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Tomorrow the Senate Health and Human Services Committee will hold a hearing on SF248, a bill that would extend the moratorium on the construction of new cancer radiation facilities in the 14-county Twin Cities metro area.

This language is especially disturbing:

[T]here shall be a moratorium on the construction of any radiation therapy facility located in the following counties: Hennepin, Ramsey, Dakota, Washington, Anoka, Carver, Scott, St. Louis, Sherburne, Benton, Stearns, Chisago, Isanti, and Wright.

The first question I have is straightforward: What’s the logic behind imposing a moratorium on cancer “radiation therapy facilities”? Here’s another straightforward question that hasn’t been answered: Shouldn’t the patients’ needs be our legislators’ highest priority? Finally, isn’t the legislature essentially extending a monopoly exception for the people that are protected by this moratorium?

It’s apparent the answer to the first question is money. Sarah Janacek dug into the money trail. Here’s what Sarah found:

Several years ago, I poured over Campaign Finance Board (CFB) reports trying to figure out how much money MRO was spending.

Here are some of my calculations. [The following numbers do not include the 2010 election cycle.] Since 1998, the CFB has kept searchable donor database reports online. From these reports, one can learn that MRO founder Dr. Robert E. Haselow, and his wife, Justine Haselow, contributed $458,325 to Minnesota political candidates, parties and party units. Other doctors at MRO contributed at least $64,600.

As to the second question, Mr. and Mrs. Haselow have put a higher priority on their own well-being and their clinics’ well-being. That isn’t illegal by any stretch of the imagination. It isn’t putting cancer patients’ needs first.

As for the third question, it’s apparent this moratorium is essentially giving Minneapolis Radiation Oncology a monopoly exception. It’s one thing if someone reaches monopoly status by offering a fantastic product. It’s another when someone reaches monopoly status through a big lobbying budget.

Are cancer patients best served by low prices and an abundance of radiation treatment locations? Are they better served by higher prices and fewer radiation treatment locations?

This moratorium is an affront to free market capitalists. It’s hurting cancer patients by limiting their options. It’s codifying into Minnesota state statute a monopoly exception.

That’s why this moratorium shouldn’t be extended. If anything, it should be dissolved ASAP.

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Dave Durenberger has a dilemma. He needs to deal with it ASAP. The solution might be difficult to find, considering his dilemma stems from making conflicting statements about Obamacare. The reality is that there’s no way out for him without him admitting he was talking gibberish:

Take it from politician-cum-professor Dave Durenberger: “All health care is local.”

Don’t get him wrong. The former Republican U.S. senator, founder of the National Institute of Health Policy and University of St. Thomas prof is a strong supporter of the 2010 Affordable Care Act, which politicians in his erstwhile party call “Obamacare.”

But the real work of improving America’s health and controlling costs won’t be done in Washington, no matter who wins the next election, Durenberger told a Minneapolis church audience last week. It will happen in those places where local political and civic leaders put better, more affordable health high on their own agendas. They’re best positioned to see what’s driving local health care costs and how to change course.

It’s difficult to see how a top-down, bureaucrat-driven plan like Obamacare fits with a local plan whose mission is to detect health care cost drivers, then shift course to make adjustments to keep health care costs low. In fact, Obamacare is the opposite of a localized, flexible sytem.

Still, both systems are fatally flawed because they aren’t patientcentric or market-driven. Without those components, it’s difficult to imagine a system whose costs are stabilized.

Durenberger’s difficulties in squaring his statements is child’s play compared with Linda Berglin’s daunting task:

Then there’s the big-picture kicker that befits Berglin’s credentials: This project aims to be a model that “is sustainable and can be replicated throughout the state and in other parts of the country.”

In other words, Hennepin County is setting out to revamp Medicaid, not just in Minnesota, but for the nation. And if Hennepin can do that right, it will also be showing how Medicare might more affordably serve seniors. And that in turn might change the practice of medicine for everyone, for the better.

That’s why a little Hennepin County health care project for 12,000 people is worth watching, even as presidential candidates debate the merits of the 2010 federal law.

“The idea is to pay to do what’s needed to keep people healthy,” Berglin said, not more and not less.

