for bipartisan solutions is that there were none of any consequence. Rep. Abeler can give us all the opinions he wants but they are meaningless because he never seriously promoted a substantive debate.

Republicans have been obstacles, not bi-partisan advisors. To them, the Health Exchange was the enemy and they floated no alternatives.

So, if the GOP wants to complain about Democrats pushing the HIX bill in a partisan way, my comment would be....

Who are you kidding?

Category: Health Care

by Dave Mindeman

The Health Insurance Exchange (HIX) is getting close to a governor's signature. It has passed the House and is expected to pass in the Senate. With Governor Dayton's signature, the health exchange will be law.

It is not a perfect bill, but a lot of things went right in the process.

First, the House had tacked on some abortion language via an amendment. That got stripped in committee and although there was an attempt to reissue the amendment in the House and send it back to committee, it was not successful. That was important.

Second, some of the things the insurance companies were fighting stayed in the bill. The HIX has a very tough conflict of interest segment which precludes anyone with a financial tie to a health insurance firm or a medical provider from serving on the governing board. This somewhat assures that the board is consumer friendly.

Third, the exchange board will have the authority to choose which insurance products are sold in the marketplace. Again, the insurance companies will have to provide products that a consumer friendly board will be analyzing.

Financing the exchange will be done with a surcharge on premiums purchased through the exchange. This protects the general fund from having to contribute. The Senate had preferred paying for the exchange with an additional tobacco tax, but the surcharge came through in the conference committee.

Republicans did their best to derail this legislation. Jim Abeler, R (Anoka) voted for the House bill - but his main purpose was to get on the conference committee. He did get there and was the lone dissenting vote on the final bill. The final House vote was mostly party line -- a few Democrats voting against because of the abortion controversy.

Let's name names - The Democrats voting against the bill BECAUSE the abortion amendment got stripped are: David Dill - Crane Lake, Patti Fritz - Faribault, Mary Murphy - Hermantown, and John Ward - Baxter.

Remember those names.

I find it especially disappointing that Democrat Patti Fritz of Faribault was the driving force for putting abortion language in the original bill.

Equally disappointing were the votes of Laurie Halverson (Eagan) in the House and Terry Bonoff (Plymouth) who were the lone Democratic votes against during the process.

It has been suspected that freshman Rep. Halverson has ties to the insurance industry and her actions and votes in the House pretty much confirm that. Her vote against the exchange will not be forgotten.

Senator Bonoff has always favored business interests over the consumer. Her vote wasn't much of a surprise, but adds to a record that confirms her strong relationship with business interests. She chooses corporations over the people time and time again.

Despite the glitches, the Health Exchange will soon be law and Minnesota will retain control over its own health care. The hope is that this state's committment to universal coverage in health care will get closer to reality in 2014.

Thank yous are in order to the progressive legislators who fought hard to make this bill work for people - not the insurance carriers.

Maybe single payer can be in the mix some day as well.