|Progressive Calendar 04.11.08||<– Date –> <– Thread –>|
|From: David Shove (shove001tc.umn.edu)|
|Date: Thu, 10 Apr 2008 18:34:41 -0700 (PDT)|
P R O G R E S S I V E C A L E N D A R 04.11.08 1. Spring market 4.12 9am 2. WILPF/Americorps 4.12 10am 3. NWN4P Mkta 4.12 11am 4. Northtown vigil 4.12 2pm 5. Cops/your rights 4.12 5pm 6. CIW house party 4.12 8pm 7. Iran/US/CTV 4.12 9pm 8. PeaceJam 4.12-13 9. Papa John/Dakota 4.12 11:30pm [NOT 4.11] 10. Stillwater vigil 4.13 1pm 11. SinglePay/AM950 4.13 3pm 12. Vets 4 peace 4.13 6pm 13. PG Allen/film 4.13 7pm 14. Marcy Winograd - Obama purge of progressive CA delegates 15. Kip Sullivan - "Medical home" in DFL "reform" bills won't work --------1 of 15-------- From: Lydia Howell <lhowell [at] visi.com> Subject: Spring market 4.12 9am This Saturday, April 12th, the World Jubilee is holding their annual Spring Market. This event provides an alternative marketing outlet for economically disadvantaged artisans and a wonderful opportunity for shoppers to learn about each of the projects. All items are fairly traded and you can rest assured that your purchases will result in profits that go directly back to the producers. The Amias Project will be represented at the Spring Market along with Ten Thousand Villages and artisan groups from over 30 countries. Items included in the market will be cards, pottery, baskets, Jewelry, clothing, carvings, toys, textiles, needlework, rugs, musical instruments and much more. With coffee available all day, it should make for a pleasant way to spend a couple of hours on a Saturday. World Jubilee Spring Market / Open 9 am to 4 pm Gloria Dei Lutheran Church 700 Snelling Ave South St. Paul 55116 Did I mention there will be coffee? --------2 of 15-------- From: Doris Marquit <marqu001 [at] umn.edu> Subject: WILPF/Americorps 4.12 10am MN WILPF presents Free "Coffee With" Discussion Saturday, April 12, 2008, 10 am - noon "AmeriCorps: Youth Respond to National Disaster: (It's not only about Hurricane Katrina)" With: Mara Cuneo Sullivan, on-the-scene participant in recovery struggles in Biloxi, New Orleans, Key West, and elsewhere Van Cleve Community Center, 901 15th Ave. SE, Minneapolis Everyone welcome; FFI: 612-522-0776; www.wilpfmn.org --------3 of 15-------- From: Carole Rydberg <carydberg [at] comcast.net> Subject: NWN4P Mkta 4.12 11am NWN4P-Minnetonka demonstration- Every Saturday, 11 AM to noon, at Hwy. 7 and 101. Park in the Target Greatland lot; meet near the fountain. We will walk along the public sidewalk. Signs available. --------4 of 15-------- From: Vanka485 [at] aol.com Subject: Northtown vigil 4.12 2pm Peace vigil at Northtown (Old Hwy 10 & University Av.), every Saturday 2:00 -- 3:00 PM. --------5 of 15-------- From: Charles Underwood <charleyunderwood [at] hotmail.com> Subject: Cops/your rights 4.12 5pm Saturday, 4/12, 5 pm, Communities United Against Police Brutality hosts a training on knowing your rights in police encounters, Arise Books, 2441 Lyndale Ave S, Mpls. http://www.arisebookstore.org --------6 of 15-------- From: Brian Payne <brianpayneyvp [at] gmail.com> Subject: CIW house party 4.12 8pm Alright everyone, get your party hats on and get ready for some fun Immokalee-style... The Twin Cities CIW Solidarity Committee is organizing two fundraisers to send three representatives to Miami for an action with the Coalition of Immokalee Workers at Burger King headquarters on April 28 where we will deliver our petition signatures. This year our representatives will include Phil, Maria and her son (his father is a farmworker and he is going to learn more about the work his father does and what he can do to change working conditions in the fields). Invite everyone you know... - This Saturday, April 12th, 8pm to ???, House Party at the Greenhouse, 2915 James Ave. S., Minneapolis. We'll have drinks ($10 at the door - or whatever you can afford - gets you all the beer you can drink, and $2.00 mixed drinks), video games ($1 per game), t-shirts ($10 each) and much more. - Saturday, May 10, 9:00pm-1:00am, Breaking the Chains Concert at Triple Rock. $10 at the door, with Nancy Drew Crew, Single Speed, Guerrilla Blue, Las Palabristas and more. If you have any questions, contact Brian Payne at 612-859-5750 or brianpayneyvp [at] gmail.com Fair food that respects human rights, not fast food that exploits human beings. www.sfalliance.org --------7 of 15-------- From: Eric Angell <eric-angell [at] riseup.net> Subject: Iran/US/CTV 4.12 9pm Minneapolis Television Network (MTN 17) viewers: "Our World In Depth" cablecasts on MTN Channel 17 on Saturdays at 9pm and Tuesdays at 8am, after DemocracyNow!. Households with basic