Readers Make Their Wish Lists, Checking Up on Health Care

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

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How To Excise Politics From Health Care

More than a decade after the Affordable Care Act took effect, we’re still trapped in a confusing and costly health care maze (“Readers Take Congress to Task and Offer Their Own Health Policy Fixes,” Nov. 12). The ACA expanded coverage and protected people with preexisting conditions, but it also layered subsidies, narrow networks, and rising premiums on top of an already fragmented system. Millions still face deductibles so high that “coverage” often means financial anxiety instead of security.

The problem isn’t our doctors or hospitals — it’s the structure. America spends nearly twice as much per person on health care as other developed countries, yet our life expectancy is shorter and our outcomes worse. We’ve allowed a tangle of private insurers, billing rules, and monopoly pricing to replace coordination with chaos.

We don’t need “socialized medicine.” We need organized medicine that guarantees coverage, controls costs, and cuts red tape. Other nations have done it — efficiently, fairly, and without eliminating private choice.

Here’s what would work (with a little help from my friend ChatGPT):

1. Universal, automatic coverage. Everyone should be enrolled from birth or residency, independent of job or income. Basic care would be guaranteed, while private insurance could supplement it.

2. Rational pricing. Hospitals, doctors, and drugmakers should follow transparent, regulated price schedules — like the all-payer systems used abroad — ending the markups and cost-shifting that drive U.S. prices sky-high.

3. Streamlined administration. We spend five times as much on billing and insurance overhead as our peers. A single set of rules and electronic standards would save billions and free doctors from paperwork.

4. Invest in primary and mental health care. Paying for outcomes instead of volume would improve health and reduce preventable hospitalizations.

5. Protect families from financial ruin. National catastrophic and long-term care coverage would stop medical bills from destroying lives.

These reforms aren’t radical — they’re what nearly every successful country already does. The obstacle isn’t feasibility; it’s politics. Every dollar saved is a dollar someone currently earns, and entrenched lobbyists fight to preserve that status quo.

The ACA was a step forward, but it left us with a patchwork of subsidies, mandates, and unaffordable premiums. America already spends enough to cover everyone. The challenge now is to spend it wisely — through a rational, universal, and efficient system that works for people, not paperwork.

— Luis Alnisu, Warrenton, Virginia

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Beating Back Mold

There are only three ingredients to mold: spores, cellulose, and water (“A Hidden Health Crisis Following Natural Disasters: Mold Growth in Homes,” Nov. 19). The spores are floating in the air when construction is taking place. No exceptions. Cellulose is in paper and wood. Its most damaging use is in drywall or gypsum board (gyp board). A single drop of water, from a roof leak or plumbing/sewer pipe, is all that’s needed to start the mold process.

The use of drywall after World War II to build housing quickly is a primary culprit. USG and similar manufacturers make an alternative product without paper sheathing that will not react with water. USG calls it “Mold Tough,” and it uses fiberglass mat instead of paper.

As an architect, I have a simple solution: Stop the use of drywall with paper sheathing.

— Marc Brewster, Bastrop, Texas

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Help Is Still Wanted

I am writing in response to the article “Help Wanted: California Looked to Them To Close Health Disparities, Then It Backpedaled” (July 28), in which Vanessa G. Sánchez explained the issues regarding health disparities among immigrant populations — such as chronic diseases, a high uninsured rate, and the more dire fact that the community health workers who do their best to support these people are paid very little for a crucial job. They offer assistance and trust to those who may not be as comfortable asking for it or are unaware that it exists because they are not from here.

She also wrote about a path opening up with the professionalization of these community health workers — how certification programs were opening up, and funding was going to increase. But it has been cut because of the budget cuts going on during this Trump administration, and programs have been slashed or abandoned.

I want to thank you for shedding light on this issue. These community health workers serve as the middle stop for health care for so many people who face immigration and language barriers. This is the workforce they appeal to and go to, and that in and of itself is honorable work that needs to be done and should be paid at a higher rate than it currently is. One could even argue it’s as important as a doctor’s visit, because even to go to the doctor, you need insurance. And who helps you with that and then sends you to the doctor? The community health workers, exactly!

