Readers Write: E-pulltabs, University of Minnesota football recruiting, threats to Medicaid enrollees, health care administration costs, affordable housing in Minneapolis, parents' screen time

E-tabs, a miracle cure or a placebo? In light of the May 2 article "Rocky rollout gives way to big haul from e-pulltabs," I thought that it would be beneficial to peel the onion back a little further.

What really happened to the $340,000 in e-tab sales at Skarda's Bar, which was cited in the article as being the second largest e-tab seller? Of that amount, $296,000 was returned to players in prizes; $15,800 went to the state in gambling tax; $13,600 went to the game provider; $6,600 went to the bar; and $1,070 was paid in sales tax (on the $13,600), leaving the St. Paul Fire Fighters Local 21, which runs the operation, with $6,930. Now pay for accounting help for the monthly returns and the annual outside audit, and the local will be the bottom rung of the ladder of who makes out with e-tabs. It will net less than 2 cents on every dollar wagered with e-tabs. E-tabs are a boon to the state, bars and the manufacturer, not so much for the charity.

The writer is executive director of Allied Charities of Minnesota, a 501(c)(6) organization representing licensed gaming charities.

A May 2 article reported that University of Minnesota Coach P.J. Fleck took a helicopter from the U campus to Apple Valley to watch a football recruit from Edina ("Edina's Carroll picks Irish over U, others"). This is approximately 22 miles by land. What a disgusting waste of resources. As a U alumna, I am very ashamed of the waste of money. Next time take a boat.

In an April 30 commentary, former Gov. Arne Carlson and former state Sen. Linda Berglin argue that a work requirement for Minnesota Medicaid enrollees would be bad policy ("Proposal sounds appealing, but is far from it").

Opinions may vary on this issue. The real threat to enrollees is not a work requirement. It is a letter enrollees received recently from the Minnesota Department of Human Services.

The letter says that "[o]ne or more of your health care providers are now part of an Integrated Health Partnership (IHP). … They will share in the savings that result from improved care and a reduced cost of care."

Let's translate this DHS jargon. IHPs are mini "provider" insurance corporations, or Accountable Care Organizations (ACO). They are typically a hospital system merged with its medical staff. ACOs lack the back-office personnel and expertise of real insurance corporations and have no insurance reserves except for the future earnings of their clinicians. Therefore, they often "joint venture" with mega HMO corporations.

The problem for enrollees is that the state pays these mini and/or mega insurance corporations a fixed (capitation) fee for each enrollee (aka "value contracting" in fed-speak.) The ACO transfers its insurance risk to its bedside gatekeeper clinicians, who are paid more for ordering less care and are paid less for ordering "too much" use of corporate money (aka 'value pay"). The corporation splits profits of rationing care among its partners (aka "gainsharing") — a clear-cut financial conflict of interest with patients needing care.

A bipartisan discussion of work for Medicaid enrollees is important, but Carlson and Berglin missed a grave issue: profit-driven rationing of care at the state's bedside.

I recently received an e-mail about my EOB. A phone call informed me: Explanation of Benefits. I went to the EOB website, which showed: Total cost of service, $905; HealthPartners member savings, $968.49; medical plan payment, $330.51; and, finally, "My Responsibility," $206, with an explanation that this was how much I might be billed for. There were links to a description of the service and a further breakdown of costs.

I've always received superb services from my doctor, preventive services and other medical providers — no complaints there.

My phone call rep explained that I might be billed for the $206 but that part of it might be covered and I would be sent a check for the covered part. In other words, I would send $206 and they would send me the difference between my plan benefit ($24) and the $206. I said that this seemed an unnecessary step and that the $206 bill had alarmed me. The cost was for a recommended shingles shot for age 87 and its administration during my routine doctor visit.

I could see why costs of medical services are so expensive. Think of the paper work, staff, time, offices, several levels of reviewing claims, billing, postage, computer costs, etc., multiplied by hundreds of thousands of patients. It could be eliminated by a better system. I've learned that these paperwork and staff costs don't exist in all other modern nations.

When do we catch on?

Congratulations to the Minneapolis City Council and Mayor Jacob Frey for an innovative application of the state's affordable apartment property tax classification ("Tax break may help keep some rents low," April 28). Their recent action will result in up to 300 units, most likely owned by smaller-scale private landlords, receiving a substantial property tax break in exchange for a 10-year agreement on rent affordability.

The magnitude of the affordable-housing challenge facing our community and cities across the nation is significant. Approaches like this, which recognize the importance of private investment in the housing stock combined with an appropriate incentive to achieve a mutually desirable policy goal, are exactly what will best address this challenge. Private and nonprofit developers are meeting to help develop additional ideas to add to the city's affordable-housing "tool kit," which now includes this great initiative.

The writer is president and CEO of the Minneapolis Downtown Council and Downtown Improvement District.

Regarding "In opposition to … disconnected parents," Readers Write, April 30:

Judgmental attitudes do nothing to improve society. Consider that those "parents on cellphones" at the coffee shop may have just spent two hours getting older kids off to school, doing puzzles with the little ones, and getting "help" with meal preparation and the laundry. They may have been returning from the park and have had zoo plans for the afternoon. Instead of getting a small break by placing the child in front of the TV, the parent took them on an outing for a treat. A child vying for parental attention does not necessarily need it.