Good morning, and welcome to mid-day on Minnesota Public Radio. I'm John Raby in for Gary eichten. The primary we're looking at the issue is important to the gubernatorial campaign focusing on one issue awake and this week. It's Healthcare candidates for Governor of all made very statements on Healthcare. And we thought you'd want the chance to test them to see what holds water and one Falls flat and what might be somewhere in the middle to I guess or two of the state's leading experts on Health Care policy and they can take your questions about minnesotacare hmos Medicare and Medicaid prescription cost employer health benefits and much more there Michael scandrette executive director of the Minnesota Council of health plans and former director of the Minnesota Health Care commission, good morning to you and state representative Lee Greenfield longtime chair of the house Health and Human Services finance division represent a thank you for coming in the morning and we would like to include you in this conversation. Here are the numbers to 276 thousand in the Twin Cities.2276 thousand or one 800-242-2828 anywhere in the listening area one 800-242-2828. Give us a call with your general questions about health care about what you might have heard the candidates say and also with your comments on Hell Healthcare is being handled in this election. Season 2 2 7 6 thousand or one 800-242-2828. We just going to toss this one out there cuz we're talking about health care issues. Do most minnesotans have health insurance right now.Well, we have the lowest uninsured rate in the in the United States are close to it as soon as depends where Hawaii is exactly but it's around 6% So 94% of minnesotans have health care coverage either through government program with through insurance or their employee insurance through their employer. I think we are fortunate Minnesota to have a combination of good public policy has good programs offered for low-income people and strong economy that combine to have a fairly stable rate of uninsured here compared to a growing rate of uninsured in other parts of the country. That sounds like you're generally both kind of happy with the way it is what we like to get to Universal coverage. Some of us have been working at that for a while and I continued to desire to do that. And I think there's a lot of agreement that at least at least the approximately sixty thousand children who don't have coverage right now should have some kind of coverage and beyond that the the candidates very and we should mention to you that you are supporting until we are actually going to be hearing from the various candidates there takes cuts from them and on various issues regarding healthcare as we continue the conversation here on midday public hospitals. They have to treat anybody who walks in the door. Yes public hospitals are actually all hospitals are required to treat anybody who needs medical attention. And in this state it works very well. We don't have the kind of problems. We've seen in other states where they minimize that to emergency and then move the person I'll get right to get rid of the person in our state. They treat people will hospitals do all emergency rooms do public hospitals do have to treat anybody who walks in the door by law or just buy some sort of agreement in terms of the county-run hospitals as by law. Public hospitals run by County are responsible for the health care of everybody in their community and another kind of basic question here. Where do we stand on employer health plans on how many Employers in Minnesota offer health care benefits to their employees are base coverage a most people do get their health coverage through their employer bears. And again, we have a higher rate of employer-based coverage in Minnesota and part due to legislation that's been passed that improves access to coverage for employers to prevent health plans from denying coverage based on the the health status of the employees and helping that is of course the state's current very low unemployment rate. So get employee. This is important which encourages the employer to provide benefits Health Care being one of them. It's 11 minutes past 11. Our phone numbers are 2276 thousand in the Twin Cities or one 802-4228 28th and R in the studio with Michael scandrette who's executive director of the Minnesota Council of health plans and former director of the Minnesota Health Care Commission State Representative Lee Greenfield gflr from Minneapolis is with us and he's chair of the house Health and Human Services finance division, and we're going to try to answer your questions about health care. And I also try to cover the various dances taken by the various candidates for Governor. This is election 98 on Minnesota Public Radio, and we're talking about Healthcare this week. We're joined online now by Mark from St.Paul Highmark turn to the role of employers and health plans what you just touched on I've had the unique position of working for both are really large in a really small company. I realize that whether you're working for a company of 5 or 5000. It's a situation where the employer is the person buying my health care coverage for the person using it. It's not actually the buyer and I just wondered what your guests we have to say about the role of employers now and in the future and Healthcare I guess I'm I'm I'm comfortable with it. But you know, there's that what is the role of the employer then it sort of the sort of the middleman because they are trying to stay out of general interest in having it not cost very much money or why. Well, they have a staffing like it cost their purchasing Health Care in sort of a cafeteria-style with you know, what to what their employees wanna with their employees can a Ford I don't get to see that whole process. Yes. I think we do have an unusual system of buying Healthcare compared to other types of consumer products. We have employers that are really making a lot of the decisions and they are balancing cost and quality and consumer satisfaction to try to pick the health coverage that's best for all the employees as a group that sometimes in contrast to what an individual employee might choose on their own behalf giving their own health status. And so what does temp sometimes cause of sort of the discrepancy between the decision of the employers make doing the best they can in the effects of that decision on individual patient says they need health care or don't I think though we should point out that most employers in the state when they provide Health Care do so because