Readers Write: Corporate tax changes, President Donald Trump, cost of hepatitis C treatment for inmates, health care policy and HMOs

Happy 2018, U.S. corporations! Now that you are beginning to revel in your giant tax cuts, please allow me to suggest some ways in which you can thank those of us (and our descendants, and their descendants) who are paying for your good fortune.

First, you can be aboveboard, ethical and moral in all of your business dealings. No more profits at the expense of safety; no more underhanded dealings with politicians; no more skimming and falsifying. If we could believe you were honorable institutions, we might feel a little better about supporting a government that is supporting you foremost.

Second, please open your workplaces without reservation and compensate your workers equally, especially protecting women and people of color by providing living-wage salaries, benefits (including health care and sick days) and an employee share in the profits. If we worked for you and felt good about it, we might be more inclined to smile when told that we must pay for you to get richer.

Third, please make sure your corporation is respectful of the environment in all of its dealings. After all, we wouldn't need federal regulations if companies were accountable for their impact and their actions. We could feel more positive about you if we thought you were interested not only in making money, barrel over barrel, but also in contributing to saving our planet for us and for future generations. I could go on, but you get the idea.

Again, congratulations on your huge windfall. Please thank us by using it justly and wisely. It's simple, and it's even good business practice: Please do the right thing.

I just spent an evening listening to reports legitimately questioning our president's mental competence and emotional stability. But the reporters are missing the crucial clinical question, i.e., whether these intellectual problems are characteristic of the man or represent a significant decline in functioning due to illness. There is a powerful case to be made that Donald Trump is, like President Ronald Reagan before him, serving while in the relatively early throes of a dementing illness such as Alzheimer's disease. It's an important question and one that we really should be trying to answer.

Regarding "Inmates sue to get costly drugs" (Jan. 2): Hepatitis C (HCV) is the most common bloodborne illness in the U.S. and the No. 1 cause for cirrhosis, liver cancer and liver transplant in our country. As health care providers specializing in the treatment of HCV, we understand the prohibitive effects of drug cost on the access to treatment. We have witnessed the negative impacts on individuals not allowed treatment and can foresee that an aging HCV population that is not aggressively treated now will only lead to an increased burden on our health care system at costs that far exceed any single HCV treatment.

Without treatment, the rate of HCV infection will only increase in our prison population, increasing long-term costs not only for treatments but also for care for those with advanced liver disease. The greatest advantage we have to treatment in the prison system is that these patients are a captive audience and we can ensure that they take the medication correctly, maximizing their chance for cure and increasing our ability to eradicate HCV not only from our prison populations but our community at large.

The writers include a physician assistant and registered nurses.

I read with great interest state Sen. Scott Jensen's Dec. 28 editorial counterpoint "Why we should start talking about a state mandate." Jensen, a physician, believes people should not be allowed to die in the streets. However, he recently posted a Facebook video in which he explained why we can't afford to provide access to health care to all Minnesotans.

I have heard Jensen speak and have met him. He is erudite, personable and from a medical practitioner point of view appears to be competent. However, when it comes to public policy, he seems to blindly follow the HMO/insurance playbook.

Jensen talks a lot about "bending the cost curve." He believes health care is so expensive because of ignorant patients who don't know how to shop; drug companies; physicians who prescribe expensive and inefficacious treatments; and basically everything except his HMO pals, whom he describes as essential partners in our health care system. But what if the insurers are the biggest cost driver in our health care system? What if they siphon off 40 percent to 50 percent of every dollar that is paid for care in our present system? Health plans self-report administrative expense of 10 percent. They routinely self-report double-digit profit margins, and recent court cases have suggested that they internally inflate the reported cost of health care by more than 20 percent. If all of this is true, that would make health insurance the problem rather than the solution.

Some months ago, Jensen told me that the HMOs rule this system with an iron hand. He is quite correct on that point. So if we are going to have a state mandate for insurance coverage, then the product must be provided by the state. It must be accountable, transparent and honest, with cost adjusted for age and income, and it must have no useless HMO brokers. State Sen. John Marty has been suggesting such a solution for many years.

Welcome to the party, Dr. Jensen. No one wants a mandate that requires them to buy something they can't use from a private concern they don't trust.

The writer is a lawyer who was for 30 years general counsel for the Minnesota Hospital Association.

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John Folsom's Jan. 4 commentary ("Lifting the veil on all-too-hidden medical fees") suggests that it is only individuals and employers shopping for health insurance who ought to bring price pressure to bear in the health care marketplace. I disagree. Government has a crucial role in this situation. Currently, Minnesota state government has evaded its responsibility to audit the $5 billion annual expenditure, given to HMOs, to run the health care programs for low-income patients. If Minnesota officials conformed to the law to get proper GAAP audits on that money, we would have most of the necessary information on actual prices paid to care for patients around the state.