Minutes of the October 11, 2023, MPPA meeting.
Hybrid meeting with the in person location at the Shoreview public library, 6 to 8 PM
In person attendance: Mike Ainslie, Twila Brase, David Feinwachs, Bob Geist, Bob Koshnick, Richard Morris, Wayne Zuelke; online Lee Beecher, Don Gerig, John Diehl, and Matt Flanders.
Invited speaker and MPPA member Twila Brase on “Three Decades of Health Care Changes.”
Twila Brase is president and co-founder of the Citizen’s Council for Health Freedom.
Twila started out by saying that her organization works to put the patient and doctor together in a way that will allow patients to get the kind of care that they need. Over the last several decades the federal government has interfered with the relationships that patients have with their physicians in their care, coverage, data, and public health.
The list of federal law interference in one or more of these areas is long: 1965 government Medicare and Medicaid in which the government set payment rates; the HMO Act of 1973 corporatizing medical care; the 1996 HIPPA that legalized data grabbing; the 2003 Medicare Modernization Act that enhanced managed care and introduced part D pharmacy coverage; the 2008 MIPPA that enhanced part D coverage; the 2009 HITECH Act that was another data grab; the 2010 Affordable Care Act that socialized medicine; the 2015 MACRA that further controlled physicians; and now in 2024 starting to impose Making Care Primary Model, which is forcing all primary care providers into accountable care organizations. Minnesota is one of the eight states that this is being tested in.
Twila then reviewed Minnesota Laws and Litigation. Minnesota stepped directly into health care with the passage in 1991-1995 of the HealthRight/MN Care bills. This was followed with the power grab of the Emergency Powers Act of 2002 and the “Best Practices” bill of 2004. In 2013 Minnesota followed up the ACA with MNsure and then in 2023 with the Surveillance Long Covid/Cancer bill. There have been some wins including the 2003 Baby DNA warehousing and opt-out bill, the Baby DNA lawsuit (the first in the nation), the MN Health Records Act, and a partial win with the 2023 Surveillance Long Covid/Cancer bill.
Twila pointed out that most legislation is not about care or coverage, it is about control. Everyone wants control, power and/or profit in our political corporate medical environment. “He who holds the dollars makes the rules.” No privacy = no freedom, outside controls, and government surveillance. Now the motto is: “He who holds the data makes the rules.”
Twila then went into the fact that HIPPA does not protect patient privacy. She handed out cards titled “Exposing HIPAA, The Deliberate Deception, a campaign that detailed this federal rule that “eliminated your privacy and allows outsiders to control medical treatment decisions.” She noted that when receiving medical care people are asked to sign off on HIPPA authorization. She suggested that people not sign that. Health care systems may threaten not to give care, but legally they must. The right to privacy was taken away when HIPPA allowed over two million entities access to our medical records, including government access. The P in HIPPA stands for Health Insurance Portability and Accountability Act, not privacy, which is how this bill was sold. The way to restore privacy is to require personal authorization to release one’s medical records to anyone. That is what HIPPA takes away.
There is a protected privacy area within HIPPA. That is anything related to Reproductive health care. This is a special “Protected Class” Designation as of 2023. This shields reproductive health from criminal behavior investigation, violation of laws (abortion/conscience/trafficking) and prohibits public health data collection. This is a tacit admission that HIPPAA does not protect the privacy of our medical records.
Seizing control of privacy means moving away from government control of payment, that gives them access to people’s medical records. The problem is that if people’s medical records are on electronic health records, medical record privacy is difficult. This is further compromised by the establishment of “quality (compliance) measures, physicians being replaced by non-physicians, team-based care, population health with social determinants of health and health equity initiatives.
The CDC is “focusing on efforts to improve data collection capabilities by accessing information buried in EHRs and utilizing cloud-based applications.” Scott Silverstein, M.D., health IT expert puts it this way: “Enterprise-wide command and control systems through which all medical transactions have to pass, control clinicians and clinical resources. They are beyond just a medical device. They’re really command and control systems.” He is saying that to control clinicians the government must control medical records EHRs.
