Editorial: This session can yield better health care

Legislators return today to the Capitol, where the forecast is for a contentious election-year session with considerable chance of gridlock. But the table's been set for one major exception: Lawmakers can and should agree this year to set in motion cost-saving, quality-improving changes in health care that lead to affordable health insurance coverage for every Minnesotan.

A rare opportunity for landmark change has come. Considerable accord exists among DFLers, Republicans and a long list of stakeholders for a set of proposals that could eventually revolutionize the way medical care is provided in this state. It would reward providers for preventing crisis episodes among patients with chronic conditions, rather than for treating them when they become very sick.

To illustrate the cost-saving potential of that approach, consider an example often cited by state Rep. Tom Huntley, a DFLer and retired University of Minnesota-Duluth medical school professor: In a Robert Wood Johnson Foundation-funded experiment with 29 congestive heart failure patients, St. Mary's Duluth Clinic supplied them with in-home monitoring devices and hired nurses to observe daily readouts and telephone patients to discuss the results. The goal was to detect trouble early, before it led to hospitalization.

The result: 48 percent less was spent on those patients during the six months of the experiment, compared with the previous six months. The hospital re-admission rate was 2.8 percent, compared with an expected 40-50 percent.

But, Huntley adds: "The current payment system won't pay for the nurses and the equipment, so they actually lost $1 million doing this."

That wouldn't be the case under the proposed changes to be considered by the 2008 Legislature. Keeping people with heart disease, diabetes and other chronic conditions out of emergency rooms would pay dividends -- not only in money, but also in longer and better quality of life.

Plenty of other ideas are shared by the legislators and health care stakeholders who, working in two separate panels, spent the last six months developing a set of proposals. Their aim is to improve health care quality, affordability and access simultaneously -- because that's the only way it can be done. Keeping people healthier will save the money needed to extend health insurance coverage to low-income people through sliding-scale subsidies, to be phased in over several years.

"This is not a multiple-choice exercise," said state Sen. Linda Berglin, DFL-Minneapolis. "We have to move forward on all parts of this at the same time."

That's why it's unfortunate that already last week, Gov. Tim Pawlenty rejected one recommendation of the task force he appointed. He's opposed to a higher "health impact fee" on tobacco products, intended to discourage smoking. "We've hit the smokers hard enough," he said.

The governor and his GOP allies in the House also reject out of hand a mandate that people buy health insurance, arguing that it impinges on individual freedom.

The problem is that the freedom to be uninsured often results in expensive, uncompensated emergency room care, paid for by insured people via higher premiums. A serious effort to control health costs must include virtually universal insurance coverage. A mandate might not be the starting point toward such a system. Better to begin with the creation of low-cost insurance policies, and subsidies sufficient to make them affordable, as one of the two task forces recommended. But a mandate might be useful eventually to finish the job.