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Klobuchar, Franken outline specifics on their health-care views

WASHINGTON, D.C. — The debate over health care reform this summer has been charged and, at times, explosive. And with all the town hall meetings, public forums and teleconferences, it can be hard to keep track of where lawmakers stand on some of the issues surrounding the debate. So MinnPost talked with Minnesota's U.S. senators, Amy Klobuchar and Al Franken, to better understand their views on some key points.

In general, the Democratic lawmakers agree. They both want to see insurance companies play by different rules that favor the consumer, such as eliminating provisions that deny coverage to people with pre-existing conditions. They also favor a so-called "value index" that would reward quality over quantity of services. But on the much-discussed government run "public option," the senators did vary slightly in their responses. Franken adamantly supports the inclusion of such a plan.

"I think that we can use the public option to cut costs because private health insurers will have to compete with it," Franken said. "The public option also doesn't have to make a profit, so we can focus more on integrating care and coordinating health care homes and increasing quality to bring down costs."

Klobuchar has taken more of a wait-and-see approach. She said that while she is open to the plan, she would not accept an option that is based on a Medicare payment model, which puts states like Minnesota at a disadvantage.

"[I] am open to a public option, but [we would] need to fix Medicare reimbursements so it works for Minnesota," Klobuchar said. "I have long advocated for opening up the Federal Employee Health Benefits Program that uses the purchasing power of 8 million federal employees to lower premiums, while still providing access to quality care and preventative services."

The following questions and answers were assembled from telephone interviews with the senators and follow-up email exchanges.

In each interview, the senators addressed the so-called "public option" and the Senate co-op proposals.

The public option plan calls for a government-administered health program similar to Medicare. Proponents of this plan argue that it is the most effective way to hold down costs while expanding access to high-quality care. Opponents say that it would short-change health care providers and amount to more government bureaucracy.

The Senate co-op proposal was offered earlier this year as a possible alternative to the public option. The specifics of the proposal have not been publically established, but the idea would be to create private, member-owned co-ops that would compete with private insurers. Proponents of this plan like that the government would not be running the co-ops. Skeptics  wonder whether these co-ops would be large enough to compete with private insurance companies.

 

Klobuchar: Top priority is to cut costs

Sen. Amy Klobuchar
Sen. Amy Klobuchar

MinnPost: What are the top three measures that you need to see in the health care bill? (In no particular order.)

Klobuchar:
The first is to make health care more affordable by doing something about costs… by reforming Medicare payments, including incentives for bundling, and implementing a quality index.

If we put that in place, it will filter through the whole system. Right now [Minnesota's] taxpayer money is subsidizing the rest of the country. So, this is my number one priority, but it is going to be a battle — not so much partisan as geographic.

The second priority is stability, making the health care system and benefits more stable, and this will mean regulation of the insurance industry and some reform. It will mean not allowing them to cut people out in terms of pre-existing conditions. It will mean being able to take insurance with you if you change jobs.

Third is keeping what is good, keeping what is good about Minnesota, allowing people to choose doctors and health plans that already work for them. We especially need to focus on keeping rural health care strong, which includes providing incentives for doctors to locate to those areas.

MinnPost: Are you in favor of the inclusion of the "public option"?

Klobuchar:
I am open to a public option, but I am waiting to see what it looks like in the Senate bill.

MinnPost: Why?

Klobuchar:
I believe we can incentivize more affordable health care in general by better regulating insurance and creating meaningful competition for health care services.  However, some of the options before Congress are tied to Medicare reimbursement rates. Before we even consider expanding Medicare, or another program based on its rates, we must reform our Medicare payment system so that it rewards value, not volume, and doesn't disadvantage states like Minnesota that provide high-quality care in an efficient way.

I would prefer a public option that would be a competitive option that would allow people to buy into a Federal Employee Health Benefits Program, which is a series of private plans…

I have long advocated for opening up the Federal Employee Health Benefits Program that uses the purchasing power of 8 million federal employees to lower premiums, while still providing access to quality care and preventative services. I am especially focused on making sure that any reforms make it easier for small businesses and the self-employed to afford health care.

MinnPost: You have faced some criticism about not coming down clearly for, or against, the public option. What is your rationale behind the position that you have taken?

Klobuchar:
We have a lot to lose if it isn't done right… I think I am doing the right thing for the state by stepping back. The problem is if you say "yes" and don't see the changes you want, that doesn't get you very far. You would give up any power to change it.

MinnPost: What is your assessment on the likelihood that the public option will actually be part of the package? What are the challenges?

Klobuchar:
I don't know. I really wish we would talk about it as a competitive option, and then we would look at the effects — how it is forecast to bring down costs. Then you can make an assessment. If the assessment is positive, it will have more political support behind it.

MinnPost: Those in the insurance industry say that it will be a tremendous boon for the private health-care insurance providers if there is an individual mandate but no public option. How do you expect to control costs if there is no public option?

Klobuchar:
I think you would somehow have to do it with major regulations… It is a concern. That is why you want to look at the whole [legislation].