of the competitive market for employees and the lodge employee employers very definitely do a very good job of trying to make sure that there's high quality Healthcare purchasing. Are you happy with that? Garrett liked it and vision systems that have the employee make more of the decision, but that would require an entire restructuring of how Healthcare is purchased now and now it's not likely to happen very rapidly an example of that would be in from the state state employees while they're limited. They have a multiple set of plans to pick from which at least allows some consumer input cuz if everybody picks in One Direction, it tells the employer something about where what people want. Which if they only offered one plan, which month many employers do doesn't give you that kind of option or consumer input direct consumer input. Do you wish that the motive was not one of the trying to get the best employees which is not necessarily a bad motor but one of altruism where you figure while I'm requiring a certain amount out of my worker and they need health care, so I should pay for it. well I mean it's more than paying for it. So it's spending the time and having the staff to understand it. Sure Trac it and everything else held out. So it's a real commitment and I don't see it happening much different from the way. It is in the American economic Market. It works because of that I think fairly well, I would still prefer seeing employees having some choice in every case. So they would have the ability to vote by moving which is a consumer-oriented approach. It's a quarter past 11. My phone numbers are 2276 thousand in the Twin Cities to 276 thousand or one 800-242-2828. It's midday on Minnesota Public Radio on and joined us on the line from Minneapolis career transition and I had to fall in between the cracks. I used to get complete coverage from a large employer that had many choices. And after I left that job I also was on the Cobra plan plate paid a high monthly feet they on it because I really liked the comprehensive plan. And then I started working temp jobs where I couldn't really afford Healthcare individual plan. So I went without and I tried to apply to Minnesota care and I made too much to apply to qualify for them right now. I'm actually in between and I'm unemployed and I'm going Get minnesotacare, but I'm wondering if there's something else that I could have done for somebody, you know it was there something else for falling between the cracks real problem is you where I'm sure that minnesotacare covers people up to 275% of poverty is very hard to solve our colleagues that we should offer a healthcare plan B on that but we haven't got a mechanism to create a group of the people who fall above that and without that your left individual coverage and I certainly would not argue individual coverage is not a very good by economically. If you have any health problems, usually involve some prior conditions and some limit up to year year-and-a-half where you may not be covered for the very things you most likely to need health care for it's a problem. Mr. Ken Dryden. One can find to either State programs are our risk pool or other private coverage a place to go where they will get insured. The problem is are they going to be able to afford that at the low incomes? We do have programs that are going to make sure that people can get the coverage, but the people are working and maybe not making a lot of money are going to struggle to purchase health care, and some of the things that we could do is look at out of state taxes on premiums look at other mandated benefit requirements that currently exist in state law to see if we can trim some of the fringes off of the policies and get the premiums back down. No more affordable amount for people if your listener who's right now just kind of ramping up on what health care is available in Minnesota what it's like here. Maybe just moved in. Maybe you can I get one of you to explain exactly what men carry is in a nutshell in Minnesota is a program that we created in 1992 for Working Poor. It covers people who are no longer eligible for Medicaid or the federal-state program for poor people, which is the poverty level are people to look below the poverty level. So it's from the poverty level to 275% of the poverty level that is available on a sliding fee basis off of people who don't have coverage through their employer or at least 18 months away from that and have not had coverage for 4 months to get their health care. The whole problem here is with trying not to damage the more individual insurance Market that exists out there and subsidized people already have coverage but the cover the people weren't able to get an affordable policy. Ideally, we like everybody to have if they have to pay for their own health care a policy that is within 10% of their income spent on healthcare insurance, Minnesota Public Radio. Candidates for Governor about Healthcare minncare came up quite a bit Ted Mondale says that the men care is not adequately publicize with missing a lot of people hear what he has to say is a $700,000 marketing budget and we know that people who don't get their Healthcare through employers. Look at the Yellow Pages. And I don't think there's a yellow pages in the state that has the Minnesota CARE program in it. It's disenrolling people faster than its enrolling people and has a 200 million dollar Surplus on going in the future and 150 million-dollar reserve the money. Is there in the program ticket to go and shirt Working Families and kids. The problem is a government agency can't do it was outside Ted Mondale what he has to say about men care Michaels Kendra is he right? Does it need to be better publicized? I agree that there are a lot of people out there that would qualify for the program that don't know about it. And I think that we do should should do more to promote it because having people out there who don't have insurance has consequences for all of us. We know that the people that insurance have health problems. They tend to delay getting treatment when they do need treatment of tents to cost more because we didn't catch it as early. So I think we could do more and that's something that I that will will encourage the legislature to do is to increase the budget. For outreach and in fact, we're starting to do more. We had not done actual Outreach until this budget and we're starting to do it. We have consistently had about a hundred and five thousand people by the way on that program for the last number of months. I'd like to see it go up about 55,000 