‘Free’ medical care is an unhelpful scapegoat

I had high hopes when Robert W. Geist began his Jan. 8 counterpoint with the valid question “Why does treating an ankle fracture cost $35,000?” I would add: Why are so many bankruptcy cases tied to medical costs? My hope was dashed, however, when Dr. Geist failed to offer any positive suggestions, instead presenting a diatribe unfortunately typical of the well-off and well-insured (“The high cost of ‘free’ medical care”).

Most of us have heard the arguments about all that has gone wrong with health care since it was made available to the poor and the elderly for “free” in the late 1960s. But there seems to be no consensus in the medical profession — there are doctors who, perhaps unlike Geist, believe in the efficacy of a single-payer system. What if, instead of constant bickering and sabotage, we tried pulling together as a nation to implement the Affordable Care Act enacted by Congress, signed by the president and upheld by the Supreme Court? As we work on that, it certainly would be a valid exercise to identify problems and fix them as we continually strive for a better system.

TOM SALKOWSKI, Buffalo, Minn.

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Presumably, Geist’s better way is to have each individual purchase private health care insurance, or go without and suffer the consequences. The Affordable Care Act is criticized as a move in the wrong direction.

He dismisses the role of health care providers in the rising cost of medical care. However, most of these are businesses with income and profit motives. Limited competition and untrained but motivated consumers incentivize some to provide unnecessary care and charge high prices. Individual insurance (or no insurance) will not correct this dysfunction.

Medical care insurers do not escape the cost disincentives. It is difficult for them to compete on the basis of denying coverage for procedures that a provider recommends.

It is well-publicized that the United States has the highest health care costs in the world, by a factor of two or more over other industrialized countries. Less well-known are the very mediocre U.S. health outcomes, ranking near 30th in many measurements of collective health. As virtually all of these low-cost, high-health countries have government-run health systems, the fault does not lie only in “free” medical care.

The Affordable Care Act is intended to alter the business model. There are incentives to focus on health outcomes (and not procedures), to provide guidelines for cost-effective care, and to increase competition among health care insurers and providers. Reducing the number of uninsured freeloaders can only help to reduce costs for the rest of us.

FRED POLLMAN, Eden Prairie



A space for senators, then, or for homeless

I agree with the writer of the Jan. 9 Letter of the Day (“State Senate office proposal adds up to one big waste”), who suggested that space could be found in other state-owned facilities. Failing that, the Legislature could rent space in the former Macy’s building that the St. Paul Port Authority just bought (“St. Paul Macy’s has buyer, but for what?” Jan. 8). No new Senate office building is called for. Not when we’re not feeding the hungry or housing the homeless.


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I’ve got it! Convert the Macy’s site into much-needed low-income public housing so that the poorest, neediest and hungriest homeless among us have a safe haven even in the coldest of winters.

Our stadium addiction notwithstanding, let’s heed the sage advice of Hubert H. Humphrey — that a society will be judged not by how it treats the well-to-do but by how it cares for its neediest and most vulnerable. I even have a name for it: The Dorothy Day/Hubert H. Humphrey Center.




At some point, they become redundant

Recently the Star Tribune has featured in articles and editorials concerns about gun carry at the State Capitol and at meetings of city councils and county boards. The concern is that government officials are at risk from angry, potentially violent citizens and that the state’s carry law should be revised to restrict permitted carry in government venues.

Such a restriction could have an effect only in the following scenario: if a permit holder — who previously has demonstrated the clean record, patience and responsibility to go through the costly and lengthy process of obtaining a permit, and who would honor such a prohibition if it were in place — might, in its absence, commit a felony with a gun in a fit of uncontrolled rage. This is highly unrealistic, given the years of experience across the United States with permitted carry that has disproved the contention that it would lead to increased spontaneous gun violence.

Murder is a crime; assault with a deadly weapon is a crime; carrying a handgun without a permit is a crime. Would increased restrictions on carry accomplish anything other than making the misuse of firearms “illegaler”?




Some numbers, for perspective

Recent letters (“A militarized United States has made the world a better place,” Jan. 7, and “Yes, it’s valuable, but there are limits,” Jan. 8) suggest the need for some numbers to inform the discussion. Data from the Web indicate that in 2012 military expenditures in the United States amounted to $682 billion, 39 percent of the world total. There are more than 700 U.S. military bases in more than 60 countries, home to a quarter-million personnel. Does this suggest keeping the peace — partly by (necessary?) wars in Iraq and Afghanistan, and almost in Syria — or dominating the sources for supply of resources needed by our economy and deterring our competitors for them? And if both, how much are we paying for each?

EVILLE GORHAM, Minneapolis