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Tuesday Talk: Next steps for health care reform?

July 03, 2012 By Joe Sheeran, Communications Director

The Supreme Court’s declaration that the Affordable Care Act (ACA) is constitutional has strengthened conservative opposition to health care reform, with their leaders vowing to fight even harder for repeal. In Minnesota, conservatives have been absent from Governor Dayton’s planning sessions to establish a state insurance exchange. The ACA’s benefits have been clearly established but it also has some drawbacks.

What will it take to convince conservatives that compromise and cooperation, not abolishment, will strengthen the Affordable Care Act?

Thanks for participating! Commenting on this conversation is now closed.


  • Donald Knudson says:

    July 3, 2012 at 7:56 am

    It appears to me that as long as Republicans think opposing implementation of the state’s obligations in the health care legislation and believe it will help them win elections, they’ll keep opposing.

    When Republicans discover people aren’t interested in fighting last year’s battles, they will turn to something else that they think will get them elected.

    There is no hint of them being “loyal opposition” in this political climate of hysteria.  “Disloyal opposition” describes their party today.  It’s clear to me that they don’t understand democracy.  It’s a method of compromise after fighting for one’s principles, interests, etc.  You win some, you lose some.  What I’m getting from Republican leaders is the impression that they are more interested in power than in democracy.  If things don’t go their way, they pout, pound the table, exclude people they disagree with, and refuse to accept the law of the land when they don’t like it. 

    Remember when Republicans were “law abiding citizens”?  I guess those days are over.

    I can’t wait until the Republican Party returns to its roots as a mature and thoughtful political tradition.  Right now that Party does not exist, to the detriment of all of us.

  • Cee Vee says:

    July 3, 2012 at 7:59 am

    This fight certainly isn’t over as evidenced by the wailing and gnashing of teeth that occurred after the Supreme Court decision last week.
    The next step I would like to see in health care reform (after we begin calling it what it really is, of course - health cost reform) should be to concentrate on more health care cost cutting measures.
    Surely a conservative and a liberal can agree that one pill shouldn’t cost $90 and that people shouldn’t have to leave our country’s borders to get affordable medicine.  They should also agree that health insurance companies’ huge profits need to be checked in some way.  And what about that $28 box of tissues the hospital provided?  Who thinks that’s right or fair?
    There is common ground here if our legislators would stop playing politics.

  • Laura Waterman Wittstock says:

    July 3, 2012 at 8:22 am

    The question in my mind is when will conservatives be convinced that compromise and cooperation, not abolishment, will strengthen the Affordable Care Act. The public will bring the Republicans back from the front of the opposition to a position more in line with traditional views, not the use of the ACA as a tactic to defeat president Obama in 2012.

    The one big issue is economic uncertainty and that is likely to wash over several of the other issues. Consider a country in which all of current single-interest issues get passed: voter ID; marriage laws excluding gays; pulling back on health care; a heightened willingness to go to war; repression of alternatives to more petroleum drilling; relaxed gun laws; and taxes too low to meet needs or balance the budget—-it’s a long list. That USA is not likely to win many friends in the world of nations because the rest are moving in the opposite direction generally, seeking reforms and greater advantage for their work forces.

    And, there are nations in deep trouble as the world economy struggles to right itself. A weak and troubled domestic society within the US won’t come forward as a source of new talent with great ideas for solutions. Leading with ideology got us in a hole during the GW Bush administration. Now the stakes are bigger as the world could face an economic calamity.

  • Sue B says:

    July 3, 2012 at 8:23 am

    Conservatives will learn that promising to fight against a bill BEFORE it is in effect is very different than trying to take away something that people already have and use.  When the right mentions “Obamacare”, many people say they hate it, but when you ask about specific provisions, they like them.  They like kids being able to stay on their parents policy until age 26, not being refused coverage for pre-existing conditions, not losing their insurance if they change jobs, no co-pays, etc. 