cable may watch. Sat, 4/12, 9pm and Tues, 4/15, 8am "Iran and the US: Myths and Reality" Interview of Nasrin Jewell, Iranian born professor at the College of St. Catherine. Co-hosted by Karen Redleaf and Eric Angell. (repeat) --------8 of 15-------- From: Charles Underwood <charleyunderwood [at] hotmail.com> Subject: PeaceJam 4.12-13 4/12 and 4/13, all day PeaceJam conference at Metro State University, with theme of "Making Friends Out of our Enemies," St Paul. http://www.metrostate.edu --------9 of 15-------- From: John Kolstad <jkolstad [at] millcitymusic.com> Subject: Papa John/Dakota 4.12 11:30pm [ed, a thoroughly bad person, wrongly put in "4.11" in the last PC] Here is a gig we have been looking forward to for some time. Papa @ the Late Night At The Dakota This is the classiest Jazz and music club in town. They do these late night shows for the after Theatre crowd and those people just not ready to go to bed too early Saturday night. My group (Papa John K & The Hot Club Of East Lake) will be performing the late night show Saturday, April 12 at the Dakota. Eric Graham will be joining us on upright Bass., along with Sam and Deano and Clint. We have two great sets of blues and Swing to play. Django to Gershwin to Slim Gaillard to Harry "The Hipster" Gibson.. We start at 11:30 to 11:45 and play until 1:30. This is our first formal appearance at the Dakota. Cover only $5.00 They do have great food by I don't know how late the Kitchen is open. Then Sunday April 13, Papa & The Hot Club Quartet are at the Kitty Cat In Dinkytown 8 to 11 PM. Neat place. Like stepping back into anohter time. No cover. It is a great listening room and very comfortable (Big chairs and couches all around the joint) Please pass it on to those who may be interested. John Kolstad 612/722-6649 --------10 of 15-------- From: scot b <earthmannow [at] comcast.net> Subject: Stillwater vigil 4.13 1pm A weekly Vigil for Peace Every Sunday, at the Stillwater bridge from 1- 2 p.m. Come after Church or after brunch ! All are invited to join in song and witness to the human desire for peace in our world. Signs need to be positive. Sponsored by the St. Croix Valley Peacemakers. If you have a United Nations flag or a United States flag please bring it. Be sure to dress for the weather . For more information go to <http://www.stcroixvalleypeacemakers.com/>http://www.stcroixvalleypeacemakers.com/ For more information you could call 651 275 0247 or 651 999 - 9560 --------11 of 15-------- From: info [at] jamesmayer.org Subject: Single payer/AM950 4.13 3pm OF THE PEOPLE: CALL FOR ACTION AM 950 OF THE PEOPLE: This Sunday, april 13th, 3 p.m. AM 950--Air America Minnesota's new name; call letters: ktnf--with Host James Mayer. We invite you to join us and our guest, Jack Nelson Pallmeyer on "Of the People", on AM 950 this Sunday, 4/13/08, from 3 to 4 PM when we'll continue to focus on the action solution to the health care crisis, Single Payer Universal Health Care. Jack Nelson Pallmeyer is the only Minnesota D.F.L. candidate for the United States Senate who supports complete Single Payer Universal Health Care. [Michael Cavlan is a Green Party candidate for the US Senate who supports complete Single Payer Universal Health Care. Perhaps he will be invited on the show soon. -ed] Of the People's on-air call-in number is 952-946-6205. Host James Mayer will get in as much phone time with callers as possible. You don't have to limit your listening to the car. You can spend productive time at your computer and stream us: www.airamericaminnesota.com/listen if you put in a MN zip code. Off-air, you can reach us by calling James Mayer at 651-238-3740, by e-mail at info [at] jamesmayer.org, or by U.S. mail, address: James Mayer, 970 Raymond Ave, St. Paul, MN ZIP CODE 55114. 952-946-6205 (To Stream: <http://www.airamericaminnesota.com/listen> http://www.airamericaminnesota.com/listen>) [still the same web address!] --------12 of 15-------- From: Charles Underwood <charleyunderwood [at] hotmail.com> Subject: Vets 4 peace 4.13 6pm Sunday, 4/13, 6 to 8:30 pm, Veterans for Peace chapter 27 meets, St Stephens Church, 2123 Clinton Ave S, Mpls. (Ring bell on north door.) John Varone 952-2665. --------13 of 15-------- From: Lydia Howell <lhowell [at] visi.com> Subject: PG Allen/film 4.13 7pm Benefit for a Film about Paula Gunn Allen April 13, 2008 7-9pm $10 ($5 low income) Center for Independent Artists 4137 Bloomington Ave S Minneapolis (CIA is inside Instituto de Cultura y Educacion at the corner of 42nd St. and Bloomington free parking in front of the building) www.c4ia.org <http://www.c4ia.org/> Phone: 612-724-8392 Thought Woman- The Life and Ideas