of my children. We get a lot of free publicity by talking about the changes in the program in the program and then it doesn't courage and we get large numbers of people applying and then is it disappears from the news? It's a problem, but we are on we put out a number of contracts around the state to do Outreach for getting people into that program exactly the paid for it's paid for by a sliding fee scale for the working family. And then the rest is subsidized by the state which we get through 2% provider tax on oil health care that is provided which is then passed through the through the insurer with his Ensure. Can you say how much your average Minnesota puts into men care? Well, it's an interesting question because what happened when we did this and this was the only tax we could agree on a bipartisan basis. We put the 2% tax on and the requirement that could be passed through that will ensure has had to pay for that in addition to what they were paying when we did it. There was Zero inflation medical inflation going on. We put a 2% tax on they was still zero medical inflation. The argument is that we essentially rearrange the money in the Healthcare System. We took it out and put it to the people who didn't have insurance and it seems to be working that way. But but again, does it cost the average Minnesotan by Muhammad in the Box 10 bucks, but it still says it's still paid for by taxes and he says that he would consider rerouting tobacco settlement money to pay for men care. One of the things that that that I would look at with. Some of the money friendships in the tobacco settlement that's going to be there. You see use those dollars to it to replace that text and then took that should be able to in fact expand Medicare does this make sense when we definitely have the money from the settlement that I think most people feel should be used for healthcare and there's a lot of needs out there. So again, the legislature will have to decide how best to use the money but we do here a lot of people talking about the possibility of reducing the tax burden somewhat by using some of the money from the tobacco settlement to replace current dollars being spent out of tax revenues. It's in the black right now. Does this make sense? Well, it's in the black because we have not been able to expand that we have an agreement. We just expanded the families without children now and what I've been talking about his families with children families without children word 135% of poverty. We now up to a hundred and seventy-five. I would hope the next Governor would allow us to move that as we always intended. Intimate in the black is a good thing that it wasn't in the red, but you're talking about this is almost a bad thing because it should be just breaking even so I wasn't as close as reasonably possible so that you sure you're not going to go in the red if you have an adequate support for but there's no reason to stockpile money. We don't need it that from that fund the object is to get people covered health insurance at the reason. I want people to have health insurance is not just when they're sick or in there an accident. They can get emergency care. It's because we want them to have the kind of care that provides preventive care keeps them as healthy as possible and generally AIDS their life as much as possible as we can do with good health care coverage. It's 25 minutes past 11. You're listening to mid-day on Minnesota Public Radio. I'm John Raby in for Gary eichten or in the studio with Michael scandrette executive director of the Minnesota Council of Health Plan in former director of the Minnesota Health Care commission last voice you heard was state representative Lee Greenfield chair of the house Health and Human Services finance division. He's a d flr for Minneapolis. Here are the phone numbers for your questions about health care in Minnesota to 276 thousand in the Twin Cities to 276 thousand or one 800-242-2828 1 800-242-2828 toll free line or the Twin Cities to 276 thousand Cynthia is on the line from Minneapolis. I sent you an independent contractor self-employed person. I've been working part-time temporary for a company for actually the university for 19 years. And I received no health care and I make about $600 over the cost of minnesotacare the cap. I was formerly with Community university health care and when the University Hospital merged with Fairview, I was tossed off my health insurance. They kept the kept all the people that brought minnesotacare or or any other subsidized people and they dropped all the people all the Working Poor folks. I've also I've also heard that on Minnesota Kare has a cap that they only cover the first I forget $6,000 of a medical of any kind of Medical Care is this correct? There is a cap on an inpatient hospitalization for adults. Not for children. That is true. Okay, and that's that's the other thing for single adults. It is very difficult to get any kind of healthcare. I think this is a very big problem in the state that really needs to be addressed addressed how making affordable health care for folks. I cannot afford Healthcare was the health plan. I was on was very satisfactory and I was very very happy with it until until the merger with the university. That was a wonderful program. Michael Scott, right? Well, I take that again affordability has to do with the type of benefits that are in the plan and we do have some issues around dumb state laws requiring probably more benefits and some people can afford but the other part of it is what representative Greenfield mentioned is that in the Minnesota Care Program. There's a much lower limit meaning you you can't make as much money and be eligible for the families for the single adults or the households with no kids. And for them. There is a gap. There are people who are working perhaps full-time but can't make enough to afford to buy coverage on their own and we could increase that income limit through though at the legislature so that people would be able to get some partial subsidy from the government through the Minnesota Care Program. I agree with that completely. But I also think we should explore the possibility of either going back to individual insurance and seeing if for the regulation of that could make that more available and more viable would certainly did in the small business market for small businesses to buy insurance or some kind of pulling mechanism could be created that would allow individuals and this kind of situation to get a kind of group rate. That would do better. One of the other should be