Denial of Health Care Comes To The US

Contrary to the protestations of the supporters of government run health care, rationing of services is a very real prospect. Just ask Barbara Wagner of Oregon.

EUGENE, Ore. — After weeks of bad news, things turned Barbara Wagner’s way this week.

Last month her lung cancer, in remission for about two years, was back. After her oncologist prescribed a cancer drug that could slow the cancer growth and extend her life, Wagner was notified that the Oregon Health Plan wouldn’t cover it.

It would cover comfort and care, including, if she chose, doctor-assisted suicide.

According to administrators of the state run plan, treatment of advanced cancer that is meant to prolong life or change the course of the disease is not covered. Excuse me....isn't that why we WANT health care....to prolong our lives and change the course of diseases? No???? Silly me - what was I thinking???? What is worse is that this is a change in policy, contrary to what the plan administrators claim.

Officials of LIPA and the state policy-making Health Services Commission say they’ve not changed how they cover treatment of recurrent cancer.

But local oncologists say they’ve seen a change and that their Oregon Health Plan patients with advanced cancer no longer get coverage for chemotherapy if it is considered comfort care.

It doesn’t adhere to the standards of care set out in the oncology community, said Dr. John Caton, an oncologist at Willamette Valley Cancer Center.

Well DUH - of course it does not adhere to the "standards of care" set by the oncology community. The doctors in the oncology community want to CURE their patients...not kill them. Remember the Hippocratic Oath - first do no harm?????? Apparently that does not apply to state bureaucrats!

Thankfully for Ms. Wagner, the "evil" pharmaceutical company that manufactures the drug has offered the treatment for free.

This is the kind of "care" that all Americans (not just Minnesotans and Utahns) can expect should government run health care become a reality. Is this really the kind of care we want for our aging parents or our children or even ourselves? Somehow I think the answer is a resounding no!

Introducing.....

Meet Ted. Ted is the patriarch of an old money family. Ted has everything that a person could want....wealth, a loving family, a great job with fantastic benefits....and brain cancer. The diagnosing doctors said that the tumor was inoperable and that Ted should get his effects in order. Ted took his great benefits and wealth and found an oncologist who specialized in "inoperable" tumors. The surgeon decided that the tumor was operable and today Ted is recovering from a successful surgery to remove the tumor.

Meet Kathy...Kathy is a cancer survivor. She chronicled her battle with "the Big C" at her blog Cake Eater Chronicles. Kathy also had the opportunity to get a second opinion when it came to her cancer treatment, something that was denied to a grandmother in the U.K. (as reported by Kathy H/T Mitch)

A Grandmother whose free NHS treatment was withdrawn because she paid privately for anti-cancer drugs has died.

Yesterday Linda O'Boyle's husband condemned the policy behind the decision and said it had made his dying wife's last months even more stressful.

Mrs O'Boyle, 64, had been receiving state-funded treatment - including chemotherapy - for colon cancer.

But when she took cetuximab, a drug which promised to extend her life but is not available on the NHS, her health trust made her start paying for her care.

Advocates of "single payer" health care here in the US claim that the program is not "government run" but as we saw during the health care debate here in Minnesota that is simply not the case. It is government run and the government will decide who gets what treatment and when....like they already do no

Meet Nancy. Nancy is a 71 year old woman with multiple chronic problems. Her daughters have seen her through bout after bout of hospitalizations due to mysterious collapses. After the last collapse (where she was taken to a different hospital), doctors determined that a weak heart, anemia and high blood pressure medication were combining to cause the mysterious black-outs. Nancy is on Medicare who has paid for some of her treatments, but most of the treatments have been paid for by private insurance and out of pocket. Nancy worries that Medicare (who will not pay for a much needed motorized scooter/wheelchair) will dump her because of the costs of her recent treatments.

Meet Linda - Linda was injured on the job (health care aid working with troubled children). Because of her injury to her knee, her back is now also injured. She has had multiple surgeries (including neck fusion) that has left her permanently disabled and on multiple strong pain medications. Recently it was discovered that she had Basel Cell Cancer in one eye. She was scheduled to have surgery to get the cancer removed when OUR government run health care dropped her. It has been one year since she lost her health care and the cancer still has not been removed and is probably spreading.

Is this really the kind of health care that we want to subject ourselves to? Is this what is best for our children and grandchildren...a system that tosses you out when you get to the point where you "cost too much" for the system...where you use too many resources? That is what Universal Health Care will give us if we are not careful!

Cross posted at State House Call a new place to find my Health Care Policy musings.

Making Matters Worse.

Well, well, well...it appears that the Governor may actually be coming around to the common sense take on HF 3391 (HT Gary)

Gov. Tim Pawlenty told legislators Monday that he is concerned that legislation now before a conference committee to revamp Minnesota's health care system might actually drive up costs instead of cutting them.

This has been a constant theme in my posting on this issue.

Health care costs continue to rise at "unsustainable" levels, he said. The Legislature's proposal, he said, would raise those costs further by expanding eligibility for state health programs. He said Minnesota still has "what is arguably the most generous human services system in the country."

Excuse me while I say....DUH! Every argument, every amendment from the House Republican Caucus tried to address that very fact - something that the DFL majority rejected time after time after time!

Under both bills, clinics could qualify for higher reimbursement by establishing themselves as "health care homes."
Those clinics would provide comprehensive and coordinated care, especially for patients with chronic conditions such as diabetes and heart disease. An estimated 80 percent of health care costs are spent on people with chronic conditions.
Pawlenty asked the legislators to simplify that concept, apparently after hearing concerns from some health care providers in rural or small, independent clinics who worry that they might not have adequate resources to compete with larger health systems such as Allina and HealthPartners.

Again - these are concerns that the HRCC tried to raise on the floor of the House....concerns that the DFL majority failed to address. Does the Governor really think that the DFL, in their utter arrogance of power, will listen to him raising these objections?

The Strib also (to their credit) reported that Sen Berglin brings up a point that Gary, the HRCC and I brought up during the debate....

Originally, he agreed to spending Health Care Access Fund money to enroll people who are eligible for MinnesotaCare, but he seems to have changed his position on that," Berglin said.
Minnesota has the lowest rate of uninsured people of any state, about 7.2 percent. Of those, half are eligible for MinnesotaCare "and getting them enrolled would be a big step toward universal health coverage," she said.

It would be a big step toward universal health coverage......can I say I told you so?

