An American Health Care Revolution

Zoom meeting attendants: David Allen, primary presenter. Lee Beecher, Noel Collis, Greg Dattilo, John Diehl, Bob Geist, Vincent Hunt, Scott Jensen, Don Kollisch, Bob Koshnick, Rick Morris, Darrin Rosha, Wayne Zuehlke. [See bios p. 22-24]

Brief Synopsis

This meeting was a discussion of David Allen’s revolutionary Healthcare reform proposal, which presented a framework called Health Transaction Cards (HTCs) to replace third-party payment systems with direct patient payment while maintaining government safety nets for low-income individuals. David proposed abolishing private insurance, Medicare, and Medicaid, giving every taxpayer a healthcare transaction card to purchase care directly, with monthly minimum payments capped at $100 and unpaid balances going to tax liability up to 10% of annual income.

The discussion included feedback from multiple speakers, with Darrin Rocha questioning the cost control mechanisms and government subsidies needed, Scott Jensen emphasizing the cultural shift required in physician practices, and Greg Dattilo highlighting the role of government regulation in creating current system problems. Other participants like John Diehl focused on restoring professional autonomy in medicine and Noel Collis discussed the potential for state-level variations in healthcare systems. Bob Geist recounted the political creation of many post 1965 complex medical cost control panaceas beginning with 1973 managed “corporate care” ending with more powerful post 2010 “fed-corporate-cartel care”. All failed cost control despite legally being able to profiteer from rationing care access. Discussed were various means of eliminating “managed corporate care” and, if so, the predictable evolution of restored professional care in a retail medical marketplace.

The conversation explored how removed third-party payment barriers could reduce administrative costs, allow physicians to return to private practice, and empower patients as prudent purchasers of care. There were concerns raised about market control, cost containment, and the feasibility of eliminating corporate practice of medicine through alternative approaches.

David Allen’s “Revolution”

David Allen: Health care is undergoing a vigorous debate about how and whether to reform health care financing. Health care consumes almost a fifth of the U.S. economy, and we don’t get good value for this level of spending. In some ways, quality is better than other parts of the world, but in other ways, it’s not as good. And we spend twice as much as most other developed countries on a per capita basis. Our federal deficit is unlikely to be able to continue growing at the levels it’s been growing.

So, there’s pressure to do something and those who advocate for reform are falling into two camps. On the left here we’ve got those decrying the fact that 28 million Americans and a growing number of Americans are without any form of health insurance and they’re shouting for health care for all but inevitably they want to do it through using third party private or government payments. On the right are the revolutionaries fighting for free markets and demanding that we overthrow the third-party payment kings. I would submit to you that the way to win this battle for the free-market solution is to offer accessibility, affordability and quality and accessibility covering everyone. I think if we can offer a free-market solution that covers everyone, we can win this battle. The framework that I am going to suggest is just a skeleton. I haven’t worked out all the details, but I think the big picture has some merit that is worthy of consideration.

[Allen’s slide show] – open and click “Slideshow > from the beginning”.

The concept can be summarized as health transaction cards, HTCs. The concept is to abolish all third-party payment for healthcare, abolish a private insurance, abolish Medicare, abolish Medicaid, and give every taxpayer in the United States an opportunity to purchase healthcare directly. HTCs act just like a credit card. Consumers would use it to purchase all their health care needs. Physicians in hospitals and other health care providers who are paid are going to get reimbursed just like they would get reimbursed from a credit card. There would be no coding, no third-party review, no risk of claim denial.

The taxpayer is the responsible payer and so they are prudent purchasers of care. Taxpayers would have a safety net from the government because the government uses their taxable income to determine what they can afford and make sure that health care is affordable for low-income people as well as high income people.

The mechanics, we get into the details and some of them aren’t nailed down. If no health care has been purchased, there isn’t any balance. People will get a health care transaction card statement every month just like they get a credit card statement. If purchases have been made, they’ll be required to make some payment. I proposed a minimum monthly payment be capped at a hundred dollars. They can pay more to get the balances down if they want. But they will be required, everybody at all income levels will be required to pay a certain amount each month they have a balance on their HTC.

If at the end of the year they haven’t paid off their account, the unpaid balance I’m proposing goes to their tax liability. And when they file their taxes, that amount is added on. And it is capped at 10% of their annual income. An aspect that I haven’t figured out is I think you need some liability to prevent people from realizing that they’ve reached their 10% maximum and just go crazy and start buying health care that really isn’t necessary. So, there might be some liabilities for extreme circumstances, but I think that’s a detail that can be worked out.

Let’s go through some examples. A single mom here earns $50,000 a year and she has a lot of health care needs for her kids, $52,000 in the previous year. She is responsible for $5,000 out of $52,000. That’s 10% of the $50,000. She makes her monthly payments of $1,000. Because she only pays for 10 months, because the first two months she didn’t have any balance on her card, on her HCT card, and she has federal tax withholdings of $4,800, $400 a month, because she anticipated that she might have expenses, and she was smart. She got a $800 refund, because she paid $5,000 on the HCT card during the year, and had $4,800 reserve. That’s $5,800, but she only owes $5,000. She gets a $800 tax refund. She loves HCT. She has no Medicare taxes. She was paying 3 or 4% employment tax for Medicare. Doesn’t have that anymore. She has no insurance premium. She was paying more than $400 or $500 in premium. $500 is a bargain. It should still pay income tax on the $50,000 though, right? She’s paying income tax on $50,000, plus this is an additional liability to $50,000. She wouldn’t get money back. Yes, you’re right. Thank you. That’s correct.

Second example is empty nesters in their 50s who earn a combined $300,000 a year. They are required to pay. They again spend $52,000 on health care. They’re required to pay $30,000 for that. And again, they pay some during the year and the remainder through withholdings or at the time that they’re settling their taxes. And again, they love HTC or at least they’re satisfied with it because their small business no longer pays Medicare taxes. They can hire employers who are otherwise out of reach, and they don’t have to pay health benefits for their employees. And they can afford to compete against big employers who previously were out of reach for them because big employers could afford, had the size necessary to buy group insurance and they were, their small business could not buy group, group insurance.

Third example is an elderly man who receives $30,000 a year in social security income. He also spends $52,000. He only must pay $3,000. Again, through withholdings and payments over the course of the year, he is a lover of HTC because the $300 per month is less than what he was paying for Medicare Parts A, B, and D, his co-payments and the services that weren’t covered. He also loves the clinic that provides 24-7 coverage with a monthly concierge fee that he was able to buy later. So, the benefits, I think, of HTC are you wouldn’t pay Medicare Part A anyway.

Discussion, Commentary, Critiques

Wayne Zuehlke: Once you’re retired, you don’t pay that. There’s no premium on Medicare Part A. right.

David Allen Yep. Okay, thank you. The benefits of HTC are that it offers accessibility, affordability, and quality. Every American can have health coverage simply by filing taxes.

Costs will be substantially lowered and quality will improve. Elimination of coding will allow more flexible and innovative forms of health delivery, lessen atomization of care delivery, decrease overhead, improve productivity.

The need for negotiating leverage with insurance companies that’s created the corporate practice of medicine will be removed, allowing physicians to leave CPOM employment and return to private practice.

