Stan and Clarence chat with Minnesota Senator John Marty on the politics of health care and SF2955. Senator Marty (40, DFL) has served as a Minnesota senator since 1987, authoring countless bills. His current legislative concerns include Climate, Health Care, Economic Justice, education, economic development, environment, ethics, energy, criminal justice, social justice, racial justice, and gender justice. Listen along as Senator Marty details SF2955 and illustrates the politics of health care. Join the conversation at healthchatterpodcast.comBrought to you in support of Hue-MAN, who is Creating Healthy Communities through Innovative Partnerships. More about their work can be found at http://huemanpartnership.org/
Hello, everybody. Welcome to Health Chatter. Today's episode is on, imagine this, the politics, quote unquote, of health care. I can imagine all of our different subjects that we've talked about up to this point. There's been a political aspect to all of them or a policy aspect. And we'll certainly get into that with our great guests and many of our listeners will know what it is.
I'll keep it a secret for one more minute. So stay tuned. We have a great background crew. as part of our Health Chatter podcast. Our research crew involves Maddie Levine-Wolfe, Aaron Collins, and Deandra Howard. They do great background research and provide Clarence and I with some great talking points to ask and bring up with our guests. So thank you to them.
Our production manager is Matthew Campbell. He takes care of all the logistics. of getting our shows out to you, including putting a little music on before and after each show. It's really kind of nice stuff. So listen in on him. And he also has an announcement at the end of each of our podcasts that you should listen in on.
And then our marketing specialist is Sheridan Nygaard that helps us get the word out about health chatter in creative ways. So thank you to all of you. Clarence Jones, there are no words to describe you. You're a great colleague, friend, co-host. And we just got done saying it's been really educational just for us too, even though we've been in this healthcare field for many, many years together.
Actually, our combined years are probably more, imagine that, more than our guests' years that he's been in the Senate, but we'll get into that in a second. And then Then, of course, our sponsor is Human Partnership, which is a community service organization that services a lot of different populations within our community in the Twin City. Actually, is it statewide clearance? I can't remember.
Is it state of Minnesota? Okay, sorry about that. State of Minnesota, great partner. And it helped us with many of the logistics and background expenses as it relates to HealthShatter. So thank you very much to Human Partnership. You can look them up. It's on our website, healthshatterpodcast.com. And there's a link to Human Partnership for their website as well. So thank you to all.
Today, we're going to be talking about the politics of healthcare, and we have a really, really fine guest with us, Senator John Marty, who I'll tell you, I've known his name for a long, long time. He's been in the Senate for, oh my goodness, since what, since 1987? 1987, yeah. Wow. Okay, so let's see if I can do the math in my head. That's like 36 years ago.
And I will tell you this, I've been in healthcare a long time and it's not hard to notice the different areas that Senator Marty has been involved with, especially around healthcare. And I can honestly say that I can't think of one particular policy that I was on the other side of the perspective. when it comes to where he was coming from.
He's a fine, fine Senator who, in my estimation, really understands the ins and outs of what we're trying to accomplish in the healthcare arena and has done it with such grace and humility. And I must say, I would really call you a statesman when it comes to dealing with, certainly with the healthcare issues. You do try to work with as many people as possible.
And I've greatly, greatly appreciated your service, woe these years. So thank you for being with us. My pleasure. So, all right. Policy and health. Okay. Where do we start? So, you know, maybe the best way to get this going is, okay, so you've been in the Senate a long time. You've seen the ups and downs and sideways of health policy.
So give us a perspective overall, historically, on where you think things were where we are now, and then maybe a little bit of a vision on where you hope to go. So past, present, and future.
Sure. Well, I think as the medical profession and our knowledge of medicine has grown, we've learned, we've gone from ancient times or even much closer to ancient times than we want to think where we had really harmful medical practices like bleeding was going to solve illnesses until a hundred years ago.
I mean, it's literally modern medicine is relatively new and we've done incredible things, life expectancy getting much better, everything else. And I think here in the United States, we've got some of the best providers in the world and so on. Minnesota, particularly, we've got some of the best medical professionals, doctors, nurses, researchers.
It's got some of the best facilities in the world, some of the best technology in the world. We've got wonderful things. And overall, mainly more from public health than from individual technologies and so on. Life expectancy, as you know, has been growing and growing and growing until, oops,
last few years, it's been shrinking, which points to one of the problems we have that the healthcare system, we think we have the best in the world.
And I would argue we in many ways have some of the best facilities, research, training, technology, professionals, some of the best in the world, but our healthcare system is one of the most, it's certainly probably the most dysfunctional of any developed nation. And we've been doing because there are problems. Healthcare is getting more expensive.
In the early 1960s, I believe it was 4% of the economy. Maybe it was 5% of the economy. Now we're almost up to 20%. We're at 18 some percent of the economy now. And so it's not just inflation adjusted, but it's kind of quadrupled. It's quadrupled what percent of the fast growing economy is. And so we are spending a lot. And
And we also have never in this country made sure that everybody has access to healthcare. And so we have, unfortunately, when you look at how things go, you hear so many politicians and others, oh, we've got the best healthcare system in the world.
