Well, well, well...it appears that the Governor may actually be coming around to the common sense take on HF 3391 (HT Gary)

 

Gov. Tim Pawlenty told legislators Monday that he is concerned that legislation now before a conference committee to revamp Minnesota's health care system might actually drive up costs instead of cutting them.

 

This has been a constant theme in my posting on this issue.

 

Health care costs continue to rise at "unsustainable" levels, he said. The Legislature's proposal, he said, would raise those costs further by expanding eligibility for state health programs. He said Minnesota still has "what is arguably the most generous human services system in the country."

 

Excuse me while I say....DUH!  Every argument, every amendment from the House Republican Caucus tried to address that very fact - something that the DFL majority rejected time after time after time!

 

Under both bills, clinics could qualify for higher reimbursement by establishing themselves as "health care homes."
Those clinics would provide comprehensive and coordinated care, especially for patients with chronic conditions such as diabetes and heart disease. An estimated 80 percent of health care costs are spent on people with chronic conditions.
Pawlenty asked the legislators to simplify that concept, apparently after hearing concerns from some health care providers in rural or small, independent clinics who worry that they might not have adequate resources to compete with larger health systems such as Allina and HealthPartners.

 

 

 

Originally, he agreed to spending Health Care Access Fund money to enroll people who are eligible for MinnesotaCare, but he seems to have changed his position on that," Berglin said.
Minnesota has the lowest rate of uninsured people of any state, about 7.2 percent. Of those, half are eligible for MinnesotaCare "and getting them enrolled would be a big step toward universal health coverage," she said.

 

 

Well, it was not as long of a night as it was a week ago during the "War of 1812" but it did try to come close.  It was also rather eye-glazingly boring at times - especially when the proponents of 3391 got into the defense of the more murky "conceptual" themes of the bill like the "Health Care Homes".  There were times when Gary and I were joking that we should request combat pay for sitting through all of that (even though he didn't live blog it).  However, if you didn't allow it to bowl you over, there were some very educational moments in the debate.

 

 

 

 

 

 

Neal Boortz has a column up today that needs to be read.

Sarah Jan Olson (aka Kathleen Soliah) is going back to prison. (HT Lassie)

 

Just days after being told she could serve her parole in Minnesota, Olson is back in a California prison, where she'll stay for almost another year.
California Corrections Department officials said Saturday that criticism of Olson's release spurred a review of her case. That review showed that her parole date had been miscalculated -- she was not supposed to be released until March 17, 2009.

 

Here is the “universal” part of on HF 3391.  Specifically I would like to focus on Article 5 Section 12.

45.5    Sec. 12. [62U.06] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT
45.6 INDIVIDUAL RESPONSIBILITY REQUIREMENT.
45.7    Subdivision 1. Phase-in goals. The state's phase-in goals for progress toward
45.8 universal health coverage for Minnesota residents are:
45.9    (1) 94 percent insured by end of fiscal year 2009;
45.10    (2) 96 percent insured by end of fiscal year 2011;
45.11    (3) 97 percent insured by end of fiscal year 2012; and
45.12    (4) 98 percent insured by end of fiscal year 2013 and thereafter.
45.13    Subd. 2. Measurement of percent insured.The determination of the percent
45.14 of Minnesota residents insured must be based on an annual survey of the Minnesota
45.15 population younger than age 65 to be conducted or contracted for by the commissioner
45.16 of health which must include questions related to the type of insurance, amount of
45.17 cost-sharing, and potential barriers to public program enrollment.
45.18    Subd. 3. Contingent individual responsibility requirement. (a) If the increased
45.19 affordability, cost containment, insurance reform, and voluntary efforts provided for
45.20 under this act fail to achieve universal coverage, an individual responsibility requirement
45.21 must have been proven to be necessary.
45.22    (b) If any one of the phase-in goals specified in subdivision 1 for fiscal year 2011 or
45.23 later is not met, as determined by the commissioner of health, in spite of implementation
45.24 of the increased affordability, cost containment, insurance reform, and voluntary efforts
45.25 provided for under sections 62U.01 to 62U.09, an individual responsibility requirement,
45.26 requiring every Minnesota resident to obtain and maintain health coverage from a public
45.27 or private sector source of the person's choice, must become effective 12 months after the
45.28 end of that fiscal year, provided that the commissioner certifies that health plans that meet
45.29 the affordability standard under section 62U.08 are available to Minnesotans.
45.30    (c) Failure to comply with the individual responsibility requirement is not a crime,
45.31 but must subject the person to a financial penalty to be specified in law.