Seriously, we are talking about a complete overhaul of a system that is serving 92.8% of the people of Minnesota and of the remaining 7.2%, 3.6% should and could be in the system. Rather than make the system worse for the 96.4% that could and should be covered, we need to find a way to get the remaining 3.6% into the system we have now. It's not rocket science....

Zero Common Sense

Parents of Minnesota school children take note. This will be coming to a school near you if the Governor signs HF 3391.

Children in a New Zealand school have been banned from bringing cakes to share on their birthdays, due to new government healthy eating guidelines.

I am one of those parents. The Junior Logician's birthday always seemed to fall on a school party day so I would bring cake for him to share with his classmates. It was a "thing" for us all through grade school. The teachers enjoyed it, the parents enjoyed it and (most importantly) the kids enjoyed it. Now the government wants to end that.

Is there really anything else we can say on this...other than how stupid are we to allow this kind of intrusion into our daily lives?????

HF 3391 - Wrap Up

Well, it was not as long of a night as it was a week ago during the "War of 1812" but it did try to come close. It was also rather eye-glazingly boring at times - especially when the proponents of 3391 got into the defense of the more murky "conceptual" themes of the bill like the "Health Care Homes". There were times when Gary and I were joking that we should request combat pay for sitting through all of that (even though he didn't live blog it). However, if you didn't allow it to bowl you over, there were some very educational moments in the debate.

First and foremost to me were the multiple times when DFL members admitted on the floor that this was a universal health care bill (as I documented in my amendments post last night) although they were mostly on point when they used the euphamism "payment reform" to try to hide the real intent of the bill.

There were, however, a couple of surprise moments last night. First and foremost was how close the vote was on Rep. Finstad's amendment. The fact that the amendment failed by only 4 votes is, to me, very significant. It also tells me just how close we are (thanks to modern technologies like ultrasounds) to finally turning the tide on abortion! That vote alone was a real ray of hope for me. Second was the diversity and the depth of knowledge in the House Republican Caucus. I heard a lot of different members get up and lay out facts and figures and data on this issue that was staggering! They came loaded for bear and there were times when the ONLY defense that the Democrats could fall back on is "where is your plan and why didn't you bring it up before?" - a question that Minority leader Seifert threw right back at them by saying "you shut us OUT of the process until tonight".

The "freedom heros" from last night were Rep. Steve Gottwalt, Rep. Laura Brod, Rep. Paul Kohls and Rep. Mark Olson. All 4 gave some of the most reasoned (and at times very impassioned) defense for a Minnesota Health Care Network that has kept us the "Healthiest State in the Nation". Honorable Mention has to go to Rep. Finstad and Rep.Larry Hosch for putting up amendments that did strike at a couple of the more glaring omissions of Universal Health Care - prenatal and elder care.

Notable surprises were Reps. Madore and Faust voted against the bill. Rep. Madore maybe not too huge of a surprise. She is representing a very conservative district - a district she narrowly won two years ago and she is facing a tough opponent this year.

Another not so surprising vote was Rep. Jim "It's only one vote" Abeler who voted AGAIN to give big government more control over your life. Even after he spoke to great length about how flawed the bill was.

All in all the debate went about the way I expected. The DFL led majority ran rough shod over the minority trying all the normal parlimentary tricks (germainness rulings etc) to keep the minority from putting up common sense amendments to protect the people of Minnesota. It's back in the Senate's hands for Conference now. We'll have to see what happens next.

HF 3391 - Floor Debate and vote?

Rep. Abeler is speaking making several good points. He said that while much progress was made tonight, this bill has a way to go. He said that there are concerns about the financial aspects of the bills that need to still be addressed.

Rep Gottwalt goes into details on the financial concerns. Rep Kohls mentions the universiality goals in the bill. He mentions that if the benchmarks are not met, individuals could be forced onto health care (98% will be covered by X). He said that the benchmarks have no means of enforcement. He mentions that Rep. Sertich's cry of "where's the Republican plan?" was misleading because the majority kept the minority out of the negotiation process.

Rep. Peppin leads of quoting PJ O'Rourke - if you think healthcare is expensive now...wait until it is free! She then goes on to remind the gathering that MN IS good at providing health care to it's citizens...let's not forget that. Of the 7% who are not insured, half are eligible for EXISTING PROGRAMS. This may be a great idea, but it cut out half the solution - private industry. She then rips into RomneyCare - saying that it is falling apart under the weight of the regulations.

Rep. Erhardt got up next (after a brief announcement from Rep. Sertich on road conditions and conditional lodging allowances) and said that he was uneasy about the wishy-washy letters of recommendation that the author (Rep. Huntley) provided. He said that he would not be comfortable going to a doctor that gave that kind of recommendation.

Rep. Olson got up and asked Rep. Huntley again about the personal clinicial allowance. Rep. Huntley said that staff checked and the personal clinicial was not in other laws impacting health care. Rep. Olson thanked him for the answer and then asked if the commissioner can not reallocate costs, it implies that the commissioner can reallocate other fees. Rep. Huntley said that it would come from savings...Rep Olson clarified and asked where the savings would go? Rep. Huntley talked about more savings. Rep. Olson went back to note the 11 different ways cost shifting is used in this bill even though the authors swear there is no cost shifting in the bill and that the answers he got above were more examples of cost shifting! He said that there IS rationing in the bill and we go home and tell people we provided them with "affordable" health care but at what cost? We need to stop telling them it is free because it is NOT.

Rep. Seifert is up now. He said that repeatedly tonight we were asked "what would the GOP do?" One thing we would do is have had the bill on the floor sooner. We tried to put our plan up in pieces (amendments) which were voted down and in one chunk that was ruled non-germane. What we would have done was to have had a free market system. This is not a free market system. We would reform welfare, we want more INDEPENDENCE and less dependence. We would NOT put Katrina style bureaucrats in charge of the Mayo Clinic and our other hospitals. We would have the government get out of the way of the consumer to allow them to make their own decisions in their care. Rural hospitals are very nervous about this bill. They are politically savvy enough to not come out and say they think the bill is horrible, they are couching their "endorsement" in language that says "I hope you can fix this first". You are going to dump thousands of people into a plan that Rep Huntley admits will be bankrupt by 2012 guaranteeing you will either have to raise rates or dump those thousands of people back OFF of the plan. We want something that is real...real reform...this is not going to do it. They are not going to see any relief out of this bill. They are only going to see people move in here from out of state in order to get benefits. Let's put together a bill that the Governor can sign and we can pass 134-0.

