Letter to MN Senators - "Seven Concerns"

DATE: March 27, 2004

TO: All Minnesota State Senators

FROM: Twila Brase, RN,
Citizens' Council on Health Care
1954 University Ave. W, Ste. 8
St. Paul, MN 55104
Phone: 651-646-8935

RE: Senate File 1760

Please consider the following SEVEN concerns regarding SF 1760, the likely omnibus health and human services bill:

1) STATE-ISSUED TREATMENT PROTOCOLS: State officials will make a list of medical practices they think physicians and other practitioners should follow. Medical decision-making at the state level will be vulnerable to discriminatory value judgments, influenced by political and rationing agendas, and unable to address the unique needs of individual and complex patients. This is not the proper role of government, and it could prove life-threatening for patients. (Section 8)

2) GOVERNMENT POWER: State officials will set criteria for determining so-called "best practices," collect and report data on provider adherence to these treatment protocols, and be empowered to withhold partial payment for failure to comply. The power to evaluate practice, pronounce judgment, and penalize practitioners may lead to less care, provision of standardized care that does not meet the unique needs of individual patients, medical malpractice litigation and, as the federally-funded Institute of Medicine wrote in a report on patient safety, skewed data from doctors willing to game the system to protect themselves and their patients. (Section 8)

3) PATIENT PRIVACY INFRINGED: To monitor and report adherence to state-issued treatment protocols, state officials will be authorized to access and use private patient medical record information. This violates the right of patients to keep their medical records and private lives free from government inspection. Patient care will be impacted. In 1999, the California Healthcare Foundation found 15% of Americans already protecting their privacy by falsifying clinic questionnaires, using pseudonyms, asking doctors to omit data, and paying cash though insured. (Section 8)

4) MANDATORY ELECTRONIC HEALTH DATA SYSTEMS: Doctors, clinics, hospitals and health plans must have in place a government-designed and government-approved electronic medical records system by January 1, 2010. This could be used to facilitate monitoring, reporting, and patient identification (see #2,#3,#6). A biometric patient identification system must also be included (fingerprint requirement for care?). (Section 9)

5) HEALTH CARE RATIONING PLAN: State officials must create a list of diagnoses and treatments that will NOT be funded by the state's health care programs. This is a modified version of the Oregon Health (care rationing) Plan which was defeated last year. Doctors and hospitals that see state program recipients with these unfunded diagnoses must either "eat" the cost for treating the patient or comply with the state's rationing directive and send the patient home untreated. (Section 26)

6) MORE MANAGED CARE: "Disease managers" will look through private medical records and databases to identify and monitor people who have, or may be at risk for, certain health conditions. These individuals will be limited to certain providers, and the providers must follow the state's list of treatment protocols. If the State saves money, involved providers (unclear if this includes individual doctors) will get a bonus. (Sec. 27)

7) PRICE CONTROLS: Caps on health insurance premiums are proposed. The 1992 MN health care reform law, which also included growth limits, forced most health insurers out of Minnesota. A second round of price controls is not the answer to rising costs and limited choices. Far better to rebuild a competitive market through implementation of health savings accounts and other legislation that will encourage the return of departed health insurers. (Sec. 2)

CONCLUSION: The legislature should not authorize the establishment of a medical decision-making bureaucracy in state government. We believe this legislation is a giant step toward state-approved health care rationing and government control of the practice of medicine. These proposals violate the rights of citizens and patients, interfere in the patient-doctor relationship, and are inconsistent with a free society.

Thank you for your attention to these concerns.