Von Ebers, 56, is currently a consultant for Blue Cross Blue Shield of Illinois and lives in Rochester, N.Y. He was chosen from a pool of 43 applicants and will begin full-time work as the leader of North Dakota’s largest insurer by Sept. 1.

The applicant pool was narrowed to four finalists by the Chicago-based search firm the Pace Group. Dennis Elbert, chairman of the board of directors for the Blues in North Dakota, said the board interviewed von Ebers and unanimously decided to hire him last week, calling him a “well-respected industry veteran.”

Elbert said von Ebers will be paid $500,000 annually a figure that he said is comparable to other executives in similar positions and regions.

Von Ebers earned a salary of $808,321 in 2007 as chief operating officer of Excellus Health Blue Cross Blue Shield in Rochester, according to the Post-Standard newspaper in Syracuse.

From 2005, von Ebers served as executive vice president and chief operating officer of Excellus Health Blue Cross Blue Shield and Univera health plans in Rochester. He also holds a master’s in business administration in finance and hospital administration from the University of Chicago.

Von Ebers has 38 years of experience with Blue Cross Blue Shield, including executive positions in Iowa and Illinois. He also has run his own health care consulting business.

Von Ebers said he and his wife and five children will move to Fargo in the coming weeks after he winds down his current consulting position.

The Blues board of directors fired its former CEO, Mike Unhjem, in March amid public criticism after the company took 33 employees to the Cayman Islands as a reward while the insurer was seeking rate increases.

Unhjem left the company after 18 years with a $2.2 million severance package and a 2008 compensation of $706,344 from the Blues and $372,215 from other sources, according to the state insurance department.

Blues Executive Vice President Tim Huckle has served the interim president and CEO since March.

During the Monday press conference in Fargo, von Ebers acknowledged the “troubled waters the organization has gone though,” and said steps are being taken internally to address them.

He added the most important issue for the company to tackle is the cost and quality of health care for the more than 449,000 people covered by BCBS of North Dakota.

The national debate over health care reform will also be among the top priorities for the company to address, von Ebers said.

Von Ebers met with state Insurance Commissioner Adam Hamm on Monday and said he wants to have a collaborative relationship with him.

For about a year, Hamm has butted heads with the Blues over requested rate increases for individual and group rates.

The insurance department ultimately approved a 7.9 percent rate increase for group polices in May after the Blues originally requested a 14.9 percent hike last fall.

“He’s an elected official who’s been asked by the citizens of North Dakota to keep an eye on the cost of health insurance,” von Ebers said. “I am confident we can find a way to protect the citizens of North Dakota and the financial viability of the Blue Cross Blue Shield organization.”

Hamm said he and von Ebers will sit down in the coming weeks for a substantive meeting about the issues facing the Blues and its relationship with policy holders and the insurance department.

“I think he’s got a big job ahead of him, a company that has 90 percent of the health insurance market in North Dakota,” Hamm said. “And you have a company that has been under fairly intense public criticism over the last few months.”

Elbert said von Ebers will be on a rolling three-year contract, and his performance will be reviewed every year.

Thursday, most of the city south of the Heart River remained a secured area as local, state and federal officials sifted through the rubble to determine the extent of the damage.

The National Weather Service determined the tornado was of the EF-3 class that carried winds in excess of 150 mph.

Miraculously, only minor injuries were reported.

About 100 soldiers from the North Dakota National Guard were in Dickinson by midday to provide security in the affected neighborhoods, as well as traffic control and clean-up help if needed.

By 8:30 the morning after, the streets were buzzing with activity as residents fired up chainsaws to clear fallen trees from their yards and city crews loaded and hauled away debris.

At a briefing at the Dickinson Law Enforcement Center that was attended by Gov. John Hoeven and Brig. Gen. David Sprynczynatyk, city officials said one of the first priorities was to clear debris from the streets so crews could get in and assess damage.

Shawn Kessel, city administrator, said he estimates “three or four dozen” homes were destroyed, but had yet to complete a full assessment of the damage.

The storm hit shortly after 8 p.m. local time Wednesday and sirens sounded about 20 minutes beforehand.

Kessel said the weather service had forecast the storm well ahead of time and the hospital had ramped up with emergency staff as a precautionary measure.

After the storm passed, emergency personnel conducted two door-to-door sweeps, searching for victims.

“That’s the miracle in all of this,” Kessel said. “We’ve had reports of just a few minor injuries.”

Hoeven credited city and county officials, as well as residents, for being prepared and coming to the aid of their neighbors.

“Our hearts go out to them,” Hoeven said.

“But that’s what North Dakotans do better than anyone else, I think. Help each other.”

Insurance Commissioner Adam Hamm also was in Dickinson to inspect the damage.