    People are ready to move on to other important issues, like job creation, the economy, energy policy, etc.  ACA is now the law of the land, so, Republicans…‘get over it’.  If righties continue to harp on and run for office on repealing health care, they will lose.  That will finally be the only thing that will wake them up.  We need to start electing people who believe in government, not those who hate it and want to privatize everything.  Now, if they could only make Medicare one of the choices in the insurance exchanges…   

  • Grant Tiefenbruck says:

    July 3, 2012 at 9:05 am

    Call me cynical, but I think the only thing that is going to get the attention of the Republican Party is going to be repudiation of their current agenda at the polls.  Right now they are continuing to ride the wave from the 2010 election cycle when people were upset about the bailouts (TARP) and the Affordable Care Act (ACA).  At that time the Republicans launched a very aggressive campaign against the ACA that succeeded in convincing people that it was a government takeover of healthcare, not an attempt to rein in costs.  If both sides could turn down the inflammatory language, perhaps reason and pragmatism would appear.  Frankly, I don’t expect anything useful to get done by Congress until after the election in November.

  • cathy says:

    July 3, 2012 at 9:21 am

    As long as they are funded by ALEC, the Koch bros. and Rove, coservatives will keep on as they are. Democrats have also done a poor job of selling the ACA. Two years have passed and people still do not know what is in it. I think that the right leaning media is part to blame. They give special attention to criticism of the ACA as though it was the truth. What ever happened to investigative journalism? We are left with the impression that the criticism is the truth.

  • Bernice Vetsch says:

    July 3, 2012 at 9:32 am

    Governor Dayton is wise to exclude conservatives from the exchange development effort.  He should also exclude the insurance companies if he hasn’t already, since both they and far right politicians seek to further an agenda that leaves corporations in charge of our health care system.  I believe waiting for the current crop of corporatist conservatives to see the wisdom of assuring access to health care for all would be a VERY long wait.

    Instead, I’d like to see efforts to remind the public that America and all the world see education as a human right, not a “product” to be purchased by those who can afford it.  We provide free public education to all children from pre-K through high school.  How is health care less essential to the growth and development of all children? 

    For that matter, we consider police and fire protection and the national defense establishment essential components of the common good, just as we do education and just as we should health care. It is sad that far right politicans no longer seem to believe in the concept of the common good and fight sharing the expense through taxation, which they call “theft,” of sustaining it. 


  • Dee B says:

    July 3, 2012 at 9:44 am

    The public must be made to realize that if “Obamacare” is repealed, we will continue to be the only First World country where our citizens can die for lack of health care or go bankrupt trying to afford health care.  They must be made aware that we do not have the best health care in the world, which many people seem to believe.  Somehow we have to correct all of the misinformation that has convinced the public that we can’t afford the health care act.  We can’t afford to repeal it.  No one has suggested what will replace it.

  • ChristeenStone says:

    July 3, 2012 at 11:25 am

    Reading through the comments above they have really hit the nail on the head in their thinking. The court decision was wonderful, also amusing. To have the most Conservative Judge cast the deciding vote. To hear Senator Boehner say “we will RIP It Out by the roots” then back pedal when the journalist pointed out some good points, saying we will keep those. HOW? WHEN? To see the picture of Romney beaming as they showed him signing Romney Care so his state could have good health care. Knowing it was the pattern for Obama Care. Seems to me it is time for people to open their eyes, have a good laugh at the confusion in the GOP Party and realize they are leading us to nowhere fast.Then take care of the situation on election day.

  • Amy Hoglin says:

    July 3, 2012 at 1:02 pm

    I would like a Republican to explain why the party is against health care exchanges.  What is partisan or political about health care exchanges?

  • Bernice Vetsch says:

    July 3, 2012 at 1:27 pm

    Yes, Amy.  Perhaps that Republican can explain why it was okay for then-governor Romney to institute exchanges in Massachusetts for a plan very like the ACA.

