Lori Sturdevant: As always, Arne Carlson speaks his mind

Business has been brisk on the former-governor beat of late, thanks to the irrepressibly outspoken Arne Carlson.

Some consider Carlson innately shy. But he's never retiring, in any sense of the word.

As he celebrated his 75th birthday last week, the dominant figure in Minnesota politics of the 1990s was every bit his usual self. He gave a speech Tuesday that more than implied that his fellow Republican governor, Tim Pawlenty, ought to be more mindful of the state store.

Peripatetic presidential hopeful Pawlenty (try saying that three times) hasn't been doing enough to balance a state budget that's tilting badly into deficit territory in 2011 and beyond, Carlson heavily hinted. He went on to foreshadow Pawlenty's likely response, decrying the "politics of avoidance" at the statehouse.

Sure enough: A day later, the incumbent all but called the predecessor Gloomy Gus. Pawlenty downplayed the state's budget problems as "very manageable."

Carlson might not have expected the additional shot from Pawlenty spokesman Brian McClung. After questioning Carlson's Republican credentials, McClung went after the former governor on the season's angstiest topic, health care.

"The government-subsidized health care programs he created are now growing at unsustainable rates, and his response is that we should raise taxes in an already highly taxed state," McClung said of Carlson. He snipped: "Some people apparently don't know when it's time to leave the stage."

Two things should be said about that. One: Carlson didn't recommend higher taxes on Tuesday. And two: The only government-subsidized health care program that Carlson midwifed is MinnesotaCare. About that, he's justifiably proud.

MinnesotaCare is the "public option" for low-income working people who have no other option. Eligibility is limited to low-income people who lack employer-provided health insurance. It's one of the main reasons Minnesota's uninsured population is smaller than in any other state, save for Massachusetts.

That's a social good. It means more people have the preventive care and early treatment that make for healthier, more productive, more taxpaying lives. Many of the 125,000 low-income Minnesotans who buy state-discounted MinnesotaCare insurance would need to leave the workforce without it. In that way, MinnesotaCare has reduced welfare costs.

About those costs: Yes, they've been galloping, but not much faster than total health care spending in Minnesota. MinnesotaCare's average annual per-person cost growth from 2001 through this year has been about 8 percent. For Minnesota as a whole, the comparable number through 2007 is 7.6 percent.

Those numbers are too high, especially if the state economist's forecast of an era of slower growth materializes. If that's what McClung means by "unsustainable," he's right.

But MinnesotaCare is not a state budget buster, because it isn't funded by the state's general fund. It has its own revenue stream, the 2 percent tax on health care services known variously as the provider tax and, to its detractors, the "sick tax." That tax funnels into the Health Care Access Fund, which has shown a surplus every year since its creation.

"The provider tax turned out to be ingenious," Carlson says now. "It always produced a surplus. It kept the tax inside the system, which made it an impetus for more efficiency." He points to total health care costs that are lower in Minnesota than in most states.

The tax was initially detested by health care providers. Then the hospitals discovered it was saving them money. A 2003 study showed that MinnesotaCare reduced charity care costs enough to cover their provider tax outlays.

Since then, docs and hospital execs have been coming to the Capitol to defend the program and its fund from raid attempts by the governor. Pawlenty has tried repeatedly to tap the fund for other purposes. A tug-of-war over MinnesotaCare will be remembered as a constant of the Pawlenty years.

Carlson is happy to defend the program he signed into law in 1992, after its birthing by a bipartisan panel of legislators and some able commissioners in his administration.

"MinnesotaCare has been a fabulous success," he said recently. "It's self-sustaining, it's inexpensive, and it works. It provides access."

It's so good that Congress and President Obama should take note. If affordable access to health insurance coverage is the goal, a controversial public option for every American might not be necessary. Minnesota has shown that a public option tailored for the uninsured working poor can get the job done.

It might even be something that a Minnesota candidate for the presidency would want to brag about.

Lori Sturdevant is a Star Tribune editorial writer and columnist. She is at lori.sturdevant@startribune.com