1.23    Subdivision 1. Selection of primary care clinic.Beginning January 1, 2009, the
1.24 commissioner shall require state health care program enrollees eligible for services
1.25 under the fee-for-service system to select a primary care clinic or medical group, within
1.26 two months of enrollment. Beginning July 1, 2009, the commissioner shall encourage
1.27 enrollees who have a complex or chronic condition to select a primary care clinic or
1.28 medical group with clinicians who have been certified as health care homes under section
1.29 256B.0751, subdivision 3. The commissioner and county social service agencies shall
2.1 provide enrollees with lists of primary care clinics, medical groups, and clinicians certified
2.2 as health care homes, and shall establish a toll-free number to provide enrollees with
2.3 assistance in choosing a clinic, medical group, or health care home.

 

27.8    Subd. 3. Premium rate restrictions. No individual health plan may be offered,
27.9 sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
27.10 determined in accordance with the following requirements:

Realize that the department of health will have a scant 4 months to put this together by mandate and that the effective date of this bill would be January 1 2009!  This drastic, rapid take over of one of the few healthy segments of the Minnesota economy right now will further deepen the recession that we find ourselves in today.

One of the continuing themes, in my build up toward Universal Health Care has been the documentation of the rationing of services that starts once the government starts paying for your "free" health care.  The posts in question can be found here.  Commenters and politicians and reporters assure us that nothing like that will ever happen here, but are they correct?  If Article 5 Section 10 is any indication.....

 

42.14    Sec. 10. [62U.05] HEALTH TECHNOLOGY ASSESSMENT.

42.15    Subdivision 1.Technology Advisory Committee. (a) The Health Care

42.16 Transformation Commission shall convene an advisory committee to make

42.17 recommendations to the commission regarding the inclusion of new and existing health

42.18 technologies to the standard benefit set and design.

42.19    (b) The advisory committee shall be made up of 11 members appointed by the

42.20 commission, in consultation with the Institute for Clinical Systems Improvement, the

42.21 Health Services Advisory Council, and the University of Minnesota. The members shall

42.22 consist of:
 42.23    (1) six practicing physicians licensed under chapter 147; and

42.24    (2) five other practicing health care professionals who use health technology in

42.25 their scope of practice.

42.26    (c) No member of the advisory committee shall have a substantial financial interest

42.27 in a health technology company or be employed by or under contract with a health

42.28 technology manufacturer during their term or for 18 months before their appointment.

42.29    (d) The members shall be immune from civil liability for any official acts performed

42.30 in good faith as members of the committee.

42.31    (e) The advisory committee shall be governed under section 15.059, except that

42.32 the committee shall not expire. Upon the expiration of the Health Care Transformation

42.33 Commission, the Health Technology Assessment Committee shall continue to exist under

42.34 the oversight of the Minnesota Health Insurance Exchange.

43.1    Subd. 2. Technology selection process. The commission, in consultation with the

43.2 advisory committee, shall select existing and new health technologies to be reviewed by

43.3 the committee. In making a selection, priority must be given to any technology for which:

43.4    (1) there are concerns about its safety, efficacy, or cost effectiveness;

43.5    (2) actual or expected expenditures are high due to demand for the technology,

43.6 its cost, or both; and

43.7    (3) there is adequate evidence available to conduct a complete review.

43.8    Subd. 3. Technology review. (a) Upon the selection of a health technology for

43.9 review, the committee shall contract for a systematic evidence-based assessment of

43.10 the technology's safety, efficacy, and cost effectiveness. The contract must be with an

43.11 evidence-based practice center designated as such by the federal agency for health care

43.12 research and quality, or another appropriate entity as designated by the commission.

43.13    (b) The committee shall provide notification to the public when a health technology

43.14 has been selected for review. The notification must indicate when that review is to be

43.15 initiated and how an interested party may submit evidence or provide public comment for

43.16 consideration during the review.

43.17    Subd. 4.Committee determination. (a) Upon reviewing the completed assessment

43.18 and any other evidence submitted regarding the safety, efficacy, and cost effectiveness of

43.19 the technology, the committee shall recommend to the commission:

43.20    (1) the conditions, if any, under which the health technology should be included

43.21as a covered benefit; and

43.22    (2) if covered, the criteria to be used to decide whether the technology is medically

43.23 necessary, or proper and necessary treatment.

