Killing health care with a thousand paper cuts (5×8: 12/18/13)


It’s been a few months since Minnesota’s health exchange website went live on the Internet and there’s only a week left until the cutoff to apply for coverage that starts on Jan. 1. The politicians involved have let themselves get into a particularly nasty pickle: If they admit the obvious, their political careers are at stake.

The obvious assessment is the system doesn’t work. That’s not to say it can’t work, given the time and brains that could be employed. But with a week to go, it doesn’t work well enough now.

When the two largest newspapers in Minnesota both agree on that point, it’s a good indication that it’s time to recognize the obvious.

The problem isn’t that April Todd-Malmlov, the MNsure boss who was sacked by her overseers last evening, went on a nice vacation to a warm place while Minnesotans navigated unnavigable waters. It’s that the move made her and the rest of the agency seem tone deaf to the plight of the people they’re employed to serve.

“The Board believes the organization is at a stage where it needs a CEO to manage both MNsure’s current challenges and position it for greater success in the future,” said MNsure board chairman Brian Beutner in a statement, a few days after Gov. Mark Dayton signaled for the executioner when he declared MNsure’s performance “unacceptable.”

It’s been at the stage for awhile.

Beutner didn’t face the reporters camped outside the closed room where the board was figuring out how to clean up the mess. Instead, he sent a spokesman — for the Department of Corrections — out with a press release.

From what we can tell from today’s stories, none of the participants in yesterday’s meeting returned any phone call from reporters looking for a better explanation of what’s going on. That doesn’t help dispel the image of an out-of-touch bureaucracy.

In its editorial today, the Star Tribune cited a growing — not declining — list of problems the system faces.

On Tuesday, an editorial writer on hold for an hour to the MNsure call center found out through the automated hold-time message that another problem has surfaced. Some consumers have received material indicating that coverage will start Feb. 1 instead of Jan. 1, likely the result of computer systems not being adjusted to reflect a recent move by the federal government to extend by about a week the deadline for coverage starting New Year’s Day.

The steady drip of problems undermines past reassurances from MNsure leaders that the majority of consumers have enrolled without snags. It also makes officials sound like they’re disturbingly disconnected from the site’s operations and tone-deaf to consumer frustrations. The timing of Todd-Malmlov’s vacation with Jim Golden, a top state human-services official working on MNsure’s rollout for medical-assistance enrollees, added to the sense that the site’s top brass are out of touch.

Meanwhile, the Pioneer Press, aligning itself with conservative opponents to Obamacare, reached a substantially similar conclusion about the current state of the process.

The board this week was expected to consider whether to exercise “active purchaser” authority, setting up additional criteria for plans offered on the exchange beginning in 2015.

“Ultimately, that’s only going to serve to limit competition and choice in the exchange,” said Bentley Graves, who directs health care and transportation policy for the Minnesota Chamber of Commerce.

Such a move also could put an advantage at risk: The ability of plans to compete this year helped give Minnesotans some of lowest premiums in the country, Graves told us.

“From a business perspective, we think the market is a good place to give people information and choices,” said Beth McMullen, health policy director for the Minnesota Business Partnership. “That’s why we generally supported the concept of an exchange. If we’re suddenly limiting those choices and saying, we know what’s best for you, we begin to be concerned.”

This can’t be fixed in a week. With an election less than a year away, opponents of health care “reform” have succeeded in their efforts to kill the system by a thousand paper cuts. Health exchange leaders are being fired in several other states, too. With an election less than a year away, it’s impossible for its supporters to concede the obvious point, which they’re going to have to do to.

And somewhere in all of this, there’s a person who needs to see a doctor.

Related: Separating fact from fiction in health care (Washington Post).

One-third of uninsured think Obamacare will hurt them, poll says (CBS).


As long as we’re on the topic of newspaper editorials, the Marshall Independent has evaluated the controversy surrounding Archbishop John Nienstedt, who stepped aside from ministry after allegations surfaced of inappropriate contact with a boy.

Through this all, we need to remember that most of the allegations of sexual abuse against the priests listed happened decades ago, and while that doesn’t take away the sharp pain felt by victims and their families still trying to heal, parents of young children today, no matter how much their faith in the Catholic church is shaken, must continue to support their church and those who lead it.