MinnPost: What do you think of the co-op proposal?

Klobuchar:
The co-op plan is worth looking at, [but] I don't have enough details on it.

MinnPost: How would you assess the debate on health care so far?

Klobuchar:
I actually think that it is healthy that people are getting engaged in this. The way they do it may not please everyone — people get mad at elected officials all the time, it just usually isn't on 24-hour cable — but I don't think that is a bad thing.

Health care is incredibly important to people, either they work in the health care field, or need health insurance or have health insurance. It is just one of the most fundamentally important issues.

MinnPost: What is the most common misconception that you have heard about health care reform?

Klobuchar:
The biggest misconception is that it is somehow a negative to reform the costs. That it somehow means that someone is going to pull the plug on grandma because we have to talk about these costs for grandma and for people just coming into the Medicare system. The thing that I have found most startles people is that the lower-cost states, like Minnesota, tend to have the highest quality.

MinnPost: What is something that is missing from this discussion right now?

Klobuchar:
As Congress considers health care reform, eldercare is the elephant in the room.  It needs to be better addressed.  Both Minnesota and the nation will soon experience major changes as the Baby Boom generation reaches retirement age and as ever more Americans live into their 80s and beyond.  By the year 2035, Minnesota's population over age 65 will more than double, as will our population 85 and older.  The well-being and financial security of families depends not only on access to affordable medical services, but also access to affordable, reliable long-term care — including care that allows seniors to live independently as long as possible.

I would hope that Senator [Edward] Kennedy's CLASS Act, which provides an optional self-directed insurance plan for long-term care, would be included in health reform.  The CLASS Act would help provide a safety net for individuals that need long term care, and save taxpayer dollars. I also have several proposals that help to provide better information and choices for long-term care insurance, making it easier for people to access long-term care services and understand their long-term care insurance policies.

We also know that most eldercare comes from informal, unpaid caregivers — and we must help provide resources and support for these caregivers.  My bill, the AGE Act, helps provide a tax credit to these informal caregivers and establishes a National Caregiving Resource Center to provide better access to information for caregiving services.  Making elder care a priority in health care reform is good for our seniors, our families and our businesses.  And because providing care to seniors at home is far less expensive than in a nursing home, it's also good for all of us as taxpayers.

 

 

Franken: Supports 'public option'

Sen. Al Franken
Sen. Al Franken

MinnPost: What are the top three measures that you need to see in the health care bill? (In no particular order.)

Franken:
There are more than three things, but I certainly want to see pre-existing conditions gone. I want to see a provision where companies can't deny health insurance or penalize people in terms of the cost for pre-existing conditions.
I want to put a cap on what people have to pay out of their pocket so that they don't go bankrupt. I don't have a specific number, but it will be a number that may depend on their income.
And, we can't do all of this without cutting the costs, and to do that we need to institute some kind of best practices to encourage quality and value over volume — a type of value index.

MinnPost: Are you in favor of the inclusion of the "public option"?

Franken:
Yes, absolutely.

MinnPost: Why?

Franken:
I think that we can use the public option to cut costs because private health insurers will have to compete with it. The public option also doesn't have to make a profit so we can focus more on integrating care and coordinating health care homes and increasing quality to bring down costs.

MinnPost: What is your assessment on the likelihood that the public option will actually be part of the package? What are the challenges?

Franken:
I think that it is touch and go, I really do. But I am going to fight for it. I am going to speak out on its behalf, lobby my other colleagues, and use all the tools I have learned in my first five weeks being in the Senate.

MinnPost: Those in the insurance industry say that it will be a tremendous boon for the private health care insurance providers if there is an individual mandate, but no public option. How do you expect to control costs if there is no public option?

Franken:
I think that then you have to have the Health and Human Services secretary impose certain ways of doing business, and it is going to be much harder to do it without a public option, and that is why I am for it [a public option].

MinnPost: What do you think of the co-op proposal?

Franken:
I don't think we have enough details on the co-op proposal… Are we going to get enough people in them? Will they be state or regional? How will doctors be paid?

I am open to it… Part of me fears that it is the best we can get. We know co-ops in Minnesota, but it may work better for dairy than in health care.

MinnPost: The Minnesota GOP has criticized you recently for not holding any meetings on health care that are fully open to the public. What would your response be to this?

Franken: I have had community forums around the state that were completely open… the right might have been confused that they were called community forums and not town halls. They were open to the public and if anyone had any questions about health care, they could ask them. And I was asked about health care.

MinnPost: How would you assess the debate on health care so far?

Franken:
The majority of Minnesotans I have met over this recess — at the State Fair and in meetings I've attended all around the state — really want to see the system reformed and have asked me to go back to Washington to get it done. But obviously, when there are people yelling over each other at town hall meetings across the country, you're not having a productive debate.
That said, I've had a lot of very good discussions with folks who have real, legitimate concerns.

"Are we really going to get the savings we need from establishing 'best practices'?" "Will Minnesota continue to be punished for its success with low Medicare reimbursements?" "President Obama says I'll be able to keep the health insurance I have. But what if my employer decides to go into the exchange and changes insurers?" "If we're not covering undocumented people, won't they continue to use expensive emergency room care?"