of Paula Gunn Allen is a documentary currently in early production by Ellen Marie Hinchcliffe about the Laguna Pueblo/Metis writer/thinker Paula Gunn Allen. Ms. Allen is the author of many books including The Sacred Hoop, Spider Woman's Granddaughters and Pocahontas: Medicine Woman, Spy, Entrepreneur. She is credited with founding the field of Native American literary studies and is Professor Emerita of English and American Indian Studies at UCLA. Come support the making of this documentary about an important thinker/elder, meet the filmmaker and see some amazing performers. Hope to see you there! Gabrielle Civil will host the evening. Ms. Civil is a Black woman poet, conceptual and performance artist. She is working on a book about Black women and performance art and is the recent recipient of a Fulbright Scholarship. Sharon M. Day is an Ojibwe artist and activist. She writes, sings and makes music with the Neeconis Women Singers and is also the Executive Director of the Indigenous People Task Force. Ardie Medina is Anishinaabe from the Lac du Flambeau Reservation and writes poems. plays and short stories. Her poems appear in Traces in Blood, Bone and Stone: Contemporary Ojibwe Poetry. Ardie lives in Minneapolis with her husband Mike and Amos, their Cavalier King Charles Spaniel. Juma B. Essie is a Black man engaged in a Socratic relationship to the world. Juma received a Jerome Commissioning Grant for Performance Art as part of the Naked Stages program 2008. Kim Thompson was born in Seoul, Korea and is a writer and performance artist. Among many pursuits Kim is currently a Many Voices Fellow at The Playwrights Center. Ellen Marie Hinchcliffe is a woman of European decent, she is a poet, filmmaker, performance artist and a loving Auntie and Daughter. She is passionately at work on Thought Woman- The Life and Ideas of Paula Gunn Allen. More about her work at http://ellenhinch.googlepages.com <http://ellenhinch.googlepages.com/> --------14 of 15-------- [The closer these candidates get to power, the worse they get. Once in, they forget us entirely, wild with the orgasmic joy of handing over to the rich whatever is left of our country. Hardly lesser evil - but good enough for meek millions desperate for any "hope" at all no matter how fake and ultimately criminal. -ed] Obama Delegate Purge Slash and Burn in California by Marcy Winograd http://www.opednews.com By dusk on Wednesday, the California Obama campaign had purged almost all progressive activists from its delegate candidate lists. Names of candidates, people who had filed to run to represent Obama at the August Democratic Party National Convention, disappeared, not one by one, but hundreds at a time, from the Party web site listing the eligibles. The list of Obama delegate hopefuls in one northern California congressional district went from a robust 100 to an anemic 23, while in southern California, the list in Congressman Waxman's district almost slipped out of sight, plunging from a high of 91 candidates to 17. Gone were strong women with independent political bases. Who was left standing, still in the running for the Sunday delegate caucuses? The bundlers, the men and women who skirt campaign finance laws by bundling cash, a bundle of $2,000 here and a bundle of $2,000 there - and some, though certainly not all, of the Obama volunteers, loyalists from day one. Who was kicked to the curb? Brian Leubitz, a Calitics blogger with a mighty pen, Tad Daley, former policy advisor to Cranston and Kucinich and a career fellow with the International Physicians for the Prevention of Nuclear War, Alan Toy, a disabled rights activist and Chair of the American Civil Liberties Union chapter in Santa Monica, and a nameless, yet tireless grassroots volunteer who toiled nights making precinct maps - and me. Marcy Winograd. I campaigned for Obama - went on Pacifica's KPFK twice, once on election day, to promote his candidacy, to tell the world he really was our hope, the candidate who could galvanize the young and the man who could strengthen an ever-expanding progressive base in the Democratic Party. I urged our Progressive Democrats of Los Angeles chapter to endorse him and we did. Obama for President. But the Obama campaign was worried their delegates would switch at a brokered convention. After the first round of voting, if no clear winner emerges, there is no such thing as a pledged delegate - according to Hillary Caesar Clinton. Did I take an Obama loyalty oath? Even better. Two years ago I picketed a Hillary Clinton fundraiser in Hancock Park and was quoted telling the Los Angeles Times. "Hillary Clinton led us to war. She is not the kind