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.

Aug 4

Comment on the “Goodman Plan” (above) from Dr. E. John English:
      Dr. Goodman’s ideas describe “Primacare Direct” that’s right here in the Twin Cities. Some important tweaks however.
  •  An independent primary care physician should NEVER accept payment directly from either Medicare or Medicaid for this prepaid plan. Only accept money directly from the patient. The whole reason the direct primary care thing works is that it is ‘direct care’ – – -between  you and the patient. Period. Let the government/ third party figure out how to do this through the patient – – -not on behalf of the patient.
  • Some other critical points:
       The direct care clinic determines what is covered and what is not covered – – – not some third party
       The direct care clinic determines the monthly fee charged – – – not some third party. 
                Thus fees/benefits may vary between clinics – but that’s the point – clinics will begin to compete for patients
                             Cover too little or charge too much, no patients – – -thus the ‘market’ will dictate how to proceed
       Based on above, the patient chooses a specific doctor in an accepting direct care clinic.
                                                – – – absolutely no assignment should be accepted by some third party. This is major. 
                                                – – – naming a specific doctor creates a direct line on responsibility
      The contract is month to month.
      The patient enrolls by making the first visit and signing up with a specific doctor (not a clinic)
                                                – – –  No paperwork is sent anywhere
      Payments come in monthly in the name of that specific doctor – by automatic credit card deduction
      There is NO billing and NO coding and NO reporting to any third party – – – – only directly to the patient
                                                – – – Thus the doctor’s note can be brief and to the point
      There is NO oversight of  the primary care physician’s care by any third party.
                                               – – – The patient alone will decide if they like/want the type of care they are receiving
                               In other words, “Quality care” is defined by the patient satisfaction, not some third party
      Unsatisfied patients make their wishes known – – – – with their feet, by either:
                                A. Choosing and visiting another specific doctor within the same clinic
                                               – – –  payments begin coming to that specific doctor
                                B. Choosing another specific doctor in another accepting direct care clinic
         Now for all specialty care coverage – – -80 / 20 indemnity plan with stop loss. (E. John English, MD )
In the televised Democratic candidate debates this past month we learn that all Medicare for All proposals mean the end of employer-purchased third party health care insurance which now covers more than 150 million Americans. See:
Current polls indicate that health care is the number one policy concern for Americans. Democrats were successful in the 2018 US congressional election (taking control of the House) by amplifying voter concerns about high health care cost and access to quality care while claiming that Republican policy proposals would not cover patients with pre-existing medical conditions. All of the Democratic candidates (including Sen. Amy Klobuchar ) want more government control and management of US health care.
What will US employers (large and small) support politically? How could or would a Medicare or Medicaid buy-in (such as Minnesota Governor Walz’s ONECare affect market competition for consumer-controlled dollars? What do patients and families want?

Marie Fishpaw at the Heritage Foundation and  I propose five health reform ideas. They are short, easy to understand and hugely impactful on consumer-directed reform. In each area, the Trump administration has already gone about as far as it can administratively. Congress needs to complete the tasks. Here are five goals of health care reform which can empower patients. For patients:

1. Personal, “portable” health insurance that travels with them from job to job and in and out of the labor market.

2. Round-the-clock communication with their personal physicians by phone, email, and Skype.

3. Telemedicine, so they can even “visit” the doctor from home — avoiding traffic, long waits, and unneeded emergency-room visits.

4. Centers of excellence that specialize in chronic health conditions (including preexisting conditions) which actively compete for patients.

5. Accounts owned and controlled by patients who are willing to manage their own care, including most forms of chronic care and even routine surgery.

Government should not mandate these changes. If employees and their employers like the arrangements they now have, they should be able to keep and modify them. But government needs to get out of the way, cut red tape and conflicting requirements, and quit interfering with the opportunity for people to have better options.

John C. Goodman


Goodman Institute for Public Policy Research

6335 W. Northwest Hwy., #2111

Dallas, TX  75225


Jul 2
Andrew Abbott and his mentor Eliot Freidson help us understand the basis of morality for the medical profession.
Eliot Freidson wrote on the ethics and underpinnings of medical professionalism.
Andrew Abbott explains the evolution of medical professionalism in this excellent overview/analysis. Click on the YouTube video above from October 2011 at the University of Chicago. Passages (28 – 31), 33 – 40), and (46 – 55) caught my attention.
As we all know, big changes in medicine have occurred after WW II (for example UK NIH, 1965 US Medicare and Medicaid, and Obamacare 2010). Changes in the moral basis for medical professionalism are influenced by the identifying of medical care as a commodity, successes in public health practices, improved medical treatments, now dominating control of services and products by (government, insurance) third party payers, and the (growing) political claim that health care in America is a human Right. But who will pay for this? And how will mounting health care costs be mitigated and by whom?
The AMA now sees the doctor’s ethical role as a steward of scare societal resources (money):
But how can she do this without knowledge of the prices for health care services and products? And how can patients as consumers make prudent choices?
MPPA sees physicians as having a primary obligation to the health and welfare of their individual patients and applying Hippocratic ethics in patient care. If the doctor’s ethical loyalties are changing, how does the medical profession justify and enforce its ethics? What does the public think about physician ethics?