Letters to the editor for Sunday, April 6

Your March 30 editorial eloquently pleads with Democrats and Republicans to work together, bridge the bipartisan divide and actually get something done in health care reform this year. I support this idea.

Your error, however, is in your analysis of the bill. Proponents say it will cut costs a whopping 20 percent, but it won't. The bill is modeled after the "Massachusetts Connector" system which is currently failing because of increased costs, and the proponents in Minnesota can't offer any other actual data on potential cost savings.

Before we spend $47 million implementing poorly designed reform during a recession year, I feel we should look at the options more closely. I support Sen. John Doll's comparative cost analysis bill, which studies the major reform bills in the Legislature. I personally believe single payer is the only way to provide quality affordable health care, but why not compare the options first?

ELIZABETH FROST, M.D., MINNEAPOLIS

A public-private plan Dr. Denis Cortese's diagnosis of our health care crisis (Opinion Exchange Q & A, March 30) is good, but his prescription is dubious. Like most inside "players," he is guarding his turf.

Yes, we have a fractured approach to health care. Yes, we should all be encouraged to stay healthy. Yes, outcomes of treatments should be quantified, analyzed and published.

But he denigrates Medicare, an insurance program that was consciously constructed and would be much more fiscally responsible had its funds not been squandered in the past few decades by payments to private insurers for HMO plans and prescription drug insurance. Indeed, a tax based on income is far more equitable than premiums based on "preexisting conditions." The latter would prevail in an insurance-mandated world. A Cato Institute report shows that mandates have already failed in states like Massachusetts where most new enrollees require public subsidies.

MARY K. LUND, MINNETONKA

Open up the debate It is easy to agree that the insurance industry interferes, but Dr. Denis Cortese seems to attribute that entirely to it being a mix of private and public, in a way that does not provide enough incentive to the private (earlier) insurance carriers to take the longer view of health (benefits will be reaped by a later carrier or Medicare). He assumes that we can find ways to realign the incentives so that the private insurance carriers will put the patients first. Most studies that I have reviewed suggest that one can improve care with some interventions, but they rarely save more than the intervention costs.

He completely ignores the much more cost-effective change, which is to simply extend the traditional Medicare to everyone. Medicare already has the longer view. [In contrast to the employer-based nonsystem now, where one may be forced to go to new physicians and hospitals every time the employer changes insurance carriers.] Medicare overhead is about 2 percent vs. about 20 percent for insurance carriers.

Cortese asserts: "Nobody is saying a single-payer system .... Nobody I have heard of is talking about system-engineering in health care to redesign the way we provide care." But that is because he is considering only the current positions of the leading three presidential candidates. Why should we be restricted to those cautious positions, seemingly crafted to avoid upsetting the large donors -- especially the medical insurance industry?

JOHN T. (JACK) GARLAND, M.D.,

Regarding your March 30 front-page article "Hospitals learn to say sorry": I work at a nonprofit organization that assists refugees with medical appointments, legal issues and jobs. We recently worked with a client who underwent a standard surgical procedure that instead left him limping, with intense leg pain, and needing another surgery to correct the mistake of the first one.

The hospital certainly deserved a lawsuit, but cultural differences, financial difficulties and a feeling that American systems shouldn't make such mistakes kept the client from filing.

Hospitals should keep cases like his in mind: The more vulnerable members of our community -- whether by immigration status, race or culture, income, physical or mental disabilities -- deserve to be told when mistakes happen. This is a moral issue, a simple act of respect to the patient, whether or not they seek legal recourse.

IHOTU ALI, ST. PAUL

Your March 30 front-page photo of an abandoned Burger King is a travesty for Anoka and all businesses trying to do their best in hard economic times. Instead of a negative portrayal of the city's current economic situation, the Star Tribune could have reported that the very location declared closed is in the final stages of a redevelopment called Union Square, and five other new businesses are soon to open in downtown Anoka.

Don't blame economy Anoka's problems are less the result of a tough economy and more directly caused by ineffective leadership, poor planning and lack of cooperation by the mayor and recent city councils. Let's hope this quaint town with the treasures of two rivers and a brick-front, historic Main Street can continue to weather the economic storms and bring back thoughtful community and business planning to ensure a strong, prosperous future.