Apr ‘10
21
Commentary from Dave Durenberger
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NATIONAL NEWS |
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THE NEW ECONOMY Somewhere between September 17, 2008 and the November 2008 election, it dawned on many of us that the “free ride old economy’ on which three generations had grown to expect health, education, and housing for “little down and forever to pay” was probably over. Replaced by what? We don’ t know because our leaders aren’t sure what a “new” economy will serve us best and what policies are most appropriate to make it happen. Tom Friedman of the NY Times via St. Louis Park, MN is the exception who talks about both all the time. FORCES BEYOND OUR CONTROL In the new economy, the same forces are at work assuring incomes to Wall Street and Main Street bankers, doctors, hospitals, health insurers and medical technology companies, and their lobbyists are doing a good job of keeping the subsidies going for the producers of everything we’ve been told we need. So far, everyone in the new economy is doing just as well as they did in the old, except us – some really large percentage of 305 million Americans. While the stock market is back, we no longer have the confidence we once had that it will cover our retirement or our kids’ education. The Federal Reserve is still bailing out big banks with incredibly low interest rates, while the banks are getting even with us for borrowing beyond our means rewarding our “new economy” penchant for saving what we can, with .025 percent interest and apparently using the “profit” to compensate the guys who killed the old economy for the great job they did. IN CONGRESS IT IS SURREAL They have taken 16 months to figure out why the financial system collapsed and how to keep it from doing it again. We the voters still don’t know what went wrong. A “commission” of politicians and look-alikes can’t figure out what their responsibility to us is, so they hold hearings with famous apologists for the industry. Democrats and Republicans debate each other on how to protect us. Both claim they are the “anti-bail-out” party because that’s the sound bite policy goal. To demonstrate how idiotic it all is, this week the 1,500 lobbyists for the U.S. money industry are courting the Senate Agriculture Committee over something called “derivatives.” Senators not on the Agriculture Committee are supposed to be producing appropriations to keep this kind of government going and a budget to assure us they are being responsible. But they can’t make progress on either. So what’s left? An 85-13 vote to endorse John Mc Cain’ s re-election campaign effort to characterize a national Value Added Tax as “a massive tax increase that will cripple families on fixed income (AZ) and only further push back America’ s economic recovery.’ From there to an effort led by Chuck Schumer and Amy Klobuchar to force the airlines to stop making us pay for our carry-on luggage!! Was it the Pew Public Research Foundation that informed us that the public’ s opinion of Congress is now at a record low?? APOLOGETIC BUT ADMITS NO GUILT That’ s about the way you would summarize the former leaders (management and Board) of Citi Group when asked to explain their roles in the near collapse of America’ s financial markets and the losses sustained by millions because of their own failures. Watching Prince and former Treasury Secretary, Clinton confidante, Wall Street demi-god Rubin walk off in their $10,000 ties left me demoralized. BEHAVIOR SHOULD HAVE CONSEQUENCES No clawback for us, but escalating compensation bonuses for many as the phoenix industry rises from its ashes to break the Dow Jones 11,000 mark. Which justifies the claims of many executives that they were not part of the problem, didn’t need the TARP, and Congress and the president have no darned business enacting regulations to protect the consumer from having to pay usurious rates for the credit they need to climb out as far and as well as the industry has. “Greenspan is nothing, if not a representative leader of his time. We live in a culture where accountability and responsibility are forgotten values. When “mistakes are made” they are always made by someone else.” Frank Rich in New York Times 4-11-10 GOLDMAN EMPLOYEES RALLY AROUND BLANKFEIN….COLLEGE OF CARDINALS RALLIES AROUND BENEDICT Speaking after 46 members of the Catholic Church’s College of Cardinals had lunch Monday with Pope Benedict XVI, the dean of the College, Cardinal Angelo Sodano reminded the Holy Father that the College of Cardinals, which elected him Pope five years ago, “is a large family, ever united with the successor of Peter,” in particular in the face of “the challenges that the modern world poses to each disciple of Christ.”