Two panels will propose big shifts in state health care

Two bipartisan panels that Gov. Tim Pawlenty and the Legislature formed to find the antidote to Minnesota's rapidly accelerating health care costs are planning to propose drastic changes to the state's health care system that include spreading insurance to all by 2011.

The highly anticipated reports due out this month would pay for that by shifting resources to preventing and controlling costly chronic conditions in aging baby boomers, and cutting waste. New online tools would help consumers shop for health care by comparing cost and quality. Insurance would move with Minnesotans from job to job.

"If we can't get control of the health care system, the rising costs will drown us," said state Sen. Linda Berglin, DFL-Minneapolis, who co-chairs the legislative panel and serves on the governor's task force.

The ambitious efforts to chart a new course on health care come as Minnesota -- which has prided itself on being the healthiest state with the fewest uninsured -- is slipping in some national rankings. Massachusetts sprinted ahead as the first state to require all residents to have health insurance. Last year, Vermont captured the title for healthiest state in a widely followed UnitedHealth Foundation ranking.

But the two influential panels may be positioning Minnesota for an innovative rebound. For months, they have been consulting with more than 200 top health care experts, advocates, providers, consumers and legislators.

Now, even as presidential candidates spar over the politics of the nation's health care crisis, strikingly similar proposals for Minnesota's future are emanating from the Republican governor's Health Care Task Force and the DFL Legislature's Health Care Access Commission.

Of course, vision is one thing, the political reality of getting it done another.

When the Legislature convenes next month, what could be the biggest overhaul of Minnesota's health care system ever -- with an estimated cost of $700 million a year to state government to insure the uninsured -- will bump up against other pressing concerns dogging lawmakers. The question then becomes whether it can be sold to a governor and legislature facing a forecasted $373 million budget deficit, loath to raise taxes and intent on dealing first with fallout from the I-35W bridge collapse.

"It's one thing to declare that everybody should be insured," said Fran Bradley, a former Republican state representative who served as chairman of the Health Policy and Finance Committee. "That's nice political rhetoric. How do you accomplish that?"

Some question whether efficiencies will save enough money to pay for universal coverage without injecting new public dollars. Others say savings within the entire health care system might not filter enough to state government, which would have to pick up the initial tab.

"How do you get some of that savings into the government so they can use it to subsidize people at the low end who don't have health insurance?" asked Rep. Thomas Huntley, DFL-Duluth, co-chairman of both the governor's task force and the Legislature's commission.

Some of the two panels' ideas would radically change the way medicine is practiced in Minnesota: Doctors and clinics would be paid to prevent illness instead of being reimbursed for each office visit, test and procedure. They calculate decreases in smokers and overweight Minnesotans alone would save $1.5 billion.

Minnesota's health care cost $29.4 billion in 2005 and is projected to rise 40 percent to $41 billion by 2011, an increase the two panels aim to drive down to about $32 billion.

Details and dollars

Examples of failed efforts at health care reform are as near as the closest border. Plans to use a payroll tax to fund universal health coverage in Wisconsin failed just last year.

"We need to be sure we don't cause unintended harm to people or businesses," said Rep. Jim Abeler, R-Anoka, who sits on the legislative commission.

Next month, as lawmakers begin debating the panels' proposals, controversial questions are certain: What should be required and what simply urged? What help should government provide and what should be left to market forces?

Pawlenty has taken a strong stance against raising taxes. His spokesman, Brian McClung, declined to say whether Pawlenty would support universal health coverage. McClung said the governor was awaiting formal recommendations from his task force.

Huntley, who with Human Services Commissioner Cal Ludeman heads the governor's task force, agrees the devil will be in the details and dollars.

"We know that we have a health care system that does not make financial or medical sense," said Huntley, director of institutional relations for the School of Medicine at the University of Minnesota Duluth. "The question is how do we make changes that will provide the good, cost-effective care that everyone deserves?"

Berglin, chairwoman of the Senate's Health and Human Services Budget Division, remains convinced an efficient system could pay for itself. "We don't need to spend more money on health care," she said. "There's enough waste from unnecessary treatments, inefficient care and in some cases inflated prices to do what we need to do."

Others disagree. "Some of those so-called savings are pretty questionable when you take a sharp pencil to them," Bradley said. He favors cutting costs to expand health coverage and opposes raising taxes to do it, but adds "I don't see any way in the really short-term to increase the number of people who are insured without using taxpayer money."

Len Nichols, an economist and director of the Health Policy Program at the nonpartisan New America Foundation, said, "If we could do this for free, we would have done it a long time ago."

Nichols said it will take time to capture savings from improved efficiency. So financing universal health insurance "will require new money at the outset, there's no question about it. You could redirect existing spending, you could increase a broad-based tax, or you could levy a new tax dedicated to health care."

Human Services Commissioner Ludeman said raising taxes or cutting spending to finance health coverage is unlikely given the forecasted budget deficit. He is intrigued about the potential to cut costs of uncompensated emergency room care and use the savings to finance expanded coverage.

Changing the health culture

Besides expanding coverage, the panels' proposals would set up systems to monitor and report the quality and costs of care provided by doctors, clinics and hospitals, and launch public health programs to reduce smoking, obesity, alcohol abuse and drug addiction.

Many of the issues are complex and require state rules -- such as setting up a new system to pay for health care for state employees or people on state-funded programs such as MinnesotaCare and Medicaid.

But experiments around the state provide a glimpse of what dramatic change could mean. In some ways, private industry isn't waiting for the state's nod to begin the overhaul. Provider networks have started putting the brakes on what they consider pricey, unnecessary medical tests. Blue Cross Blue Shield of Minnesota's new HealthcareScoop.com website lets consumers recommend doctors to one another.

"There are pilot projects out there -- HealthPartners and St. Mary's Clinic in Duluth, for instance -- that are doing a lot of what we're talking about," Abeler said. "They're cutting for treating conditions like diabetes by sort of a team approach to treatment, which includes the patient as a partner. So we know this can be done."

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