Readings for Letters Training - Letters & opinions on the NYHA

Skim the openings of the 12 letters & select ONE opinion piece to read. THEN, if you have time, focus on the following questions:

  • For the 12 letters (use line # for reference if you’re reading electronically)
    • Skim through the openings (and the closings): which grab your attention to keep reading and which don’t? Any observations?
    • Of those that seduce you into reading, what keeps you reading? What sends you away? Observations?
    • After casual perusal, do any “speak” to you? Do any seem “memorable”?
  • For the 3 opinion pieces — pick one to respond to on Apr 6 — and think about how an opinion piece grabs a reader’s attention … and keeps it.


Twelve Letters

Skim the Openings for Observations:

What causes you to read A, not B? What keeps you reading C? What’s compelling about D?


Letter #1: Canadian Therapist (250 words)

As a Canadian therapist, I find American healthcare insane. A common definition of insanity is “doing the same thing over and over again and expecting different results.” Change is the opposite of doing the same thing, but it can be scary. Even when we know rationally that something will be good for us, fear can keep us from getting there. Expanding Medicare to All New Yorkers (New York Health Act) is one such change. Fear-mongering and often disingenuous remarks are uttered to appease major campaign donors. We need our elected representatives to represent us, their constituents, not those who buy their campaign ads. Often, politicians express verbal support unaccompanied by concrete actions. For instance, NY State Senator Marisol Alcantara, who represents my district, maintains her support for the NYHA yet has not acted to advance the process of passing this legislation.

As a therapist, I appreciate the challenges of changing how we see the world, but I know that change is possible and worth the struggle. Let us recognize the challenges of bringing universal, comprehensive healthcare and increased well-being to the people of NY state. Let us recognize that those who profit from our current system will scare us into tolerating the status quo again and again. Let us stand firm and tell those running for political office that we are not scared of universal healthcare and that we will not support any office holder or candidate who doesn’t pledge to support the NY Health Act with real actions.

Letter #2: Insurers are huge corporations (150)

My NY Senator doesn’t support the NY Health Act — and that scares me.

Another 14,000 New Yorkers are losing health insurance because Northwell is shuttering their health insurance. (Iohud, date).  

We should all be scared. All these huge corporations — Aetna, Humana, UnitedHealth — claim to be consumer-centric, but the consumers they value insulate them from loss. Like big banks during the financial meltdown, these companies are socializing risk and privatizing profit. The market is working fine for insurance behemoths. It’s not working for New Yorkers.

Here’s the problem: health insurance is about profits — paying for healthcare reduces those profits. Insurance executives are focused on the health of their corporations (i.e., out-sized profits). It’s high time we shutter business models that put insurance profit in conflict with public health, real people with real needs for real coverage. Health Care is a public good and we should treat it that way.

New Yorkers need the New York Health Act — now.

Letter #3: The LCD is Profit (200)

While there are many problems within our system of health care delivery, they all have one common denominator - the profit motive. Other Western industrialized countries have universal health care programs. Their constituents all receive better health care than we and at a lower cost. We lag behind all other countries in the basic indices of health care performance: longevity, maternal and infant mortality, etc. Note that no two countries have exactly the same program. Some (the Netherlands, for example) have  “Conservative” programs, much like our Obamacare. Others (England) have programs that may be appropriately called “Socialized”. All countries however share one commonality --- cost is regulated; profit eliminated. Let us consider one small example of the waste in our system,  “preauthorization”.  Many millions of dollars in administrative costs are spent yearly by the requirement of insurance companies to approve requests for service. The process frustrates both physicians and patients. Many requests are rejected, only to have those rejections overturned on appeal. Thus on this process alone we spend millions of dollars to accomplish nothing. No other country wastes money like this. 

The only reasonable solution is a single payer system, “Medicare for all”. 

Letter #4: GOP Misinformation (280)

Mr. Dick Tracy’s commentary “Socialism is Not Freedom” (Vermont Standard, May 10, 2018) does the usual caveat of those who sanctify the free market and lumps communism, socialism and social democracy” together to conclude that they have “failed everywhere they have been tried.” This aptly shows why we cannot let our standards of education fall as they eventually would under Governor Scott’s education proposals.