These are questions I've gotten, and they're good questions. And people haven't been shouting.

MinnPost: What is the most common misconception that you have heard about health care reform?

Franken:
Obviously, the "death panels" is an especially egregious lie intended to frighten people. And the idea that a public option is a government takeover of health care is totally unfounded.

We see opponents of the bill citing a figure from the Lewin Group, a health-care think tank which is the subsidiary of a health insurance company, saying that if we adopt a public option, over a hundred million Americans will "lose their employer health insurance." Well, that's a very outdated number based on the very most extreme model of what a public option could be. The Lewin Group has since revised its number to 10.4 million, while the Congressional Budget Office puts the number at just 150,000.  And, of course, those people will not "lose" their health insurance. In fact, they may very well end up with better coverage under the public option.

Yet you see Republican office holders, who clearly know better, put out the old number, suggesting that over 100 million people will lose their health insurance.  Again, this is totally disingenuous — which goes back to your last question. Instead of having a real debate, we have politicians throwing up dust for political reasons. Health care is a serious, complex problem, and that kind of demagoguery is the very last thing we need. Fortunately, most Minnesotans I've met are seeing through this cloud of misinformation and asking me to fight for the public health option in the reform bill.

Finally, there is a misperception that the United States has the best health care system in the world, so we should just stick with the status quo. We do have some of the best health care in the world — in fact, right here in Minnesota. But our health care system is a mess.

The Swiss don't go bankrupt when they get sick. The French don't worry about losing quality, affordable health-care coverage if someone in their family has a pre-existing condition. Every other developed country provides universal health care at about half the cost that we do and have better outcomes and higher satisfaction. It's hard to break through with that information because Americans can't believe that we're not the best at everything. Well, we just aren't when it comes to our system of delivering health care and keeping our people healthy. But there's no reason we can't be. But we need to start with an honest debate about how to fix our system.

MinnPost: What is something that is missing from this discussion right now?

Franken:
Well, I think we need to put more focus on all the socio-economic determinants of health. That's a big topic. Your health has less to do with your doctor and your health insurance than with where you live. Does your neighborhood have clean air and water? Do you have ready access to healthy, affordable food? The way we eat has an enormous impact on health and health care costs. Obesity rates have shot up over the last 30 years. This leads to diabetes and heart disease.

Then there are things like exercise. Are there areas for recreation in your neighborhood? To socialize with friends and neighbors? Is there a high incidence of alcohol and chemical dependency where you live? Of crime and violence?  Do the schools have physical education? Healthy school lunches? And breakfasts? There are public health and prevention provisions in the bills that address these concerns either directly or tangentially. But we don't discuss them enough, and there's much more in the whole arena of health care disparities to be done.

Cynthia Dizikes covers Minnesota's congressional delegation and reports on issues and developments in Washington, D.C. She can be reached at cdizikes[at]minnpost[dot]com.

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Comments (35)

"I have had community forums around the state that were completely open… the right might have been confused that they were called community forums and not town halls. They were open to the public and if anyone had any questions about health care, they could ask them."

Try calling Senator* Franken's office to get a schedule of his completely-open-to-the-public appearances.

Try asking him when he might be found at the state fair. No, not even the time, just try to get a day.

I swear, this guy is a perfect fit for the Democrat party.

Klobuchar's comments are incredibly disconcerting! They are weak and a detriment to any health care reform for these reasons:
1. The public option is the only thing that will rein in costs even if the other reform measures can get passed. It is the ONE thing the insurance industry fears -- and there is a reason for that; it will be effective.
2. The other reforms she notes are going to be ineffective without teeth, and the Blue Dogs want them to be toothless. We had hoped for stronger voices from the left, and they are needed in this crucial fight for better and universal health care.
3. She has totally failed to recognize the true agenda of the Republicans -- defeat of ANY health care reform. Their latest mantra is "let's start over again" -- her waffling plays directly into their strategy. Get real Amy!

What is needed now to get effective health care ofr ALL Americans is clarity (including a public option), strength among the Dems, a degree of partisanship as called for in the 2008 election, and unity. That is what we hoped to see when we elected her.

I wish Senator Klobuchar would stop speaking about pending health care legislation as if it lacks medicare pricing reform. Is she unaware of the Independent Medicare Advisory Panel, or just unimpressed? Either way, I continually hear her referring to the legislation as if there is no change planned for Medicare reimbursement rates, which is simply not true. There is, and it is structured in such a way that it has the support of Mayo Clinic, judging by comments on their health policy blog.

http://www.whitehouse.gov/omb/blog/09/08/04/AnotherlookatIMAC/

Swift, I agree completely that this guy is a perfect fit for the Democrat party.

I'm glad he mentions that the public option would not have to make a profit - think about his statement for a moment. What does it mean to be free of the need for profit? It means no incentive to improve quality OR cut costs! It means no matter how much money is put into the program, results will not matter. Who will taxpayers complain to when dissatisfied with the public plan? Congresspeople?? What alternative will there be once the public plan is enacted?
There'll be nowhere for the dissatisfied to go, and no one to care about dissatisfaction.