Rep. Huntley got up (I hope he is last...I am ready for sleep) and thanked the staff that has worked on this over the summer, fall and winter. He handed out two editorials both from the Star Tribune that beg that the bill pass. He goes back to the letters of "endorsement" saying that the groups do support this bill.

VOTING - 83 Ayes - 50 Nays the bill passes. Good night folks. Wrap up will post in the morning!

Live Blogging HF 3391 Amendments

Rep. Huntley is offering up the first amendment which he calls a "technical" amendment. Rep. Abeler raises to ask what a "legally recognized person" is. Answer is a guardian. Why did you delete the "best part" of the program where the state supervises the process. A: because we are requiring the administrator to come back to the Legislature. The amendment is passed on a voice vote.

The next amendment is from Rep. Thao - the amendment adds oral health professionals to Section 9 on workforce shortages. The amendment passed on a voice vote.

Rep. Holberg has the next amendment and has to deal with data collection and privacy rights issues are. This is considered a friendly amendment from the sounds of it. The motion carries on a voice vote.

Most of the amendments that they are talking about now are technical in nature.

Rep. Olson just gave an interesting speech in support of the Brod Amendment. He talked about how our health care crisis is a crisis in cost shifting and he pointed out the successes of pre-paid health care where the onus of reducing the cost of health care is on the patient and the provider. Kinda what I said before.....

I should add that the Brod Amendment was an amendment to the Thissen Amendment. Most of the amendments to the amendment were to make compliance voluntary and Rep. Thissen just got up and said that it NEEDS to be mandatory or it won't work! You have to be forced into doing what they want in order for this to work???? And they call it reform...

Rep. Liebling has an amendment up and she says that her amendment will change individual mandate (f0r private insurance) but will not change the UNIVERSAL coverage portion. It also changes the starting date of the bill from January 1 to July 1 to allow for more input from rural hospitals. Rep. Dean has moved to divide the Liebling Amendment in two. The Speaker and the clerk are meeting to see if it is divisible. It is and they are voting on the second half of the amendment first.

OK - now they are getting into the meat. Rep. Brod was asking for clarification on how this bill is not considered single payer since people are required to go to their county "agent" to buy the approved plan for their area. Right now they are voting on lines 1.1 thru 1.16 of the Liebling Amendment I'll grab that shortly. Here is a link to the amendment. What currently seems to be the point of contention is lines 1.14 to 1.16 where it dictates what benefits are covered. The covered benefits include interpretive services, chemical dependency, mental health coverage and other high cost services. Rep. Seifert moved to split lines 1.14 thru 1.16 out and vote on the seperately. These two lines were adopted 84 - 49 on a roll call vote.

Attn: Gary Gross - Rep. Larry Hosch actually gave a decent amendment. His amendment states that medical services and technologies are not denied services based on age and disability. That has long been one of my problems with universal health care because Universal Health Care has long had a history of doing so.

Rep. Gottwalt is making some good points. He mentioned that he gets frustrated when people say that we "don't have a system" that Minnesota AGAIN was just rated the healthiest state in the nation, that we have the best access to healthcare that we have the best outcome of healthcare IN THE NATION! And yet the Legislature wants to completely undo that in favor of single payer in a bill that will bankrupt the state.

WOW - I am in absolute AWE....Rep Laura Brod has just given the most empassioned defense of choice (real choice) and the family and not having the government take over decisions that a family should make. I can't even begin (without the benefit of a rewind button) to give you the full impact! I will have to do a recap post just to include her defense of keeping government out of the day to day decisions of the families of Minnesota! This is all in defense of Rep. Dean's amendment. Rep. Tom Emmer just had an exchange with Rep. Huntley that is going to have to get the same treatment that Rep. Brod's remarks get. It was too important to not be covered en toto.

Rep. Huntley, in an exchange with Rep. Olson, stated that he talked about the NE Journal of Medicine's article (and he did) earlier and it said that health care homes and managing chronic care and the payment reform were all mentioned in that article. One problem...he ONLY mentioned payment reform in his previous remarks. He did not ONCE mention the other two itens in connection with the NE Journal of Medicine article!

One of the recurring themes of the opposition to this bill is the fact that if this bill does what the authors say it will, the system will go bankrupt in 2 years and at that time the state will be forced to take people OFF of the health plan in order to keep it afloat.

Rep Gottwalt is up again - this time commenting on the stack of "endorsement" letters from the medical community on this bill and he mentioned that these letters do not fully endorse the bill as written. He quotes the MMA letter where it strongly opposes the payment form that is in the Senate version of this bill. The Mayo Clinic expresses concerns of unintended consequences for national health care provides like Mayo! The "endorsement" letters actually show that the endorsers have concerns about the bill going in the direction that it ended up going in! He quotes one rural care center who fears that this bill will set back care delivery in rural Minnesota!

OK - I got majorly interrupted. Lots and lots of phone calls. Gary probably knows what I missed....

Ooooo this amendment is going to spark fireworks. Rep. Dean has put forward an amendment that basically would require checking citizenship status of applicants to the program! Oh yeah - lots of fireworks, but in the end Rep. Dean withdrew his amendment.

OK that last amendment was an interesting one. Rep. Finstad offered up an amendment that would require that all women seeking an abortion to have an ultrasound first. One or two Democrats stood up to give a rather perfunctory opposition to the amendment and then Rep. Abeler told the story of his brother. When his mother was pregnant she was told that the baby was hydrocephalic and would not survive birth. When the child was born the doctor was wrong. It was a very touching story. The amendment failed BARELY 64-68.

Rep. Kohls has an amendment on the floor which would change the affordability standard. Right now households making up to 400% of the poverty level (up to approximately $80,000 a year) would qualify for health assistance. The floor arguments are how to pay for that out of the health impact fee (smoking tax revenue and remember...they want to eliminate smoking as part of their health care plan...). The bill right now has no plan on how they are going to pay for the program. It will simply be studied and reported on in a year!

We are closing in on the 5 hour mark (in case you were wondering) and there is another amendment on the floor. This one by Rep. Holberg. It was not passed.

HUZZAH!!!! Amendments are done. Now comes the debate on the bill as amended....NEW POST!

