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Pawlenty contrasts his health care plan with others but sidesteps Romney-plan politics

LEBANON, N.H. — Speaking at a health care forum at New Hampshire's largest hospital, one often compared to the Mayo Clinic in Rochester, Tim Pawlenty drew stark contrasts between his health care plan and both health reform measures nationally and nearby in Massachusetts, questioning the legality and sense behind the individual insurance coverage mandates that underpin both plans.

However, when asked specifically if he would have vetoed the Massachusetts law, Pawlenty passed on answering, only saying that he'd taken a "different approach" in Minnesota from the one then-Gov. (and now likely presidential candidate) Mitt Romney took in Massachusetts.

Pawlenty's speech was part of Dartmouth-Hitchcock Medical Center's "Health Policy Grand Round" series, where Dartmouth-Hitchcock has prominent politicians and would-be presidents talk face to face with doctors and nurses to bridge the gap between policy and practice. 

The medical center was explained to me by several political analysts as New Hampshire's version of the Mayo Clinic. It's the largest hospital complex in the state, a nonprofit that posts its patient outcome reports on its website and is frequently cited as among the top hospitals in America. If that sounds a bit Mayo-ish, it should — in fact, it was founded with doctors who were associated with the Mayo brothers.

Yet Dartmouth-Hitchcock is located in an area unlikely to be hospitable to a Pawlenty campaign. Leaving Ovide Lamontagne's house in Manchester (where Tim Pawlenty spoke Thursday night to a houseful of friendly conservative activists) and heading north on Interstate 93, this is about as far as one can go on that stretch of highway before hitting the Vermont state line. One guy in the audience joked that he could see Vermont from the top of the hospital and Pawlenty, having a bit of a laugh, seemed to catch the reference.

Here Pawlenty defended his market-based prescription for U.S. health care and opposition to insurance coverage mandates in a room full of some supporters but many who were skeptical. 

Dr. Ken Dolkart, a geriatrics physician, told Pawlenty that his let-the-market-decide analogies might work for Fords and Cadillacs, but not for health care for those without coverage. Citing a study about appendicitis hospital rates, Dolkart told Pawlenty that those without insurance coverage were most likely to wind up in the emergency room. Those with a high deductible plan were likely to have to head to the ER, too, as a result of waiting too long because they're worried about the cost.

Decisions about what medical care to seek, Dolkart said, aren't being made in the physician's office so much as they are in the household. And without universal coverage, he worried that people would make economic decisions that put their health in immediate jeopardy.

Pawlenty, in closing the session, thanked Dolkart for his comments but said they'd have to agree to disagree.

Pawlenty told reporters afterward that it was a "dramatic overreach to have the federal government mandate that individual citizens purchase a good or a service."

After deferring multiple questions on the legality of the Massachusetts health care plan, which has been mentioned as an early blueprint for parts of the national health reform law, Pawlenty was asked directly if he would have vetoed the Massachusetts law, had the DFL legislature offered it to him in Minnesota.

"You guys just can't let this one go, can you?" Pawlenty responded with a chuckle. "I'll just tell you what I stand for, and what I do, and so I've given you my Minnesota approach. There's going to be a lot of time to discuss these issues, and I know you're very interested in this angle, but I just took a different approach than Massachusetts."

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Comments (1)

Odd that Mr. Pawlenty should call Medicare and Medicaid less efficient thaan the market. The average percentage of Medicare dollars spent on actual healthcare ("Medical Expense" as they call it in the healthcare financing industry) is 95%. For Medicaid it is 97%. For the industry as a whole it is somewhere between 65% and 92%, depending on whom you ask (the lobbying industry group is about the only source for numbers over 85%). To put is another way, the overhaed for Medicaid and Medicare are 3% and 5% repspectively, while for Blue Cross plans nationwide it is just under 16%. I would think 16% overhaed is less efficient thatn 3% overhead. Unless, of course, you are talking about the rate of efficiency in transferring member premium dollars to executive bonuses. Let the market decide, and it decides to use premium dollars for sales commissions and executive salaries and bonuses, even at the "non-profit" Blues.