Readers Write (Jan. 3): Cabin tax, Affordable Care Act and MNsure

I agree that owners of cabins should not bear an unfair burden of taxation ("Plan to ax cabin tax gaining traction," Dec. 27; also see "Counterpoint: Cabin-tax coverage misled readers" on page OP4 today). Their property should be valued for taxation purposes based on comparable values of other homes in the area. Of course, the fact that the home is on a lake should be taken into consideration, as that is part of the value of the property. And they should not receive an advantage because this may be a second home.

One item that was not included in the article was any example of what a typical cabin is being taxed and how it compares to taxes for properties that are similar. Even the man who met with his siblings to discuss their property's costs did not mention what their taxes are, but that their taxes are "our single largest bill." My home in Lakeville is not on a lake and my tax bill is also my single largest bill. I would be surprised if that were not the case for most homeowners.

• • •

State Rep. Paul Marquart says he would like to see tax breaks for farmers instead of cabin owners. Maybe he needs to research the tax breaks given to farmers that cabin owners and business owners don't get. If a farmer has a million-dollar farm (business), he pays approximately one-fifth of the taxes that a business owner pays on a million-dollar business property — yet both are businesses. The cabin owner not only pays school district taxes in his home district, but also in the district his cabin is located in. For this privilege, he does not get to vote on school referendums but when passed, is taxed on them. The cabin owner's property is also taxed as recreational, one of the highest tax rates, he has no say in government where he is paying cabin taxes and, in many cases, he gets no services for the taxes he pays. And when he goes to a tax meeting or government meeting, he gets the typical answer to his concerns: "If you can own it, you can afford to pay. If not, sell it." Maybe politicians should look at the decline in values of most lakeshore property in the last few years. Most are selling for 60 to 75 percent of the appraised value. When real estate taxes catch up with this loss of value, watch the counties and state start crying.

I was impressed with the two divergent views of the Affordable Care Act on Dec. 27 ("The ACA in action," Opinion Exchange). One piece by Allison O'Toole extolling the virtues of MNsure ("Trending up: For MNsure, the lights have turned from red to green") and the other by Stephen Parente ("Trending toward terrible: Expect higher bills, fewer covered") prophesizing the collapse of the ACA. How could two knowledgeable people look at the same thing and come to such wildly different conclusions? The answer is found in the fact that both of them ignored the single most important issue impacting the future of American health care: the use of private managed care organizations to discharge what is now clearly a government program. Notice I didn't say "insurance" companies. There is no insurance function in these transactions anymore. The government — state and federal — and self-insured employers pay for the cost of health care, and these managed care organizations act only as disbursement agents, spending other people's money. This explains why prices keep going up. If you're paying bills with someone else's money and there is no oversight or audit, then it's easy enough to inflate the actual costs and pocket the difference. This is exactly what these managed care organizations have been doing.

Don't take my word for it. Look at the Segal report that the Dayton administration commissioned. In March 2013, Segal said that the trend methodology that relied solely on managed care organizations' self-reported data produced "a systemic overstatement of the trend, causing the program to exceed targets over time."

Still skeptical? Look at a federal case in Michigan in 2014 (Hi-Lex vs. Blue Cross of Michigan). In this case, the courts found that "regardless of the amount [the managed care organization] was required to pay a hospital for a given service, it reported a higher amount that was then paid by the self-insured client." In other words, the managed care organization inflated its reported costs of health care in order to be paid more money.

We have created a system whereby third-party administrators benefit by inflating their reported costs of health care. The feds think that the state audits this, but the state does not because it regulates only the business of insurance — and this isn't insurance. Thus, these managed care organizations are free to inflate and misrepresent costs. Furthermore, they are rewarded with subsidies and increased profits for doing so. And we passed a law requiring Americans to buy a useless, overpriced product from these managed care organizations or pay a fine to the IRS. High-deductible plans are useless and overpriced. They provide the illusion of insurance with no meaningful coverage. This explains why costs keep going up and why the ACA in its current structure and administration is unsustainable. Most people inside health care have some understanding of these issues, yet apparently choose to avoid discussing them, lest they offend those abusing the system.

The writer is a former lobbyist for the Minnesota Hospital Association.

• • •

An open letter to Allison O'Toole, our new CEO of MNsure:

No, Ms. O'Toole, MNsure is no better now than it was three years ago. Recently I tried for 4.5 hours and seven phone calls to get through. I talked to two supervisors who appeared to be in high school, was hung up on two times and still I have no answers. Only a couple of glitches? It appears your whole employee base is one huge "glitch." The website is still not user-friendly, and the staff is uneducated, unknowledgeable and rude. The CEO is in denial. My premiums are three times what they were for half the coverage — before the Affordable Care Act was rammed down our throats. No, Ms. O'Toole, writing articles about how great you are and how far you have come will only pull the wool over some people's eyes. You are risking the health and welfare of thousands of people like me who pay high premiums for minimal coverage. Stop the lies — you are killing people.

• • •

As a graduate of the University of Minnesota's Carlson School of Management, I expect more from an associate dean than a context-free presentation of data skewed to alarm readers and reassure Affordable Care Act (ACA) opponents about the failure of the ACA to expand access to health care. Prof. Parente, I have no quarrel with your research or even your premise that rising premiums will conspire to prevent some individuals from purchasing health insurance. But I have no tolerance for figures presented without context. Would the cost of insurance rise without the ACA? Undoubtedly. As much? I don't know, but I suspect you have estimates that could create the context we need to know whether the problem lies with a flawed approach to expanding care or elsewhere within the system. For example, your estimate that over the next decade "rates increase more than 61 percent" is lower than the 63 percent growth in per capita health care spending tracked by the Kaiser Family Foundation for the decade prior to the Great Recession. With a rapidly aging population, it is unreasonable to believe that rates will not increase. Would there be even more uninsured Americans without the ACA or not? It is helpful to know whether the ACA is part of the problem, or part of the solution. Unfortunately, we don't have the information we need to reach a conclusion from your commentary. We simply have sound bites. Are you running for office?