Mn-prog-events Mailing List: Progressive Calendar 04.11.08

[David Shove (shove001]

          P R O G R E S S I V E   C A L E N D A R    04.11.08

1. Spring market     4.12 9am
2. WILPF/Americorps  4.12 10am
3. NWN4P Mkta        4.12 11am
4. Northtown vigil   4.12 2pm
5. Cops/your rights  4.12 5pm
6. CIW house party   4.12 8pm
7. Iran/US/CTV       4.12 9pm
8. PeaceJam          4.12-13
9. Papa John/Dakota  4.12 11:30pm  [NOT 4.11]

10. Stillwater vigil 4.13 1pm
11. SinglePay/AM950  4.13 3pm
12. Vets 4 peace     4.13 6pm
13. PG Allen/film    4.13 7pm

14. Marcy Winograd - Obama purge of progressive CA delegates
15. Kip Sullivan   - "Medical home" in DFL "reform" bills won't work

--------1 of 15--------

From: Lydia Howell <lhowell [at] visi.com>
Subject: Spring market 4.12 9am

This Saturday, April 12th, the World Jubilee is holding their annual
Spring Market. This event provides an alternative marketing outlet for
economically disadvantaged artisans and a wonderful opportunity for
shoppers to learn about each of the projects. All items are fairly traded
and you can rest assured that your purchases will result in profits that
go directly back to the producers.

The Amias Project will be represented at the Spring Market along with Ten
Thousand Villages and artisan groups from over 30 countries. Items
included in the market will be cards, pottery, baskets, Jewelry, clothing,
carvings, toys, textiles, needlework, rugs, musical instruments and much
more.

With coffee available all day, it should make for a pleasant way to spend
a couple of hours on a Saturday.
World Jubilee Spring Market / Open 9 am to 4 pm
Gloria Dei Lutheran Church
700 Snelling Ave South
St. Paul 55116
Did I mention there will be coffee?


--------2 of 15--------

From: Doris Marquit <marqu001 [at] umn.edu>
Subject: WILPF/Americorps 4.12 10am

MN WILPF  presents Free "Coffee With" Discussion
Saturday, April 12, 2008, 10 am - noon

"AmeriCorps: Youth Respond to National Disaster: (It's not only about
Hurricane Katrina)" With: Mara Cuneo Sullivan, on-the-scene participant in
recovery struggles in Biloxi, New Orleans, Key West, and elsewhere

Van Cleve Community Center, 901 15th Ave. SE, Minneapolis
Everyone welcome; FFI: 612-522-0776; www.wilpfmn.org


--------3 of 15--------

From: Carole Rydberg <carydberg [at] comcast.net>
Subject: NWN4P Mkta 4.12 11am

NWN4P-Minnetonka demonstration- Every Saturday, 11 AM to noon, at Hwy. 7
and 101.  Park in the Target Greatland lot; meet near the
fountain. We will walk along the public sidewalk. Signs available.


--------4 of 15--------

From: Vanka485 [at] aol.com
Subject: Northtown vigil 4.12 2pm

Peace vigil at Northtown (Old Hwy 10 & University Av.), every Saturday
2:00 -- 3:00 PM.


--------5 of 15--------

From: Charles Underwood <charleyunderwood [at] hotmail.com>
Subject: Cops/your rights 4.12 5pm

Saturday, 4/12, 5 pm, Communities United Against Police Brutality hosts a
training on knowing your rights in police encounters, Arise Books, 2441
Lyndale Ave S, Mpls.  http://www.arisebookstore.org


--------6 of 15--------

From: Brian Payne <brianpayneyvp [at] gmail.com>
Subject: CIW house party 4.12 8pm

Alright everyone, get your party hats on and get ready for some fun
Immokalee-style...

The Twin Cities CIW Solidarity Committee is organizing two fundraisers to
send three representatives to Miami for an action with the Coalition of
Immokalee Workers at Burger King headquarters on April 28 where we will
deliver our petition signatures.  This year our representatives will
include Phil, Maria and her son (his father is a farmworker and he is
going to learn more about the work his father does and what he can do to
change working conditions in the fields). Invite everyone you know...