Live Blogging HF 3391

The session was scheduled to start at 11 and guess what? Still no call to order. As soon as the session is called to order the live blog will start. I will have to break from noon to one from my regular Tuesday/Thursday appearance on MidStream Radio but I will be monitoring and if anything juicy comes up I will post it here.

The House has been called to order and they are doing the invocation.

Well that was quick - Rep. Sertich is already asking for a recess and wants to know from Rep. Seifert how many amendments will be coming from the minority side of the aisle. Rep. Seifert said that there will be more than 5 and less than last Thursday (44). Both sides will caucus during the recess!

12:49 and still in recess. I am watching and will start reporting once they are called back to order.

The House was finally called back to order. They are talking about HF 1314 - Truth in Music Advertising.

Now debating HF 3569 - directing the U to study worker health in the taconite industry. 2:34 OK they are STILL debating the taconite bill....if this is any indication of how the debate on 3391 is going to go it's going to be a LONG night.

Oh Glory....they are finally voting on HF 3569. Rep. Tinglestad is introducing a special guest...oh boy. HF 3391 is finally up for debate.

Rep. Huntley is the author and is up talking about how the health care system needs dramatic change and that we need to provide coverage for the uninsured. He is listing all the groups who support the bill including the unions and all the other usual suspects.

Rep Erin Murphy is talking about the health care home concept. She said that it is not a place but a concept. She says that it is voluntary for providers and patients, but that is countered later in the bill. Rep. Theissen is speaking now about how it is necessary for all Minnesotans to have affordable quality health care. He then mentions that only 7% of the population of MN is lacking said affordable quality healthcare. So we are taking over the who system for 7% of the population???? He also acknowledges that many of the uninsured are uninsured by choice and that this will "fix" that. So we are taking away free choice?

Rep??? (I missed her name) is talking about chronic care and how this will take care of it. She is also talking about how this bill will reduce obesity and tobacco usage.

Rep Huntley is speaking again. Quoting a member of the MMA who said that he "wished that people would quit saying that the health care system is broken because that implies it can be fixed." He is now talking about how this is payment reform (so that is how they are going to spin it ed). He quotes NE Journal Of Med article that says payment reform is necessary and implies that this (government take over of the system) is the way that they are advocating. He totally ignores the possibility of payment reform that puts the PATIENT in charge.....

Amendments in another post.

Your "Right" to Health Care

Neal Boortz has a column up today that needs to be read.

A typical column runs some 800 words.

For some subjects, that’s far too many.

One case in point: your “right” to health care. Among the rights guaranteed (not “given” as Bill Clinton believes) to you in our Constitution are:

Freedom of religion
Freedom of speech
The right to peaceably assemble.
The right to petition the government.
The right to keep and bear arms.
The right to be free of unreasonable searches and seizures.
Protection from double jeopardy.
Due process.
A speedy and public trial by jury.
The right to legal counsel when charged with a crime.

With one exception, the right to representation in court and a trial by jury, these rights require nothing of any other citizen but that they recognize your rights and not interfere with them.

Your “right to health care” would require some other person to give up a portion of their life or their property to either treat you or to provide you with drugs or medical implements. The Constitution does not provide for another individual to be indentured to you in this manner.

Therefore, you have no “right” to health care.

Deal with it.

Point made in only 200 words.

That’s short and sweet.

Short, sweet, too the point and most importantly all too true!

Live Blogging Senate File 3309

OK - I'm back and they just voted on the A46 Amendment. Since I have no idea what it was about, I will just report that it not adopted 22-41.

Senator Vandeveer just put up the A50 amendment. It is to strike 125 plans from the bill. Apparently this is supported by small businesses. The amendment was not adopted 15-47.

I will not liveblog all the amendments....if there is anything interesting I will report back and the live blog debate on the amended bill.

Sen. VanDeVeer has an amendment up to remove the health reinvestment assessment (A49). He made a remark during the debate about how Minnesota is the only state that seems to think raising taxes in a down economy is a good thing. Needless to say the amendment was not adopted - 15 to 47.

Sen. Erickson Ropes is correct....an assessment is A TAX! Didn't we (as a state) learn our lesson last year with the "health impact fee"?????

Sen. Hann puts up an amendment to pull the BMI monitoring in children in the schools out of the bill. Roll call vote has been called. Sen. Bergland says that this is the "only" way to monitor how well the program is succeeding???? Ummmmm - and the doctors won't be monitoring that Senator????? Amendment was not adopted 22-44.

Debate on the bill has begun....Sen. Ortman called this a fraud being foisted on the state. She pointed out that the bill gives taxing authority to an UNACCOUNTABLE, UNELECTED bureaucrat - over the House and over the Senate and over the people!

Sen. Bergland calls this market based????? In what alternate universe??

Sen Hann the Senate to task for the intrusion into Joe and Jane Citizens life. He said that the government should not be in the business of telling people what activities they can and can not participate in (staying home reading versus walking 5 miles) and what they can and can not eat. He also expresses puzzlement at Sen. Bergland calling this bill "market based"...

The bill is passed 41-22.

Bureaucratic Nightmares

Sarah Jan Olson (aka Kathleen Soliah) is going back to prison. (HT Lassie)

Just days after being told she could serve her parole in Minnesota, Olson is back in a California prison, where she'll stay for almost another year.
California Corrections Department officials said Saturday that criticism of Olson's release spurred a review of her case. That review showed that her parole date had been miscalculated -- she was not supposed to be released until March 17, 2009.

This is just one more example of the type bureaucratic inneptitude that runs rampant in big government. Do you really want to give bureaucrats like this - who can not perform simple math - control of YOUR healthcare????? I know I don't!

HF 3391 - It's UNIVERSAL!

Here is the “universal” part of on HF 3391. Specifically I would like to focus on Article 5 Section 12.