But we are now, we spend a lot more than others do, our life expectancy, infant mortality rates, all of which have been getting more negative the last few years. They were never near the top. I mean, they were not nearly as good as they should have been. I think one WHO, World Health Organization, I think they've rated us like 37th best in the world.
And when you count how many developed nations there are, it's not that good. And so I'd say it's been getting worse. And part of the reason it's getting worse is because of health policy. Because each individual practitioner using the knowledge they have, they make mistakes. And we have lacks of knowledge. And we've got all that.
But aside from that, the system, the way we put it together and make it work has been getting worse. And it never was a system. It was sort of a non-system patchwork quilt of how we cover people and everything else. And unfortunately, again, as you said, this is my 37th year in the state senate.
And I didn't plan to be there that long, but I'm not willingly going to leave until we pass universal health care and have a logical health care system. That doesn't mean I'll make that, but I'm committed to doing everything in my power to try.
But one of the problems I've seen has been throughout my career and started probably in the 70s is that policymakers say we've got several problems with our health care system. One, not everybody's covered. And two, it costs too much. So In the economic world, if something costs too much, you buy less of it. That's just supplying them. That's the way the market works. So we buy less of it.
And so healthcare professionals are saying, or the health policymakers have been saying, well, it's too expensive. And so let's make it harder for people to get so they don't use as much of it. Because obviously, if we're spending so much, it's because people are using too much healthcare. And you know, and I know that as new technologies and new things more expensive happen, but
The last 30 or 40 years, most of the health reforms, the reforms designed to make it more affordable and cover more people, Affordable Care Act was one of those. I would argue it did nothing to make it more affordable. It probably made it less affordable. But nevertheless, it cut the uninsurance rate. The people who have no coverage, it cut it by half. And that's a huge benefit to people.
So it's done a lot of those things. But all these reforms... making healthcare more difficult to get, probably contribute to health inequities, probably contribute to declining overall health. And they haven't worked to save much money.
Because now after those 30, 40, 50 years of these healthcare reforms designed to save money and cover people, we still have in Minnesota, it's only about three, four, 5% of the public that has no coverage.
but arguably about half the public doesn't have the coverage they need because they don't go to the dentist because they can't afford it or they can't afford the co-pays or deductibles, so they, whatever. But we haven't covered everybody, which is pretty essential for a good public health system. And the other thing is we haven't really done a very good job of saving money.
Matter of fact, we spend literally two times what anybody else in the world spends per person on healthcare with about 10 or 12 exceptions. Other countries, All but 10 or 12 spend half per person or less than we do. And many of those have better outcomes and so on. So our healthcare reforms have been going the wrong direction. Real quickly, what the summary of what I'd like to have
I'd like to have a logical healthcare system. I don't care what I was telling people. I got a system. I proposed one 12, 15 years ago that I think makes good sense. I think it would be the best healthcare system in the world, frankly. It's not very modest, but I really think that's not a very high mark to meet because, frankly, nobody's doing a wonderful job of it.
But have a healthcare system that covers everybody for all their medical needs and doesn't put barriers in their way. And so the analogy of what I'd like to see is with education. In Minnesota, our constitution says we are supposed to provide a quality education system for all kids. So how do we do it?
Well, when you turn five years, now when you turn four years old, you are basically able to get an education. You don't have to have, your parents don't have to have the right insurance plan, school insurance plan. They don't have to worry about co-pays or deductibles. You don't have to worry about if the local, if some of the teachers are going to be out of network.
You don't have to worry about any of those things. Why? You turn four years old, you get to go pre-K. You turn five years old, you go to kindergarten. You get to go. You are qualified. Why? Because you're a human being and you live in Minnesota and you're that age and it's school age. Why do we do that? Because we want every kid to get a good education.
If we care about public health, as pandemics and epidemics and infectious diseases show us, We don't want to cover, oh, 80% of the public. We want to cover 100% of the public. We want everybody covered. So my vision is let's have a healthcare system and the reform, the policy I'm looking for is not one that tries to save money. I'm not trying, we're twice as expensive as anybody else, as I said.
I'm not trying to save money. I'm saying, why don't we try and design a healthcare system that does what a healthcare system should, tries to keep people healthy, when they need care, help them get care. Very simple. And I would argue, and we're actually working on a, the state funded a study this year at last of it.
I would argue that making a logical healthcare system that focuses on health and public health and wellbeing, not focused on saving money, ironically actually does save money because we get rid of all the crud that's putting up all these barriers that in the end don't get around the need for healthcare. They do that.
So my, my ideal, what I want us to do, and you never hit your ideal, but why can't we cover everyone? Why can't we do, again, you can find fault with the schools. I can too. And we could certainly improve them and we're working at that. And I, And I think you can fight all we want about that. But the bottom line is the idea that every child gets an education is pretty important.
There's a common denominator. Yeah. Everybody has it. I think we ought to do it. So that's my vision for what we ought to do is have a health care system. And I can go into more about the barriers to care. But just one more philosophical thing for the discussion. And that is Stephen Covey, the author, about 40 years ago, proposed two world mindsets, one of which is one of scarcity.