- This Saturday, April 12th, 8pm to ???, House Party at the Greenhouse,
2915 James Ave. S., Minneapolis.  We'll have drinks ($10 at the door - or
whatever you can afford - gets you all the beer you can drink, and $2.00
mixed drinks), video games ($1 per game), t-shirts ($10 each) and much
more.

- Saturday, May 10, 9:00pm-1:00am, Breaking the Chains Concert at Triple
Rock.  $10 at the door, with Nancy Drew Crew, Single Speed, Guerrilla
Blue, Las Palabristas and more.

If you have any questions, contact Brian Payne at 612-859-5750 or
brianpayneyvp [at] gmail.com
Fair food that respects human rights,
not fast food that exploits human beings.
www.sfalliance.org


--------7 of 15--------

From: Eric Angell <eric-angell [at] riseup.net>
Subject: Iran/US/CTV 4.12 9pm

Minneapolis Television Network (MTN 17) viewers:
"Our World In Depth" cablecasts on MTN Channel 17 on Saturdays at 9pm and
Tuesdays at 8am, after DemocracyNow!.  Households with basic cable may
watch.

Sat, 4/12, 9pm and Tues, 4/15, 8am "Iran and the US: Myths and Reality"
Interview of Nasrin Jewell, Iranian born professor at the College of St.
Catherine.  Co-hosted by Karen Redleaf and Eric Angell. (repeat)


--------8 of 15--------

From: Charles Underwood <charleyunderwood [at] hotmail.com>
Subject: PeaceJam 4.12-13

4/12 and 4/13, all day PeaceJam conference at Metro State University, with
theme of "Making Friends Out of our Enemies," St Paul.
http://www.metrostate.edu


--------9 of 15--------

From: John Kolstad <jkolstad [at] millcitymusic.com>
Subject: Papa John/Dakota 4.12 11:30pm

[ed, a thoroughly bad person, wrongly put in "4.11" in the last PC]

Here is a gig we have been looking forward to for some time. Papa @ the
Late Night At The Dakota This is the classiest Jazz and music club in
town.  They do these late night shows for the after Theatre crowd and
those people just not ready to go to bed too early Saturday night.

My group (Papa John K & The Hot Club Of East Lake) will be performing the
late night show Saturday, April 12 at the Dakota.  Eric Graham will be
joining us on upright Bass., along with Sam and Deano and Clint.  We have
two great sets of blues and Swing to play.  Django to Gershwin to Slim
Gaillard to Harry "The Hipster" Gibson..  We start at 11:30 to 11:45 and
play until 1:30.  This is our first formal appearance at the Dakota.
Cover only $5.00 They do have great food by I don't know how late the
Kitchen is open.

Then Sunday April 13, Papa & The Hot Club Quartet are at the Kitty Cat In
Dinkytown 8 to 11 PM.  Neat place.  Like stepping back into anohter time.
No cover.  It is a great listening room and very comfortable (Big chairs
and couches all around the joint)

Please pass it on to those who may be interested.
John Kolstad 612/722-6649


--------10 of 15--------

From: scot b <earthmannow [at] comcast.net>
Subject: Stillwater vigil 4.13 1pm

A weekly Vigil for Peace Every Sunday, at the Stillwater bridge from 1- 2
p.m.  Come after Church or after brunch ! All are invited to join in song
and witness to the human desire for peace in our world. Signs need to be
positive.  Sponsored by the St. Croix Valley Peacemakers.

If you have a United Nations flag or a United States flag please bring it.
Be sure to dress for the weather . For more information go to
<http://www.stcroixvalleypeacemakers.com/>http://www.stcroixvalleypeacemakers.com/

For more information you could call 651 275 0247 or 651 999 - 9560


--------11 of 15--------

From: info [at] jamesmayer.org
Subject: Single payer/AM950 4.13 3pm

OF THE PEOPLE:  CALL FOR ACTION
AM 950

OF THE PEOPLE: This Sunday, april 13th, 3 p.m. AM 950--Air America
Minnesota's new name; call letters: ktnf--with Host James Mayer.

