The status of health care in an evolving Minnesota

  • Article by: LORI STURDEVANT , Star Tribune
  • Updated: April 9, 2011 - 9:03 PM

Lutheran-rooted organizations make a push to preserve the state's 'lovely values.'

Two ideas deeply imbedded in Minnesota thinking proved so attractive to Mark Peterson in 1987 that he uprooted his family from his native Michigan to become CEO of Lutheran Social Services (LSS) of Minnesota.

"Minnesotans seemed to believe two things, without debate," Peterson recalls. "One was that in a society, we have a responsibility to care for one another. Secondly, they believed that if we come together and apply ourselves, we can make things right."

Peterson has been sharing those circa 1987 observations with most anyone who'll listen as he prepares to step down from his LSS post later this year. He holds that those "lovely values" are seldom evident elsewhere, and are at the root of Minnesota's quality-of-life success story.

Would Peterson say the same about state's prevailing mind-set today? He had a discouraging but predictable answer last week. "It's less true," he sighed.

Watching this year's legislative session, it's hard to argue otherwise.

The Legislature's health and human services bills should be the "care for one another" bills. This year's versions might instead be called the "you're on your own" bills for thousands of poor and disabled Minnesotans.

With some variations, the House and Senate versions both set out to replace some or all of MinnesotaCare and Medicaid with "defined contributions" to apply to the purchase of private health insurance.

If you know enough about pension funding to cringe at that phrase, you know that the poor have reason to worry. "Defined contributions" are likely to be too small to keep health care affordable, especially for those with chronic illnesses.

By a DFL analysis, the House bill would leave at least 105,000 more Minnesotans without health insurance. DFL Sen. Linda Berglin says the Senate bill's toll would be 200,000 more uninsured.

Minnesota's Republicans evidently are comparing notes with their congressional counterparts. U.S. House budget chair Paul Ryan announced last week a plan to replace Medicare for future seniors with vouchers that might (or might not) allow them to purchase private insurance instead.

So much for the pose as defenders of Medicare that the nation's Republicans struck in last fall's campaign.

Turning an entitlement into a voucher saves government money. But if the voucher is inadequate, it pushes costs from government's ledgers onto everybody else's. If it denies primary care to the poor, it enlarges both costs and sickness.

In Minnesota, bills that would do that have now arrived in conference committee, where they will bump into resistance from DFL Gov. Mark Dayton. The challenge for those lawmakers is to turn "you're on your own" bills into a better reflection of two values: Minnesotans care about one another. And Minnesotans want tax dollars used wisely.

It's time to make Minnesotans believe again that they can "come together ... and make things right."

One way to do that would be to make the most of the opportunity that the feds left last year to states like Minnesota.

The new federal health law aims to increase access to health insurance. It does little to change the practice of medicine, in ways that keep people healthier, treat them more effectively, and save money. But it invites states with such ideas to try them, perfect them, implement them and see how much they can save.

Minnesota is way ahead of most states in this regard. Already, Blue Cross Blue Shield is designing contracts with health care providers that move away from fee-for-service to payment strategies that reward quality outcomes. Preliminary steps for making the same move with public health programs were taken by the 2008 Legislature.

This year, measures that would pick up the pace of that change sit alongside the "you're on your own" provisions in budget bills. Making those measures a negotiating priority makes excellent sense. So does creating incentives for cost-saving experimentation.

Cue the Lutherans.

I've had intriguing conversations lately with leaders of two Lutheran-rooted organizations, Peterson at LSS and Mick Finn, a senior vice president at Ecumen, one of the state's largest providers of housing and services for seniors. Among their ideas:

•Apply the coordinated-care concept to the frail elderly population that's now at risk for frequent hospitalizations and nursing home stays, Finn suggested. It would be an elder-care version of the hospital-coordinated care Minnesota offered low-income adults in 2010, under General Assistance Medical Care.

If the payment structure made a single care coordinator (say Ecumen) accountable for minimizing hospitalizations among the low-income elderly, care would improve and costs would drop, Finn predicted.

•Employ trained volunteers -- senior companions, in LSS parlance -- to help at-risk people manage chronic illnesses. Volunteers can make follow-up phone calls and home visits and help recovering people with mobility challenges get to follow-up appointments.

"There needs to be change within the medical community to embrace volunteers and embrace social solutions to our problems," Peterson said. "That's a very steep hill to climb. We have an institutional mind-set about health care in this country that's not oriented to improving health."

Figuring out how to use volunteers to hold down health care costs ought to be right up the alley of people who believe "we have a responsibility to care for one another." How quickly and how well such ideas can be applied will depend on how able today's state leaders are to come together in the next six weeks.

Lori Sturdevant is a Star Tribune editorial writer and columnist.

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