What we should ask of our elected representatives

By Dave Durenberger

(This is the second of two articles by former U.S. Sen. Durenberger on Minnesota’s health leadership and what we should expect of policymakers. You can read Sen. Durenberger’s first HealthBasics article here.)

A lot of time and energy is spent on blaming partisan politics and politicians for the gridlock in St. Paul and Washington, D.C. What we often forget in our finger-pointing is to look in the mirror. Those who represent us usually reflect those who elected them.

That’s certainly true when it comes to health policy. The HealthBasics survey found that more than two-thirds of Minnesotans see the health system challenges and solutions through the perspective of their political ideologies. Conservatives place cost and quality above coverage, believe these goals are best reached through the marketplace and want the government largely to stay out of health care. Moderates and liberals are more inclined to put affordable universal coverage at the top of their priorities, and believe government must focus on how to achieve these goals.

How can we bridge this partisan divide? By we the people holding our elected representatives accountable to eight tasks:

First, consider the value to all 5.5 million Minnesotans they represent of finding bi-partisan improvements in both national and state health policy. Leave the ideological route to consumer-driven care quality and accessibility at the legislative door. Get to work finding the common ground occupied by most health policy researchers, and go for it.

Second, expand the rewards for improving the health of each Minnesotan, often by tackling and resolving challenging social conditions. Raise the profile of healthy communities in Minnesota and the routes they choose to take to meet the special needs of the very young and the very old.

Third, the most important route to consumer-driven care quality lies in the interoperability of health information technology. For some strange reason we haven’t figured out how to make health care communications as simple as every other important thing in our lives.

Fourth, invest more of our public research dollars in effectiveness research. Spend resources on comparative research to determine what procedures and technology work best for what purpose. The medical technology industry – drugs, devices, and diagnostics – has a long history of opposing comparative effectiveness research. Meanwhile they pass on all the cost of research and development for international products to American purchasers.

Fifth, Minnesota has been a national leader in measuring and using health systems performance data to improve clinical outcomes. The Institute for Clinical Systems Improvement was founded as an employer/insurer/health systems cooperative 23 years ago. The Community Measurement Project is in its sixth year. Combining these two organizations into a entity with a mission of research, analytics, measurement and evaluation focused on Minnesota and financed by insurers and health systems would create a powerful health reform driver.

Sixth, create a genuinely “blue ribbon” commission to look at the future of the health care professions and modernizing professional education, its financing, licensure and credentialing. The goal should be quality based on performance rather than credentials.

Seventh, as our population ages, advance preparation for “honoring all of our choices” as we age into our disabilities and to the reality of the end of life can better be done in Minnesota than any state in the nation. We’re already doing it for those who can afford to, but public financing policy for long term care is stuck back somewhere in the 1960s.

Eighth, political partisans make much of Greater Minnesota vs. Greater MSP. A great deal of public money is wasted on trying to spend as much on one as the other. Consider what makes all of Minnesota different from every other state. It is not what we invent here, but how we use what nature has already provided us as our Minnesota Opportunity. Renewable resources. What we grow here, the water we use to grow all of it, and the mighty corporations whose employees make our resources available to everyone anywhere in the world, anytime.

In three terms on the U.S. Senate committees responsible for health policy, I helped shape every piece of national health policy, including much of what became the foundation of the ACA. I can assure you every policy we sent to the President was the product of bi-partisan consensus. There is absolutely nothing partisan or ideological about health or health care and there should be nothing partisan about its financing. It’s up to “we the people” to demand that our policymakers place these realities ahead of scoring political points. The future of an affordable, high-quality health system depends on it.

(Dave Durenberger served in the U.S. Senate from 1978 to 1995 and was the founder of the National Institute of Health Policy at the University of St. Thomas, a resource for using the performance of Upper Midwest health care systems and leaders to influence national health policy. )