Physician Patient

Archive for September, 2018

MPPA Meeting: September 25, 2018

Friday, September 28th, 2018

MPPA Meeting Wednesday September 25, 2018 at 6-8 PM in the conference room at Crutchfield Dermatology, Egan MN.
Those present: President Lee Beecher MD, Bob Geist MD, Carl Burkland MD, Dave Feinwachs JD, PhD, Neil Shah MD, , Wayne Zuehlke CPA, Steve Burgeson (new Fellow), and Matt Flanders. It’s of interest the we had 25 responses to the meeting announcement. Last-minute illnesses of some, the active political campaigns, and a very busy group of people reduced attendance to eight from the scheduled 16! Two sent remarks regarding their experiences in Canada’s Medicare system, which I read at the meeting.

A fruitful meeting attested to by the long length of these minutes. Please note that my comments are in [brackets]. We had excellent open discussions of all issues! Read on…

Minutes of the May 23, 2018 meeting were circulated to all before the meeting and were not discussed further.

1. Election issues—Single payer panaceas [Favored by 26% of physicians 2018 survey.]
• Bob Geist described the two Medicare-for-all bills now in congress including BernieCare and another from the Physicians for a National Health Plan—neither has a CBO fiscal note. Bob then discussed the Mercator Center (George Mason U) 10-year cost analysis of BernieCare at $ 32 Trillion (with a T) and found near the same cost as the end result of implementing the ObamaCare cartel-like program now in progress. BernieCare advocates claim that it will be $2T cheaper. The problem is that these are two socialized programs with the same catastrophic result albeit one is to be run by the feds (B’Care), and the other by a government-backed (i.e. crony) HMO-ACO industry (O’Care).
• Dave Feinwachs described the MN MNCare buy-in (DaytonCare) proposed by the DFL—MNCare is a state program linked to Medicaid. The opinion was that this is a state supported premium for an expensive poor product. His estimates are that it would save a family buyer $69/mo., or about $800/year with the same high price (hidden with tax-payer props) and poor benefits plus access problems due to poor pay rates for clinics. The same HMO-ACO industry will run the program—a middleman expense of what was described as enormous, as is already evident in the MN Medicaid program. In the discussion, one suggestion was for a real FFS alternative of 80% state major med insurance and 20% individual insurance and cash payments [I hope this is an accurate recounting of the idea, It’s of interest this mixed concept is favored by a significant 35.5% of physicians: 2018 survey RWG] In regard to the election, hanging in part on the DFL DaytonCare proposal, absentee ballots, pre-filled out, have been sent to all registered Democrats for early mailing—the GOP has no such program as far as is known. Re-constituting a MN high risk pool (the successful old MCHA program killed by Obamacare) was discussed. It was pointed out that merger mania continues with the Blues outsourcing back office work to Anthem. Finally, the Office of Legislature Auditor (OLA) claimed it could not find an independent auditor for MN Medicaid as required by law and would do the audit itself—this is a highly suspect excuse and a continuing story.
• Critiques of SP panaceas. I read two brief letters from two ex-pat Canadian doctors regarding problem with the Canadian Medicare system. Its attributes are that it’s free open access, It’s problems are that the appearance of free care generates unlimited demand too often met with harsh rationing of care measures resulting in a rotting infrastructure of equipment and available clinicians plus long queues for the ill paying a high price in lost wages, morbidity and occasional mortality. The burden of triage for an interventional radiologist recounted wait-times of 7 months for a CAT scan and 13 months for an MRI. In one case the doctor had only the typical 2-line limited clinical history on the referral; a triage to the end of queue resulted in a preventable death—the doctor could no longer in good conscience practice in such a harried poorly funded system. He moved to the US to practice good patient care rather than impossible bureaucratic care. He wrote: “I quickly realized that the moralistic Canadian system is not really about providing care, but about providing an illusion of care.”
• Free-market Alternatives.
o Bob Geist described the Family Medical Account (FMA) Medicaid program, which funds an enrollee-owned debit card for outpatient care. The simplicity of onsite payments eliminating the expensive HMO middleman function ought to meet the state goal of lowering Medicaid costs much as has happened after Conn. fired all its Medicaid HMOs. Would lack of independent primary care docs be a problem? [Probably not the way the program is constructed; details on request.]
o Cash only practice was discussed, and in some detail, both the CCHF “Wedge” program and concierge practice.
o It was noted that Denmark will run a large trial using the Medibid program.
o We have in the past discussed at length expanded and reformed HSAs—p. 6-7
2. Sen. Scott Jensen’s priorities for the 2019 session were discussed. These are appended to the minutes (see p. 4) including SF numbers. Please note that these priorities mimic almost all of the MPPA initiatives discussed in part #3 of these minutes. The exceptions are MOC reform and the possibility of a state legislative Resolution to a) repeal of 2011 federal waivers of patient protection laws and b) amend 2015 MACRA franchising law (i.e., payments for services exclusive to providers underwriting-insuring population costs). Repeal and amending federal law would eliminate coercing providers into underwriting (insuring) the risk coercion population costs and mandate that clinics have freedom to contract for underwriting or not. Scott has just completed a new AWP bill—more on that later.
3. Legislative Patient-Clinic Protection Issues.
• Freedom to choose Any Willing Provider (AWP). Neil Shah noted that since insurance is vital for clinic survival, patients ought to have freedom to escape a network for care paid at least the same rates as are providers in the network. Balance billing is a non-starter. A SD state referendum approved freedom to choose by > 60%–a freedom to choose bill was promptly passed by the legislature, Other states (e.g., Utah) have passed similar bills, but some state laws are more limited in scope.
• Clinic Fair Care bill would mandate payments for deductible services by the insurance corporation holding the patient’s deductible money, which the patient ought to be able to spend as they please.
• Clinic Fair Contract Act would eliminate state mandated quality reports, would require any entity wanting clinic data to pay for it, would mandate that a clinic be free to contract or not. It would require that patients opt-in to reporting their clinic data to 3rd parties even, if the clinic contracts to report data to a 3rd party.
• A patient financial bill of right would require itemization in plain English, never receive a surprise bill, and 7 other common-sense requirements including price transparency (see P. 5).
• Transparency bill amendments would eliminate gag clauses, include all providers, make sure that facility fees are posted up-front before a service is provided, pre-care estimates of all (4 possible) fees, and truth in pharmacy pricing.
• Amend MN CON law to eliminate requirement of no overnight stays.
4. Matt Flanders briefly discussed the CCHF Wedge program and Twila Brase’s new book, Big Brother in the Waiting Room. I personally give it highest praise—a book that for the next few years will be a necessary reference for any healthcare activist. It’s #1 in sales in its category; going like hot cakes. A second printing is pending—only four more at the Amazon warehouse as I write, but more coming. My recommendation: Buy it on-line now!!
5. A MN Legislative Resolution to repeal waivers of patient protection laws was discussed. This will be sent to the Fellowship when completed,
We are again grateful for Dr. Crutchfield’s gracious hospitality for use of his conference room.
The next meeting date is to be determined.
Respectfully submitted,
Robert W, Geist MD

