" Managed care may be a market solution given the huge tax bias in favor of third-party payership, but third-party payership remains the problem."

Holman W. Jenkins Jr., "Can Managed Care Ever Make Us Happy?," Wall Street Journal, December 30, 1998, p.A11.

 

"So-called integration means that billions of dollars crossed over tables that made zero contribution to patient care or cost structure...I think that while the intent of consolidation was described as a noble one, in point of fact the effect was to layer plans with a massive bureaucracy of highly paid executives."

Nazi Eftekhari, CEO, The Araz Group, a managed care company, quoted in "Charting A Course," an editorial in Minneapolis/St.Paul CityBusiness, May 2, 1997.

 

"The only distinction between an HMO...and a traditional insurer is that the HMO provides medical services directly, while a traditional insurer does so indirectly by paying for the service."

"9th Circuit Defines HMO as Insurance Opening an Attack on the ERISA Defense," The Recorder, July 8, 1998.

 

"Kleinke suggests that in the future six or seven huge HMOs will dominate the market, looking much like the indemnity insurers of old with the exception that they are at-risk companies; at risk, in the sense that they are responsible for paying doctors a set fee per member per month and managing the margins."

"Of physicians, health plans, consumer outcry," State of The Industry Report, Managed Healthcare, August 1998, p. 20.

 

 

"It's never a question of how we can help you. It's a question of how can we slow things up. How can we delay it a little bit? What other objections can we have?

Stuart Jamison, M.D., cardiologist, University of California San Diego, speaking about managed care on The High Price of Health, a 1998 PBS Special.

 

"We're being forced into a circumstance where a very personal intimate interaction is being transformed into a business transaction."

Jeffery Thurston, M.D., obstetrician and author of Death of Compassion, News 8 Midday, WFAA-TV, Dallas, Texas.

"Liberty and equality are not associates, but enemies."

William Foege, Principal Investigator, All Kids Count National Program Office, at the AKC Annual Immunization Registry Conference, St. Paul, Minnesota, April 27, 1999.

"I mentioned...to the first lady about medical savings accounts and just right away she said, 'We can't do that.' And I said, 'Well, why?' And she said, 'Well there's two reasons.' And I said, 'Well, what are they?' [And she said,] 'The first reason is with the medical savings account, people have to act on their own and make their own decisions about health care. And they have to make sure that they get the inoculations and the preventative care that they need, and we just think that people will skip too much because in a medical savings account if you don't spend it, you get to keep it or you can...accumulate it in a health care account. We just think people will be too focused on saving money and they won't get the care for their children and themselves that they need. We think the government, by saying 'You have to make this schedule. You have to have your kids in for inoculations here, you have to do a prescreening here, you have to do this'--the government will make better decisions than the people will make, and people will be healthier because of it.'

"I said, 'Well, part of that's an education process. People have to understand that [if] they behave a certain way, they're going to save money, [with the] preventive medicine issue--you get the prescreenings, if you can inoculate your kids you save money on it. I mean, they're not sick. You save money.' She said, 'No. We just can't trust the American people to make those type of choices...Government has to make those choices for people.'

"I said, 'Okay, we just disagree there. But what's the second reaosn?' And she said, 'Well, the second reason is, with a medical savings acount, savings are [like] an IRA. They go in as actually money saved and all that money will go into IRAs which goes to the private sector.' And she said, 'We can't afford to have that money go to the private sector. The money has to go to the federal government because the federal government will spend that money better than the private sector will spend it.' And so [I thought] holy mackeral. I can't argue these issues. These are philosophical issues."

Rep. Hastert, whose legislative plan included tax-deferred Medical Savings Accounts with contributions by employers. He concluded after a discussion with First Lady Hillary Clinton that there was little common ground on which to negotiate with the Clinton Administration on health care legislation. "Health Has No Fury," David Brock, The American Spectator, November 1996.

 

"Any child who goes unimmunized is a fundamental medical error."

Dr. Harry Hull, Minnesota State Epidemiologist, before the Minnesota Ad Hoc Committee on Information Technology, 12/11/00.

 

"The right to seek advice on one's health and the right to place reliance on the physician of one's choice are basic to Fourteenth Amendment values. We deal with fundamental rights and liberties, which, as already noted, can be contained or controlled only by discretely drawn legislation that preserves the "liberty" and regulates only those phases of the problem of compelling legislative concern."

U.S. Supreme Court Justice William O.Douglas ( 1898 - 1980) 410 U.S. 179, 219-20 (1973).

 

"The real cure for what ails our health care system today is less government and more freedom."

Presidential hopeful Steve Forbes addressing a health care industry meeting March 30, 1999, Fox News Online, March 30, 1999.

 

"We could give it back to you and hope you spend it right. But...if you don't spend it right, Medicare and Social Security will run out of money in the next century."

President Clinton speaking about the budget surplus, Buffalo, New York rally, January 20, 1999, Washington Watch, February 1999.

 

"We need more than a strategy. We need an infantry."

DHHS Secretary Donna Shalala, AARP Medicare Fraud Fighters Rally, February 24, 1999.

