Heartfelt – November 2011

Posted on November 1, 2011 by Tim B

As I begin writing this message it’s the last week of October.  The weather is still unseasonably mild with daytime temps in the low to mid 50’s.  It makes me a bit nervous when we get a break from really cold weather for an extended period of time, and makes me wonder if we’ll be paying for this a bit later.  Well, it’s out of my control so I’m taking it off the radar, for now…

October, surprisingly, has been pretty busy.  In addition to the usual seasonal activity of meetings or workshops, there’s also an abundance of phone calls to the office, there’s planning for our November meetings and our December Volunteer party, truckloads of items being donated to our One More Time Stores and the changeover of retail seasonal offerings, as well as rent rebate questions galore and inquiries about Senior Partners Care.  Not only has it been hectic and  challenging, but also fun.

A flurry of advocacy activities also started mid-month and continued through the end of October.  Phone, e-mail, and in-person strategy sessions have taken place with our Greater MN Health Care (GMHCC) Coalition partners and our statewide allies.  A lot of time, effort and consideration have been given to moving our plans forward for both County Based Purchasing (CBP) development, as well as the Minnesota Health Plan.  CBP Outreach efforts have been slowed a bit recently when our GMHCC Outreach Coordinator Kyle Bozentko accepted another position with the Jefferson Institute in St. Paul.  Even though his position was listed as temporary (because it was funded by a Bremer Grant), we had hoped that we could have use of his talents until at least the end of 2011.  Unfortunately, that didn’t come off as planned, as his talents and ability made him attractive to another non-profit and we knew it wouldn’t be fair to stand in his way.  The good news is that in the ten-plus months Kyle worked for GMHCC he made and maintained a number of vital contacts in the region, so we are thankful for what he accomplished during his tenure with us.   We feel confident that we should be able to build on Kyle’s efforts for GMHCC and CBP education and advancement.

As far as the MN Health Plan goes, and healthcare reform in general, we’ve done a number of things related to that which should yield measurable results.  First of all, a letter has been sent requesting a copy of the Actuarial Rate Certification letter related to the HMO’s delivery of healthcare for bidding for the state’s low-income and subsidized programs.  This is a difficult if not impossible document to obtain, according to all reports, but it’s supposed to be available under the Freedom Of Information Act (FOIA).  We are awaiting response to our request for it from Minnesota’s Department of Human Services, where the letter was addressed.  Co-signers to the letter/request include the MN Nurses Association (MNA), Physicians For a National Health Program (PNHP-MN), the Minnesota Chiropractic Association, MN Universal Health Care Coalition (MUHCC), and the Minnesota Podiatric Association.  The response should tell us a lot about how “open and accountable” our administration is (in Minnesota) to common-sense requests for information.

Secondly, we have requested a meeting to compare notes with County Based Purchasing (CBP) representative Michael Scandrett, to get his “take” on what effect the recently passed budget cuts to healthcare will have on their groups in Minnesota.  We have hopes that CBPs, because of their unique and open nature, will be spared some of the drastic cuts targeted at HMOs who deliver the bulk of state healthcare programs.  The meeting should give us a more accurate picture of who will be affected and to what extent.

Finally, we have had numerous information exchanges, via phone and e-mail, with our advocates and allies culminating with a couple of in-person strategy sessions in St. Paul.  No surprise, strategic planing for the rest of 2011 and all of 2012 comprised the bulk of our meetings.  As expected, we will all be continuing a lot of work in pushing for greater transparency and accountability for our tax dollars spent on healthcare.  This bipartisan call for action on healthcare cost transparency is just what’s needed to keep the process moving forward.  We will monitor and report on the activities as they become clearer.

I had the pleasure of taking in the Annual MN Council on Nonprofits (MNCN) workshop in St. Paul in early October.  It’s a great way to network with other non-profits, as well as to take in some updated program and issue training.  The workshops are very well run and the topics are suggested by MNCN members, so they are targeted at specific issues and challenges in the non-profit world.  One workshop on expanding reach with other non-profits, regardless of their mission or location, was a bit of welcome news and opened more than a few eyes in the room.  Another workshop on the challenges faced by non-profits in greater/rural Minnesota was also timely, and provided some good ideas for dealing with rural challenges.   I also took in a workshop on “messaging” for non-profits, which is slightly different than messaging (advertising) for business or social purposes.  There is almost limitless potential for developing and using this rapidly expanding technology and we already have our “toe in the water.” Our goal in 2012 should be to get our entire leg “in the water” so as to take advantage of the communication possibilities available to us with social media technology.  The good news is that, relatively speaking, the cost of doing social media expansion is low in comparison to other forms currently being used.   I’m confident that our 2012 Seven County budget will reflect that shift in communication channels and priorities.

I had the opportunity to be part of a healthcare rally and march in support of healthcare reform.  The rally took place on October 25th with over one hundred (100) people showing up to lend their support on a very cool and drizzly late afternoon in downtown Minneapolis.  Many of the people we work with on the issue of healthcare were there, including folks from MNA, MUHCC, PNHP-MN, and the MN Chiropractic Association, among others.  The march and rally (to the U.S. Appeals/Bankruptcy Court) lasted almost two (2) hours and was a high-energy gathering.  It launched from the Hennepin County Government Center Plaza, which is the site of Occupy Minnesota (spawned by Occupy Wall Street activities).