of leader we need." I sit on the Executive Board of the California Democratic Party and will vote in June on DNC delegates who will preside over the convention in August. These are the men and women who will make the rules at a potentially brokered convention. How very sad, indeed, that the Obama campaign has chosen to slash and burn its list of supporters, as this purging policy projects the wrong image, makes the campaign look nervous, not at all confident - and, I'm afraid, anti-democratic and mercenary, given the coveted treatment of bundlers running for delegate seats. pdla.org Marcy Winograd is an Executive Board member of the California Democratic Party, representing the 41st Assembly District (Santa Monica, Pacific Palisades, Topanga, Malibu, and Brentwood). In 2006, she garnered 38% of the vote in her congressional peace challenge to Jane Harman. At the last California Democratic Party convention in San Jose, she lobbied successfully for Party platform amendments calling for prison sentencing reform and card check certification in union-organizing drives. --------15 of 15-------- "Medical home" proposal in DFL "reform" bills won't work By Kip Sullivan April 8, 2008 The DFL leadership in the Senate and House introduced health care "reform" bills late last February that contain a few good provisions and a lot of bad ones. The good provisions include those which expand MinnesotaCare and Medical Assistance, and finance programs to reduce obesity and smoking. The bad provisions are the "payment reform" sections which shift insurance risk from the insurance industry to clinics, hospitals, and other providers, and those which subject providers to report cards. I discussed the bad provisions in my first two articles in this series. The bad provisions in the Senate bill, SF 3099, came within one vote of being deleted from the bill when the entire Senate debated SF 3099 on March 27. The vote came on an amendment to SF 3099 offered by Sen. John Marty that would have cut the "payment reform" and report card language out. His amendment failed on a 32-33 vote. The bill passed an hour later by a 41-22 vote. The companion bill in the House, HF 3391, has not yet come to a floor vote. A very similar debate is going on in that chamber between the authors of HF 3391 and the single-payer legislators who oppose the "payment reform" and report card provisions. The single-payer legislators are telling the authors of HF 3391 there will be a fight on the House floor if the authors don't take the objectionable provisions out. One other novel "reform" in the DFL bills that is generating much discussion, but not as much controversy, is the "medical home" (or "health care home") proposal. This proposal was popularized by the Health Care Access Commission (HCAC), one of two health care "reform" commissions that met throughout most of the last half of 2007. The HCAC recommended that the Department of Human Services (DHS) create "health care homes" for people who qualify for the state's three big public health insurance programs - MinnesotaCare, Medical Assistance (Minnesota's Medicaid program), and General Assistance Medical Care. Sen. Linda Berglin (<?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" />Minneapolis) and Rep. Tom Huntley (Duluth), who chaired the HCAC and who are the authors of SF 3099 and HF 3391 respectively, included that recommendation in their bills. The "medical home" proposal has nowhere near the potential to harm providers and patients and drive up costs that the "payment reforms" and the report card requirements do. Nevertheless, it is objectionable policy. It has no clear definition and will, therefore, be impossible to evaluate with anything resembling precision. It is supposed to cut costs by improving care. But it won't work for those public program enrollees who are only eligible for a few months and are then bounced from the rolls; and it may not do much even for the minority of enrollees who stay on the rolls for years. If it accomplishes any good for some patients, it will be at the expense of other patients because the legislation authorizes DHS to take money from non-"home" clinics to help "home" clinics defray the cost of qualifying as a "medical home." These costs include expenditures to finance extra nurses and clerks, to help patients schedule appointments, to stay open later, to buy computers and software, and to spend more time interacting with patients and their family members. AN EVOCATIVE METAPHOR BECOMES POLICY If "medical home" were merely a synonym for "regular source of medical care maintained by the patient over a long period of time," the phrase would