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In a health care forum last night, Minnesota representative Tim Walz said that "not doing anything is a choice, not doing anything will have consequences!" He added "There will be a personal cost, there will be a business cost and there will be a detrimental cost in doing nothing about health care." Since 2001, average family insurance premiums are going up in Minnesota by 74%, while  average family incomes are only up 17%. Rep. Tim Walz referred to a chart that I don’t have. However, here is a similar chart based on national data:

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Tim Waltz then described that in addition to affecting people and the economy, health care costs are affecting the government as well. The country is spending 1 in 5 dollars on health care, twice as much as any other country. Even with increased health care spending, still more and more people are not covered. In the next 25 years, if we do nothing then 1 in 3 dollars is going to be spent on health care. All federal government tax dollars will be spent on defense and health care.

Representative Tim Walz said if the status quo is unsustainable, then how do we do reform? This forum is meant for listening. How do we do 1) cost containment 2) choice for you 3) affordability and 4) support for the entrepreneurial spirit.

For further clarification, here is quote from a published opinion written by Rep. Tim Walz:

As I consider my vote, I am guided by the following principles: (1) if you like the coverage you have, you should be able to keep it; (2) we should pay doctors for good outcomes, not the quantity of care they provide; (3) reform should lower costs and streamline the system; and (4) reform should not increase our budget deficit.

The House legislation creates a public health insurance option that would introduce competition and allow the free market to lower insurance costs for families. The bill would also prevent insurance providers from denying coverage to someone based on a pre-existing condition and would close the "donut hole" in prescription drug coverage for seniors.

While I think giving Americans a public insurance option they can never lose is a good start, one of the problems in our current system is that existing government health care programs are too focused on quantity rather than quality of care. This problem is often cited as the Medicare reimbursement rate issue and what it means for southern Minnesota is that states like California and Texas receive more reimbursement money because they offer less efficient care.

(Owantonna Peoples Press)

<h1>Setup</h1>

Many buses were in the stuffed parking lot, with people also parking in the neighborhood. Some bus loads supported the public option, like the progressives and the Teamsters. Some bus loads opposed the public option, like the Tea Party organizers and a save America group. The first congressional district is huge, so buses might have been just convenient economical transport.

A huge crowd had been left outside the school because of lack of seating. Some of them were still there after the forum. One person said he was there because of the Christian mandate to support everyone, so he supported the public option. One Teamster, holding  a plastic wrapped sign, said that he hoped for the public option and cost containment. Strangely, the one LaRouche supporter held a Obama picture with an added Nazi mustache. That sign was actually totally misfired marketing because the person supported a single-payer health care plan. Through the Obama mustache sign, the LaRouche supporter was trying to say that the current Obama plan would still end up leaving people without health care to die, just like the Nazis left poor people without health care to die. And yes, that analogy falls apart with any historical knowledge, which is why I call it a total misfire on marketing.

Inside, there was comfortable auditorium seating with no signs allowed, with every seat filled, extra seating in folding chairs. About 20 video cameras filled the remaining space. The opening featured patriotic songs and prayer invocations. The moderator, Dave Durenberger gave an introduction.  Rep. Tim Walz spoke with a huge graph, displayed behind him. In addition to Rep. Tim Walz, there was a panel of experts from Mayo clinic, from the insurance industry, and from other places, waiting to answer questions.

Then this forum was opened up to take comments and questions from four locations, including both balconies. People lined the walls waiting to speak. Retired Republican Durenberger moderated with rules and a request for courtesy. Many people in the audience were also enforcing courtesy. My take was that there was an attempt to stack the audience with people who wanted no health care bill, however the teacher-like interaction, the obvious courtesy and the caring position of Rep Tim Walz eventually set the standard for everyone. Rep. Tim Walz even over-ruled the moderator at one point, to take a little extra time with a distraught commentator. He always honored that people could respectfully disagree.

At an early point, the "hecklers" did try to take over. One person tried to assert that tort reform would solve the whole problem. Rep. Tim Walz said the evidence did not support that. The standard tactics of "Read the bill" does not work here because Rep. Tim Walz could readily refer to any section of the bill, with a copy in front of him. Rep. Tim Walz also has a pocket copy of the constitution. Plus the panel of experts were readily available on factual questions. Indeed, our blogging requirement of cite your sources was evident when people in the audience started saying "Source?". When there was audience volume, I visually surveyed the audience, with video. There really was not widespread volume and the balconies were particularly quiet. This was pushy front-loaded staging for the "quick story" reporters present. Note that by the end, there were only a few reporters left. I stayed past the end, interviewing people.