Hoeven and Sen. Byron Dorgan, D-N.D., said Stark County residents are already eligible for federal aid under an emergency disaster declaration issued for spring flooding. A Federal Emergency Management Agency office is expected to open at Dickinson’s Prairie Hills Mall by Saturday.

About 250 homes remained without electricity Thursday morning as crews from Montana-Dakota Utilities worked to restore power.

A shelter was opened at the National Guard Armory on Wednesday night, where 15 people took refuge, and the Salvation Army and Red Cross also have set up emergency aid stations.

David Hunter was at his apartment complex at 534 Second Ave. when the storm hit.

He said when a friend noticed rotation in the clouds they decided to head indoors.

First, the screens came off the windows, he said, and then, the windows themselves imploded, sending him airborne through his apartment.

“I felt like I was in the movie ‘Wizard of Oz,’” he said.

Hunter received stitches on his right arm, but not before he went downstairs to pull a neighbor from the rubble.

“Everything is gone,” he said.

At the Breakforth Bible Church just off south Main Street, Mikayla Reisenauer and Sydney Martin sifted through what was left of the brick structure, the roof gone and the stage now exposed.

“I was here maybe 45 minutes before it hit,” Martin said.

“We’re trying to salvage what we can.”

They managed to pull two flags and an electric guitar from what remained of their church.

Just across street, Mindi Ulmer stood in the front yard of the house where she and her boyfriend have lived for about a year, a tree poking through the roof into her kitchen.

Ulmer said she was at work when the house was hit.

She said her dad checked on the house afterward and by the time she got off work it was too dark to see anything.

When she drove past the church and witnessed the damage there, she feared the worst.

“If the church went down, I thought my house had to be down, too,” she said.

A new pickup and a Harley Davidson in the garage seemed to have survived undamaged, she said.

“There is so much damage,” Ulmer said as see looked up and down the streets of her neighborhood.

She said they would clean up the mess and go on with life.

“We’re staying here for now, I guess,”she said.

The 65-year-old had sliced open his left hand on a Wednesday afternoon while working on a garage door at his Hazelton home. He held a paper towel to the bleeding wound while his wife escorted him into the Linton Hospital, just a few miles down the road.

An hour later, Fortner had received four stitches, a tetanus shot and was ready to head home. Medicare would pick up the bill for the routine procedure.

But things hadn’t always been so easy for Fortner, a semi-retired carpenter.

Like many Americans, Fortner lived most of his life without health insurance, paying out of pocket for doctor visits while hoping nothing serious would happen.

Last year, Fortner finally started to receive Medicare, the government-funded health insurance for those 65 or older, and started a supplemental policy with Blue Cross Blue Shield of North Dakota.

“Basically most of my life, I just took care of myself,” Fortner said, donning a Chevrolet baseball cap while lying on the emergency room table as a nurse practitioner finished the sutures. “I guess I never did complain about it because when you’re sick or you need help you really don’t want to sit there and complain about the cost of it.”

For much of his life, Fortner was one of the estimated 46 million uninsured Americans, a number that is expected to climb to 72 million by 2040 if current trends continue, according to a report by the Council of Economic Advisers to President Barack Obama.

This summer, Congress is debating sweeping health care reform, one of the most difficult issues in American politics that has eluded presidents dating back to the original Rough Rider, Theodore Roosevelt.

The questions are big and the costs just as large, which are estimated in the ballpark of $1 trillion to $1.6 trillion over the next 10 years.

Congress is mulling bills in five committees with proposals ranging from tax subsidies for the uninsured, to a publicly funded insurance provider to one proposal that has its roots in North Dakota’s rural, progressive past: cooperatives.

Sen. Kent Conrad, D-N.D., introduced the plan to establish health care cooperatives in all 50 states with government providing the startup costs, which he said could amount to $3 billion to $5 billion.

It is a proposal that has earned support from those on the right who oppose any government-funded “public option” and barbs from those on the left who want to see a public insurance plan signed by the president this year.

Despite Obama throwing his weight behind a public plan, Conrad contends the votes are not there to pass it.

“There are certainly strengths to a public option. The problem that one has is that there is strong opposition among some Democratic and virtually all Republicans to any of the public option concepts, because what they fear is a government takeover of health care,” Conrad said. “That’s why I was asked to come up with a compromise to bridge these differences.”

Sen. Byron Dorgan, D-N.D., and Rep. Earl Pomeroy, D-N.D., have both said they would support a public option as long as it wouldn’t put private insurers out of business. Dorgan also said he would be supportive of Conrad’s proposal as he learns more details.

In North Dakota, medical providers are watching the health care debate with interest while the details are hammered out on Capitol Hill.

The problems facing the Peace Garden State - which has some of the lowest health care costs in the country - are different than issues facing other states, namely low Medicare and Medicaid reimbursements to North Dakota health care providers and access to hospitals in rural areas.