a way of reorganizing that and I think it's time we started exploring that It's midday on Minnesota Public Radio or conversation continues in just a moment here on Minnesota Public Radio events in on the next All Things Considered residents along the st. Croix River organized against Plans for a new high voltage power line. You can't be a quaintest Oreck inviting in Charming town. With that at your front door that story and the next in our candidate series on Health Care on all things considered weekdays at 3 on Minnesota Public Radio. Can o w FM 91.1 in the Twin Cities. Programming on Minnesota Public Radio is supported by Ecolab A supplier of cleaning and sanitizing products and services near the forecast for you across the state today partly to mostly cloudy skies a chance of showers and thunderstorms in the Northwest eyes from 70 in the tip of the arrowhead the mid-80s won the Iowa State Line as for today now for the Twin Cities this afternoon clouds with a high in the mid to Upper 70s tonight Claudia 50% chance of showers and thunderstorms. It'll be humid low in the mid to Upper sixties and then Wednesday muggy at 40% chance of more showers and thunderstorms expected high in the low to mid-80s. It's 11:30 or listening to mid-day on Minnesota Public Radio. I'm John R A B & R in the studio with state representative Lee Greenfield chair of the house Health and Human Services finance division and with Michael Scott rats executive director of the Minnesota Council of health plans and former director of the Minnesota Health Care commission case you missed it our mission and this hour, Of midday is to look at all the various things that the candidates are talking about as Healthcare is concerned and kind of testing out some of the things that they've been saying and their campaigns and seeing weather holds water or not. And let's hear from another candidate. It's this is kind of interesting because it's kind of like the I don't know if I could dog in the night-time or not. This is a topic Universal Health Care coverage. The lot of candidates are not talking about Jesse Ventura objects to Universal Health Care coverage. If you're going to have a single Healthcare and go to socialism. It has to be done at the federal level because if you do it at the state of Minnesota level, you will get every ill person in the country will then move to Minnesota, you know to get us to foot the bill for them. It will bankrupt our state Michael scandrette do you think is right about that but I think we've had a lot of experience in Minnesota with giving our residents really good benefits in a lot of different areas whether it's educational. Human Services Program social service programs in healthcare. I'm sure that there may be some amount of moving into the state of people that care about making their life better for themselves, but I don't know if that's necessarily a bad thing. I don't think we've seen any sign in any of these areas of widespread spread migration of people into the state, but at the same time I would say that there are certain federal laws that make it very challenging for Minnesota to act to solve all these problems alone. And we really would like to see the federal government take some action in this area and and establish some Universal set of have the right to healthcare and the protections for a residence that would apply in every state so that we would have less of an issue another Healthcare Bill of Rights. Well there a lot of proposals out in that Washington that are portrayed as Healthcare Bill of Rights that have a lot more to do with protecting a pocket books of providers and other interests out there. But we do what we do have some experience in Minnesota with establishing rights for patients and hmos in and Healthcare. Generally, we've learned what works and what doesn't the problem is we haven't seen a lot of the proposals out in DC that they're really going to make a difference. A lot of them are chasing problems that don't exist or they are using solutions that are not going to be very effective to solve the problems that they purport to so I'll let none the less. We hope that they'll get more educated and learn from our experience here out there and and do something meaningful. I should point out that many of the same questions were raised with minnesotacare. We create minnesotacare aren't people who work in Hearne salaries within the eligibility range going to move from other states to get that coverage. They can't get from their employer and I don't think anyone sees any grade science of that or any great numbers. Nor do we see any huge migration to Canada where everybody is covered. Even if you just show up you do have health care coverage somehow people don't move that easily. Also, I should point out moving to Universal coverage does not mean the state provides the cat. It means we have a system where we would use the same kind of providers. We currently provide the same kind of healthcare insurance or health plans, but there is worked out so everybody is covered. It's kind of brings up the state to state comparison and gubernatorial candidate Doug Johnson have a question why prescriptions cost less for seniors in Florida, then I do here. We should go to Washington and have Minnesota senior citizens treated like senior citizens in Florida and some of the other states were there prescription drugs. In fact are covered by the health insurance companies that administer the Medicare money is exactly what what is he talking about? What has happened is on the 2 Coast the amount of money that Medicare makes available to an HMO fully covers senior citizen on Medicare is much greater than it is in Minnesota. First of all was based on historical rates in the 50s, but then Congress over the years has provided increases particularly in the most populous state strangely enough has something to do with the members of Congress. And so that the rates available to an HMO in Florida so high the amount of money Medicare is paying them that they can give away to the enrollees as a way of attracting them prescription drugs fully covered it like $7 a month for drugs or something like that. Whatever they whatever the Florida co-pay is and in Minnesota, we get such a low rate that they that the senior citizen has to pay premium and isn't covered for drugs. Yeah, this is an example of where politics interferes with really good public policy and died at the expense of Minnesota seniors. We have just by moving to another state of Minnesota senior could suddenly get much better coverage under Medicare then they