We invite you to join us and our guest, Jack Nelson Pallmeyer on "Of the
People", on AM 950 this Sunday, 4/13/08, from 3 to 4 PM when we'll
continue to focus on the action solution to the health care crisis, Single
Payer Universal Health Care.

Jack Nelson Pallmeyer is the only Minnesota D.F.L. candidate for the
United States Senate who supports complete Single Payer Universal Health
Care.

[Michael Cavlan is a Green Party candidate for the US Senate who supports
complete Single Payer Universal Health Care. Perhaps he will be invited on
the show soon. -ed]

Of the People's on-air call-in number is 952-946-6205. Host James Mayer
will get in as much phone time with callers as possible.

You don't have to limit your listening to the car. You can spend
productive time at your computer and stream us:
www.airamericaminnesota.com/listen if you put in a MN zip code. Off-air,
you can reach us by calling James Mayer at 651-238-3740, by e-mail at
info [at] jamesmayer.org, or by U.S. mail, address: James Mayer, 970 Raymond
Ave, St. Paul, MN ZIP CODE 55114.

952-946-6205 (To Stream:  <http://www.airamericaminnesota.com/listen>
http://www.airamericaminnesota.com/listen>) [still the same web address!]


--------12 of 15--------

From: Charles Underwood <charleyunderwood [at] hotmail.com>
Subject: Vets 4 peace 4.13 6pm

Sunday, 4/13, 6 to 8:30 pm, Veterans for Peace chapter 27 meets, St
Stephens Church, 2123 Clinton Ave S, Mpls.  (Ring bell on north door.)
John Varone 952-2665.


--------13 of 15--------

From: Lydia Howell <lhowell [at] visi.com>
Subject: PG Allen/film 4.13 7pm

Benefit for a Film about Paula Gunn Allen
April 13, 2008  7-9pm
$10 ($5 low income)
Center for Independent Artists
4137 Bloomington Ave S Minneapolis
(CIA is inside Instituto de Cultura y Educacion at the corner of 42nd
St. and Bloomington free parking in front of the building)
www.c4ia.org <http://www.c4ia.org/>
Phone: 612-724-8392

Thought Woman- The Life and Ideas of Paula Gunn Allen is a documentary
currently in early production by Ellen Marie Hinchcliffe about the Laguna
Pueblo/Metis writer/thinker Paula Gunn Allen. Ms. Allen is the author of
many books including The Sacred Hoop, Spider Woman's Granddaughters and
Pocahontas: Medicine Woman, Spy, Entrepreneur.  She is credited with
founding the field of Native American literary studies and is Professor
Emerita of English and American Indian Studies at UCLA.

Come support the making of this documentary about an important
thinker/elder, meet the filmmaker and see some amazing performers.  Hope
to see you there!

Gabrielle Civil will host the evening.  Ms. Civil is a Black woman poet,
conceptual and performance artist. She is working on a book about Black
women and performance art and is the recent recipient of a Fulbright
Scholarship.

Sharon M. Day is an Ojibwe artist and activist.  She writes, sings and
makes music with the Neeconis Women Singers and is also the Executive
Director of the Indigenous People Task Force.

Ardie Medina is Anishinaabe from the Lac du Flambeau Reservation and
writes poems. plays and short stories.  Her poems appear in Traces in
Blood, Bone and Stone: Contemporary Ojibwe Poetry. Ardie lives in
Minneapolis with her husband Mike and Amos, their Cavalier King Charles
Spaniel.

Juma B. Essie is a Black man engaged in a Socratic relationship to the
world.  Juma received a Jerome Commissioning Grant for Performance Art as
part of the Naked Stages program 2008.

Kim Thompson was born in Seoul, Korea and is a writer and performance
artist.  Among many pursuits Kim is currently a Many Voices Fellow at The
Playwrights Center.