not be difficult to define. And there would be no question as to whether it would be a good thing. A small body of research has demonstrated that longevity in doctor-patient relationships improves quality of care. Of course, the main threat to longevity of doctor-patient relations is our sick health care system. Our system permits 47 million of us to go without health insurance, and it forces those of us who are insured to change insurers every two or three years, which in turn often means changing doctors because most insurers limit which doctors we can see. Unless we establish universal health insurance and restore complete freedom to choose our doctors, the dream of a "medical home" a place where doctors get to know their patients over many years - will remain unfulfilled for the large majority of us. These impediments to long-term patient-doctor relations are especially severe for the low-income Minnesotans who qualify for MinnesotaCare, Medical Assistance, and GAMC (the programs that will be required to create "medical homes" under the DFL bills). According to research done at the national level, 60 percent of Medicaid recipients lose their Medicaid coverage within one year of getting it. "Medical home" proponents do not explain how it is possible to establish long-term doctor-patient relations when continuity of insurance coverage is non-existent. But advocates of the "home" concept do not limit their definition of "medical home" to just - "a regular source of care". They claim that "medical homes" will provide much higher quality of care than your run-of-the-mill clinic. They say this will be achieved by numerous tactics that go beyond merely facilitating longer patient-doctor relations, and that these tactics will culminate in greater use of preventive services and better "management" of chronic disease, and this in turn will bring costs down in the not-too-distant future. The tactics "medical homes" are supposed to use include * hiring more staff (especially non-physician staff such as nurses and physician assistants), * providing or "arranging all - care" patients might need, * improving physician compliance with existing guidelines on how to treat and prevent particular diseases, * making greater use of computers, * achieving greater "linkage" with non-medical service agencies, * improving access through either longer hours or more availability of doctors and nurses by phone and email, and * communicating more often with patients and family members. And, of course, there are the ever-popular report cards. "Medical home" advocates believe all clinics should send their patients' medical records to some third party so that party can prepare report cards on how well clinics treat hundreds or thousands of different types of disease ("home" advocates are very vague about what proportion of treatments report cards should cover). Like all managed-care proponents and advocates of "market" solutions, "medical home" advocates believe doctors and nurses will be motivated to take better care of their patients if they are subjected to the embarrassment of seeing low "grades" next to their names on public report cards, and to financial rewards and punishments based on their grades. With the exception of report cards and the destruction of patient privacy report cards entail, and with the possible exception of greater use of computers (it is not at all clear that computers improve care or reduce costs), these features of "medical homes" are quite attractive. Who wouldn't want access to clinics with all the extra services "home" advocates want to make available at "medical homes?" But if that's what the "medical home" is - if it's nothing more than a clinic endowed with more resources than the average clinic - why not say so and dispense with the "medical home" poetry? The maddening vagueness of the "medical home" proposition is best illustrated by examining the two most important mysteries left unsolved by proponents of "medical homes": Who will pay for all the extra services, and will the enrollees in MinnesotaCare and the other public programs be forced to visit one and only one clinic during their tenure as public program enrollees? I discuss these two mysteries in the remainder of this article. LUNCH WILL NOT BE FREE "Medical home" proponents have no idea what it will cost Minnesota clinics to do all the things necessary to qualify as "medical homes." (DHS and the Department of Health will be jointly in charge of deciding which clinics qualify.) What will it cost, for example, to hire extra nurses to provide above-average volumes of preventive services, more advice to the chronically