Minnesota Health Care Transformation Task Force: A sow's ear of corporate socialism

Driven by cost reduction, the recommendations of the Governor's Health Care Transformation Task Force, many of which are rapidly moving through the Legislature in health care reform bills, are, as I discussed in Wednesday's column, a fundamentally flawed approach to health care reform.

The Legislature charged the Transformation Task Force with reducing the cost of Minnesota's health care system by 20 percent by the year 2011, while increasing access to health care and improving quality. Should task force recommendations become law, state government and corporate health plans will make decisions about your medical care and set standards by which you conduct your everyday life.

The task force ignored economic factors affecting health care costs (including government policies) and instead focused on the very narrow assumption that the "culprits" creating rising health care costs are physicians who perform too many expensive procedures and the rest of us who live unhealthy lifestyles.

To control our doctors' and our personal behaviors, the Transformation Task Force would:

• Expand the concept of "public health" so virtually no behavior would be exempt from regulatory oversight.
• Radically reform health care provider pay by shifting "accountability for the total cost of care" from health plans to providers.
• Radically overhaul the insurance market by creating a nonprofit health insurance exchange that would de facto control the price and variety of insurance available in Minnesota.

For the layman, the most disturbing sections of the Transformation Task Force report are those that expand the concept of "public health" to include virtually any behavior with an impact on the cost of health care. Sure, Minnesotans would be better off if we were all a little skinnier, exercised a little more, smoked and drank a little less, and never strayed one toke over the line. Good health habits can prevent chronic diseases, and chronic diseases raise the cost of health care.

But do Minnesotans really want to live in a state that requires "the active engagement of employers, schools, communities and the health care system" to enforce healthy behavior? Is the body mass index of your children a matter of public health? Is it the legitimate responsibility of the Department of Education to "ensure that schools are held accountable for making progress on health improvement goals" (A No Child's Behind Left Behind Act)?

Does recommending the Legislature "encourage and/or require employers, schools, communities and health care organizations to adopt age-specific goals" for certain health conditions and diseases portend any consequences we ought to fear? (My emphasis added.)

"If we want to control costs, we need to stop adding more people with preventable chronic disease to the health care system," the task force declares. That idea is common to every resurgence of eugenics from Margaret Sanger to the Third Reich to the forced sterilization of 1,200 "feeble-minded" patients in Minnesota during the 1920s.

For now, the Task Force offers the unhealthy among us the opportunity for re-education and repentance — but what will Minnesota do with those who can't kick their unhealthy habits or the heretics who refuse to turn in their Milky Ways? What will Minnesota do with those who persistently, as Justice Oliver Wendell Holmes wrote upholding a forced sterilization law, "sap the strength of the State"?

Cost reduction also drives the way the Transformation Task Force misconstrues the meaning of common words.

The task force defines words in terms of costs to the health care system, not their meaning to an individual. Thus, it makes perfect sense for the task force to believe a board of experts should determine if new medical technology has enough "value" to be included in the system.

An example of this attitude is the reaction of Sen. Linda Berglin to a proposed private cancer radiation treatment center in Woodbury. Berglin served on the Transformation Task Force and is chief sponsor of the Senate health care bill. Berglin and other legislators supported a moratorium on radiation therapy centers to limit duplication of costly facilities and protect hospitals from competition for lucrative outpatient cancer services.

How can that be — when the Transformation Task Force report promotes "competition" and "patient-centeredness"?

"Competition" logically means individual health care providers competing for individual patients on quality and price based on the individual's conception of value — much like Lasik surgery works today. Independent Lasik surgeons have had to innovate, improve their procedures, upgrade their technology and lower their prices to attract patients. Lasik surgeons operate outside the managed care payment system.

In the task force world, "competition" is "managed." Under the task force payment reform plan, health care providers must bid as low as possible for a contract to serve a population of patients offered by a managed care organization. Think of it like putting out a bid to provide computer maintenance: The task force approach is health care on an industrial model where we carbon-based units are maintained and repaired according to the manual. Unfortunately, we are not all the same make and model.

In the task force health care system, a provider's profit depends on how "efficiently" it provides medical treatment. The provider can be "efficient" by developing innovative treatment methods or by rationing the treatment it provides. Which method the provider chooses has great consequences for the patient, but from the task force's perspective of keeping costs down, either approach would yield "high value health care."

And, lest the Transformation Task Force leave any minor detail of your life untouched, it would require every Minnesotan to have a minimum amount of health insurance, dictate to health plans whom they must cover for what at what price, and create a health insurance exchange that effectively would eliminate the role of private insurance brokers.

Wednesday's and today's columns have scratched the surface of the Transformation Task Force recommendations. They haven't touched the report's bureaucratic proposals, data privacy issues, the true costs of implementation or the biases of the organizations that guided the task force's process. Those are not minor issues, but as noted Wednesday, the devil is not in the details of the Transformation Task Force report — he is sitting in plain sight.

While claiming to be "market-driven" and "patient-centered," "competitive" and "focused on outcomes" and structured around "quality," "price transparency" and "value," the Transformation Task Force report is none of these. From the sow's ear of corporate socialism, one cannot stitch a silk purse "market-driven," "patient-centered" health care system.

The Health Care Transformation Task Force is not a starting point for reform; it is a dead end.

This commentary originally appeared in the St. Paul Pioneer Press on Thursday March 20, 2008.

Part One of this two-part series appeared in the St. Paul Pioneer Press on Wednesday, March 19, 2008.