One is a model of abundance. The abundance model, there's enough for everyone. We take care of each other. We all do better, that sort of thing. And the scarcity one is there's not enough to go around. If you get more healthcare or you get more of whatever, I get less of it. And you're fighting among each other. You're doing all this.
You're making sure nobody gets something they don't absolutely deserve. And I would argue in the healthcare world, the American model has been Clearly, the scarcity one.
If somebody is getting any care they don't absolutely need, especially if we're paying their bill and they're lazy people and we're going to take care of them, but only the minimum they need and we're going to make them jump through all these hurdles to do it and everything else. That scarcity mindset is ironically making health care scarce and too expensive and unaffordable.
And the broader mindset, which I think a number of countries actually do. And that is your healthcare matters to me and mine matters to you while we all take care of each other. Let's assume there's enough to go around because frankly, there is when you do it that way. So I would say let's get the abundance mindset, which is a whole different way of looking at healthcare.
And I can give you examples of why that matters so much. But with that, I would say that's the past, present and future for what I'd like to see.
You know, Clarence, I'll get to you in a sec. I can't help but agree with you. It's like the analogy that you use with education. It's just like everybody knows that your kids can get educated. Yes, are there some bad apples over here and bad apples over here? Yes. But the bottom line is you can get it. For many people, when you're talking about health care, that isn't the case. And that's...
In my mind, that's absolutely ridiculous. Clarence.
Yeah. Just like Stan, I'm an admirer of your work. But I do want to ask you some questions because you kept mentioning money in a lot of your conversation. I want to ask you this. Who benefits from the dysfunctionality of our system? I think that that's an important question to be answered.
Sure, and I'll say that that gets to one of the big problems we have. We have a system that puts, as the Minnesota nurses often say, it puts profits before patients. And everybody's got their own niche on how they're going to do it. It's the, quote, non-profit health care systems in the state.
Our insurance companies until a couple of years ago that sold health policies were all, quote, non-profit. We changed the law because we didn't want to be the only state that didn't allow for profits in because somehow that was going to make health care cheaper.
But our hospital systems, most of them are nonprofit, and they're supposed to be doing it, but their CEOs are all making multimillion-dollar salaries. They're all very heavy bureaucratic things, top-heavy administratively. Because we can make money doing this. And even though they're not profit-making entities, there are a lot of people who are making a lot of profit off of it.
And more and more of them are partnering with for-profit groups. And they share board memberships of them. And so everybody's got their own niche. Ten years ago or so, there was some new entity came into Minnesota. Great idea. And they were saying they were selling a product to employers saying, you know, we will scrutinize the bills, the health care bills of all your employees.
We'll charge like I think it was like 500 bucks per employee. And we will basically guarantee you we'll save you more money than that because there's so many errors on the on the bills and everything else that you and your employees are paying a lot more than 500 or more than you should per year because of that.
So the only thing they do is scrutinize the bills in a logical way and figure out where the errors are. That's all they did. It was a multimillion-dollar business, and their entire business is a logical business. They are saving employers and employees money, but how do they improve health care? They don't provide one penny's worth of health care. Correct.
And hospitals now are all big hospital systems. The hospital systems, Mayo, Essentia, Fairview, M Health Fairview, Health Partners, they're all health systems. But Abbott Northwestern Hospital – It is a healthcare provider. It provides healthcare to people, but it's part of a line of healthcare system. What does a line add to? Oh, administrative stuff.
We're going to do things more efficiently, more bureaucratically, more, I'd argue, less humanely. So a lot of people making a lot of money off it. Pharmaceutical industry, everybody's got their own cut of it. And pharmaceutical industry used to be just the manufacturers. Then it became... the pharmacy benefit managers, and everybody's got their own cut. The system gets more bureaucratic.
So that's why people make a lot of money on it, and they like to keep what they're doing.
So, you know, I'll tell you. Yeah, I was going to say this. I always make this say, but the color of America is not black or white. It's green. It's about the money. And if you remember that, then it helps to shape some of the conversation. So thank you.
Absolutely. I couldn't agree more. Green is what shapes a lot of stuff. And we can't act as if it doesn't exist or isn't an important part of the economy. That's important. Again, my focus when I say I didn't design Minnesota Health Plan is a way to save money. I designed it because I think I want to have the best health care system in the world.
So people are healthier and they don't need to go to the doctor. And when they do, they get the care they need. But it will save money too.
Correct. Correct. In the long run. Always. So I want to get to this concept of administrative costs in a second, because in this last legislative session, you know, to the legislature's credit, they said, okay, you know what, we have to get kind of our arms around this a little bit. So they required some reporting mechanisms, and we'll talk about that in a second. But
And on our last show, it was interesting. We were talking about mental health and, you know, one of our guests said, you know, it's like a bowl of spaghetti. It's just like, okay. So I asked her, I'm going to ask you the same question only as it relates to what we're talking about today, policy and healthcare. If you're going to take out one noodle. Oh,
or two noodles out of this bowl of spaghetti that seems to be getting more and more complicated than easier. And you've been around the block for a few times and had many, many discussions on this. What are the one, two, three noodles that you would pull out of the bowl to really get us on the right track? Because God knows, I personally don't think we are on the right track.