As a point of fact, there are now well over one hundred (100) “Occupy” sites in cities around the country, with the number of sites growing every day.  A really insightful person has repeatedly said, over the past 2 years, that “…nothing is going to change until the people take to the streets in protest.”   That summary is proving to be prophetic.   Some folks have drawn comparisons to the Occupy movement with the Arab Spring protest movements.  Those protests caused a number of oppressive regimes to topple in the Middle East.  Occupy’ state and national activity is focused much more on business practices than government function.  The relationship between big business and government is intricately intertwined, oftentimes to the detriment of the general public; therefore the focus of Occupy is on big business.   We are glad to see the attention paid to healthcare inadequacies, as well as all issues of social justice, and will always support the cause of common-sense reforms.  Stay informed and get involved in making your world, our world, a better place to live.

Peace, and affordable accessible healthcare to all!

Posted in Heartfelt-Director's Column | Tagged , , , | Comments Off

Heartfelt – October 2011

Posted on October 1, 2011 by Tim B

It was a totally energizing experience (again) to spend the better part of a day with friends and allies to the cause of healthcare reform.  It was made doubly enjoyable by getting to hear from, and speak to, Dr. William Hsiao, Harvard Professor of Economics and healthcare architect.

An estimated 175 people were on hand on a Sunday afternoon in St. Paul to hear Dr. Hsiao’s address.  The topic, of course, was healthcare reform and a description of the role he has played over the years in helping to design customized systems.   It was impressive in that giving up a Sunday afternoon in September in Minnesota requires a real commitment to a cause; these people have it.  Dr. Hsiao seems to be as sincerely passionate about improving healthcare as anyone I’ve come across.   Obviously, he knows his stuff and he communicates his message in a disarmingly powerful way.   To say that his message was welcomed would not do it justice.  He imparted some insight into not only the healthcare system, but the techniques that have been effective in moving substantial changes forward at various levels.  For that the audience was quite appreciative and rightly so.  The ongoing struggle to bring about change has been spread out onto so many fronts that it becomes increasingly difficult to focus energy on a specific goal, as the field seems to constantly be shifting in front of us.  Clarity will lead to focus, which will give way to progress.  His presentation had the compounding effect of not only helping to create focus, but also served to recharge the “batteries” of the advocates on hand.  It was a day well spent.

Dr. Hsiao’s bona fides are as follows:  Prof. William Hsiao is the K.T. Li Professor of Economics and leads a new program in health systems studies at the Harvard University.  Hsiao received his Ph.D. in Economics from Harvard University. He is also a fully qualified actuary with extensive experience in private and social insurance.

Mr. Hsiao has conducted national health system reforms for more than two decades. He led the team that designed the Taiwan’s national health insurance.  He has been actively engaged in designing health system reforms and universal health insurance programs for many countries, including the USA, Taiwan, China, Colombia, Poland, Vietnam, Hong Kong, Sweden, Cyprus, Uganda and South Africa. He developed an analytical model that can diagnose the causes for the successes or failures of national health systems. His analytical framework has shaped how we conceptualize health systems, and has been used extensively by various nations around the world in health system reforms. Meanwhile, Hsiao tests his model by conducting large scale social experiments in several developing nations, including China.

Hsiao was elected to be a member of the Institute of Medicine, US National Academy of Science. He was also elected to serve on the Board of Directors, National Academy of Social Insurance. Hsiao was named the Man of the Year in Medicine in 1989 for his development of a new payment method (the resource-based relative values) for physician services. He has served on the boards of many community organizations including hospitals.

Dr. Hsiao has published more than 170 papers and several books and served on several editorial boards of professional journals. He has served as an advisor to three US presidents, the US Congress, the World Bank, the International Monetary Fund, World Health Organization, and International Labor Organization. He is a recipient of honorary professorships from several leading Chinese universities and has earned several awards from his profession. ~

Okay, so what’s on the immediate horizon?  Meetings with a number of our alphabet-soup of allies including MUHCC (MN Universal Health Care Coalition), PNHP-MN (Physicians for a National Health Program), TAMN (TakeAction Minnesota), MNA (MN Nurses Association), LSP (Land Stewardship Project), AMC (Association of MN Counties), and a couple more.  Together we will map out the strength and direction of our efforts over the next 12-24 months.   The issue of accountability with HMOs (see front page) will continue to be a large part of our focus.  It’s visible and common sense, and people understand the issue, as well as what we’re asking for; namely clear accounting for billions of dollars in tax money turned over to the HMOs every year.  Your participation and input are always welcome and encouraged.

And one last reminder… Open Enrollment for Medicare Part D participants begins October 15th and ends on December 7th.  That’s a bit earlier than previous years and also a slightly longer enrollment period, but don’t wait until the last minute if you want to get some help comparing or changing plans… call and make an appointment early.