<h1>Testimony</h1>

Perhaps the most dramatic and impactful testimony were the healthcare horror stories of the current system. One veteran says that he gets excellent healthcare through the VA (Veterans Administration) system. He loves the government-provided single-payer health insurance from the VA.  His son was currently covered under his family coverage (not VA, I think) until graduation. His son has Crohn’s disease that requires drugs that cost $60,000/year with insurance and $120,000/year without insurance. After graduation, his son has no coverage. There is a required 4 month gap before Minnesota care can kick in, that no one has any idea on how to fill.  One person said that he handed this veteran a note saying, "I will pray for you". That is about the best idea that anyone had for a fix, within our current system.

Many people expressed support and respect for Rep. Tim Walz even if they disagreed with him on this particular issue. It was obvious that many speakers had been able to communicate with Rep. Tim Walz before.

The first comment was from a medical claims processor saying that costs are constantly going up, while Medicare and Medicaid payments do not go up. Rep Tim Walz responded that Minnesota is not being reimbursed fairly because we are efficient and effective compared to other states, This is "the Medicare effect" from the New Yorker article. Dr Wood from the Mayo clinic spoke to this problem, saying that "fee for service" should be replaced by "fee for performance".  Rep. Tim Walz  then described the public option as a "honesty keeper" on the free market to ensure cost containment.

The next comment was that the public option on health care was unconstitutional, referencing Article 1, Section 8 and Section 10 saying that powers not given to the federal government are given to the states and the people.  Rep. Tim Walz responded that 237 years of constitutional interpretation have said that national parks, Medicare and Veterans care is allowed under the commerce clause. So either we have to dramatically change our interpretation of the constitution, removing those government programs, or we have to allow that the proposed health care plan is also constitutional.

Many very strong comments were made in support of the public option. There were requests that insurance not be involved in health care at all. Another way it was phrased, is that government should provide the national health care insurance that covers every human being in the United States. One person said it very plainly, "The enemy is not government, it is the profit blood-sucking insurance companies."

A few people went the other direction in support of insurance companies, saying that the profits of insurance companies needed to be protected. One person said that health care should be a free market situation without government involvement. After panel experts pointed out the lack of customer information and even lack of any choice in the market, she wanted the government to force more free market choices. It was exchanges like this that prompted some humor on government involvement. Rep. Tim Walz had one of the best points on free market, where a free market has to allow failure and failure in health care is not an option.

In a sort of opposite states' rights declaration, one person requested that states be required to accept a health care plan by any other state. The person cited that the same plan by the same company went up just because he moved between Arizona and Minnesota. What this person does not know is that the Arizona plan had few consumer protections that people assume exist. The Arizona plan was a bit like my proposal of pirate's insurance where all you get is a card and no coverage at all. Really the plan changed drastically because the state of Minnesota has many consumer protections that people take for granted!

Overall, there where many comments where we don’t trust the government to work well. People liked Medicare and VA care, however not the government care given to Indians. Rep. Tim Walz had applause from pointing that both parties got us to where we are in the health care situation. Paperwork was seen as a negative. Specially, there was a request not to accept a 300 page change to the bill at the last minute. Also, one person cited the story of his over 100 year old grandmother as a example of our current system does do many good things.

Excessive amounts of advertising was seen a negative. One suggestion was that both heath care companies and health care insurance companies not be allowed to use advertising as a business cost to reduce taxes.

Both the audience and the panel suggested that the health care payment plan be built to encourage health care outcomes from a diverse group of health professionals acting in a coordinated way. So include people like nurse practitioners. Long term care by friends and family needs to be supported since the alternative is expensive nursing home care. Our payment model needs to shift from the last 6 months before death care to a model that promotes health care overall. Rep. Tim Walz did warn that current studies are muddled in whether preventative health care will lower costs.

Many comments also pointed to the lack of transparency in both health care and health care insurance. Information is not available. One reason the VA care is seen as better is that it has better transparency that reports even when something might have been a problem.

The Uptake may post a full recording of the more than 2 hour forum, I will update here with a link when that happens.

Overall, I was very impressed by the quality of the discussion at this health care forum. Through the efforts of many, the forum stayed courteous and Minnesota nice, allowing greater discussion and understanding.

Cross posted on MN Progressive Project.

Originally posted to MN Progressive Project on Fri Aug 21, 2009 at 01:42 PM PDT.

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