    Romney copied the plan used in Switzerland and a few other European countries.  He left out the part where those governments—-

    (1) reviewed health costs each year and told providers whether or not they could raise their prices;
    (2) then told insurers whether or not they could raise their premium prices, all of whom were nonprofits who charged exactly the same for premiums as all the others;
    (3) achieved universal health care by paying (or helping pay) for premiums for the poor. 

    But that would be a gov’mint takeover, I guess.

  • KJC says:

    July 3, 2012 at 1:44 pm

    Is your question that, since having their own previuosly published ideas be incorporated into the ACA didn’t sujsequently garner any Republican support ... what is it going to take?
    This points to a grave inauthenticity.  Why? Most would be happy to have gotten their plans largely enacted.  Unless, of course, this resistance is just “cover” for something else.  Then you will get the “I won’t give you a yes, no matter what you give me” response, over and over. 
    This is reinforced by? The fact that despite their now very loud screams for “repeal,” after the affirming Supreme Court decision, there still is not even the slightly sign of any alternative Health Care plan from them.  Just “rip it down” talk, not any “let’s build this” talk.
    This comes after a long history of resisting universal health care… despite that we already spend about twice the percentage of our GDP (per capita) than other civilized countries.
    Sadly, this points to something very ugly:  “Now I’ve got mine, and I don’t want to pay for you.”
    So?  This will go on until the public stops taking the “bait,” often diversionary “social” issues, and starts punishing them at the polls.  Evidence would suggest that this is the minimum of what it Will Take to get their efforts to become aimed at genuine good governance, not at mere obstruction (win at all costs, scorched-earth politics.)
    Wish I had better news… Happy 4th, anyway.  We The People!

  • Tom Larsen says:

    July 4, 2012 at 12:57 am

    This is a Democracy. Convincing the “conservatives” is a fools errand.True
    conservatives are informed, which is a prerequisite—knowing Medicare works and wishing to preserve it.Expanding it to all is an overdue moral imperative-informed voters know this.

    Informing the uniformed-or more aptly,the mis-informed (by the medical-media complex)is the task.
    For them, we shall out-vote them, set up good healthcare for them and they shall soon have no complaints. We shall “show them”.

    HOWEVER ACA won’t do that! It perpetuates a confounding confusion for
    the purpose of corporate profit(“a compromise”). Our dollars belong in a risk pool, not a profit stream.

    Any injury or illness has it’s own natural complexity. Our funding scheme is
    artificial complexity, needless, costly and cruel. SINGLE PAYER NOW!

    Over 60% of physicians, a greater percentage of nurses, and 57% of the public support single payer.

    Get insurance& big pharma MONEY out of
    politics by insisting on PUBLIC finance
    of elections…and the complicated and corrupt funding of care will cease.

    Since majorities in our government are either bought outright or threatened to submission:we must get our feet in the street and DEMAND SINGLE PAYER.

    We have John Marty & many others ready to apply the particulars to Minnesota.

    I ask you all to hasten the inevitable
    and leave the “compromise” out of this life and death issue. Do not fiddle as your neighbor burns.

  • Ellen Watrall says:

    July 4, 2012 at 7:30 am

    There is only one health care plan worth fighting for - single payer, universal health care coverage.  I am sick of this talk about compromise.  Compromising with the right means a continual movement to their position.  If our elected representatives were truly representing our interests they would be working to create a system that has repeatedly and conclusively proven to lower costs by eliminating paperwork, redundancies and super wealth of profits going to the top few corporate executives.  It has proven that a healthier population promotes a society of achievers, entrepreneurs, scientists, problem solvers and possibly a better quality politicians (this last is my observation).  Longer life expectancies, fewer long term health needs (and consequent lower cost to the health care system).  There is no data to refute these conclusions. 
    Let’s not compromise our health away.  Those who profit are not about to act in our best interests and we keep following behind hoping to pick up their waste.