Care will be more geographically diversified, convenient, and patient-centered. Care will be more Emergencies. Dollars diverted from the coffers of private insurers will be restored to health care.

Employers will no longer bear the cost of providing health care to their employees, allowing for higher wages, greater profitability, and enhanced competitiveness of small businesses.

Of course, there will still be some need for government. Price transparency will be essential. There will be fair trade, particularly the treatment of emergencies and tertiary care, and we’ll need to retain anti-kickback statutes and retain the Stark Laws.

To make this happen, I think the next step is to assess economics, do much more than I’ve done in my simple analysis. Things like knowing whether you pay premiums for Part A and the other mistakes I’ve made in the presentation need to be addressed and calculating how much it’ll save. I mean, the total, I don’t remember the exact figures, but in total, we spend over $5 trillion on healthcare in the United States. The cost to the government of Medicare and Medicaid is something like $2 trillion. How much will this cost the government?

What formulas between taxpayer liabilities and government safety nets will remain affordable for both the government and the taxpayer? I think it’s obvious to me, and I suspect those of you who’ve studied market-based healthcare will agree that costs will be dramatically lowered if we have a free-market healthcare system. But we need an economist or somebody to help figure out what exactly those savings are. And then we’ll need to define if it is 10% of income that it should be the maximum, or is it 12% or is it 8%? I just pulled a number out of the air that sounded reasonable to me. And that piece that I mentioned at the beginning of defining liability for extreme circumstances, if somebody knows that they’re at the max, we don’t want to create an incentive, an unintended incentive, to just run up health expenses and buy unnecessary care.

I think the third step is that we need to advocate. And it needs to be nonpartisan. I don’t think this should be sold as a movement of a certain political party. I think it needs to be nonpartisan, representing both the new, the post-revolution. It has the best elements of all sides currently debating health care reform, both coverage for everyone and free market, and unfortunately without me, because as I’ve said, I’m not really a health care expert anymore, if I ever was, and I am unable to run with this too far. I just thought it was a good idea, and I wanted to share it. So that’s my presentation, and I’m looking forward to other people’s comments and questions.

Bob Geist: Introduce yourselves when you ask questions.

Darrin Rosha: I have been a part of this dialogue a long time. My participation in this discussion as a non-physician has been my relationship with Charles Crutchfield, who’s been very interested in many of these issues for the balance of his career and his life. I have been part of a conversation about the university’s role in healthcare and the challenges that it’s faced in recent decades.

My impeccable medical credentials are I was a combat medic trained at Fort Sam Houston for 10 weeks in the early nineties. I employed those skills one time as a civilian when a young woman at a summer event for my fraternity bumped her head on a boogie board out on a lake and that was that was the extent of my medical practice. But I served on the University of Minnesota Board of Regents from 1989 to 1995. That was a very significant period for the change as the university went from the shining Castle on the hill with tertiary care experience to being lapped up by the HMO community. I was back on the University of Minnesota Board from 2015 to 2023 so 14 years of board experience. My personal training was in economics with a political science degree. I went on to the Humphrey Institute in law school. I still owe the Humphrey Institute a Plan B paper, which they don’t require anymore.

Yeah, it’s intriguing. I think everybody that has responded has said this is really an intriguing concept. One way I approach it is, well, what’s the practical capacity for us to ever get there? And obviously, the big question is, what’s it going to cost? You know, we’ve gone through an interesting period in our nation’s history where deficit spending has almost made Congress indifferent to the cost of things, right? They just pass debt on to the next generation. But I do think that there is a cost component to it. The cost of the care is not going to go away.

What this proposal really does is talk about what cost is assessed against individuals based on their income. The bottom line is you’re going to leave something that’s not covered by that individual if they’re only subject to 10% of their income for the cost of care. That opens the question, what does the government have to do to subsidize it? The other side of it, in terms of what jumps out at me, is how are we negotiating the cost with providers? We used to say doctors, now we have to say providers because of some of the changes in the last decade or so, or more. But what are the competitive components that are going to have some sort of controlling effect on the rise in the cost of care? Because when we really get into this and we start talking about other regulated industries, whether utilities or otherwise, where people pay a percentage, then they have very little incentive to keep the overall cost down. That is what I’m trying to understand.

Maybe Mr. Allen can help with this? Understanding how there’s a competitive impact so that physicians or medical clinics or hospitals are going to try to attract patients because they’re going to be the most cost-effective way for those people to receive the highest quality care. So those would be my first question is. What in this proposal is going to have a controlling effect on what the cost of care is going to be?  On the other side is, how do we possibly measure what the cost of government is? Because if it’s so high, it’ll be a non-starter with the federal budget.

David Allen: Yeah, do you want me to try to answer some of that? I think in terms of the total cost, I mentioned that we’re spending over $5 trillion, but on a per capita basis, we’re spending twice what other developed countries are spending. And other developed countries are keeping their costs lower through rationing and queuing care. But they’re also keeping costs lower because they control what doctors are paid and the supply of physicians. I think it would be possible if we had an efficient system, to reduce the $5 plus trillion that we’re spending to $4 trillion and still maintain a quality of care and provide care to everyone.

Now, how do we do that? And what are the mechanics? That’s kind of a big picture question. Let’s get down in the weeds and say, what does an individual do? What do doctors do? How does individual doctor’s behavior change? Well, now the statistics show that physicians spend more than half of their time documenting and doing paperwork that has nothing to do with providing care for patients. That productivity can be unleashed by removing third-party payments. There are people on this call, much better qualified than I am, to explain why doctors spend twice their time doing that. But hospitals have a tremendous infrastructure that is solely about coding.

The electronic, the epic electronic health system, health record system, which is used by most major facilities, is a coding system. It’s not a health record system. That’s a secondary purpose, is maintaining health records. Its primary purpose is maximizing reimbursement from third-party payers. That would be obsolete if we had a free market system. When patients are looking for value, they will gravitate towards caregivers who offer value and physicians will be able to provide that value.

I alluded to our Medicare example patient getting concierge care for a fixed dollar fee per month. He pays $200 per month to a local clinic who can provide most of his needs for that $200 because they are able to have their nurses respond. They can serve a population of people much more cost effectively than the current system, which requires the patient to arrive at the clinic for them to be reimbursed. They can’t provide care over the phone and get reimbursed. When he comes in, they must have him charge separate fees for their diagnostics and for referrals to other people. All of that is obliterated when you get to a free-market system.

Physicians are going to be free to leave the employment of these mega corporations because they’ll see an opportunity to set up a practice in their hometown that serves the local people and they’ll get paid for it. They won’t need to worry about hiring three people or four people for each physician to do the coding and collecting. There are costs built into the current system that are going to be removed by going to free market health care. And there’ll be a change in the way health care is provided to being patient centric rather than coding centric.

Darrin Rosha: Well, if I can put on my lawyer hat and cross-examine the witness. please. There’s a lot in there, in what you just said, and I very much appreciate it.

A few vignettes from my work with Dr. Crutchfield, both as outside counsel and a couple of times he brought me in because he knew that I had to shut down my practice, so I spent the better part of a year running his clinic as manager and helping him find his next manager. I got some inside perspective.