43.24    (b) The commissioners of human services, employee relations, and corrections may

43.25 use the committee's recommendation in making coverage and reimbursement decisions,

43.26 unless the recommendation conflicts with an applicable federal statute or regulation

The Minnesota Constitution states that the State of Minnesota is responsible for educating the citizenry.  As school districts are fighting to fund their mandate with the dollars they have, our wise legislators have decided to throw yet another unfunded mandate on top of the mix (HT Drew)
 

1.1A bill for an act
1.2relating to public health; adding nutrition as a required academic standard;
1.3requiring a BMI monitoring program for children and youth; establishing a
1.4statewide health improvement program; establishing a health, nutrition, and
1.5physical education advisory council; requiring reports; appropriating money;
1.6amending Minnesota Statutes 2007 Supplement, section 120B.021, subdivision
1.71; proposing coding for new law in Minnesota Statutes, chapters 120B; 145.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
 

 

4.14    Subd. 3. Fee imposed. (a) A fee is imposed upon the sale of cigarettes in this
4.15 state, upon having cigarettes in possession in this state with intent to sell, upon any
4.16 person engaged in business as a distributor, and upon the use or storage by consumers
4.17 of cigarettes. The fee is imposed at the following rates:
4.18 (1) on cigarettes weighing not more than three pounds per thousand, 37.550 mills
4.19 on each cigarette; and
4.20 (2) on cigarettes weighing more than three pounds per thousand, 75 100 mills on
4.21 each cigarette.
4.22 (b) A fee is imposed upon all tobacco products in this state and upon any person
4.23 engaged in business as a distributor in an amount equal to the liability for tax
under
4.24 section 297F.05, subdivision 3, or on a consumer of tobacco products equal to the tax
4.25 under section 297F.05, subdivision 4. Liability for the fee is in addition to the tax under
4.26 section 297F.05, subdivision 3 or 4.
4.27 EFFECTIVE DATE.This section is effective for sales and purchases made after
4.28 June 30, 2008.

 
Hmmmmm - why does an increase in the cigarette tax sound so very familiar?  Oh yeah....well to be fair, that part of HF 3391 appears to have been taken out in committee....

Something to comtemplate while HF 3391 is winding its way through the House.

 

The Democratic candidates tell us they can provide healthcare for all either mandated or not. It sounds utopian except they don't say how we will pay for it or that the quality and quantity of care will go down as costs go up.

If we think we want universal healthcare first we need to make a few reality checks. It hasn't worked in Britain, Canada, France, Germany, and Russia.

There are some alarming health abuses going on in the United Kingdom recently noted by the Association of American Physicians and Surgeons and others.

To meet U.K. government targets, which require emergency department patients to be treated within four hours, thousands of patients are kept in ambulances outside the department for hours. Last year, more than 43,000 patients waited for more than an hour before being allowed into the emergency room.

Ambulances that are being used as "mobile waiting rooms" are unavailable to take fresh calls. The Labour government brought in the four-hour standard in an effort to end the scandal of patients waiting in casualty for days (Daily Mail 2/20/08).

I spoke earlier of my intent to dig into HF 3391 and I have spent the last couple days doing that (and a lot of BPOU business).  I thought what I would do is tackle the bill in small sections - covering one or two articles at a time.  In all fairness to the author(s) I should clarify that this is not necessarily a "universal" health care bill...from Article 2, Section 1,  subdivision 4...

 

5.1    Subd. 4. State health care program. For purposes of this section, "state health
5.2 care program" means the medical assistance, MinnesotaCare, and general assistance
5.3 medical care programs.

 

...but it is a start!

 

2.10    Sec. 3. [145.986] STATEWIDE HEALTH IMPROVEMENT PROGRAM.
2.11    Subdivision 1. Goals. The initial goals of the public health access fund are to reduce
2.12 the percent of Minnesotans who are obese or overweight to less than half by the year
2.13 2020 and to reduce tobacco smoking by 2 percent annually starting in 2011.

 

 

2.18    Subd. 2. Grants to local communities. Beginning January 1, 2009, the
2.19 commissioner of health must provide grants to community health boards to convene,
2.20 coordinate, and lead locally developed programs targeted at achieving measurable health    2.21 improvement goals.

