My brother Mark, who has been consumed with sound engineering the new tax-supported baseball stadium for the Minnesota Twins, noted in this morning’s e-traffic that in six pages of Tribune coverage of Favre’s first day in MN there was a large ad headed “Cash for Clunkers.” Jason Lewis who is MN’s “Mr. Right” on KTLK radio declared “Favre may cost the Vikings millions, but they’ll get a lot of it back if he’s injured because his medical expenses will be covered by Medicare.”

THE TOWN HALL MEETING
I did hundreds of them and loved doing them. Because of what I could learn there. Because in their home towns, people tell you what they think and expect you to listen and to react, tell them what you believe. Something they’ll never do for you when they visit in Washington, D.C.

Longer ago than my time, the town hall was where township residents met every other year to elect their officers who met there to do the township business. Minnesota had a particularly strong township base. As a Senator, I met with them frequently and their national association named a leadership award the Durenberger Award.

Over time, the town hall meeting began to be attended by larger numbers of persons who came prepared to speak to a single issue, often with information provided by a state or national association to which they belonged. By the time I retired, it was possible to anticipate the tenor of the meeting by the “issues of the day” in Washington, and the genuinely concerned found it more difficult to express that concern and I found it more difficult to make time just for them.

by Dana Summers

THE HEALTH POLICY REFORM TOWN MEETINGS
I discovered that things haven’t changed much in 15 years. But the attendance is a lot better and the numbers of people who came to make their voices heard is a whole lot greater. In “greater Minnesota,” however, the essence of the town hall is still there. People come to see and talk to their representative in Washington. They even want to hear and talk to an old geezer like me, perhaps assuming I have less at stake in my responses than their Congress members.

Everyone is deeply concerned about their own health care access. Costs are a big concern for everyone, but uncertainty about the future even greater – a sense of “something has to be done, but what?” Those most concerned about losing coverage, and about those without, are supportive of the efforts in Washington to expand coverage. Especially by reforming the health insurance system which is perceived to be the biggest part of the cost and uncertainty problem. Aspersions were cast on the undue influence of big corporations on prices, on change and on members of Congress and their decisions.

Almost no one questions the quality of their own health care or their doctor or hospital. A number of veterans say “quit worrying about government-run health care – the VA health care system is the best you can get and ought to be a model for change.” Health care providers all seem to favor major payment reform. They support universal coverage and any effort to improve “fairness” in the third-party payment system, like Medicare and Medicaid.

People who speak against the current Democratic bills seem concerned by forces beyond their control: Congress members who don’t know what they are voting on. The power of federal programs and those who sponsor and run them over the lives and decisions of ordinary people. The president. Why is he in such a hurry to tackle these huge problems? Why not take them one at a time? How can he promise we don’t have to change when we all know change is coming or he wouldn’t be doing this? If the system’s so bad, why expand it to more people? Then, of course, there are a couple dozen people with HR 3200 pages to cite for threats designed by opponents in D.C. And of course, there was a young man with a camera from the Minnesota Republican Party recording everything that was said especially by the Democratic congressman.

SYSTEM 2009
While Tiger Wood and Padraig Harrington were tuning up for their Thursday PGA match at Hazeltine G.C., veterans of the 1993-94 health reform effort gathered in Washington, D.C., to discuss the 2009 reform effort. In April of 2008, each of us had been part of a group of some 40-plus vets who spent a weekend together at a conference center across the street from Hazeltine in Chaska. The result of that weekend was a set of 10 recommendations to those who next tackle health reform on how to improve on our results. We called it System 2009 to reflect our consensus that anticipating the environmental challenges around reform is a more difficult task than creating the reform plan itself. Read more…

PUBLIC PLAN . . . CO-OPERATIVE . . . HEALTH INSURANCE REFORM
North Dakota is a unique state. It votes Republican for president and Democrat for the U.S. Senate. It has a state-run bank that competes with other banks to keep them honest. It gave Blue Cross Blue Shield of ND a monopoly on health insurance and has the lowest premiums and close to highest quality health care in the country. Its elected reps fight for farmer/rancher subsidies and are the first to take on the Cargill/ConAgra big corporate business control of food production. North Dakota is as populist as it gets in America.