can in Minnesota because the federal government pays those other states so much more than they do in Minnesota Minnesota. It's very difficult for health plans to even break even on the Medicare business and what they have to do is charge the premium to make up the the remaining cost so that they're able to break even on the Medicare HMO coverage in other states. The profit margin is so huge on the HMO products with the hmos are aggressively marketing their products and offering all kinds of free additional benefits under Medicare all using taxpayer dollars from the Medicare agency and so is right that we should be in Congress trying to say, we're not getting a fair deal that, Minnesota. Seniors who pay it in for Medicare the same rates everybody else did I'm not getting what they deserve in the payout cuz it is not fair. And also the other ironies are hmos in more course that's cost-effective one more cost-effective than the others in the country. Let's bring him some more colors. We've got Norm on the line from Inver Grove Heights. Not that I guess good morning Joe, you know, it's interesting. When you point out these kind of the kinds of the national inequities in the Medicare system it is however, if you look at it from a little different perspective, it is very consistent with the with the ethic and the philosophy behind health insurance namely that it that it is not the intended to be Equitable the system as president and mrs. Clinton had pointed out about four years ago is broken. Jesse Ventura is write the solution really does lie at the federal level. However What we really need to focus in on here is not the fact that it is maybe not affordable as a lot of people bring out the support ability issue before the ability to say to a large degree a result of the fact that we have such a strange weird inequitable many many holes type of system that caused a great deal of money and accounts for a major part of the reason why we spend 14% or at least it used to be about 4 that for years ago about 14% of GDP versus 9% for a nearest other first-world country named Ali Canada, which spends about 9% of GDP. And what we need in this country is universal health insurance and discrimination free that is free of discrimination based upon age and free of discrimination based upon pre-existing pre-existing medical conditions. Now, why can't we get to that? Why can't we eliminate those kinds of problems and I I would suggest to you that many of the other problems are some of which event brought up there by previous callers about losing insurance for not being able to get a good Lord sort unaffordable or one of the recourses that you have is an insurance policy of a so-called insurance policy, which is really a minnesotacare which puts a brand on your forehead that stamps you as being in a certain economic class. First of all and all state programs including Medicaid and minnesotacare you get a health care card, you will get a chance to enroll in for people with families and people in Minnesota care families with children and Medicaid they get a health care card and they go use it and nobody knows who pays for it. The proof is not part of identification that is made. When you go to your provider you have access to the network and you go you prevent your car just like anyone else who can roll their people on minnesotacare are paying part of that care and I think regard that is very important since they are working for people that they're not getting something free the game something that working for and that's available to them. Is that helping pay for Yeah, that's clearly minnesotacare is clearly not a sham for the people. I've talked to who don't have any other option or so grateful to have some form of coverage. Especially those that have kids and to have been neglecting primary care for the kids. But I would agree with the collars comment that there are some things that we can do and I think the national government could learn a few things from Minnesota and what we've done to sort of balance of reasonable approach to us some some ground rules for health coverage without really taking over the system and having the government decide for everybody what the best choices for them in terms of their Health Plan her healthcare provider, but why hasn't this been really addressed on the on the federal government failed to President Clinton developed a proposal or at the Congress and then Democratic Congress failed to act on it. They were under a lot of pressure is a lot of money at stake and help get the insurance companies particularly the middle-sized natural Indemnity insurance. Really opposed they make a lot of money on the current system. They weren't anxious to give it up and they found an advertising way that changed the polls when the polls change Congress didn't have the guts to go ahead. I think it cost Democrats. So my party the majority in both houses and I would hope in the future that's different. I will tell you their number of states Minnesota's far from alone that are continuing to work in this area and while it should be done at the federal level. We were we all believe if we can't get it done at the federal level. Some of the states will lead the way and if we do that, I'm crazy enough pressure to get it done on the federal level that state representative Lee Greenfield who has joined us to talk about health care in Minnesota or also with Michael scandrette executive director of the Minnesota Council of Health Plans former director of the Minnesota Health Care commission. We're taking your calls and Stay tuned news headlines on the way in just about 18 minutes or so. We're also hearing from the candidates are reporters went out and talked with all the gubernatorial candidates about their stand on Healthcare and overhearing little Snippets in this hour of. Midday. Mike Freeman is concerned about discrepancies in Medicare payments within the state and we talked to him said he was considering filing a class-action lawsuit on behalf of seniors. For example, shark shows that in Miami $640 a month is the average medicare payment cover glasses hearing aids in outpatient pharmacy in Minneapolis is $390 a month. No eyeglasses, no hearing aids and Noel patient Pharmacy in amount of video. It's $227. So what is going on here who this is again based on historical rates. This is the difference between the rural areas and the metropolitan area. I will point out when the Physicians had a chance to spread that evenly across the state and their rates they did. I think we would be much happier if the federal government