Ellen Marie Hinchcliffe is a woman of European decent, she is a poet,
filmmaker, performance artist and a loving Auntie and Daughter.  She is
passionately at work on Thought Woman- The Life and Ideas of Paula Gunn
Allen.  More about her work at http://ellenhinch.googlepages.com
<http://ellenhinch.googlepages.com/>


--------14 of 15--------

[The closer these candidates get to power, the worse they get. Once in,
they forget us entirely, wild with the orgasmic joy of handing over to the
rich whatever is left of our country. Hardly lesser evil - but good enough
for meek millions desperate for any "hope" at all no matter how fake and
ultimately criminal. -ed]

Obama Delegate Purge
Slash and Burn in California
by Marcy Winograd
http://www.opednews.com

By dusk on Wednesday, the California Obama campaign had purged almost all
progressive activists from its delegate candidate lists.  Names of
candidates, people who had filed to run to represent Obama at the August
Democratic Party National Convention, disappeared, not one by one, but
hundreds at a time, from the Party web site listing the eligibles.  The
list of Obama delegate hopefuls in one northern California congressional
district went from a robust 100 to an anemic 23, while in southern
California, the list in Congressman Waxman's district almost slipped out
of sight, plunging from a high of 91 candidates to 17.  Gone were strong
women with independent political bases.

Who was left standing, still in the running for the Sunday delegate
caucuses?  The bundlers, the men and women who skirt campaign finance laws
by bundling cash, a bundle of $2,000 here and a bundle of $2,000 there -
and some, though certainly not all, of the Obama volunteers, loyalists
from day one. Who was kicked to the curb?  Brian Leubitz, a Calitics
blogger with a mighty pen, Tad Daley, former policy advisor to Cranston
and Kucinich and a career fellow with the International Physicians for the
Prevention of Nuclear War, Alan Toy, a disabled rights activist and Chair
of the American Civil Liberties Union chapter in Santa Monica, and a
nameless, yet tireless grassroots volunteer who toiled nights making
precinct maps - and me. Marcy Winograd.

I campaigned for Obama - went on Pacifica's KPFK twice, once on election
day, to promote his candidacy, to tell the world he really was our hope,
the candidate who could galvanize the young and the man who could
strengthen an ever-expanding progressive base in the Democratic Party.  I
urged our Progressive Democrats of Los Angeles chapter to endorse him and
we did.  Obama for President.

But the Obama campaign was worried their delegates would switch at a
brokered convention. After the first round of voting, if no clear winner
emerges, there is no such thing as a pledged delegate - according to
Hillary Caesar Clinton.  Did I take an Obama loyalty oath?  Even better.

Two years ago I picketed a Hillary Clinton fundraiser in Hancock Park and
was quoted telling the Los Angeles Times.  "Hillary Clinton led us to war.
She is not the kind of leader we need."

I sit on the Executive Board of the California Democratic Party and will
vote in June on DNC delegates who will preside over the convention in
August.  These are the men and women who will make the rules at a
potentially brokered convention.

How very sad, indeed, that the Obama campaign has chosen to slash and burn
its list of supporters, as this purging policy projects the wrong image,
makes the campaign look nervous, not at all confident - and, I'm afraid,
anti-democratic and mercenary, given the coveted treatment of bundlers
running for delegate seats.

pdla.org

Marcy Winograd is an Executive Board member of the California Democratic
Party, representing the 41st Assembly District (Santa Monica, Pacific
Palisades, Topanga, Malibu, and Brentwood). In 2006, she garnered 38% of
the vote in her congressional peace challenge to Jane Harman. At the last
California Democratic Party convention in San Jose, she lobbied
successfully for Party platform amendments calling for prison sentencing
reform and card check certification in union-organizing drives.


--------15 of 15--------

"Medical home" proposal in DFL "reform" bills won't work
By Kip Sullivan
April 8, 2008

The DFL leadership in the Senate and House introduced health care "reform"
bills late last February that contain a few good provisions and a lot of
bad ones. The good provisions include those which expand MinnesotaCare and
Medical Assistance, and finance programs to reduce obesity and smoking.
The bad provisions are the "payment reform" sections which shift insurance
risk from the insurance industry to clinics, hospitals, and other
providers, and those which subject providers to report cards. I discussed
the bad provisions in my first two articles in this series.

The bad provisions in the Senate bill, SF 3099, came within one vote of
being deleted from the bill when the entire Senate debated SF 3099 on
March 27. The vote came on an amendment to SF 3099 offered by Sen. John
Marty that would have cut the "payment reform" and report card language
out. His amendment failed on a 32-33 vote. The bill passed an hour later
by a 41-22 vote.