ill, more meetings with patients and their families, and more hours to keep the clinic open longer? No one knows. Similarly, no one can say for sure how these costs will be paid for. You might think the Health Care Access Commission, which devoted hundreds of people hours to this topic, would have addressed the cost question before endorsing the "health care home" as a cost-containment device. You would be wrong. The closest the HCAC got to explaining who will pay for all the extra features is to imply that all these features will pay for themselves, apparently in the near future. Here is how the HCAC (which used the phrase "health care homes" more often than "medical homes") put it in their February 2008 report to the Legislature: "The health care home would support the reliable delivery of preventive care and disease management through care coordination, which has been shown to increase health care quality and reduce health care spending." There was no footnote appended to this statement. (The HCAC report is available at http://www.commissions.leg.state.mn.us/lchca/HCAC%20Report%20final%202-08.pdf.) Even if this statement were true, it would leave unanswered the question: Who will front the money to the clinics so they can buy the people and equipment they need to be certified as "health care homes"? After all, even the most effective forms of preventive and disease management services take time to pay off in the form of reduced medical bills. But the statement is not true. There is no scientific research (as opposed to junk science produced by business consultants and insurance companies) supporting the claim that prevention and disease management save money. In fact, the research suggests that many preventive and disease management services raise health care costs. ("Preventive services" refers to medical services, like flu shots and mammograms, given to people before they get sick, or at least before they have outward signs of being sick. Disease management refers to medical and education services given to patients who already have a disease or show signs of getting one. Disease management services are typically aimed at prevalent, chronic diseases like heart disease, asthma, diabetes, and depression.) Here is how experts characterized the professional literature on preventive medicine in the February 13, 2008 edition of the New England Journal of Medicine: "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not" (Joshua T. Cohen et al., "Does preventive medicine save money? Health economics and the presidential candidates," 358:661-663). There are several reasons why most preventive services don't save money. One is that they are given to massive numbers of healthy people, only a small fraction of whom were going to get the disease anyway. A second is that preventive services are rarely 100 percent effective. The result: We spend lots of money providing preventive services to millions of people, but the savings from warding off disease in a tiny percentage of those people are too small to offset the cost of administering the preventive services. The rule of thumb that prevention does not save money applies as well to disease management, for similar reasons. The disease management services (the most common of which is phone calls from nurses to patients to see if they are following their doctor's orders) cost money, and they do not always result in improved health and lower use of medical services. Research indicates that disease management of a few diseases save money (management of congestive heart failure is an example), but most don't and some raise costs. Here is how a review of the scientific literature published last December in the American Journal of Managed Care characterized the current evidence: "[T]he results of our review suggest that, to date, support for disease management is more an article of faith than a reasoned conclusion grounded on well-researched facts" (Soeren Mattke et al., "Evidence for the effect of disease management: Is $1 billion a year a good investment?" American Journal of Managed Care 2007;13:670-676). Just yesterday the New York Times reported on a three-year experiment sponsored by Medicare to see if disease management saves money. Medicare paid disease management companies like Healthways and Health Dialog up to $2,000 per patient (the patients had, among other diseases, heart disease and diabetes) and measured the impact these companies had on the cost of medical services. The preliminary finding is that the money paid to the disease management firms was not offset by reduced medical expenditures, and the net effect was to raise Medicare's