(00:00:00) Thank you Greta six minutes now past 11 o'clock. Morning, welcome to midday on Minnesota Public Radio. I'm Gary eichten glad you could join us Minnesota Senate (00:00:18) health committee holds a hearing tomorrow (00:00:20) on a bill which supporters say would give doctors and their patients more clout when they're dealing with hmos the bill proposed by Minnesota's new attorney general. Mike Hatch would allow patients to sue hmos for damages when the HMO is refused to pay for a doctors recommended treatment. It would put the burden of proof for denying treatments on the HMO is rather than the patient. It would prohibit hmos from paying bonuses to doctors who limit the number of referrals to Specialists and it would require doctors to disclose to patients their financial arrangements with hmos supporters as we say argue that the bill would simply level the balance of power between doctors and hmos but opponents say the bill would drive up health insurance costs to the point where many people would be priced out of the market. Plus they argue Minnesota already has programs in place to help patients deal with their HMO. General Mike hatches with us today to talk more about that bill and talk about some of the other issues that the AG's office is involved with and we sure invite you to join our conversation as well. Give us a call. Our Twin City area number is 6512276 thousand 6512276 thousand outside the Twin Cities 1-800 to for 228286512276 thousand or one eight hundred two, four two two eight two eight Our Guest this our attorney general Mike hands, mr. Hatch. Thanks for coming in today. Well, thank you. Thank you very much Gary. (00:01:45) You having fun with your new job? (00:01:46) Well, I'm learning and yeah, it's fun. It's they're good people in the office and I've learned a lot from them and we're getting off into all sorts of different issues Health Care being one of them. I have to say it. It's kind of surprising that that you haven't gotten more a publicity frankly because you over the years. Have been a kind of a high-profile guy and you made a real that a real reputation as Commerce commissioner that you've been swamped by the governor. Well, that's that's that's sometimes that's good though to you know, get it's fascinating. I have worked around Governor's before and Governor Ventura. I walk out of my office and I'll see they won't be a case of just seeing a television station there a radio station. They'll be a boom over him. It'll be some national or International television station from Japan or Europe or wherever and they he comes walking out and he says morning Mike and good morning governor and he's just it's part of his business. It's a very different environment for him and I suspect it makes it a little more difficult at times to address some of the issues and government when you've got all of the media flocking like that. Do you expect you'll be able to work well with the governor? I think so. We've had that we've had a good relationship to date. We have basically have an agreement that he sets the policy we Beetle office we get rid of what are called policy directors. They have used our services. I think a lot more we were very cognizant of some of the disagreements that existed between Governor Carlson and attorney general Humphrey and we want to make sure that that didn't occur here and we're doing our best to keep the the discussions going we meet once a week the two offices have a weekly meeting and we exchange information and it's important that we continue that I have to ask you about the health care plan that comes up before the senate committee tomorrow. Apparently if you believe surveys most people are relatively happy with their medical coverage if they have it what what would this bill do that? We really need here in Minnesota in Europe. Well, it it does not change the system in a great way. What it tries to do is to again level the playing field put some fairness between the patient-physician relationship and the physician HMO or Managed Care relationship a number one it would Define necessity may be the most important issue in a health insurance contract or HMO contract is what is necessary Healthcare. That's what they cover and we think the definition of necessity should be done by Statute because all too often now companies drafted in a in a more restrictive language to the degree that necessary Healthcare is what the insurer decides based upon their internal criteria, and they're not going to tell you they're not going to show it to you or at least not a not willingly and we think that necessity necessity ought to be defined and necessary Healthcare ought to be defined as a healthcare that they Professionals in that field and if it's a specialty treatment a specialist in that field believe is appropriate for that type of disease or illness. Experimental we think experimental treatment Autumn do be defined because all too often again ensures hmos Define experimental more broadly so that it is very difficult to get Innovative or new treatment, which is not experimental which has been proved which practicing Physicians and experts in that area that are board certified believe is the best approach and yet because of the definition is not included in the contract. We believe most important we have what's called a stark Amendment at the federal level. We have a mini star commitment at the state level which essentially says that Physicians should not receive Kickbacks with regard to let's say prescriptions from pharmaceutical companies or MRIs or any of the other type of diagnostic or or treatment type of issues yet when it comes to HMO is there's an exception it allows the HMO or Managed Care entity to give an incentive to The Physician not to refer people to physician to Sore not to refer them to a hospital and we think that's