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Health care reform comes to the Capitol -- sort of

State Sen. Linda Berglin, DFL-Minneapolis, has a soft-spoken demeanor that belies her tenacity at the Capitol on health care issues. Health care reform has been overshadowed this legislative session by the transportation bill, the budget deficit and the looming bonding bill initiatives, but some are viewing it as a key legislative piece this year.

To that end, some thought Berglin's Senate File 3099 might hit the Senate floor today, but Berglin and others crafted a 75-page monster, one that lawmakers wanted to digest before acting on it.

"The Republican caucus in the Senate wanted more time," Berglin said this afternoon at a media conference at the Capitol. "Forty-five minutes is not enough time to understand a bill as big as S.F. 3099."

A Senate Majority Research cheat sheet on the bill notes that it was constructed with input from both the Legislative Commission on Health Care Access and the Governor's Health Care Transformation Task Force. The bill has Republicans signed on as co-authors, went through 10 separate committees and has the theoretical blessing of Gov. Tim Pawlenty — who, as Berglin noted, "agreed to the framework of the bill."


But that doesn't necessarily mean smooth sailing. The bill purports to increase health care access to 47,000 uninsured Minnesotans and has four separate articles: "Public Health, Health Care Homes, Access and Continuity, and Health Insurance Purchasing and Affordability Reform." In short, it's a sweeping piece of legislation.

What the bill will do

 Some key components, according the Senate Majority Research, include:

• A "health improvement plan that is designed to lower obesity and cigarette use, and alcohol and chemical dependency."

• "Better automation and coordination between public health care programs" and "financial incentives to programs helping people enroll in MinnesotaCare."

• A "Health Insurance Exchange" that "will be operate similar to a stock exchange where health insurance products will be available for purchase by individuals and small businesses."

Some "fiscal notes" on the bill:

• The "health improvement" plan will cost $20 million in 2009 and $80 million in the 2010-11 biennium.

• Some $8 million will be appropriated from the state's Health Care Access Fund (HCAF) in 2009 for start up of the Health Insurance Exchange.

• Next year the HCAF expenditure will be $38.4 million and $253.7 million for the 2010-11 biennium. "These funds," according to the Senate Majority Research, "will go to expand MNcare," and other administrative and access funds.

However, as Berlgin noted, "At the time we talked about the bill, we did not know the extent" of the state's current $935 million budget deficit. For that, the sticky wicket will prove to be HCAF. The governor wants to use some $250 million in surplus from that fund to help balance the budget.

"The governor doesn't propose expanding health care access" with that fund, Berglin said, hinting that it shouldn't be used as a slush fund. "We're pretty lucky in Minnesota to have the Health Care Access Fund, and we need to be good stewards."

Still, it's likely that Pawlenty views it as key piece of budget salvation, something that will likely lead to serious politicking across the aisle next week, when lawmakers reconvene after an Easter break.

Then again, it's a solid bet that the bill might go poof, as the bonding bill and the budget crisis threaten to dominate the rest of the legislative session. But Sen. Tarryl Clark, DFL-St. Cloud and the assistant majority leader, expressed optimism that something would get done on health care reform.

"In the Republican caucus," Clark concluded, "they're saying 'Gee, this might be one of the things we can get done together.'"

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Comments (2)

Another way to look at what the Transformation Task Force bill will do:

-- Expand the concept of "public health" so virtually no behavior would be exempt from regulatory oversight.
-- Radically reform health care provider pay by shifting "accountability for the total cost of care" from health plans to providers.
-- Radically overhaul the insurance market by creating a nonprofit health insurance exchange that would de facto control the price and variety of insurance available in Minnesota.

As I wrote in the Pioneer Press: The devil is not in the details of the Task Force report, he's sitting in plain sight: The task force recommendations are a giant leap toward classical corporate socialism, a "friendly fascism," but fascism nonetheless. The task force recommendations are an integration of government and private corporations that destroys the distinction and endangers individual liberty and the quality of health care.

Do Minnesotans really want to live in a state that requires "the active engagement of employers, schools, communities and the health care system" to enforce healthy behavior? Is the body mass index of your children a matter of public health? Is it the legitimate responsibility of the Department of Education to "ensure that schools are held accountable for making progress on health improvement goals" (A No Child's Behind Left Behind Act)?

The Transformation Task Force steered away from “economic economics” and pursued "culprit economics" — leaping to the narrow assumption that the culprits creating rising costs are physicians who provide "uneven health care” and the rest of us with our "unhealthy behaviors."

Thus, changing behavior — the way doctors practice medicine and the way people live their lives — becomes the one best path to reducing health care costs, as if the laws of supply and demand could be eliminated.

The Health Care Transformation Task Force is not a starting point for reform; it is a dead end.

I direct a nonprofit that can't afford better than to pay low wages to our diverse staff. From 1995-2006, our average annual medical insurance increase was 17%. This year the increase was 20%.

The Linda Berglin/Pawlenty bill will do nothing to limit future increases, much less roll back where things stand now. Nor will it change the incentive I have (which I refuse to follow) not to hire people over 50, or who have diabetes or other medical conditions for which they should not be faulted as the first commenter (Westover) correctly notes. Instead Berglin seeks to further institutionalize the same wasteful insurance system that has already proven it can only add to medical costs, and cannot control or reduce them. Not so surprisingly, the executives and mouthpieces of those insurers dominated the task force that seeks to control needed reforms in directions that are safe for them, and Berglin's bill is what they came up with.

The first commenter seems to imply a free market solution. When putting my plan up for bid I got to see the free market in action. Forms which inquire into every medical condition of every family member of every employee. A phone call to one employee who had a major car accident in 1983 to see if there still are after effects. The free market seeks only to insure the healthy, which means the free market has nothing to do with helping people better access (and pay for) health care. Business is good when you only sell your fire insurance for igloos.

The only bill that improves public health AND lowers costs is Senator Marty's, single payer, Minnesota Health Act. And contrary to the message many insurance industry public relations dollars pay for, single payer is the one reform that gets government OUT of the doctor patient relationship.