No wonder Senator Kent Conrad (D-ND) has chosen to take on big health insurance and big government with his “health care co-operative” solution to insurance reform. I love Kent and know his heart is always in the right place. But the value of his co-op as national reform was evident on Monday when the stock market went down 186 points on the DJA, but most national health insurance corporate stock went up – substantially. And corporate insurance jets were flying to Washington to take advantage of the opening. I can just imagine the White House “woodshed” where HHS Secretary Kathleen Sebelius and health reform czarina Nancy Ann DeParle were closeted with Rahm Emmanuel.

RIGHT OF CENTER REPUBLICANS
Texas Republicans are planning to have an election for governor next year that will set records for national interest, money collected and spent, and pundit analysis of the future of the GOP. Governor Rick Perry is running for a third term and has moved so far to his right that he’s suggesting secession from the union as an answer to President Obama’s programs. Senator Kay Bailey Hutchison was elected to replace Lloyd Bentsen as U.S. Senator has been re-elected three times. Each is raising big bucks in a state that has an unlimited supply of same. Hutchison is to the Republicans what Lloyd Bentsen was to the Democrats – a bit too close to the center of American public policy opinion. Perry succeeded to the governorship in 2000 as George Bush’s Lt. Governor and was strongly supportive of the Bush war and spending policies until after the 2006 election, when he began moving right, completing the journey with the election of President Obama in 2008.

Texas money is also funding a start-up non-profit called America’s Action Network, which is designed to give definition to a principled “role of government” approach to the Republican Party’s future. In the process, its founders hope to leave some of the “other issues” like those which firmed “the base” in the social values arena behind. New president of the right-of-center group will be former Minnesota Republican Senator Norm Coleman. This will place two Minnesota Republicans in the national political spotlight as Governor Tim Pawlenty seeks to similarly define the next national GOP for what he calls “Sam’s Club” Americans.

LOUISIANA POLITICS GETS ROUGH
New Orleans adult film star Stormy Davis is planning to run against self-confessed escort service patron Senator David Vitter (R-LA) in 2010. Just recently, a car belonging to Stormy’s campaign consultant Brian Welch was blown up on a side street in downtown New Orleans.

BILL CLINTON DOES NORTH KOREA
I knew if Bill Clinton went to North Korea he’d come back with the imprisoned journalists. Bill Richardson once did the same thing as a member of Congress. The dear leader, Kim Jong Il, has long wanted the world to recognize him as a head of state. He came close to getting President Clinton to make the trip in 2000, so it’s been only a matter of time, and politics, before it would happen. While I am not an expert on North Korea, one week in the country in 1995 taught me it was a cult not a state and needed only be treated as such. Republicans refuse to do it. Democrats seem eager. Let’s see what happens as a result – long term. The neo-con and WSJ crowd will never approve, so let them be surprised.

What I continue to find remarkable about events like this is the potential this president has. Not because he’s smarter than everyone else, but because he has a confidence that comes to few in politics. Barack Obama chooses his main primary opponent, the presumed heiress to the Clinton presidency, the loser, to be his Secretary of State. Like the Clintons used to tell us in 1991-92, “you vote for one, you get two.” What president wants both Hillary Clinton and a former President Clinton, with their egos, representing him and America? Only a confident Barack Obama. Or so it seems.

SENATOR JIM WEBB IN MYANMAR
One might have expected a former president’s success in gaining the relief of hostages from North Korea’s cultist dictatorship. The fact that a member of the U.S. Senate could secure the promised release of a similar hostage from the military dictatorship that has run Myanmar for years was a surprise. In both cases the non-surprise was the foreign policy establishment’s reaction. You can’t allow anyone but the executive to negotiate foreign policy. And from the Republican right: “We can’t negotiate with murderers, terrorists, etc.”

So it has always been. Congressman Charlie Wilson was warned off of the mujahidin cause in Afghanistan, until he became successful in persuading clandestine support against the USSR. While I was chair of the Senate Intelligence Committee, I was told we couldn’t send staff investigators to places like Angola. Through an African president, I was asked to meet in a neutral place with Libya’s Muhamar Khadafi, but could not because we were pressuring him to release perpetrators of Pan Am 007. What he wanted was what he eventually got after 9-11 – an opportunity to conditionally rejoin the nations we’ll talk to. Senator Arlen Specter and others have been criticized for talking with leaders “we aren’t talking to,” like Bashir Assad of Syria.

