Five years of high-level exchange visits by Minnesota and German health care policy leaders have borne more fruit than most Minnesotans know, state Rep. Joe Atkins disclosed at a debriefing Thursday at the University of Minnesota’s Center for German and European Studies (CGES).
Atkins, DFL-Inver Grove Heights, revealed that the health care policy lessons he derived from exchange visits to Germany in 2010 and 2012 inspired his decision to sponsor the 2013 bill that authorized creation of MNsure, the state’s new Obamacare-linked purchasing exchange.
“If MNsure works, we get the credit. If it doesn’t, we’re blaming the Germans!” Atkins joked – I think.
MNsure is a far cry from the German system, which might be fairly described as Medicare for all combined with an opportunity to opt for private insurance instead, as about 10 percent of Germans do. But MNsure aims to do what Germany long has done – give every citizen the benefit of health insurance.
Germans spend about half the amount per capita that Americans do on public and private health care combined. Learning how that’s done, while giving Germans a chance to borrow ideas from Minnesota, is the focus of the annual CGES exchanges, which are funded by the German government.
This year’s 21-member Minnesota delegation to Berlin, which traveled in mid-September, took note of German price controls on pharmaceuticals, government financing of medical education, and a requirement that every citizen have long-term care insurance. But the biggest difference between American and German health care is cultural, the delegation said.
“In Germany, the rich help pay for the poor. The healthy help pay for the sick. The young help pay for the old. The males help pay for the female patients. They all agree with that. That’s the culture of that country, and it’s not the same in this country,” said state Rep. Tom Huntley, DFL-Duluth.
Kevin Goodno, a former Republican legislator and state human services commissioner, added: “Germans are not more caring than we are as Americans. They’ve just been raised in a system that has the expectation that government will provide these services…. It’s not impossible for us here to have the same culture and the same expectations. It’s just that we have to go through these growing pains. I think the ACA [Obamacare] is part of that, for better or for worse.”
Saturday’s first anniversary of the Sandy Hook Elementary School shootings in Newtown, CT was punctuated earlier this week by a New York Times report about state gun law changes enacted in that massacre’s wake.
Nearly two-thirds of the new laws weren’t intended to take guns out of the hands of potential mass murderers. On the contrary: They aim to expand the rights of gun owners.
Also notable has been the surge in sales of assault weapons similar to that used by Adam Lanza to kill 20 children, six teachers, his mother and himself. They’re up 36 percent in the past year, weapons maker Freedom Group reported Monday.
Those statistics suggest that many Americans responded to Newtown with fear, not empathy. That’s the analysis of the Rev. Peg Chemberlin, executive director of the Minnesota Council of Churches and a past president of the National Council of Churches. Empathy, she says, is an essential building block of American democracy, and on divisive issues such as gun control, it’s in dangerously low supply.
That concern is behind the Minnesota Council of Churches’ decision this year to adapt its Respectful Conversations program to the gun control issue. Created in 2012 to help Minnesotans understand each other’s views about the contentious same-sex marriage issue, Respectful Conversations employ parish settings, trained facilitators and tested ground rules in meetings intended “not to change minds, but to soften hearts,” said MCC program manager Jerad Morey.
Nine congregations have hosted conversations about guns to date. MCC’s goal is to conduct 25 of them by spring. In subsequent evaluations, a strong majority of participants report gaining better understanding of views different from their own, Morey said.
That’s not the same as finding consensus or charting new state or national policy. But on matters of deep national division, it may be an essential first step. Chemberlin says the conversations tend to reveal the deep values that are behind diverse opinions, and often shpw that the deepest values of each side are shared with the other.
“People living into their fear is not going to help us. It’s not going to heal us,” Chemberlin said. “We need something other than fear to rally around.” Something other than grief, too, I’d add – though that sentiment will be inescapable as this weekend’s sad anniversary is observed.
Gov. Mark Dayton was in understandably good form Thursday as he commented on the just-released news that the state budget is on track to produce a $1 billion surplus by mid-2015. All that green is grease to an incumbent’s political skids in the runup to a re-election campaign.
The DFL governor relied on prepared remarks to announce his desire to use about 60 percent of the surplus funds that are not already committed for tax relief – a perennial election-year favorite. Dayton said he will ask an as-yet noncommittal DFL Legislature to repeal three new business services sales taxes (warehousing, telecommunications and equipment repairs); to conform to federal law for joint married filers, thereby reducing the tax burden for many of them; and to enrich the Working Family Tax Credit for low-income earners.
Dayton sounded even more like a candidate when he set his script aside. In response to a question about the economic consequences of the higher income tax rates for top earners that he pushed through the 2013 Legislature, he vigorously defended what he called “the Minnesota model for economic success.”
Minnesota is doing well with “a balanced approach,” Dayton said. “We’re not the lowest tax state. We don’t strive to be. We haven’t been, under Republican governors or Democratic governors. But we are a high-value state. By putting money into education, we have a well-educated workforce.
“Look at high-value manufacturing – we’re increasing there. Look at the kind of investments we are making for [Rochester’s] Destination Medical Center and 3M’s research and development expansion. Other projects like that are going to create more jobs in the future. The balanced approach is one that has proven successful for Minnesota for decades now, and we’re continuing on that path.