….L’Osservatore Romano. Leaders of hierarchical organizations all face the same challenges that presidents of nations face. There is never enough time in any day to meet “the buck stops here’ challenge. So you are surrounded by people whose future is staked to yours and who specialize in telling you what they think you need or want to hear, rather than what you really need to hear. It never fails. As President Paul Kagame of Rwanda told me early in his career, leaders too often have nothing but conditional relationships with those around them. What every leader needs is some unconditional relationships – with people who are willing to put friendship on the line by telling you what you really need to hear and suggesting what you need to do about it. MEDIA, VATICAN FOCUS ON CHILD ABUSE BY PRIESTS THE GOOD OLD DAYS AND WHY PUBLIC TRUST IS SO LOW In places like Elbow Lake and Wendell we knew and trusted our doctor, our teachers, our banker, our auto and used auto dealer and we traded homes with each other as families grew and aged or moved “down to the Cities.” We wanted the best for our kids but didn’t spend a lot of time having to “keep up with the Schroeders.” All that has changed in our life time. There’s much to have and small town boys like John Stumpf of little Pierz, Minnesota, can go off to San Francisco, California, and make millions running a “too big to fail” bank like Wells Fargo. Or, like Tom Petters, who left St. Cloud to make millions in “The Cities” and will end up spending the last 50 years of his life in jail for letting his appetite get ahead of his Stearns County conscience. That’s good. But there’s a price. We as a people are paying it right now. Big and more isn’t better. Better is better. How do you know it when you see it? WHEN IS A SECRET WORTH KEEPING I can’t count the number of times, just in the two years I chaired the Senate Select Committee on Intelligence, that the same problem arose. Then the favorite recipient of leaks was not so often the Times, but the Washington Post. Reporters at the Post were great intelligence journalists. Bob Woodward for example, has made a career making money off “insider” books. During the time of bi-polar “cold” wars, it was critical to keep our superior knowledge and offensive capabilities from the Soviet leaders. Or so we thought because we presumed theirs to be at least equal to ours. Since our intelligence was so faulty. In the iPhone era one wonders just what a “secret” really is and how much it is worth and to whom. NUCLEAR FREEZE ONE OF AMERICA’ S TOP DOCS NOMINATED TO LEAD FUTURE OF MEDICARE – MEDICAID Because of the new reform law, his leadership skills make it possible for us to evolve a genuinely American health system. The instincts that make Berwick good at what he advocates we do, is that he knows health and healthcare improvement will happen one community at a time. Starting in those U.S. communities where leadership is already in place to shape this goal. A good reason to be optimistic about health reform. A Berwick quote reported by veteran health reporter Robert Pear this week says it all: “The best health care is the very least health care we need to gain the long, full, and joyous lives that we really want. The best hospital bed is empty, not full. The best CT scan is the one we don’ t need to take. The best doctor visit is the one we don’ t need to have.’ I have reported from time to time on how two medical clinics in La Crosse, WI, led by gifted physicians, compete to keep people out of their hospitals, and to give them the most effective, safe quality care if they need to be in the health care system. This is an American health system. Medicare Advantage data shows it costs 248% less for the same person with the same health care problem in La Crosse as it does in Dade County FL. IT ISN’ T GOING TO BE EASY HHS awarded $17 million to combat hospital acquired infections in 2009 and the new reform bill will provide payment incentives to hospital staff to do what they know already should be done to stop the problem. Dr. Peter Pronovost of Johns Hopkins, working with the Michigan Hospital Association, reduced the number of deaths in 100 Michigan hospitals from avoidable central line infection by 1500 patients and saved $175 million. Wouldn’ t you think every hospital would adopt his “check-list’ solution? Nope. AHRQ says no progress has been made nationally to deal with a killer that takes nearly as many lives each year as breast cancer!! HEALTH REFORM IS A JOURNEY NOT A DESTINATION What’s most exciting about it is the many ways we Americans are out to “bend the cost curve.” And we haven’t yet awakened to the biggest and best – the useless medicine and unwarranted mistakes and deaths visited on us by America’s medical establishment. Fortunately the medical establishment is on to it. Half spend their energy criticizing studies and authors like Dartmouth Atlas, but the other half, like Wisconsin Collaborative for Healthcare Quality (WCHQ) are putting performance improvement ahead of income generation. When the Cleveland Clinic spends $250,000 on a 16-page advertising supplement to the New York Times Magazine (4-18-10); and it’s entitled “Wellness” and describes the famous “sickness clinic” as the new center of the health business; man, you know health reform is on its way. In fact the entire magazine is devoted to health and wellness. By the way, the Obama reform bill has many provisions designed to reward Americans and their employers for taking responsibility for our healthy lifestyles and restoration of well-being. Three years ago a friend suggested I read Michael Pollan’s Omnivore’s Dilemma (Penguin Paperback $16 best-seller 131 weeks) and promised it would change the way I think, I did. It