Continued: Readers write, for Aug. 7, 2009

HEALTH CARE REFORM

High-cost cities should learn from low-cost areas

Not surprisingly, some doctors and hospitals in high-cost areas such as Los Angeles are resisting the idea that they can reduce health care costs by adopting medical practices of low-spending regions ("A health care fix too good to be true," July 29). They offer a variety of arguments to defend their high spending. I believe these arguments are misleading.

Argument No. 1: Comparing California to Minnesota is unfair, and payment reform is simply an attempt to benefit providers in Minnesota. In relative terms, the proposed payment reform is likely to offer greater benefit to South Dakota, North Dakota, Hawaii, Iowa and Maine than it is to Minnesota.

Argument No. 2: Los Angeles patients are sicker and therefore consume more health care resources. In February 2008, Peter Orzsag, as director of the Congressional Budget Office, reported to Congress that three previous studies of patient health status found that patient differences explained less than one-third of the regional differences in Medicare spending.

Argument No. 3: Medicare spending is high in Los Angeles because it has large poor, minority populations. Medicare spending in Los Angeles is more than 30 percent above the national average. In contrast, Medicare spending is at or near the national average in several other cities -- for example, Cleveland, Buffalo, Pittsburgh, Milwaukee and El Paso -- that have substantial minority populations and median incomes that rank them far below Los Angeles.

High-cost areas are generally limited to a few geographic regions within just 10 states. These areas often provide lower-quality results as well. Several legislators have introduced bills to adjust the Medicare physician payment system so that it appropriately rewards high-quality, affordable care. I believe that these payment adjustments will encourage caregivers to change their behavior, leading to lower long-term costs for everyone.

DR. RAY GIBBONS, ROCHESTER;

MAYO CLINIC HEALTH POLICY CENTER

TOWN HALL DISRUPTIONS

Colbert tells the truth;

why can't the Strib?

When Stephen Colbert can spend five minutes of his show lampooning a memo from the organizers of the "grass-roots" disrupters of congressional town hall meetings, I am astounded that the Aug. 6 article "Democrats getting an earful on health care during recess" did not report on the organized efforts to disrupt these meetings. As Colbert said, "we don't need to be a majority, we just need to say it" as he showed a pie chart of support for health care reform with a majority supporting some reform.

These organizing efforts are facts, not opinions from Speaker Nancy Pelosi, as the article states.

Is the next story going to be: "Sun circles the earth? Opinions differ."

MARC ASCH, NORTH OAKS

•••

For years, weekly protests by left-wing extremists have been held at U.S. Rep. John Kline's local office.

Now it seems the hard-core left is shocked that, for once, the average guy is protesting against "Obamacare" at congressional town halls. It's as if the right to protest only belongs to them.

The left-wing agenda on health care, cap-and-tax and crazy spending has overreached, and the sleeping dog has finally awakened.

MICHAEL TIERNEY, BURNSVILLE

•••

The problem with today's political discourse is that the Democrats think the Republicans are stupid and the Republicans think that the Democrats are stupid. And they're both right.

DOUG WILLIAMS, ROBBINSDALE

TEA PARTY PROTESTERS

Taxpaying, well-dressed and fed up with Obama

I am in my 60s. I am a college graduate. I am a wife. I am a mother. I am a grandmother. I am a small-business owner. I am a taxpayer. I am well-dressed.

Are you scared yet? BOO! I am a supporter of the Tea Party movement.

And to make it worse -- I'm proud of it.

CRYSTAL QUIRING, SHAKOPEE

CASH FOR CLUNKERS

Why the anger over it?

Why are so many upset with the cash-for-clunkers program? Is it because it helps the car dealers? Is it because it helps the workers in the factories keep their jobs? Is it because it gets gas-guzzlers off the highways? Is it the cost?

The program costs less than two weeks in Iraq. Are certain senators and members of Congress only willing to spend money if it is for war?

Or maybe cash for clunkers just works too well.

JAMES BETTENDORF, BROOKLYN PARK

minnesota nice

A Delaware traveler finds it's the real deal

To the people of Minneapolis and St. Paul: I recently visited your great cities and found the residents to be delightfully warm, friendly and hospitable.

I'd been told of something called "Minnesota Nice." Not sure what it means, but please continue to keep the charm. I felt welcomed and hated to leave. We could learn something here in the East about random kindness to strangers and neighbors.

GREG COY, WILMINGTON, DEL.