The companion bill in the House, HF 3391, has not yet come to a floor
vote. A very similar debate is going on in that chamber between the
authors of HF 3391 and the single-payer legislators who oppose the
"payment reform" and report card provisions. The single-payer legislators
are telling the authors of HF 3391 there will be a fight on the House
floor if the authors don't take the objectionable provisions out.

One other novel "reform" in the DFL bills that is generating much
discussion, but not as much controversy, is the "medical home" (or "health
care home") proposal. This proposal was popularized by the Health Care
Access Commission (HCAC), one of two health care "reform" commissions that
met throughout most of the last half of 2007. The HCAC recommended that
the Department of Human Services (DHS) create "health care homes" for
people who qualify for the state's three big public health insurance
programs - MinnesotaCare, Medical Assistance (Minnesota's Medicaid
program), and General Assistance Medical Care. Sen. Linda Berglin
(<?xml:namespace prefix = st1 ns =
"urn:schemas-microsoft-com:office:smarttags" />Minneapolis) and Rep. Tom
Huntley (Duluth), who chaired the HCAC and who are the authors of SF 3099
and HF 3391 respectively, included that recommendation in their bills.

The "medical home" proposal has nowhere near the potential to harm
providers and patients and drive up costs that the "payment reforms" and
the report card requirements do. Nevertheless, it is objectionable policy.
It has no clear definition and will, therefore, be impossible to evaluate
with anything resembling precision. It is supposed to cut costs by
improving care. But it won't work for those public program enrollees who
are only eligible for a few months and are then bounced from the rolls;
and it may not do much even for the minority of enrollees who stay on the
rolls for years.

If it accomplishes any good for some patients, it will be at the expense
of other patients because the legislation authorizes DHS to take money
from non-"home" clinics to help "home" clinics defray the cost of
qualifying as a "medical home." These costs include expenditures to
finance extra nurses and clerks, to help patients schedule appointments,
to stay open later, to buy computers and software, and to spend more time
interacting with patients and their family members.

                AN EVOCATIVE METAPHOR BECOMES POLICY

If "medical home" were merely a synonym for "regular source of medical
care maintained by the patient over a long period of time," the phrase
would not be difficult to define. And there would be no question as to
whether it would be a good thing. A small body of research has
demonstrated that longevity in doctor-patient relationships improves
quality of care.

Of course, the main threat to longevity of doctor-patient relations is our
sick health care system. Our system permits 47 million of us to go without
health insurance, and it forces those of us who are insured to change
insurers every two or three years, which in turn often means changing
doctors because most insurers limit which doctors we can see. Unless we
establish universal health insurance and restore complete freedom to
choose our doctors, the dream of a "medical home" a place where doctors
get to know their patients over many years - will remain unfulfilled for
the large majority of us.

These impediments to long-term patient-doctor relations are especially
severe for the low-income Minnesotans who qualify for MinnesotaCare,
Medical Assistance, and GAMC (the programs that will be required to create
"medical homes" under the DFL bills). According to research done at the
national level, 60 percent of Medicaid recipients lose their Medicaid
coverage within one year of getting it. "Medical home" proponents do not
explain how it is possible to establish long-term doctor-patient relations
when continuity of insurance coverage is non-existent.

But advocates of the "home" concept do not limit their definition of
"medical home" to just - "a regular source of care". They claim that
"medical homes" will provide much higher quality of care than your
run-of-the-mill clinic. They say this will be achieved by numerous tactics
that go beyond merely facilitating longer patient-doctor relations, and
that these tactics will culminate in greater use of preventive services
and better "management" of chronic disease, and this in turn will bring
costs down in the not-too-distant future. The tactics "medical homes" are
supposed to use include

* hiring more staff (especially non-physician staff such as nurses and
physician assistants),

* providing or "arranging all - care" patients might need,

* improving physician compliance with existing guidelines on how to treat
and prevent particular diseases,

* making greater use of computers,

* achieving greater "linkage" with non-medical service agencies,

* improving access through either longer hours or more availability of
doctors and nurses by phone and email, and

* communicating more often with patients and family members.

