Minnesota is famous as the "land of 10,000 lakes."  Of these lake "Woebegone" is now the best known because of Garrison Keillor's "Prairie Home Companion" fables.   Another Minnesota trademark for which this fair, and sometimes frigid, land takes less pride is that of being the mother of managed care. 

At the start of the next millennium it is interesting to monitor the Minnesota health care headlines in the local press.  Prominently featured have been articles on the failure of Minnesota HMOs to meet preventive care goals in the past and are rife with dire predictions of continuing double digit increases in health care costs.  In all fairness to Minnesota, however, it must be pointed out that predictions are that all American health care consumers will soon be facing the greatest surge in health care costs since the early 1990s.  What does this really mean?  Simply put, it warns of higher insurance premiums, increased cost of care and drugs, decreased services, as well as less recourse for the consumer.  

And what of the American insurance industry?  Aetna, the largest health insurance company in the United States, which has been siphoning billions of customer dollars in its search for profit now finds, on the basis of its poor business decisions, that it must now shed employees as well as its unprofitable customers and, of course, raise its insurance coverage rates. (Star Tribune, December 19, 2000).

Why do we steer our ship of state onto the rocks when there are so many other attractive courses open to us on the ocean?  This approach simply defies logic and common sense.

The greatest single cost in the American health care system (after removing the expense of psychiatric illness and chemical dependency) is that of treating spinal disease, most specifically low back pain.  It is estimated that this alone represents 80% of the remaining health care cost.  The great majority of individuals undergoing spine treatment and spine surgery have congenital problems reflecting development or biochemistry gone awry.  With genetic testing and/or screening studies essentially all of those at high risk could be identified early in life and placed in self-administered preventive programs emphasizing fitness over drugs and surgery leaving only those others incapacitated by acquired insult or injury.  Few in medicine, the allied health community or government have a clue regarding this subject or the existing solutions available in this area. 

By simply focusing on the management of spine health alone the State of Minnesota, which leads the nation in the field of spine care, could serve as a shining example of health care gone right for a change and, in the process, place the patient in the driver's seat.  How long must the American public continue to tolerate the unending perversities of the present approach to health care producing a continued degradation of what is still the finest health care system in the world today?