This year, a Minnesota law set high goals for the state when it comes to broadband internet access. MinnPost reports a lack of connectivity costs the country $55 billion a year. Yet if internet industry titans have their way, that access might not be worth what it used to be.

That’s because the fight over net neutrality is heating up. “Net neutrality” is the view that the internet should remain an equal-access forum. It’s the belief that web sites shouldn’t have to pay internet service providers (ISPs) to ensure internet users can access their site, or to guarantee their site will load at the same speed as a competitor’s. It’s the principle that websites’ followings should develop based on the value of their content, not on their ability to pay an ISP to ensure their site loads the fastest.

If you think slower loading times wouldn’t affect your choice of sites to visit, know that ISPs pushing these new standards are betting differently, or there wouldn’t be money in creating top tier loading capability.

For reinforcement of the dangers in abandoning net neutrality, ask Google—or at least, ask them four years ago: “Today the Internet is an information highway where anybody – no matter how large or small, how traditional or unconventional – has equal access. But the phone and cable monopolies, who control almost all Internet access, want the power to choose who gets access to high-speed lanes and whose content gets seen first and fastest. They want to build a two-tiered system and block the on-ramps for those who can’t pay.”

Yet despite Google’s 2006 position, it has now reached an agreement with Verizon abandoning net neutrality principles. The agreement is not a business deal, nor has the force of law. The Washington Post explains, “The embattled FCC (Federal Communications Commission), which saw its authority over the Internet challenged by a federal court ruling earlier this year in a case involving Comcast, has been hoping for an industry-led proposal to be adopted by Congress.” How the FCC should classify broadband internet for regulatory purposes has long been a gray zone; this year’s court ruling cast further doubt, likely leaving the FCC with its hands tied until Congress acts to update and clarify its regulatory powers. It’s that decision the Google-Verizon agreement hopes to influence.

The agreement leaves Google and Verizon walking a tightrope. Out of one side of their mouths, they argue for the importance of preserving net neutrality. Yet out the other, they exempt mobile wireless devices like cell phones, and any new broadband services. ISPs would be free to create fast lanes for higher-paying sites or even block off parts of the internet on mobile devices and to do what they want regarding any new services.

The Washington Post elaborates on Google’s about-face, writing, “Google officials have testified at FCC and congressional hearings that fair rules of the road need to be in place to keep Internet service providers from becoming ‘gatekeepers’ of the Web, favoring their own business interests.” Yet Google’s fears have evaporated regarding mobile devices now that the Google-Verizon partnership has created the Droid mobile device.

If Congress views the Google-Verizon proposal as an industry compromise accounting for all positions, it could become law. Luckily, some in Congress voiced pro-net neutrality positions, including Minnesota’s own Senator Franken. The opinions expressed in his Op-Ed on CNN.com last week put him firmly against the Google-Verizon agreement.

Net neutrality moves Minnesota forward. Allowing for free and open discussion means more Minnesotans can express their views and share their good ideas, so strong policy arguments can spread without corporate meddling. Preserving the internet as we know it must be a policy priority to ensure future policy solutions.

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Despite their common availability in retail stores and the large size of the industry, many Minnesotans don’t realize that dietary supplements are subject to lax regulation, often resulting in dangerous products.

Consumer Reports (CR) ran a recent article discussing some of these dangers, where they identified 12 ingredients found in many readily available supplements that are linked to cardiovascular problems, blood pressure changes, liver injury, kidney failure, heart attack, and stroke. They also report that despite common “all natural” labels for supplements, some have been found to contain heavy metals, pesticides, prescription drugs, and synthetic steroids.

Unlike most drugs and medicines, supplements are regulated under the 1994 Dietary Supplement Health and Education Act (DSHEA), which CR describes as “industry-friendly,” explaining, “it is difficult for the FDA to put together strong enough evidence to order products off the market. To date, it has banned only one ingredient, ephedrine alkaloids. That effort dragged on for a decade.”