And, of course, there are the ever-popular report cards. "Medical home"
advocates believe all clinics should send their patients' medical records
to some third party so that party can prepare report cards on how well
clinics treat hundreds or thousands of different types of disease ("home"
advocates are very vague about what proportion of treatments report cards
should cover). Like all managed-care proponents and advocates of "market"
solutions, "medical home" advocates believe doctors and nurses will be
motivated to take better care of their patients if they are subjected to
the embarrassment of seeing low "grades" next to their names on public
report cards, and to financial rewards and punishments based on their
grades.

With the exception of report cards and the destruction of patient privacy
report cards entail, and with the possible exception of greater use of
computers (it is not at all clear that computers improve care or reduce
costs), these features of "medical homes" are quite attractive. Who
wouldn't want access to clinics with all the extra services "home"
advocates want to make available at "medical homes?" But if that's what
the "medical home" is - if it's nothing more than a clinic endowed with
more resources than the average clinic - why not say so and dispense with
the "medical home" poetry?

The maddening vagueness of the "medical home" proposition is best
illustrated by examining the two most important mysteries left unsolved by
proponents of "medical homes": Who will pay for all the extra services,
and will the enrollees in MinnesotaCare and the other public programs be
forced to visit one and only one clinic during their tenure as public
program enrollees? I discuss these two mysteries in the remainder of this
article.

                        LUNCH WILL NOT BE FREE

"Medical home" proponents have no idea what it will cost Minnesota clinics
to do all the things necessary to qualify as "medical homes." (DHS and the
Department of Health will be jointly in charge of deciding which clinics
qualify.) What will it cost, for example, to hire extra nurses to provide
above-average volumes of preventive services, more advice to the
chronically ill, more meetings with patients and their families, and more
hours to keep the clinic open longer? No one knows. Similarly, no one can
say for sure how these costs will be paid for.

You might think the Health Care Access Commission, which devoted hundreds
of people hours to this topic, would have addressed the cost question
before endorsing the "health care home" as a cost-containment device. You
would be wrong. The closest the HCAC got to explaining who will pay for
all the extra features is to imply that all these features will pay for
themselves, apparently in the near future. Here is how the HCAC (which
used the phrase "health care homes" more often than "medical homes") put
it in their February 2008 report to the Legislature: "The health care home
would support the reliable delivery of preventive care and disease
management through care coordination, which has been shown to increase
health care quality and reduce health care spending." There was no
footnote appended to this statement. (The HCAC report is available at
http://www.commissions.leg.state.mn.us/lchca/HCAC%20Report%20final%202-08.pdf.)

Even if this statement were true, it would leave unanswered the question:
Who will front the money to the clinics so they can buy the people and
equipment they need to be certified as "health care homes"? After all,
even the most effective forms of preventive and disease management
services take time to pay off in the form of reduced medical bills.

But the statement is not true. There is no scientific research (as opposed
to junk science produced by business consultants and insurance companies)
supporting the claim that prevention and disease management save money. In
fact, the research suggests that many preventive and disease management
services raise health care costs. ("Preventive services" refers to medical
services, like flu shots and mammograms, given to people before they get
sick, or at least before they have outward signs of being sick. Disease
management refers to medical and education services given to patients who
already have a disease or show signs of getting one. Disease management
services are typically aimed at prevalent, chronic diseases like heart
disease, asthma, diabetes, and depression.)

Here is how experts characterized the professional literature on
preventive medicine in the February 13, 2008 edition of the New England
Journal of Medicine: "Although some preventive measures do save money, the
vast majority reviewed in the health economics literature do not" (Joshua
T. Cohen et al., "Does preventive medicine save money? Health economics
and the presidential candidates," 358:661-663).

There are several reasons why most preventive services don't save money.
One is that they are given to massive numbers of healthy people, only a
small fraction of whom were going to get the disease anyway. A second is
that preventive services are rarely 100 percent effective. The result: We
spend lots of money providing preventive services to millions of people,
but the savings from warding off disease in a tiny percentage of those
people are too small to offset the cost of administering the preventive
services.