 

"You can be our eyes and ears."

Nancy Ann Min DeParle, Administrator, Health Care Financing Administration, AARP Medicare Fraud Fighters Rally, February 24, 1999.

 

"The government should coordinate the competition among health insurance plans, and get itself out of the insurance business."

Dr. Robert Waller, Mayo CEO and president, testifying at a Medicare commission hearing on August 21, 1998, "Mayo pitches medicare reform plan," Rochester Post Bulletin, September 9, 1998.

 

"When the state runs into financial difficulties, the first thing to go is the health plan."

Kathleen Call, assistant professor at the Institute for Health Services Research in the University of Minnesota's School of Public Health, talking about why the MinnesotaCare program should be funded out of the 2% provider tax and the health care access fund rather than the state's general fund. "Study praises MinnesotaCare, coverage of kids," St. Paul Pioneer Press, October 8, 1997.

 

 

"National health care reform may make many of the program approaches...easier to finance and implement, provided that the underlying principles assure comprehensive services to infants and children who are at high social as well as medical risk."

Caring Prescriptions: comprehensive Health Care Strategies for Young Children in Poverty, National Center for Children in Poverty

 

 

"Solving the problem of the uninsured requires us to forge a new relationship between government and the private sector to expand access to high-quality, affordable health insurance. It must be bigger than promoting programs -- however well-intentioned -- that simply pool limited public resources.

Karen Ignagni, President and CEO of the American Association of Health Plans, PRNewswire, January 18, 1999.

 

"Furthermore, [Mark Merritt] said Congress realizes that '[y]ou can't eviscerate managed care. Too many state governments rely on it...[T]here's no alternative to it, except for government-run health care and the old system which is way more expensive'"

American Health Line, "106th Congress: Look for HMO Reform, But Expect a Fight," December 10, 1998, talking about comments given by Mark Merrit, American Association of Health Plans vice president for public affairs at the National Post-Election Conference, co-sponsored by National Jornal's Hotline and the University of Virginia's Center for Governmental Studies.

 

 

As you all know, Healthy People 2010 is the nation's prevention agenda for health.

Hannah Rosenthal, Regional Director, Public Health Service, Region V, Healthy People 2010 Conference regarding the proposed 680 page, 1 5/8 inch thick, Healthy People 2010 Draft for Public Comment, November 5, 1998, Chicago.

In 1962, nearly half-46%-of health care spending was financed by individuals.
The rest was financed by a combination of private health insurance and public programs.
By 2002...out-of-pocket spending at the point of service was estimated to have dropped to 14 percent.

"21st Century Challenges, Reexamining the Base of the Federal Government," U.S. Government Accountability Office, February 2005

"...because insured people are more likely to seek care, the demands on the health-care system are ratcheted up.

Ingrid Case, Mpls. freelance writer, "Managing Costs, Not Care" Twin Cities Business Monthly, November 2000.

 

"The Robert Wood Johnson Foundation has restructured its grantmaking program, ensuring additional funding for action on "health causes" such as eating, smoking, drinking and sexual behaviors. Whereas the foundation currently devotes about two thirds of its grants to improving health care, it will now evenly divide its grants among health-care issues and efforts to influence people's private behaviors."

Philanthropy Notes, Foundation Watch, January 1999.

 

"Epidemiologists, those disease number crunchers, tell us that about 80 percent of all visits to our doctors are for 'self-limiting' illnesses. That is, we go to see the doctor when we have colds, rashes and other ailments that will go away by themselves. We are reaching out for reassurance."

Charlotte DeVries, columnist, Northfield News, July 31, 1998.

 

 

"[M]anagers and physicians must learn to act in each other's arena--doctors in administration and managers in clinical issues."

Irv MacDowell, Cost Physician Management Issues in Organized Care Settings #020414 Boston University School of Management, Robert Wood Johnson Foundation Grant Report, November 1996

 

"'Drugs are as important today as a hospital bed was in 1965,' when Medicare was created, Breaux said."

Panel Urges Overhaul of Medicare Payment System, New York Times, January 7, 1999. Senator John B. Breaux(D-LA) is Chairman of the National Bipartisan Committee on the Future of Medicare.

 

 

" Managed care flatly denies the individual's freedom in seeking health care; instead, it believes that only management is capable of making the best decisions for individuals...Organized medicine must realize that only if it flies high the banner of patient advocacy that is the foundation of patient-physician relationship[s] can it unify highly-individualized physicians.

Robert Bear Smith, M.D., "The American Health Care Crisis & Organized Medicine," HOPE [a Taiwanese medical journal], Volume 17, 12/20/96.

 

"Clearly, there are many...that claim that privacy begins in their own cubicles and not in the doctor's office.

"Most people understand the right to privacy of medical records is not absolute."

Professor Timothy Church, biostatistician, University of Minnesota, arguing against patient consent, Minnesota House Health and Human Services Committee hearing on patient consent and health care privacy, February 20, 2001.