Peace… and good, affordable, accessible healthcare to all!

Posted in Heartfelt-Director's Column | Tagged , , , , | Comments Off

Heartfelt – September 2011

Posted on September 1, 2011 by Tim B

It’s September 2011… where HAS the summer gone?   Around here it’s disappeared amidst a swirl of: county fairs, GMHCC/7County meetings, parades, ECHOES editions, potluck fundraisers, 4th of July holiday activities, store promotions, volunteer fun trips, income tax preparations, senior defensive driving classes, SPC program rollouts, special birthday celebrations, insurance counseling sessions, and even some vacation time as the calendar would allow.  Summers seem to fill up and flash by nearly at the speed of light.  I suppose if we had fewer things going on the pace would slow dramatically, but who wants that?

Under the heading of most current meetings in Seven County, and in conjunction with our GMHCC allies, we had the privilege of meeting and conversing with key members of Minnesota’s government administration.  Four people (see story in Echoes Newsletter) made the trek to St. Paul to spend an hour or so with new Commerce Commissioner Michael Rothman.  The elected presidents of three (3) regions accompanied Northeast staff director Buddy Robinson to a meeting held in downtown St. Paul.  By all accounts the meeting was very productive and should foster an open dialogue with yet another state government agency associated closely with the quality and access of healthcare services in the state.  Mr. Rothman gave every indication that he would be pursuing the accountability reform that was so prominently discussed during the 2011 legislative session (thanks in large part to GMHCC and its allies).  Efficient and transparent use of state tax dollars targeted for healthcare programs is the stated goal of the Commerce Department, the Department of Health (MDH), and the Department of Human Services (DHS), as per our conversations with the heads of all of those state agencies this year.

Following the meeting with the Commerce Commissioner, a group of us made a trip to Duluth and had a very enlightening meeting with Lt. Governor Yvonne Prettner-Solon at her office.  Many of the same discussion points were covered during the meeting, as we also were joined via teleconference by Dan Pollock, special health policy advisor to Governor Dayton.  Ms. Prettner-Solon reinforced the notion that the healthcare directives issued in early spring by the governor would be moving forward, especially the segments dealing with accounting standards and transparency.  Additionally, the focus of these efforts will parallel the administration’s work in preparing for the implementation of the state health insurance exchange.  The exchanges (or an equivalent) will need to be up and running in Minnesota by January of 2014, so there’s lots of work to be done in the meantime.   GMHCC and its allies will, of course, be offering up their input into the structure and delivery changes that are being considered.

There are some early indications that the new state budget (passed during special session) will do a lot of damage to our highly-successful CBP (County Based Purchasing) operations in Minnesota.   It appears that legislative efforts to get HMOs to be more competitive (and hopefully reduce their massive, excess reserves) have had the effect of causing collateral damage to CBPs by treating them just like HMOs.  It might be the only time in history that HMOs and CBPs are treated the same.  Seeing as how CBPs are completely transparent and operate under a more open set of reporting rules, it seems fair that they should not be handled the same way as HMOs.  The baby is being thrown out with the bath water in this instance, with no way to even know if the legislation aimed towards accountability in the HMO world will have the desired effect.

All of this goes back to our original contention that turning over all of the state financed healthcare business to private HMOs over twenty years ago was a big mistake.  The mistake was compounded by allowing the HMOs to design their own accounting/reporting standards and have NEVER have been asked to openly demonstrate how they spend our tax dollars, or on what.  Main street businesses would never, and could never, operate that way; writing checks to a contractor without ever asking for a detailed invoice?  So let’s just take their word for it?  It’s more than just bad business; it’s incompetence of the worst sort.

We will be sharing all of our most current updates, healthcare and more, when we get back into the regular swing of things at our September Seven County meeting on Thursday the 8th. Hope to see you all there as we get back to “normal” business.

Peace… and good, affordable, accessible health to all!

Posted in Heartfelt-Director's Column | Tagged , | Comments Off

Echoes – August/September 2011

Posted on August 2, 2011 by Tim B

GMHCC Members Meet With Commerce Commissioner

Mike Rothman

Mike Rothman

A group of people representing GMHCC (Greater Minnesota Health Care Coalition) had an opportunity to meet with MN Commerce Commissioner Mike Rothman and his Assistant Commissioner Jaki Gardner.

The goal of the group is to open lines of communication with the Commerce Department as this group oversees and has regulatory power over the Minnesota Insurance industry.  With healthcare reform at the top of GMHCC’s priority list over the years, and with the accountability issue leading the list, leaders felt that this communication bridge was a critical link to establish.

Those who met with Rothman and Gardner included Fran Levings-Baker (Seven County President), Charlotte Fisher (Central Senior Federation President), Vicki Sanville (N.E. Citizens Federation President), and Buddy Robinson (staff director of N.E. and GMHCC co-coordinator).

The meeting was termed as being “very productive” and with a good exchange of information and issue positions by both parties.  Rothman said that the accountability issue, related to state-financed and privately-administered healthcare service, is at the forefront of  items to be scrutinized for change.