For example, it could involve making sure that someone who is prescribed expensive medicine that must be kept in a refrigerator actually has a refrigerator, so the medicine isn’t wasted. Or paying more to shelter and clothe the homeless, so taxpayers can spend less on emergency-room services. Or beefing up mental-health services, so taxpayers can spend less on hospitalization and jails.

Micromanaging health care down to the point of making certain that people who use “expensive medicine that must be kept in a refrigerator” has a refrigerator. Is Ms. Berglin proposing that her Hennepin County office hire a refrigerator inspector? What salary would this refrigerator inspector make? Would property taxes need to be increased? Or would police officer or firefighters get cut to pay for the refrigerator inspector?

Saying that Ms. Berglin’s plan faces some implementation challenges is understatement. Saying that Ms. Berglin’s plan, refrigerator inspector and all, will need a massive bureaucracy is understatement, too.

Apparently, Ms. Berglin thinks money grows on trees watered by R.T. Rybak’s artistic drinking fountains. The chance that this ambitious program will save Hennepin County taxpayers money is slim, especially when you factor in the cost of the bureaucracy needed to sustain the program.

It’s time for Dave Durenberger to stop talking out of both sides of his mouth. More importantly, it’s time to shut Linda Berglin’s bureaucrat-centric plan down before it bankrupts Hennepin County.

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In a stunning move, Sen. Linda Berglin announced today that she’s resigning from the Minnesota State Senate effective Aug. 15:

State Sen. Linda Berglin, who served in the Minnesota Legislature for nearly 40 years, has announced she’s retiring from the Senate next month.

Berglin, DFL-Minneapolis, has been influential in setting health care policy. She helped create MinnesotaCare, a state-subsidized health insurance program for low- and middle-income Minnesotans.

Berglin said the fact that Democrats no longer hold the majority in the Legislature was a factor in her decision, as were a decade of budget cuts to Health and Human Services programs.

“During the last six months, I felt that my talents and skills have been underutilized in the Minnesota Senate,” said Berglin. “As I see so much of what I have worked on over the years being chipped away or repealed entirely, I worry that our state is moving away from the community spirit that has made us such a great place.”

Berglin is taking a position with Hennepin County. Her retirement will be effective on Aug. 15. Gov. Dayton will have to call a special election to fill her seat.

Frankly, it’s been a tumultuous session for Sen. Berglin. Her goal seemingly was to keep the programs she’d passed in place. I’d heard rumors that there was a growing rift between Sen. Berglin and Human Services Commissioner Lucinda Jesson. Whether this alleged rift was personal or profession wasn’t known but the rumors weren’t singular. They’d been heard 2-3 times.

When she says that “so much of what I have worked on over the years being chipped away or repealed entirely,” she’s likely referring to Steve Gottwalt’s Healthy Minnesota Contribution Program legislation, which does change the direction of taxpayer-subsidized health care.

It isn’t difficult to picture Gov. Dayton’s signing Rep. Gottwalt’s legislation into law as being the final straw that led to Sen. Berglin’s resignation.

That might’ve been the final straw for Sen. Berglin but the first straw likely was her not being included as a conferee to the HHS conference committee.

This isn’t insignificant in that Sen. Berglin likely saw that as tarnishing her legacy and her reputation. It’s apparent from her statement that Sen. Berglin was bitter about the role she’d been delegated to. Any politician who’d wielded that much authority for that long is likely to have a healthy ego.

In the end, Sen. Berglin will be remembered for her work on health care issues. Still, it’ll be interesting to see how the debate shifts without her in the legislature.

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Thirty-four DFL legislators wrote a friend-of-the-court brief explaining what part of the Constitution justifies the federal government’s takeover of the health care industry. It can’t be more embarassing than this:

The Framers Wrote The Constitution To Give The Federal Government Legislative Power To Address National Concerns, While Preserving The States’ Ability To Act In Matters That Do Not Require A National Response.