I am part of the Hispanic community and care about the health disparities that exist within it, such as diabetes, and am also very aware of the language barrier that exists in the hospital field. Working together, is there a way to reinstate some certifications or training to promote higher wages and improve health for all Hispanics/immigrants?

— Avelino Cortes, San Leandro, California

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Where To Draw the Line on ‘Urgent’ Care?

As a pediatric emergency medicine physician who regularly works shifts in a community hospital, I read the article on a short “nonurgent” but expensive ambulance ride for a child with interest and horror (“Bill of the Month: Not Serious Enough To Turn on the Siren, Toddler’s 39-Mile Ambulance Ride Still Cost Over $9,000,” Nov. 25). I would not have come close to guessing that an Advanced Life Support, or ALS, ambulance would cost over $9,000. Often, patients’ costs vary based on which ambulance company arrives, their insurance plan, whether they are uninsured, etc. We, at least as doctors, rarely have that information at our disposal.

I try to have parents drive their children to the referral hospital when it is safe and feasible, but this is not always possible. What risk of your child dying would you accept if you went by car? 10%? 1%? 0.1%? 0.01%? Just because no treatment was administered during this ambulance ride does not mean that the ambulance was not needed.

What makes us good at our jobs in medicine is worrying about the worst-case scenarios. Do providers sometimes overreact and send kids by ambulance who don’t need it? Absolutely. But there are also too many cases in which children die or become critically ill because someone didn’t recognize how sick the child was or the risks. If we send you in an ambulance, or admit you to the intensive care unit, because we are worried you are at risk of something like shock or respiratory failure, it doesn’t mean you will definitely need intensive care. But, if you go into shock or stop breathing while in your parents’ car, you are much less likely to survive than if we are watching for it and treat it right away. The same way that when we tell you it is a virus, after doing lots of tests, it doesn’t mean we didn’t need to do those tests. The absence of needing treatment doesn’t mean the admission or testing we recommend was unnecessary.

Perpetuating the impression that it is wasteful treatment just because everything works out well is a luxury you have when you don’t regularly see how quickly kids can go from looking relatively well to critically ill and at risk of dying. Those of us who are good at what we do know when to worry and when not to worry. Please don’t disparage our caution or treatment without even asking for our rationale. Ask this doctor why he said the baby absolutely had to go by ambulance. Maybe he didn’t have a good reason. But maybe he did. Maybe if a similar child had been sent by car and the child had gone into shock, this article would instead be talking about how incompetent he was in missing the risk of sepsis and causing the child’s death by letting the parents drive him to the hospital.

We are doing our best to provide good care in a broken, overloaded system. If we are going to work together to fix it, we all must work to understand one another’s points of view. Thank you for helping us understand these unexpected and incredibly burdensome costs our patients face. Please try to understand that caution may not be us dismissing the burden or cost but knowing the risks.

— Samantha Rosman, Boston

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Investing in Your Own Health Care

About 20 years ago, I switched to a high-deductible health plan and a health savings account. It was the best decision I ever made for health care for my family (“Trump’s Idea for Health Accounts Has Been Tried. Millions of Patients Have Ended Up in Debt,” Dec. 9).

Today, after years of contributions (compounded with investment gains), the dividends and gains return a higher amount than our health care withdrawals. We’re also still contributing the max family amount per year.

We’re in the process of retiring now, and we’ll continue to select an HDHP and max out our HSA contributions. Once on Medicare, our premium payments can be made with our HSA account. Also, it’s another form of IRA once we reach age 65. It’s a double-tax-advantage account.

I don’t understand the resistance to switching to an HDHP and an HSA. The more you insure yourself, the more money you save. Long-term, it compounds into serious money. At my workplace, I try to talk as many people as possible into choosing an HDHP. They’re all so thankful years later.

I believe people are just afraid of change — not realizing it can seriously be the best health care decision they ever made.

— Tim Eckel, Toledo, Ohio