Candidates for MN Governor: Tim Walz and Jeff Johnson on Healthcare Policy

Tuesday, September 25th, 2018

Minnesota’s gubernatorial candidates have starkly different visions for healthcare policy. However, both DFL candidate Tim Walz and the GOP’s Jeff Johnson want to assure that all Minnesotans with pre-existing medical conditions (i. e. expensive, chronic illnesses) have affordable health care insurance. The difference is in how they propose to do this.

Tim Walz

DFL candidate Rep. Tim Walz believes that all US citizens have a (presumably constitutional) “right to health care.” Accordingly, he supports federal legislation to allow US citizens to buy into the federal-state Medicaid program. And he proposes permitting all Minnesotans to buy into state MinnesotaCare. a program which was designed to cover patients who do not qualify for the Medicaid program. MinnesotaCare (MnCare) pays doctors at the same (very low) rates as does Minnesota Medical Assistance (Medicaid). As a Congressman, Tim introduced federal legislation: See:

Click on:

We are a state of innovators

I'm running for governor because I believe when Minnesotans come together, anything is possible.

Posted by Tim Walz for Governor on Wednesday, September 19, 2018



Jeff Johnson

GOP hopeful Jeff Johnson, on the other hand, wants to empower Minnesotans as health care consumers with money and information to choose their health care in a private sector marketplace which features price transparency for both health care services and insurance coverage.


From Jeff: Our current approach to healthcare (and paying for it) has been tried for 40 years and has failed to contain costs. It is time for a new approach that actually increases competition and drives down health care costs.

The insurers have managed healthcare delivery for four decades and have failed to contain cost. Cost per capita in 1980 was $1,180/year before managed care. It is now over $15,000/year. Healthcare cost doubled under Obamacare. Everything that has been tried is dependent on the management of healthcare delivery and has consequently failed because management is simply too labor intensive to ever be cost-effective. A single-payer system, which the DFL is proposing, will fail to contain cost for the same reason. It is time for a new approach that drives down costs and still takes care of our most vulnerable Minnesotans and those with pre-existing conditions.


WHY: Competition among health insurers is almost non-existent and competition is necessary to drive costs down. Employers who self-fund provide meaningful competition to the insurance industry.

ACTION: We will promote private-driven plans to finance care as an alternative to the traditional insurance model. To do this, I will propose tax exemption for contributions into healthcare benefit accounts and allowing pre-tax dollars to accumulate in accounts that can feed HSA’s and similar vehicles to pay for care. These alternatives will force insurance providers to compete for health care dollars.


WHY: Large corporations are able to distribute risk across large pools of employees and keep premiums lower, but small businesses and individuals are forced to pay according to their individual circumstances and risk being dropped for utilizing their insurance for unforeseen events.

ACTION: I will propose allowing Minnesotans to form associations, maybe by a group of businesses in a small community or as a group of churches or other organizations to have the same buying power and risk distribution that large corporations enjoy. The legislature explored something similar this session by allowing farmers to create a cooperative.