The rule of thumb that prevention does not save money applies as well to
disease management, for similar reasons. The disease management services
(the most common of which is phone calls from nurses to patients to see if
they are following their doctor's orders) cost money, and they do not
always result in improved health and lower use of medical services.
Research indicates that disease management of a few diseases save money
(management of congestive heart failure is an example), but most don't and
some raise costs. Here is how a review of the scientific literature
published last December in the American Journal of Managed Care
characterized the current evidence: "[T]he results of our review suggest
that, to date, support for disease management is more an article of faith
than a reasoned conclusion grounded on well-researched facts" (Soeren
Mattke et al., "Evidence for the effect of disease management: Is $1
billion a year a good investment?" American Journal of Managed Care
2007;13:670-676).

Just yesterday the New York Times reported on a three-year experiment
sponsored by Medicare to see if disease management saves money. Medicare
paid disease management companies like Healthways and Health Dialog up to
$2,000 per patient (the patients had, among other diseases, heart disease
and diabetes) and measured the impact these companies had on the cost of
medical services. The preliminary finding is that the money paid to the
disease management firms was not offset by reduced medical expenditures,
and the net effect was to raise Medicare's costs.

Two final arguments some "health care home" advocates make is that
computerized medical records and report cards will somehow cause doctors
to become better doctors, or at least more efficient doctors. As is the
case with the arguments for prevention and disease management, these
arguments are not supported by the scientific evidence.

Bill Gates and the computer industry eagerly promote the notion that
getting all clinics and hospitals to spend billions on computers and
software in order to switch from paper to computerized records will save
money. They claim the investments in computer technology will save more
money than the new technology cost by replacing human workers and by
improving care and reducing future medical costs. But the small body of
research on these claims indicates electronic medical records have a mixed
effect on cost and quality of care. Some research (but by no means all
research) actually shows that computerized medical records make doctors
less efficient and increase the risk of medical errors.

The evidence on report cards is almost nonexistent, and what there is
lends no support to the claim that report cards improve care. In fact,
some research indicates report cards harm sicker patients because doctors
avoid them to keep their grades from being dragged down. Report cards are
going to cost something to produce. If we do report cards on even a
substantial minority of the thousands of treatments available in a modern
nation, the total cost is going to be huge.

To sum up, even if preventive services, disease management, computers, and
report cards saved money, they can't save money before a clinic opens as a
"health care home." But the fact is these things don't save money. The
fact is, the "health care home" lunch will not be free. If there will be
no savings, where do "health care home" advocates think clinics will find
the funds to provide more services than the average clinic does now?

                          MEDICAL HOTELS

The mystery of how the extra services of "health care homes" will be
financed is intimately related to the other mystery I mentioned: the
question of how any clinic can be held responsible for its services to
patients when those patients are not forced to "enroll" with that clinic
and to promise not to seek care from other clinics for a defined period of
time.

The HCAC and the Berglin-Huntley bills call for DHS to pay
"per-person-per-month coordination fees" to every "health care home."
These fees are to be higher if the patient for whom the fee is paid is
sick and lower if the patient is healthy. (Just as the HCAC did not hazard
a guess as to how much it will cost clinics to gear up to be "homes," and
did not hazard a guess as to how much report cards will cost, so the HCAC
did not hazard a guess as to how much it will cost DHS to figure out how
healthy each of the hundreds of thousands of public program enrollees are
and to adjust the "coordination fee" accordingly.) The HCAC and the early
versions of SF3099/HF3391 stated that the "coordination fee" could not
exceed $50 a month for the sickest patients. Thus, for a typical primary
care doctor with 2,000 patients (let's pretend for the moment they all
took an oath to visit only that doctor), the "coordination fee" would
amount to somewhere between zero (if all the patients are very healthy) to
$100,000 a month (if they are all very sick).