HILLARY GOES GOMA
“This is something I want to do, and we’re going,” is how Secretary of State Hillary Clinton dealt with advice she not fly from Kinshasha in the west to Goma in the embattled east of the Democratic Republic of Congo this week. Goma is an otherwise lovely town I’ve visited a couple times either by boat on Lake Kivu or by car after visiting the famed gorilla preserve in the area. Its people are Hutu and Tutsi just like neighbors in Burundi and Rwanda. Not so long ago, the UN gave them all the option to form one nation, which they rejected. For the last 15 years the Tutsis in eastern Congo have suffered from the spillover of genocide in their neighbors. Hutu rebels from Rwanda in particular have created havoc, and only recent intervention by President Paul Kagame and the army from Rwanda have settled things down.

Hurray for Hillary for going to Goma and for condemning the combination of corrupt politicians, private mineral companies and official Chinese policy that exploits, in the worst sense of the term, Africa as a source of needed minerals and for the employment of Chinese workforce.

THE POST OFFICE GOES THE WAY OF THE NEWSPAPER
The General Accounting Office (GAO) added the U.S. Postal Service to its list of “high risk” federal programs recently. USPS lost $2.8 trillion in FY 2008, and is headed for a $13 trillion loss in FY 2009. Efforts to cut out Saturday service or to reduce post offices meet Congressional barriers where Republicans like JoAnne Emerson of Missouri swear, “My constituents feel very strongly about having their post al service continue as it always has.” Congress members like this also wanted GM, Ford and Chrysler to continue every dealership in the country while the car makers were heading for oblivion.

THE WEEKLY STANDARD GOES THE WAY OF TALK RADIO AND FOX NEWS
Billionaire Rupert Murdoch, who has proven a “fair and balanced” conservative publisher, just sold the news magazine to billionaire Philip F. Anshutz, who is anything but. This will assure jobs for Bill Kristol and Fred Barnes, who are Standard and Fox News regulars – as well as the creators of Sarah Palin as vice president. It also keeps us reading the humor-laden punditry of Matt LaBash.

Analysts say the ownership goes from a man who craves proximity to and the exercise of power, to one who aims only to shape powerful people to his way of thinking about the world. Murdoch, of course, does that only on the editorial and two opinion pages of his Wall Street Journal.

THE FINANCIAL CRISIS INQUIRY COMMISSION GOES CA
Most folks missed the news that Congress has asked 10 Americans from both major political parties to tell the rest of us why the American financial system failed us. Chair of the inquiry will be former Democratic State Treasurer of California Phil Angelides. The co-chair will be our friend Bill Thomas of Bakersfield, CA, recently retired Republican chair of the House Ways and Means Committee. Other members are retired FL Democratic Senator Bob Graham and former CBO Director, MEDPAC member and McCain economic adviser Douglas Holtz-Eakin.

JUDICIARY CHAIRMAN GRASSLEY
Proving how easy it is to turn a “friend of Max” into a political advantage, GOP ranking member Chuck Grassley assured his GOP colleagues that he will never sell them out by making a deal with Baucus. Chuck, who has done deals with Baucus before, was initially wise enough not to get specific about what “deals” meant. Today he gives a new definition to fair health policy: “It isn’t a good deal unless I can sell my product to more Republicans.”

Over on the House side, the GOP Healthcare Solutions Group will present a Republican health care policy reform policy sometime in September. The bill was to be ready in July, but had to get in a line to be “scored” by the Congressional Budget Office. So now Republicans have time to tout savings, and to claim constituent support from an August recess saturated with advertising by the growing number of opponents to health reform.

DICK CHENEY’S BOOK TO DESCRIBE RELATIONSHIP WITH PRESIDENT BUSH
The former vice president has shown no reluctance about speaking his mind on his stewardship of the nation during the first eight years of this century. The Washington Post told us last week that Cheney intends to be honest about the way he views the president whom he also served. The article by Barton Gellman suggests that George Bush did some push-back in the first term and was somewhat distant in the second.

BIO TECH IN PINE ISLAND
The City of Pine Island has been a wide spot in U.S. Highway 52 between the Twin Cities and Rochester for many years. Known to most of us locals for its road side cheese factory and to travelers as the highway speed trap on their AAA maps, Pine Island will soon have a highway interchange to take you to one of the biggest biotechnology ventures in the nation, assuming billionaire venture capitalist and bio tech guru Steve Burrill has his way. Steve’s a Wisconsin boy who lives in San Francisco since making it in the ventures world of Silicon Valley.