Rothman also indicated that the appropriateness of HMOs’ reserve levels is very clearly on his agenda.  “I have the same questions as you do, and I want answers” he said in response to inquiries on the topic.

He did not have an opinion of what a proper upper limit should be (for reserves), butis interested in the notion that it is in need of review.

                          ***~~~***~~~***~~~***

Commerce Department Focused On Insurance Exchange

Statement from Minnesota Commerce Commissioner Mike Rothman  -  Aug. 16, 2011

 ST. PAUL, MN - Last week, Governor Mark Dayton announced the state received a $4.2 million grant to further the planning and establishment of a Minnesota-made health insurance exchange. The following is a statement from Commerce Commissioner Mike Rothman concerning ongoing collaborative efforts to establish a Minnesota-made health insurance exchange that will drive market competition and reduce health care costs for Minnesota consumers and businesses:

The Administration is focused on using this grant to thoughtfully and effectively prepare the infrastructure necessary for a Minnesota-made exchange built by Minnesotans, for Minnesotans. We are focused on ensuring that exchange meets the unique needs of Minnesota’s consumers, businesses, and economy while driving market competition and reducing health care costs for Minnesotans.

In preparing for an exchange, we will actively seek constructive public input from all parties. We need all hands on deck – consumers, employers, legislators, insurers, agents, navigators, and health care providers – to help design an exchange that supports Minnesota’s unique health care system and demonstrates again why Minnesota leads the nation in health care innovation.

It is urgent for Minnesota to act to design and develop an exchange. Our window of opportunity to craft and implement a Minnesota-made solution is right now. States have only until January 1, 2013 to create the infrastructure for their own exchanges, which would be available to consumers in 2014.

A request for use of exchange establishment grant funds was included and authorized as part of Governor Dayton’s biennial budget request to the 2011 Minnesota Legislature for the Department of Commerce.

The Administration informed lawmakers of the grant Minnesota received last week. We are committed to a constructive, collaborative process with all stakeholders to design and develop an exchange that best serves Minnesotans. We are always open to discussions with the legislature and stakeholders.  ~

Michael Rothman, MN Commerce Commissioner

                    ———-

Medicaid Waiver Renewed WITH Changes

A broad effort among allies like GMHCC, MUHCC and TAMN to help bring transparency and accountability to Minnesota’s HMOs was not entirely successful, although there were some measurable victories.

On June 30th the CMS 1115 Waiver that allows Minnesota HMOs to administer Minnesota’s public health programs was renewed.  We were able to send dozens of postcards and direct many phone calls to CMS Director, Cynthia Mann.  GMHCC also was one of many organizations who wrote letters to CMS Director Mann asking her to carefully re-evaluate the waiver process, especially in light of the lack of transparency and accountability in the state-funded, but privately administered health plans in Minnesota.

Our allied efforts were also heavily responsible in bringing together Republican Sen. Sean Nienow and Democratic Sen. John Marty to call for accountability and transparency from Minnesota’s HMOs.  As a result of our efforts there were some transparency requirements that CMS placed on the HMOs.  Participating HMOs must submit financial reports quarterly and annually along with additional reporting requirements.

GMHCC also sent a letter to the Minnesota Dept. of Human Services asking for some specific answers to questions regarding the direction that would be taken in implementing and evaluating the directives that were issued by Gov. Dayton early this year. DHS Assistant Commissioner Scott Leitz offered a four-page response with some detailed answers to our questions, many of which give reason for optimism that some accountability changes are finally starting to emerge.

Posted in Echoes-Senior News | Tagged , , , , | Comments Off

Heartfelt – August 2011

Posted on August 2, 2011 by Tim B

We have a tendency to fool ourselves a little bit here at Seven County when it comes to summer.  It seems we always kid ourselves into thinking that we will finally get a bit of a break from some of the rigors of our legislative advocacy work, and all that comes with it, being that the legislative session (usually) has ended.   With the state shutdown this year, due to the inability of the legislature to agree to a final budget, it meant that we had extended conversations/contact with all of our legislators, allies and members.   For the most part, conversation and dialogue leads to better understanding and more efficient working relationships, so this opportunity to continue talking will likely benefit Seven County in the long run.

Not every conversation with legislators was totally positive as the legislature reached the end of session and then was forced to shut down all but “essential” state services due to the lack of a budget agreement.  You could sense the angst in the tone of some legislators as they attempted to put a reasonable face on the whole process leading up to and into the state shutdown.  Their attempts at being positive were only partly successful (likely deliberate?) and partisan talking points would usually creep into their communications with us and our allies.  As of this writing, a number of bills have been passed and are awaiting final signatures in order to be put into law.

Speaking of the legislative session, many observers, me included, feel like the solution that was reached did more to “kick the can down the road,” rather than solve some of the major financial issues faced by the state.  At this point, it appears that education system funding has been the easiest target for “kicking” again this biennium.   It’s possible that in two years’ time some of these “chickens will come home to roost” and will face another “kicking” because a more permanent funding solution was not reached.    I may have coined a phrase: “kickin’ the chickens.”  It somehow seems appropriate in more ways than one, especially with 2012 being an election year.