 

2.33    Subd. 4. Media campaign. The commissioner of health must conduct a statewide
2.34 marketing campaign using public media to reinforce local efforts at addressing health
2.35 improvement goals.

 

3.14    Subd. 3. Fee imposed. (a) A fee is imposed upon the sale of cigarettes in this
3.15 state, upon having cigarettes in possession in this state with intent to sell, upon any
3.16 person engaged in business as a distributor, and upon the use or storage by consumers
3.17 of cigarettes.

 

 

 

On Tuesday, I got a very interesting email in the Inbox. 

Greetings Congresswoman Betty McCullum,
 
The School of Public Health at the University of Minnesota is hosting the 4th annual National Public Health Week Film Festival April 7-11, 2008. We’d love for the Congressional Global Health Caucus to be a co-sponsor of our Tuesday, April 8, global heath-themed film, “¡Salude!.” The documentary tells the story of how the cash-strapped country of Cuba has become ‘one of the world’s best health systems.’
In 2007, the Film Festival attracted approx. 500 people. This year, we are please (sic) to announce that the City Pages is the exclusive media sponsor of the Film Festival. The City Pages reaches nearly 130,000 people from the area.
Your participation as a co-sponsor would help ensure this critical public health issue get the attention it deserves.
Here are two things we would ask of you as a co-sponsor:
1.      Spread the word. Help us advertise the Film Festival through your network, using various communications tools. This could include announcing it at an upcoming event, listing it in your newsletter, posting it on your organization’s calendar, or hanging or handing our Film Festival flyers.
2.      Drive attendance. Ask your staff, board of directors, key stakeholders and constituents to pledge their attendance in support of the Film Festival and environmental health.
 
In appreciation of being a co-sponsor, we’d:
1.      List your organization as a co-sponsor for Monday, April 7, 2008, on the NPHW Film Festival website; www.sph.umn.edu/filmfest08.
2.      Provide a table for you to display your organization’s information and other relevant materials in the evening on Monday, April 7. If your organization is looking for volunteers, please feel free to post a sign-up sheet at your table. Students at the University of Minnesota not only want to learn more about an issue, they want to know how they can participate in finding solutions to the problem.
3.      Offer a unique venue to raise awareness about environmental health and promote your coop.
 
The SPH hopes that the Congressional Global Health Caucus will join us in this
exciting event. Please feel free to contact me to discuss your participation.

Now I got this email just as Jazz and I were going on the air at MidStream Radio so I mentioned it to Jazz.  Jazz and I both expressed amazement in the fact that there was a "Global Health Caucus" (members include Rep. McCollum D-MN, Rep. Vic Snyder D-AR, Rep. Wayne Gilchrist R-MD, Rep. John Boozeman R-AR, Rep. Donna Christensen D-PR and Rep. Michael Simpson R-ID) and we decided that it was an issue worth pursuing at a later time.  So today we asked Fausta to come on and talk to us about it (since Fausta's specialty is Central American politics).  Luckily for us, Fausta had seen the movie "Salud! What puts Cuba on the map in the quest for global health" last spring at the Princeton Human Rights Film Festival.  One of the things that Fausta talked about (you can listen to the podcast here) was how the movie showed Cuban "medicos" (which do not necessarily mean doctors) do make regular house calls.....in the company of members of the Committee of the Revolution!  Let me clarify - the medicos are accompanied by a member OF THE GOVERNMENT and that member of the government is there to make sure that you (the person that the medico is checking up on) is not taking illegal drugs or you drink too much or whether you are eating right or not.  Again - let me clarify....the medicos bring government officials TO SEARCH YOUR HOUSE to make sure that you are not doing anything unhealthy!  That is what government run health care brings to you.

 

 

The first member of the audience to speak was a Princeton University student who
has travelled to Cuba three times and witnessed the deplorable conditions of a Cuban hospital (dirt, roaches, etc.), which he compared to the deplorable conditions of the pre-Cuban doctor South African hospital shown in the film. While on another trip he also witnessed how a Cuban citizen he rushed to an emergency room was turned away for being Cuban as that hospital only treated foreigners.  Another gentleman in the audience had a similar experience where he rushed a very ill Cuban to a hospital in the island and she was turned down because that hospital was for foreigners only.

 

 

On a final note, isn't it comforting to know that this propaganda (and there is no other word for it) is being funded by your tax dollars.