Dr. Crutchfield had nine exam rooms. And he had a small platoon of medical assistants and nursing assistants. He was very successful. His approach was, “I do nothing that you don’t need a medical degree to do.” He examined patients and then had his medical assistant as a scribe who took care of all the notes and all of the coding. This is one of the reasons why he never went to private equity.

He taught as an adjunct professor for a class of pre-med students at Carleton. And he came and said, I’d like you to be a guest lecturer, and I’d like you to teach the students about the Affordable Care Act that was being, at that point, first being proposed. And I said, well, then I suppose I should probably read something about the Affordable Care Act, because I don’t know anything about it. I brushed up on that to be able to go in and give that class. So, I did that for over a decade.

From the first class that I provided a lecture to the last one they had gone from about 50-50 wanting to establish their own practice the first year to two kids out of 30 that wanted to have their own practice. They all wanted to go into a system, into a hospital, something where they just went in and practiced and somebody else took care of all the noise.

You see in my background, I put the greatest doctor that I’ve ever known, Doc Baker, from Little House on the Prairie, as my backdrop back when that was the practice of medicine. It’s a very, very different world for what young physicians are looking to do and expecting to do. It would take somewhat of a cultural change to get to what you’re describing.

Back to the cross-examination part. You referred to the European model where there are price controls. And then you referred to the free market as a way of controlling cost and promoting quality. Those two things are diametrically opposed. You’re not going to code, but you’re still charging the patients and then the government for medical care, if you’re not working off of a coding system, how will people be billed for care and how will the government be billed for the excess cost of that care?

David Allen: They’ll do it their own unique ways, according to their practice. One clinic will offer concierge care for whatever you need for $200 a month. Somebody else will say it’s $60 a visit. Somebody else will say, I’m going to charge you for how much time I spend with you. There’ll be lots of different ways that people will charge. But the point is, it’s the patient who is using their card from their pocket and shopping for the care that they want.

If they want fast, convenient care, they’ll go down to the place with the plastic chairs and sit and wait a while and only be charged $50. If they want to spend some time with their physician and a real physician and get the advice. They will spend $300 to do that. It will be up to the prudent purchaser of care and the physicians who want to market to those prudent purchasers of care to define how care will be provided.

Bob Koshnick: Darrin, I agree with you about the change in culture. When I went into practice we all expected to go into private practice. Now big systems have taken over, and medical students expect to be employees. There has been an 800% increase in Direct Primary Care since 2017, so maybe there’s been a movement back towards private practice, in part because of the high burnout (and moral injury) of the corporate practice of medicine of big systems.

Wayne Zuehlke: Just a couple of comments on David Allen’s, if I could just take a minute. Yep. As I understand it, based on first, one of your examples. For the lady who makes $50,000 a year would max out at $5,000. And then above that, the government would pay. Is that correct? That’s correct. The way I’m looking at it from her perspective, once she’s above $5,000, she is not motivated to save any money, because she knows the government will cover it.

Lee Beecher: And that’s a problem.

Wayne Zuehlke: And, given the—maybe if she wasn’t quite honest, she might have a second cousin who’s got an autism clinic, and she could take her kids there, being a little cynical about it. But that’s kind of an issue with it.

On Greg’s point on the disparity between what Medicare and private pay, Medicare and Medicaid.  A weeks ago, I looked at Hennepin HealthCare’s financial statements for 2024, Hennepin HealthCare’s 71% Medicare and Medicaid, so I don’t see how they can survive, and on top of that, they have $100 million in bad debts, so that seems to be the source of their problem right there, so that’s all I have.

Bob Koshnick: Scott Jensen, can you introduce yourself.

Scott Jensen: I’ll just make a few brief comments. And thank you, David, for writing the intriguing and provocative essay several weeks or months ago. And I appreciated Darren’s cross-examination as well.

I have three children, girl, boy, girl, an anesthesiologist, a lawyer, and a family doctor. The anesthesiologist works for a large system, and she likes that. She has book ended shifts. She starts at 6 a.m. She’s done at 6 p.m.

My youngest, the family doctor who works with me, does not have bookended shifts. Sometimes, her patient’s needs spill over into the evening, and it interferes with her ability to put her three children to bed. She, for whatever reason, has embraced that, perhaps because her father embraced that.

David, I think the ship has sailed in terms of changing the mindset of young physicians coming out. I don’t think it’s going to work. I think that 80 percent of physicians or more are employed, and I don’t think that’s going to change. I think people want a lifestyle, and I think the days of Marcus Welby are gone.

When I look at a model that might work, I always think of my wife, because Mary’s a veterinarian. And most people, when Mary was taking care of clients that owned pets, the pet owners knew that when they bought a dog or a cat in, there would be some obligatory annual and predictable expenses, heartworm, vaccinations, and examination. And that was not something they ever expected insurance to cover. But during Mary’s career, she saw the advent of catastrophic insurance for these animals. If the hunting dog got his leg ripped up by a barbed wire fence or was hit by a car, there would be some kind of insurance.

This group has talked for years about catastrophic insurance and direct primary or concierge care which you’ve mentioned, David. I think that that’s where we must go. What we’ve done is we’ve slid into sort of restaurant modality where patients come to the doctor’s office thinking that there’s a menu that they can order from. Do they want an appetizer, an entrée, a dessert or just a beverage? I think physicians need to say, no, I don’t think an MRI is indicated. Physicians need to not be involved in that transaction that goes on between them ordering an MRI and them profiting from an MRI. We must absolutely put a firewall between that.

I think what’s happening in the healthcare field today is that physicians are going to be rewarded for their brains and their hands. What we can do with injections and surgery and thinking things through. I think Dr. Crutchfield is right. He shouldn’t be doing anything that someone else could do.

I was intrigued by what you said, David, that there was a certain simplicity in having a credit card that was devoted to healthcare and having people oversee their own expenses. I’m convinced that the person who most closely follows the recommendations and the algorithms that Blue Cross and UnitedHealth come up with are not the healthiest people. A lot of times the healthiest people are the ones who strike out on their own and say, I’m not going to turn over or abdicate my responsibility for my health care to anyone else. I’m going to make my own best decisions and be that as it may, I will accept the outcome.

Quick example, 18 months ago, I tried to show my six-year-old grandson how fast his grandfather could be in a game of touch football. I tore all my hamstrings. At the time, I thought, I’m invincible. I will heal. I didn’t go to the doctor. I just called the orthopedist, told him what I did, showed him my bruised thigh and said, what do you think? He said that most of the time it healed. 18 months later, I continue to have difficulty. Now I have an MRI. It shows that there’s nine centimeters of retraction. The only way you could do this surgery is to use cadaver parts, and it would be very complicated surgery. At the age of 71, I think it would be a bad investment. So, I said, no, thanks. I’ll just be a little slower than I used to be. I take responsibility for the decision I made 18 months ago and can live with it.

I really think that patients are well equipped to make life-or-death decisions. In the emergency room, people need an emergency doctor telling them that their troponins are negative, that they haven’t had a heart attack, and that they’re not in congestive heart failure. Of those emergency situations where there’s no way in the world anybody would want to shop because it’s crunch time. But in most situations patients can be shoppers and doctors should be able to say what they think. I think we can sell that to the public because it makes so much sense.

