RENEE MONTAGNE, host:
Former Minnesota Governor Tim Pawlenty is deciding whether to take a big leap.
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MONTAGNE: A crowd cheered Pawlenty at a 2005 ice fishing festival as he leaped into freezing water. The jump he's considering now is whether to seek the Republican nomination for president.
STEVE INSKEEP, host:
Today, Pawlenty releases a book calls "Courage to Stand." It recounts his early life growing up in South St. Paul, Minnesota, the home of giant stockyards back then. Pawlenty writes of the awful smell, and also the community's pride.
Former Governor TIM PAWLENTY (Republican, Minnesota): There's a street that ran through the stockyards and the meat-packing plants and it was just full of bars and restaurants and the hubbub of all of that. It wasn't always pretty but there was a vibrancy to it and kind of a hopeful sense. And people, even if they missed the educational rung for whatever reason - you know, they were disenfranchised, disadvantaged, disconnected - as long as they weren't disabled, they could still often go get what my dad called a strong-back job. And they could support a family often with a living wage and benefits, and life for those families, at least during those times, was good.
INSKEEP: Many years later, Governor Pawlenty tried to help his state adapt to a changing economy. He also gained wide attention for Minnesota's efforts to rework the health care system. That may surprise some people, since Tim Pawlenty also joined a lawsuit against President Obama's health care law. Pawlenty argues that Americans can do more to restrain what they pay health care providers.
Mr. PAWLENTY: Don't just say we're going to pay you for endless volumes of procedures. We've got to start paying them for better health and better health care outcomes, and that's what we've done in Minnesota, and when you do those kinds of things, even in the primitive or early-stage ways that we've done it, it's extremely promising and it works.
INSKEEP: You got involved in Minnesota in a program that encourages health care providers to charge differently. If somebody has an operation and there are seven different things involved in the operation, from an X-ray to the charge for the surgeon, they just charge one price, right? It's for the basket of care that you need, is that correct?
Mr. PAWLENTY: Yeah. We've done a number of reforms in Minnesota. That reform that you mentioned begins to say to providers, you know, we're going to give you an amount for, say, for example, a knee replacement.
INSKEEP: And don't send a separate bill for every Q-tip or bandage or whatever might be used.
Mr. PAWLENTY: Exactly, exactly. You know, if you think about it, if you were in the business getting paid for how many words come out of your mouth and you were given no limits on how long you could talk, what do you think you would do?
INSKEEP: I'd be fired already. That's okay.
Mr. PAWLENTY: You'd be talking all day. You'd be on the radio all day. And I analogize it to a wedding. I say to people, you know, go to two weddings. Go to one with an open bar, where the alcohol and the drinks are free, and go to one where there's a cash bar. You'll see very different behaviors.
INSKEEP: Well, here's something that makes me curious, just as a citizen, trying to figure out how people's positions differ. You've just described to me this system whereby health care providers are incentivized, even instructed, to charge differently, to charge for a service rather than every little individual thing as line items and the prices can go wildly out of control.
Doesn't President Obama's health care law include a pilot program that does exactly the same thing?
Mr. PAWLENTY: Well, it has all kinds of little pilot projects in it, but fundamentally that's not the direction the law or the health care delivery system's going to go. And importantly, it also has to be attached to outcome. So in Minnesota we have a program where we pay providers more if they get better outcomes and follow better protocols.
So for example, in diabetes and heart disease, we're not interested just in how many procedures you're to perform, we're interested in did this person get optimal care? Did they get better quicker? And if they did, and you get more and more of your patient load meeting those kinds of criteria, we'll pay you more as a provider.
But this notion that we're just going to have an open checkbook to all these folks who can bill us endlessly based on how much volumes and procedures, and the consumers have no knowledge really about price or quality, that's a completely screwed-up system.
INSKEEP: Well, that's the system we have now. But doesn't...
Mr. PAWLENTY: Exactly.
INSKEEP: ...the health care law that was passed by Congress try to address some of those very same issues that you say you're concerned about?
Mr. PAWLENTY: Well, I think what it does is to say we're going to expand access through government subsidies mostly to the current system as it's currently configured with the exception of a few pilot projects. And so I think what President Obama's proposal is ultimately going to do is it's going to expand access but it is going to do nothing to control costs. And for most Americans, their primary concern about their health care is that it's becoming unaffordable.
INSKEEP: If you're going to talk about controlling costs, doesn't that open you to the same argument that was made against the White House and against the Democrats in Congress - they're trying to restrict our health care, they're trying to make sure that we can't get the health care we need, that kind of argument?
Mr. PAWLENTY: No. You know, the principle behind what we try to do - and I'll give you one other real-life example - with our state employees, the costs were going through the roof so we created a new system. We said, look, you can go anywhere you want, but if you choose to go somewhere that's really expensive with poor results, you're paying more. And if you choose to go somewhere that has better results and is more efficient, you'll pay less.
People now have an incentive to make wise decisions and comparison shop. And even in the rudimentary form it's in in Minnesota, it works.
INSKEEP: But there were conservatives over the past couple of years who found it terrifying that the government would get involved in deciding which treatments were effective, which treatments were not worth the money.
Mr. PAWLENTY: Well, again, the ultimate goal here isn't for anyone to decide which treatments are good or bad.
INSKEEP: But you're deciding what you're going to pay for and how much.
Mr. PAWLENTY: No, but as a proxy for outcomes people sometimes want to pay for best protocols, but that isn't the ultimate goal. The ultimate goal is to say we're going to pay for better outcomes. If you go someplace with bad outcomes and it's really expensive, you'll pay more of the bill.
INSKEEP: Well, let me ask another thing that perhaps you can offer advice on. We can presume that Republicans in Congress will vote to repeal President Obama's health care law. We can presume that repeal will not go very far, since Democrats still control the Senate and the White House. And as that battle goes on, there will be the question about whether there is something Congress might pass that might improve the health care situation.
If asked for one piece of advice, whether large or small, what would you suggest that people in Congress consider in the next two years?
Mr. PAWLENTY: Payment reform and stop paying for volumes and procedures and start paying, at least in part, for better health care outcomes.
INSKEEP: Take that pilot program and actually make that something broad that applies to millions of people.
Mr. PAWLENTY: Yes. The pilot program's interesting and it's, in general, might be of some value, but it was tucked in there, I think, to satisfy some of the Republicans and doesn't have, I don't think, broader, deep impact.
INSKEEP: One other thing, Governor Pawlenty. Many people are expecting you to run for president. How will you decide if you really do?
Mr. PAWLENTY: Well, I've got this book tour coming up. After that I'll decide what's next. And I am considering running in 2012, but I won't make that final decision until probably, you know, later this quarter or early next quarter.
INSKEEP: What's the latest moment that you have to decide?
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Mr. PAWLENTY: Well, you know, technically, I suppose, you could let it drag on.
INSKEEP: Oh, but you know how it goes. You've got to raise money, you've got to build support.
Mr. PAWLENTY: Sure. You know, for somebody like me, I think, whose name ID is not very high yet and from a relatively small state, you know, I think you'd want to start earlier rather than later compared to some of the others who are more well-known or got more of a running start.
INSKEEP: Whose advice are you seeking?
Mr. PAWLENTY: My wife's.
INSKEEP: What's she telling you?
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INSKEEP: Spousal privilege? Are you going to claim spousal privilege here?
Mr. PAWLENTY: Yeah, spousal privilege. She's a loving and encouraging spouse, no matter what I do.
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INSKEEP: Tim Pawlenty was until this month the governor of Minnesota. His new book is called "Courage to Stand."
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INSKEEP: This is NPR News.