Admittedly, part of the blame lies with the FDA, too, for not making full use of the limited powers it does have. Despite a 2007 amendment to DSHEA requiring supplement makers to pass on reports of serious adverse events to the FDA, those reports have rarely been made public. The lack of dietary supplement regulation is a gaping hole in our health care market. With so many health products already going through the FDA, buyers could easily assume that these products have been approved as well, when nothing could be further from the truth.

Minnesota had 154 dietary supplement stores in 2002 that did $55 million worth of business, according to the U.S. Census Bureau. If industry growth here matched that of the rest of the country, Minnesotans likely spent more than $300 million on dietary supplements last year.

It’s great that CR is stepping up and evaluating these products when the government isn’t, but unfortunately not all of the Minnesotans who bought supplements will see CR’s results, and CR doesn’t have the power to remove dangerous products from shelves as the FDA can. It’s further evidence that there are certain functions only the government can perform properly, and this kind of regulation is one of them. There’s no reason supplement companies shouldn’t be open to government regulation; if their products really do offer health benefits, then they should be happy to have them backed up by a scientific process which will weed out any competitors whose products don’t pass muster. Such approval could also lead to greater trust in and more widespread use of supplement products.

CR reports that roughly a third of supplement products have been through some level of approval, and recommends buying supplements marked “USP Verified,” meaning the company has voluntarily submitted the product for review by nonprofit U.S. Pharmacopeia. CR also points out 11 supplements worth considering. But even all of this leaves two-thirds of supplements without any scientific review process to verify benefits or safety still available on store shelves for unsuspecting consumers.

Discussing regulation in the journal Democracy, Elizabeth Warren wrote, “thanks to effective regulation, innovation in the market for physical products has led to more safety and cutting-edge features.” If applied to the dietary supplement industry, we can attain a similar result, benefiting both the industry and consumers.

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Recently, U.S. Senators McCain and Coburn released “Summertime Blues,” a report on 100 “stimulus projects that give taxpayers the blues.”

The Pioneer Press story on the report includes a project in Eagan and Woodbury that, with the help of federal stimulus dollars, will manage the temperatures within local ice rinks to prevent heating of the ice surface while also warming spectators, annually saving $230,000 for Woodbury and $130,000 for Eagan. “It seems to be anything other than ‘pork,’” said Eagan Mayor Mike Maguire. “This is a sound use of a tax dollar.”

Woodbury City Manager Clint Gridley chimed in, saying, “[T]he geothermal heating/cooling project at Bielenberg Sports Center was an excellent use of federal dollars. The project has produced significant energy savings, reduced costs for Woodbury and it did create/support jobs.”

This is one of the major problems with attacking “pork-barrel spending” by Congress—one person’s wasteful spending is another’s wisely-funded program. With the exception of an occasional Bridge-to-Nowhere, it’s difficult to judge whether federal dollars going to things like research grants, infrastructure, and military projects are waste or wise allocations of resources.

Another major problem with attacking “pork-barrel spending” is while it makes for an easy target and great sound bite, it really doesn’t amount to all that much. The 100 pork-laden stimulus projects cited in “Summertime Blues” amount to 0.2% of the stimulus package; strip out the six most expensive projects—the Minnesota project isn’t one of them—and the other 94 make up 0.04% of stimulus dollars.

As is clear from a real look at them, our deficit problems are much more structural than a handful of earmarks. Crying “Pork!” can do more harm than good if it makes us think our budget problems are easily solvable. And there’s definite hypocrisy when conservatives oppose unemployment benefits bills that would add $30 billion to the deficit, yet advocate for reinstating the Bush Tax Cuts when they expire at the end of this year—as this graph shows, the tax cuts would do horrendous things to the deficit, yet Congressional conservatives see no reason to offset them. Ezra Klein of the Washington Post writes, “The issue isn’t that conservatives don’t care about the deficit… The issue is that they care about tax cuts and defense spending more.” He makes the case that conservatives prefer these to budget-balancing, but prefer budget-balancing to funding progressive programs, making them seem the deficit hawks when out of power.

