Former Gov. Arne Carlson smiled prominently from a framed photo atop the office credenza of House GOP Majority Leader Matt Dean last week.

That would be the same Republican governor who quite publicly endorsed Dean's DFL opponent, then state Rep. and now State Auditor Rebecca Otto, in 2004, when Dean first won his Stillwater-area seat.

I asked whether the photo's placement signified rapprochement between the two.

Dean's laugh told me that Carlson's visage may have been bait for that very question. "We're reaching out," the majority leader said with a grin.

That's good to hear -- especially if it means that today's Republicans are looking to Carlson's example for guidance on how to approach the trickiest part of this session's budget-balancing act, health and human services.

That's where the dual imperatives to slow spending growth and do right by vulnerable people are colliding and demanding creative change.

Instead, in both the House and Senate last week, Republicans seemed to be choosing as their model another former Republican governor, Tim Pawlenty, and his treatment of General Assistance Medical Care (GAMC) in 2009-10.

Pawlenty's approach to containing the galloping costs in that program was to whack first and look out for the people who would be hurt later.

He vetoed all of GAMC's funding in 2009, effective in 2010 -- allowing time but little guidance on how to keep the very-low-income, often chronically ill adults the program served from losing all but emergency-room health care.

Health care providers, advocates for the poor and lawmakers in both parties -- Dean among them -- got busy.

They crafted a skimpy GAMC fix that caused a lot of disruption for poor, sick people and financial hardship for four participating hospitals. But today, even DFL critics of the "new GAMC" say it wasn't all bad.

The participating hospitals functioned as accountable care organizations, accepting a fixed payment for all the care needed by a set population and coordinating that care with other providers to keep their clients healthy and make the money stretch.

Dean and other Republicans say those hospitals might have eventually pulled that off had Gov. Mark Dayton not opted to take advantage of the new federal health care law and collapse GAMC into Medicaid in January.

"There were a lot of parts of GAMC that didn't work. There just wasn't enough money in it," said Lucinda Jesson, Dayton's human services commissioner. "But it had lessons we should learn."

The GAMC story illustrates one way to approach health care reform. It wasn't Arne Carlson's way.

Twenty years ago, Carlson also started with a veto, of a DFL attempt to move Minnesota toward a single-payer health system. But he then initiated a serious study of alternative ways to bring health insurance to more low-income Minnesotans.

When the idea arose for a state-run, premium-based health insurance plan for the working poor, Carlson put his top staff on the case and invited a bipartisan working group of eight serious legislators to meet with stakeholders and hammer out the details.

What emerged after many months is MinnesotaCare. It produced better health and dignity for the newly insured poor and cost savings for everyone else.

Its very survival despite Pawlenty's repeated funding raids attests to its worth, and that of the careful process that produced it.

"Careful" doesn't seem to describe the $1.6 billion to $1.8 billion in cuts contained in the two GOP majorities' human services bills unveiled last week.

The House has advanced a whack-now, reform-later bill that's so sketchy about how savings will be achieved that the nonpartisan analysts who attach numbers to spending bills say they can't price it.

Jesson's analysis: "If you cut as much money as they are talking about, instead of saving money, you just drive people off programs, by making them ineligible.

That doesn't save money. They're going to end up in institutions and in emergency rooms, and that will cost more."

The Senate's idea of reform is to replace Medicaid and MinnesotaCare with vouchers, so that the poor can buy health insurance in the private market. I can imagine Carlson's reaction: "Oh, you mean the market that was serving the poor so well in 1991."

These bills are racing toward floor action next week. But that doesn't mean there isn't time for Carlson-style reform: Convene a bipartisan group of smart, serious legislators with Jesson and the best creative minds from various stakeholder groups.

Take the lessons from GAMC about what can be accomplished through accountable care organizations.

Try applying that contract-for-optimal-care model not only to down-and-out adults, but to children and the frail elderly. Start a batch of pilot projects, perhaps as soon as this fall.

By a year from now, the nation's health reformers might be looking to Minnesota as a model again -- just like they did in 1992.

Lori Sturdevant is a Star Tribune editorial writer and columnist.

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