costs. Two final arguments some "health care home" advocates make is that computerized medical records and report cards will somehow cause doctors to become better doctors, or at least more efficient doctors. As is the case with the arguments for prevention and disease management, these arguments are not supported by the scientific evidence. Bill Gates and the computer industry eagerly promote the notion that getting all clinics and hospitals to spend billions on computers and software in order to switch from paper to computerized records will save money. They claim the investments in computer technology will save more money than the new technology cost by replacing human workers and by improving care and reducing future medical costs. But the small body of research on these claims indicates electronic medical records have a mixed effect on cost and quality of care. Some research (but by no means all research) actually shows that computerized medical records make doctors less efficient and increase the risk of medical errors. The evidence on report cards is almost nonexistent, and what there is lends no support to the claim that report cards improve care. In fact, some research indicates report cards harm sicker patients because doctors avoid them to keep their grades from being dragged down. Report cards are going to cost something to produce. If we do report cards on even a substantial minority of the thousands of treatments available in a modern nation, the total cost is going to be huge. To sum up, even if preventive services, disease management, computers, and report cards saved money, they can't save money before a clinic opens as a "health care home." But the fact is these things don't save money. The fact is, the "health care home" lunch will not be free. If there will be no savings, where do "health care home" advocates think clinics will find the funds to provide more services than the average clinic does now? MEDICAL HOTELS The mystery of how the extra services of "health care homes" will be financed is intimately related to the other mystery I mentioned: the question of how any clinic can be held responsible for its services to patients when those patients are not forced to "enroll" with that clinic and to promise not to seek care from other clinics for a defined period of time. The HCAC and the Berglin-Huntley bills call for DHS to pay "per-person-per-month coordination fees" to every "health care home." These fees are to be higher if the patient for whom the fee is paid is sick and lower if the patient is healthy. (Just as the HCAC did not hazard a guess as to how much it will cost clinics to gear up to be "homes," and did not hazard a guess as to how much report cards will cost, so the HCAC did not hazard a guess as to how much it will cost DHS to figure out how healthy each of the hundreds of thousands of public program enrollees are and to adjust the "coordination fee" accordingly.) The HCAC and the early versions of SF3099/HF3391 stated that the "coordination fee" could not exceed $50 a month for the sickest patients. Thus, for a typical primary care doctor with 2,000 patients (let's pretend for the moment they all took an oath to visit only that doctor), the "coordination fee" would amount to somewhere between zero (if all the patients are very healthy) to $100,000 a month (if they are all very sick). Will that $100,000 come from new taxes? No, it will come out of the hides of clinics that serve public program enrollees that do not volunteer to be "health care homes." SF3099/HF3199 has a "cost neutrality" provision in it. This provision states that if "initial savings" from implementation of "health care homes" are nonexistent or insufficient to cover the cost of the "coordination fees," "the commissioner [of DHS] shall reallocate costs within the health care system." This is a vague way of saying the commissioner of DHS is authorized to lower reimbursements to non-home clinics and all other non-primary-care providers if that's what it takes to pay the "coordination fees" to "home" clinics without raising the total cost of the MinnesotaCare, Medical Assistance, and GAMC programs. This brings us to the second unsolved mystery: How will DHS know which patients "belong" to any particular "health care home" clinic? You might think patients would be required to enroll with one clinic, just as people with health insurance enroll with one insurer each fall for the coming calendar year. But neither the HCAC report nor the DFL bills require that. They do say DHS shall "encourage" public program enrollees to "choose" a clinic (in some sections the verb is "select") within the