Here’s the text of the Tenth Amendment:

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

Here are the powers granted to the federal government:

Congress’ powers are enumerated in Section Eight:

“ The Congress shall have power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;
To borrow Money on the credit of the United States;

To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;

To establish a uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;

To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;

To provide for the Punishment of counterfeiting the Securities and current coin of the United States;

To establish Post Offices and post Roads;

To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;

To constitute Tribunals inferior to the supreme Court;

To define and punish Piracies and Felonies committed on the high Seas, and Offenses against the Law of Nations;

To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;

To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;

To provide and maintain a Navy;

To make Rules for the Government and Regulation of the land and naval Forces;

To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;

To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;

To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the Acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings;—And

To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

Here’s the text of the Ninth Amendment:

The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people.

The Ninth Amendment essentially says that the rights not listed in Article 1, Section 8 of the U.S. Constitution are rights reserved to the people and the states. PERIOD.

The DFL’s opening sentence in their amicus brief isn’t rooted in constitutional reality. The enumerated powers of the Constitution are the only things that the federal government originally had the authority to do.

Over the course of time, precedents were established by various courts but the Constitution’s Enumerated Powers and the Ninth and Tenth Amendments haven’t changed. They’re eloquently stated.

The Framers Included The Commerce Clause In The Constitution To Allow The Federal Government To Legislate Affairs Among The Several States That Require A Federal Response.

Here’s a little history on the Interstate Commerce Clause:

As explained in United States v. Lopez, 514 U.S. 549 (1995), “For nearly a century thereafter (that is, after Gibbons), the Court’s Commerce Clause decisions dealt but rarely with the extent of Congress’ power, and almost entirely with the Commerce Clause as a limit on state legislation that discriminated against interstate commerce.[5] Under this line of precedent, the Court held that certain categories of activity such as “production”, “manufacturing”, and “mining” were within the province of state governments, and thus were beyond the power of Congress under the Commerce Clause. When Congress began to engage in economic regulation on a national scale, the Court’s dormant Commerce Clause decisions influenced its approach to Congressional regulation.

The courts used the Interstate Commerce Clause to strike down “state legislation that discriminated against interstate commerce.” Since federal law says that health insurance can’t be sold across state lines, there isn’t a “state law discriminating against interstate commerce.”

Since these rulings happened in the years closest to the writing of the Constitution, I’m betting that they had a better grasp of what the Founding Fathers intended.

Under The Text And Original Meaning Of The Necessary And Proper Clause, Congress Has Broad Latitude To Employ Legislative Means Naturally Related To The Lawful Objects Or Ends Of The Federal Government. The Affordable Care Act Respects The Federal-State Partnership On Health Care And Preserves Constitutional Federalism.

Let’s examine what the Necessary and Proper Clause says:

The Congress shall have Power To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

The only thing that the Necessary and Proper Clause says is that Congress can write laws that pertain to the federal government’s affirmative responsibilities.

In other words, if the Constitution prevents the federal government from doing something specific, then the Necessary and Proper Clause isn’t relevant.

Simply put, this is the DFL’s attempt to spin what the Constitution and its amendments mean. The DFL’s brief doesn’t have anything to do with constitutional reality. This is nothing more than the DFL’s desperate attempt to justify O’Care.

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This post highlights the fact that Sen. Berglin was asleep at the switch the past 4 years. Gov. Dayton essentially admitted that with this announcement:

Minnesota health plans will now be required to compete against each other to manage state-subsidized health care programs for elderly, disabled and poor Minnesotans.

Gov. Dayton announced the change in state policy Wednesday (March 23). He said noncompetitive contracts have favored managed care plans at the expense of taxpayers. Last year the state paid more than $3 billion to health plans doing business with the state.

Had Sen. Berglin been paying attention, she could’ve included a provision into either the past 2 HHS omnibus budget bills that required bidding or she could’ve written and passed a policy-only bill that would’ve gotten substantial bipartisan support AND Gov. Pawlenty’s signature.

Gov. Dayton’s actions this week should give Minnesota’s businesses a chilly feeling:

One example of the type of savings that are possible made news headlines last week, when UCare voluntarily returned $30 million in excess reserves it had accumulated from doing business with the state. UCare’s donation suggests that plans could be profiting from state programs.

In announcing the UCare giveback, Gov. Dayton called upon all of the state’s public health plans to also return their excess earnings and reserves.

First, what does Gov. Dayton consider “excessive earnings”? Next, doesn’t this sound too much like strong-arm tactics that the PEUs use?

The governor also issued an executive order that requires regular audits of health plans, and full public disclosure of their profits, reserves, and administrative expenses.