But if we really want to reduce our federal deficit, we can’t take the easy way out by attacking earmarks or alleged “wasteful spending” programs that add little to the long-term deficit. We need to think bigger than that, such as looking at ways to get our long-term health care costs under control and putting revenue-raising options on the table. Cries of “Earmark reform!” and “Wasteful spending!” often make great sound bites without digging into the real issues.

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Minnesota 2020 recently discussed the Center for Disease Control’s (CDC) numbers on obesity trends, which placed Minnesota’s obesity rate at 24.6%, just below the national average of 27%. In fact, only 11 states have obesity rates lower than Minnesota’s.

But as longtime readers of MN 2020 know, we prefer looking to trends, which are often much more revealing, rather than simply snapshot data.

The good news here—if you can call it that—is Minnesota’s trend toward greater obesity basically mirrors that of the national increase over time. The U.S. has seen a 69% increase since 1995, while Minnesota has seen a 65% increase. In the last 5 years, the U.S. obesity rate has increased by 13%, while Minnesota’s rate has increased by 12%. Graphs of both Minnesota’s and the nation’s trend lines can be seen at the CDC’s site.

But lets dig a little deeper into the numbers. Asking “How fat should we be?” might seem difficult to judge, and it is. What should be our baseline? The CDC’s target obesity rate for 2010 is 15%—twenty  years ago, no state had an obesity rate that high; today, it looks like not one state will have a rate that low come year’s end. And we know our rate is below the national average—we’re even below the Midwest regional average of 28.2%. Should that be good enough?

Digging into Minnesota’s demographics numbers from the Minnesota State Demographics Center should offer some clues. We fare decently well when obesity rates by race and ethnicity are used to predict what our obesity rate should be based demographics: the CDC’s latest data would predict a 25.5% obesity rate, while our rate is actually 24.6%.

But if our obesity rate is instead predicted based on our demographic breakdown by age, Minnesota doesn’t fare nearly so well. Obesity rates by age would predict that 20.3% of our population is obese; we’re actually a full 4.3% bigger.

These are numbers worth paying attention to; despite our otherwise-good health as a state, obesity can function as a leading indicator of coming health care troubles. It’s likely one reason our health rankings have been sliding in recent years.

If we just say that a better-than-average obesity rate is good enough for Minnesota, then our health ratings might not be better-than-average for much longer.

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Americans have long valued the chance to live at home well into their golden years. There’s comfort in remaining in one’s own, private space even late in life. Additionally, staying at home saves money. The Star Tribune reports the annual cost of a private room at a Minnesota nursing home averaged $54,750 in 2009, and $62,780 in the Twin Cities.

Fortunately, emerging new methods will help Minnesota seniors stay in their homes.

The Star Tribune article details Minnesota’s Living at Home Network, which includes 43 local programs, staffed by volunteers, who assist seniors so they can live at home. One of those local programs, Nokomis Healthy Seniors, serves 502 individuals on $165,000 annually. The Network as a whole served 1,222 senior citizens in 2008-09.

Other new methods are technological. The New York Times had a story last week mentioning Harriet Meyers, 84, a Minneapolis woman whose daughter, a New York resident, receives a programmed phone call from her mother’s pillbox if she fails to take her daily pills.

Similarly, Colorado resident Michael Murdock and his mother in Virginia placed sensors in her home, enabling him to monitor her. According to The New York Times, “[Murdock] said his GrandCare system cost $8,000 to install—about as much as two months at the local assisted-living facility…—plus monthly fees of about $75.” The Times quotes counseling psychologist Nancy K. Schlossberg who acknowledges there could be “Big Brother” fears related to such technology. “It has to be negotiated with the parents,” she says. “If it’s not an agreement with the parent, it can be a very destructive thing.”

Overall, the sensors are non-invasive, and report on things like if the medicine cabinet, refrigerator, or front door open, indicating if Murdock’s mother has taken her medicine, eaten lunch, or left home, respectively. She reports that the system hasn’t been the privacy issue she initially worried it could be.

Another sensor-system user, 91-year-old New Jersey resident Ray Joss, reports the monitoring system has improved her relationship with her son. “We talk about other things rather than just how I feel,” she says. “He doesn’t have to ask me.”