“We’re at one of those pivotal 20-year periods,” said Brad Gibbens, the interim co-director for the Center of Rural Health at the University of North Dakota. “There’s going to be a lot of opportunity for explosive change.”

What is the status

of health care?

While many details of the health care reform debate are still fuzzy, the problem can be boiled down to three issues: how to stop the rising cost of health care, how to cover Americans without insurance and how to pay for it.

There also seems to be a general agreement among Americans and those in the health care system: “There’s a rather compelling set of facts and evidence that indicates that health care has got to change,” said Jim Cooper, CEO of Medcenter One in Bismarck.

But what those changes are will not be determined by Congress until later this summer, if at all.

The public also has indicated to polling firms that it overwhelmingly wants a change in the health care system, with recent poll for CBS News and the New York Times finding 72 percent in favor of a public system for all Americans that would mirror Medicare.

Policy writers also point to a disturbing trend in the country’s health care system: 18 percent of the country’s gross domestic product is spent on health care. That figure could grow to 28 percent of GDP by 2030 and 34 percent by 2040 if current trends persist and nothing is done to stop them, according to the CEA.

Health care in North Dakota is comparatively cheap, averaging $6,108 for Medicare reimbursements while the nationwide average is $8,304, according to the Dartmouth Institute for Health Policy and Clinical Practice. In McAllen, Texas, the nation’s most expensive city for health care, Medicare reimbursements are nearly $15,000.

But those low Medicare and Medicaid reimbursements are also hurting North Dakota health care providers, especially in the state’s 39 rural hospitals who say they are operating on the edge of a financial cliff. Medicare reimbursements are a common payment many hospitals receive in North Dakota, considering its aging population.

Roger Unger, administrator of the Linton Hospital, said the time has come for change. He is wary of some of the proposals in Washington, specifically plans to cut Medicare reimbursements as a way to rein in costs.

“If I get a cut in my reimbursement levels, I’m out of business,” Unger said. “I cannot pay my bills. It is just that simple.”

That problem will continue to worsen as North Dakota’s aging population continues to climb. By 2020, 46 counties are expected to have 22 percent of their populations over the age of 65, according to a June study of the state’s health care environment that Gibbens co-authored at UND.

North Dakota Insurance Commissioner Adam Hamm said the state lags about 30 percent behind the rest of the country in terms of Medicare reimbursements.

“So by the federal government not paying its fair share in North Dakota, hospitals and clinics obviously can’t eat that entire amount, so what do they do?” Hamm said. “A part of that gets passed on to the private health insurance companies, the Blue Cross Blue Shields of the world, who then pass that on to the policy holders.”

Blue Shield Blue Cross of North Dakota premiums also have increased in recent years, including a 7.9 percent rate increase for group rates that takes effect on Wednesday.

Other problems persist in the state. About 51,900 North Dakotans, or about 8.2 percent of the state’s population, are uninsured, according to the UND report.

The state’s uninsured rate is low when compared to the national average, which is about 15 percent, and a far cry from some states, such as Florida, Nevada and California, that have uninsured rates hovering around 20 percent or more, according to the U.S. Census Bureau.

Meanwhile, 12 percent of North Dakotans live in poverty.

Jackie Grunefelder, a family nurse practitioner at the Linton hospital, said it’s not uncommon to see a person debate which drugs or tests to forgo because of high costs.

“I think they’ve become more selective, sometimes they wait too long or they really are sick because of the cost for them,” Grunefelder said. “And you do see them picking and choosing which medications they’re going to be on because of cost.”

Unger’s also noticed another trend in the four years he’s worked in Linton: the “charity care” his hospital provides for patients who are unable to pay has tripled from $20,000 a year to nearly $60,000.

“What has happened is fewer people have the ability to pay,” he said. “If somebody’s depending on a job at the Gas Plus down here, they’re probably not going to have enough money to pay the medical bills if it’s anything serious.”

But North Dakota has many bright spots, too. The state is among the highest when it comes to medical quality, ranking 13th in the nation, according to a 2007 Commonwealth Fund report.

Youth smoking, a leading cause of heart and lung disease, also has decreased by nearly 20 percent since 1999, and seat belt use was at an all-time high of 82 percent in 2007.

Still, Gibbens said there is room for improvement, especially when it comes to preventing future disease and injury. In North Dakota, 65 percent of the adult population is overweight or obese, 21 percent smokes and the state has the second-highest rate of binge drinking in the nation at 23 percent.

Gibbens said more could be done to help decrease patient infections during hospital stays - a growing problem around the country - as well as increasing preventative care among patients rather than treating problems when they occur.