On the other hand, private insurers make a profit through efficient operations and cost-cutting measures. Customers have somewhere to direct complaints and can even switch companies if they're unhappy.

Mr. Franken apparently wants us to pay up, shut up, and be happy with, whatever service Washington DC deems we are worth. I THINK NOT!

Thank you, Al, for reminding me why I voted for Dean Barkley. I don't need a Federal babysitter telling me what's best for me.

One thing I forgot to mention: Notice how Al mentions the effects of obesity on our healthcare costs.

When a public plan is enacted, don't you think the next step is to regulate what and how we eat?? In the name of the "good of society", or "cost reduction"?

Overweight people will be demonized for consuming more than their fair share of health services. Do any of us want that? Do we need Washington DC forcing us to eat healthy or exercising?

Do we enjoy being free to make those decisions for ourselves?

I am all for allowing people into private insurance if they have pre-existing conditions IF there is some sort of mechanism to prevent people from jumping on and off the plan.

If you don't think this happens it does. In fact state workers do it all the time with their MNCare clients. If a MNCare client is diagnosed with a high dollar disease or pregnancy, they tell the client to go on their employer plan while they are treated and then come back on MNCare when the treatment is over. MNCare pays for the employer plan premium but does not get hit with the claims.

Rules Matter with Co-ops!

So much depends on the rules established to govern a co-op and how they compare to the rules governing other members of the healthcare system. More insights: http://www.healthcaretownhall.com/?p=1288

Amy's "wait and see" approach needs improvement. Another 22,000 people are going to die each year Amy "waits and sees". Also, the number of individuals without coverage increases daily. We can't afford Amy's sitting on her hands. Amy's malingering is especially problematic for the 40-somethings and 50-somethings who are being laid off in droves in this recession. Many of these individuals have pre-existing conditions and are faced with insurance crises because many cannot afford COBRA payments and because many have exhausted the 18-month COBRA limit.

Amy appears more and more callous by the day.

I talked with an elderly lady today who chatted with Franken at the fair and I have no idea of her politics as she mostly wanted to talk about her grandson.

I would be curious to know if Senator Klobuchar makes any sort of distinction between allowing the uninsured or underinsured to buy into FEHB and the House Bill's creation of a health care exchange with or without a public option. I would also be curious to know if she would propose or support the same subsidy levels for non-federal employees buying into FEHB that current federal employees enjoy regardless of income.

Diane Robinette's arguments actually PROVE why the private sector cannot provide us with effective health care -- they are indeed focused on PROFIT!

How can a not-for profit organization give us good helath care? Only if their mission and goal is to be focused on improving the wellness of all Americans; and that is exactly why a public option is needed.

What is the goal of an insurance company? Certainly not wellness, as she points out it is PROFIT. And how is that profit earned? By rejecting pre-existing conditions...by stonewalling and paying as few claims as they can escape from...by shedding patients who have high claims...and obstructing the system with needless paperwork and slow pay to the providers.

Just check out their Annual Reports (I did). They do not talk of wellness and wellbeing of our citizens. They talk about rising profits andrevenues, and shareholder values. United, in the past 6 months made over $3 BILLION NET profit -- and that was after about $1 billion paid out in class action suits for bad and/or illegal practices.

Oh...and as Ms Robinette added, I should also mention that United's Annual Roport stated that 18.5% of revenues went for "administration" (more went for soft costs like depreciation etc); and 6.5% was bottom line net profit = 25%. That's 25% of YOUR, repeat YOUR, health care dollar went to support United Health company and its shareholders. Not for better health or coverage, or treatment. She is right, the government does do it for less and without profit -- about 3%, not 25%. No wonder there are only 2 of the 30 western industrialized nations who do not have some sort of government assisted health care:
the USA and Turkey. What an elite club.

"One thing I forgot to mention: Notice how Al mentions the effects of obesity on our healthcare costs. When a public plan is enacted, don't you think the next step is to regulate what and how we eat?? In the name of the "good of society", or "cost reduction"?"

Diana, I pray that the Democrats start in tying behaviors with cost to society.

We gonna get into behavior modifications to reduce health care costs? Sure, bring it.

Al says: "Your health has less to do with your doctor and your health insurance than with where you live."

Anyone want to take a guess what the annual health care tab for area code 94114 comes to?

~nuff said.

Myles, you cannot say that the US does not already have government-assisted health care. Indeed we do. Plenty. Even for illegal aliens. (See CHIP for confirmation) Do any other industrialized countries provide THAT??

I'll take you at your word regarding Turkey, but the US does not belong in your "elite club".

You make interesting points in your other post concerning profits - Quickly, the substance of my ojection to your points regard how private insurers distribute profits (stock appreciation and dividends) to millions. Who do you think "shareholders" are, anyway? Not just the wealthy - millions of Americans own shares of insurance companies via stock or mutual fund.