  • W. D. (Bill) Hamm says:

    July 4, 2012 at 7:59 am

    There are 2 things needed to convince conservatives and other opponents of the ACA of anything. First and foremost, how do we pay for it? Since we did nothing to deal with the existing 30%ish of Medicare fraud, adding this many more bodies to medicare is only going to increase said fraud. The other issue is “Quality Patient Based healthcare” which the ACA does nothing to address. This is a third class healthcare system for the poor that is horribly overpriced on a world scale. As if that is not enough this is again a top down fix not a bottom up fix, meaning it does not empower people but rather furthers the empowerment of government over the people for no meaningfull gain.

  • Mike Downing says:

    July 4, 2012 at 10:12 am

    The next step is to “Repeal & Replace” Obamacare/ObamaTax with a true Affordable Care Act that reduces health care costs. Elements of a true ACA would include: encouraging high deductible health insurance with a HRA, buying insurance across state lines, reforming medical malpractice like Europe, tax deductions to patients buying health insurance, reducing mandates and putting patients in charge of their health care decisions, etc.

    To those who think our federal gov’t knows how to run health care, I ask you to look at the geographic disparity data on Medicare. Medicare allows spending >$14,000 per Medicare recipient in Miami when spending in Mpls/St Paul spending is only $6700 per Medicare recipient. Enough said…..

  • Steve says:

    July 5, 2012 at 3:05 am

    For Republicans, this whole debate is not about reforming health care, but defeating Obama this election year. They say they want repeal and replace, however they make no mention of with what. Republicans very short on details and that’s their plan. They have no plan for replacing. There is nothing stopping them from passing a new health care reform bill in the House of Representatives next week.  Next week Boehner is planning voting again repealing “Obama Care”.  If Republicans win this fall, “Obama Care” will be repealed and never replaced with any new legislation. Trying to bring them to the table and discuss insurance exchanges now is pointless. They will come after the elections assuming Obama wins.

  • Cee Vee says:

    July 5, 2012 at 8:31 am

    I see that you used the right’s newest talking point (“Quality Patient Based healthcare”)in your response.
    What does that even mean (besides providing a way to sound like Republicans have any idea at all of how to replace ACA)?  That’s not a rhetorical question.  I’d really like to know what is meant by this term now that I’ve been hearing it constantly for the past week.

  • Bernice Vetsch says:

    July 5, 2012 at 8:40 am

    Mike:  What you describe is what the far right Republicans in the national and Minnesota law-making bodies want.  It is the TRUE method of punishment for the poor for daring to seek care. 

    Please read HR-8, the bill authored by Rep. Gottwalt and Sen. Hann.  The state’s only contribution would be to pay 80% of the cost of premiums.  Families would have to buy a separate policy for each person, each with a minimum deductible of $3,000 (but ranging up as high as $12,000) before their insurance pays anything in full.
    There are also penalties for buying name-brand drugs (even if the generic does not work for you) or for using an out-of-network provider.  The working poor would be priced out of care altogether.

    Medicare for All, in spite of your criticisms, would be a great solution. It is not free, but premium costs are fairly low and the deductible for hospitalization is only $1,100.  The only expensive part is the foolishly privatized drug benefit, which was designed to benefit the drug and insurance companies. 

    Fraud is committed for the most part by phony providers, not patients.  The disparities in provider payments go back to when Medicare was created and care cost a lot more in Florida than here.  Part of the disparities come also from (again) the privatized Private Fee for Service program.  Patients pay the same monthly premium as regular Medicare patients, but the government pays the insurance companies quite a bit extra to cover things like gym memberships.

    Moderator’s note: the bill mentioned by Bernice—HF8 “Unified personal health premium accounts permitted”—can be found here:

  • Lucas Smith says:

    July 5, 2012 at 10:46 am

    Great discussion guys! I just wanted to clear up a some things about the ACA regarding medical fraud and quality of care. The ACA does deal with both.

    It has numerous new provision that deal with fraud (see: And the ACA tackles the problem of patient centered care ( Both the links provide a good overview of the ACA on these issues.

    Thanks for reading and keep up the lively debate!

  • tom larsen says:

    July 5, 2012 at 10:50 am


    The more money and the more complexity is what leads to more fraud. What is true, and already pointed out: it’s providers, not patients who need regulation…just like the banks and the other (snow)“job creatoers”!