It’s up to them to decide if the archdiocese has handled this fluid situation to the best of its abilities, and it’s up to them to search inside themselves to determine when they’re ready to forgive and move on, if they haven’t already.

“They conspired to obstruct justice, if nothing else,” a reader countered. “This is clearly a job for the criminal courts, not only Catholic members.”


A North Dakota man is again free to post pictures and articles critical of white supremacists in Leith, N.D., now that a judge has lifted a restraining order against him.

Greg Bruce has been protesting the attempts by several white supremacists to set up camp in Leith. He runs a website and Facebook page calling attention to the actions of Craig Cobb by posting stories and pictures about him and his friends.

A woman claimed he stalked her to do so and won the temporary restraining order, which was lifted this week by Judge Bruce Haskell. But Haskell noted the irony of the free speech provisions of the Constitution which protect Mr. Bruce, the Fargo Forum reported:

Because he found no disorderly conduct, Haskell ruled that it wasn’t necessary to address whether Bruce’s actions were constitutionally protected. Still, he added in his ruling that the court “does find it interesting that Bruce cloaks himself in the right to free speech.”

“The Court assumes the majority of people in Leith, in Grant County, and in North Dakota do not agree with Neo-Nazi and separatist doctrines,” Haskell wrote. “However, the purpose of the First Amendment is not to protect majority, mainstream speech and ideas. It is to protect those with minority opinions, even if those opinions are repugnant to the majority. … Bruce wants the benefit of the First Amendment for himself, but is not prepared to provide it to those like Henderson with whom he disagrees.”


As we head for the darkest day of the Minnesota winter, we have the prospect of spring training for baseball to get us through. In the meantime, there’s the enchanting land of baseball parks in winter, which challenges our brains to process the unnatural in the natural world.

Target Field:

Via @NewBravesHome

Fenway Park in Boston (More images here).

Courtesy of Heather Cundiff.

Citi Field in New York.

Progressive Field in Cleveland.

Fifty-nine days to the start of spring training.

Related: Blaine didn’t get Vikings stadium, but it’ll get the stadium dirt (Minneapolis / St. Paul Business Journal).


What’s the matter with kids today? They’re not that interested in driving cars anymore, National Geographic says. Is it a passing phase, it asks, “or have we finally erased the last traces of American Graffiti and the car-centric teen culture that once celebrated cruising, hot-rodding, and drive-ins?”

Bonus I: What’s not wrong with this picture?

Bonus II: Shoe-shining benefactor to Children’s Hospital to retire after 30 years (Pittsburgh Post-Gazette). (h/t: Matt Black)

Bonus III: St. Paul Pioneer Press offers buyouts, agrees not to oppose unemployment claims (Romenesko).

Should we be getting more of our power from nuclear energy?

Posting will be light in this space today. I’m out doing an interview.

Daily Circuit (9-12 p.m.) – First hour: New banking rules, fines, and settlements.

Second hour: Chaos in North Korea, Ukraine and Central African Republic.

Third hour: An update on HIV/AIDS research and outreach.

MPR News Presents (12-1 pm) – New York Times reporter Peter Baker, author of “Days of Fire: Bush & Cheney in the White House.”

The Takeaway (1-2 p.m.) – Zbigniew Brzezinski, former National Security advisor to President Jimmy Carter, on the Ukraine and Russia’s role in the region.

All Things Considered (3-6:30 p.m.) – At this time of year when holiday shopping is at its peak, many of the people behind the cash register or in the giant warehouses of online retailers often work for little more than minimum wage. Starting in January, expect to hear a lot of debate about that wage — currently $7.25 an hour — on Capitol Hill. President Obama and many Democrats plan to push for a minimum wage increase ahead of the 2014 election. MPR’s Brett Neely will have the story.

From the Lone Ranger to the sequel of the Smurfs, Hollywood recently bankrolled a big number of blockbusters. And many of them were a flop. The big studios also released some smaller, critically acclaimed films, like 12 Years a Slave. But those were financed by independent producers with deep pockets. NPR looks at the money behind this year’s movies.