would negotiate with us and do something across the state. I would make a lot more sense but historically if you look at what people spent in this is the basis for that there was a difference difference between the Metropolitan and the world larious make us can drive option to traditional Medicare coverage people can enroll in Medicare hmos and there are a number of options available to them and they're very affordable when you get out in the Greater Minnesota that option is not available to a Are people do to the federal policies on how the health plans in hmos are paid under Medicare. So I think if if we could get the federal policies and proved we would see a lot of people in Greater Minnesota Latias seniors with additional options that are voluntary but that they could choose as an alternative to the current Medicare program Mary for Minneapolis joins us. Welcome to midday, Mary. I have been following this for some time and somebody there at that panel made a comment about much money is at stake in healthcare. That is so true. And there are some Minnesota Health plans that I find it hard to break. Even I guess I'm concerned about the high salaries that are being paid to administrators. I don't see how they can defend the high salaries are paid and they can call themselves nonprofit and they close a loophole so they can call themselves nonprofit so they can read what they learn and I think that some cap should be put on a lot of the salary and I will hang up and listen. Let me Begin by pointing out that Minnesota Law requires an HMO to be non profit in order to sell an HMO product in the state of Minnesota. Secondly the high salaries your hearing about aren't the sea. Lowe's of Minnesota hmos Minnesota the salaries of the Minnesota hmos which have to be can be called to account by the Attorney General have to be reported they are available to the state and they are printed on newspapers as nonprofits they range and that high I don't they're good salaries there something like the three to $500,000 range which Physicians also earn specialist earn as much. So these are not out of line with what people with expertise get in healthcare. Now, you might want to just say you what can you sue a HMO executive for malpractice down the same way and you can sue an HMO for not providing care. You can sue a physician for malpractice and in Minnesota if you are denied coverage for something or denied a particular Care by law if you appeal that that denial must come I'm a physician in the HMO not permit administrative interested in getting patient's ability to sue hmos. Actually for malpractice. Here's what he says right now. If you are denied, what do you believe is proper care by your HMO or other health care provider. If you want to seek a remedy to that or even change the decision to 9 care you are embarked upon a bureaucratic maze that makes even the federal government look efficient and timely signs Mark Dayton enough his support for patient's ability to see way to mode for malpractice Michael scandrette. You want to weigh in here by the oceans about medical treatment are made by physicians in the clinics in the hospital's the health plans make decisions about what's covered. And what's in the benefit set that you purchase when you buy health coverage. They aren't making Asians about what treatment you should get but only about what's covered by your policy and hmos can be sued and are sued for the things that they're responsible for. If they don't provide payment for care that you're entitled to under your policy. You cancel your HMO and you can win if they're in the wrong but if your position is making a bad medical judgment or making mistake about health care that you need that's a physician decision and they health plans don't believe that they should interfere with that position session decision nor would they be liable for the consequences of a bad decision in many cases? It's just a deeper pocket that's available through the health plans for a recovery for malpractice decisions, and it's still at the end will increase cost in the healthcare system without really changing a responsibilities of the various organizations and assistant midday, and we've got Linda online from Hopkins Island. Spiders which by the law may not be passed on to the consumers. So it isn't causing the general Minnesotan anything it's costing the Physicians and then my second think I'll keep you up here because of the ocean can either pass it on to an insurer if the signature involved and if not in those cases where it isn't it is passed on to the consumer this position isn't paying for it as such it being paid for by the insurance company at the Texas a little bit confusing to some people but really the way it's structured is that the positions in providers are the collector of the tax, but they collect the money to pay the tax from the insurance companies hmos send a purchaser's that are buying the health coverage. So it is it appears in your premiums and in other places as part of the cost of healthcare Linda, are you confused or you just subjected to the way people phrase it? And then the other thing was there was one in the in the paper. There was one of the HMO CEOs who was in the top 10 earners that were lifted that lives here. And he was paid in the multi. Multi Millions from United Healthcare United Healthcare is domiciled in the state of Minnesota. When going to the history of why however it cannot sell an HMO product in the state of Minnesota. It cannot be an HMO. They own hmos in other states not in Minnesota and point three Oh just it was that $10,000 under men care really isn't very much coverage for hospital care. Is there another safety net above the 10,000. Let me explain what happens that it is a $10,000 limit. The reason we put it in was the insurance companies we're getting very nervous that we were going to get all kinds of people not to give up private insurance or individual insurance and take Minnesota care. However, if you have a family with children and they are on Minnesota Minnesota care and one of the adults goes in for hospitalization and has that kind of hospital bill the money the state spends for minnesotacare will be part of their spend down to put that family on Medicaid and cover the rest of the bill and most of the families this is occurred to that is what has happened. So, in fact, they family has not been stuck with the extra bill and the cat. Been provided riding nursery care is not a question. Got jammed on the line from St. Louis Park High Janet. Is there a specific provider Network that the