an appropriate of its own an appropriate for a physician to be paid a kickback on a prescription. It seems to me to make sense. That shouldn't be a taking a an incentive with regard to treatment of a patient by a specialist also with regard to disclosure if I'm operating as a physician being paid on a capitated basis, so I have an incentive not to treat or at least my make more money by not treating perhaps I ought to be required to disclose that lawyers disclose. It insurance agents disclose it real estate people disclose a journalist disclose it if you have a conflict if money is being paid or consideration given from other people. It makes sense that in that could possibly affect your judgment the answer most ethical values will say you should disclose that to the patient and what the patient does with it. Maybe they do nothing. Maybe they decide on their own dollar. They'll go out and get a second opinion. But at least that they ought to know that that kind of a system is operating when they when they're in the the Examination room finally actually, it's not finally but with regard HMO liability if today if a physician is negligent with regard to treatment or failure to treat a patient the Physicians exposed medical malpractice, but in the same way, but it but unlike that practice if an HMO or Managed Care entity should turn down coverage basically telling a patient. Listen, I we don't care if you're a physician thinks it's necessary. We don't we're not providing the coverage and as it turns out they should have that the contract and Phi in fact provided for it. We think the HMO had to be liable for that kind of problem. These are all laws by the way, all these Provisions I've talked about have been adapted in a variety of different states. They have not increased in a dramatic way. None of these are what are called been mandated benefits that some of the opponents indicate. They're not saying they must cover a specific treatment disease or or illness. They're simply Saying that these are simply definitional process-oriented disclosures that we believe hopefully put some parent fairness in the system. I'll give you another example is two other Provisions in the bill one is when a Managed Care entity turns you down they ought to call you today. You don't get that call it today you get a letter basically saying we've determined is not necessary to bad for you. It seems to me that if a patient is seeking treatment if they physician has recommended the treatment and the HMO is denying it seems to me common decency indicates that they should pick up the phone call the patient tell them they're not providing the coverage and let the patient if it's a question of some document paper some opinion diagnostic treatment, whatever that hasn't been provided the HMO. They can bring it up at least they can talk about it that time and clear the air as opposed to the person simply not being not knowing why they're not having that Treatment available and then finally many occasions to go to a specialist or go to a hospital. Patient needs to get pre-certification approval pre utilization approval from the HMO or Managed Care entity and many times they get it they get a letter to the hospital letter to the patient saying you are approved this she'll confirm that there is a pre-certification approval with regard to the fact that coverage exist only to later find out when the treatment is rendered and the bills are incurred. They get a letter saying however, simply because we said you did have coverage in this was a member of our Network that hospital we've determined that the treatment that was have provided is not necessary. Therefore we're not paying and it seems to me if you're going to require / utilization approval and people rely on it including the hospital The Physician and the patient. It seems to me that the HMO should not be able to thereafter come back and tried to renege or decline the coverage at that point and that's that's the whole nine yards. That's the whole bill right there. It's about 7 points. Again. They're not mandated benefits has been. They're not requiring more treatment. They're simply process-oriented. So he wouldn't wouldn't affect costs premium costs at all. Well, the Congressional budget office has done a study with regard to many of these issues and basically concluded that the cost of any would be under 1% the the item that is perhaps most controversial inside it in by some of the lobbyist is that HMO liability portion saying that the HMO would be liable if it failed to deliver services that it was under contract to provide and Texas pass such a law. And again there was a great claim of oh this is going to you know, the the going to be a storm of lawsuits that occur as a result of it. In fact, they've had one lawsuit and what these type of laws do is essentially puts the Managed Care entity the HMO on notice that they could have such problem if they don't treat the patient fairly and one lawsuit is hardly. Indicative of any increase in rates might there be a tendency though on the part of the HMO to say well given the fact we could be sued here and really really a blasted heck approve any prove it all well and we'll just jack up the premium a little bit to pay for the extra cost. Well most people when they you know, in other lives commercial practice we enter into contracts, we recognize that we could be sued and we could be liable for not only the damage under the contract. But for what for what are called consequential losses and we don't simply give more than is appropriate because of a fear of a lawsuit. I don't see why HMO should be having any exception to that practice. Perhaps the best example, there was a movie or in a book John Grisham novel called The Rainmaker and they had a lawsuit against a company which denied coverage that lawsuit