The proposals

The last time a president tried reforming health care was in 1994 under former President Bill Clinton, whose proposal fell with a thud on the floor of Congress despite a similar Democratic majority in the nation’s capital today.

Two presidencies later, things are “15 years worse,” Gibbens said.

But what the political realities are in Congress will determine the outcome later this year.

“Everything is on the table,” Unger said. “So it’s very hard to say which direction it’s going to go.”

Conrad has said his proposal would establish 50 nonprofit cooperatives, one in every state, which would be run by a board of directors elected by the cooperative’s members.

After an initial government-funded start up, “They would not be eligible for any additional federal insurance; that’s one of the key elements of this, that it not be government controlled,” Conrad said.

States with smaller populations, such as North Dakota, would be allowed to team with other states of similar size, such as South Dakota and Montana.

“I think in D.C., they’re not used to thinking outside of the box,” Gibbens said. “So when Kent Conrad starts talking about an old progressive idea from out of the 1930s, this is a real North Dakota contribution to the debate on health care.”

Conrad’s proposal also has the support of some health care providers in the North Dakota.

“I understand from Sen. Conrad’s proposal, it’s a way to fashion an insurance program that has local roots yet doesn’t have the government control at all,” Cooper said. “I think it would be a mistake if the government controlled everything.”

Any new system is going to have to address the payment disparity, he said. “I think we’re all of the mindset that would welcome a system that pays us on quality, outcome and performance rather than a system that we have now.”

There also is plenty of skepticism.

“I think the issue is, and we don’t know the details about it, how is this going to be funded?” said Andrew Wilson, CEO of St. Alexius Medical Center in Bismarck.

For example, Wilson said, will there be a group rating and a pool of members to negotiate coverage? Or will it be underfunded by the government?

“If it’s going to be an alternative to the insurance industry, and not a health care purchase cooperative under the traditional sense,” Wilson said, “then it will be disastrous to hospitals in North Dakota.”

Hamm said all ideas, from public options to cooperative, should be on the table despite any philosophical or party differences.

“All of that stuff needs to be in place, day one,” Hamm said. “Otherwise, I don’t know how it controls costs, expands access and pays for itself.”

Obama has pushed for a system that would include a government-backed insurance program that would compete with other health care providers as a way to cut insurance costs. It’s an idea that has the support from Dorgan and Pomeroy.

Obama also recently told CNBC that he would support a cooperative concept similar to Conrad’s if “that is a better way to reduce costs and help families and businesses with their health care.”

Among other key proposals in Congress are Sen. Edward M. Kennedy’s bill, which would provide government subsidies for health care premiums for Americans with incomes of up to 500 percent of the poverty line, or $110,000 for a family of four.

The proposal also includes expansion of Medicaid coverage, the government program that covers the poor, to 150 percent of poverty, or a family of four earning $33,075 a year.

Republican critics, as well as some moderate Democrats, have distanced themselves from any “public option,” including Conrad, who has remained skeptical of such a proposal passing the Senate with 60 or more votes.

Dorgan said he would support “some kind of backstop public plan,” noting that most health insurance would be provided by private insurers.

“I will support health care reform if it will allow everybody to keep their own health plan. If they’re satisfied with their health plan, they should be able to keep that,” Dorgan said. “No single-payer government-run plan. I am interested in seeing an approach that would get some control on health care cost.”

Pomeroy said the state’s largest insurer, Blue Cross Blue Shield of North Dakota, needs competition, noting revelations over the more than $1 million in annual compensation and $2.2 million severance package going to ousted Blues CEO, Mike Unhjem.

“I’m for more competition in health insurance. You look in North Dakota, you have a one-company environment,” Pomeroy said, adding, “It needs to play fair on a level playing field. I’m not for a public plan option that would give the public plan significant advantages over any private company would have.”

Back in Linton

Two years ago, Melvin Fortner experienced something much more serious than a wounded hand. He suffered a heart attack.

He was rushed to the Linton Hospital, where the staff there did all they could until they determined Fortner would better off going to Bismarck for specialized care. It was the nearby hospital ambulance that helped save his life, he said.

Fortner also notes that he is lucky he didn’t suffer a heart attack at 40.

As a young man, Fortner said he considered getting health insurance, but decided he couldn’t afford the cost.

So he waited.

“We receive calls every day from people new to Medicare that need help,” Insurance Commissioner Adam Hamm said Tuesday. “These seminars are a great way to learn more about the program.”

Bismarck’s Turning 65 seminar will be held 6:30-9 p.m. June 2 at the Doublewood Inn, 1400 E. Interchange Ave.

Fargo’s Turning 65 seminar will be held 6:30-9 p.m. June 9 at the Country Inn and Suites, 3316 13th Ave. S.

The free seminars include information about Medicare Part D, Medicare supplements and Medicare Advantage plans.