If Mr. Tracy had bothered to do the research instead of regurgitating GOP misinformation, he would have known that communism, socialism, and social democracy are quite different from each other. I will give him communism and I have never liked that. Socialism, however, has not failed at all and is alive and well in places where Mr. Tracy would never think to look for it. One of these hideaways, for example,is in the GOP gift to the billionaires, which makes the middle class and the poor subsidize their lifestyle even more than we already have since Ronald Reagan.

Social Democracy is also alive and well and has surpassed us in many respects. Social Democracies like Denmark, Germany and Norway (to pick three at random) have vibrant capitalistic economies where there are plenty of consumer goods on the shelves and no such thing as bread lines. What they do, however, is to divide the nation’s wealth more evenly among the population so that one class (the capitalists, for example) are not exploiting another  class(the laborers).You are not free when you are mired in vast income inequality, poverty, medical debt, student debt, and so on. 

This is why “if polls are to be believed, a majority of our young people have rejected free market capitalism in favor of one of the alternatives.” This is why Bernie Sanders is so popular among our young people.

Letter #5: Cross-Walking (325)

Under the headline “Insurers Game Medicare System to Boost Federal Bonus Payments,” The Wall Street Journal (3/11/2018) reported on a practice called “cross walking” where insurance companies routinely shift millions of seniors from lower rated Medicare Advantage Plans into higher rated plans so that insurance companies benefit additional Federal government subsidies.  The seniors are led to believe they will get higher value but, in fact, they pay more for no better care — while insurance companies get more of our tax money to augment already record-breaking profits.

All the major insurance players participate in this “cross-walking” charade. The Wall Street Journal gave particular attention to Humana. When Humana got a caught “cross-walking” seniors from Medicare plans that pay Humana less to those that give seniors less and pay Humana more, share prices plunged  5% —  a $1.4Billion drop in market capitalization. But share prices recovered completely upon news of increased enrollment in more profitable plans — that is, “cross-walking” 1.27 million seniors.

Executive bonuses were safe, but taxpayers and seniors were not.  Humana alone netted $600 million from taxpayer coffers this year — to enrich the top 1%, some of the top 20%, and  certainly no seniors who will pay more for actuarially less. These plans are, in fact, more expensive for 90% of enrolled seniors — and far more expensive for the taxpayer.  “Cross-walking” creates substantial revenues to the insurance companies, basically funding the record-breaking earnings and executive compensation — and making health insurance one of the most profitable sectors in the U.S. Capitalism at its finest? Hardly.

The New York Health Act will improve Medicare without squandering tax money, will expand benefits to all New Yorkers, while costing seniors less — rechanneling healthcare dollars for health, not for rapacious corporations.  NY Health ( is close to passing, needing only one NY Senator for a majority, having already passed the Assembly repeatedly and overwhelmingly. 

Our lives. Our money. Call your NY State Senator and Assembly Member. Tell them we want to see passage soon.

Letter #6: Killing Women with Stress (350)

Health insurance is killing us, especially women. Too many of us who have health insurance can’t afford to see a doctor or get care because it costs too much. I’m not yet thirty and yet I have tragic stories.

When I had an emergency appendectomy, I didn’t have a choice about getting care. But I also couldn’t afford the bills. Fortunately, my mom helped, but this means I took money she needed, but we didn’t see a choice.

Somewhat later, my doctor prescribed medication that my insurer wouldn’t cover. Although I’ve been told that half of all insurance denials are accepted if the doctor and patient persist long enough, my doctor wouldn’t follow up. Since he wouldn’t fight for me there, I put off seeing a specialist who would need prior authorization, which would need my doctor fighting for it, which means my digestive problems are even worse. For-profit insurers intrude into the doctor-patient relationship like this all the time — because every denial puts money in their pockets.

I’m young and pretty healthy — so far — but my family has horror stories. My cousin wasn’t feeling well but didn’t have the money to see a doctor. One day he was dead. It was an undiagnosed heart condition. He didn’t have the money to find out, so no one knew.