would not occur in Minnesota. I couldn't occur 39 States it could have We've been out here and and indeed even under this bill such a lawsuit would not result in punitive damages as was done in that case. We would not the statute does not authorize such thing. All this statute says is that if your declined the coverage and they should have provided it and you are damaged you have to be damaged as a result of it. Then the HMO must compensate you for that damage if I was to get supposed to get some surgery. They said no, you can't get it. I can't afford it. Therefore I incur permanent injury on to be compensated in most cases. Hopefully the person has the ability to raise the funds to be able to pay for the surgery. And basically the extended liability would be as it is today the cost of that surgery. I think the what that what that essentially this says is that if you can't afford it and you end up with permanent injury, you'd have a right to get compensation Minnesota attorney general Mike hatches with us today to talk about his So Bill of Rights proposal and there are many other issues before the State Attorney General. If you'd like to join our conversation, give us a call six five one two, two seven six thousand 6512276 thousand outside the Twin Cities 1-800 to for 228281 other question before we get to our callers lot of attention recently about Twin Cities International competition or the lack of it out there. Is that something that you're going to be involved with? Well, we are making an inquiry with regard to the market structure with regard to the pricing and service and and at number of issues related to the airport. Some of which we have jurisdiction over some of which is more of a federal nature, but we are making an inquiry. We think it's appropriate function and and will continue to do so. Okay Patrick your question, please (00:14:02) yes. Thank you very much for taking my call. I just would like to disagree with the Well, and most of the points in the bill is not being consumer-oriented as actually being you know HMO bashing and it's a very popular thing to do right now. Actually I submit that you're damaging People's Health Care more employers will not be able to have comprehensive coverage because of the added costs or potential added cost. You don't you're actually asking you're actually getting into an HMO and just telling them how to run their business and actually the product is purchased by employers and if the employers dissatisfied with the product, they can choose not to carry that that plan or have that contract. There's really not a patient doctor issue. It's an employer problem with with their product. Okay. Are you moving into an area (00:15:04) here that you shouldn't really be involved with? Well, that's it. It's an interesting. I'm a day. There's only one organization. I'm aware of the employer organizations that take that position and maybe Jonathan represents them. But the fact is everything from the Minnesota Medical Association to virtually every consumer group. I'm aware of supports it what we're talking about here basically is ethics should a doctor be disclosing the profit motive and not treating. I mean the employers say no we shouldn't have to disclose that. It seems to me that's just common basic ethics. If I am as a lawyer received money from a third Source, am I not to tell my client? Of course, I'm going to tell my client should an insurance agent or a journalist. Of course, these are high matters of controversy when it happens in any other profession at Medical Care is probably the most intimate and important issue facing a person in their life and we're going to say that a pay that a physician who occupies probably the highest fiduciary relationship in terms of trust that we that the physician shouldn't have to disclose that keep in mind the amount. Association and virtually every provider I talked to agrees. Yes. That's something that ought to occur. Keep in mind a couple of years ago. They actually had gag orders and rules in these contracts. Seeing a doctor couldn't disclose certain facets of the contracts. Those gag orders are gone you even the hmos blushed at that one. Now, the issue is should a doctor be able to disclose because most people don't know that when they getting turned down they say gee I'd like to I think I'm entitled to a specialist. I think I'm entitled to some treatment here. You're telling me no and it's a fourth time and you know, it basically disclose. It doesn't second add any more cost because the patient if they don't like it they can go out and network. Maybe they can afford it themselves or they can you know protest it say is this really an issue. Will it cause a physician perhaps to give treatment that he otherwise wouldn't give if he didn't disclose maybe if that adds class but then think about it, why do we have that incentive there the incentive there is for a reason I assume the incentive there is for the physician at Not to treat and that's why we don't have rebates or kickbacks in the area pharmaceutical and other areas if that's the case if it's working, perhaps we ought to at least require disclosure with regard HML liability. Everybody else in the world is liable for the damage. They caused to people why shouldn't an HMO be similarly responsible for its actions. Bob your go ahead Bob your question, please (00:17:34) I wanted to know Forcing responsibility on these Managed Care entities will this not merely Drive what's left of the non self insured employee Insurance into the protection of the federal exclusions for the power of the insurance industry is such that absolutely no control is going to be given and could I just raised another issue as a Medicare recipient the financial squeeze on the actual real duration for services on the providers is such that if you're a Medicare patient, you