state has contracted with for men care? Men wear which one would that be varies by county or they have attempted to have at least two hmos in each County. So there's some Choice by the individuals who are enrolling or alternative is to do that because the companies are saying we can't make a profit on these people. So we're just going to push them over to the state if they will pay for it text back to the text and send them to the same people will actually it's the other way around that in Minnesota as represented Greenfield mentioned Minnesota Health plans are nonprofit organizations and Shout addition to their their mission is non-profit. There's a state law that says that they're required to participate in the government programs. So I Minnesota Health Plans despite the fact that nearly all the help pain. Gas money last year, I continue to serve people in the government programs not because they're making a lot of money on them. But because they feel it's part of their mission and also because state law requires them to participate. So it's the same health plans that are going to get the business either way and really clearly is not a way to 2 Shift costs under the government is 8 minutes before 12. You're listening to mid-day on Minnesota Public Radio. I'm John Raby in for Gary eichten, but 7 more minutes to talk about health care with Michael scandrette and state representative Lee Greenfield, then it's off to news from National Public Radio in Minnesota Public Radio. And then we're back with a speech from dr. Robert Butler a psychiatrist. One of the nation's foremost gerontologist. He talks about preventive ethics and speech is called end-of-life decision-making. So we'll continue our focus on health care after the news stay tuned more. Midday is on the way. Let's go to this caller from Minneapolis. Thanks for calling. Statement that I heard earlier in regards to salary of a channel CEOs and the fact that someone was saying that some of the specialist make as much money I should say being in being a physician. I should say that I doubt there is so many specialists making that kind of money. No days and Greenfield 2010. You'll have to realize how many years they put in there, you know education and how much loan they take off to go to the training and does so, you know, I don't think there's any I don't think that we can compare their especially if that makes that much of money we can see you. The company considering their years of training but it sounds this is something very close to you. Maybe the Greenfield was saying was that how come CEOs should be making as much as Physicians who put in so much work and are open to malpractice, etc, etc all the time and you're tired of hearing it. Yeah. Yes. I am and you know and you know patience and you know people around a think that you should make more money. So whatever happens whatever that removes I'll make you know who make rules and whatever to the Physicians no one have any sympathy with Physicians and their Astro everyday hassle they have to go through making the best judgment for their for their patients and they're protecting them. And so you were here over and over and a game that their overpaid. Well I have to tell you that they're not really overpaid. They are making less than us. First of all while I understand your position with physician salaries positions in this country are reasonably paid and nobody is saying we should cut the salaries are there other people who are paid reasonable salaries to hospital administrative always gotten very good salaries, but the number of Administrators in these systems is very small less than the number of Physicians and that is not they are not the reason there is crossing Healthcare. They are very minor part. I will also point out all are hmos run. About a 90% payment out of the premium dollar into Healthcare so that there was ratios. Are there spending the money on Healthcare? It's not going elsewhere. It's not the cheating by Administration or administrative costs. In fact a very reasonable in our health plans in this state Michigan Drive is true. When you look at organizations of similar size of the executives who were responsible for very large organizations that handle a lot of business and make a lot of decisions that affect a lot of people's lives the Minnesota Health Plan CEO stand to make less than much less than the private sector for profit system for sure, but they even make less than similar Executives and other nonprofits in the hospital systems as represented Greenfield mentioned time and time again to be a teacher you get your Summers off, etc, etc. Well, the other part of that is there are some extremely high salaries in the four prophets. In other states size same size plans as we have in this state currently instead of being in the range. I indicated would clearly in the for-profit area be by one and a half million or more per year sounds even to me like an awful lot of money and the question is how much is that is justifiable reasonable expenses are amounts and the supposed to State Department of Health and the Attorney General could take action if an HMO was paying an unreasonable amount for a salary cap is here. We have just about a minute left and represented Greenfield. You're supporting skip Humphrey in the government re-election, but you like the way the candidates are talking about health care that are they avoiding the issue or should they be focusing on up more at least among the Democratic candidates? Listen to almost by Nature. Are there talking about expanding Healthcare access? They're talkin about improving some things using the tobacco money for healthcare discussion is generally pretty positive. I like the one thing that I have concerned about is that it is real tempting for candidates that are trying to get voter attention to exploit individual anecdotes of problems that occurred in in healthcare and make a big deal about those when in fact in Minnesota. We do Joe and very high satisfaction Minnesota Health Plans. Generally, I'm only at 6% or less of of people Express dissatisfaction with their plans. Are they generally on a recent survey rated their health plans and eight and a half on a scale of one to ten in the average and only one third of 1% of people in Minnesota were enrolled in hmos register complaints against their plans and that's in stark contrast to what you would think exists are based on some of the Eric of the political campaign, thank you both for your time. This hour Michael executive director of the Minnesota Council of health plans and former director