45.5 Sec. 12. [62U.06] GOALS FOR UNIVERSAL COVERAGE; CONTINGENT
45.6 INDIVIDUAL RESPONSIBILITY REQUIREMENT.
45.7 Subdivision 1. Phase-in goals. The state's phase-in goals for progress toward
45.8 universal health coverage for Minnesota residents are:
45.9 (1) 94 percent insured by end of fiscal year 2009;
45.10 (2) 96 percent insured by end of fiscal year 2011;
45.11 (3) 97 percent insured by end of fiscal year 2012; and
45.12 (4) 98 percent insured by end of fiscal year 2013 and thereafter.
45.13 Subd. 2. Measurement of percent insured.The determination of the percent
45.14 of Minnesota residents insured must be based on an annual survey of the Minnesota
45.15 population younger than age 65 to be conducted or contracted for by the commissioner
45.16 of health which must include questions related to the type of insurance, amount of
45.17 cost-sharing, and potential barriers to public program enrollment.
45.18 Subd. 3. Contingent individual responsibility requirement. (a) If the increased
45.19 affordability, cost containment, insurance reform, and voluntary efforts provided for
45.20 under this act fail to achieve universal coverage, an individual responsibility requirement
45.21 must have been proven to be necessary.
45.22 (b) If any one of the phase-in goals specified in subdivision 1 for fiscal year 2011 or
45.23 later is not met, as determined by the commissioner of health, in spite of implementation
45.24 of the increased affordability, cost containment, insurance reform, and voluntary efforts
45.25 provided for under sections 62U.01 to 62U.09, an individual responsibility requirement,
45.26 requiring every Minnesota resident to obtain and maintain health coverage from a public
45.27 or private sector source of the person's choice, must become effective 12 months after the
45.28 end of that fiscal year, provided that the commissioner certifies that health plans that meet
45.29 the affordability standard under section 62U.08 are available to Minnesotans.
45.30 (c) Failure to comply with the individual responsibility requirement is not a crime,
45.31 but must subject the person to a financial penalty to be specified in law.

There it is…..the “Devil” in the details…..Universal Care! According to this bill, the legislature wants to take over health care for 98% of ALL Minnesota residents by 2013. This is a change in earlier language (in the bill). Earlier language in the bill talks about how this is coverage for only those Minnesotans who are on specific already existing plans. The authors go to great pains to make sure that it is spelled out (in earlier sections) that the “universality” is for people who are on MN Care and Medicare and Medicaid! So now when you take this language and go back up to Article 1 Section 1. Note the difference between line 1.24 and line 45.8.

1.23 Subdivision 1. Selection of primary care clinic.Beginning January 1, 2009, the
1.24 commissioner shall require state health care program enrollees eligible for services
1.25 under the fee-for-service system to select a primary care clinic or medical group, within
1.26 two months of enrollment. Beginning July 1, 2009, the commissioner shall encourage
1.27 enrollees who have a complex or chronic condition to select a primary care clinic or
1.28 medical group with clinicians who have been certified as health care homes under section
1.29 256B.0751, subdivision 3. The commissioner and county social service agencies shall
2.1 provide enrollees with lists of primary care clinics, medical groups, and clinicians certified
2.2 as health care homes, and shall establish a toll-free number to provide enrollees with
2.3 assistance in choosing a clinic, medical group, or health care home.

Up until line 45.8, the talk was all about “program enrollees eligible for services” That all changes in 45.8….now it reads “Minnesota Residents”. Understand that THIS MEANS YOU. If you have employer provided health care you will still be required to register with a state primary care clinic (or health care home) and you will be required to undergo an initial screening in order to determine whether you have a “chronic condition” (including obesity) that requires long term care. Realize that this means that no matter whether you pay for your own insurance or not, you are still going to eventually be brought under the umbrella of state run health care and instead of your insurance company getting your premium payments, the STATE WILL. Also realize that this means your premiums will go UP and that rate will be mandated by the State!

27.8 Subd. 3. Premium rate restrictions. No individual health plan may be offered,
27.9 sold, issued, or renewed to a Minnesota resident unless the premium rate charged is
27.10 determined in accordance with the following requirements:

AND the State will tell your employer what kind of policy that they are required to provide to you (start reading lines 29.4 thru 31.23) and what your employer can contribute.

Realize that the department of health will have a scant 4 months to put this together by mandate and that the effective date of this bill would be January 1 2009! This drastic, rapid take over of one of the few healthy segments of the Minnesota economy right now will further deepen the recession that we find ourselves in today.

There is still time to stop this, my friends. HF 3391 is still in committee (next stop the Health and Human Services Finance Division) and is subject to being amended. Call your legislator, call your Senator (SF 3099 is the companion bill to HF 3391) and most importantly call Governor Pawlenty and urge them to defeat this bill.

WELCOME Hot Air readers. Pull up a chair and stay a while.

HF 3391 - You Want WHAT TEST?

One of the continuing themes, in my build up toward Universal Health Care has been the documentation of the rationing of services that starts once the government starts paying for your "free" health care. The posts in question can be found here. Commenters and politicians and reporters assure us that nothing like that will ever happen here, but are they correct? If Article 5 Section 10 is any indication.....

42.14 Sec. 10. [62U.05] HEALTH TECHNOLOGY ASSESSMENT.
42.15 Subdivision 1.Technology Advisory Committee. (a) The Health Care
42.16 Transformation Commission shall convene an advisory committee to make
42.17 recommendations to the commission regarding the inclusion of new and existing health
42.18 technologies to the standard benefit set and design.
42.19 (b) The advisory committee shall be made up of 11 members appointed by the
42.20 commission, in consultation with the Institute for Clinical Systems Improvement, the
42.21 Health Services Advisory Council, and the University of Minnesota. The members shall
42.22 consist of:
42.23 (1) six practicing physicians licensed under chapter 147; and
42.24 (2) five other practicing health care professionals who use health technology in
42.25 their scope of practice.
42.26 (c) No member of the advisory committee shall have a substantial financial interest
42.27 in a health technology company or be employed by or under contract with a health
42.28 technology manufacturer during their term or for 18 months before their appointment.
42.29 (d) The members shall be immune from civil liability for any official acts performed
42.30 in good faith as members of the committee.
42.31 (e) The advisory committee shall be governed under section 15.059, except that
42.32 the committee shall not expire. Upon the expiration of the Health Care Transformation
42.33 Commission, the Health Technology Assessment Committee shall continue to exist under
42.34 the oversight of the Minnesota Health Insurance Exchange.
43.1 Subd. 2. Technology selection process. The commission, in consultation with the
43.2 advisory committee, shall select existing and new health technologies to be reviewed by
43.3 the committee. In making a selection, priority must be given to any technology for which:
43.4 (1) there are concerns about its safety, efficacy, or cost effectiveness;
43.5 (2) actual or expected expenditures are high due to demand for the technology,
43.6 its cost, or both; and
43.7 (3) there is adequate evidence available to conduct a complete review.
43.8 Subd. 3. Technology review. (a) Upon the selection of a health technology for
43.9 review, the committee shall contract for a systematic evidence-based assessment of
43.10 the technology's safety, efficacy, and cost effectiveness. The contract must be with an
43.11 evidence-based practice center designated as such by the federal agency for health care
43.12 research and quality, or another appropriate entity as designated by the commission.
43.13 (b) The committee shall provide notification to the public when a health technology
43.14 has been selected for review. The notification must indicate when that review is to be
43.15 initiated and how an interested party may submit evidence or provide public comment for
43.16 consideration during the review.
43.17 Subd. 4.Committee determination. (a) Upon reviewing the completed assessment
43.18 and any other evidence submitted regarding the safety, efficacy, and cost effectiveness of
43.19 the technology, the committee shall recommend to the commission:
43.20 (1) the conditions, if any, under which the health technology should be included
43.21as a covered benefit; and
43.22 (2) if covered, the criteria to be used to decide whether the technology is medically
43.23 necessary, or proper and necessary treatment.
43.24 (b) The commissioners of human services, employee relations, and corrections may
43.25 use the committee's recommendation in making coverage and reimbursement decisions,
43.26 unless the recommendation conflicts with an applicable federal statute or regulation