Ms. Robinette, I can give you a great example of a publicly-owned entity giving better service than a privately-owned one.

From 1986 to 1993, I lived in a town in Oregon that is otherwise rather conservative but has a municipally-owned power company. Not only did it provide good service (one blackout in seven years), but it charged only about 1/2 of what the privately-owned power companies in other towns charged.

People who lived in Portland, which was served by Pacific Gas and Electric, which was later bought by Enron (remember them?), couldn't believe it when I told them what my average electric bill was. They were even more astonished when I told them that this included the heat for a two-bedroom apartment.

I later moved to Portland, and the first winter, we had five blackouts.

In 2001, when California was supposedly suffering from "unavoidable" brown-outs, later found to have been deliberately engineered by Enron as a form of blackmail to gain permission to build more power plants, Los Angeles was mysteriously immune from any such trouble. Not coincidentally, Los Angeles has a municipal power company.

So yes, in these two cases, the publicly owned entity provided better service.

It must be a sad world you live in, Ms. Robinette, one where you think people are motivated only by money.

Amy Klobuchar's "wait and see" approach to this and other questions illustrates a complete lack of courage and leadership. We deserve better. The crisis in affordable healthcare and access to health insurance is one of the greatest crises of our society today. Why can't the good senator do more than wait for others to solve this huge problem?

One often overlooked advantage of a public option is that it costs much less than private insurance. A public program similar to Medicare would cost customers around $3,000. Taxpayer subsidies for a $3,000* plan would surely be a small fraction of those to help people buy $12,000 plans. In fact, Thom Hartmann suggests that the public option BE Medicare by letting anyone under 65 buy into it by paying its premiums.

*Medicare A/B monthly premium = $96.40; Blue Cross gap insurance = $126.00, Blue Cross basic drug plan = $24.70. Total: $247.10/mo x 12 = $2,965.20.

The insurance companies hate this plan because they want the "reform" legislation to force people to purchase their insurance and for taxpayers to help fund them with unnecessarily large subsidies. Amy Klobuchar will, I hope, come to understand that a public option is in the interests of every taxpayer AND of every person who needs help in paying the cost of premiums.

I hope both senators will vote against any bill that does not include a strong, effective public option, as about a hundred members of Congress have already promised to do.

Kudos to Sen. Klobuchar for her support of the CLASS Act and working in support of long-term care financing reform that helps people live as independently as possible.

Kudos to Senator Franken for his commitment to a public option as an alternative to no, or private but expensive health care insurance.

Senator Klobuchar seems to be caught between the interests of United Health Care, Mayo, Allina, HealthPartners, etc versus citizens who need health care services ....and she still wants to find the middle between our national and regional health care insurer/providers and what citizens really need.

It's a false choice.

Senator Klobuchar needs to understand the necessity of a public option to pressure private markets. Or support single-payer approach, screw the private insurers. Else, she may as well be Republican

Re: Ms. Robinette:
"On the other hand, private insurers make a profit through efficient operations and cost-cutting measures."

The fact that many people are without insurance, the fact insurance is not portable. Those problems all stem from a single cause. Which is that we rely on private insurers to provide health insurance. That's a failed business model effectively for this enterprise.

The private insurance companies imperative is to not sign up as clients, people who need medical care. They want to find healthy people or people who won't need medical care. Much of their budget is devoted to identifying who is going to need care and then taking steps to exclude those people from their policy rolls.

Another major part of their budget is based on aggressive efforts to deny reimbursement claims, so if you do have a policy and you do get a procedure and then you seek reimbursement for it. They have experts who get extra salary if they deny a higher proportion of claims. That is a failed business model for providing health care. That is called the adverse selection problem.

Health insurance benefits, unlike other types of income, aren't taxed, and so individuals are less cognizant of them if it shows up on their paycheck at all. Not only, then, is the free market maxim of perfect information violated, but it's violated in such a way that creates artificial profits for the insurance industry: the government is effectively subsidizing every dollar that an employee's company is willing to spend on their insurance benefit.

The profits the insurance industry are making, of course profits artificially boosted by an enormous backdoor tax subsidy don't seem to be buying the customer much of anything in terms of improved service or cost savings. On the contrary, health care costs are rising by as much as 9-10 percent per year, without any concomitant increase in the level of service. If Delta airlines were raising the cost of its fares by 10 percent per year, they'd be out of business.

The reason the insurers are staying in business, though, is because barriers to entry in the health insurance industry are in practice quite high. Insurers benefit from pooling risk. The larger the pool, the better in terms of the insurer's ability to hedge its risk and build negotiating leverage with its providers. That makes it very difficult for a new type of start-up to compete: they'll have trouble getting together enough customers to pool their risk adequately, and even if they do, they won't have as much negotiating leverage as the big guys. Health care providers may demand a better deal or refuse to accept them. As such, they'll never get off the ground.

Insurance, in other words, is a volume business, the main requirements for which are that (1) you have a lot of money pooled together and that (2) you've been around for a while.

