Twin Cities Medical Society

News and Events
Health Care Directive Form
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The Honoring Choices Minnesota (HCM) Advisory Committee has approved this health care directive form for use with patients.  Click here to open the document.
National Healthcare Decisions Day is Friday, April 16
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National Healthcare Decisions Day promotes the need to think about end of life care preferences and to go through the process of advance care planning.

It is also a great vehicle to promote Honoring Choices Minnesota! Visit the Minnesota National Healthcare Decisions Day Web site.
Have you joined our online forum?
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Our forum can be found at Dr. Thom Siefferman, EMMS President-elect, is the forum moderator.

The forum provides a central location for discussions related to legislative issues, public health matters, upcoming events, the MMA Annual Meeting, etc. Please visit the forum and sign up for a username. We ask that you use your real name, or perhaps at least your last name, as part of your username so we know who you are. Feel free to contribute to a discussion, or create your own topic about a current issue that affects other local physicians.

We think this will be a valuable way to communicate. If you have any comments or questions about the forum, please contact Katie Snow, forum admin, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 612-362-3704.

Report on "Meaningful Market Based Heath Reform: An Odyssey"
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Minutes of the EMMS Council on Professionalism and Ethics Meeting, November 22, 2009.

  1. Call to order at 7:30 AM in the Miller-St. Luke’s Room, John Nasseff Medical Center at United Hospital by the Chair, Robert W. Geist MD.
    • Dr. Geist welcomed the near full house crowd to the 6th annual open public meeting of the Council co-sponsored by the medical staffs of Health East and United Hospitals. He thanked Dr. Steve Kovar, VP Health East, and Dr. Richard Shank of United Hospitals for their help and signaled out the fine efforts of Ms. Marge Avoles and her United Hospital staff in making the meeting hospitable for all attendees. We were grateful for attendance of Rep. Carol McFarlane (White Bear), of David Allen III, post grad economics student at Yale, and of Prof. Vernon Weckworth, world-renowned economist at the U of MN’s Carlson School.
    • Dr. Geist noted that the Council’s agenda this year is: Cost Control Frenzy: Rhetoric and Reality.”

  2. Introduction: Dr. David Thorson, Chair of the MMA Board of Trustees, introduced the speaker, Stephen T. Parente, PhD, Associate Professor, Department of Finance, Carlson School of Management, University of Minnesota, Adjunct Faculty, Department of Health Policy and Management, Johns Hopkins University, Director, Medical Industry Leadership Institute, Carlson School of Management, University of Minnesota, Principal, Health Systems Innovation (HSI) Network, LLC. He received MS and MPH at the U of Rochester, NY and his PhD at Johns Hopkins University. His research interests are focused on health economics, insurance, information technology, and medical technology evaluation.

  3. Presentation: Stephen T. Parente, PhD, discussed: "Market-Based Health Care Reform: an Odyssey."
    • He noted the views and roles of the many “stakeholders”: consumers, providers, technology companies, insurers, employers and government. He asked why we think reform was possible now after prior failures, noted the contradictory goals of old laws locking us into paradoxical policies, i.e., medical schools producing specialists, and health policy schools producing administrators and promoting expansion of insurance…or Utility America. He tells his friends in finance, “a ‘Business Venture’ is not called a Ponzi scheme unless it fails.”
    • He discussed his anxieties when economists find: technology both good and a cost driver, when stakeholders don’t come clean on their past efforts and what’s different this time, and that actuaries find the best way to keep costs within general inflation is insurance for catastrophic financial risk.
    • He noted his own Odyssey from single payer work in the UK, to advisor to the McCain campaign, to advisor to 2009 congressional leaders, and to the cost of current Democratic congressional bills.
    • He shared with us his estimates of current bills at $2.1 to 2.4 Trillion over 10 years, double the estimates of the CBO and its deficient data base and the skew of increased tax collections starting 4 years before a shortened 6 years of spending starts in 2013 [Further, the bills carve out the “SGR fix” and predictable non-fix that hides a $210 Billion added cost to “reform” no matter which happens—RWG]
    • Dr. Parente’s recommendations:
      • Let insurance be purchased across state lines
      • Target vulnerable population for help
      • Make eHealthInsurance (and friends) be the ‘exchange’
      • Draw a ‘en liten linje i sanden ’ (Norwegian for little line in the sand) to address Employer Sponsored Insurance $300 billion tax distortion
    • He outlined the legislation that he and U of MN colleague, Roger Feldman, with Mark Pauley, of the U of Pennsylvania, have developed:
      1. Low Touch: Bolster state high risk pools to allow people to get insurance if they have been turned down—with limited demonstration grants.
      2. Medium Touch: States administer high-risk pools in exchange for federal government taking over long-term care Medicaid costs (aka D. Holtz-Eakin).
      3. High Touch: Federal auction model for federal high-risk pool tranches (i.e., bonds with three year contracts) with 5% built in margin for administration.
        • Vulnerable Attributes (any one will do): Older, major chronic condition, pre-existing condition.
      4. Appeal to target buyers: Millennials, Gen-X, ‘cuspers’. Let majority of people buy insurance COMPLETELY online based on the risk profiles already available from existing data on an ‘OPT-IN’ basis only.

We are grateful to Dr. Parente for this superb presentation and its insights, to our hospital staff co-hosts, and to our many guests and Council members for an excellent discussion. I can send you a copy of Dr. Parente’s presentation—let me know.

  1. Adjournment. The meeting was adjourned at 8:30 AM.
  2. The next meeting. I’ll be in touch but Pencil in:
    • Thursday, January 21, 2009 at Bethesda Hospital Board Room.
      7:00 AM to 8:30AM
    • This is our annual legislative meeting with a panel to discuss health related business in the 2010 session, and I hope some discussion of 2008 MN “reform” as it is affecting clinics.
  3. Pencil in the last two meeting dates. Again I’ll be in touch:
    • Thursday, 7:00 AM, Feb 18, 2009 with Kip Sullivan, well-known health care activist, analyzing current State and Federal reform agendas.
    • Wednesday, 7:00 AM, March 11, 2009 with duo designated clean up hitters: Mr. David Allen, well known medical consultant, former provider sector CEO, health insurance executive, and Dr. Lee Kurisko, former interventional radiologist in Thunder Bay, Canada now practicing in Minneapolis.

Best wishes to all,


Respectively submitted,
Robert W. Geist MD, Chair EMMS Council on Professionalism and Ethics
(651) 484-6968; This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Action Plan From 2008 MMA Annual Meeting
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