To receive maximal payment, doctors must install government approved EHR systems, use it in a “meaningful” way, follow treatment protocols, report compliance, and receive good MIPS scores. MIPS payments is not only are based on quality and cost, but also on “improvement activities,” which duplicate board certification update requirement. The base score starts at 50%. That can go up to 90% of maximal reimbursement and an additional possible bonus to receive 100% by complying with advancing care information protocols.
The government control of health care payment interferes with the physician-patient relationship and the joy of the face-to-face relationship with patients that physicians enjoy, and why they went into medicine in the first place. These burdensome regulatory impositions on medical care lead increase physician burnout. Patients do not like it as physicians are required to pay more attention to documenting every detail of care into their computers rather than providing medical care.
Twila then put forward the “New Framework for Health Freedom!” A parallel system of cash-based, transparent pricing, patient-centered, privacy-protected, affordable clinics, pharmacies, labs, radiology, surgery centers, and hospitals. Instead of the triangle of patient-payer-physician, it is patient-doctor, patient-hospital, patient-insurer, patient-pharmacist, etc. What must happen is to put patients back in control of their medical dollars and spending.
Twila then reviewed the “Wedge Principles” Framework for Health Freedom: Transparent, affordable pricing. Freedom to choose. True patient privacy. No government reporting. No outside interference. Cash-based pricing. Protected patient-doctor relationships. All patients welcome. JoinTheWedge.com is where people can find clinics and physicians operating on these principles.
The CCHF (Citizen’s Council for Health Freedom) is working to build this parallel framework to not only promote this vision, but also to push federal and state legislative changes to allow this to happen. They are getting feedback from patients who appreciate the access to Wedge clinicians around the country. People who are interested in promoting her work can contact her at firstname.lastname@example.org, call the office at 651-646-8935, or go to the websites of cchfreedom.org, JointheWedge.com, or patienttoolbox.org.
Dr. Scott Jensen then gave a brief update on his lawsuit against the MN Attorney General and the MN Board of Medical Practice. An important date was to come on October 17th. They are arguing that the 6 board actions against Dr. Jensen were based on protected freedom of speech since they did not involve medical care related issues, but rather his personal comments on COVID related controversial issues. Another claim is that the Attorney General is not providing all the necessary information legally required, which is hampering their case.
The MMA does not have policy on Direct Primary Care. I worked with a direct primary care provider, Dr. Najaha Musse, and MMA staff member Adrian Uphoff to draft it, and then got the MAFP to present it. The MMA board will approve or disapprove it on November 4th. It was posted on the PULSE website and had high levels of approval from MMA membership. It urges MN to not consider DPC as insurance under the jurisdiction of the MN State Commerce Department, and that it was medical care. The IRS disputes that, calling it as insurance and thus not allowable for health savings accounts payments.
David Feinwachs then gave an extensive presentation on what happened to the Freedom to Choose bill in the legislature. It passed both the house and the senate committees but was taken out in the conference committee at the last possible moment. The gist is that the managed care companies get so much money from the 340 B federal drug program where there get drugs at 20 to 50 percent of their retail price but then charge 100 percent or more of usual retail price for enormous profits. Thus, they depend, with the full knowledge and support of the MDH, on this cash flow to stay profitable. I will attach the link to David’s excellent article with the introduction.
Unfortunately, we were not able to get to two very important topics. The first is the corporate practice of medicine doctrine. John Diehl gave an excellent written summary on the corporate practice of medicine. The question is whether it can be revitalized to return medical care to be between the patient and doctor, not the patient and the corporation/state.
The second is how so called “gender affirming care” should be handled. We hope to revisit both topics in our first 2024 MMPA meeting and have a local expert talk to us about non medicalizing “gender affirming care.”
Bob Koshnick, M.D.