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Dear Governor Pawlenty:
It's 3 o'clock in the morning, and somebody is making a phone call. Not to the White House. A child has spiked a fever of 104. Worried parents are trying to reach a doctor.
When people have medical emergencies or just simple medical questions, whether it's 3 in the morning or 3 in the afternoon, they don't care how the Health Care Access Fund is divvied up. They're worried. They want to talk to doctors they trust, find out what is wrong and have their doctors make it all better.
Public policy that helps that happen is good public policy, Governor. Public policy that hinders that happening is bad public policy.
Before the end of the legislative session, you will be called upon to sign or veto a health care bill. It will be a complicated bill that spins the brain of a central planner, so a free-market guy who said he wanted legislation that supports the patient/doctor relationship ought be a bit flummoxed. Nonetheless, given the legislative sentiment to "get something done," you will be pressured on all sides to sign the legislation.
Before you do, I'd ask you to ask yourself just one question:Who is going to make decisions about your family's health care — you and Mary and a doctor you trust, or somebody else?
Yes, I know. Bill sponsors Rep. Linda Berglin and Rep. Tom Huntley and members of the Health Care Transformation Task Force, including the business community and organized medicine, have assured you this bill is not a government takeover of health care. It is a "public-private partnership," albeit one where the distinction is virtually indistinguishable. People still choose their own doctors, they say. In fact, each patient will have a "health care home" to coordinate his care. Government saves money, employers save money, health plans save money, physicians make money and patients ... ah, therein lies the rub.
Patients, which would be you and me, Governor, and about 5 million other Minnesotans, have a lot more at stake, with all due respect, than the fate of the Health Care Access Fund.
That "health care home" concept the bill is pushing — that's not Dr. Marcus Welby's cozy den. It's a gatekeeper function ensuring that doctors provide only "medically necessary" care defined by standards that may or may not be relevant to any one specific patient. Sure, patients may still choose their own doctors, but when a doctor's care recommendations depend on meeting the expectations of someone other than the patient, it drives an unnecessary wedge between doctor and patient.
The conflict we're talking about, Governor, is so much more than the ever-present caveat emptor tension that exists in a voluntary customer/vendor relationship. As government (even when it's cloaked as a silent partner) becomes ever more intrusive and pervasive in how physicians are paid (and the conference committee bill is intrusive and pervasive), we start talking about the very survival of medical practices — the concern you hear from rural and independent clinics. For us patients, we're talking about fewer, more costly medical options.
Yes, I realize, Governor, that you haven't gotten a lot of alternatives from your party's caucus. No real plan, just some equally confusing mumbo-jumbo about Health Savings Accounts. And with so many people heavily vested in a health care system that depends on government to preserve their market power, reforms promoting competition based on consumer choice don't have a lot of short-term political upside.
Frankly, Governor, if you have real conviction about preserving the integrity of the doctor/patient relationship, you're facing a situation where leadership must rise above polls and popularity.
That guy concerned about patient/doctor relationships would demand reform where patients are free to choose their doctors based solely on their personal judgment, doctors are free to choose and price their services informed by patient expectations, and insurance companies are free to offer products that meet a diverse set of consumer needs and tolerance for risk — and we are all free to buy them.
It is ironic, Governor, that legislators want to arbitrarily create a "right" to government-provided health care while denying you, me and 5 million other Minnesotans our unalienable right to make our own health care decisions.
Your decision on the conference committee bill, Governor, is not about cost or the Health Care Access Fund. It's about that 3 o'clock call and whether it's routed to a doctor the parents know and trust or a triage center inIllinois. It's about whether Minnesotans and their doctors make decisions about their family's health care or somebody else does. Strip out the politics, and it is that simple.
Craig Westover is a contributing columnist to the Pioneer Press Opinion page and a senior policy fellow at the Minnesota Free Market Institute (www.mnfmi.org). His e-mail address is
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This commentary originally appeared in the St. Paul Pioneer Press, Tuesday, April 29, 2008. |