When we get mired down in this or that or the other thing, we lose our audience. Bob Geist has made the comment numerous times that what has really driven our system wrong is taking the patient out of the payer equation. He has talked about it being the driving force of overutilization and inflation. I think he’s right. We utilize too much health care that doesn’t amount to a hill of beans in terms of enhancing a patient’s health.

So that’s all I really have to say. I’m fascinated by the conversation. Legislators don’t get it. They don’t want to get it because once you get an election certificate, you’re fully confident that you have now joined God’s greatest creatures on earth. And Nobody can teach them anything.

Bob Koshnick: Scott, you’re no longer one of them, but that’s right. John Diehl, can you introduce yourself and takeover?

John Diehl: I’m John Diehl. I previously typed up some notes of my reaction to David Allen’s essay. [see attachment].

I guess I’m echoing what others have said. I thought that this was very interesting, very thoughtful, and reflected some key ingredients as people work to improve our system. I feel that our medical care financing system must change. But I think that we’ve been trying for 50 years to change our system through the money end has ruined our healthcare system.

The big picture thing is that medicine must be put back in charge. And when I say that I think of a profession where everybody, when they graduate from medical school, takes a solemn oath that becomes a part of their being. That they then spend the rest of their professional life trying to live up to that.

And with people watching, largely peers, peers, but not just peers. With people watching, to make sure that the oath is honored, I think we build a system from that. That’s the imperative. There are all kinds of other examples of where we’ve turned policy over to, in essence, we’ve relied on professional standards and professional people.

I look at the legal profession. I feel we’re at risk of being taken over by capital. If that happens, it will ruin the legal profession. The legal profession is a group of men and women upon which our entire system of business and government depends. We’re regulated by the Supreme Courts of various jurisdictions. We bumble along. Some people spend a life with a marginal income serving the public. Dome people are opportunistic and make a lot of money by not doing anything they’d be proud to tell their mother.  We have a cadre of thousands of people that are dedicated to taking care of their business. Medicine did that from its emergence in its modern form 100 years ago, until we started screwing around with it 50 years ago.

I don’t think that the public knew what medicine really did. I don’t think that a lot of people in medicine really understand the whole system. People didn’t feel a need to educate the public, guard what was there, or work against the weaknesses. Therefore, we lost it. I focus on the earlier part of the essay about the goals of the system and the characteristics that we ought to strive to have.

I am troubled by the idea of a monolithic payment system. I also have a philosophical problem with mixing up our government revenue system, i.e. taxes, with our government’s social support. The Affordable Care Act’s premium subsidy is a negative tax. You get money instead of paying money. It destroys all discipline in the way we look at our government and our life.

I have philosophical problems when your tax obligation is really a source of money to you. I believe that the government has important roles in our healthcare system. But we must limit the government to those functions. When they get outside of those functions, they start putting the thumb on the scale. The government is the ultimate safety net. My personal point of view is that we should let the financing take care of itself

My first job was as an assistant attorney general in Minnesota. My client was the insurance industry. It took me a long time to realize that insurance got deregulated. We should remember that insurance got regulated in the first place because a hundred years ago it was one of the largest scandals. And then insurance companies became subject to regulation of adequacy of capital, solvency, business practices, and so on.

When I represented the department, an insurance company would come to the department with an actuary. The department had an actuary. The company had to prove their rates were neither excessive nor inadequate, and that the amount that they planned on making was not too much by actuarial stuff. Two very smart math guys would sit there and work it out. So, in healthcare there were regulated rates for covered service. The rest got taken care of out of your pocket.

We got away from that. Maybe we don’t want to go all the way back to that. But I feel that that’s the kind of thing, a mix of payers with different focuses of regulation, is a better way forward on the finance side.

Bob Koshnick: John, when’s your book coming out?

John Diehl: I have a hybrid publisher, and he promises me July 31.

Bob Koshnick: Greg, are you there?

Greg Dattilo: Thanks for having me, and this has been an unbelievable experience listening to all the different views from everyone. My view, of course, is going to be a little different because I basically come from the insuring people for 50 years, and I’m on the front line of employees and their issues with the system.

And, of course, it’s always price, the cost. John was just talking about the regulations. Well, I don’t know if anybody knows what PCORI is. That’s the Patient Centered Outcome Research Institute that was done through Obamacare. It has about 30,000 pages of cookbook recipes of medicine for insurance companies to follow. That’s why you get so many consumers upset with getting things approved the first time around. The doctor, who usually knows more than the cookbook, says, oh, no, you don’t need to do that, let’s just do this. The patient agrees, and then the claim goes into the insurance company. The insurance company has staffer saying you didn’t follow the recipe, so we’re denying the claim. That was created by the government.

I live down in Lee County, Florida. Guess what the annual premium for a platinum plan under the ACA Act is?  If you go to the healthcare.gov and you put in my zip code of 33913 and you sort by Platinum Plans, they have a plan for a family of five. That’s two spouses, age 50, and three children, 16, 18, and 20. The annual premium, I know you’re not going to believe this, which is why I told you to go to healthcare.gov and put zip code 33913, and you’ll see the annual premium is $140,397. Okay, it’s a joke, right? Well, that’s again with government driven healthcare.

David (Racer) has been working with the hospitals, and their facility charges that nobody knows about. A facility charge was the beginning of the end of what the small private practices were because providers weren’t stupid.  Provider, as Dr. Jensen says, wanted predictable hours where they can make more money if they join a hospital staff position. The large corporate healthcare systems copied the regional health plans that Hillary Care was introducing back in the 90s, which never even got a vote because it was political suicide.

Hillary’s bill was 1,300 pages. Obamacare was a 2,600-page bill. It reflected everything in Hillary’s bill except one thing that they needed to get insurance companies to go along with it. Hillary Care didn’t make it was because of the “Harry and Louise” ad around the kitchen table that talked about you’re going to lose your doctor.

To make a long story short, government did what, okay? They were going to get involved and eliminate insurance companies at that time. And the insurance company said, no, no, no, no, no, we’re going to fight you. Well, they won, but Obama knew that. So, what did Obama do? He put in what’s called a minimum loss ratio, an ML. Which says to insurance companies if you come in, we’ll trade off covering pre-existing conditions with the minimum loss ratio.

The public wanted pre-existing conditions covered. The insurance companies know that people will select against them. They won’t buy insurance until they need it, and then they’re going to be selected against. Just like a person on their deathbed that wants to buy life insurance. Nobody’s going to give you a life insurance policy on your deathbed because it’s an adverse selection.

Insurance companies know as a basic rule, you can’t have a selection against you at the time of need. A long story short, what happened under Obamacare is that to get the insurance companies to jump on board Obamacare guaranteed them a profit. They guaranteed under the minimum loss ratio that they kept 15% to 20% of the total amount of claims. That’s minimum loss ratio. No other business has the government guarantee you can make a profit. That’s how Obamacare passed. The insurance companies didn’t fight.

Insurance companies knew the government could eliminate them at any time by kicking us out. Here we are guaranteed to make a profit. So, I see so much of the brokenness in our private health care system is due to government. And I know Don Kollisch is going to totally disagree. I would love to hear from him regarding this.

