Physician Patient


Minnesota Physician-Patient Alliance, Inc. ("MPPA") is a not-for-profit organization committed to improving our health care system. We do this by communicating information to the public and within the industry about important health care issues.

MPPA believes that efficient, quality health care depends on strong doctor-patient relationships. Interference in the doctor-patient relationship by third parties such as health plans and the government, is widespread in today's health care system and often limits what doctors or patients are allowed to do, altering market-based reimbursement, and undermining the traditional ethics of the medical professions. While the intentions of the third parties in interfering with the relationship may be honorable (for example, to control costs or improve quality), ironically the cumulative effect of this interference is unnecessarily high costs and reduced quality. Efforts to reform health care, therefore, must first and foremost address the issue of strong doctor-patient relationships.

The MPPA board consists of physicians, health care consumers, and others who share these concerns and values. We seek to communicate our message by collaborating on research and publication, sharing information about market developments, and individually being active in a variety of health care and community organizations.

To see who belongs to MPPA, please visit our Who We Are page by clicking on the link to the right. To see some of our communications, click on one of the Publications links to the right. If you would like to learn more about MPPA or our positions, click on the Contact Us link to the right.

MPPA was established in 1997 as a Minnesota 501(c)3 charitable nonprofit organization. If you would like to be added to the MPPA listserv, the respected MPPA online discussion group, send us your contact information and we will add you.

Apr 17

Europe’s Alternative to Medicare for All
Swiss and Dutch private insurance provide better coverage than Canada’s single-payer system.

By Regina E. Herzlinger and
Bacchus Barua
April 16, 2019 7:33 p.m. ET

Sen. Bernie Sanders described his Medicare for All legislation in a Fox News town hall the other night: “What we are talking about is simply a single-payer insurance program, which means that you will have a card which says Medicare on it, you go to any doctor that you want, you will go to any hospital that you want.” He added that “you’re not paying any more premiums, you’re not paying any more copayments, you’re not paying any more deductibles.” In another context, he said the plan “would allow all Americans, regardless of their income, to get the health care they need when they need it.”

Not so fast. The experience of Canada, which follows the Sanders model, shows that single payer is not the best way to achieve the goal of access to timely care. Its single-payer program is universal, funded by taxpayers without deductibles or copayments, and excludes premiums for most users. Objective measures of performance show it’s a comparatively expensive system whose results are mediocre—and sometimes very poor.

A Fraser Institute study published in November examined 28 universal health-care systems across 45 indicators of performance. After adjusting for differences in the proportion of seniors, Canada ranked among the top spenders—fourth-highest as a percentage of gross domestic product and 10th-highest per capita. Yet it had less medical resources available for patients and painfully long wait times for specialists. Canada ranked 26th out of 28 for number of physicians, 22nd out of 27 for MRI units, and 25th out of 26 for hospital beds.

In Commonwealth Fund data comparing 11 developed countries, Canada reported the most patients waiting more than four weeks for a specialist appointment (56%), vs. only 22% for Switzerland and 23% for the Netherlands, the top performers. The proportion of patients waiting more than four months for elective surgery was 18% for Canadians, 2% for the French and zero for Germans. Canada performed well on only five of the 12 indicators of clinical performance and quality included in the Fraser Institute’s study. Its performance on the other seven—including obstetric traumas and diabetes-related amputations—was poor or average.

Overall, Canada performs worse than other universal-coverage countries, particularly Switzerland, the Netherlands and Germany. Why? Unlike Canada’s single-payer system, the Swiss, Dutch and German systems rely on private insurers, whether nonprofit or for-profit. Government helps the needy make premium payments.

German enrollees can use a public system composed of 145 competing independent nonprofit “sickness funds” or buy insurance from 43 companies or nonprofits. In the Netherlands and Switzerland, residents must select a standard insurance package from private insurers, of which both countries have dozens.

Unlike the U.S., with Medicare and its massive trillion-dollar unfunded liabilities, these countries cannot pass un-reimbursed current expenses onto future generations. If the expenses of private insurers exceed their revenues, they face bankruptcy.

The relatively successful universal health-care systems also rely on private hospitals and physicians. As of 2012, 42% of German hospitals were for-profit, almost all of them open to patients with public insurance. These regulated for-profit vendors can readily access private capital to fund medical innovations—unlike government-run systems, which need bureaucratic approval to use tax revenue.

Consumers and the private sector drive the health-care systems in these countries, which accomplish exactly what Mr. Sanders and his supporters say they want—universal coverage, controlled costs, high quality and ready access. In contrast, Canada’s experience shows the dangers of the Medicare for All model.

Bernie Sanders’ new ‘Medicare For All’ plan is co-sponsored by Democratic presidential rivals Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren.

Ms. Herzlinger is a professor at Harvard Business School. Mr. Barua is associate director of the Fraser Institute’s Centre for Health Policy Studies.

This article appeared in the April 17, 2019, Wall Street Journal print edition as ‘Europe’s Alternative To Medicare For All.

Mar 17

As  emphasized in the March 17 Star Tribune editorial, the real priority for achieving “mental health parity” should be to help “struggling families,” rather than enfranchising the [health care] industry. We have ample proof that insurance company payment criteria for mental and substance use disorders cover short-term and crisis-focused mental health conditions and disregard the value to patients and families of continuity of professional relationships, as well as allowing adequate payment for non-acute, complex, chronic, care (including children and adolescents). 

The (bipartisan) federal Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008 (signed by President Bush) enfranchised insurers to decide on claims of “medical necessity.” Thus, an unintended consequence of (well intentioned) mental health parity legislation is industry justification for denial of third party payments for mental health care.

Why not encourage the patient’s insurance company to pay mental health insurance benefits directly to the enrollee (patient or family)? Then, regulators can monitor and compare real money spent on “physical” and “mental” conditions, and consumers can choose licensed “providers” who are responsive to their needs?


Minnesota Legislation

Lee Beecher, MD
President, Minnesota Physician-Patient Alliance