will be examined as in you will be seen as infrequently as possible monitoring tests will be run as infrequently as possible. It's a matter of a financial squeeze in your bill. I don't believe will affect Medigap Insurance because I believe they're only obligation is to pick up the co-pays and deductibles. I wonder if you come in (00:18:31) please. Well here are Bob raises a couple of good points one on the first one there is there is the fact that Much of health coverage is written through self-insured plans, which is governed by Federal Regulation. I had to in private practice done substantial amount of work in that area and while a an employer for instance could seek Safe Haven. Let's say in terms of dried going self-insured to avoid state laws. In fact, most self-insured plans are administered by hmos and insurers and in those cases virtually, I would say all but almost all of the requirements of state law or Incorporated in those contracts. So it's a case of the tail wagging the dog the state law will be picked up especially when we're talking about issues concerning which I think is the big one is the Disclosure by The Physician. The HMO liability has been upheld in Texas to apply to self insureds and under erisa and with regard to physician exclosure. I think the physician will disclose it is not going to sit there and say by the way, are you a self-insured? He's going to disclose it one way or the other the the issue with regard to the definition of necessity and experimental. I suspect that most of these companies would pick it up. It's a good point, but I think that in it's one that again given a great deal of consideration to that Bob brings up but I do believe that the way this bill is drafted that this health insurers will necessarily pick it up. The second issue with regard to Medicare Bob again is right. This does not apply to Medicare contract snore to supplemental contracts unless of course they were under what's called an HMO risk contract which very few people have in the state. It would not help or hurt that relationship Diane. You're next. (00:20:29) Oh, I generally Earth. Yeah attorney general hatch. I'm just wondering with the class. You keep stating that the cost of the insurance as won't go up based on the new man. They said would be put on but where have you gotten your research besides the fact that the hmos the the Blue Cross of the world or they're telling you what they're going to go up probably 30% you're saying that the rates are going to go up at all. But we know that the rates have been going up at a double-digit rate increase for the last five years and at this rate the small employer and again back to the fully insured employers because they're the only ones that have to pay the full boat. They're not going to be able to afford the insurance and all these employees are going to end up with more uninsured than you have insurance. And actually I think you're sounding more like a Hillary Clinton at this point where let's just all go to National Health Care system and will be under USA health insurance or Minnesota Health insurance and will have no (00:21:22) choices. Well, let me throw out the Congressional budget office has undertaken a study of these of this proposal which has been adapted and in other states and they conclude it's less than 1% It is fairly common for hmos in some employer groups. Do yell at anything any change in healthcare results in a cost increase. In fact, in this case, when you break out this bill and you try to apportion a cost increase you find it lacking. I mean a 30% increase would be am glad that the hmos and the employers make that kind of comment because it's beyond the realm of of credibility a physician disclosing that he has an incentive. How much do you think they would cost and why would it cost? I mean are we saying it's because Physicians would somehow be now required to treat people because they have to blush and say gee I have an incentive or not to treat you. I mean all basically what they're going to say is I here's my recommendations you To keep in mind you're under a capitation agreement, which does have an effect with regard to the profitability of this clinic. But however, I've kept that in mind and I don't believe that you should need a specialist at this time Simply Having that disclosure shouldn't cost a nickel more and it frankly if it does if the inference is that somehow a physician by having that disclosure is now going to send you to a specialist then maybe we ought to be having that but it won't cost more not unless you're willing to find the hmos can produce a physician is saying, yep because I don't disclose I save a few extra bucks for the HMO because I don't send these people onto the special to The Specialist and I don't send him to the hospital and if I had to disclose it, yeah, I guess I'd be more reasonable in my treatment but I don't think you're going to find a physician saying that and I don't think you're going to find an HMO claiming that that happens with regard to HMO a liability. They made the same claim of high percent increases in Texas. There was one lawsuit 39 states have such a provision no effect with regard to the cost. With regard to the definition of necessity we're saying basically it's a statutory definition that's adapted had previously been used in almost every contract in this country. And I don't see how the fact that an HMO would have to qualify. We would have to Define medical necessity and the basis of experts in the field as opposed to their own internal guidelines should necessarily raise costs. It is not credible to say that any increase would occur because those Provisions none of them are mandates. It's a great term to say, oh these are increased to mandates. You'll note that the caller's use that same term, which is a term coming this