Nursing home care already costs plenty—the Star Tribune reports the Living at Home Network saves $20 million over nursing home care, much of which would be taxpayer dollars—and those costs will only increase in coming years as Minnesota’s population ages. Volunteers and new technology can go a long way toward reducing that cost.  However, families and policymakers must realize they’re a great supplement, not a substitute, for regular health and welfare checks. Nor should these new methods excuse state health care officials from working toward formulating the most comprehensive approach available for senior care. As elderly care costs grow, Minnesota would be wise to chip in state dollars for such options if doing so will save money in the long run.

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Photo by Medtronic

Recent years have seen greater integration of information technology into the health care field—some of it beneficial, some not. A general pattern is emerging: new technologies that provide doctors with greater information and increase patient-doctor interactions are the technologies that both improve quality of care and reduce cost, even if the interactions are not face-to-face.

Remote medical devices (RMDs) are a great example of this. RMDs transmit information from one’s home to one’s physician, working to eliminate the need for check-ups that either come later than they should after a change in condition, or waste time when they “find out everything is still the same,” as heart patient Ray Freeland puts in The Wall Street Journal.

RMDs often include daily testing of weight and blood pressure, where a sudden change can indicate increased risk of a heart attack. To date, heart attacks have been the primary focus of RMDs, since they can be triggered by small mistakes and are the leading cause of hospital readmissions.

Minnesota-based Medtronic’s CareLink Network is the largest remote monitoring network in the world, using implantable cardioverter-defibrillators which collect data that can be transmitted via phone line. As a Medtronic press release from April explains, “Because patients can transmit critical data from their heart device using a phone line from home, work or while on vacation, they enjoy freedom from time-consuming travel to the physician’s office for device monitoring.”

Studies reveal RMDs are having the desired effect: Medtronic’s CONNECT trial, released in March, found that time from clinical event (arrhythmias, cardiovascular disease progression, and device issues) to physician decision for RMD patients took 4.6 days, 17.4 days less than those without RMDs, and that hospital stays were reduced on average from 4 days to 3.3 days, costing $1,659 less.

The Wall Street Journal details a study published July 27 that found RMDs “reduced in-hospital evaluations by 45%. Suspected cardiac events were evaluated in less than two days compared with 36 days.”

The hope is that RMDs will cut down on doctor’s visits and provide patients with peace of mind, though there are worries that patients will become complacent and trust the devices too much.

In part to reduce any complacency, some insurers are incorporating teleconferencing between patients and nurses into remote monitoring systems.

“The relationship between the consumer and doctor is primary,” says Sam Meckey of UnitedHealth in the Journal. That relationship is becoming increasingly digital, to the benefit of all parties involved.

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click to enlarge

Recent rankings reports from different organizations paint a similar picture: Minnesota’s health system tends to rank among the best in the nation, while also demonstrating some signs of worry.

First, a Press Ganey Pulse Report finds that Minnesota ranks 5^th among the 50 states in shortest visits to the Emergency Room in 2009, averaging 3 hours, 11 minutes per visit, a mere 16 minutes behind the leader (Iowa). Only Iowa, the Dakotas, and Nebraska ranked better. The national average is 4 hours, 7 minutes, with Utah bringing up the rear, with an average ER visit lasting 8 hours, 17 minutes in 2009. Shorter visits are correlated with high patient satisfaction; as it currently stands, shorter times are indicators of efficiency, not rushing. Both the length of Minnesota’s average ER visit and the national average have not changed much since 2008, though other individual states have seen significant improvements or declines.

Next up is a newly-released ranking from the Census Bureau on percent of those without health insurance under age 65 per state in 2007. Minnesota comes in 3^rd at 9.6%, one of only four states under 10% (the others are Massachusetts, Hawaii, and Wisconsin). This compares to a U.S. average of 17.1%. The report is also useful in that it includes breakdowns by county (see map). For instance, Minnesota’s lowest uninsured population is in Anoka County, at 7.3%, while Cook County struggles the most, with 18% uninsured.