Can I just say one thing.....I TOLD YOU SO!

If you that getting your HMO to approve experimental treatments (under todays existing market based system) is bad just wait until you have to argue for that care in front of a board of doctors who are accountable to the Legislature and not to you and your health.

Teaching Healthy Eating or Controlling Our Lives

ARTICLE XIII
MISCELLANEOUS SUBJECTS
Section 1. Uniform system of public schools. The stability of a republican form of government depending mainly upon the intelligence of the people, it is the duty of the legislature to establish a general and uniform system of public schools. The legislature shall make such provisions by taxation or otherwise as will secure a thorough and efficient system of public schools throughout the state.

The Minnesota Constitution states that the State of Minnesota is responsible for educating the citizenry. As school districts are fighting to fund their mandate with the dollars they have, our wise legislators have decided to throw yet another unfunded mandate on top of the mix (HT Drew)

1.1A bill for an act
1.2relating to public health; adding nutrition as a required academic standard;
1.3requiring a BMI monitoring program for children and youth; establishing a
1.4statewide health improvement program; establishing a health, nutrition, and
1.5physical education advisory council; requiring reports; appropriating money;
1.6amending Minnesota Statutes 2007 Supplement, section 120B.021, subdivision
1.71; proposing coding for new law in Minnesota Statutes, chapters 120B; 145.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Now I can certainly understand teaching language arts, science, mathematics, social studies, health, physical nutrition and health. I have no qualms with that, but just WHO is going to be conducting the BMI monitoring program? Would the individual school districts, strapped as they are, responsibile for buying the equipment necessary to conduct BMI testing? Who would be responsible for keeping the records? Would they be kept in the school district or would the state keep them? The bill calls for the establishment of a health, nutrition and physical education advisory council....who would be responsible for that additional layer of government employment? The individual school districts or the state? Who is going to pay for all of this? Funny you should ask.....

4.14 Subd. 3. Fee imposed. (a) A fee is imposed upon the sale of cigarettes in this
4.15 state, upon having cigarettes in possession in this state with intent to sell, upon any
4.16 person engaged in business as a distributor, and upon the use or storage by consumers
4.17 of cigarettes. The fee is imposed at the following rates:
4.18 (1) on cigarettes weighing not more than three pounds per thousand, 37.550 mills
4.19 on each cigarette; and
4.20 (2) on cigarettes weighing more than three pounds per thousand, 75 100 mills on
4.21 each cigarette.
4.22 (b) A fee is imposed upon all tobacco products in this state and upon any person
4.23 engaged in business as a distributor in an amount equal to the liability for tax
under
4.24 section 297F.05, subdivision 3, or on a consumer of tobacco products equal to the tax
4.25 under section 297F.05, subdivision 4. Liability for the fee is in addition to the tax under
4.26 section 297F.05, subdivision 3 or 4.
4.27 EFFECTIVE DATE.This section is effective for sales and purchases made after
4.28 June 30, 2008.

Hmmmmm - why does an increase in the cigarette tax sound so very familiar? Oh yeah....well to be fair, that part of HF 3391 appears to have been taken out in committee....

Seriously, it is stunning to me just how far this Legislature is to reach into your wallet and your home. Not only will they dictate what you will eat, they are now going to tell you what you can and can not feed your kids. They are going to tell you what to eat and how much exercise you will be forced to engage in (because you simply can not loose weight by diet alone - I know from experience) and when! This from the party that claims to be all about privacy rights....at least they are if you are engaging in a same sex relationship or aborting a baby...

How much government intervention is going to accepted by the people of Minnesota before they finally rebel against the DFL led legislature?

In The Waiting Room

Something to comtemplate while HF 3391 is winding its way through the House.

The Democratic candidates tell us they can provide healthcare for all either mandated or not. It sounds utopian except they don't say how we will pay for it or that the quality and quantity of care will go down as costs go up.

If we think we want universal healthcare first we need to make a few reality checks. It hasn't worked in Britain, Canada, France, Germany, and Russia.

There are some alarming health abuses going on in the United Kingdom recently noted by the Association of American Physicians and Surgeons and others.

To meet U.K. government targets, which require emergency department patients to be treated within four hours, thousands of patients are kept in ambulances outside the department for hours. Last year, more than 43,000 patients waited for more than an hour before being allowed into the emergency room.

Ambulances that are being used as "mobile waiting rooms" are unavailable to take fresh calls. The Labour government brought in the four-hour standard in an effort to end the scandal of patients waiting in casualty for days (Daily Mail 2/20/08).

Is this the kind of care we want for our families?

HF 3391 - Make Them Eat Tofu

I spoke earlier of my intent to dig into HF 3391 and I have spent the last couple days doing that (and a lot of BPOU business). I thought what I would do is tackle the bill in small sections - covering one or two articles at a time. In all fairness to the author(s) I should clarify that this is not necessarily a "universal" health care bill...from Article 2, Section 1, subdivision 4...

5.1 Subd. 4. State health care program. For purposes of this section, "state health
5.2 care program" means the medical assistance, MinnesotaCare, and general assistance
5.3 medical care programs.

...but it is a start!