CIGNA and Aetna have a lot of money pooled together and they've been around for a while but they don't have as much money, nor have they been around as long, as the federal government. It's certainly possible that the profit motive in the insurance industry has driven more innovation than we're giving it credit for. But that isn't my bet.

Your second claim that: "Overweight people will be demonized for consuming more than their fair share of health services."

I believe its called "personal responsibility". Isn't that one of the touchstones of the conservative movement?

Risky behavior by choice such as: overeating, smoking and alcohol consumption. All of these carry heavy external costs to society as well as to health care costs. Perhaps the "market" will price them out of their personal choice of "risky behavior" with rates that are relevant to their "self imposed" risk.

Hope you find this relevant to your thoughts about insurance and its relationship to a free market.

Perhaps the insurance industry might consider two bipartisan initiatives. One is to increase the age and eligibility of a dependent to 26 years old. Second would to be to remove the "pre-existing condition clause from its policies.

These two items would seem to be two huge steps in the correct direction for some market/industry initiated reform. Without the hand of government being involved. Self correcting if you will....

Diana,

I hate to pop your bubble of ideology with facts... OK, that's a lie, I actually quite enjoy doing so. Anyways, The myth of private superiority and profit motive are negated by several observations. First, our Fire and Police services are government run quite efficient. The private sector health system in this country has produced run away costs and double digit inflation for thirty years while government run/regulated systems elsewhere have controlled costs and produced more efficiency and better care. Finally, Medicare and the VA have both out performed the private sector in terms of customer satisfaction, trust, and cost for the last ten years.

Believe it or not Diana, there are people in the world who believe in doing a good job for a fair days wages. In fact, the majority of human beings, and the greatest human beings in history, are driven towards excellence by a variety of motivations and goals the least of which is greed. The igloo was not a "market" innovation. Jesus and Gandhi were not a CEO's. We have one of the best state health departments in the country, most of the people working there could make more working in the private sector but the choose to serve the public instead of stock holders. Meanwhile 50% of all private ventures fail with five years while our government... 233 years old and counting.

Sen Klobuchar helped lead the charge to bail out Wall St, there was no talk of wait and see. Now that we the people are stuck with $24 trillion of debt, she wants to cut health care costs in order to further bail out the hopelessly bankrupt banks. Sen Klobuchar should begin listening to her constituents, they know more than her about what is right for this nation.

There are so many questions around the terms "public option" and "co-op" that just haven't been answered yet.

A public option in a marketplace where all other plans are still allowed to deny coverage on the basis of pre-existing conditions would do nothing to control costs but would let other insurers cherry-pick healthy people. So that kind of public option would not result in the cost reductions we are looking for. I don't think that's what any of us mean when we say public option, but I fear compromises that could create such a perverse situation.

Similarly, a co-op plan that does not have the force of nationwide participation could fairly easily be driven (or "gamed") out of business in certain markets. This situation would also undermine the intended cost savings.

It seems irrelevant whether Sen. Klobuchar's idea of allowing people to buy into the Federal Employees Health Benefits program is a "public option" or a "co-op". The real question is how effectively it sustainably controls costs while making quality care accessible.

I don't mean to disparage Sen. Klobuchar's motives but whenever you see someone complaining about Medicare reimbursements you know they've been talking to providers or providers lobbyists. Providers are afraid of Medicare precisely because they know it will contain and roll back costs, and that will cut into their bottom line. In other words the know they'll make less money with Medicare.

The question is whether or not reduced costs are bad for our health care system? If providers make less money, will they deliver poorer health care?

There are a few things to keep in mind when considering this question. First, how much profit is enough profit? Every provider in the country with the exception of the VA currently overcharges for everything they do. The hospital I worked in for instance charged $100 for $20 egg crate mattresses. Procedures like colonoscopies are typically billed at $1,500 - $1,700 dollars which almost twice cost, and that's at so-called not for profit providers. There's also considerable inefficiency in many hospitals and financial stupidity. I worked on a psych unit 15 years ago, hospitals at the time were spending $300 for ear thermometers that were selling at Target for $60 at the time. Literally millions of dollars were spent on failed attempts to computerize systems, install pneumatic tube systems that constantly broke down, supply management schemes, so called quality assurance programs, and consultants. The consultants were either ignored, gave bad advice, or duplicated advice that staff were trying to give for free. Everyone is making money, equipment manufacturers, consultants, drug manufacturers, office supply catalogs. The only people who've seen cuts in pay or slow growth are the direct patient care staff, even doctors have seen decreased income. It's a upside down system that pays the people who have the least to do with your health care the most money. And none of these people are going to admit any of this. Hospitals are always complaining that they only collect 52 cents for every dollar they bill, but they don't tell you they overcharge to begin with so even at that rate they're still making 10% - 20% above cost at least. It's a cash cow and no one wants to kill the golden goose, THAT'S why they're afraid of Medicare.