    “As if that is not enough this is again
    a top down fix not a bottom up fix, meaning it does not empower people but
    rather furthers the empowerment of government over the people for no
    meaningfull gain.” You obviously don’t
    know your top from your bottom. Everyone in, fearless of losing care, is what will empower the people to demand best practices and audit fraud.

    “Malingerer” , which is the Dx for patients who seek care they do not need are that rare hypochondria type cases
    and there are treatment plans for them
    as well. You will be happy to know it is not ostracism & death.

    Prescription drug abusers are the dream and creation of big pharma, a single system will help us “treat” them as well. 

    Human health is organically complicated.
    That can’t be legislated. Healthcare financing is ENTIRELY artificial complexity and ONLY serves as a deadly distraction for people and is the lifeblood of profiteers.

  • Mike Downing says:

    July 5, 2012 at 12:26 pm


    Retrospective studies have shown that high deductible insurance with HRAs reduce health care costs significantly because patients pay the bill and then are reimbursed from their HRA. It is similar to the 1970s at 3M where employees wrote checks to pay their health care bills and employees were reimbursed after we filed for reimbursement with Blue Cross.

    Blue Cross only reimbursed for valid health care costs. Fraud was virtually nonexistent since employees would only use reputable health care providers for reimbursable care.

    We paid 100% and therefore knew the costs. We now pay 10-20% and don’t think or care about the remaining 80-90%. Our Federal government doesn’t care about the cost either or would not allow the geographic disparity.

    We must reduce the cost of health care in the US! What do you recommend as an alternative to putting patients in control of their health care costs?

  • Bernice Vetsch says:

    July 5, 2012 at 1:33 pm

    What do I recommend?  The only system that—in spite of leaving not a single person without access to health care—would save us at least $400 billion per year is a single payer system that puts patients and their doctors in charge instead of insurance companies.

    Low premium/high deductible insurance plans mostly just transfer the cost from the insurer to the patient.  One young couple with two children told me they had such a policy.  Their deductible was $5,000 per person before the insurer would pay a penny toward the care of that one person.

    For four years they had paid for premiums and 100% of care costs without their insurance company EVER having to pay a penny.  That is why insurers dearly love those policies.

  • Bernie says:

    July 6, 2012 at 10:24 am

    No one has mentioned, perhaps on purpose, the additional tax burden that comes with this bill. A 2.3 percent tax on medical device makers will raise the price of every pacemaker, prosthetic limb, stent, and operating table.  We are currently allowed to deduct medical expenses on our 1040 form to the extent the costs exceed 7.5 percent of one’s adjusted gross income. This bill will raise that threshold to 10 percent. Flexible Spending Accounts will face a new federally imposed $2,500 annual cap. These pre-tax accounts, which currently have no federal limit, are used to purchase everything from contact lenses to children’s braces. Health insurance premiums which can now be paid with pre tax dollars will be subject to this cap. Also, the Medicare payroll tax will be increased. For a bill touted as one to help the middle class it appears that the majority of the tax burden will fall squarely on that same middle class.


  • Dan Conner says:

    July 10, 2012 at 2:42 pm

    Mike Downing is wrong about HSA’s being the biggest influence in lowering health care costs.  HSA’s reduce health care costs because so few people can actually afford it.  Plus, the quality of care is diminished, in many cases, because people can’t afford to get necessary care.  Single-payer is the proven biggest reducer of health care costs.

    It is silly to say that patients are the best judge of reputable health care providers.  Most patients have been bamboozled at some time or another.

  • Mike Downing says:

    July 10, 2012 at 3:08 pm

    Dan Conner has opinions without clinical data to support his opinions. I spent 32 years in health care,  have reviewed the data on high deductable insurance with HSAs and know they reduce health care costs. There is only one way to reduce health care costs with a single payer system and that is to deny service, increase wait times for diagnostic procedures, increase wait times for therapy and increase wait times for procedures. Our wait times will mirror Canada’s & the UK’s wait times. Our cancer survival time will reduce to that of Canada & the UK, etc.  The only good news is that patients from Canada, UK, Saudi Arabia, etc. will no longer be using our health care.

