Regarding "Tricky operation" (Jan. 21) by Dr. Steve Calvin: Those on the left do not believe that "Medicare and Medicaid dollars flow from a magical federal fountain providing an ever-increasing flow that will never run dry." Rather, it is the excessive administrative overhead of our private health insurance system that is draining our country, its individuals and businesses.
A single-payer system would spend fewer dollars on administration. For example, Medicare, which is a single-payer system, spends less than 3 percent on administration vs. 15 percent to 20 percent with private insurance. Not only that, a single-payer system, by including everyone, would have greater ability to control costs by negotiating down the exorbitant prices Americans pay for prescription drugs. And it could create uniform reasonable transparent charges for other overpriced segments of our current system.
Fiscal conservatives might want to look at the savings single-payer could achieve, through stemming the flow of public dollars that are already being used to support our health care system. Not only does our current multipayer system prevent or delay individuals from getting needed health care, leading to unhealthier workers, but wages are stagnant and global competitiveness is reduced due to rising premiums.
Calvin introduces many important ideas for improving our system, such as regulatory reform, innovative efficiency, transparency, reevaluation of pricing, and roles of doctors and hospitals. But if the bipartisan Minnesota Senate Select Committee on Health Care Consumer Access and Affordability does not take a serious look at the elements of state Sen. John Marty's comprehensive Minnesota Health Plan, then it will fail to address the central issues it seeks to solve: access and affordability.
Dr. Carol Krush, Minneapolis
The writer is a retired family physician.
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Calvin provided good analysis. However, I would like to point out two misconceptions in his article: the idea behind the opposition to block grants and health care as a closed system. Calvin's argument that Democrats were against block grants for Medicaid due to their belief in the magical flow of cash misses a valuable point of opposition. The change to block grants gave no consideration to epidemics in a given year. If there is a higher flu rate one year and thus Medicaid spending increases and uses the block grant, then what? Do we kick people out of their nursing homes? Do we forgo services for the patients who receive Medicaid? This was really the issue, not the lessening of the magical cash flow.
The other point, not Calvin's but one I think needs to be addressed, is William Kissick's idea that care is provided in a closed system. Nothing in the world happens in a closed system. This is part of the problem when we attempt to use positivist research approaches in the real, open world. Any approach toward health care must be done through an acknowledgment that it is being implemented in an open and chaotic system.
A final plug I would like to make is for the inclusion of other disciplines in the policy process, such as nurses, social workers and respiratory therapists — disciplines not restricted by the view that illness is reducible to pathology but rather exists in an open system.
Ian Wolfe, Minneapolis
The writer is a registered nurse.
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Indeed, it will require millions of "skillful touches" to cut Minnesota health care costs and preserve medical care quality. Who in America is better able than individual patients and families to do the "fracking" of our health care system suggested in the article? The elephant in the room is lack of price transparency to patients and families for their health care services and insurance. Patients don't know what things cost until after the bill arrives. We need to have real-time answers to the critical question: "How much does this care or insurance cost?" And we need public policy to make price transparency real in Minnesota. The "tricky operation" on the health care system can then be performed by the millions of individual decisions made by patients and families. State Sen. Scott Jensen and the Legislature are urged to support real health care price transparency to Minnesota consumers.
Dr. Lee Beecher, Maple Grove
The writer is president of the Minnesota Physician-Patient Alliance.
RACISM
If Edina is taking action, trust me, it's sorely needed
I live a few blocks from Edina in Richfield, and I know that my friends and colleagues of color are very cautious driving in either city ("Edina acts on racism concerns," Jan. 21). I went to the Edina City Council meeting following the public outcry after video footage of the arrest of an African-American man went viral. Mayor James Hovland and City Council members were gracious and concerned with the public testimony. But …
I drove to this event with an African-American friend who works at the Hennepin County Juvenile Detention Center, and when we pulled off Hwy. 100, the scene was intimidating. There were police cars with their lights on, and in the parking lot by Edina City Hall, even more of them. We walked into the council chambers, and there were three police officers standing by the council members — also the police chief. It was intimidating and angering.
Articulate young Black Lives Matter members were there, along with Nekima Levy-Pounds. About a third of the 100 or so people there were of color. We were all allowed time to testify, and I will never forget the first young African-American man who stepped up and said he works at Southdale Center; he is fearful of the Edina police whether he walks or drives at night. He feels safe only when he gets to the Minneapolis city limits near 50th and France.
One after another, the people testifying expressed fear of the Edina police, almost exclusively a white force. All my friends of color told me they are often stopped by the police.
After that evening, I called the CEO at Fairview Hospital and asked him to query his employees, doctors, nurses and staff (who represent many countries) to see if they are harassed driving in Edina to their workplace. I asked the Southdale mall manager to survey his businesses and people of color as well. My husband is in Mount Olivet Careview Home in Minneapolis, and almost all the nurses, support staff, dietitians and custodians are African immigrants and provide a very caring environment.
If you are white and have not had to worry about going to church or work, shopping or seeking care in the Edina medical mecca, maybe you need to listen to people of color and take action to change your community.
Kay Kessel, Richfield
POLICYMAKING
Needed: not just new federalism, but less government overall
I enjoyed Lori Sturdevant's Jan. 21 column "Policy still has a chance — at the state level." Sturdevant interpreted Ted Kolderie's writings as favoring a shift from "New Nationalism" (centralized federal power) to "federalism" (giving power to state and local governments). Certainly, part of this is true. But, as was quoted in the column, Kolderie's ultimate solution is to have state governments "maximize efficiency by contracting with private or nonprofit service providers, unleashing the power of both competition and cooperation."
Put simply, this is a clear argument in favor of smaller government, both federal and state. Why? Because we all see the proof everyday that government-operated programs, whether overseen by Democrat or Republican politicians, don't work very well and cost a lot of money.
How about this idea: When we complete our tax returns and calculate how much we owe in taxes, we are given the option to direct 25 percent of our federal and state tax liability to nonprofit service organizations of our choice. Each taxpayer must pay the same amount of money (not a tax cut), but instead of all the dollars going to fund inefficient government programs, we shrink the government by 25 percent and "incentivize citizens to make choices that coincide with the public interest," as Kolderie advocates.