An effort to pass a separate piece of legislation (standalone bill) for more transparency and accountability in our privately-delivered, but state-funded healthcare system never materialized.  On that front, there is still some hope that the healthcare initiative declaration from Gov. Dayton (back in February) will actually develop into a mechanism to reach those accountability goals.  A four page letter to us in June from DHS Assistant Commissioner Scott Leitz indicated as much to us.   We are also still working to secure a meeting with Commerce Commissioner Tom Rothman. His division will have much to do with oversight of the insurance companies who receive billions of dollars in taxpayer dollars every year.  It will be good to be on the same page with the Commerce Department as we move forward.

Related to healthcare, it was fun to be part of the MUHCC Summer Fundraiser event with author T.R. Reid as the featured speaker.  Dozens of allied groups and individuals were also on hand that evening and it was great to be able renew our commitment to healthcare reform with likeminded advocates.  Reid’s message was a real down-to-earth and realistic assessment of where healthcare is and where it should be headed.  I would not want to diminish his message but would rather have you hear it for yourself.  To do that, just go to this web link:   http://muhcc.org/    When you get to the page, simply scroll down just a bit and you’ll see the video image and introduction to Reid’s presentation.  It’s worth your time.

I’ve developed a new theory that should be of interest (and great comfort) to everyone.   It comes after years of analyzing the inner workings of the human mind, observing the social interaction with those in our lives and, finally, implementing the things I’ve learned.  It was as plain as the nose on my face but up until now I have completely overlooked it.  My theory has to do with how our power of memory supposedly evolves changes, grows and shrinks.  In case you are thinking of trying to capitalize on my discovery you can “forget it,” so to speak.  I’ve already forwarded my theory to the folks at the Harvard Medical Journal and Johns Hopkins Research Institute.  My theory is that we really never lose our ability to remember things, it’s just that our brains are only created with a certain amount of storage space and it cannot be exceeded.  We don’t have the luxury of upgrading our “hard drive” storage space  in our cerebrum; we have what we have.   As a consequence, once we “max out” our memory capacity in our brain, things that we attempt to input after that point either:  a.) won’t be accepted… or  b.) if the brain does accept them, it will immediately push other bits of information out of permanent storage and onto the desk or table or ground around you.   The good news is that you can offset this loss once you recognize it.   Simply make it a habit of carrying a pad of “sticky notes” and a pencil around with you at all times (we have some 7 County versions on hand right now).  You will recognize people that have followed this advice by the plethora of paper stuck to their clothing or shoved in their pockets and/or purses.

Hope to see you at the Potluck Fundraiser on THURSDAY, August 11th in Hinckley…

Peace, and good, affordable, accessible healthcare to you and your family!

Posted in Heartfelt-Director's Column | Tagged , | Comments Off

Heartfelt – June/July 2011

Posted on June 2, 2011 by Tim B

You can tell it’s almost summer because the Legislative Session has finally come and gone in Minnesota (well, not exactly) and there still are many unanswered questions regarding healthcare.   The trendy idea of demanding accountability from HMOs who gobble up $3 billion dollars in tax money every biennium and only belch up self-serving, non-informational reports, is but a memory.  Fiscal hawks from both sides of the aisle who, as recently as 30 days ago, were demanding that HMOs show us their expenditures “clearly and concisely,” now seem content to have just mouthed the demand in the first place.  Talk about your staying power.  What does it take to right a wrong that has gone on for nearly three decades?  To me that’s some really weak tea.

On the national scene there’s still a lot of talking, but little action.  So far, one thing seems certain; any significant change proposed to alter Medicare will most assuredly trigger a “gray-nami” wave of action.  Seniors really like their Medicare and any attempt to significantly change this most successful program will be met with powerful protests and strong resistance.  Case in point:

Rep. Paul Ryan of Wisconsin has submitted a Medicare redesign plan, and *Peter Orszag writing in the Washington Post offered his analysis…  ”At the heart of the Ryan plan is a shift within Medicare toward consumer-directed health care (vouchers) — which in turn is predicated on increasing beneficiaries’ ‘skin in the game’ to make the health system more efficient. While more consumer cost-sharing would help reduce unnecessary care, the plan would not live up to its billing in cutting health costs for America. According to the nonpartisan Congressional Budget Office, it would do the opposite. That’s right: The CBO found that the Ryan Medicare proposal (vouchers) would substantially increase total health-care spending… By 2030, health spending on the typical beneficiary would be more than 40 percent higher under the Ryan plan than under existing Medicare, according to the CBO report.”

I sometimes chuckle (or is it grumble?) when I hear healthcare “experts” stress the need for seniors to have more “skin in the game” in order for them to be better consumers.  Who has more “skin in the game” right now than seniors?   Most of them have paid into the Medicare system their whole lives in confidence and believing that the program they helped fund would be there when they needed it most.  Those folks in Congress who want to throw the Medicare program up in the air and just grab a few pieces of it as it falls are in for quite a shock; seniors and seniors-to-be are in love with their single-payer (Medicare) system and won’t stand for a total restructuring.  They will revolt with their precious dollars and with their votes.