  • Bernice Vetsch says:

    July 10, 2012 at 4:00 pm

    Mike:  The cost saving with single payer comes from eliminating private, for-profit insurance companies—the middleman that we pay for here.  Research done several years ago by Harvard Medical School physicians found that we (in public and private spending) would save $400 billion per year. I believe later research now puts that figure at $500 billion.

    Everyone would have access to whatever care each patient and his/her doctor decided was necessary.  Things like elective cosmetic surgery might have to be done at a patient’s expense, but no bona fide treatment would be denied.

    Canada does not deny care.  It does delay some non-emergency care in order to reduce costs, but all care needed at once is provided at once.  And Canada outshines the US in public health measures like longevity and maternal and child health.

    Canada’s citizens were asked a few years ago who they thought should be named The Greatest Canadian Ever.  They chose the founder of their current health care system, Tommy Thompson.

  • cathy says:

    July 10, 2012 at 5:55 pm

    I have relatives who live in Canada. They say the healthcare is wonderful. All we hear is propaganda put out by the insurance companies. By the way, we don’t hear about Canada when it comes to big debt!!  The problem our country has is that our healthcare is for-profit. When the CEO of a healthcare company makes $90+ million a year, who is paying for it? Offering high deductables only increases profits because we pay premiums and high deductables and insurance never has to pay. What a racket! I have been in the healthcare business for 39 years. We are all getting screwed. It is time for universal healthcare, or Medicare for all. We need to take profit out of healthcare.

  • Bernice Vetsch says:

    July 10, 2012 at 6:30 pm

    Oops.  The “Greatest Canadian Ever” was not Tommy Thompson but Tommy Douglas, who was able to get single payer passed in Saskatchewan, from where it eventually was in effect country-wide.

  • Mike Downing says:

    July 10, 2012 at 8:28 pm


    Then why are cancer outcomes, etc so poor in Canada & the UK?

  • Bernice Vetsch says:

    July 11, 2012 at 8:12 am

    Please cite the research, Mike.

  • cathy says:

    July 11, 2012 at 8:21 am

    Mike, Our healthcare system is rated 37th in the world. We have one of the poorest newborn survival rates. The system is broken.

  • Mike Downing says:

    July 11, 2012 at 11:39 am

    Cathy & Bernice,

    The WHO stats are not normalized for the US murder rate, US DWI deaths, US deaths due to obesity etc. You can keep your head in the sand & look at the WHO & UN stats. Or you can think for yourself and look at cancer survival rates in the US vs all the socialized medicine countries. Here are two URLs but you need to do your own reading and stop drinking the union & Democrat Kool-Aid.

  • Lucas Smith says:

    July 11, 2012 at 12:04 pm

    Good discussion guys!

    Here is a nice breakdown of the cancer numbers:

  • cathy says:

    July 11, 2012 at 12:16 pm

    I stay away from biased information and rely on my professional healthcare journals. I hardly call “Forbes” and a right wing blog unbiased. Sometimes you need to seek out the truth and think outside the box.

  • Mike Downing says:

    July 11, 2012 at 2:28 pm

    Canada’s & UK’s system of national health insurance is often cited as a model for the United States. 

    In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.

    * The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.


  • Tom Larsen says:

    July 11, 2012 at 3:40 pm

    Healthcare all over the world should be expanded to provide what is needed and all treatment improved upon.
    It is the payment system in the US that is a horror and WE WOULD DO BETTER in care delivery with more resources devoted to care rather than profit.

    To attribute the “health” or the “delivery of service” to how such is financed is one big lie perpetuated by the the profiteers.

    Please use your intelligence to examine your morals.

    You don’t need stats. Logically consider a small sample of people you know.How do you care for them? How can you make a profit off their human condition? Which is the question you ask?