Readers Write for Friday, July 31

Before enacting and implementing an extensive health care reform, why not apply many worthwhile evaluative findings in a pilot project as a part of our existing and soon-to-be insolvent Medicare program? It happens to be a publicly funded health program that includes private providers and insurance companies.

The pilot project would include cost-saving and quality-improvement findings without involving a tax increase or adding to the federal deficit. Examples include: rewarding cost-effective outcomes and penalizing unnecessary procedures; establishing an independent advisory panel to set research-based standards of care; using physician assistants and nurse practitioners for less serious issues; reducing drug pricing by competitive bids; reducing overpayments for the Medicare Advantage option; increasing education for prevention and for end-of-life decisions; setting caps for malpractice lawsuits, and continuing private supplemental insurance for people desiring more coverage.

SHELDON OLKON, GOLDEN VALLEY

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Regional Medicare payment disparities (front page, July 30) have long been a complaint. The obscure formula set when Medicare was enacted 40 years ago did its best to reflect cost-of-living disparities in America. A BLT sandwich will cost more in New York City than in Ames, Iowa. Quality has nothing to do with it.

What is needed is a new formula that will reflect overall cost of living in a census tract and not simply the current medical charges. Quality of care will need to be assessed locally as patients normally cannot travel to "the best" sites but must be served by local providers. Surely we do not need additional bureaucracy.

MARY K. LUND, MINNETONKA

So, those who oppose a health care plan fear a mindless, faceless (by their estimate), incompetent government bureaucrat dictating, and possibly rationing, our health care.

And the difference between that and a mindless, faceless health insurance corporation bureaucrat rationing our health care based on "market forces" where fealty is given to shareholders, then executives, then the corporation -- and what might be left a patient, is what?

M.F. HOFFMAN, RICHFIELD

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If Congress adjourns without acting on health care, pharmaceuticals and health insurance companies get more time to zero in on raising premiums and increasing costs so that they can raise dollars to pay for lobbyists. Representatives and senators are elected by the people who need relief from increased medical costs, not special interests and lobbyists.

GLORIA M. TURNBULL, ST. PETER, MINN.

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I see a lot of people in their late 50s or early 60s losing their jobs. Not only will it be hard for them to find new work, but the odds are against them that their new job will provide health insurance. People in this age group should be able to see a doctor more often, especially for preventive care, not have to cut corners with their health.

Fortunately the health care bill in the U.S. House would help by giving people who were forced to retire early the ability buy Medicare coverage at an affordable rate.

FLOYD HIAR, SAVAGE

SHARON FORTUNAK, COTTAGE GROVE

E.J. Dionne Jr., in his "Heck, let's let guns into the U.S. Capitol" opinion piece (July 29), could just as well have said "I've made up my mind; don't confuse me with facts."

Reason tells us that there will always be large numbers of people who don't agree with the actions of Congress.

Reason also tells us that out of those large numbers there will be many who have no regard for what is morally good or morally bad. Such people wouldn't hesitate to go after those who have angered them. Hence guards and metal detectors.

Ordinary citizens don't have these security benefits. Hence the right to self-protection. Very simple; very reasonable.

Thinking about Michael Jackson's sleep deprivation, I turned to Shakespeare's great meditation in Macbeth: "Sleep that knits up the ravelled sleeve of care." The word "sleep" screams throughout the play, and after the murder of King Duncan, Lady Macbeth sleepwalks so dramatically that she frightens her physician.

Not to be able to sleep, to have the "Balm of hurt minds," is frightening. Drugs may not have been needed as much as a descent into the soul. These old writers are physicians of the spirit.

MICHAEL ALLEN MIKOLAJCZAK,

ST. PAUL

This Sunday morning I walked with the dog along the river where the night before a spectacular fireworks show had been created by Target. Midmorning, less than 12 hours after hundreds and hundreds had watched this show, not one scrap of trash remained in the area.

KATHLEEN CLARKE ANDERSON,