Sure. A couple of responses that the first one of which is which noodles would you pull out? Well, I spend a lot of my time and what we're talking about today is the big picture, how we need a different logical healthcare system. And I think we absolutely have to work on that.
And part of the trouble is because of this noodle bowl, you're in your analogy, pulling one out is really a sticky, slippery mess. And yeah, And it's not easy to do. And so I would say let's not lose focus on let's fix the big picture. But in 36 years in the legislature, I spent an awful lot of time on the incremental things, the one noodle at a time, one noodle at a time and so on.
And I would like to make the case that arguing that working on the big picture is I think we need to do and we haven't been doing. is critically important. We cannot stop doing that. That should be our number one focus. But that does not excuse one from not saying, hey, we could make this change and make people's lives better now and improve the health care system now.
There is no excuse for not doing that. Most of my time on health care has been on those incremental changes. And I would make the same argument on others, and that is that those who are working on incremental changes because we want to accomplish something, That's very important. But that does not excuse you from looking at the big picture. So we don't have this messy bowl of noodles.
Absolutely.
Yeah. And part of the thing, when you talk about mental health, we have a huge shortage of mental health practitioners across the board. And Fairview... mHealth, Fairviews are now called. They keep changing their names, but every health system, their marketing plans, somebody's making a lot of money changing names all the time.
And it's good for their business model, but it's not necessarily a change in healthcare. But when they bought out HealthEast, another health system in the past, Metro HealthEast was East Metro. When Fairview announced that they were buying that out a few years ago, They talk about they will enhance and improve services in the East Metro area. Look at their press releases. They promise that.
First, one of the first things, major things they do is to close Bethesda and St. Joe's Hospital. I'll focus on St. Joe's Hospital, which tended to deal with mental health, tended to deal with addictions, substance use disorder, tended to deal with mental health, those kind of what some call behavioral health issues. Why do they want to shut it down? They were losing money on it.
There are other systems, and they're struggling as an overall system, they say, and I'll take them at their word for it. I would do some things different than they do. But they shut this hospital down. And I am thinking, how does that expand healthcare coverage? And they say, oh, we're doing this and this instead, and this will be much better.
Well, I'll say that some of the things they're doing are good things to be doing, but is it better overall? Do we really... Can we get by with less inpatient mental health and substance use beds? Not necessarily. So what we, why, what I wrote the CEO and the board several times when they were announcing they were closing this down, kind of angry because they shouldn't be doing this.
And I understand when they say they're losing money on it, but why don't they then tell the state, because the state pays a lot of mental health and substance use costs through our public programs. And why don't you, fight the state and say, look, because we're doing more mental health stuff than other health systems are. And we're not getting paid enough for that.
And maybe you pay too much for orthopedic surgery. And why don't you as a state negotiate with us, pay a little more for this and a little less for this. You know, I'm told, and I'm not sure this is accurate, but if I go see my family practice doctor and go to see her about some mental health challenge, some medication or something,
That she's paid more for my visit than if I visit a psychiatrist who is more training and most specialists get paid more. Well, I understand that's the way we bill for mental health and so on, but there's something amiss there. And so using the mental health illustration is we should be paying more for mental health, less for other things.
Well, OK, that's going to then it's just there's a zero sum game. You're not doing better. But, you know, if the other thing is, if we have a logical system where the health care providers and the health care systems, everybody have fewer costs, administrative, bureaucratic costs, if you cut a third of their costs away.
You can cut their compensation overall by 25%, and still they're much better off. So one of the things we have to do is we have to get out a lot of the bureaucracy, and that's why we need the bigger change. The second one I'll mention is the mental health one. There are huge gaps in coverage there, and I think we have to be addressing that.
And those two, I mean, to me, it's the pricing because we don't have any logical system for negotiating prices. We have all this bureaucracy. And I'm going to relate one third issue to this because it relates to the bureaucracy. And that is, and it's partly the Affordable Care Act to blame for this. but it's been an ongoing thing for 30, 40 years.
And that is, we figure, you know, when they're saying how we're not just trying to save money, we're trying to improve quality, the triple whatever measure they're trying to do. They want to improve quality too. So we're going to measure quality. And we tried the same thing with schools a number of years ago. It was a bad mistake.
Unfortunately, people backed off of it, but we're further into it in healthcare. And that is you try and evaluate teachers, right? And how do you do it? Okay. Each principal goes and evaluates. Each teacher will pay them for their performance, pay for performance, value-based care, pay quality measures. All those things are designed.
If we do the same thing in education, which we were trying, some people were trying for a number of years, we're going to measure teachers. Well, there's no, objective way to do so. You have the principal come in and measure what, well, principals have their favorite teachers and they, different people are evaluating every way. So how do you measure it?
So how are you going to pay some more because of that? So instead we do think, oh, we'll use standardized tests. When teachers quickly figure it out is if we're going to do standardized tests, I'm going to take the senior teachers who may be the most qualified and best ones. I'm not going to take the troubled kids. I'm going to take the good kids.