Article 1 begins with a few "goals" for state wide health improvement(from Article 1, Section 3)

2.10 Sec. 3. [145.986] STATEWIDE HEALTH IMPROVEMENT PROGRAM.
2.11 Subdivision 1. Goals. The initial goals of the public health access fund are to reduce
2.12 the percent of Minnesotans who are obese or overweight to less than half by the year
2.13 2020 and to reduce tobacco smoking by 2 percent annually starting in 2011.

...so the state is going to tell everyone on MN Care and other general assistance programs (aka THE POOR) what they can eat and how much they can weigh. Continuing...

2.18 Subd. 2. Grants to local communities. Beginning January 1, 2009, the
2.19 commissioner of health must provide grants to community health boards to convene,
2.20 coordinate, and lead locally developed programs targeted at achieving measurable health 2.21 improvement goals.

...and...

2.33 Subd. 4. Media campaign. The commissioner of health must conduct a statewide
2.34 marketing campaign using public media to reinforce local efforts at addressing health
2.35 improvement goals.

While there are laudable and lofty goals in this bill, the first question that springs to mind is where in the heck is the state going to get the money for all of this new spending (remember - we are looking at a $935 million dollar budget deficit already). Well the authors turned to their favorite patsy.....smokers (Article 1 Section 4)!

3.14 Subd. 3. Fee imposed. (a) A fee is imposed upon the sale of cigarettes in this
3.15 state, upon having cigarettes in possession in this state with intent to sell, upon any
3.16 person engaged in business as a distributor, and upon the use or storage by consumers
3.17 of cigarettes.

So let's see.....we have a new gas tax, a new sales tax and an increase of the cigarette "user fee" all of which hurt the poorest among us the most! Tell me again who is the party of the poor?

Aside from all that, what gets me is the lack of logic that is going into these funding schemes...and schemes is exactly what we are. We are funding health care programs on the backs of smokers all the while saying we are going to stamp out smoking? We are going to fund roads and bridges on gasoline taxes when gas tax revenues all the while mandating more fuel efficient vehicles, mass transit and alternative fuel vehicles? Where is the logic in that thinking?

Not only is the DFL funding the future on the backs of the poor today, they are setting us up for larger and larger tax increases as the current funding starts to dry up. Is this really the way we want to fund roads....or health care?

Salud!

On Tuesday, I got a very interesting email in the Inbox.

Greetings Congresswoman Betty McCullum,

The School of Public Health at the University of Minnesota is hosting the 4th annual National Public Health Week Film Festival April 7-11, 2008. We’d love for the Congressional Global Health Caucus to be a co-sponsor of our Tuesday, April 8, global heath-themed film, “¡Salude!.” The documentary tells the story of how the cash-strapped country of Cuba has become ‘one of the world’s best health systems.’
In 2007, the Film Festival attracted approx. 500 people. This year, we are please (sic) to announce that the City Pages is the exclusive media sponsor of the Film Festival. The City Pages reaches nearly 130,000 people from the area.
Your participation as a co-sponsor would help ensure this critical public health issue get the attention it deserves.
Here are two things we would ask of you as a co-sponsor:
1. Spread the word. Help us advertise the Film Festival through your network, using various communications tools. This could include announcing it at an upcoming event, listing it in your newsletter, posting it on your organization’s calendar, or hanging or handing our Film Festival flyers.
2. Drive attendance. Ask your staff, board of directors, key stakeholders and constituents to pledge their attendance in support of the Film Festival and environmental health.

In appreciation of being a co-sponsor, we’d:
1. List your organization as a co-sponsor for Monday, April 7, 2008, on the NPHW Film Festival website; www.sph.umn.edu/filmfest08.
2. Provide a table for you to display your organization’s information and other relevant materials in the evening on Monday, April 7. If your organization is looking for volunteers, please feel free to post a sign-up sheet at your table. Students at the University of Minnesota not only want to learn more about an issue, they want to know how they can participate in finding solutions to the problem.
3. Offer a unique venue to raise awareness about environmental health and promote your coop.

The SPH hopes that the Congressional Global Health Caucus will join us in this exciting event. Please feel free to contact me to discuss your participation.

Now I got this email just as Jazz and I were going on the air at MidStream Radio so I mentioned it to Jazz. Jazz and I both expressed amazement in the fact that there was a "Global Health Caucus" (members include Rep. McCollum D-MN, Rep. Vic Snyder D-AR, Rep. Wayne Gilchrist R-MD, Rep. John Boozeman R-AR, Rep. Donna Christensen D-PR and Rep. Michael Simpson R-ID) and we decided that it was an issue worth pursuing at a later time. So today we asked Fausta to come on and talk to us about it (since Fausta's specialty is Central American politics). Luckily for us, Fausta had seen the movie "Salud! What puts Cuba on the map in the quest for global health" last spring at the Princeton Human Rights Film Festival. One of the things that Fausta talked about (you can listen to the podcast here) was how the movie showed Cuban "medicos" (which do not necessarily mean doctors) do make regular house calls.....in the company of members of the Committee of the Revolution! Let me clarify - the medicos are accompanied by a member OF THE GOVERNMENT and that member of the government is there to make sure that you (the person that the medico is checking up on) is not taking illegal drugs or you drink too much or whether you are eating right or not. Again - let me clarify....the medicos bring government officials TO SEARCH YOUR HOUSE to make sure that you are not doing anything unhealthy! That is what government run health care brings to you.

In her post on the movie, Fausta talks about some interactions that audience members had with the vaunted Cuban Health System.

The first member of the audience to speak was a Princeton University student who has travelled to Cuba three times and witnessed the deplorable conditions of a Cuban hospital (dirt, roaches, etc.), which he compared to the deplorable conditions of the pre-Cuban doctor South African hospital shown in the film. While on another trip he also witnessed how a Cuban citizen he rushed to an emergency room was turned away for being Cuban as that hospital only treated foreigners. Another gentleman in the audience had a similar experience where he rushed a very ill Cuban to a hospital in the island and she was turned down because that hospital was for foreigners only.

Another thing that Fausta mentioned on the podcast (at approximately the 21 minute mark) was that AIDS patients are isolated from the community....shunned for having this disease. Oh sure, they are isolated in a "medical facility" but they are not allowed to leave the facility, they do not get visits from family and friends....they are shipped off to the sanitarium to die. To all of my gay friends out there - is that something you want for your friends and loved ones? I know I certainly don't want that for my cousin who has AIDS.....She also talks about how the average Cuban citizen must bring their own linens and medicines and even bandages with them when they check into the hospital. She also reminded us that when Fidel needed a gastro-oncologist last year, he did not use a Cuban doctor.....oh no, he had a specialist flown in from Spain!