Let me be among those who predict big success for Burrill’s venture on a 2,350-acre planned development site owned by Tower Investment Company of CA. Success is predicated on its sheer size and Burrill’s audacity. He’s the closest thing to a Rudy Perpich we’ve seen in the state of mediocrity in decades. That alone could do it. The other is that the Mayo Clinic and academic medical research centers at the University of Wisconsin and the University of Minnesota will have to pay attention to the investment potential this brings.

Academic medicine in America is engaged in a medical research arms race playing off the NIH’s $30 billion a year in grants, drug industry research and research facilities, billionaire philanthropy and inter-state competition for income tax breaks. Much of academic research goes to maintain inefficient medical education and clinical enterprises. Not so Burrill’s billion-dollar bio-tech center. Audacity, money and location means Mayo has to play at some level. So will IBM Rochester and hundreds of information technology start-ups that see health care modernization and sickness prevention as the future.

CASH FOR CLUNKERS…
…is an outgrowth of efforts made in the 1980s and the Clean Air Act 1990s to reduce auto emissions without doing too much harm (per Congressman John Dingell) to the U.S. auto industry. Today it has the added benefit of energy conservation and cleaner air without elaborate bureaucracies, and of restoring American’s confidence in themselves, the economy and the auto industry. Someone should have farmed out the government end of the electronic verification program to a gang of 20-something inventors so that the government’s side of the highly successful program wouldn’t be helping to do in public opinion of government funding of health care. Republicans who object think it’s another government give-away and Democrats that it isn’t going far enough on verifiable emissions performance. Nothings perfect in Washington World.

CAP AND TRADE LEGISLATION
President Obama had the notion that he could shape energy, economic and environmental policy with legislation which would limit toxic air emissions. David Brooks neatly summarizes what experts tell me is wrong with the bill: “On cap and trade, the House chairmen took a relatively clean though politically difficult idea – auctioning off pollution permits – and they transformed it into a morass of corporate give-aways that make the stimulus bill look parsimonious. Permits would now be given to well-connected companies. Utilities and agribusiness would be rolling in government-generated profits. Thousands of goodies were thrown into the 1,201-page bill to win votes.”

Economist A. Gregory Mankiw does a more detailed job in the New York Times. The National Defense University is releasing studies on climate change world-wide and the de-stabilizing effect it will have on politics and national security. John Broder in the New York Times.

A lean, muscular gray-bearded man about 60 at a health care town hall meeting in Willmar, MN sits quietly for 2.5 hours holding this sign: “Veracity Not Velocity.”

A South African woman who remembered to Hillary Clinton all the other American visitors to her project, “In the end, all we got was a pile of business cards.”

Peggy Noonan on health reform: “The Obama White House has done the near impossible: it has united the Republican Party, social conservatives, economic conservatives and libertarians.”

To which I would add: “United by the synchronization of right wing radio and cable TV pundits using Wall Street Journal editorials and op-eds by the people who brought us the end of the last health reform effort.

Maureen Dowd of the New York Times said “I’m not sure the man who popped off and tweeted that Sonia Sotomayor was a “Latina woman racist” is the best Henry Higgins for the Eliza Doolittle of Alaska. But Newt Gingrich was a professor. And he does know something about pulling yourself up by dragging down others and imploding when you take center stage – both Palin specialties. Besides, he agrees with Sarah – who fretted that her parents and son Trig might be in danger from Obama “death panels” – that we should be very wary about trusting government with end-of-life decisions. So Newt took it upon himself to become Palin’s Pygmalion.”

“Members of Congress are afraid to hold town halls. We are winning. They are afraid of us.” Twila Brase who runs an anti health reform, pro consumer driven health association in MSP to ensure no doc has to be measured and no clinical data can ever be used for research.

Congress will spend $500 million to buy new jets for members of Congress to travel the world and find facts in out of the way places. The drug industry’s PHRMA will spend $150 million promoting the Obama health reform bill once it is clear TV viewers understand it’s as good for their health as Cialis is for erectile dysfunction.

High Performance Health Care Blog
The High Performance Health Care Blog highlights significant new articles in the business literature, reviews key concepts being taught in University of St. Thomas programs, reports on findings from faculty research projects and provides analysis of current health care reform efforts.

This blog is written to be of use to progressive health care leaders, clinicians, policymakers and academics. It is authored by the faculty and staff of the St. Thomas health care programs. Dave Durenberger has recently joined the HPHC blog as a regular guest contributor.