Everybody talks about simple transparency. KISS is what I live by. Keep it simple, stupid. If we do what I wrote in the last book, what’s your number? Everybody’s got to present what their number is. And that number, if the number is 300, if the number is 200, which one costs more? Oh, 300, not 200. If your number is 100, 150, it’s the same exact way that insurance companies now have been negotiating with all these lousy networks that everybody hates because everything’s in secrecy. You don’t have price transparency because of networks.

Doctors can’t tell anybody what the price of care is (even if they want to because they do not know the cost of what they order). If we really want consumer-driven health care, you must first know what the price is before you order it. I have got to compliment David (Racer) for putting his hand in here on the complexity of 161,000 billing codes that’s over the top.

The Affordable Care Act has not controlled health care costs. A single-payer system is not the solution. And consumers are generally more engaged when spending their own money. It’s just how are we going to get there?

Bob Koshnick: Greg, can you go through the reference-based pricing a little bit more?

Greg Dattilo: Reference-based pricing is where an insurance company tells you, the provider, we’re going to pay 180% to hospitals and 140% to providers (of Medicare reimbursement rates). It’s in a free market. I want you, the providers, to tell us what your number is.

Nobody has control over it. So, if you want to charge 300% of Medicare, go right ahead. If you want to be an anesthesiologist and charge 1,000 to 1,300% of Medicare, fine, do it. It’s up to you. But what’s going to happen is that everybody’s going to know your price instantly on health information exchanges where you must report by October 1st to the health information exchanges what your number is. If you want a number of 200, that’s two times what Medicare allows. Fine. Right now, the average is 250%.

David (Racer’s reference based) proposal used Medicare, even though we are getting rid of Medicare. But right now, if we used a Medicare $116,000 reimbursement, private insurance right now, on average, pays $290,000. There’s a large loss of revenue when the government becomes the payer (Medicare pays 70 % of private insurance). Medicaid pays 70% of Medicare. It’s a joke. We know that the healthcare system would collapse if we went to a Medicare or Medicaid reimbursement because it’s the private sector, what I call a hidden tax, that’s bailing out the government’s low reimbursements.

And that’s the problem. People must know this because as soon as they go, well, what’s 200? Well, what’s the government Medicare? Well, that’s 100. Well, why am I paying two times that? You know how many times I have told employees in employee meetings saying you know why your healthcare costs so much is because Medicare pays 100 bucks and your private insurance is paying 250 for the exact same CPT code? They go, but that’s not fair. I go, yeah, I know it’s not fair, but that’s how the system is.

It’s all in secrecy. The corruption is. And, you know, providers that charge unbelievable rates, there’s no way of the consumer knowing it as long as they’re part of the network.

And I agree with David. The network was created by the HMO Act with Nixon. They required employers of 25 or more to offer an HMO plan if there was one.  It’s government interference again. I’m sorry, I’m not a government guy because I know how hard it is for the working staff to make a living in paying the high health care premiums that, on average, you’re paying 25 to 30 percent, and the employers paying 70. But as we all know, it’s out of their wages.

(Our book) Entering the Golden Age of U.S. Health Care, the Blueprint, requires price transparency.  It’s simple. Everything is simple. The reason it’s simple is because unlike how the system currently works right now, we’re going to make it transparent, where everybody can see what’s going on.

 

Robert Geist Presntation: See the attached slides: 1-click opens with “Slide Show” view to best follow the narrative.

 Several things to talk about. The first number is what does Minnesota Health Care insurance cost in 2024 for a family of four? It’s about $25,000. The car insurance for the same family costs About 5,000. Now you figure out where the difference comes from.

And I want to compliment David on his presentation and his ideas on what I call a replacement revolution of the managed care Goliath. There’s the battle, David. And it’s you and us versus Goliath. And don’t bring a slingshot to this knife fight. I’ve also want to look at the system once the Goliath is gone and see how it might evolve.

1^st, I noted that retail markets caused prosperity compared to the poverty of state social engineered managed markets ala the old Soviet Union up to 1991, and the UK up to 1980. I then examined the timeline of our US medical system’s premium cost inflation between 1879 and 1988 from 0% to 18%. I recounted the fed1942 and 1965 interventions that resulted in abrupt post-1965 fed subsidized demand inflation. An inflation that was uncontrolled by subsequent 1973 “managed care” corporate obsessive “cost control” through rationing access. It failed.

2^nd, I then showed how inflation impoverished families, our hospital corporations, professional care givers, and the nation while the system itself was awash in money and PE predators descended to suck up the extra juice.

3^rd , I depicted the failure of US corporate and NHS cartels abroad to control cost inflation and its poverty. The US version developed a similar massive costly bureaucracy to unsuccessfully control cost through rationing care. The US creation of a belated HMO nirvana time developed from 1988-1994. It was depicted in David Himmestein’s graphic showing the US post 1970-2009….3,000%+ growth of bureaucracy, 2,300% inflationary growth of spending, and a miniscule growth of providers of care.

The success of unleashed HMO corporate draconian rationing to control costs from 1988 to 1996 was shown to be transitory as people around the nation cheered vilification of draconian rationing in the 1996 movie “As Good as it Gets”. The “black hat” corporations quickly reduced rationing as state legislatures passed patient protection acts. The result was return of cost inflation to 15.5% by 2003.

Congress then created a 2004-2009 era of a free retail-like medical marketplace of real service prices for professional care and indemnity catastrophic insurance legislating HSA-HDHP style insurance. By 2009 this era had almost killed the more costly HMO comprehensive “corporate care” system through premium price competition from affordable real (indemnity) health care insurance. An era killed by 2010 regulations to clear a path to Obama’s “affordable” more powerful fed-corporate-cartel care collusion for “cost control”. It too has failed. Premiums and taxes rise. Service prices remain hidden. A neat bait and switch game.

David Allen’s concept of eliminating costly corporate care while funding patient/family care has great appeal although Noal Collis did quip, “A government backed credit card– what could go wrong?”

A possible wise addition to Allen’s proposal might be improved by addition of a secondary market of indemnity insurance protecting families from catastrophic expense—after all, there are million-dollar illnesses.

4th, I then speculated what would happen if Allen’s fed program eliminated the CPOM. Would the medical sector be like other retail sectors where we buy refrigerators, autos, houses and their insurance?

Next, a caveat arises from Allen’s proposed price fixing to control “price gouging” when following the program’s money flow. Also, would absence of corporate palaces frighten medical service providers (comfortable with regular hours and pay), or HC gurus, and the public, who enjoy the appearance of “free” covered expenses?

The problems of Allen’s proposed price service price fixing and of assessing the role of high low family income levels might beget complex and troublesome IRS regulations. Total program costs were discussed pertinent to a new federal program replacing the old federal dystopic managed care model. My calculations of total annual up-front fed costs of Allen’s proposal are: $8.85T/year ($25,000 X the US 340,000 population) vs $5.28T spent 2024.

5th, Are there simpler alternatives to a new federal replacement program? This group’s November 2025 discussion of 5 compatible means to eliminate the CPOM were recounted. Would they simply create affordability through eliminating the CPOM complexity, i.e., through elimination of costly large, coalesced powerful fed-corporate-cartels employing various profiteering scams? Why not? The free medical market competition era of 2004-2009 demonstrated such affordability free of expensive corporate care rationing.