Another chuckle(?) I get is when I hear the folks in the Minnesota legislature talk about the revolutionary new idea they have for reshaping the healthcare system with “Accountable Care Organizations,” or ACOs for short.  The short version of what the new ACOs will do is simply shift a large part of the financial risk from the (current) insurance companies and HMOs, directly onto the backs of the direct care providers (hospitals, clinics, doctors, etc).  It does not reduce cost, it will not improve access, and it certainly won’t improve quality of care (talk about lose-lose-lose).  The only change that occurs is that direct care providers would then have more “skin in the game” for delivering services.  Seems like I’ve heard that phrase somewhere before.   It’s just the newest iteration of the HMOs with a brand new name, but with the same old issues that have made them undesirable and unworkable.  The only change is shifting the party at risk; from HMOs onto the backs of the direct-care providers.

My suggestion is that when your hear the words “ACO” or “voucher” or “skin-in-the-game” used in a healthcare proposal, simply repeat to yourself “re-run.”  Or, better yet, scream it out if you’re in a crowded room and you want to make the point of calling someone’s bluff.  It’s repackaged floor sweepings and nothing more, and if allowed to become part of this broken system will only make it worse, not better.  Be wary and vigilant.

*Peter R. Orszag, is vice chairman of global banking at Citigroup and an adjunct senior fellow at the Council on Foreign Relation and was the director of the Office of Management and Budget.

Posted in Heartfelt-Director's Column | Tagged , | Comments Off

Heartfelt – May 2011

Posted on May 2, 2011 by Tim B

The calendar says “May” but my senses are telling me it’s November… well at least as I write this it feels like that.   Who has stolen spring and what have you done with it?  Oh well, out of my control…

There’s plenty to share this month as we have a chance to look back on the recently completed 2011 convention in Aitkin.   It wasn’t a success… it was a rousing success.  Before going any further, let me again offer thanks to Bob Skogman who helped pull together a lot of the details that made this year’s event so thoroughly enjoyable.   Next time you see him feel free to give Bob a pat on the back and a hearty “well done” for his efforts.

The 40 Club Inn Banquet and Convention Center was a near perfect venue for our convention, and it allowed us to conduct our business without a hitch.  The sound system worked well, the room was spacious and had comfy chairs, the food was delicious and plentiful and the entertainment was wonderful.   These aren’t my adjectives but those that came from many of you, either in your written evaluations or by your comments after the event.   Our initial concerns about the attendance levels proved to be groundless as we actually exceeded last year’s total by a couple of bodies.   Many (many) thanks to all of those folks who came early in the morning, or even the day before the convention, to help get things set up and running on time.   It worked out great.

The regular business of the convention was handled efficiently, and without a hitch, as master of ceremonies Jim Oxberry (thank you, Jim) walked people through the various parts of the morning activities.  From what I heard, a good many of his jokes were new.

The voting/balloting for setting issue priorities and to determine who the new Seven County officers would be went very smoothly, with results of that voting displayed on this month’s front page.  Hearty congratulations go out to newly elected President Fran Levings-Baker from Pine County, as well as to our new 2nd Vice-President Patrice Winfield, also from Pine County.  Both new officers have demonstrated their commitment to Seven County, and to improving the lives of people in this region as well as across all of Minnesota.

It would be remiss of me to not give credit where credit’s due.  Lila Skramstad stepped down from the Seven County President’s post, having served the maximum allowable number of terms (2-2 year terms).   Her energy, leadership and determination over the past four years have been instrumental in keeping the organization healthy and growing in the right direction.  Lila has been a good friend to Seven County, and to me personally, something which I value immensely and hold dear.   She has upheld the Seven County tradition of strong, smart, compassionate and principled leadership and has helped guide this organization with great vision.  Don’t fear though, Lila will continue to grace us with her presence and insight as a valued member of our Steering Committee as Kanabec County delegate.

Before I put a bow on this note, I would like to add a little more substance to convention business, specifically the priority voting.  Our issue priority voting is one of the most important parts of what we do every year, as it allows members to set the path for our next twelve (12) months of our advocacy activities.  This year’s presentation of the important items (identified by the Issues Committee) was one of the best in memory.  The presenters who volunteered to read the issues aloud were skilled and efficient, and the discussion among the convention delegates was excellent.  It showed great understanding of the relevance of all of the issues involved and simultaneously revealed the passion felt for each critical item.  That’s what makes this organization great; the ability to openly discuss the pros and cons of an issue and then move ahead for the common good, with respect for all sides and opinions.  It’s truly a privilege to be part of the Seven County Senior Federation.  Everyone who is part of it should feel proud of what it is and what it does… I know I do.

Finally, the healthcare debate will rage on in St. Paul and in Washington, D.C.  We will stay involved and keep you up to date as you guide us through our important work in improving the lives of people by working to improve the healthcare system.  It’s a tall order and we’re just the group to take it on… along with our friends and allies.  Keep up your support of Seven County and its issue work; it will be well worth it in the end.