Now for the bad news: when these numbers are examined over time, our trend is worse than the nation’s. Based on numbers from America’s Health Rankings, Minnesota has seen a 21.1% increase in the size of its uninsured population since 2001, compared to a U.S. increase of 11.5%.  It’s also important to note that because Census data is only available up to 2007, before the Great Recession, the total uninsured percent of the U.S. population has likely increased in the last three years.

Finally, the Annie E. Casey Foundation’s annual Kids Count report ranks Minnesota 2^nd in children’s well-being for the third year in a row, behind only New Hampshire. The ranking is based on statistics such as youth mortality rates, teen births, school attendance, and children in poverty. However, the Star Tribune reports that many Minnesota child advocates “fear Minnesota’s poverty rate – higher than a decade ago – could undermine its success.” These advocates worry that while our numbers remain strong in many categories, our increasing poverty is a leading indicator that these numbers could soon be declining.

The Tribune quotes research director for the Children’s Defense Fund-Minnesota Kara Arzamendia, who was speaking of the Kids Count results but whose comment is true of Minnesota’s health system as a whole: “Minnesota isn’t doing very well compared to itself.”

It’s become a common theme: In snapshot comparisons to the rest of the country, Minnesota’s health continues to hold up well. But compared with our proud past, in category after category, Minnesota has begun to slip. We’ll need to reverse that trend if we want to maintain our high quality of health and remain the national leader we are today.

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From my grandma to college students to the president, lots of people have been talking about sustainability. Some are waiting for business or government to take the lead, but a group of Macalester students have put their own plan into action, and now the initiative is growing.

Summer of Solutions (SoS)  is a program aiming “to build the green economy and youth leadership,” says program participant Martha Pskowski. This summer marked the third year for SoS, which is run through the non-profit Grand Aspirations.  Macalester students founded both in 2008. Now, nine SoS programs have spread nationwide.

The Twin Cities program includes roughly thirty individuals participating either full- or part-time, and seeks to partner with existing community organizations to broaden its reach and increase its impact in four focus areas: energy efficiency, bicycle transport, urban agriculture, and green manufacturing.

For energy policy, the group partnered with Cooperative Energy Futures to recruit and train a sales team to sell energy efficiency kits to low income families. SoS’s Willy Raedy says that the kits are designed to pay for themselves within a year’s time, as the group knows many low income families are renters who move around a lot and need the savings to manifest quickly.

Both Pskowski and Raedy helped with SoS’s bicycle transport focus, which was conducted through a partnership with not-for-profit Sibley Bike Depot. Sibley offers free bike repair help from mechanics and teaches repair skills, while also doing bicycle loans and even allowing individuals to earn bikes through volunteering. SoS conducted a listening project to see what other services community residents would want from Sibley, and as a result, designed a women-specific bike repair class.

With urban agriculture, SoS partnered primarily with the Harrison Neighborhood Association and worked to build up and network preexisting urban gardens while helping implement a market at which to sell produce from the gardens.

Finally, for their green manufacturing focus, SoS partnered with the Alliance to Re-Industrialize for a Sustainable Economy (ARISE) and designed a plan for transitioning a St. Paul Ford manufacturing plant slated to close in 2011 into a green technology plant. SoS also built a universalized template from the plan that can be utilized elsewhere.

Though the SoS program itself will come to a close with the end of July, its projects are designed to sustain throughout the year until SoS launches again next year. Pskowski and Raedy are proud of their service within local communities in the Twin Cities over the summer and of the groundwork they have laid for the future. Looking ahead, Raedy hopes SoS participants will start down the entrepreneurial path and create future green jobs. He says interested individuals should look to apply for Summer of Solutions 2011 next spring, and hopes the program can fundraise enough to offer participants some financial support.

Pskowski hopes that their work will prove “being socially and environmentally responsible can work for businesses and communities as a whole… It’s about creating a system that can make money, but has greater benefits as well.”

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The Federal Communications Commission (FCC) recently announced it will expand broadband subsidies to rural health providers. For Minnesota, this announcement could not have come at a better time.