6^th, I then examined the predictable evolutionary system response of medical institutions and of US families being the new kings in a medical system enjoying affordable indemnity insurance against catastrophic illness expense. Then I examined the predictable evolutionary providers’ response, when corporate ACO palaces became medical office buildings. The predictable evolution would be that medical staff became possible mini-Park Nicolett or Mayo-like clinics while many independent clinics of all kinds evolved including mixed or solo specialty clinics of surgeons, internists, FP, Derm, OB/Gyn, etc., in various forms. Forms including simple FFS clinics, or Direct Pay Clinics (DPCs) with monthly or annual fee Concierge clinics. That’s how all free FFS retail affordable markets evolve. That’s what makes predictable the nature of a free retail medical marketplace.

7th, I again recounted how retail markets caused prosperity compared to the poverty of state social engineered managed markets. I implored each of us to use our various talents, abilities, and available time to eliminate cartel managed care; that would make possible an evolutionary restoration of a professional patient-centered medicine.

 The irony is that we’ve got poverty for everybody, except the system is full of a zillion dollars, and the PE people, vultures, are ready to suck up the juice. What’s the solution? David has already said it very nicely. Eliminate the payer corporations and empower the families with the money, not the corporations. RWG

Continued Discussion, Commentary and Critiques.

Bob Koshnick: Thank you very much, everybody. Good job.

The basic idea that I had in the book that I wrote, Empower-Patient Accounts Empower Patients, was to fund money so that everybody could have a Health Savings Account and could afford to buy direct primary or specialty care.

I don’t think direct payments should cover everybody. People that can afford it have the ability to put their own money into health savings accounts and should be empowered to do that. People can put $4,400 into a single account and $8,759 into a family HSA. If you’re 55 and older, you can add $1,000. I think those figures should be doubled.

It might be possible to superimpose David’s system for people on Medicaid and Medicare patients. It would be one way to do away with the corporate practice of medicine. It basically simplifies the system by cutting out the middleman.

I am hoping that we can get everyone in to comment. Rick Morris, you had a lot of comments. Do you want to chip in? What’s your impression?

Rick Morris: Well, thanks, Bob. It’s late. I mean, we’ve been at this—my rear end is getting tired, not to mention my brain. But I hope David Allen has gotten some feedback that is useful. And David, if you wouldn’t mind— we hope that you continue the path for a little longer before you abandon it, I think we’d all be the better for that.

What I was going to comment briefly, very briefly about this evening, is that everybody sees the elephant from a different angle. Some of us emphasize payments. Some of us emphasize patient empowerment. Some of us emphasized doctors not being employed and being able to practice their profession. We’ve got multiple perspectives on all of this. And I think it would be great if somebody could pull those perspectives together. We’ve got a three-legged stool we’re looking at.

Donald Kollisch: We need to have somebody realize that no one perspective is going to carry the day. No one perspective looking at the elephant is going to characterize the elephant and improve it. It’s got to be a combination, the best of all three, but not a total prerogative of any one of the three. And that’s where the difficulty is. I don’t know if there’s an answer to it, but I think David’s approach came the closest that I’ve seen to balancing the three legs of the stool.

Greg, what I think is missing from your analysis is looking at the actual costs of care. You talk about Medicare’s reimbursement rate being 70 cents into the dollar and Medicaid’s being 52 cents on the dollar, the actual cost of care and commercial insurance paying 92 cents on the dollar, the actual cost of care by a lot of studies is in the range of about 73 cents of the dollar that is being charged. It’s really the payer mix that we must talk about. But I think that’s another side conversation. I’d like to focus a little bit more on David’s proposal.

David, the big question I have is twofold, two questions. One, do we really believe that the healthcare marketplace operates as a free market? Does it operate the way that we’d like it to, with appropriate elasticity, and that we all as consumers will make the choice that’s best for us and that the market will balance things out?

Kenneth Arrow has been telling us since 1963, and backed up by other health economists, that the healthcare marketplace does not operate the way that the automobile or the candy bar marketplaces work.

That when we are sick, we cannot shop. And I’m agreeing with all of you that the corporate practice of medicine is taken over, such that the combination of the corporate, but apologies, Greg, AHIP, and with apologies to those of you who are hospital-based, and I know that the hospitals collude in the corporate practice of medicine. And because of the power that they wield, that the marketplace is now even less balanced and less well-functioning than it did in 1963, when Kenneth Arrow pointed that out.

The other point that I’d like David to comment on is your belief, and I’ve heard it echoed by a couple of other people, that patients need skin in the game. Otherwise, they consume too much health care. And my own experience as a rural family doctor is that the last thing my patients want is more health care. None of them want to spend extra time waiting in my waiting room for trivial things. They don’t want an MRI if they don’t need it.

Robert Geist: On skin in the game, and these are multiple, both U.S. and global studies, that patients respond to that not only by having less inappropriate care but also deny themselves appropriate care and end up with higher morbidity and mortality. David, the two questions I’d love to have you address: number one, what data do you have showing that skin in the game works? And number two, what evidence do you have that the marketplace will control quality and cost, as it does in widgets and Almond Joy candy bars? Medicine was once a microeconomic sector, not a government budget sector.

Bob Koshnick: There were two eras when it worked perfectly well and was affordable.

Lee Beecher: That was before 1965 when the government put its shoe in. The second era was 2004 to 2009 when there was a true free market run with HSA high-deductible health plans. So, the business that medicine is not like the regular market is not correct. That is one of the arguments that people often use that they want a single-payer government program.

We have government programs, but they don’t work. The microeconomic sector in a free society with the freedom that we have with our heritage in the United States, it would work perfectly well. So, I’d have to disagree with what you said about the system itself, but thank you very much for your comments, Don.

When I was on the Republican Health Care Task Force years ago, we decried the loss of the individual risk assessment, and I think that’s where insurance lost it. We must be willing to look at the potential costs in the best way that we can if we’re going to have insurance. And looking at these very, very high bills now that the families are having to pay, the middle class or the employer has to somehow pay for that.

Noel Collis: There must be a way to do individual risk assessments if we’re going to have a marketplace. The second point I would make is that I do think that people on Medicaid are needy people many of whom are poor, but some are disabled as well. So, we’ve got to have a system, a government system, that picks up that population. The trick is phasing that into a middle-class situation where there is skin in the game. We can have insurance that families can pay for. Ideally, different states would be able to develop their own systems.

Robert Geist: We ought to think about the concept of each state having its own system.  If Washington State wants to have one like Cuba and North Korea, let them have it. If Idaho and Wyoming want to have a traditional system that helps the truly needy and working people, let them have that. The idea of putting more government and corporatization into this equation or a Washington-centered approach is going to simply compound the problems that got us where we are right now.

You said, what could go wrong? Lee had some very good points about the public sector in Medicaid. Senate file 1261 does what everybody here is talking about. It gives money to the enrollee. I’ve sent out the handout for that many times, and I hope some of you have seen it and read it, but it gives the money to the people, the enrollee, for outpatient care. Their debit card never runs out of money. If they use it all up, the state simply picks up the tab.