first month or two of being enrolled in MinnesotaCare, MA, or GAMC. But that's it. Will patients be required to sign a statement saying they promise to seek care at only their chosen clinic? If they violate that pledge, what are the consequences? No health care? Will "health care homes" be required to call up "their" public program enrollees every month or two and ask them, "Do you consider yourself a loyal patient of our clinic even in the months when you don't need to come in for a visit?" Will DHS ask the "health care homes" for documentation of such calls? What will all that cost? And if patients are not going to just one clinic, how is it possible to hold any one clinic responsible for providing and "arranging" for all of the patient's medical care services? By what logic should a single clinic be graded on the quality of care that it gives to patients who visit multiple clinics? It is not clear why the HCAC report and the DFL bills failed to address these issues, in particular why they failed to state explicitly that public program enrollees will have to choose one clinic and promise to go only to that clinic. I can think of only two reasons. Either the authors of the "home" proposal overlooked this question, or they did not overlook it and decided they did not want to call attention to the unpleasant fact that patient choice of provider will have to be severely circumscribed in order to give the "health care home" fantasy a snowball's chance of working. So, to repeat the question at the heart of the second mystery: How will DHS know which "health care home" should get the monthly "coordination fee"? I, for one, have no idea. If the authors of SF3099/HF3391 know, they aren't saying. CONCLUSIONS The DFL bills include provisions that require DHS to report regularly to the Legislature on how "health care home" clinics affect both the cost and quality of health care within the public health insurance programs. But, for several reasons, it is extremely unlikely that DHS will be able to do that with anything resembling accuracy. The vague definition of "home" clinics is one problem. The apparent inability of anyone to require patients to "enroll" with one "home" is another. A third reason is the enormous cost of collecting data on patient health and other factors that can influence the cost and quality of health care and adjusting cost and quality data to reflect differences in those factors. Even assuming all "home" clinics adopt the identical set of new features, and even assuming all public program enrollees can be forced to visit only one clinic, differences in factors outside of clinic control must be accounted for if comparisons between "home" and non-"home" clinics are to be fair and useful. If data on these potentially confounding factors are not collected, DHS will have a hard time determining whether differences between "home" clinics and non-"home" clinics were due to something the "home" clinics were doing or to factors such as differences in the health of patients in the two types of clinics. One solution to this problem would be to reduce the "home" proposal to a pilot project covering, say, four "home" clinics and four non-"home" clinics. DHS could insist that all "home" clinics adopt the same features, and DHS might actually be able to afford to do the rigorous data collection necessary to produce reliable results. Our Legislature has been for too long in the habit of adopting health policies based primarily on insurance industry propaganda. It is high time they adopted a policy of recommending solutions that have some support in the scientific literature or, failing that, have been tested by pilot projects. My guess is that if the "health care home" legislation is enacted, few providers will sign up until DHS, or perhaps the Legislature in a future session, clarifies some of the ambiguous language used to describe "health care homes." I'm confident that once a some clinics are certified as "homes" under the language currently used in SF3099/HF3391, we will never know for sure how well or how poorly the "homes" functioned. That doesn't mean they won't be hailed by "home" advocates as the finest thing since sliced bread. ---------------------------------------------------------------------------- - David Shove shove001 [at] tc.umn.edu rhymes with clove Progressive Calendar over 2225 subscribers as of 12.19.02 please send all messages in plain text no attachments To GO DIRECTLY to an item, eg --------8 of x-------- do a find on --8 impeach bush & cheney impeach bush & cheney impeach bush & cheney impeach bush & cheney
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