I talked to one teacher who said, you know, years ago, I felt I thrived with the most troubled kids. They're more challenging, but I think I did better with them than other kids, with other teachers, comparatively me compared to other teachers, he said.
And to me, I thought, when you're measuring that, you find out that the ones who have the sickest patients, or in the school case, the struggling students, you know, you're discriminating, you're making disparities worse.
And so to me, one of the things we have to do is recognize that all these quality measures, which are designed to save money and improve health, maybe are costing money and arguably are making care worse. Why do I say that? There was a, one of the measures they often use to prove how good this stuff is, is a hospital readmissions reduction project or whatever it's called.
Medicaid and Medicare, the federal government was pushing this. And there was actually one study out in 2017 that suggested that this quality measure that for cardiac patients, it was having the impact. Hospitals would be penalized if a patient came in, was readmitted within 30 days or something when they last left.
And hospitals, they also penalized a little bit of somebody for mortality kind of thing. So Actually, the incentive, if you look at it carefully, the incentive was actually kick people out of the hospital. And if you don't readmit them, well, they might die.
But anyway, there was one study suggested there may be a University of Michigan study suggesting as many as 5,000 more fatalities from this quality measure. Well, if a quality measure is killing people, instead of trying to tweak the quality measure, maybe the first thing we should do is get away from the quality measure. So in real short, that's a long story to say.
One of the things is that the bureaucracy, a lot of the bureaucracy is well-intended. We're going to measure quality. We're going to pay for quality. And the fact that it may cost 10 times as much and take hours and hours of doctor and medical staff time to evaluate and bill and everything else, maybe That's counterproductive.
And maybe what we should be doing is trying to focus on having doctors and nurses and others be well-trained, have them have peer pressure and their own personal pride that makes them want to do a better job and not a little more. So, all right.
So, all right. We've, we've got seemingly, we've got, we've got these things that are kind of creating angst in, in the system, good, bad, and, and, and whatever. So, for instance, administrative costs overall are absolutely crazy. I'll give you a simple illustration. I had to go in for a visit, a medical visit recently, and I got a bill. Okay, I have insurance and all that kind of stuff.
I get a bill from the providers. Okay. On the other hand, I'm thinking, oh, wait a minute now. This is covered for my insurance. Okay. So guess what? I, as the patient, was put in the middle of an administrative nightmare, on one hand, dealing with the provider, on the other hand, dealing with the insurance, and say, excuse me, Aren't you guys talking here?
Isn't that what you're being supposedly paid to do? But the system is broken. All right. So let's talk about administrative things. One sec. And then also. The advantages that technology has also provided for us. Let me give you a for instance.
Years ago, frankly, not that many years ago, when you had a knee replacement, you were probably going to be in the hospital for a minimum of three, four, five days. Now you can have your knee replaced and actually go home, believe it or not, the same day. Okay, so from a technology perspective and a procedural perspective, things have gotten better.
that are there, people are hospitalized less, so there is cost savings there. But all right, so on one hand, technology has grown. On the other hand, it's kind of like a double-edged sword. We're also paying for that incredible technology these days. All right, reflect on, in this legislative session that just closed up,
The, all the different reports that you guys recommended that for instance, the health department does or should be doing or will be doing to address administrative issues, addressing whether or not we at least maybe in the state of Minnesota, should be addressing the concept of maybe single payer. So reports that you're asking for.
Some of them have a shorter timeframe, 20, 25, 26, or what have you. Is this all in line, Senator Marty, with where you hope useful information will lead to some of the ideas that you're trying or have tried all these years to get us on the right track with.
Sure. Yes and no. First of all, on technology, technology has in some ways saved huge amounts of money. In other ways, much of the way we use the technology is not on patient records and so on. Absolutely. If they did not have to report what we're doing and why we're doing it and how much we're charging for each thing. I agree.
If you took out the billing side of it, you would cut the cost, bureaucratic cost by half. Huge, more than half. And the technology stuff. Because if doctors and medical providers and in hospitals and so on were sharing all the medical stuff.
The medical stuff, the health records for patients, without sharing the cost and the billing, if they were using it for medical care and not for that, it would be a huge plus. But anyhow, we're using technology to make it more expensive, unfortunately. But that's not good. The studies.
Administrative reports, I guess, is what we're looking at here.
Right. I would say that some of the studies, there's one I've been pushing for for 10 years. We finally got it. And that's to do a cost analysis of a logical, universal health care system using as a proxy for that proposed Minnesota health plan. Compare that, the cost to everyone, the cost, economic and health costs and benefits, cost benefit analysis.
a logical universal healthcare system to what we're doing now. Not government costs, not employer costs, not patient costs, not anybody costs, but the whole system, all the costs. And that includes things like, you know, when we figure out medical care costs, a lot of the costs I would argue that they call as medical costs
prior authorization where a doctor has to approve, I mean, where an insurance company has to approve the care your doctor wants to give you, that to me is not improved medical care. There's no purpose. The insurance company has not interviewed the patient. They have not
treated the patient they have not examined the patient they're making decisions based on some chart and what they think makes sense right and that's hugely that's purely administrative burden meant to save money and to me um that's what we have to look at everything and another type of cost we don't ever figure it out but the time you spend trying to figure out your co-pays and your bills
What's your time worth? No kidding. Nobody thinks that's fun. What are you paid at work? How many hours are you spending a month doing that?