Secondly, if they don’t spend all the money, they get to keep what’s left over. The amount given on the debit card is about 40% of what it costs the federal government to fund a Medicaid adult patient or child. So, there is a way of funding the enrollees with money, just like we were all talking about tonight.

David Allen: And they get to keep it if they don’t spend it. So, there’s a real incentive not to overuse it. I think there is a way out of our system with the Minnesota Medicaid reform bill. If we can take that and enlarge it and tailor it for Medicaid, we would have a free market system, or if you will, the kind of system we want with patients with money and catastrophic care covered.

And we could do it with an HSA-like program for the United States. And I think that’s what I hope that Steve Parente is going to be trying to get into legislation. Unfortunately, he isn’t here tonight to talk about that. But anyway, thank you, Lee. I think you had some good points in the public sector.

Can I just briefly respond to Don’s questions? In regard to the proposition that was famously made by Ken Arrow in 1963 that healthcare is unlike other things and can’t be, people can’t choose healthcare appropriately or be effective purchasers of care, I reject that premise.

I think there are lots of things that we buy that we don’t fully understand. I think of car repair for me as an example. I think of Dr. Jensen’s wife’s veterinary practice. I don’t know what veterinary medicine that my pets have needed requires, but I know I feel comfortable shopping for it.

The same with health care. There are lots of things that we don’t know. There’s a scale of things that we’re perfectly capable as human beings to purchase that we don’t fully understand. And as for the issue of, what was the other issue?

Darrin Rosha: The other issue was “Skin in the game.” The question there is, who’s going to make the decision? The best people to make the decision are the patient and their physician.  Third parties should have no place in it. The solution of having an insurance company or a government program like Medicare make decisions instead of the patient and the doctor, I think, is inferior.

A lot of good comments tonight. Thank you very much for inviting me. You’ve given me a lot to think about.

I’d like, if I can, to say a couple of things and challenge some premises. I struggle with the idea that we call access to healthcare a right. We assume everybody should have a right to great medical care and essentially the same medical care. But somebody in Nimrod, Minnesota, is not going to have access to the same kind of out the door care that you get if you live in the Twin Cities or in Rochester. We have to accept the fact that there are going to be differences based on choices that people make.

If you took the same approach to other rights, like the right to free speech, if we took the position that the government has an obligation to make sure everybody has the same ability to get their opinion out through ads or letters or otherwise through the Star Tribune, and anybody, no matter what your income level is, has a right to put your message out the same as the tremendously wealthy, it would be just a crazy system.

Almost everything we talk about has that third party being part of the discussion about what the care should be and what the care should cost. What’s happened with tuition when the government got involved by putting money in there? All it did was drive up costs but nothing else changed. It just meant kids now were leaving with $80,000 in debt for a bachelor’s degree, which used to be reserved for you medical types.

You have a mandatory product that everybody must buy through Affordable Care Act, for instance. If you put all this money in, you’re going to have a really hard time controlling these costs. You’re going to have a lot of people running the system that have almost no incentive to control costs.

And so rather than trying to give everybody this even playing field, which of course we can’t, like I said, because not everybody has the same access to the facilities across regions, but providing access to a base level of care that reflects the fact that, you know, people will choose to make different decisions much like Dr. Jensen did when he chose not to have surgery at his age under those circumstances.

People have a right to pursue care as opposed to having care delivered. That is the only way that you’re ever going to get any market forces controlling the prices and providing incentives (to limit demand). DR

Bob Koshnick: Vince Hunt. I’d like to hear from you. I haven’t heard from you in a long time. Are you still on?

Vince Hunt: Yeah, I’m still here. Can you hear me? It’s getting late. I’ve been following this for some time as well as you, of course. But I do not have any specific words of wisdom right now, thank you.

Bob Koshnick: I would like to maintain the health savings account and try to incorporate it into your system. I think it’s a great idea, but I don’t think it should be a monolithic one system for all.

Donald Kollisch: But I think it could very well fit in very well because it gets rid of the corporate practice of medicine. And I think it would dramatically decrease the cost for many of the reasons that you point out.

Bob Koshnick: I hope I can stay in communication with you.

David Allen: Absolutely. Thank you, Bob. And thanks to everyone.

Robert Geist: Thank you, everybody. This has been very interesting, as usual. A lot of good minds. A lot of good ideas.

Don Kollisch: Thanks to all of you for letting me visit from the East Coast. You guys in Minnesota are damn wise and smart.

Bob Koshnick: Well, you filled in for Kip Sullivan. He wants to wait until the dust has settled to see if something there still there.

Don Kollisch: Well, if you if I can compare in any way favorably to Kip, then I’m honored. Thank you.

And I want to say to Vince that 30-some-odd years ago, you were a wonderful influence on my professional life.

Vince Hunt: Thank you for that. Oh, my gosh. Thank you. Thanks/Bye/Arrivederci.

Respectively submitted,

Bob Koshnick MD

Secretary pro tem

Two Post Meeting Observations

1. Robert Geist’s final analysis: We heard Dr. David Allen’s proposal for legislation with the worthy goals of giving people the wealth they need for medical care and of ending the corporate practice of medical care (CPOM) that has caused much dystopia (poverty) for patients and professional provider hospitals and medical staff. Allen’s proposed legislation has some problematic complexity including price fixing to eliminate “price gouging”, high upfront annual costs, and IRS regulations related to family income. The nation’s medical affordability (prosperity) depends on developing a non-legislative, non-complex, evolving restoration of an affordable retail marketplace of professional care in the absence of costly “corporate care”.

Discussed were means to achieve a retail medical marketplace evolution of patient provider choice and of real service and affordable indemnity insurance prices. The battle for a restored professional retail medical marketplace will be fraught with powerful political opposition from federal-corporate-cartel interests threatened with loss of profitable political and financial control of medicine. Is change possible? Why not?

System change is possible once “corporate-cartel care”, which takes up all the oxygen, is eliminated. There are at least 4 compatible suggestions of how to replace the current costly system of rationing care.

Once patients and families are empowered by not having their medical budget taken away in taxes and/or from their wage, individual patients and families will find affordable care from professionals dedicated to the ancient covenant of exclusive loyalty to the interests of each patient.

Bob Koshnick’s final analysis: David Allen has presented a system that would increase price transparency and individual choices. This could directly undermine the rent-seeking corporate practice of medicine we now have by promoting price transparency, discouraging the open-ended demand of Medicaid and Medicare for limited medical care resources, and offering another alternative option to the uninsured.

The risk is the likely attempt by the federal government to crush all other economic options to obtain medical care.  A state-run financing monopoly would limit capital investments and disincentivize innovation. Ultimately the quality and accessibility of care would decline as the state inevitably runs out of money. This is not to mention how state-run financing would inevitably be used to politically manipulate elections.

Ludwig Von Mises, the economist, noted that it is difficult to abuse people who have another place to go. That is a strong argument against instituting a monolithic health care system. He argued in his book: “Socialism: An Economic and Sociological Analysis” that socialism lacks a mechanism for rational economic calculation due to the absence of price signals. This results in misallocation and inefficient use of capital and services. Socialism stifles innovation and entrepreneurship by removing incentives for individual initiative. He argued that individual choices are essential for a functioning economy.