Is it any wonder that most thinking people will recoil away from a government health care system once they find out what it is truly like? I mean, if our health care system were so bad, why is it that so many Canadians take out second and third mortgages in order to come to America for their critical health care needs?

On a final note, isn't it comforting to know that this propaganda (and there is no other word for it) is being funded by your tax dollars.

Good Intentions?

There is an old saying about the road to hell and what it is paved with. Last Tuesday, Jazz and I did a show on health care options. Since both of us take more of a free market approach we were castigated by one emailer as being cold-hearted (ok there was a little more to the description but it is not suitable for polite company). I suppose, if the emailer is correct, then maybe we are a little cold-hearted. After all Jazz and I were opposing a system that makes pregnant women wait 10 months for a slot in the maternity ward. We are opposing a system that telling doctors to with hold treatment for the old and unhealthy in order to maintain costs. After all - they MEAN WELL when they have government give out "free" health care. Surely the Greater Minnesota Health Care Coalition and the NEA don't want old folks to be denied health care any more than the want disabled children denied health care....right?????

I was sent this article in relation to the pending Breed Ban that Rep. John Lesch is proposing this session. The National Animal Interest Alliance (NAIA) has a long history of fighting this kind of legislation. However, the study that they quote has a larger implication.

A landmark study published last year in one of America's most respected scholarly journals provides powerful evidence that "feel-good" legislation – indiscriminate and/or unenforceable bans, as well as draconian sanctions applied to behavior that is already illegal – degrades respect for law and reduces compliance, while aggravating (or at best, failing to improve) the problems these laws were supposedly enacted to solve.

The study specifically addresses gun laws in the U.S. and worldwide. "Would Banning Firearms Reduce Murder and Suicide? A Review of International Evidence," by Don B. Kates and Gary A. Mauser: Harvard Journal of Law & Public Policy, vol. 30, pages 651-694. But its broader point supports a central reality that has long been recognized by the National Animal Interest Alliance: whether lawmakers target pet owners or gun owners, ill-conceived "feel-good" laws usually just make things worse.

Emphasis mine. I understand that the folks at the GMHCC really want to help....they want to make it better for those without health insurance. I GET THAT....what I don't get is why people like our emailer just don't get that rationed health care - such as they are seeing in the UK and in Canada are worse! They simply don't get that it will lead to something much worse than what we have today....a system where people with chronic diseases are shuttled off to institutions and left to die...with minimal care because that care will cost the government too much. Can someone please tell me what is "compassionate" about that?

It's called the Law of Unintended Consequences it is something that we really need to be aware of the next time we want to do something in order to "feel good".

Why Government Provided Health Care IS SOOOOO Wrong

Much has been said (in the last 2 years) about health care. All of the Democrats running for President (and most of the ones running for lesser offices) have been advocating some sort of government paid for insurance/health care as part of their official platform. I have written many posts outlining why government insurance/health care is not a good idea and today I have another one (HT Dennis Prager).

Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget.
Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out "self care" as the Department of Health (DoH) tries to meet Treasury targets to curb spending.
The guidelines could mean people with chronic conditions:
• Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home
• Reporting medical information to doctors remotely by telephone or computer
• Administering their own drugs and other treatment to "manage pain" and assessing the significance of changes in their condition
• Using relaxation techniques to relieve stress and avoid "panic" visits to emergency wards.

The emphasis is mine, and I will explain why that particular one is so very troubling to me.

My mother has been suffering from chronic pain for probably 20 years. She has rheumatoid arthritis, gout, a replacement hip, two knees in need of replacement, hyperthyroidism, heart issues and 7 vertebrae in her neck that are fused together. She is about as "chronic" as you will ever see.

In 2006, she had a physical collapse in her home (she lives alone as my parents are divorced). My sister found her (she had been out of town when the collapse happened) 4 days later at deaths door. We spent Easter weekend in the ICU wondering if she would recover or not! After two weeks of hospitalization for every kind of test under the sun, we had lots of possibilities but no physical reason for her collapse. It remains a mystery to this date. One of the things that her doctors at the hospital had us do was take an inventory of her medications and bring it in to him (to see if it was a drug interaction that caused the problem). Growing up, my sister and I used to joke about mom being a walking pharmacy, but what we found in her home was startling. There were approximately 40 different prescriptions from 3 different pharmacies and many were pain killers. While we don't know for sure if she over medicated, it is a possibility that we had to consider given what we knew.

That is why I find the highlighted passage to be so very disturbing! Encouraging people in chronic pain to self medicate without proper doctor supervision is a recipe for disaster. That person could get behind the wheel of a car (the last thing my mom remembered of that day was driving home from a luncheon with friends) and cause an accident. At the least, they could medicate themselves to death! Aside from that, people don't know about the subtle changes that need to be watched for when dealing with chronic health problems. My mother, being an RN by training, noticed some subtle changes in her breathing and circulation that led to the doctors testing for arterial blockage around the heart (which they found and cleared). If it were not for dealing with her health, I certainly would not have thought that the problems she was having to be worthy of a doctors visit....I probably would have written them off to my allergies or my weight. We are not trained physicians! Even the class on self care that the NHS provides will not be enough to make sure that everything necessary is covered. There are too many variables - ESPECIALLY with the elderly who tend to have multiple health problems.

I do realize that there are problems with our existing system of health care, but that does not mean we should just let the government take over the system. Patients and doctors and insurance carriers and hospitals AND legislators all need to work together in order to improve the system that we have. The system can be fixed, but having government pay for it is NOT the answer at all!

True Choices

Our friends on the left have long claimed to be "pro-choice". However when you look at the record, they are only "pro" the choice to abort an unborn baby. When it comes to choices in other areas though, they ideas seem to be choiceless.

Case in point is the health care "crisis". The answer, according to all of the Democratic Presidential Contenders, to the health care crisis is similar forms of single payer/government run health care. Even in Minnesota our DFL legislators are all responding by proposing a HHS takeover of all Minnesotans medical care. Well today, the House Republican Caucus announced a real choice in the health care "crisis".

2008 HEALTH CARE REFORM INITIATIVES
FREEDOM AND CHOICE
It is a matter of personal r