No shortage of calls and e-mails to Minnesota's delegation in health care debate

As the national health care debate grows more strident, members of Minnesota's congressional delegation say constituents are swamping their switchboards and e-mail in-boxes to weigh in on the issue.

Despite a full plate of other issues facing the Obama administration and Congress -- from the still-sickly economy to dual wars overseas -- health care trumps them all.

Fully half the calls made to Democratic Sen. Al Franken's office are on health care. It's also Topic One in the office of U.S. Second District Rep. John Kline, where more than 3,000 calls, letters and e-mails have poured in, with most running against the proposed reform.

At Third District Rep. Erik Paulsen's office, the number of letters and e-mails has quadrupled the past two months.

Amid this outpouring, the delegation is scrambling to figure out the best way to talk to voters during the August congressional recess while avoiding the chaos that has engulfed congressional town hall meetings coast to coast.

After meeting with a handful of constituents at a private home in Rochester on Tuesday, Democratic Rep. Tim Walz says he will hold a traditional town hall meeting sometime next week and hopes to have the event televised.

Here is the response I received from Senator Amy. It appears that she has learned to filibuster in Washington.

Thank you for contacting me about health care. Knowing your views is important to me as I work to ensure that Americans have affordable, high quality health care choices. I am committed to protecting what works and fixing what’s broken in our health care system. It is getting harder and harder for Americans to pay for health care and that is why I am focused on making it more affordable.

Good health care is a very personal matter for me and my family. When my daughter was born she was very sick. But due to an insurance company rule, I was forced to leave the hospital just 24 hours after she was born. Along with other mothers, I went to the state legislature and got one of the first laws passed in the country guaranteeing new moms and their babies a 48-hour hospital stay. That experience was a crucial part of my decision to enter public service and fight for common sense health care solutions.

Americans rightfully expect to choose their own doctors and their own health plans. While protecting these basic principles we must reform the way our system delivers quality care, and in so doing reduce costs, provide safeguards so that people don't lose their coverage if they lose or change jobs, and promote wellness and prevention. According to the Congressional Budget Office, each year nearly $700 billion is spent on health care services in the United States without improving health outcomes. We must make the system cost-effective, proactive and stable.

I believe the following priorities should guide our health care discussions: First, we must reform our system to reward high-quality, efficient care. As it happens, doctors and hospitals in many regions of the country, including Minnesota, practice exactly this kind of medicine. However, Medicare does not currently reward them for it. The problem is that, despite periodic efforts at reform, Medicare pays for quantity not quality. States that have historically delivered low quality, inefficient care are still rewarded for wasteful practice, while efficient states such as Minnesota are punished. For example, according to a study by the Dartmouth Institute for Health Policy and Clinical Practice, if spending for chronically ill patients everywhere in the country mirrored the efficient level of spending in the Mayo Clinic's home region of Rochester, MN, Medicare could save $50 billion in taxpayer money over five years. To reign in costs, we need to have all states aiming for high-quality, cost-effective results like those we have achieved in Minnesota. That’s why I’ve introduced bi-partisan legislation that would create a “value index” as part of the formula used to determine Medicare’s reimbursement system. My bill would give physicians an incentive to maximize the quality of their care to patients and help to reduce costs.

One of the driving forces behind Minnesota's well-earned reputation for high quality health care is a team approach of coordinated, accountable care, including prevention, and measures to remove perverse financial incentives from patient care decision-making. The beauty of integrated care systems is that a patient’s overall care is managed by a primary care physician in coordination with specialists, nurses and other care providers, as needed. To better reward and encourage this collaboration, we need to have better coordination of care and less incentive to bill Medicare purely by volume. Increasing the “bundling’’ of services in Medicare’s payment system has the potential to deliver savings and start encouraging quality, integrated care. The lesson of the high-quality, efficient states like Minnesota is that someone has to be responsible for the care of the patient from start to finish. Bundling will help ensure that practice is rewarded.

Second, America has a serious problem with health care inflation, runaway costs and wasteful spending. Ever-rising drug prices are among the leading causes. The "non-interference" clause in Medicare Part D expressly prohibits Medicare from negotiating directly with drug companies to obtain lower drug prices for seniors and lower costs for taxpayers. To reduce prescription costs, health care reform legislation should allow the government to negotiate the drug prices for Medicare Part D. I also support the re-importation of drugs from Canada to help slow sky-rocketing increases in pharmaceutical pricing.

I also believe we can reduce drug prices if we intensify scrutiny of the anti-competitive practices of drug companies. Last year, after hearing concerns from Minnesotans that a life-saving medication for premature infants had suddenly and dramatically increased in price, I requested the Federal Trade Commission investigate this case. As a result, Ovation Pharmaceutical -- the company with sole rights to the drug -- was charged with price-gouging and anti-competitive practices in violation of federal antitrust law. Greater competition in health care will go a long way to reducing costs.