Nobody pays you for your time.
Right. And for that matter, employers, the same thing. How much time they spend shopping for health care each year for their employees and then teaching their employees what's covered and helping them through the mess. That's a huge thing. If they just had, here, health care coverage. It'd be so much simpler. But all those costs, figure that in.
So one cost analysis, Minnesota health plan versus current law, what it would cost, what it would save, what it would do. And I'm talking both medical health costs and benefits and economic costs and benefits, because my premise is it's cheaper and far better health wise. But that's a study. I'm really thrilled we're doing it. Some of the other studies I'm really troubled by.
They had a study which is getting better, which got better along the way because a lot of people objected to it. But it was a health care affordability board. And in the health department, others were going to calculate For entities, they defined them as entities. They didn't define them, but they basically meant health systems or insurance plans or whatever.
That these entities, they were going to analyze how much, not only how much they're spending now, but how much their costs should be growing per year and what should be the expected growth and are they keeping above it or below it.
Didn't they call it something like unproductive administrative?
Everybody wants to get rid of unproductive stuff, but much of the stuff they're doing is adding to bureaucratic stuff. The bill originally had a thing in there that They would estimate what these were. And if the plans, if the entities, which are, again, bureaucratic entities who are part of the cause of this, were giving them a taste of their own medicine.
But if they didn't meet the cost stuff, they would have to come in with a corrective plan. And if not, they could be fined.
um fines of up to i think half million dollars which is not substantial in terms of multi-billion dollar entities but you know it's a fine and i that was supposed to do something my question is first of all how is the health department able to calculate what costs are and what they should be because they can say hey i got sicker patients than i had in the past we have sicker patients in your hospital severity it's it's all severity adjustment yeah
And trying to analyze that, again, it's the grading. We're going to spend 10 times as much on grading as we're going to improve anything out of it. But so they were going to do that. And what would the impact be? How would that bring down affordability? If I'm, say, I'm mega health system, I can name any of them.
But if I'm a mega health system and I'm being told our costs went faster up than they should, what am I going to do? I'm going to hire more people to figure out to write a corrective plan, which we have to write a corrective plan. I'm going to make sure it is the best corrective plan you've ever seen.
And it's going to cost us thousands and thousands of bucks of time of very high paid executives to figure out this clever plan. That doesn't save any money. That's more paperwork. Where are we going to save money then? Well, we're going to cut back on the number of people staffing our clinics, going to have your hold times on the phone be longer, your wait time for appointments longer.
We're going to tighten up the health care. spending and increase the bureaucratic spending to bring down the cost. So to me, that's a very more data is good. So I don't have a gripe about what we've changed it to that we're going to try and measure it. But I'm afraid this is going to be used in a way that doesn't get to the big problem. We're all concerned about it.
So let me ask, you know, there's that blob of spaghetti for sure. Here's something that's kind of nagged at me. I was at the health department heading up the cardiovascular unit for many, many years. And, you know, if, and I'll go on record as saying this, I probably couldn't have gone on record if I was still at the health department. I can go on record now.
If we had not received funding from the Centers for Disease Control to address preventive oriented aspects in healthcare, frankly, our whole unit at the health department would have gone away, which is really, when you think about that, excuse me, a state health department not having a cardiovascular health unit or a diabetes unit, or I can go on and on and on and on.
It's like, okay, here's my question for you. based on all your years in the Senate, where are you guys coming from? I mean, as far as the state putting in their fair share to address community health oriented initiatives in order, and this gets to, you know, kind of the bottom line, if we prevent, hopefully we can keep a lot of people out of health care, which will keep health care costs down.
But where's the state's initiatives in order to, in this case, meet CDC even halfway? Or for that matter- I would even argue this. It's like, okay, would Senator Marty put out a bill that says, look, if the state health department is not successful in getting their funding from CDC to address diabetes for our citizens, our state will kick in.
Our state will assure that these kinds of prevention-oriented chronic disease initiatives that a lot of people are dying from and getting sick from, the state will assure that these things would go forward. So I'm asking the question on the prevention aspects in order to address health care costs.
Right. The prevention aspects are critically important. And unfortunately, it's always a sort of a stepchild or an afterthought in terms of dealing with prevention. And the trouble is, if we're going to put money into that, oh, we've got to take money for other things because we don't have the money to do this.
And that's why a logical health system, that's why a Minnesota health plan proposal has changed. its own decision-making authority and the legislature doesn't set the budgets for it. It would, well, the legislature has to approve the premium rates that they'd be charging, but the premium is based on ability to pay.
And basically what we would have is trying to have them in setting up the health policy for the state is... A logical way to do that might be we deliver health care in a public health manner. Every school should have a health care clinic. Every school have a health care clinic. We'd invest in the prevention efforts instead. Or we give grants to do this. We have this local public health grant.
