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I am very glad to hear that D.J. Tice is recovering and doing well ("How I survived my summer vacation," Opinion Exchange, Aug. 7). He is right, we are fortunate to have the high-quality care we do in this country. Of course, we really pay for it too.

Beyond the debate on whether the fabulously rich pharmaceutical companies should have to negotiate drug prices and if it will hurt innovation, there is the larger issue of the cost of the whole health care industry, including pharmaceuticals. At nearly 20% — and growing — of our GDP, it's twice as great as the next most expensive country. It seems that we have apparently decided to pay any price try to cure every possible disease that plagues us humans. How much is enough? How much is too much — $50,000 a year, or $100,000, or a million for a pill or procedure for one particular disease or problem for one person? What do we do when the majority of our spending is going to pay for health care? And if we do nothing, what do we give up in our quest for immortality? Education, roads, fire protection — retirement?

What to do? I don't know, but these are the hard questions — with no easy answers — we need to ask before the whole thing collapses.

In the meantime, welcome back, D.J.!

D. Roger Pederson, Minneapolis

The writer is a retired health care analyst.


Tice makes the claim that "there's no better place in the world to be when you get really sick" — a bizarre claim given that the CEOWORLD magazine's Health Care Index ranks U.S. health care 30th best — behind Canada, Japan and pretty much all of Western Europe. Perhaps Tice doesn't travel much.

I recently returned from a family vacation in Croatia (42nd best according to the magazine), where I fell down some steps, ruptured the ligaments attaching my quads to my patella, and was rushed to the hospital for emergency surgery ("out of network," of course.)

I can say, from firsthand experience, that health care in Croatia (only 42nd best, after all), is truly barbaric. I was admitted into a hospital room with five other men (none well enough educated to speak English), and post-surgery they encased my knee in a plaster-of-paris cast (which amused the staff at TRIA Orthopedics when I got home).

But nothing was so telling of the primitive nature of Croatian health care as the bill, which my "Medicare Advantage Plan" won't cover. Ambulance ride, emergency room admission, major surgery, and two nights in the hospital: approximately $1,000.

John K. Trepp, Minneapolis


Readers were pleased with Tice's positive report about his heart condition in his commentary on Aug. 7. But a guess is that a lot of us were not pleased with his defense of Big Pharma. True, its research is important, but Congress' effort to rein in its prices does not have to reduce the research. Pharma's well-above-average profits allow plenty of room to continue finding new drugs. An online article from Bankrate that is a guide to investing in Big Pharma is telltale. Three of the industry's top earners gained operating profit margins over 20% during each of the past five years. Pharmaceutical companies in general collected close to 25 cents in operating profit for each dollar of revenue they earned. Compare that to the approximate 12 cents for the overall market. Good grief, during the years 2009 to 2018 the average net price of brand-name drugs went from $149 to $353 for Medicare Part D.

Jim Bartos, Maple Grove


If you can't afford it, no drug will be worth a damn!

Brian Layer, Becker, Minn.


The U.S. is the only developed nation where drug prices are not controlled on a national level. We are paying much more than Canadians or Europeans or South Americans for medications. The reason cited is that if we were to pay the same amount for medications as the rest of the world, drug company profits would drop and they would cut back on research and development. That would decrease our supply of new medications. This argument is supported by a large lobbying effort in Washington.

The idea that decreased profits will lead to less R&D makes no sense. Drug companies are in business to make money and incidentally they develop useful medications. They make most of their profits from high-priced drugs, which are patented. There is no competition for patented drugs so the companies can pretty much set their prices in the U.S. Patents have a time limit. Once the drugs are off patent, the profits drop sharply. Drug companies are dependent on a constant supply of new drugs so they can get new patents. The supply of new drugs comes from their R&D. Research and development are the lifeline of these companies and cutting back will cut back on their big sources of income. It makes no business sense for these companies to cut back on new drug development.

Drug companies are making good profits. American drug companies spent more money on stock dividends and buying back stock than on R&D in the last few years. Their executives are well compensated and they have a multibillion-dollar advertising budget. The drug companies are not in any financial distress. Controlling drug prices in the U.S. like the rest of the world will help put the drug industry on a fairer basis for everyone.

Martin Urberg, Edina

The writer is a retired physician.


We can tackle this

It's pretty unrelenting, isn't it? Within hours of the primary election ending, the media are already full of ads looking to paint the surviving rivals in the darkest light. Of course, politics has always been a full-contact contest in American life, a form of popular entertainment that can be relied upon even now during the few weeks when other sports are out-of-season. Voices of moderation ("Close win carries a message for Omar," editorial, Aug. 11) urge opponents to recognize their limitations and work together, but only those who expect the imminent outbreak of world peace are counting on this, right? To be sure, the vote remains the ultimate democratic weapon, but what happens between elections? And what happens when the validity of elections themselves is called into question? Extreme commentary has shifted to the possibility of another "civil war."

Thirty-second commercials, even with "footnotes," don't even start to address the things on our mind. In any case, it's not the politicians who need to talk more; it's us. I spent some time last week at the Washington County Fairgrounds, staffing a booth for Braver Angels, a national organization whose goal is reducing polarization in our politics. We were there simply to start conversations, without any intention of changing minds or tamping down partisan zeal. It was surprising to see how many folks shrugged off the question, "Are you happy with the way government is working now?" Maybe they were simply exhausted or discouraged. Others stopped and began talking, often to express frustration with the images the media have created or with the serious concerns they have overlooked. A remarkable number of people said they have trouble listening to views they disagree with. It can be painful to have political discussions with colleagues, friends, even family.

Yet citizens need to grapple with issues, and that process begins with understanding exactly what the "other side" is saying. If you are interested in practicing the skills needed to do this essential listening, you can find more information at BraverAngels.org.

A quotation, allegedly from Ben Franklin, often makes the rounds of Congress and Twitter: Asked what form of government had emerged from the Constitutional Convention, he supposedly replied, "A republic, if you can keep it." Ominous stuff — just one more bit of history for pundits to argue about. I prefer what one of my fellow Braver Angels member said. For people who are interested in having a future that works, talking about divisive topics is "difficult, possible, necessary."

John Ramsbottom, Minneapolis