Health insurance is not protecting most of us from financial ruin, and it’s not helping our health. My family and our doctors would like to emphasize prevention rather than constantly moving from medical crisis to financial crisis to medical crisis. This won’t happen until Americans can see doctors when medical issues are trivial or early — rather than fully developed and in crisis.

There is no reason so much financial stress should be added to the heartache and worry of illness. Healthcare is a civic good, like schools and libraries and fire departments. New York Health will offer healthcare that is universal (everybody in, nobody out), comprehensive (all essential care), affordable (no payment at point of service paid by taxes that go up with income), and cost-effective (saving NYS $45B/year). My family needs it yesterday.




Letter #7: Correcting Your Editorial (200)

Thank you for your editorial on Healthcare — an urgent issue for voters that’s only recently captured the attention of candidates. A few comments.

Lobbying: The health sector spent $600M on lobbying last year (3335 lobbyists for 535 Members of Congress), 75% of them opposing single-payer healthcare as an existential threat. Saying "more pharmaceutical lobbyists than lawmakers" misses the scale.

Public Citizen calculates Big Pharma spent $280M lobbying in 2017 — 1300% more than the lobbying expenditure you cite ($21M).

Medicaid expansion benefits aren’t just about patients covered and dollars spent —67 rural hospitals have closed since 2013, almost all in non-expansion states (NYT 10/29). Losing maternity wards and trauma centers means job loss, worse health — and unnecessary death.

Polling : 70% of Americans support Medicare for All according to a Reuters and Ipsos poll (August 2018): 85% of Democrats, 52% of Republicans.

Vermont's "running out of money": the plan involved a flat tax, the wealthy paying the same as the poor, and wasn't universal — ultimately, it wasn’t single-payer and didn’t save much. Vermont ran out of political will, not money.

Americans know our health system is broken. We want a better, more stream-lined, less wasteful healthcare for all. We want single-payer.

Letter #8: The Insurance Calculation Dilemma (385)

Health insurance is a drain with no upside. As a New Yorker who doesn’t qualify for a subsidy, the cheapest plan I can find is $450/month with a $7,000 deductible. For someone like me, who is basically healthy, such insurance makes seeing the doctor, getting a few labs and a few prescriptions per year extravagantly expensive: an outlay north of $12,000 per year for less than $2,000 in value.

On the other hand, not having insurance is a constant worry — what if something catastrophic happens and I face bills of $20,000 or $50,000? Am I better off paying a king’s ransom for years, and watching all that money pay for $20M salaries to health insurance CEOs? (It only takes 6,000 healthy people like me NOT using my insurance to pay for one CEO salary that big!) Or, should I try to save $12,000 every year so that if I fall on the ice and break my arm ($20,000), I can pay? But what if I’m hospitalized ($50,000) or diagnosed with cancer ($1M)?

Recently I was told I might have glaucoma — about $2,000/year in medications or $10,000 minimum for eventual surgery. So I signed up for Oscar, hoping it’s a false alarm. It is the largest bill I have except rent. It also has a $7,500 deductible, so if I “only” have glaucoma, it will be a wasted outlay. I got it in case my eye difficulties are worse than glaucoma and might need urgent and terrifying medical treatment.

For someone who is healthy and not rich, health insurance feels like a parasite — draining your resources but giving no value, even when possibly serious conditions are diagnosed. For someone who isn’t healthy, it may be worse: you can never be certain that the medical treatment you need will be fully covered and, if it’s not, you may face financial ruin. A third of us, mostly with insurance, forego medical treatment every year because of cost, while 3-5% are hit with catastrophic medical costs.

I’m exhausted from worrying about insurance cost and coverage, rather than focusing on my health, my job, my family. I’m not alone. New York needs NY Health to bring every single one of us comprehensive and affordable coverage — so financial obstacles are removed from care and we can focus on what really matters.

Letter #9: Canada (235)

A “disaster”? Wade Haposki says his Canadian family members suffer because Canadian medical resources are inconsistent (DATE).