That's a great idea. But, you know, it's just kind of extra money. We're spending like one tenth of one percent of our health care dollars on prevention.
Correct, on prevention.
Maybe we ought to be spending 5% or 10%. No kidding. I don't know. But the only way to do it is a logical way. But that's the way we've come at this piecemeal. We have a shortage of providers in greater Minnesota. Oh, we have a $3 million program to provide more family practice practitioners in greater Minnesota. The number is made up there. I don't know exactly what it is.
But we put a few million dollars in to get more practitioners. That's not going to get a lot of practitioners and we have shortages across the board and so on. So we need to have a logical system. Who's in charge of making sure we have enough health care providers? Nobody. University of Minnesota is in charge of providing. They do most of the doctors. We graduate in this state.
They're the vast majority or graduated through there. Is anybody making sure that they we provide if the need is for more general practitioners and less specialists?
Is anybody in rural areas?
And they say in my pitches, do you want to tell med students? Do you want to tell them, oh, you've got to go into general practice? Well, a lot of them want to go into general practice, but they find out they're compensated more here. So they do that.
But we have nobody in charge of saying, you know, maybe if we've got a shortage of this kind of practitioners, like I used mental health earlier or general practice, maybe we should pay more for them. Maybe we should pay off their med school debts. Maybe we shouldn't have med school tuition for those incentivize, incentivize the threat or use the economy to do it.
But nobody's in charge of making sure we have enough practitioners. Nobody's in charge of making sure we do public health and health departments. I've been fighting health department for years, trying to get commissioners to say we need more money, whether it's for sexually transmitted infections or whatever.
getting the health department commissioners to say it because they say, oh, no, we're not. And I asked several of them because I was chair of health committee at one point confirming the commissioners that were saying, you know, I want to know if you think there's a need for something, would you speak up? Oh, yes, I would. But no, they present their budget to the governor.
The governor says, here's what you can do. And that's what they're for. And I'm saying, but you're a medical professional. I want to know your judgment. Do we need more money for prevention? And but that's what we need a logical system for. We don't have
Right. Right. You know, I, it's interesting. I, I remember testifying in front of a health committee as the, the head of the cardiovascular unit. And I was, I was laying out specifically, you know, what the data is saying. Oh, I could do it county by county. Okay. Population by population. And, and,
basically saying, excuse me, we've got a cardiovascular disaster going on here in the state of Minnesota. People are dying from heart attacks and strokes. And I remember one of the people in the committee asked me, well, what do you recommend, Dr. Shanling? And I said, what I recommend is that the state, you know, meet us halfway to help out. How would you go about doing that?
And I turned it around to them. I said, that's for you guys to decide. Come on. It never happened. But those are the things that we have. Frankly, where you're at, where you're dealing with is the healthcare delivery system, okay?
There's also- And trying to do the broader one. One of the 10 principles behind our bill is that it must focus on preventive health. Thank you, thank you.
And disease management, and disease management.
The healthcare system, in designing the bill, it has 10 Minnesota health planners, 10 principles designed to make sure
um that it's a logical healthcare it has to cover everyone for all their medical needs patients get to choose their medical providers and patients and doctors make the decisions not government or insurance companies or business nobody else does patients and doctors do we focus on preventive health things like that providers have to be paid in a timely and fair manner um 10 principles that would be legally binding on the health plan and you need them all
I think you need to focus on public health. We don't want to have more money on health care. We want to have less money on health care and more on keeping people healthy. But that's all tied into it. So we need the whole package. That's why the piecemeal thing is very important to work on. But we can't forget the big picture.
So Aaron, you notice here county by county data for health doesn't exist. Actually it does. We have county by county breakdowns of data, certainly by death and also by condition. Erin, you're a constituent of Senator Marty, so there's a connection there. So what might you wanna ask your Senator as it relates to all this health stuff that we've been talking about?
Absolutely, and before I ask my question, I think I should clarify that the data is not publicly available. You have to go about certain ways
Oh, that's true. That's true. Yeah. It's through the health department. Yeah. Yeah.
And it really it really should be available to the public. You should be educated about your health. You should be educated about the environment that you're living in. And I think that that would influence a lot of people's decisions about their day to day life if they had access to that data, especially for people who are interested in stuff like that, like me.
Anyways, my question, I think to kind of tie up the episode two would be to ask what the priorities are. Maybe for you and your office on a small scale, maybe on a larger scale, what the priorities are for next legislative session in regards to health policy. Everything we talked about is such a big pill to swallow, and I think it's got to happen step by step.
So I'd be interested to know what you think your next step in all of this is going to be in the next session.
Sure. Well, first of all, I think there were some very significant improvements, little piece by piece things in terms of pharmaceutical price gouging types of things. Lots of good little steps forward. But I also want to keep focusing this cost analysis of the Minnesota health plan or a logical universal health care system versus what we have now is a two and a half year study.
