Ramstad: Readers praise idea for insurance-free doctor’s offices in Minnesota

While my election-related columns about politics and the economy generated the most reader responses in recent weeks, I found the reaction to my column on direct primary care most interesting.

In these arrangements, patients pay doctors directly, like in the old days, rather than through insurance.

The topic tapped a vein of nostalgia with readers who remembered what health care was like 50 years ago, before the rise of interlinked networks of care systems and nationwide insurers.

For others, the concept — in which patients essentially become members of a doctor’s practice and pay a flat monthly fee of around $70 to $90 — just seems practical.

“We only need health insurance for major medical procedures. Health care would be much less expensive without it,” reader Mary O’Connor wrote.

She then offered a plan for getting more people to use direct primary care physicians.

“I suggest we start with public employees,” she wrote. “Take away their health insurance except for major medical procedures and give them an increase in pay. They can use this for doctor appointments. Doctors will lower their charges if they don’t have to wait for an insurance company to pay them.”

Dr. Darrell Krieger, a physician in Crystal, wrote to point out a problem.

“What is left unsaid in the article is the issue that primary care physicians are decreasing in number at an alarming rate, with no one to replace them, making access for patients increasingly difficult, particularly as older physicians such as myself retire,” he wrote.

“This is a nationwide problem that is recognized within the medical field but gets little attention in the media,” he added.

Though I didn’t mention it in the column, I talked with Dr. Laura Slings and her husband Steve, who runs the back office in her practice, about the broader numbers at stake. When she was working at one of the large health systems, Dr. Slings had more than 2,000 patients in her practice. She’s aiming for about 500 at her independent clinic.

“If all these doctors leave the system and open direct primary care ... that’s going to contribute to the shortage, right?” Dr. Slings said. “It actually is a potential solution to the primary care crisis because so many primary care docs cannot continue to sustain what’s being asked of them right now. They’re retiring early. They’re burning out.”

How, and whether, all this works out will take years, I suspect. My colleague Karen Tolkkinen last week wrote about the most acute shortage of doctors in Minnesota: dentists outside the metro area.

Separately, several readers asked about something I left out of my Oct. 16 column on ninja gyms: whether kids are more prone to getting injured in them than a playground or school gym.

Kids are kids, of course, and they’re out flinging themselves around in these places. At Ninjas United, the Maple Grove gym I visited, the padding is everywhere and there are coaches and spotters all around.

“You’ll see we have some $800 mats called cloud mats and they’re phenomenal,” co-owner Chris Voigt said.

His wife, Jen, who runs the gym, said she notices teenagers are more prone to sprains or strains because they need to warm up. “But they still remember being a kid when they didn’t need to warm up,” she said. “So some are a little more relaxed in their warm-ups, when they should be a little more focused during that.”

This past week, several readers reacted to my column about the dramatic, ignominious end of Bremer Bank, the longtime St. Paul institution that sold to Indiana-based Old National, by noting that the bank’s beginning was just as dramatic.

Before starting the bank and the charitable foundation that owned it, Otto Bremer and his brother Adolf in 1911 took over the Schmidt Brewing Co. from its founder, Jacob Schmidt. They built it into one of the nation’s largest by 1920, when prohibition started. Through the 1920s, Otto started to purchase banks and, as the Depression started, “pledged every asset he owned” to keep them shored up.

That included his stocks in “eastern banks,” according to the Star Tribune’s obit of him in 1951. “The eastern stocks were lost by sale when additional margins in a declining market could not be furnished,” the obituary said.

Finally, a good news update to a column I wrote at the start of the year urging Minnesota regulators to allow taller buildings with a single staircase. On Oct. 31, the technical advisory group responsible for updating the state’s building code unanimously approved a proposal that will allow single-stair residential buildings up to four stories.

“This approval makes Minnesota the first among the new wave of states around the country moving in this direction to actually adopt a code change statewide,” said Cody Fischer, president of Footprint Development in Minneapolis.