Peace… and good, affordable, quality healthcare to all!

Posted in Heartfelt-Director's Column | Tagged , | Comments Off

Echoes – April/May 2011

Posted on April 2, 2011 by Tim B

Is this Healthcare change… or just rhetoric?

Legislative Jockeying…

The flurry of healthcare related activity in St. Paul over the past month has not really cleared up where the state will land on the accountability issue.

A number of bipartisan bills targeted at  fiscal accountability for the HMOs serving state funded healthcare programs did not meet committee deadlines.  This doesn’t mean that they are gone for the year, but the road ahead is much more difficult if these bills are to be brought  to a vote in the MN Legislature.

An aide to Sen. Sean Nienow, author of a  number of health reform accountability bills, said that even if those bills don’t get a committee hearing before the deadline that doesn’t mean they are dead.  It means that there could be plans to submit bills through the Rules Committee or even have them included in the Omnibus bill.

Adding a bit to the confusing state of legislation is the continuing push by Gov. Dayton to add his pieces into any healthcare reform this year. Those pieces include, but are not limited to, competitive bidding by HMOs for the right to service state funded healthcare programs and limiting the profitability by HMOs to a 1% maximum limit every year.  Both of those moves, although laudable, offer substantial wiggle room for the HMOs who currently provide insurance for all of the state funded programs.  The wiggle room comes in the form of non-standardized accounting practices that the HMOs are allowed to offer up as proof of their own accountability.  These self-funded and self-reported audits are done by  agencies hired by the HMOs, not by external sources.  The reporting requirements are uniquely determined, in large part, by the HMOs themselves, giving strong reason to question the overall accountability for the $3 billion tax dollars funneled into these companies each biennium.

At stake in all of the healthcare reform talk and/or actions,  are a couple of things:

First, there is the overriding issue of reforming an increasingly expensive and increasingly exclusive system whose cost seems to be running out of control.  More and more people are excluded from the current system every day, as costs continue to soar.  HMOs have taken to attributing those rising costs to the care providers themselves thereby deflecting any and all inferences that the HMOs themselves could have waste or unwarranted expenses.

Secondly, there is the political issue of who is being a “good watchdog” of  the tax dollars collected and spent on healthcare in Minnesota.  The tag of being labeled the “fiscally responsible” group is much coveted and seems to, in many cases, outstrip the concern for improving the accessibility and quality of the healthcare system.  The jockeying for achieving most-favored status, in the eyes of the MN electorate concerned about health reform, has turned into a real heavyweight bout.

The HMOs, the MN legislature, the governor and the MN Council of Health Plans (the trade group representing all MN HMO providers) are all slugging it out  to protect their turf, their image and their (our) tax dollars.

Advocates allied and working together for healthcare reform like *GMHCC, **MUHCC and Take Action-MN, have all played a significant role in getting the debate going, aided in large part by the November 2010 firing of whistleblower Dr. David Feinwachs, the 30-year general counsel to the MN Hospital Association.  Feinwachs was terminated from his position after pressure was applied by the HMOs in Minnesota. They were upset with a video, produced by Feinwachs, which highlighted the lack of accountability for healthcare spending  of tax dollars in the state, which directly and indirectly  pointed out the culpability of the HMOs.

Seven County and GMHCC will be in St. Paul to work to make sure your tax dollars are spent wisely.

*Greater MN Health Care Coalition   ** MN Universal Health Care Coalition

Posted in Echoes-Senior News | Tagged , , | Comments Off

Heartfelt – April 2011

Posted on April 2, 2011 by Tim B

Just a few quick notes, as we are jammed for space with all of our convention items…

There has been a great deal of activity, some of it unexpected, on the healthcare front.  Multiple (bipartisan) bills have surfaced in the legislature, as well as an executive order from the governor, targeted at clearing some of the murkiness from healthcare accounting and oversight.   We see this as a good sign, a sign of potentially tangible reform.

There are folks, who have been in the middle of this health reform fight for dozens of years, who are also urging caution related to making bold proclamations about what benefit these “new” initiatives will provide.   I say “new” because these same folks  cite many similarities to reform activities that happened in 1993, when the term “managed competition” was the catch phrase for reform that took place in that era.  Elements of competitive bidding and risk-sharing designed to improve cost and access were part of the 1993 efforts, similar to what is happening now in Minnesota.   Naysayers liken it to rearranging “deck chairs on the Titanic,” to coin a phrase.

Seven County and GMHCC folks who have been working on the health reform issue since the formation of our coalition have taken a more optimistic approach.  Recent developments, though similar in nature and substance to those of 1993, feel different.  There is a broader base of support even though the polarization of today makes 1993 pale by comparison.  If, in this polarized climate, you can agree on substantial parts of reform like excess reserves and lack of accountability, you can make substantial progress towards improving the healthcare system as we know it.  This is the nearest thing to a breakthrough on real health reform in Minnesota that we have had in almost 30 years, or since the time when HMOs were first given carte blanche, and a blank check, to run the show.   Yes, we need to stay involved in the process to make sure that the teeth are in the final bill(s), and yes, we need to keep reminding ourselves that everyone needs encouragement and support to stay true to their principles, values and goals for healthcare reform; that’s the advocate’s job.  That doesn’t change; that’s our job.