Will that $100,000 come from new taxes? No, it will come out of the hides
of clinics that serve public program enrollees that do not volunteer to be
"health care homes." SF3099/HF3199 has a "cost neutrality" provision in
it. This provision states that if "initial savings" from implementation of
"health care homes" are nonexistent or insufficient to cover the cost of
the "coordination fees," "the commissioner [of DHS] shall reallocate costs
within the health care system." This is a vague way of saying the
commissioner of DHS is authorized to lower reimbursements to non-home
clinics and all other non-primary-care providers if that's what it takes
to pay the "coordination fees" to "home" clinics without raising the total
cost of the MinnesotaCare, Medical Assistance, and GAMC programs.

This brings us to the second unsolved mystery: How will DHS know which
patients "belong" to any particular "health care home" clinic? You might
think patients would be required to enroll with one clinic, just as people
with health insurance enroll with one insurer each fall for the coming
calendar year. But neither the HCAC report nor the DFL bills require that.
They do say DHS shall "encourage" public program enrollees to "choose" a
clinic (in some sections the verb is "select") within the first month or
two of being enrolled in MinnesotaCare, MA, or GAMC. But that's it.

Will patients be required to sign a statement saying they promise to seek
care at only their chosen clinic? If they violate that pledge, what are
the consequences? No health care? Will "health care homes" be required to
call up "their" public program enrollees every month or two and ask them,
"Do you consider yourself a loyal patient of our clinic even in the months
when you don't need to come in for a visit?" Will DHS ask the "health care
homes" for documentation of such calls? What will all that cost? And if
patients are not going to just one clinic, how is it possible to hold any
one clinic responsible for providing and "arranging" for all of the
patient's medical care services? By what logic should a single clinic be
graded on the quality of care that it gives to patients who visit multiple
clinics?

It is not clear why the HCAC report and the DFL bills failed to address
these issues, in particular why they failed to state explicitly that
public program enrollees will have to choose one clinic and promise to go
only to that clinic. I can think of only two reasons. Either the authors
of the "home" proposal overlooked this question, or they did not overlook
it and decided they did not want to call attention to the unpleasant fact
that patient choice of provider will have to be severely circumscribed in
order to give the "health care home" fantasy a snowball's chance of
working.

So, to repeat the question at the heart of the second mystery: How will
DHS know which "health care home" should get the monthly "coordination
fee"? I, for one, have no idea. If the authors of SF3099/HF3391 know, they
aren't saying.

                             CONCLUSIONS

The DFL bills include provisions that require DHS to report regularly to
the Legislature on how "health care home" clinics affect both the cost and
quality of health care within the public health insurance programs. But,
for several reasons, it is extremely unlikely that DHS will be able to do
that with anything resembling accuracy. The vague definition of "home"
clinics is one problem. The apparent inability of anyone to require
patients to "enroll" with one "home" is another. A third reason is the
enormous cost of collecting data on patient health and other factors that
can influence the cost and quality of health care and adjusting cost and
quality data to reflect differences in those factors. Even assuming all
"home" clinics adopt the identical set of new features, and even assuming
all public program enrollees can be forced to visit only one clinic,
differences in factors outside of clinic control must be accounted for if
comparisons between "home" and non-"home" clinics are to be fair and
useful. If data on these potentially confounding factors are not
collected, DHS will have a hard time determining whether differences
between "home" clinics and non-"home" clinics were due to something the
"home" clinics were doing or to factors such as differences in the health
of patients in the two types of clinics.

One solution to this problem would be to reduce the "home" proposal to a
pilot project covering, say, four "home" clinics and four non-"home"
clinics. DHS could insist that all "home" clinics adopt the same features,
and DHS might actually be able to afford to do the rigorous data
collection necessary to produce reliable results. Our Legislature has been
for too long in the habit of adopting health policies based primarily on
insurance industry propaganda. It is high time they adopted a policy of
recommending solutions that have some support in the scientific literature
or, failing that, have been tested by pilot projects.

My guess is that if the "health care home" legislation is enacted, few
providers will sign up until DHS, or perhaps the Legislature in a future
session, clarifies some of the ambiguous language used to describe "health
care homes." I'm confident that once a some clinics are certified as
"homes" under the language currently used in SF3099/HF3391, we will never
know for sure how well or how poorly the "homes" functioned. That doesn't
mean they won't be hailed by "home" advocates as the finest thing since
sliced bread.


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   - David Shove             shove001 [at] tc.umn.edu
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