"Implicit [in the 'need of society ' approach] is that medical data ultimately is the property of the state...Implicit is state ownership."

Ken Peterson, arguing for patient consent, representing the Minnesota Office of the Attorney General, Minnesota House Health and Human Services Committee hearing on patient consent and health care privacy, February 20, 2001.

"Recognize that absolute protection of electronically stored data on individuals from inappropriate disclosure or abuse is not possible. The only data that cannot be disclosed is that which is never collected."

Summary of Fifteen Key Action Steps: Confidentiality, Community Immunization Registries Manual, Chapter II: Confidentiality, January 28, 1997.

 

"Twenty years from now...immunization registries will not exist as a stand alone program. They will be part of a much larger integrated information system."

Alan Hinman, Senior Consultant, All Kids Count National Program Office, All Kids Count Annual Immunization Registry Conference, St. Paul, Minnesota, April 28, 1999.

 

"...some of us were quite shocked at the State legislature's passage of a law [1996 medical records privacy] which, I think, makes it more difficult to collect exactly the kind of data that [allows you to] make informed choices...One of our concerns is that if additional States move in this direction, it's going to make it more difficult to collect the kind of data that we think is essential for statistical examination of best medicine practices..."

Rep. Bill Thomas (R-Calif) at the Minneapolis, Minnesota hearing of the Bipartisan National Committee on the Future of Medicare, July 13, 1998.

 

"It's essential that the government find a fair balance between the public need for scientific data and the private hunger to profit from it."

Los Angeles Times editorial on latest Freedom of Information Act regulation allowing public access to federally funded research data, quoted in the Minneapolis Star Tribune, March 2, 1999.

 

"Little in life is as precious as the freedom to say and do things with people you love that you would not say or do if someone else were present."

Private Matters: In Defense of the Personal Life, Janna Malamud Smith, p. 238.

 

"In a democracy a majority can consent for the society."

Douglas McCarthy, United HealthCare, Minnesota Health Services Research Conference, February 23, 1999. When asked, he said that he was using materieal from a 1997 report by F.Reid Cushman, a Robert Wood Johnson Foundation Health Policy Scholar, and Don E. Detmer, chair of the National Committee on Vital Health Statistics called "Information Policy for the U.S. Health Sector: Engineering, Political Economy, and Ethics."

 

"Regardless of personality traits or demographic background, results reveal that clients and college students were less willing to be candid with a therapist under a managed care regimen than in a standard fee-for-service setting. The impact of managed care requirements on clients' willingness to disclose was quite powerful, indicating that psychologists may be deprived of significant amounts of client information due to fears about confidentiality infringements."

Kremer, T.G. & Gesten, E.G. (1998), Portion of summary of a study called "Confidentiality Limits of Managed Care and Clients' Willingness to Self-Disclose," published in Professional Psychology: Research and Practice, 29, Vol. 6, 553-558.

 

"The Drivers Privacy Protection Act recognized that information had become a commodity, and that there were risks to individuals due to the availability of that information."

Deirdre Mulligan, staff counsel on privacy issues for the Center for Democracy and Technology quoted in CNET News.com, January 6, 1999

 

"Due to the mobility of the patient population and the personal nature of medical information, there exists an inherent need to share information."

WILLIAM M. GUST, Managing General Partner Anthem Capital, Baltimore, Maryland (410) 625-1510 quoted in The Daily Record (2/13/99 p. 2B) on why his company is providing venture capital to Sequoia Software, the company that won a U.S. Commerce Department grant in 1997 to devlelop the national Master Patient Index (MPI) to link U.S. patient records.

 

 

"By the year 2000, I think we'll see a major infrastructure attack that leads the nightly news. The odds are good that either the petroleum or the medical/health care [industries] will be the first to suffer a pervasive hack. Going forward, we can expect the medical community networks to suffer significant invasions of privacy. "

Mark Genbicki,Warroom Research Inc., former National Security Agency, Research and Develoipment Unit, in an interview for ComputerWorld, 1/4/99

 

 

The only privacy that's left is inside your head.

"Brill," played by Gene Hackman in the 1998 motion picture "Enemy of the State."

 

"Your Health Profile," the most recent of Medica's health assessment tools, is now part of the "healthy lifestyles kit" that goes to new enrollees...New members may complete and return the questionnaire to receive an individual analysis of their healthy habits and areas of risk...The profile uses a broad list of questions to address lifestyle risks for a variety of diseases...It gives members and their personal providers a snapshot of the individual's risk for disease by correlating health habits, lifestyle behaviors and heredity.

"Health profiles give doctors 'snapshot' of patient lifestyles and disease development," Medica Connections, Summer 1997.

 

CPRs[computerized patient records] and CPR systems can respond to health care's need for a 'central nervous system' to manage the complexities of modern medicine--from patient care to public health to health care policy.

Dick RS, Steen EB, eds. The computer-based patient record: an essential technology for health care. Washington, D.C.: National Academy Press, 1991 (as quoted in "The Computer-based Patient Record and Confidentiality," Beverly Woodward, The New England Journal of Medicine, November 23, 1995)