My two cents: It's not in our best interest as a matter of public policy to have the most expensive health system in the world. It's not in our best interest to have the highest paid doctors, or health care executives, that's not our problem as a nation. Having the highest paid doctors and executives is not a rational goal for a health care system. Our goal must be affordable universal, high quality health care. We can have that without making health care executives insanely wealthy. I've always thought just about anyone can squeeze by $500,000 to a $1,000,000 a year. We can reduce costs without decimating the health care system financially. If we had a national system we could actually get our arms around some of these cost issues and make some rational policy.

Klobuchar needs to stop worrying about provider income and focus on constituents health care.

Diane
You continue to PROVE the case why a public option is needed, and the pprivate sector is failing us. Check the United Health financial reports.

Yes, the stock may be owned by millions, but a very few own millions of the shares. In fact, it was the stock option fiasco which gave retiring CEO McGuire $1.25 BILLION IN A GOLDEN PARACHUTE! I repeat, those are your health care dollars, and mine.

Regarding their so-called dividends: last year the yeild of the stock was 1/10 of 1% -- or $.03/share. This means, if you owned 100 shares, you would have gotten $3.00 in dividends. Whoopee. Or maybe you would invest about $28,000 to get 1000 shares; then you would have $30.00 in dividends. NO, this company is on the cheap in every way, and is sued for their egregious behavior frequently.

I will take the public option anyday.

"screw the private insurers"

And there, gentle readers, is the boiled down essence of the Democrat plan to socialize medicine.

Grasping covetousness is a common thread in leftist ideology, of course, but nowhere has it been so starkly revealed as it has been during this latest campaign.

When the nonsense of the leftist propaganda is exposed (no great feat) their argument almost always comes down to their unwillingness to live in a country where someone is achieving greater success than they.

Thoughtful deliberations necessitate one look at the examples of socialized medical systems now in place in several countries. Without exception they are all marked by a never ending need for increased public taxation to pay for a system whose quality is an inverse to the costs incurred.

Socialized medicine is marked by rationed services, a scarcity of people and equipment and debt. When the truth is exposed, the only rationale remaining to proponents of government takeovers is someone needs to get screwed, put in their place and chopped off at the knees.

You might expire while waiting for your CAT scan, but damnit, at least no one is getting rich!

I don't know about you, but that's not a referral I'd rely on if I ever needed a major surgury.

Mr. Udstrand,

The Medicare reimbursement issue isn't a class-protection move, it would be nice to frame this as rich doctors are getting paid too much issue but it's not that simple. It is actually about empirically supported treatments and the enormous waste generated by fee for service, waste that will be needed to be recouped if everyone is to get universal coverage. In short, there are smart ways to do medicine and stupid ways to do medicine and the way Medicare now operates, it doesn't distinguish -- you provide, you bill, you are paid. Klobuchar rightly wants to end this but appears not to realize that she is protesting a dead issue, if the IMAC proposed by the president is approved.

Tom Swift continues with demogoguery unrelated to facts!

No one has suggested "Socialized" medicine in the USA!
No one has said they would eliminate private insurers...just give folks an option, and they are welcome to keep their current insurance if they so desire
There is no evidence that government assisted health care in other countries is causing the issues he mentions. I have seen two recent polls lately: the first from Canada which says 86% of Canadians like their health care; and a second one from England (which actually IS modified Socialized medicine) in which over 90% of the English are satisfied with their health care system.

All the negative comments Swift states are apocraphol, and unproven. If this debate is to have any merit we have to stop the myths and fictions...and deal with facts and truth!

Mr. Swift says, "their argument almost always comes down to their unwillingness to live in a country where someone is achieving greater success than they."

Nonsense. The health care problem is two-fold:

1- People with health insurance can not afford the rapidly escalating costs.

2- People without health insurance either forego care, or receive very expensive care through emergency rooms for nonemergency medical issues, forcing the insureds' costs to be even higher.

The current private health insurance market is the context for these two problems. It's too expensive, and it doesn't cover everybody.

I'm much more interested in citizens getting the health care they need than whether a private health insurance company is profitable for it's owners.

If it must be a choice between going to public insurance that is affordable and comprehensive, or keeping our current, unsustainable private insurance approach .... yes, screw the private insurance companies in favor of citizens getting the health care they need. Everything doesn't have to be a profit-seeking enterprise. Private insurance people will find something else constructive to do surely.

Paul Scott,

//It is actually about empirically supported treatments and the enormous waste generated by fee for service, waste that will be needed to be recouped if everyone is to get universal coverage. In short, there are smart ways to do medicine and stupid ways to do medicine and the way Medicare now operates, it doesn't distinguish -- you provide, you bill, you are paid.

Mr. Scott, health care practice is the responsibility of the practitioner, not the payer. You are only obscuring the issue by trying to hold Medicare responsible for quality of care. Private insurers currently interfere with quality care by denying coverage for treatment options that are more expensive but medically necessary. You want your doctor making your treatment decisions, not your insurance company. You want your insurance company to pay the bill, that's what they are there for, that's what you pay them to do. Whether or not your practitioner is delivering the best care is another issue. Sure, providers would like to shift that responsibility to someone else for financial reasons, but it's smoke an mirrors. The truth is providers are responsible for the quality if care they deliver, no matter who pays them or how.