Ninety percent of the U.S. medical system reimbursements are through third party payers (private and public). Costs are hidden. There are incentives not to control costs with the minimum loss ratio in private insurance and open-ended access in Medicaid and Medicare. Cash only, cash with catastrophic coverage, and health savings account-based financing can force greater price transparency and foster greater individual choices that can meaningfully create cost consciousness and lower medical care costs. Making catastrophic insurance readily available can protect people from major medical expenses.  Health savings accounts (HSAs) and Bob Geist’s Medicaid plan effectively have health transaction cards. The government is the backup in Bob’s plan and private catastrophic insurance is with HSAs.

What if an incentive was built into David Allen’s health transaction cards by funding the government plan with $2,000 that individuals keep if they have no qualified medical expenses? People would likely pay for low-cost medical care directly to ensure that they would get the $2,000 yearly put into their HSA, which they would own. This could incentivize cost conscious consumer medical care and create a more efficient medical marketplace that would reduce the estimated third of health care spending that is a waste. The long-range goal could be to replace the soon to be bankrupt Medicare system with one where people have HSAs with catastrophic health insurance.

Addendum: MPPA 6/2/26 meeting Roster and Bios

1. David Allen S. Penn’s Wharton School, retired from a career that included HMO and medical group management, consulting, Executive Director of Minnesota Specialty Physicians and president of MPPA, author of “Dappled Psychiatric”.
2. Lee H. Beecher, MD: Past president and founder MPPA, retired private practice psychiatrist, former U. of Minnesota adjunct professor of psychiatry, author of Passion for Patients (2017), website; leebeecher.com.
3. Noel Collis MD– University of Minn. 1979- Taught one year in USD Medical School then went into practice in Little Falls until retirement in 2022. Helped develop a med pulse device company, Electromed (ELMD).
4. Greg Dattilo, BS, CEBS, the founder of Dattilo Consulting, Inc. and ClientServ LLC, based in Minneapolis, Minnesota, has served as an employee benefits consultant since 1975, working with employers of all sizes.

• His belief that better healthcare begins with transparency, choice, and consumer empowerment.
• Since 1991, Greg has also pursued a second professional passion: healthcare policy focused on strengthening the private healthcare marketplace. This mission is countering what he views as the massive expansion of government intrusion and the resulting erosion of the private healthcare marketplace.
• He has lectured nationwide on healthcare issues and co-authored six nationally distributed books with Dave Racer, together (with more than 150,000 copies in print). Their works include:
• Your Health Matters: What You Need to Know About U.S. Healthcare (2006)
  • Facts, Not Fiction: What Really Ails the U.S. Healthcare System (2007)
  • Why Healthcare Costs So Much: The Solution—Consumers (2009)
  • Why Healthcare Costs So Much: Government’s Real Role (2010)
  • The Manual—Healthcare 2020: Connecting the Dots (2020)
  • Entering the Golden Age of U.S. Healthcare: The Blueprint (Year 2025)

Greg earned the Certified Employee Benefit Specialist (CEBS) designation from the University of Pennsylvania’s Wharton School of Business in 1993 and was named a Fellow of the International Society of Certified Employee Benefit Specialists in 1995. He holds a bachelor’s degree from the University of Wisconsin–Stout, earned in 1975.

5. JOHN E. DIEHL, JD, University of Iowa (BBA 1964, JD 1969);
   • Special Assistant Minnesota Attorney General (Attorney for the Minnesota Department of Insurance and other agencies) 1969-1972; Private Practice,  Criminal Prosecution and Government Relations, 1972-73; Chief, HMO Unit, Minnesota Department of Health, 1973-75;
   • General Counsel, University of Minnesota Hospitals and Clinics, 1975-1983;
   • Private Practice of Law, Larkin Hoffman Attorneys, 1982- Present, with a practice focus on health care, and fifty years of experience in development of health care policy, regulation, regulatory compliance, and client advocacy.
6. Robert W. Geist MD: MPPA chief librarian, former pres. Ramsey Co. Med Soc., retired MN Urology clinician 1960-1997, and retired clinical professor UMN Dept Urology and author of “A History of the University of Minnesota Department of Urology: 1932 to 2012”.
7. Vincent R Hunt MD: Rural GP, 1960 – 69; further training U. of MN 1969 – 70; HCMC FM staff 1970 – 71;
   • Director Family Medicine (FM) Residency, St. Paul Ramsey 1971 – 86; Chair, Department of FM, Brown U Med School, 1986 – 2000; consultant to a variety of ministries of health and medical schools over the years;
   • co-author, “Improving Health Systems: the Contribution of Family Medicine” – a Collaborative Project of the World Organization of Family Doctors and WHO.
8. Scott Jensen, MD. is a Senior Fellow specializing in Family Medicine with over 35 years of clinical experience in Carver County, Minnesota. He is the founder of Catalyst Medical Clinic, a holistic and independent healthcare center with offices in Watertown and Chaska.
   • Jensen served in the Minnesota Senate from 2017 to 2021, where he was vice-chair of the Health and Human Services Committee, and was the Republican candidate for governor in 2022.
   • A respected educator, he taught at the University of Minnesota Medical School for over 30 years and was named Minnesota Family Physician of the Year in 2016.
   • Jensen is also an accomplished author, with books including “Relationship Matters”and “We’ve Been Played”
9. Donald Kollisch, MD Geisel School of Medicine at Dartmouth. Associate Professor of Medicine Associate Professor of Community and Family Medicine.

• Donald Kollisch is a family medicine physician and educator based in Hanover, New Hampshire, with over 45 years of medical experience. He has notably served at the VA Medical Center in White River Junction, Vermont, and spent decades volunteering at the Good Neighbor Health Clinic. He is also an active advocate for universal healthcare.
• Kollisch has dedicated much of his career to both clinical practice and academic medicine. He earned his medical degree from the SUNY Downstate Medical Center in Brooklyn and previously practiced in the North Country of New Hampshire. He is an Associate Professor at the Geisel School of Medicine at Dartmouth.
• Beyond his clinical work, Dr. Kollisch is heavily involved in medical advocacy and community activism. He is the Convener of the New Hampshire chapter of Physicians for a National Health Program (PNHP)and writes on issues surrounding the U.S. healthcare system, veterans’ health, and public policy.

10. Robert Koshnick MD: Graduated from Carleton College, University of Minnesota Medical School, and Hennepin County Family Practice Residency. Helped set up a residency program in Fargo, N.D., and then practiced for 44 years in Detroit Lakes. Author of 2019 Patient-Directed NIMBLE Healthcare; 2022 Empower Patient Account Empowers Patients!
11. Richard Morris, M.D. Retired internist – allergist – immunologist, Clinical adjunct professor of medicine at the University of Minnesota. Author of 41 articles. Former member of the Board of Regents of the American College of Allergy Asthma and Immunology.
12. Darrin M. Rosha JD: Private practice attorney in Long Lake, Minnesota, former General Manager and Legal Counsel to independent medical clinics, Regent Emeritus, University of Minnesota.
13. Wayne A. Zuehlke, CPA (retired), audited many Minnesota hospitals when he was an active CPA. and then left public accounting to become a financial officer of several publicly held  technology companies.