And I want to be preparing for that. But one of the other things I wanted, we have, we have roughly almost 20% of our population in Minnesota is on public programs, Medicaid, medical assistance, we call it, and Minnesota care. Roughly over a million people out of less than 6 million people in the state are on those programs. And those are public programs.
but they are run by private insurance companies. If I'm on, if I qualify for Medicaid or Minnesota care, I get my care through one of the health plans, Blue Cross or Health Partners or whatever. And it's an extra bureaucratic step that costs a lot more money and it's resulting in bad outcomes, worse outcomes, not better outcomes.
One of the health plans is prohibiting its doctors at its public hospital to from treating prenatal treatment for visits for women who are on Medicaid. And that's a public program. They're telling people, they're telling their doctors not to treat certain Medicaid patients until they come in the hospital for a childbirth. And these are often low income at risk women who have more complications.
Why are we doing it? Well, because we have a public program is being administered by people trying to make money off of it. And to me, one of the hopes I have next year is that we can move to just say, let's go back to, let's kick out this pilot project we've been doing with no evaluation for 30 years.
kick out the private insurance companies from the public programs, because then we could start fixing some of the things like the disparities where mental health is paid less. We could make sure patients aren't being denied care because they're not in the right health plan. These are public programs. Public is spending literally billions, billions and billions of dollars a year on
And why are we turning that over to private plans to do nothing more than administer and allegedly save money? But basically, they save money by denying care. Right.
So what what I can promise Clarence and I can promise is that you can use health chatter as as a vehicle to to get some of your ideas and and. and thoughts out to the public. It's another venue through podcasts that absolutely, um, we're open to that.
And, and we, and we invite you to, to, to use that, use this vehicle just for that, including this particular podcast, which, you know, we could go on and on about, about policy. My hope Clarence, I'm sure yours as well is, um, We're all carrying the torch to try to make it better.
I think what we're all a little frustrated about is how fast those changes in the right direction are happening or should happen. And perhaps if we become more aware, the public becomes more aware of it, even through venues such as this, things will happen a little quicker. Clarence.
Yeah, I think I'm going to ask you this or make the last statement. And I'm not necessarily asking for one answer. I just, it's just a thought for me is that knowing that everyone needs healthcare, why has it become so politicized?
Yes. And politics affects how we govern ourselves as a people, how we relate to each other as a society. And because some people can make more money doing certain things their way, they may not be bad people. I don't think they are. I talked to a woman who worked for one of the large companies. HMO plans in the state. And she said, John, what do you think? Why?
I've been spending my whole career trying to make sure more kids get Medicaid, medical assistance, so they get care. What's wrong with that? I said, nothing's wrong with that. But why do we have to have some insurance plan trying to help people get coverage? Why don't we just say you're all covered, period?
Right.
And so it's not bad people, but their jobs depend on it. And to me, making that change, we want to treat them fairly. I want to make sure if we're replacing, if we're displacing people in insurance and billing and collections and those jobs, if we're going to displace people, we want to make sure they get good jobs elsewhere because we got to be concerned about them.
They're our fellow human beings. But we also don't want to have, we'd be better off, I think we'd actually save money We took everybody working in health insurance in Minnesota and had them sit at their desks and do nothing. And then just provide health care in a logical, cheaper way. It would be cheaper in my mind. But that's the trouble.
The reason it's so slow to change is people all have their vested interest in it. And we never take a look. That's why I'm saying we work it. Tinkering on each of these is important. Tinkering is important. sounds tiny, but big tinkering things that are good things to do. We've got to keep working on that. But at the same time, let's look at the big picture. Why do we do it this way?
And how would we do it if we wanted to have a logical system that addresses healthcare disparities, that addresses the lack of access to care, that addresses the high costs of care, and has people focus on how we keep people healthy and make sure they get the care they need? To me, that's a simple question, but it's a big question and it's a huge challenge, which is why
medical providers have got to be involved. And I'm thrilled that med students at the U of M are more engaged in health policy than I think med students were 20, 30 years ago. Because they see it's going to affect their practice.
Absolutely. Well, I'll tell you, we could keep going on and on. I truly thank you for one word here, dedication. I mean, you've been dedicated to this arena all these years. And I know that you're committed to make it work. And I really, really do want to thank you for your insights and commitment to this subject. It's an important one.
And obviously, it's important related to all the different subjects that we do here on Health Chatter. So thank you for being with us today, John, Marty, Senator Marty. It's been an absolute pleasure. pleasure.
For our listening audience, our next show, we're going to be addressing the issue of asthma, which is ironically kind of timely because we're also dealing with issues in our atmosphere from all the smoke that's coming down from the fires in Canada. And we're seeing an increase of patients presenting themselves into the hospital with asthma oriented conditions. So it's very, very timely.
So I appreciate that. Senator Marty, remember, We always would love to have you come back. And we probably will, given some of your ideas for the next legislative session. For those of you in our listening audience, keep health chatting always.
Hi, everyone. It's Matthew from Behind the Scenes. And I wanted to let everyone know that we have a new website up and running, HelpChatterPodcast.com. You can go on there. You can interact with us. You can communicate with us, send us a message. You can comment on each episode. You can rate us.
And it's just another way for everyone to communicate with Stan and Clarence and all of us at the Help Chatter team. So definitely check it out. Again, that's HelpChatterPodcast.com.