of the Minnesota Health Care commission and state representative Greenfield chair of the house Health and Human Services finance division, if you tuned in late or you'd like to hear discussion again will be rebroadcasting this program at 9 tonight. So TuneIn here on Minnesota Public Radio. I'm Lynn nearing a White House intern the secret tapes the talking points the Blue Dress the independent counsel and Immunity deal the presidential subpoena videotaped testimony. Will it ever end our coverage continues on the next Talk of the Nation from NPR news? Listen to Talk of the Nation from 1 to 3 weekday afternoons. You're on Minnesota Public Radio. Coming up in the next hour. Midday are going to talk about end-of-life decision-making and with a speech from one of the nation's leading gerontologist. So tune in for that after we get a look at noon, which is coming up in just about a minute. Cross the state today partly to mostly cloudy with a chance of showers and thunderstorms in the Northwest highest from around 70 in the far Northeast to the mid-80s in southern, Minnesota. It's time for the Minnesota State Fair in Minnesota Public Radio. Is there Live join us at the corner of Judson and Nelson for Midday sound money and the noontime gubernatorial debate for information visit our website at www.mpr.org. You're listening to Minnesota Public Radio. It's cloudy and 67 at k n o w FM 91.1 Minneapolis-Saint Paul been City's weather for this afternoon Cloudy Skies with a high run 78° should be cloudy overnight. We're looking at a chance of showers and thunderstorms humid below around 65 degrees at 1 past 12 time for news. From national public radio news in Washington on Korva Coleman many members of Congress including some Republican leaders are reserving judgment on the president's political future following his grand jury testimony and address to the nation yesterday and be ours Brian Naylor reports. It's an issue that few in Congress seem willing to take on for now. There are exceptions Republican senator, John Ashcroft of Missouri, a likely presidential contender in 2010. Mister Clinton has lost his moral authority to act Senator Orrin Hatch of Utah said the president expression of regret maybe enough to put off possible impeachment hearings in the house house Speaker Newt Gingrich told reporters that all of this is part of a much bigger story and the quote. I think everyone would be best served if they waited for judge Stars report and found out what all the facts are Democrats are also treading cautiously house Democratic leader, Richard Gephardt issued a statement saying he is very disappointed in the president's personal conduct that part added that it's his hope for the nation. That this investigation can be brought to its long-overdue conclusion. Brian Naylor NPR News Washington Secretary of State Madeleine Albright has moved on to Kenya to visit survivors of the embassy bombing their she paid an earlier visit to Tanzania today where she met with victims and relatives of those killed in the second bombing in Dar es Salaam Albright says the tragedy is bringing the United States Kenya and Tanzania closer together together. We pray for those who have been injured and together. We vow to rebuild and maintain our commitment to warm relations between the United States and Tanzania and between the United States and all Africa. Together we promised to bring to Justice the murderers of our friends 257 people were killed in the bombing 12 days ago more than 5,500 were injured. NATO forces are practicing Maneuvers in neighboring Albania. The military exercises are showing the Serbian government NATO's ready to step in if ethnic Bloodshed does not stop and Kosovo NPR's Edward lips and reports from Belgrade. Show me a Chris Hill. Negotiation for Kosovo, even though many serve and ethnic Albanian official say privately that neither side is ready to talk Ambassador Hill acknowledged Tuesday that the peace process has a long way to go. But he said it has begun. He's working on a two-phase bees process first getting serve and Albanian institutions in Kosovo working towards democracy. And only later will the toughest should be tackled of how much tonomy the ethnic albanians will have with in Kosovo diplomats are still trying to include representatives of the Kosovo Liberation Army in the peace talks some KLA factions are trying to form their own team separate from the one headed by the American supported Albanian leader Ibrahim rugova. No face-to-face negotiations are yet scheduled between the coast of are albanians on the serbs Edward lifson NPR news Belgrade. This is NPR. Support for National Public Radio comes from the Corporation for Public Broadcasting and the Geraldine R Dodge foundation for reporting on biological resource issues. Good afternoon with news from Minnesota Public Radio on William wilcoxen. The chair of the end of the Republican party of Minnesota says serious questions remain about whether President Clinton committed perjury or obstruction of justice. However, Bill Cooper says, it's up to the president to decide whether to resign Hooper says, he doubts the president situation benefits Republicans politically is that it really turns off the boulders and you get low turnouts and kind of extremist activist 10 to take over both parties in the in that environment. I think it's unfortunate for everybody involved. Cooper cooper defends independent counsel Kenneth Starr then he was appointed by Clinton's attorney general Janet Reno and that stars just doing his job Republican attorney general candidate Charlie Weaver cause of reprehensible that more than a third of Minnesota school districts failed to report weapons incidents a 1994 law requires districts to report how many weapons are found on campus including knives guns explosives and blunt object but a report from the State Department of Children families and learning set 36% of districts failed to report the incidents for the 1997-98 school year. We were said the state should withhold school late payments from districts that do not report Dayton Hudson Corporation reports a 32% jump in second-quarter earnings. Thanks to strong performances by its department store and Target division, the minneapolis-based retailer and 172 million dollars in the quarter ending August 1st that compares with 130 million dollars a year earlier. Partly to mostly cloudy in Minnesota showers and thunderstorms are possible in the Northwest this afternoon eyes from 70 degrees in the arrowhead the middle 80s at Rochester. That's news from Minnesota Public Radio. I'm William wilcoxson.