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This spring, the Minnesota Legislature is on a path to finance millions of dollars for many capital projects — new public buildings like convention or sports facilities and park amenities — proposed by cities and counties competing for this state support. These funds pay for the brick-and-mortar portion of these public projects, when property taxes dollars aren't enough.

Legislators have a difficult job selecting from among so many great projects. But one criterion should be the proposers' financial capacity to rehabilitate or replace these projects, once built, over time.

State Rep. Fue Lee's legislative proposal to evaluate the long-term public cost of extending the life of these publicly funded projects is spot on. We were pleased that Lee acknowledges that the bonding bill doesn't just award cash prizes but that these investments are only the beginning of a decadeslong financial commitment from localities to protect that asset.

That's why we write to recommend that consideration also be given to the costs to operate and maintain the facility once it opens its doors — and throughout its useful life. As former public officials, we know that taxpayers are unaware and underinformed of the cost of these new obligations, typically covered by an increase in the local property tax levy.

Legislators and taxpayers expect their local leaders to maintain facilities and not let them fall into disrepair. A great example of this failure to maintain public assets is the recent approval for the city of St. Paul's new 1% sales tax to pay for neglected maintenance of its public facilities — roads, bridges and recreation centers. Yet right now, St. Paul is at the Legislature seeking millions of bonding dollars for new public facilities — even when it has a backlog of maintenance needs for its current assets.

Legislators need to ask: How does St. Paul intend to pay for the ongoing staffing, operating and maintenance costs of these proposed assets when it couldn't pay for the existing ones?

Although the details of local projects to receive state bonding have not yet been announced, we support the provision, including guarantees requiring any public facility built with state bonding money or local sales tax revenue include a plan to adequately fund proper maintenance of the new assets over their useful life and to be clear about the amount and source of funding to staff, operate and maintain them.

Jane Prince and Carl Michaud, St. Paul

Prince is a former St. Paul City Council member, and Michaud is a former Hennepin County Public Works director.


HEALTH CARE

More transparent pricing is here

In the Wednesday letter to the editor "Every player contributes to the mess," a writer asks: "Why can't patients and insurance companies get clear, transparent pricing for procedures?"

The answer is: You can. Under my hospital pricing transparency law that passed last year, hospital systems are now required to publish their prices in a consistent format. If you want to know how much a health care procedure will cost you at different hospital systems under your health plan, you can visit the Turquoise Health website (turquoise.health) and enter your ZIP code and the name of the procedure. Turquoise will present the list price, the cash price for patients without insurance and, if you click "See All Rates," it will show you the rates at all hospitals near you for each health plan, as well as each hospital's quality rating.

Be prepared to be shocked by what you see. The prices for common procedures can vary wildly by hospital and by health plan — it really does pay to shop if you're facing a procedure that can be planned in advance.

Beginning next year, the law applies to surgical centers, specialty medicine practices and large dental practices as well.

Steve Elkins, Bloomington

The writer is a DFLer in the state House.


MENTAL HEALTH CARE

Law wouldn't loosen safeguards

Around 2.4 million Minnesotans live in regions with inadequate access to mental health care. This crisis demands legislative action, and that's why it's critical for the public and lawmakers to understand the facts about a bill currently pending in the Legislature.

HF 3494/SF 4124 would not reduce collaboration among physician assistants (PAs) and other mental health care professionals; rather, it would expand the capacity of health care teams to provide mental health care to more patients in our state ("Don't loosen the safeguards," Readers Write, April 28).

Specifically, this legislation would update Minnesota law by aligning it with federal policies recognizing PAs as health professionals able to diagnose and treat mental disorders. For example, Medicare includes PAs among the health professionals eligible to provide outpatient diagnosis and treatment for mental health disorders.

PAs are highly educated medical professionals who practice in every medical setting and specialty. PA education and certification standards specifically require training and knowledge of mental health disorders. This bill would not allow PAs to practice psychotherapy, as that is outside of a PA's scope and training. However, PAs can and do refer patients to psychotherapy as part of the team-based approach to health care that is a tenet of the PA profession.

Increasing mental health care access in our state will require the commitment of all medical professionals, and PAs are ready to do their part. I urge lawmakers to support HF 3494/SF 4124. Inaction is the greatest threat to mental health.

Brittany Strelow, Rochester

The writer is president, Minnesota Academy of PAs.


ELECTIONS

Caucus system flawed but preferable

Former Minneapolis Mayor R.T. Rybak made valid points in his recent commentary suggesting that the caucus-convention system has flaws, and that primaries open the decision of who runs in a general election to a broader audience ("We needn't be bound by caucuses," Opinion Exchange, May 1). However, primaries have this disadvantage: They allow for decisions to be swayed by excessive election-related spending. The caucus-convention system is a grassroots process, and campaigns at the more local level spend very little money on them.

The current cycle showed serious flaws in the caucus-convention system. Not to get too far into the weeds, but having several House district conventions fail is in part a procedural matter, as Rybak implies. When a convention runs out of time, one or both of two things often went wrong: The endorsement phase of the meeting was placed too far down on the agenda, or one or more candidates abused the rules of order to extend the process and thus avoid not losing the endorsement. Both of these problems can be fixed.

Another factor should be considered. The basic nature of the process is different in Minneapolis than it is in the suburbs, and different as well in rural areas. The likely level of involvement, the nature of conflict and how it is settled, and several other aspects of the caucus-convention process varies by geography. The process also varies by level. We've not elected an endorsed governor in recent memory, but endorsed House candidates routinely end up representing their party on the general election ballot.

I was raised up decades ago in a political system where decisions were made in smoky backrooms. (I assume they smoke less these days.) The caucus-convention system replaces the smoky backroom, and it is much more welcoming and inclusive. By that metric, the caucus-convention is better, if flawed.

Greg Laden, Plymouth