did. Pollan’s a neighbor in the CA Bay area and his appearances there are always sold out…. Former Stanford President Don Kennedy, now editor of Science, writes in Sunday’s NY Times about 30 years of bad agriculture policy to inject cows with antibiotics…General Mills follows others in starting to reduce -salt and sugar in the boxed food they sell our kids….The FDA will launch a 10 year effort to wean Americans and our $600 billion food and beverage industry from salt in prepared meals and packaged foods. THE NEW ECONOMY and LOW COST HEALTH CARE All that is about to change. As Americans conclude that regardless of who runs Washington D.C. the price of medical services aren’t coming down without some help. From inside – the professions themselves; or from outside, employers who are paying a majority of the costs; health insurance plans who know from claims processing which doctors practice medically necessary, appropriate and cost effective surgery and which do not, but could: and from those of us who can arm ourselves with the ability to make outcomes comparisons and the will to do just that. With a financial nudge in the right direction. CREATING A DEMAND FOR LOW COST HEALTH CARE UnitedHealth Group Inc. 1st Q 2010 income rose 21% to $1.19 billion and the company expects 2010 profit to rise more than expected. Much is attributed to increases in government program business like Medicare and Medicaid. And to expanding its business lines “to put information and technology to work,” per CEO Steve Hemsley…. Obviously this translates to election campaign fodder for Democrat proponents of reform. But a former health insurance executive raises a more important question: Where is the “value added” to the customer, the taxpayers, and the health system of all that money we’re paying insurers to be “information and technology” intermediaries? Drs. Robert Hauser and Barry Maron, Minneapolis cardiologists, have asked a federal judge not to approve a record $296 million fine the Justice Dept negotiated with Boston Scientific over defective implantable cardiac defibrillators (ICD). In this case the ICDs were made by Guidant Corporation which was acquired by Boston Scientific. The government is cheering for the settlement because it sets records and makes lawyers look like they are doing their job. Hauser and Marone say “what good is the fine if no one is held accountable?” They may have added, “and the fine is simply passed through to customers of ICDs (hospitals and insurance companies/you and me) in increased prices.” What can we do? Read “The New Economy and Creating a Demand for Low Cost Healthcare”, my keynote speech to the University of Minnesota’s 9th annual Medical Devices Conference last week RATIONAL AND DISPASSIONATE A small point on the statement that “The average American’s hospital stay today costs $28,000.’ The amount paid by private insurers in our benchmarking universe, which I suppose includes the subsidy of Medicare and Medicaid, is about $8,700. Maternity is about $4,000, NICU is $18,000, General Acute is $9,400, Mental health is $4,000. Resource: Douglas Sherlock HIGHER EDUCATION I was an “insider” on this one, having once served on the board of a Minnesota loan-maker, before going to the Senate and asking “what’s the public getting for its investment in private lending?” I co-authored with Senator Paul Simon (D-IL) the original legislation to take back the loan program from the Student Loan Marketing Association (Sallie Mae) and the banks (like TCF Bank in Mpls which made millions on low/no risk student loans). Sallie Mae hired liberal staffers from Howard Metzenbaum of Ohio to help kill our efforts with liberals. Moralist Education Secretary Bill Bennett and now-Senator/then Education Secretary Lamar Alexander rallied GOP members to fight us, and we compromised in committee to continue both private lending and direct lending by the government. Bob Shireman, who staffed Paul Simon, is now at the Obama Education Dept and led the charge to put direct lending back on the agenda and deserves credit for its passage in March. RAMSTAD RECOVERY FUND WHO SAID “NO NEW TAXES” DOESN’T FORCE POLITICAL AND POLICY REALIGNMENT Since the 1983 effort by President Reagan’s Education Secretary Ted Bell to warn America of the decline in education quality, every president and every Governor – both parties – has tried. The union sticks to its quality means more money reaction to reform. DFL legislative leaders have broken their lockstep with the union this year, just as President Obama and his Secretary Arne Duncan are encouraging states to do. Education at $37.1 billion is 37% of state budgets and at least that large a chunk out of fast-growing local property taxes. But the logjam is breaking. DFL Senate tax chair Tom Bakk: “There’ s not enough money for the status quo. I can’t raise enough taxes to solve this problem. . . Change is hard, change takes leadership.” One area that the Governor and some DFL education leaders agree on, but the union refuses to discuss, is creating new pathways to the school room for teachers. Making it possible for degreed professionals in other fields to receive a limited license to teach after 200 hours of training plus mentoring, peer coaching, and skills exams.