The entrenched powers of the HMOs are quite overwhelming and seem to increase exponentially every day.  It could give the faint of heart reason to walk away from the process of trying to reform this massive insurance company bureaucracy.  Fortunately and thankfully, we are not faint of heart…

See you at the convention on April 14th!

Posted in Heartfelt-Director's Column | Tagged , , | Comments Off

Echoes – March 2011

Posted on March 2, 2011 by Tim B

Governor and Legislature Moving Towards Healthcare  Accountability?

Efforts by Seven County and their GMHCC allies to call attention to the lack of transparency and accountability have begun to yield tangible results in St. Paul.

No less than a dozen assorted pieces of bipartisan legislation aimed at either improving transparency, or making HMOs offer better accountability, are now active in the current session.

To add to the progress, started as a result of continued GMHCC  watchdog work, an executive order was enacted in late March by Governor Mark Dayton.  Dayton’s memo specifically outlines and gives direction to Minnesota’s Health Plans, as well as to the affected commissioners, to begin changing the way healthcare business is conducted in the state.

Elements in his letter include a bidding process for Health Plans to vie for the $3 billion dollars (per biennium) in state funds for programs like MNCare, GAMC and Medical Assistance. That process does not really exist at this time.

One of the elements in Dayton’s plan is the creation of an annual comprehensive managed care report to be overseen and reviewed by the Commissioners of Health and Commerce.  That report would details information about administrative expenses, premium revenues, provider payments, contributions to reserves, service costs and more.  Previously, the aforementioned items have only existed in theory, according to reports prepared by GMHCC researchers.  With HMOs allowed to self audit and self report, with no outside audits of these activities, many questions have now been raised in the face of a $5 billion dollar budget deficit.

Seven County and its GMHCC partners are cautiously optimistic about the recent legislative moves to improve the healthcare system in Minnesota and will monitor all developments.

*****************************

Computer Classes for Seniors

Free computer training classes are being offered to seniors by the Central Minnesota Jobs and Training offices in Mora and in Cambridge.

In Mora the classes take place at the Workforce Center, located at 903 E. Forest Ave., from 12 noon until 3 p.m. every Tuesday, Wednesday and Thursday.

In Cambridge classes are held at the Cambridge Library/Computer Lab, located at 244 Birch St. S., on every Tuesday, Wednesday and Thursday from 9 a.m. until 11 a.m.  Walk-ins are welcome and for more information you can call (320) 679-6484 or toll-free 1(800)284-7425.  These classes are made possible through Central Minnesota Jobs and Training Services and a grant from Senior Services of America.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Who’s Watching Your TAX Dollars?

The fact that Health Maintenance Organizations (HMOs) in Minnesota have been allowed to create their own accounting standards has now created some buzz at the state capitol, especially among those legislators looking for ways to eliminate waste of taxpayer dollars.

Since the early 80s, Minnesota’s non-profit HMOs have been given free rein to operate the state funded healthcare programs basically without any interference by government in the way of accountability and outside audits, which are required of all state vendors, except HMOs.

The reporting standards that are used by the HMOs in Minnesota, for the $1.5 billion dollars they receive annually in state tax money, are created by the HMOs themselves, for the most part.  These reports are created by the HMOs as they see fit and are then “audited” by accounting firms, which are hired by the HMOs themselves.

It’s worth knowing that the standards used by HMOs to report their expenditures are not the same reporting standards used by other businesses in Minnesota.

Many advocacy groups like GMHCC (Greater MN Health Care Coalition), the MN Nurses Association and Take Action MN have begun a push to demand fiscal accountability for state tax dollars (GMHCC has championed the cause for more than 6 years).  With the state now facing a $6.2 billion dollar shortfall there seems to be an increasing sense of urgency in the legislature to become fiscally responsible. Demanding a standard method of accounting would be a logical first step when it comes to the state-funded, HMO-run healthcare programs.

David Feinwachs, for 30 years the MHA (MN Hospital Association) general counsel, called attention to the accountability issue, or lack thereof, in a 30 minute video.  His accountability work caused great concern among the powerful HMO lobby in Minnesota, so much so that they pressured Feinwach’s employer (MHA) to fire him.

The newly appointed Commissioner for the MN Department of Health, Dr. Ed Ehlinger, is well aware of the lack of accountability and transparency in the area of state funded HMO programs.  Ehlinger has reached out to advocacy groups, including GMHCC, and has offered to meet with them to discuss the issue and to try to find a common sense solution.

Likewise, the new head of the MN Department of Human Services, Lucinda Jesson, has agreed to meet with GMHCC and others to address the accountability issue.

The Human Service budget represents the largest segment of the overall state budget. All spending programs will be subject to closer scrutiny and certainly should be made to demonstrate fiscal accountability for the tax dollars they receive every year.

Posted in Echoes-Senior News | Tagged , , , , | Comments Off