That’s because beyond the federal health reforms that will require more health information technology and therefore greater broadband use, Minnesota passed health reform measures in 2007 and 2008 that mandate all hospitals and health care providers have interoperable electronic health records by 2015, and that all prescriptions be filed electronically by 2011. “I don’t think a lot of other states were out in front with legal structures and incentives like Minnesota,” says Karen Welle with the Office of Rural Health and Primary Care.

Welle says the expanded subsidies—which will fund 85% of installation fees, 50% of recurring costs (up from 25%), and increase the types of facilities eligible—will allow rural health providers in Minnesota to increase broadband speed, enabling many augmented services. Central to these is telemedicine.

Minnesota 2020 has discussed telemedicine previously, but the central premise focuses on enabling videoconferencing between patients and specialists. “When you’re in the city, you just go to the doctor,” Welle says. But in rural areas, it can be very difficult to consult doctors and specialists, particularly on a regular basis. Welle suggests that with Minnesota’s aging workforce and aging citizenry, especially in the western part of the state, telemedicine and broadband access are things rural Minnesotans “have to have.”

Another clear positive of the expanded subsidies is that beyond direct health care providers, the subsidies are now also available to nursing homes, renal dialysis centers, administrative centers, and data centers. “Nursing homes have been a missing piece in the subsidy in the past,” reports Welle. She’s also enthusiastic about the expansion to data centers, which will allow smaller hospitals to pool their resources to meet their electronic needs.

As Minnesota transitions toward a more techno-savvy health care future, this subsidy will help make sure our rural communities aren’t left behind.

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The West Central Tribune ran a recent story on Kandiyohi County’s new health care decision: the county Board of Commissioners will begin paying the $4 a month premiums necessary for GAMC recipients to instead enroll in MinnesotaCare. Minnesota 2020 has detailed how under the gutted version of GAMC, only four Metro-area hospitals offer GAMC patients comprehensive care, leaving residents of counties like Kandiyohi with significant travel time to the Twin Cities in a tough spot.

Into this bleak picture stepped the Kandiyohi County Board of Commissioners. Its smart approach recognizes that prevention and insurance, though costing something in the short run, can save money in the long term. Commissioner Richard Larson acknowledged as much, saying that by not paying the premiums for these individuals, a number of whom are mentally ill, “It’ll bite us in the backside.” Larson called the decision a “no brainer,” and Kandiyohi County Family Services Director Jay Kieft said it would cut down long-term expenses for the community.

Unfortunately, for many conservatives, this isn’t a “no brainer.” By focusing only on immediate and individual costs without factoring in long-term and community savings, they conclude that a dollar spent on most types of social services is a dollar wasted.

Many conservative critics of the federal Affordable Care Act (AFA) complained that it focused too much on access without paying attention to cost. Yet as Kandiyohi County’s decision makes clear, above and beyond the cost savers written into the law, the AFA lowers costs by the very nature of expanding health insurance access.

This really isn’t that surprising: If you’re without insurance and you develop a bad cold, you probably skip going to the doctor. But when that cold becomes a full-blown case of pneumonia that requires you to be rushed to the emergency room, your expenses skyrocket.

Admittedly, part of the problem is the way progressives promote  increased access: We often emphasize the moral reasons for expanding coverage without giving enough attention to the economic benefits.

Tom Schaller points to a 2007 study by the Milken Institute which found that from 2003 to 2023, without any reform, $7 trillion dollars of GDP would be lost due to chronically ill workers taking sick days, showing up onsite but performing subpar work, and simply through living shorter lives. A 2009 analysis by the Center for American Progress concluded that lost productivity from the uninsured based on these factors cost Minnesota $2.62 billion in 2009 alone—and Minnesota was in the middle of the pack.

By increasing insurance coverage and allowing for better preventive care for many Minnesotans, we can begin reducing these costs. Kandiyohi and other counties making similar decisions are leading the way with their smart, progressive decisions that move Minnesota forward through a focus on long-term rather than up-front costs. It’s a county-level step toward a healthier and more productive state and country.

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