Again, this is an admission that Sen. Berglin wasn’t doing her job. Either that or she thought this wasn’t that important because she thought their profits were reasonable.

At minimum, it’s proof that Sen. Berglin didn’t conduct oversight hearings on the issue. Shame on her for that. Regardless of the findings, the legislature should constantly searching for the truth. Oversight hearings must be at the center of that truth-finding mission.

The Minnesota Nurses Association chimed in with this statement:

“For too long, former Gov. Tim Pawlenty’s administration looked the other way when it came to these HMOs, and as a result these corporate executives were making massive profits off our taxpayer dollars while our patients suffered,” said MNA Vice President Eileen Weber, RN. “Thanks to Governor Dayton, we’re finally going to start getting some definitive answers to what has become a $3 billion question.”

HMOs and health insurance plans receive $3 billion in taxpayer funds per budget cycle to provide state health care services. MNA Nurses joined former Minnesota Hospital Association Attorney David Feinwachs and others in late 2010 to begin blowing the whistle on the disturbing lack of transparency and accountability involved in these contracts.

Prior to this year, Sen. Berglin had chaired the Senate HHS committee for well over a decade. At any point during that period of time, Sen. Berglin could’ve held oversight hearings into these issues. That she didn’t either reflects her disinterest in the issue or her understanding that profits from these programs was reasonable.

I’d also note that the MNA is both a union and a politically active, partisan organization. They’re enthusiastic supporters of single-payer health care:

Member and staff time, as well as substantial financial resources, will be committed to advancing the following areas of priority.

  • Position MNA for negotiations from strength across Minnesota
  • Organize to increase MNA membership and participation and promote MNA mission and strategic goals through political activism and collective action.
  • Educate and mobilize members around health care reform, and pursue short and long-term strategies to achieve a single-payer health care system with guaranteed health care for all.
  • Ensure the integrity of nursing practice and advance safe patient staffing standards and principles through collective action, collective bargaining, legislative initiative, grassroots organizing, political action and education consistent with the MNA Strategic Plan and the objectives of National Nurses United (NNU).

I’ve yet to find a single-payer advocate who doesn’t think health insurance companies’ profits aren’t outrageous. I’m 99+ percent certain that’s because they don’t exist. Look at AMSA’s take on single-payer:

  • Increased access to preventive care and the ability of government to purchase prescription medications in bulk would also help drive down health care costs. However, the corresponding drop in revenue for pharmaceutical companies could lead to a reduction in overall research and development, slowing down technological advancement.
  • There would be a removal of profit-motive in health care. The driving force behind the health industry would be patient care and not profit maximization.

That’s the nuttiest thinking I’ve seen lately. Eliminating the incentive is eliminating the product. Why would doctors continue practicing if they aren’t making money? Why would people go into medicine? They’d rack up huge student loan debt, then find out that their wages won’t pay their loans off quickly. How is that appealing to students?

One hopes that what Gov. Dayton and Minnesota DFLers have set their sights on is something like this. But it will be a little under two years, before things can really start moving in that direction.

I’m betting that 2 years is optimistic squared. To move in that direction, you need control of the legislature. That won’t happen anytime soon, especially considering how redistricting will alter the state legislative map. People moved to the most conservative districts while fleeing the most liberal districts. Look at the legislative districts in Rep. Ellison’s and Rep. McCollum’s districts. Compare them with Rep. Kline’s and Rep. Bachmann’s districts. Rep. Ellison’s and Rep. McCollum’s districts have to grow by roughly the same amount as Rep. Bachmann’s has to shrink. Then there’s Rep. Kline’s district, which has to shrink by 69,524 people to get to the 662,991 per district person average. I’m not a redistricting expert by any stretch of the imagination but I’ve gotta believe that there will be a significant migration of state legislative districts from the urban/inner ring suburban parts of the state to the outer ring/exurban parts of the state. That won’t be kind to the DFL. At the end of the day, the reality is that either Sen. Berglin didn’t pay attention to the health insurance industry or Gov. Dayton’s EO is a PR stunt in search of a problem. It might look good to his supporters but it won’t change anything that Sen. Berglin couldn’t have gotten changed at any time during the past 4 years.

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