nice assume that they are representing of represent of the HMO Council or the Business Partnership because they're unique to those two groups in making those kind of comments long-term. Do you think we need a major overhaul of the way? Medical Care is delivered in this country. We tried the fee-for-service deal and that apparently became way too expensive Managed Care became all the rage and there are complaints about that. Do we need a third system Universal single-payer type? Well Ram or something like that changed is its there's no doubt to change will occur in our health care System when and how it occurs remains to be seen if you go back in the 40s Healthcare basically did not have insurance not until 1939. Was there a California where any was any type of physician service covered by a contract? It was done on an experimental basis not until about 49 did insurers come out with what's called major medical which is not major medical simply coverage for the work of Physicians. A hospital and you know the the employer-based system that we have in this country is adopted during the 40's do to wage and price controls was one of the vehicles through which employers could give incentives to employees since I couldn't increase the salaries they offered fringe benefits since the 50s with this employer-based system intact or in place. We've seen great miracles in healthcare. We don't die of pox. We don't die of measles we don't die a polio. We don't die of first time heart attacks cancer is many types of cancers are no cured or at least put into remission. But as we go into the hospital for each of these treatments we incur higher costs and now we get into genetics and biotechnology and great advancements that occur in the cost will always go up Healthcare as Innovation occurs will cost more money the issue is how are we going to determine what is covered and not covered for our public in? Health Care was not considered part of the gross national product. Today you're talking in the teens in terms of the cost is one of the highest increases for employers when the highest increases in our society and will continue to go it's a great system. It's a miracle system, but it's an extremely expensive one. The issue is who decides the issue is is a corporation to make that decision because we're frankly chicken or frankly not enough courage as public officials to address those kind of issues because we don't want to do it's very controversial if you think abortion is difficult is people in politics of grappled with it for what 25 years now these issues with regard to health care who decides what type of treatments to be given raises even bigger issues. And so far we've done in this country simply say, let's push it off to an HMO some other Corporation let them make the decision because frankly we don't want to Grapple with it and it's it's a tremendous issue. I wish that in a Happen because people as time go on as time goes on there will be more outcry now. I don't have the Magic Bullet to solve that. Nobody does It's a Wonderful system it Rose. We are going to have to hit not just the financial issue. But with it under the guise is the ethical issue is the in in those are very very difficult as just Medicare what Bob has brought up earlier is a tremendous issue in terms of cost how much money is reasonable and it's something we have to Grapple with there because we're dealing with a government insurance program. The system will change how a changes remains to be seen Minnesota attorney general Mike Hatch is our guest this hour again. If you have a question, give us a call six five one two, two seven six thousand or one eight hundred two, four two two eight two eight reminder over the noon hour. It's off to the Minnesota meeting where bioethicists art. Caplan is speaking today about some of the Shocking mind-numbing developments in the world of biology ethics medicine in the rest and some of the implications ethical implications raised by those developments will gets more callers in just a couple minutes. So I'm Bill cling. I just want to tell you that you're a wonderful audience. We do our best to produce quality programming. We tell you what we need you to do to support that programming and you respond in our short three-day drives. We raised over seven hundred twenty five thousand dollars from 7000 contributors including mm first time members, you've made it clear that you value public radio and that you'll do what's necessary to keep it strong that's very smart and on behalf of all of mpr's listeners. Thank you for making yet another membership drive a complete success programming an MPR is supported by carousel automobiles the Audie store offering the 1999 Audi A6. Sedan and A6 Avant wagon 6125449591 news headlines. Now, here's got a Cunningham Greta. Morning, Gary President Clinton is starting his four-day tour of Latin America to see some of the worst damage from Hurricane Mitch. His first stop is one of the first few homes left standing in some of the villages hit by a wall of mud that slid down a volcano in October. The president's visit comes just as 15,000 Guatemalans and Salvadorans who are in the United States illegally become eligible for deportation back to their home countries. The Central American nations have asked that those deportations be delayed once again, so that the recovery from the deadly storm won't be sidetracked. The sports world is mourning the loss of baseball great Joe DiMaggio DiMaggio died at the age of 84 after battling cancer baseball commissioner Bud selig calls DiMaggio the personification of Grace class and dignity funeral arrangements for DiMaggio are still pending in Regional news. 3 dfl senators are proposing a package of tax credits targeted to families send a tax Committee Member Sandy Pappas Steve Kelly and John Hollinger say over the past 