This is the first of two articles by former U.S. Sen. Durenberger on Minnesota’s health leadership and what we should expect of policymakers.
By: Dave Durenberger
I was a 32 – year old South St. Paul lawyer with a wife and four kids in 1966 when my law partner, Harold LeVander, was elected governor of Minnesota and chose me as his executive secretary. Immediately, I face the tasks of organizing his office, hiring staff, helping choose a cabinet and preparing for a session of the Legislature to begin in less than two months.
I was a relative novice in both politics and policy. But I quickly discovered Minnesotans eager to educate me and to influence LeVander’s approach to the policy issues they cared about. One of the first of these teachers was Dr. Paul Ellwood, then the executive director of the American Rehabilitation Foundation. With the implementation in 1966 of the new Medicare and Medicaid programs, he foresaw the impact of predictable spending increases on the medical system. Unbeknownst to me he was launching his career as a health reform evangelist as well.
And so was I. Nearly 50 years later I am asked why Minnesotans are having difficulty matching their expectations of our health care system with the trade-offs required to achieve them. For example, the HealthBasics research found that many Minnesotans recognize the cost drivers in the health system, but reject solutions if they affect our personal interactions with the health system. We want whatever treatment is prescribed by a physician; we want to see specialists without referrals; and, we want our health insurance to pay the full cost of care. And never mind the contradictions. For example, while 52 percent agree that doctors often order too many tests and treatments that don’t really improve a patient’s health, 67 percent of us say that insurers should pay for every treatment or service a doctor prescribes.
And, I’m often asked why most of us seem to define the policy goals of health reform, like access for all to high quality services at affordable costs, in ideological rather than practical terms.
There aren’t simple solutions to the challenges behind these questions. Only in the United States are you and I expected to take some responsibility for our families’ health, for financing its access to health care and for selecting service providers with only our best interests in mind. On top of that, we are expected to elect policymakers who will align our financial incentives and those of the individual and corporate members of a $3 trillion a year health care industry.
But then we face the political dilemma that comes when public policy is implemented, including the Affordable Care Act of 2010.
So, here’s the good news. You live in Minnesota. It’s a somewhat unique state. Much of what’s life-saving, limb-sparing, function-restoring in American health care started here. What’s gold standard good health and quality care, as well as state-financed efforts at universal coverage, started right here. Not coincidentally, this is happening in one of the few not-for-profit health care and health insurance states in the country.
The same is true of health policy reform. It started here. With Republicans and Democrats in the Minnesota Legislature agreeing on the goals of universal access to high quality care and informed choice of health insurance. Informed by health professionals way ahead of their time and their class.
The pay-off for nearly 50 years learning the health system from Minnesota professionals, and digesting it in terms of good public policy, is seeing the ACA in context of what Minnesotans have long believed the goal of good health policy should be: Healthy people, healthy communities, and an affordable and understandable health care system. Better quality, more affordable care in healthier communities for all.
It’s good news that the ACA makes it a national responsibility to help finance access for all, rather than Minnesotans having to rely as much as we have on state taxes. Affordable access for most other Americans also means that the uninsured costs of care in states like Arizona, Texas and Florida, with much larger numbers of uninsured, will no longer be shifted to Minnesota taxpayers via Medicare and national private insurers. And the new national insurance rules introduce informed competition into insurance markets as well.
In this environment, Minnesota can be the leader in charting a course to a better health system for everyone by following three guideposts:
- Put evidence-based facts ahead of political rhetoric. Health policy and health care should be based on what works and what is most effective, not on scoring points for Election Day advantage.
- The health of the community is important to the health of each of us. We all benefit when all Minnesotans are healthier.
- Look to the future. Make decisions based on what Minnesota’s changing and aging population will need; invest in researching the treatments that deliver the best health outcomes, then apply the knowledge to how providers prescribe treatments and how insurers and others pay for health care; and, use technology to make us all smarter and better informed about our health choices.
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. The second of Sen. Durenberger’s two HealthBasics articles offers eight expectations we should have of our elected representatives.