At 80, Durenberger reflects on the future of health care

Shortly after Dave Durenberger signaled his retirement from the University of St. Thomas with an e-mail headlined, "New Life Begins June 1," he traveled to Phoenix with his wife, Susan Foote, who was attending a board meeting at a local hospital.

"It was so much fun being a spouse," Durenberger, 79, said recently. "I hung out, I read, I called a couple of people I knew in Phoenix, I ate well. I thought: I could do this for the rest of my life."

After representing the state as a Republican U.S. senator from 1978 to 1995, Durenberger has spent the last half of his career as a middleman of sorts in the ever-more-partisan health care debate.

He held massive weekend retreats for policy wonks, where Democrats and Republicans, doctors and insurers, CEOs and consumers debated such weighty issues as long-term care and the medical arms race. He took his University of St. Thomas health care MBA students on 20 trips to Washington for seminars that drew White House officials and top congressional leaders.

As he embarks on retirement, Durenberger reflected on the impact of his work over breakfast at one of his favorite St. Paul haunts, the Downtowner.

Q: You supported President Obama and his federal health legislation. How do you talk to your fellow Republicans about moving forward?

A: We're not going to repeal Obamacare. Everybody is too far down the line. While they may disagree with this, that or the other little thing, everybody knows this is the way we have to go. Everybody knows we have to change Medicare and Medicaid, that we have to change what we're paying for. But no one will stick their heads out on politics anymore — the CEOs or the politicians.

If we start working from that, how can Demo­crats not work with us? Democrats specifically said: No single payer; no Medicare for all. They have put themselves in the position where they've given a gift to the Republicans.

Q: Why hasn't that worked?

A: I can't affect the politics of it. But I know what I'm talking about. I can predict the future. It's coming, and it's real.

It's frustrating now to live through this period of time with Obamacare on the agenda, where I would love to help some Republicans. But they all insist on attacking Obamacare. You can't repeal that thing. You've got to improve it. We have to find a way to drive some consensus. But we can't do it in today's environment.

Q: Do you feel like you were able to elevate the conversation around health care?

One of the more illuminating things I've done was the Minnesota Citizens Forum on Health Care Costs. It took us the better part of a year to pull it together. When we came to the end we said, what did we learn? What did citizens tell us? It didn't take us more than an hour to figure out. First: If you want to reduce health care costs, stay healthy. What public policy needs to do is take a little of the money that it's paying people to get sick and reward those of us who are willing to maintain a healthy lifestyle. Second: healthy communities. Not everything gets cured by buying health insurance. The beginning of life and end of life is all about community. It's about who spots behavioral health problems in kids and who deals with aging and palliative care issues. You don't need government to do that. The third one is "This is not a pill," which is the current medical system which gets paid for treating problems, not preventing them.

The first time I had to summarize Obama­care for anybody who I thought needed to understand it, I said, 'What do you think we now have as a result of this new legislation that every developed country in the world has always had?' Most people would say universal coverage. I'd say, No. The answer is, We have goals for health policy — national goals. As far as I can tell, this president is not ready to say what they are, but here's what they are: healthy people, healthy communities and a system that produces better health care. It isn't rocket science. Public policy is there to define how everyone can participate to become healthier people and create healthier communities. It's not there to take over doing it — that's what single-payer countries do. But that's not our goal. Our goal is healthier people.

Q: You make it sound so simple.

A: Maybe I can say it with conviction because I've had 40 years of doing this sort of thing. It's logical. The difference between me and Al or Amy [U.S. Sens. Al Franken and Amy Klobuchar] is that they don't have all this background and experience to lead them to be confident that's what people in their constituencies believe.

I'd love to get inside Obama's head. If only he had started talking this way three years ago.