Durenberger wields new influence
For 16 years, Durenberger was Minnesota's senior senator in Washington, rising to chair the Senate Intelligence Committee and honing his expertise in health matters on the Senate Finance Committee. But he stumbled midway though his tenure on an ethical lapse over reimbursement expenses, an episode that cast a pall over his political career.
Today, Durenberger, 72, is back in Minnesota and has evolved into a devil's advocate for health care, asking the questions others won't ask. There often aren't answers to those questions, but Durenberger is helping to push the drive to improve quality and control costs amid the often-competing interests of the physicians and hospitals that provide the care and the insurers and employers who pay for it.
It's a role in which Durenberger thrives.
"We have to come up with a way to define the problem, and then answers will follow," Durenberger said in an interview. "You don't start with the solution, you start with the facts."
Durenberger and the National Institute of Health Policy (NIHP) that he heads haven't exactly been the change agents that some had hoped they would be. Health care costs are still skyrocketing. Doctors and insurers are often still at each other's throats. But most acknowledge that his biggest success is bringing the different players in the health care debate to the table. His position as an outsider -- outside politics, outside health care -- frees him from the vested interests that bog others down.
"He's probably one of the greatest leaders I've ever met in health care," said Carolyn Pare, chief executive of the Buyers Health Care Action Group, an organization representing large employers. "He's a visionary, he's civic-minded, he's so into doing the right thing."
But Pare is among those frustrated that talk can't be turned into concerted action. "When push comes to shove, we [in the health care community] give up," she said. For example, while many hospitals are introducing electronic medical records, they aren't able to share them across different hospital groups because they all use different technology.
On Thursday, Durenberger will host a major forum in St. Paul on health care spending called the "Medical Arms Race Syndrome" featuring Princeton University's Uwe Reinhardt, a national expert on health care economics. Durenberger and others are concerned that the quest for the latest in technology is fueling overspending by hospitals as they compete for patients.
An Upper Midwest model?
The institute, which started in 1999 at the University of St. Thomas, is the kind of forum Durenberger envisioned for himself after determining there was more to life than "being a former senator."
Durenberger, a Republican, was elected to the U.S. Senate in 1978 to fill the remainder of the term of the late Hubert Humphrey. Durenberger won handily over Minneapolis businessman Bob Short after barely registering in the polls early in the campaign, in what became a strong Republican year in Minnesota.
He was reelected in 1982 over Mark Dayton and again in 1988 over Hubert Humphrey III.
But Durenberger's Senate career was marred in the late 1980s when he was among a number of congressional members questioned about ethical lapses involving outside income such as book deals.
Durenberger was denounced, a mild form of reprimand, on the Senate floor in 1990, and in 1995 he pleaded guilty to misdemeanor charges involving $3,800 in overpayments from reimbursements for staying in his Minneapolis condo. Durenberger conceded he made mistakes but denied he did anything deliberately wrong.
"He showed considerable resilience," said Doug Kelley, a Minneapolis attorney who was Durenberger's chief of staff from 1985 through 1989. "He managed to keep going through it all and was able to concentrate on the great love of his life, and that was health care policy."
Durenberger chose St. Thomas to conduct his health care initiative, in part because of its health-business graduate programs. Early funding for the program came from a $1 million donation from former Cargill head Whitney McMillan and his wife.
When Durenberger came to St. Thomas to head up the NIHP, he decided to focus on the health care policy of the Upper Midwest -- Minnesota, the Dakotas, Montana, Wisconsin -- because these states had similarities with their nonprofit provider systems and because one national solution for health care was not in the foreseeable future.
But Durenberger also brought with him an extensive Rolodex of Washington policymakers and national health care experts.
"When Dave Durenberger calls someone either locally or nationally, they pick up the phone," said Dr. Sanne Magnan, president of the Institute for Clinical Systems Improvement (ICSI), an organization that uses the latest research to develop treatment guidelines.
Magnan said it was Durenberger who put her organization in contact with Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality to get federal input in a model program for treating adults with depression. Clancy, for her part, calls Durenberger the agency's "patron saint," for his role in writing the legislation that created the agency in 1989.
Dr. Terry Pladson, chief executive of Centra Care Health System in St. Cloud, recalled taking a health policy class from Durenberger and going on a field trip to Washington where the class of a dozen or so students met ranking congressional health care leaders and had an audience with Donna Shalala, then the secretary of health and human services.
"As a teacher and leader of NIHP, Dave really draws out a variety of interests without partisanship," Pladson said. "The challenges of health care, the problems that we are facing, won't be solved by narrow thinking."
NIHP also was the launching pad for a Medicare test program to improve care of seniors by reimbursing doctors for providing more complete care, such as post-hospitalization visits, rather than Medicare's current fee-for-service system.
"If Medicare changes the way it pays, we'll improve quality and outcomes," said Sheila Delaney Moroney, a former NIHP staff member currently with Halleland Health Consulting. The application for the test program involves 12 Upper Midwest organizations called the Innovative Care Coalition and is awaiting approval.
Looking toward retirement
Beyond the conferences he organizes, Durenberger writes a twice-monthly commentary that covers the waterfront on current issues, from health care to Iraq. He has 4,000 names on his electronic mailing list, and recipients frequently forward it to others.
In his Feb. 14 edition of the commentary, Durenberger asked why it is necessary for the University of Minnesota Fairview to build a new $175 million children's hospital when Children's Hospitals and Clinics of Minnesota plans an expansion of its own.
"But where do all the really sick kids come from with their challenging diseases that attract world-class professionals?" Durenberger wrote, referring to better-known child-care centers such as Children's Hospital of Pittsburgh.
In the same commentary he scoffed at the complaint of newly elected U.S. Rep. Michele Bachmann, R-Minn., about the five-day work week imposed on House members and how that reduced the amount of time she could spend in her Minnesota district.
Referring to Bachmann as "The Big Kisser" for her much-publicized buss of President Bush after his State of the Union address last month, Durenberger said, " 'Work in the district' is a euphemism for 'two years is a short time to get yourself reelected.' "He calls it as he sees it," said Tom Horner, a public policy consultant who served as Durenberger's press aide from 1978 until 1985. "He remains influential even 12 years after leaving the Senate."
A little over a year from now, Durenberger intends to step down as head of NIHP and cut back his St. Thomas work schedule to 25 percent of full time. He and his wife, Susan Bartlett Foote, an associate professor for health policy and management at the University of Minnesota, have bought a home in San Rafael, Calif., and plan to split their time between there and their Crocus Hill home in St. Paul.
NIHP officials say they don't know yet who will replace Durenberger.
"There is no Dave in the wings that we've identified," Magnan said.
Over a recent lunch, Durenberger told a story he heard Sen. Robert Byrd, the silver-tongued West Virginia orator, tell on the Senate floor. It was about a town situated on a cliff with folks who sometimes would accidentally drive over the cliff's edge.
Well, the town eventually bought an ambulance to take accident victims to the local hospital. When someone suggested the town instead construct a fence at the edge of the cliff, town leaders got together, considered the idea and rejected it. "We've got too much invested in the ambulance," they said.
That, Durenberger said, is what is wrong with health care today. There's so much invested in a system that's broken that participants are unwilling to consider alternatives because it would threaten the status quo.
"We're running out of money to keep that ambulance going," Durenberger said.
David Phelps • 612-673-7269 • dphelps@startribune.com