NEW MINNESOTA TWINS Mike Opat and I are part of a small group of Catholic men and women who meet every Monday at 6:45 a.m. to help each other test our faith against our beliefs, our experiences, and the events in our lives. Mike’s also chair of the Hennepin County Board of Commissioners and Lori Sturdevant tells us how he made the new stadium a reality. Mike’s a husband and father of three and a pro-life DFLer who believes he should seek higher office some day, but is unlikely to be endorsed by his party because of his beliefs. WASHINGTON INSIGHTS House Majority Leader Steny Hoyer (D-MD) recognizes that MN Congress member Michelle Bachmann (R) has no trouble playing fast and loose with facts. As anyone who attended her Palin/Bachmann rally can attest. Hoyer is quoted in D.C. as “chiding” Bachmann for denying that Tea Party protesters shouted “the n-word” at Congressman John Lewis (D-GA) during last month’ s health care battle. Senator Arlen Specter (R-D-PA) on the Supreme Court decision in Citizens United v. FEC giving corporations the same freedom of speech rights as citizens, “Let’s be candid about the Supreme Court being an ideological battleground today. That happens to be a fact. When some decry judicial activism, what could be more judicial activism than reversing 100-year old precedent that corporations may not engage in political advertising?”. . . Senate Republicans have warned President Obama that they will filibuster any nominee who will not attest to upholding Citizens United as the original intent of the founding fathers. Who will succeed Andy Stern as President of the Service Employees International Union? Andy’s record in organizing hospital and long term care employees and negotiating on their behalf is legion. In this day and age. Predicting whether it’s an insider like Mary Kay Henry (well known in MN hospital negotiations) is well nigh impossible. FATHER PAUL MARX, OSB GIRIJA PRASAD KOIRALA |
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| QUOTABLES | |||
| “It is easy to look back and see your mistakes, but what is to be gained by endless self examination?”…..Former Fed chairman Alan Greenspan to the Financial Industry Inquiry Commission.
“Who wants to be a Cubs fan? It’s really not fun. Some people think it’s cute – lovable losers. Wrigley Field is the biggest singles bar in Chicago, yada, yada, yada….I think it’s disgusting. I really think protracted mediocrity is not admirable…The Cubs I think have something like $11 million tied up in eight players through 2011. That’s not funny, that’s malpractice.”….George Will END OF THE WORLD |
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| UPCOMING EVENT | |||
| International Forum on Health Policy University of Minnesota April 27-28, 2010 Discuss health policy and share best practices with experts from across MN and from Germany. Minnesota is a national leader in innovative health policy. Germany has adopted and implemented system-wide many techniques and approaches first developed here. The 6th annual American & German Healthcare Experts’ forum focuses on how to manage innovation and reform. Speakers include Dr. Frank Cerra (AHC); Mary Brainerd (HealthPartners); David Durenberger (University of St. Thomas .); Germany’s Deputy Minister of Health; Dr. Rainer Hess, chair of Germany’s national board that determines the catalogue of benefits all not-for-profit health insurers must cover (90% of Germany’s system of 80 million people); and the CEO of Germany’s award-winning not-for-profit health insurer. Register now. Full details at http://www.cges.umn.edu/outreach/forum.htm UST Executive Education for Physician Leaders |