Another way to incentivize more affordable health care in general is to better regulate insurance and create meaningful competition for health care services. I have long advocated for an option like the Federal Employee Health Benefits Program to give everyone access to the same health care benefits as members of Congress, and that is one of the competitive options under consideration, along with many others. I am especially focused on making sure that any reforms make it easier for small businesses and the self-employed to afford health care.

Third, I want to ensure that health care reform takes into account the needs of rural Americans. People in rural areas are less likely to have access to employer-provided health insurance, which means more people rely on the individual insurance market or public programs like Medical Assistance and, in Minnesota, MinnesotaCare. Rural Minnesotans also tend to be older and may have to travel long distances to visit their health care providers. Similarly, we must ensure that all Americans have access to primary care physicians. We are facing a shortage, especially in rural areas, and research suggests that improving access to primary care can reduce reliance on specialty care and improve the efficiency and quality of the health care we receive.

Finally, it is imperative that health care reform does not ignore the importance of elder care. Seniors want to be able to live independently and stay in their own homes as long as possible. Family support is essential to making that option available. However, elder care responsibilities can result in high out-of-pocket health and long-term care expenses for families that care for aging parents and relatives. I have sponsored three pieces of legislation, the AGE (Americans Giving care to Elders) Act, the Long-Term Care Affordability and Security Act, and the Long-Term Care Insurance Consumer Right-to-Know Act to assist families who care for aging family members and to improve understanding of long-term care insurance policies. The legislation is designed as a starting point to relieve the financial and other burdens faced by family caregivers.

Time and time again, the President has used Minnesota as an example of cost-effective, high-quality care because Minnesota is ahead of so many states when it comes to health care. Before supporting any specific health care plan, I want to make sure that it works for Minnesota—that is makes health care more affordable for families, individuals and small businesses in our state. Unless we make a long-term effort to reduce costs, we will not make health care more accessible and responsive to Americans. One of the most important parts of my job is listening to what the people of Minnesota have to say to me. I am here in our nation’s capital to do the public’s business and to serve the people of our state. With that in mind, I hope you will contact me again in the future about issues of concern to you.

Sincerely,

Amy Klobuchar
United States Senator

[from Erik Paulsen] Dear -------:
Thank you for letting me know of your opposition to government-run health care and H.R. 3200, the so-called "Affordable Health Choices Act."
Like you, I am strongly opposed to a government takeover of our health care system, which would stifle the innovation that has produced life-saving breakthroughs. This bill also includes proposals that would increase taxes, raise health care costs, ration care and leave key medical decisions to government bureaucrats rather than patients and their doctors. This poorly-crafted proposal will do little to help solve problems in our nation's health care industry and will only lead to excessive federal spending and obtrusive regulation.
The non-partisan Congressional Budget Office (CBO) estimates that this bill will increase the deficit by $239 billion in the first ten years. And once the spending fully starts, the bill adds over $60 billion a year to the deficit and slaps a new 2.5% tax on individuals if they do not purchase "acceptable coverage."
Based on new rules for "acceptable coverage," many currently insured individuals will have to pay even more expensive insurance premiums. This bill clearly does not do enough to lower health care costs that are already too high, and I am concerned that people will not be able to keep their current coverage.
An independent study has shown that under the "public option" up to 114 million people who receive health benefits through their employer or other sources could lose their coverage. Millions of seniors will also see their Medicare Advantage plans cut, including nearly 20,000 people in the Third Congressional District. In addition more than 8 million Health Savings Account (HSAs) plans may not be classified as "acceptable coverage."
Another great concern I have is a provision that will result in more than half a trillion dollars in tax increases, a majority of which will be put on the backs of small businesses. Some businesses would face up to an 8% surtax of their payroll costs if they did not offer insurance coverage to their employees. Instead of helping those living with the challenge of affording basic health care for themselves and their families, these mandates could encourage people to drop employer-sponsored coverage.
One size does not fit all when it comes to health care. Minnesota is widely regarded as a high-quality, low-cost health care state. We need to keep it that way, while at the same time addressing the cost problems in the system for small businesses and consumers who are struggling to get a handle on coverage and costs.
H.R. 3200 has not been brought to the floor for a vote, but you can be sure of my continued opposition to a government takeover of our country's health care system, along with my continued efforts to find bipartisan solutions to expand access to health care and lower costs. With the right reforms, we can improve access and cure our health care system.
Thanks again for sharing your concerns, as I appreciate hearing from you. Please let me know whenever I can be of assistance.

Sincerely,
Erik Paulsen
Member of Congress

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