WHY: The cost of health insurance has skyrocketed since the creation of MNSure and Obamacare. In fact, in some counties in Minnesota, there are practically no choices at all for consumers on the exchange.

ACTION: I will lead the effort in creating more competition for insurers and more choices for consumers by forming a compact with our neighboring states to allow Minnesotans to buy across state lines regionally. This will increase the number of insurers competing for Minnesotans’ business, giving consumers more choice while driving premiums downward.


WHY: While providers are transparent with their fee schedules, insurers consider their fee schedules a trade secret. This viewpoint incentivizes abuse through overcharging and not permitting consumers to make informed decisions when considering their healthcare. After all, the true cost of a service or procedure is not what the clinician or hospital charges but the amount that the insurer actually allows for payment.

ACTION: I will push hard for certification of independent third-party administrators whose fee schedules are public to replace the role traditionally held by insurance providers. This will introduce true price transparency to the medical marketplace and lower costs.


WHY: The many coverage mandates in Minnesota create one-size-fits-all plans that don’t always meet individual Minnesotans’ needs while also driving insurance out of the realm of affordability.

ACTION: I will work to allow Minnesotans to purchase limited coverage policies that are affordable for every Minnesotan and cover both basic preventative care and potential catastrophic events. And I will propose to roll back some of the coverage mandates that have accumulated over the past decades.


WHY: The Affordable Care Act mandated insurers to sell policies to everyone, no matter their risk. This lowered the number of uninsured, but it also drove up the cost to the point of unaffordability for many. I think we have moved in the wrong direction and should take a step back toward common sense. Minnesota had the first high risk pool in the nation and we were viewed as a model throughout the country prior to the ACA.

ACTION: I will advocate for reinstating a MCHA-style pool for those with pre-existing conditions, guaranteeing competitively-priced coverage for everyone in Minnesota – even those with pre-existing conditions.


WHY: Currently, those receiving government-funded health insurance have no choice. They either accept what government gives them or go without.

ACTION: I will work to allow those receiving government health insurance to shop their dollars in the marketplace among multiple providers to buy the plan that best fits their individual needs and get the most ‘bang for their buck’.

WHY: Recent census data shows aging Minnesotans are electing to move away from the metro area. Research shows our seniors are overwhelmingly rejecting nursing homes and senior living facilities and electing to stay in their homes. However, our policies inhibit the growth of aging-in-place services.

ACTION: I will deliver more choices for our seniors when it comes to their healthcare services by making it easier to start and run in-home care businesses, increasing access to care, and promoting tele-health technology and services. This is especially important because we have a duty to provide our seniors with the ability to live independent and healthy lives, whether they live in the metro, or in our rural areas.

WHY: We don’t find cheaters because we don’t check. The Legislative Auditor, Jim Nobles, found $233 million spent in just six months going to non-qualifying people. Bottom line: MNSure doesn’t even know how much money is owed to MNCare.

ACTION: My Administration will work with counties to create a new eligibility determination system. I believe a county-based system giving authority and money to 87 counties to build a new system with greater accountability than our current system would be a step in the right direction.

WHY: There were 64,000 deaths from opiate overdoses in 2016. However, the focus of the media and our government has been misdirected in addressing this crisis. According to the NIH, deaths from prescription opiate pain relievers increased almost twofold from 2002 to 2011. Since 2011, deaths from prescription opiates have been stable at about 17,000 per year. This is still far too many, but prescription opiates are only one part of our crisis. Deaths from heroin overdoses increased over 600% between 2002 and 2015, and deaths from cocaine increased over 150% between 2010 and 2015.

ACTION: The legislature came up with a good start to address this crisis on a bipartisan basis in the 2018 legislative session, but that solution was a victim of Governor Dayton’s veto and the chaotic end of session. I will revive that plan as a starting point in 2019. I will also make certain law enforcement has the tools and funding necessary to fight the flood of illicit opiates, specifically heroin and carfentanil, that are responsible for much of the opiate epidemic.

Sent: 9/24/2018 7:02:12 PM Central Standard Time
Subject: Single-payer healthcare coming to Minnesota?

Simply put — Tim Walz supports single payer healthcare.

Not only will the cost be immense, but the major consequences of this massive government overreach will also affect every single Minnesotan for years to come.

Tim has refused to address specifics of his plan because he knows he can’t tell Minnesotans the truth–they simply won’t put up with it.

But everyone should know what his plan is if he’s elected Governor, and here are three simple questions we asked him last week;

Studies and the experience of other states indicate this will cost Minnesota at least $17 billion per year. What specific taxes will be raised on Minnesotans to pay for this?
Will every Minnesotan lose their existing healthcare plan?
How would the Walz plan impact the practices of Minnesota physicians if they are paid only the equivalent of Medicare reimbursement rates?

Click on the tab “Minutes of MPPA Meetings” to learn more about what was discussed at our September 25, 2018 MPPA meeting.