“The results -- 122,000 more people working than when I took office, and the fact that we’re the fifth-fastest growing state economy in the country -- just show that fear-mongering and nay-saying about Minnesota are being defied by the facts.”
The rumor that Dayton would opt not to seek a second term has been a nine-lived cat for months. Dayton’s post-forecast performance should bury that cat once and for all.
Exhibiting a fine sense of timing – and maybe to make a point -- the U.S. Supreme Court picked Cyber Monday to announce that it would not take a case challenging states’ ability to apply their sales taxes to online purchases.
One might surmise that the justices were telling online retailers that if they’re big and powerful enough to get their own named shopping day, they don’t deserve a sales tax advantage over their bricks-and-mortar competitors. Not in New York, anyway.
But as often happens when the high court chooses not to take a case, the consequences of Monday’s refusal to take up Amazon’s appeal of a New York appellate court’s decision are mixed and the message muddled. Left in force is a 1992 dawn-of-the-internet Supreme Court decision that says online retailers must have a physical presence in the state to be required to collect and remit state sales taxes.
The New York law, which was preserved by the high court’s inaction Monday, says that the presence of sales or advertising affiliates in a state is sufficient presence, or nexus, to make a sales tax collection requirement legally permissible. This year, the Minnesota Legislature enacted a requirement similar to New York’s.
But that leaves Amazon free to do what it did in Minnesota. Within weeks of the law’s enactment, it ended its relationship with its Minnesota-based affiliates, denying them revenue so that it could continue to dodge tax-collecting responsibilities. Nationwide, 45 states have sales taxes; Amazon collects them in only 16, Minnesota not among them. It's why the new "affiliate nexus" tax is expected to show very little new revenue for Minnesota when the next state revenue forecast is issued on Thursday.
Only Congress can bring uniformity and some needed fairness to state taxation of online retail sales. The U.S. Senate has passed the Marketplace Fairness Act that would allow states to collect sales taxes from online retailers with annual sales in excess of $1 million. That bill, which would have added add an estimated $23.3 billion to state coffers in fiscal 2012, is stalled in the U.S. House. The surge in online shopping that Cyber Monday brought this year will run up that number – and ought to run up congressional interest in that bill.
Minnesota’s lower-than-average health costs are often traced to sources ranging from the quality of its medical care (think Mayo and the University of Minnesota) to the Clean Indoor Air Act of 1975 (thank you, Rep. Phyllis Kahn) to the local gene pool (all those long-lived Vikings).
A more important contributor may be this: Minnesotans believe in strong communities, populated by people who don’t lack for life’s necessities, and they are willing to expend effort to keep them that way. So suggested Health Partners CEO Mary Brainerd Thursday at a fundraising luncheon for Hearth & Hope: Women of Habitat, a subset of Minnesota’s chapter of Habitat for Humanity.
What’s a health care executive doing promoting a nonprofit dedicated to affordable housing? Brainerd explained that housing and health are powerfully linked.
She cited University of Wisconsin research that ranks living in a stable and prosperous community as more important than the quality of medical care as a predictor of good health and longevity. “Whether people live in stable housing, in neighborhoods where people own their homes, in families where people can take pride and live a stable life, makes a huge difference,” Brainerd said.
Community assets such as the availability of living-wage jobs, healthful food and quality education even outrank behavioral choices such as exercise, alcohol consumption and smoking, she said, though that distinction is fuzzy. One’s community influences one’s behavior. For example, safe neighborhoods allow people to be physically active.
At a time when national policymakers are understandably focused on the changes being wrought by the Affordable Care Act, Minnesotans have an opportunity to think more broadly about how best to achieve health care’s goal – good health throughout a long life. Affordable access to medical care is necessary; Brainerd and Habitat for Humanity do well to note that it’s not sufficient.
A moderate Republican governor in a Democratic-leaning state wins reelection, and the national chatterers are ready to anoint him with the next GOP presidential nomination.
Remember 2006 and Tim Pawlenty?
Gov. Chris Christie of New Jersey is basking this week in the capricious national political spotlight, having clobbered a longtime legislative Democrat (shades of Roger Moe in 2002) to win a second term. He’s being praised for his outspoken candor and bipartisan pragmatism, and hailed as well-positioned for a presidential run.
If Christie agrees, he might want to take a lesson from the presidential quest of Minnesota’s former Repubican governor. Pawlenty too enjoyed national notice and presidential mentions after winning his second term in 2006, otherwise a good year for Democrats. He too was seen as a pragmatic Republican, conservative on social issues but susceptible to striking a deal on higher cigarette taxes – er, “health impact fees” – with DFLers in the Legislature.
But Pawlenty evidently decided that to play in the national arena, he needed to shore up his conservative credentials. As a result, not even a bridge collapse in 2007 or a massive budget shortfall in 2009 could get him to raise taxes. When he finally ran for president in 2011, he criticized former Massachusetts Gov. Mitt Romney for enacting a state health care exchange, something Pawlenty himself had proposed for Minnesota four years earlier, then dropped.
When Pawlenty’s presidential bid faltered, among the defects in his candidacy those same national pundits cited were continuing doubts about his sincerity as the deep-red conservative he said he had become.
Christie appears clever enough to know that his popularity rests in large part on his reputation for authenticity. If he really wants to be president, he should ignore calls to recast himself in a more conservative light.