Fixing America’s Health Care System

More from our inbox:

• Trump’s Trial Dates and the Odds of Conviction
• Does Barbie Really Need Ken?

To the Editor:

Re “How Do We Fix the Scandal That Is American Health Care?,” by Nicholas Kristof, with photographs by September Dawn Bottoms (column, Aug. 20):

Nicholas Kristof scratches the surface of the failures of the health care system in this country. I have been in practice for 28 years as a cardiologist and internist and have seen firsthand the miraculous breakthroughs in cardiac care as well as the appalling level of care typical in treatment of chronic diseases, especially among minority populations.

Most care in this country is delivered by large for-profit and nonprofit entities (which function largely as for-profit entities but avoid taxes). These systems are incentivized to invest in high-end tertiary care, typically cardiac, orthopedic, neurosurgical and oncologic care, as they have the highest reimbursement.

Chronic care for conditions such as obesity, diabetes and high blood pressure are not sexy areas of medicine and for the most part offer low compensation from Medicare, Medicaid and commercial payers.

Our health care system needs to incentivize primary care and force nonprofit entities to allocate larger portions of their budgets to primary care or lose their nonprofit status.

Daniel Zanger
Brooklyn

To the Editor:

Nicholas Kristof has written a cogent and damning column. One piece of the health care crisis we must also address is physician education and remuneration.

New physicians have delayed earning potential in order to attend medical school and have endured at least three years of paltry pay and extremely demanding schedules as medical interns and residents. By the time they are able to practice medicine after at least seven years of post-college training, they are unlikely to set up practice in rural areas with the lowest pay, fewest colleagues for support, professional isolation and limited call coverage. They are alsoless likely to practice in pediatrics or family medicine than in a medical specialty.

Indeed, no one can blame them for wanting to work in a place conducive to comfortably repaying student loans as well as paying for malpractice insurance.

Bright, hardworking young people can find myriad other fields of work and skip the stress that is modern U.S. medicine.

If we are serious about improving health outcomes and reducing infant mortality, depression and skyrocketing rates of diabetes and other illnesses, then we need to completely revamp physician education.

Nurses, doctors and hospital staff are heroes. Let’s treat them as such. Pay for their education, and incentivize work in underserved and high-risk locales.

Susan Balogh
Boston

To the Editor:

Only last month the Department of Health and Human Services found that some of the country’s largest for-profit insurance companies, which together manage Medicaid programs that cover the majority of the 87 million individuals on Medicaid, denied more than one of every four requests for doctor-ordered treatments or medications for patients enrolled in their Medicaid plans.

Medicaid serves many who live with the disadvantages that often lead to higher rates of diabetes and other chronic illnesses for which timely and consistent care is essential to better outcomes. Providing the services that doctors prescribe for these patients would go a long way to fixing the scandal described by Mr. Kristof.

Ted Herman
Providence, R.I.
The writer is a former health insurance executive.

Trump’s Trial Dates and the Odds of Conviction

To the Editor:

Re “This Indictment Does Something Ingenious,” by Norman Eisen and Amy Lee Copeland (Opinion guest essay, Aug. 16): The Georgia indictment might be ingenious, but the fact remains that Donald Trump won Georgia in 2016 and missed by a whisker winning again in 2020. So there is an overwhelming likelihood that some of his base of supporters will be on his jury and will not vote for his conviction no matter the strength of the evidence.

Harold J. Smith
White Plains, N.Y.

To the Editor:

There are many legitimate factors to take into account in determining when any criminal trial might begin, but one factor not to take into account is the defendant’s job. At the moment, Donald Trump is looking for a job (president) and in essence interviewing to get the job (campaigning).

So let’s hope that the one factor that none of the judges consider in setting Mr. Trump’s trial date is his “interviewing schedule.”

The judges might consider that at least some of Mr. Trump’s potential “employers” might want to know before hiring him whether or not he is a felon and set to spend many years in prison.

Eugene D. Cohen
Phoenix

Does Barbie Really Need Ken?

To the Editor:

Re “Why Barbie and Ken Need Each Other,” by Ross Douthat (column, nytimes.com, Aug. 9):

As a young woman, I agree with Mr. Douthat that “Barbie” contains some real, not-talked-about ambivalence concerning what female empowerment truly means.

However, the core failing of “Barbie” is not, as he suggests, its failure to unite Barbie and Ken romantically, but a failure to imagine a world in which people of all genders can successfully lead together. Mr. Douthat’s insinuation that romance and reproduction must be the basis of any kind of productive union between men and women is archaic and troubling.

This being said, the assertion of the “Barbie”movie that Ken is “superfluous” is also concerning. It is not, of course, that women have a need for men, but that humanity requires all of its members’ collaboration to achieve its highest potential. And yet, at the end of the movie, when Ken is relegated to a status equal to that of women in the real world (read: oppressed), any hope for a world in which people — or dolls — of all genders can live fulfilled, empowered lives remains elusive.

Mary Elliot
Lenox, Mass.

To the Editor:

Certainly, there is evidence that married people tend to be happier than the unmarried. But that largely applies to people who are happily married. Unhappily married people are not only less happy than the happily married, but also less happy than those who are divorced, and less healthy than those who are single, divorced or widowed.

There are some important factors that suggest Barbie and Ken’s union might not be a happy one. Barbie never expressed any interest in a relationship with Ken or with anyone else. As Barbie was being ushered into a black S.U.V. and taken to the Mattel headquarters, Ken high-tailed it back to Barbieland solo. While there, as Gloria (played by America Ferrera) so clearly summarized, he took Barbie’s house, he brainwashed her friends, and he tried to control the government.

No one needs 40 years of General Social Survey data to know that they would be miserable. Stop trying to convince women that the key to their happiness is committing to emotionally damaged men against their self-interest and better judgment.

Theresa Hastert
Ann Arbor, Mich.