50 years the States income tax burden has shifted to families with children. Our plan contains cuts that would go toward a modest income tax rate reduction and increases in the child tax credit The Proposal also includes some 90 million dollars for property tax relief another 170 million dollars would go to tax breaks for companies buying telecommunications equipment heavy snowfall is continuing to make some slippery driving conditions around the region today. The Minnesota Department of Transportation reports roads in the Twin Cities are slippery and roads in southern Minnesota are in poor to Fair driving condition up to 10 inches of snow is expected by tonight in parts of South Central and Southeastern Minnesota reminder. There is a winter storm warning in effect for southern Minnesota today and tonight and a snow and blowing snow advisory for West Central Minnesota and a snow advisory for Central Northwestern and East Central Minnesota today. And tonight the snow will spread today from the southwest to the Northeast with areas of blowing and drifting snow in West Central and Southern Minnesota today highs will range from 25 to 35 degrees right now Rochester reports some light snow and 22. It's snowing in Fargo. 26 Duluth reports cloudy skies and 23 and in the Twin Cities snow is falling a temperature of 26 degrees and Gary. That's a look at the latest news headlines. All right, thank you Greta. It is now 22 minutes (00:31:30) before noon sort of tourney General. Mike hatches Our Guest this hour we're talking about some (00:31:35) of the issues that the Attorney General's office is wrestling with these days. And again, if you would like to join our conversation, six, five, one two, two seven six thousand or one eight hundred two, four two two eight two, eight Daniel. Go ahead. (00:31:49) Yes. I'd like to say that the in the end. It is better to have healthy people. I'm a nurse at at a hospital here in Minneapolis. And I would think and why I know that the biggest cost that I see medicine is that when disease becomes gets into full bloom when it gets it to its Advanced stages. And people stay in the hospital for 30 days instead of instead of five days, or as an example a cancer patient that a woman who could just have a lump removed and then but that's missed and it spreads into full-blown cancer throughout her lymphatic system or or heart disease spreads and gets to the point where they need bypass surgery and they could have had intervention long time before that would think that hmos what would have learned by now that it's cheaper to have healthier members. Then it is to let them get sick and then pay for it (00:33:03) then. Are we talking primarily? Mr. Hatch about as a practical matter here talking primarily about the denial of Care at the at the extreme kind of at the end of the disease when it's at its worst as opposed to the preventive kipe care that caller talks about here. You know, I'm not the one to ask and I talked to primary care physicians who indicate that the difficulty in referring to a specialist early on does create problems. So to a degree the caller hits it on the head with regard to that issue in a smaller vein. There is a the other issue with regard to the definition of experimental care that I mentioned which is the in stage issues and what attempts should be made one at one of the comments. That is that he brings up underlying his comments is the is that that issue a cost an HMO or an insurer has a short rise in there looking Over the next year and in many cases, they're looking to get off the contract if they see too many claims Bloom up and and the contrast is let's say a self-insured company an employer who's looking beyond the the one year Horizon. They're on the hook for many years. You can find situations where it is. If you only have six months to go on a contract it's better to put it off. It's better to not get that preventive or that early stage treatment simply because you can get off the the cost of it by the time it hits full bloom when the contract is has run. Its course. I can think of in cases involving own a variety of cases where if you take a look at all an alternative form of treatment over a two or three year span, it is substantially less than perhaps the conventional treatment that is being prescribed by the panelled doctor. Which is cheaper in the short run but in the end ends up with those and end-of-life costs. The nurse was referring to when we shift gears here to a few other issues of the state DWI task force suggested at the end of last week that it's time for Minnesota to take a serious. Look at suing the alcohol industry in the same way that we sued the tobacco industry. Would you be leading that charge? Well, I think there are significant differences between tobacco and alcohol and we'll certainly look at it's my understanding that they will be giving us the benefit of their thoughts on it. But at least the first blush review of it, there are significant differences differences between tobacco and alcohol. And tobacco. The premise of the case was fraud was that the tobacco industry in concert as a conspiracy basically told the public told Congress told everyone. I was told over the world. There is no addictive side effect. There is no Health causing problem of any major significance and that there are making healthier cigarettes Etc. And they said hold us to our aunt told us to our promise here and what that law suit against the tobacco industry essentially is is yes. We are holding you to your promise and the fact that you lied not only did you lie. Don't lie where the representations wrong, but you knew it at the time and in alcohol. It's a little more difficult. We've we know nobody can hide the fact and I don't believe anybody in the alcohol industry has ever made any effort to claim that alcohol is not