Ann Arbor, Mich.
Dude! Your Band-Aid is inside out! [Cover art, July 13] How’re you going to “cure…the global economic crackup” if you can’t apply the world’s most basic boo-boo device? Kiss it and make it all better? Not to mention that the Band-Aid is “flesh” tone. A cure for/by those of Caucasian persuasion?
The Public Option: Doomed to Fail
Cambridge, Mass.; Washington; Chicago
Regarding your editorial “Public Option Now!” [July 20/27]: a public option won’t fix the mainstream Democrats’ flawed healthcare reform proposals. Only a single-payer reform would make universal, first dollar coverage affordable. It would save about $400 billion annually on bureaucracy and rein in costs over the long term through global budgeting and rational health planning.
Even a public plan option far more robust than anything on the table in Washington would forgo most of these savings, making comprehensive coverage unaffordable. While a public plan might cut into private insurers’ roughly $10 billion in yearly profits (which is why they hate it), that’s only 10 percent of their overhead. They spend much more tracking eligibility, collecting premiums, marketing to healthy (profitable) patients, demarketing to avoid the sick, and shifting costs to patients and providers. A competitive public plan couldn’t match the efficiency of Medicare, whose integration with Social Security allows automatic enrollment, disenrollment and premium collection.
Moreover, a hybrid plan would forgo hundreds of billions in administrative savings because hospitals and doctors would still have to maintain armies of administrators and billing clerks to joust with hundreds of insurers.
A kinder, gentler public plan would quickly fail in the healthcare marketplace. Insurers compete by not paying for care. Competition in health insurance is a race to the bottom, not the top. A public plan that did no marketing would soon be saddled with the sickest patients, whose high costs would overwhelm any administrative efficiencies and drive premiums to uncompetitive levels. Similarly, eschewing private insurers’ schemes that shift costs to patients and other payers would be a crippling competitive disadvantage. To survive, a public plan would have to imitate private plans’ bad behaviors.
A healthcare system dominated by private insurers cannot provide families with the affordable coverage they need. A public clone of private insurers won’t help.
DAVID U. HIMMELSTEIN, MD
STEFFIE WOOLHANDLER, MD, MPH
SIDNEY M. WOLFE, MD
QUENTIN YOUNG, MD
MARCIA ANGELL, MD
2nd Sex, 2nd Wave, 2nd Thoughts
Katha Pollitt observes, “Nobody wants to hear, though, from middle-aged women with relaxed and generous views about sex, let alone who are still having it” [“Subject to Debate,” June 15]. And ain’t that the truth! I’ve been researching the involvement of people over 50 in alternative sexualities for my book. Editors like the writing, compliment the proposal and then tell my agent, “Yuck! Would my mother really do that stuff? No one wants to know about it.”
I’m a pro-sex second waver: passion has not waned. But the demographic of editors has changed big time, especially with all the consolidation in corporate publishing leading to the replacement of senior editors with less-expensive younger ones. The “sex wars” turn up in all sorts of contexts, not just within the feminist movement. Thanks, Katha Pollitt.
Life Under the Bridge
Re Ben Ehrenreich’s “Tales of Tent City” [June 22]: There are many who would agree with Tom M. that homelessness can be traced back to President Reagan in the mid-1980s and his reduction of the funds to house our nation’s poor. Ehrenreich quotes former Tent City resident John Kraintz saying the cause of homelessness is “falling wages and rising rents.” Then Joan Burke of Loaves and Fishes is quoted saying that the causes of homelessness are far from hazy: “It’s the lack of housing that people can afford.”
There are two types of people experiencing homelessness: those who can work and those who cannot. According to the last several US Conference of Mayors reports, no one in this nation can afford a one-bedroom apartment at the current federal minimum wage. That means the government itself has set a standard that continues to create homelessness. And Supplemental Security Income (SSI), for those who cannot work, is about half of that failed standard.
The answer is simple, really: economics–affordability. The single most expensive item in the budget of nearly every American is housing. Our Federal Poverty Guideline, established in 1963, is based on food. But in 1963 food made up only 23 percent of our monthly family budget, and housing made up 29 percent. Today, food makes up only 16 percent, and housing makes up 50 to 60 percent. We need to link the federal minimum wage to the local cost of housing. This way, if a person works forty hours a week, he or she can be assured of putting a roof over his/her head (other than a bridge) no matter what the price rises to. Similarly, we need to link SSI to the local cost of housing so that disabled folks everywhere can be housed (see UniversalLivingWage.org for details).
RICHARD R. TROXELL
National Coalition for the Homeless
US Mess in Colombia
Teo Ballvé, in “The Dark Side of Plan Colombia” [June 15], brilliantly details the ways that US economic aid to Colombia has gone to paramilitary death squad leaders and associates who have stolen land for palm oil plantations. US assistance has also been directed to officers from Colombian army units with the worst records of collaborating with paramilitaries and of killings and other abuses of civilians.
State Department officials claim that they vet all military units proposed for assistance to ensure they have not committed human rights abuses; and they claim that the vetting process for Colombia is a model of rigor. But officers and soldiers from more than 500 Colombian military units that had not been vetted received military training and other aid, according to a document the State Department released last year. These units include battalions in the 17th Brigade, which, together with paramilitary gunmen, massacred and forcibly displaced thousands of peasants in the Urabá region Ballvé describes. In addition, Washington vetted and approved assistance to army brigades operating in the heart of paramilitary country and units that killed civilians to add to the body counts by which they measured their success.
US law prohibits assistance to units with credible records of gross rights violations, and Washington has consistently violated this law in Colombia by training officers from unvetted units. But the law doesn’t require any evaluation of the impacts on human rights after training and other lethal assistance is given, so policy-makers never measure the human consequences of feeding war. The anticipated reform of the Foreign Assistance Act should require this evaluation for all foreign military aid. More fundamentally, respect for human rights should be a central objective of such aid.
JOHN LINDSAY-POLAND, co-director
Latin America Program
Fellowship of Reconciliation
Liza Featherstone’s “Out of Reach: Is College Only for the Rich?” [June 29] erroneously stated that faculty at Muhlenberg College were laid off. In fact, staff, not faculty, lost their jobs.