The best health care solutions just might bubble up

Take it from politician-cum-professor Dave Durenberger: "All health care is local."

Don't get him wrong. The former Republican U.S. senator, founder of the National Institute of Health Policy and University of St. Thomas prof is a strong supporter of the 2010 Affordable Care Act, which politicians in his erstwhile party call "Obamacare."

But the real work of improving America's health and controlling costs won't be done in Washington, no matter who wins the next election, Durenberger told a Minneapolis church audience last week. It will happen in those places where local political and civic leaders put better, more affordable health high on their own agendas. They're best positioned to see what's driving local health care costs and how to change course.

That idea propelled me to the Hennepin County Government Center to say hello to Linda Berglin.

Before her unexpected exit from the Legislature this summer, Berglin was for three decades the Senate DFL's peerless shaper of state health care policy.

It was plain during the Republican-dominated 2011 session that minority status didn't suit her. Still, some wags whispered that resigning at midterm to become a health policy manager for Hennepin County amounted to a step down.

Her ready smile and evident enthusiasm for her new work said otherwise.

So does a unanimous vote by the Hennepin County Board on Sept. 13. It authorized application to the state Department of Human Services for permission to launch a "Medicaid demo project" in 2012. The project: a new kind of one-stop clinic/welfare office/HMO hybrid for the poorest and sickest of the poor, known in health policy parlance as an accountable care organization.

The project's stated goals are plenty ambitious. It proposes to improve the health of about 12,000 people between ages 18 and 64, while simultaneously upgrading the "provider/staff experience" and costing taxpayers less money.

Then there's the big-picture kicker that befits Berglin's credentials: This project aims to be a model that "is sustainable and can be replicated throughout the state and in other parts of the country."

In other words, Hennepin County is setting out to revamp Medicaid, not just in Minnesota, but for the nation. And if Hennepin can do that right, it will also be showing how Medicare might more affordably serve seniors. And that in turn might change the practice of medicine for everyone, for the better.

That's why a little Hennepin County health care project for 12,000 people is worth watching, even as presidential candidates debate the merits of the 2010 federal law.

"The idea is to pay to do what's needed to keep people healthy," Berglin said -- not more and not less.

For example, it could involve making sure that someone who is prescribed expensive medicine that must be kept in a refrigerator actually has a refrigerator, so the medicine isn't wasted. Or paying more to shelter and clothe the homeless, so taxpayers can spend less on emergency-room services. Or beefing up mental-health services, so taxpayers can spend less on hospitalization and jails.

Hennepin County has its own health plan, its own hospital, a clinic system, mental health clinics, social services, housing resources and job training resources, and a public health agency, Berglin noted.

"It's like a puzzle box with all the pieces. You get all the pieces working together, and bingo! ... Then you are using your resources wisely in a targeted way, rather than using the most expensive services there are and failing time and again."

Employing Berglin for this work was a coup for Hennepin County, I opined when I circled back to Durenberger. He agreed. But he said he has already advised the county's Board of Commissioners not to think that health care reform is something they can delegate, either to Washington or to a high-powered staff member. If this region is to enjoy the much-to-be-desired benefits of a healthier population at a more affordable price, local politicians have to take the lead themselves.

"Leadership is about using the bully pulpit," Durenberger said. "It's defining the problem. It's suggesting where to look for solutions. It's starting a dialogue. It's getting everybody into the act."

Not every bully pulpit is in Washington. Neither is every solution to the nation's problems. A big dividend lies ahead for the locale -- or the state -- that starts tackling the high cost of health care on its own.

Lori Sturdevant is a Star Tribune editorial writer and columnist. She is at lsturdevant@startribune.com.