addictive. I don't think anybody in the alcohol industry has ever tried to claim that alcohol doesn't damage people. So it's a little different the key to the tobacco case. It was fraud the key to the tobacco case was that the industry lied the that's not an element that Certainly find in the alcohol and is in a straight least at least to my knowledge. What about the proliferation of lawsuits against the gun industry to a degree? It's a little different there. I but again number one do people know that guns kill people. The answer probably is yes. I mean a five-year-old kid knows that so they are selling a weapon that kills people but in this state it's a little different than City of Chicago the city of New York where they're more restrictive gun laws in the states permitted to sue them. I mean the legislature has these debates every year. It is State policy to permit the sale of guns. So it is difficult from a state perspective to say, okay, we're going to file suit because guns kill and we didn't know it or you've sold guns in this state. We told you not to the fact is they are allowed to sell guns in the cities where those lawsuits have occurred. It's my understanding that they do have restrictive gun laws and that one of the Allegations is that they've dumped the guns in the surrounding suburbs and places like that with the idea of them being that they would proliferate within the city limits, but that's not the case in this state. So we have look at that gun issue. We're not pursuing it attorney general is the chief law enforcement officer. What do you think about the concealed handgun proposed change the one that would make the issuance of the permits more uniform across the state and I have to ask you what about the governor? Well, I with regard to the concealed permit law today. We have a law that says that you can have a permit. Excuse me. You can carry a concealed weapon. If you have a permit that permit is issued by either the sheriff or the police chief in your municipality and they essentially use certain criteria. There is a is noted and that there are more Permits issued in some of the northern counties some of the northern cities and there are in the metropolitan area and there is a belief that there is some arbitrary Behavior going on with regard to how they criteria is applied. I have worked closely with the police and my office Works closely with the police and I think it's important that we represent their interests on public policy issues such as this and it's been very clear very strong to me that they would like the law to remain as it is, you know, I had a very good conversation with Sergeant Ganley from the City of Minneapolis Police Department who pointed out to me that 15 years ago 20 years ago, the the whole concept of weapons was different they would go into a home and if there was a domestic or something going on the the type of weapon would be an Old World War II service revolver that was rusted didn't work and there were no no ammunition at today. They go into a place and at the ammunition the the Weaponry is very sophisticated very deadly and when you add to what the component that somebody's carrying concealed weapons, it brings about a whole different. Cheering already a stressful environment for that police officer. If somebody grab goes to the glove compartment to quick they reach under their pocket too quick too many things that can go on some ptions are made and people get hurt and that's not good. You know, we do have a difference in terms of some counties and how these permits are issued but keep in mind this is a big state and it's a state where the east meets the west and the metropolitan area. It's very similar. I think to a, you know, you could go out to Boston and probably see a lot of similarities in terms of the culture and and yet if you the rest of the state, I think we're more Western and you go to Montana to and and see some similarities in the and I think if I see I'm from Northern Minnesota. I see somebody with a well I gotten in a car. It's not a big deal. I mean, they're going hunting. I see some somebody with a gun down here. I'd get real nervous and I think perhaps the law enforcement. Shows the Chiefs and the sheriff's are reflecting that so my opinion is I'm with the police on this thing. And I believe that we should not have any change in the permitting law at this point John your question for attorney general (00:41:31) hatch. Yes. Thank you for taking my colleague. I strongly support the legislation that you're proposing. I have two questions. The first is that I recently went to my doctor got a prescription went to the drugstore to get it filled and was told that the insurer would not pay for that prescription, but it would pay for a different prescription. I assumed it was generic I asked they said no, it was an entirely different prescription. Now my understanding is the only person that can write a prescription is a medical doctor. So how is it that an insurance company can make the decision that I can get some other drug? It strikes me that and your second question. My second question is I wanted to ask About my understanding is that there is the attorney general is investigating Pine Shores the chemical dependency Treatment Center up in Pine City. There is report on KSTP some time ago and questionable suicide in four staff members there have been sexually assaulted and I just wanted to get comment one if that if there is an investigation if so, how what's comment. (00:42:44) I'm all right. I think those in reverse order well on the first item, I wouldn't comment. I can't comment one way or the other as to whether his investigation and and wouldn't do so. I just just not appropriate with regard to the issue on the prescriptions. He raises a good point and that is the use of formularies hmos and ensures