The waste in the system isn't caused by fee for service, it's caused by incompetent administration. Yeah, administrators are constantly trying to shift the blame to someone else, but don't fall for it. Again, Klobuchar needs to keep her eye on the ball and not get distracted by all these additional problem sets various parties keep trying to ad to the mix.

RE: health care practice is the responsibility of the practitioner, not the payer. You are only obscuring the issue by trying to hold Medicare responsible for quality of care.

No actually, I am in agreement with you..health care is the responsibility of the practitioner, and they are at times practicing poorly...some providers are providing the wrong care and billing for it, for reasons of either greed or ignorance, and while you can't legislate practice, If medicare stops paying for a practice that is not supported by comparative effectiveness research, the result will be that better treatments are rewarded, people are treated less for the same outcome, outcomes go up, costs go down. There may be indeed be a host of administrative problems in health care, but I would bet that administration follows services, rather than the other way around. They are, just guessing here, often putting stents in people who might benefit greater from aspirin, giving back surgeries to people who need rest or physical therapy, virtual colonoscopies to people who would be better treated, according to outcome research, from scopes, etc etc etc.

I wish I shared your bottomless faith in the pristine judgment of thousands of individual doctors around the country, trained to different levels of ability and with different motivations for practicing medicine, but at the very least, it seems safe to say that doctors are busy and do not always keep up on the research and often practice outdated treatments, or treatments they like simply because they have been given a box of donuts from a marketing person, who knows. Medicare reform would address that problem.

I chatted with Al at the Fair, and I was glad to have the chance to tell him about my four adult children's health care situation. The only one who has health care is in the army. Two others work for companies that do not provide health care, and one lost her job and health care insurance several months ago. The private insurance I help them pay for excludes pre-existing conditions.

As far as the government regulating what you eat, my wife's health insurance provider already has started requiring obese folks and smokers to take steps to change their behavior. If they don't take those steps, they pay higher out of pocket costs. Much of the fear mongering going on about what might happen with health care reform is about things that are already going on in our current system.

I certainly respect other people's opinion and I welcome opposing beliefs, but I just wish people would investigate what they are talking about before making decisions.

For example, has anyone looked at Medicare benefits?

1. For 2009, the inpatient hospital deductible is $1068. And if you are admitted to the hospital again after 60 days, guess what, you have another $1068 deductible. Private health plan deductibles are once per calendar year.

2. In 2009 you have to pay a one time $135 deductible and then your office visits are covered at 80%. That means you have to pay 20%. Guess what, there is no cap on that 20%. You keep paying your 20% until the end of the year. Private health plans all have Out of Pocket (OOP) maximums that cap how much you pay out of pocket in a year.

3. Want a routine physical on Medicare? Medicare covers one, yes, one routine physical within the first 12 months that you are on Medicare Part B. And that physical applies to the $135 deductible and you are responsible for 20%. After that one physical, you are not covered again.

4. Want a routine eye exam on Medicare. They are only covered if you have diabetes.

5. Want coverage if you are leaving the country. Good luck. There are only rare instances in which Medicare covers treatment outside of the country.

I guarantee you if a private plan offered a plan that had these benefits, people would blast the carrier who offered them.

There is a rhyme to the reason of insurance companies, and whether you believe it or not, it is not all profit based. In fact, all of the insurance companies that sell insurance in MN are non-profit (except those selling Medicare Advantage plans like UHC and Humana). The unforunate reality in the insurance world is that you only hear the negative stories and sterotypes. As someone who works with Medicare on a daily basis, trust me, you do not want a government plan to be run by the likes of them.

Mr. Simplot: Re your Item 2: Medicare gap insurance was created to cover the 20% Medicare does not pay. Mostly, though, they do not pay the whole 20%, but only a portion of it. Only rarely do we on Medicare receive a bill for the unpaid portion.

And yes, out-of-pocket costs can really count up. Eyeglasses and hearing aids, dental care, and some other services are not covered at all. The drug benefit, because it was privatized by the Republicans in power costs $80 billion per year more than it would if it were a simple Medicare benefit and prices were negotiated. (The $80 billion is the combined excess cost in taxpayer dollars and seniors' premiums, copays, deductibles and doughnut hole purchases. Dean Baker, 2006 report).

HOWEVER, with all its faults, you will find few seniors who would prefer a private plan that told us we could use only in-network providers, that forbade seeing a specialist without their permission, that dredged up reasons not to pay expensive claims, and that held profit instead of care as its highest value.

//I wish I shared your bottomless faith in the pristine judgment of thousands of individual doctors

Mr. Scott, I used to work in a hospital alongside Dr.'s. Believe me I have no reservoir of bottomless faith in that regard. I'm simply pointing out that quality of care and best practices are treatment issues, not insurance issues. When your treating patients, you have no idea who's paying or how, nor should you care. This is why trying to tie best practice issues to Medicare only create more noise. Quality issues are an ongoing issue in the field of medicine and always will be. Getting everyone covered and providing access is an immediate issue that can't be deferred until every other problem with the health care system is solved.