a generally enter into agreements with either directly or indirectly through a company formulary company that essentially allows them where they get incentives. Get the rebates the refunds whatever the term is for bulk purchasing if you will of certain drugs and so each of these companies will have a list and it may be some with squibbitt. Maybe somebody with Bristol-Myers whatever it is. It's going to be they're going to have a list of what what medications what are on the list and they do get a kickback for that money. I don't have Kickbacks too strong a term maybe refund would be better as a result. Those formularies are posted with the pharmacists are involved in when you as a member walk in you will be told what is covered and what isn't in generally it's based upon that that refund although some people say, oh no, it's based upon the quality of the of the medication but I suspect it's more than coincidental that the refunds are usually highest with the prescriptions that are on the medication. The price does run this Market the some plans do allow you to buy the medication that was prescribed by the physician. And but you'll have to pay more for it others simply say no, we won't permit it the issue you raised us with regard to who's making the decision here because kind of the fundamental issue that we talked about all the whole our who does make the decision in the healthcare. Is it going to be your physician or is it going to be a corporation and basically at this point we've shifted these matters off to the corporation's what this bill tries to do is put a little balance in it doesn't destroy Managed Care recognizes it Managed Care is here to stay are there many bills that would destroy it. But when it tries to do is put a little balance in that system for our we wrap up here. Can we talk politics for a few minutes? Absolutely former State dfl party chair. And of course you ran for governor for twice. I think you were the top dfl vote getter. And then the last election Statewide obviously you can run for Senate in two years. No, I'm not going to run for the Senate. I'm not going to run for governor and the only office I went for is it true? General and I will run for attorney general again. But I this is one of the party came to you and said Mike, you know where we've got to win that senate seat back and you're a proven vote-getter. You can get votes all across the state. We need you here the well, that would be fiction. The party will not be coming to me number one, but number two, even if it was a really bad day and they did come to me I would still say no. I mean it just it isn't going to happen and I really this this this position is it's good for me. I enjoy it. I'm working with good people. You can do a lot of things as attorney general frankly. I think you can I mean I just it's well suited for me. I think I run for governor. I've tried that. I don't want to do that again and I am frankly as attorney general. I think it'd be very very difficult and to do that. I think part of the stress that occurred between Governors and attorney general's is in the past is because you can get Attorney general the first thing you do is you live across the hall and you say gee that's a nice-looking office and it happens in every state but it creates an unhealthy environment. It is fun to be attorney general in a situation where I don't have that interest in running for a different position. I want to I would dearly love to do a good job at this position and if I can do this for eight years and I'm not committing it'll be just ate but if I could do it for eight years, I'd be really pleased and very proud of it and then I can go back and private practice and and finish up my career, but I'm not I'm absolutely not interested in running for another another position and then just on the off chance, they'd call you up and say well gosh, we we took quite a beating here last year. What do we need to change? We being the dfl? What would you tell them that they can't be? So pure they got a you got to recognize that there is a great Center of this country and it was a great Center in the state people don't like Politics as Usual. They don't like the dominance of interest groups Governor Ventura. Won an election as I think a backlash against Politics as Usual and to tell you the truth, one of the great disappointing things I've seen in the last couple of months and I've been you know, I was in government ten years ago. It is changed the lobbying and the influence of these groups is a much more extreme during the campaign. I had not seen it. I not seen until I got over to st. Paul but it is very very dominant by lobbying activity. I'd not seen in 10 years 10 years ago just didn't exist. Like it does today the relationships between legislatures and lobbyists and I don't care about Marty reforms and all that. It doesn't it's it that that didn't change it. I mean John try to put it did that didn't change it. There's the influence the information influences is phenomenal. So I think and I would, you know, six months ago. I watched that governor's race and have been Toro would talk about this and I thought he was all wet. You know, he's right. I don't know if he knew it at the time, but he it is it government needs a good shaking up and and I tell the dfl that 8 they've got to participate don't be just government as usual. Thanks for coming in today. Thank you. Appreciate it. Minnesota's new attorney general Mike hats joining us in this first hour of our midday program to talk about some of the issues before the Attorney General's office. Now reminder over the noon hour. It's off to today's Minnesota meeting Arthur Caplan bioethicist. One of the nation's best-known ethicists will be talking about the ethics of making babies and other moral dilemmas in the Brave New World of Medicine.