Then he slams single-payer with anecdotes less vicious than those on Yelp critiquing hospitals in Oneida County: “the world's first do-it-yourself emergency room!!” A second hospital, “waited hours to be seen by a doctor, who only took a 2-second glance at me and proceeded to do nothing.” A third hospital, “Vitals, registration and six hours waiting.” Am I foolish for believing Oneida hospitals give good care?

Tommy Douglas, repeatedly voted the “greatest Canadian of all time” introduced single-payer healthcare in Saskatchewan province, providing “proof of concept” so powerfully successful that the rest of Canada followed suit within ten years. Douglas fought to give every Canadian quality healthcare. That means that Canadians, most of whom live in provinces less populated than Montana or South Dakota — some provinces with only 2 or 3 times Oneida County’s population but encompassing a half million to a million square miles — enjoy access to premier healthcare at world-class facilities — emergency transport included, however remotely they live.

Yes, Saskatchewan had impassioned naysayers spouting frightening rhetoric while Douglas was fighting for single-payer — with predictions as terrifying as opponents to American Medicare, which enrolled 19 million elderly into healthcare in 11 months with no hiccups, even as it also dismantled racial segregation in 2,000 hospitals nationwide.

Don’t base your vote on anecdotes. Find out more at

Vote for candidates who want New York State to enact legislation that keeps ALL New York residents healthy. In the 22nd district that means supporting Anthony Brandisi.

Find out more at

Letter #10: Maternity (200)

Doctors and patients both suffer from sky-high insurance. NY Health will reduce malpractice premiums better than tort reform.

We are the most dangerous country in the developed world for giving birth.  Our maternal death rate had a 50% spike between 2000 and 2015 — despite deaths decreasing everywhere else. American mothers are 8 times more likely to die than Finnish mothers, 4 times more likely than Italians or Kuwaitis.

Why? Shuttering maternity wards has reduced rural obstetrics practices. Having to drive hours for pre-natal visits reduces care. So do pricey co-pays.  When emergencies arise, local ERs — without obstetricians or staff trained for delivery complications — often send distressed mothers on multi-hour ambulance rides.

Even with insurance, childbirth is too often unaffordable. Medicaid pays for half of NYS births. It’s better than no care, but about like Kazakhstan.

NY Health, by eliminating liability for catastrophic or lifetime medical expenses, will reduce actuarial risk (and malpractice premiums) bringing them closer to Canada's — for obstetricians and hospitals. Adding the higher reimbursements paid by NY Health could encourage reopening maternity wards; while removing financial obstacles for patients will increase pre-natal care. 

NY Health will mean lower malpractice premiums, more neighborly obstetricians — and fewer grieving families. 

Letter #11: Our Mouths (210)

Yes, dental care is essential healthcare. And it’s expensive. And none of the dental insurance I’ve ever had has been useable.

Missing teeth increase the risk of death — by as much as 30% says the NIH. Severe periodontal disease that goes untreated for 5 years increases the risk of chronic kidney failure four-fold more than those with healthy (American Society of Nephrology) . Does periodontal disease lead to cardiovascular disease? The American Heart Association notes an association. Other studies link gum disease and untreated cavities to strokes, diabetes, and dementia.

Americans are dying because of Medicare’s gaps and restrictions. Yes, Medicare should cover healthcare for the mouth — without restricting coverage to an “average” patient’s needs, not 30-40% of the cost of the cleaning, with nothing for the x-ray, only within highly restrictive networks, and not for dentures. Ditto for no coverage of hearing aids — those with hearing loss are at greater risk of social isolation, increasing dementia, increasing mortality.  

NY Health (Gottfried/Rivera), Improved Medicare for all (Sanders/Ellison), and other single-payer legislation (in process in two dozen states) ALL include dental care — and vision and hearing — because, as NY Assembly Member Gottfried puts it “teeth, eyes, ears, brain are ALL essential body parts,” and good health requires that care be covered without financial obstacles.  

Letter #12: Healthy & Young, until not (164)

As a former health care administrator in both for-profit and nonprofit programs, I am appalled by this administration’s assertion that “short-term, limited-duration” policies for healthy people are an answer to providing insurance to this group.

I would like to hear them tell this to the faces of some of the young “healthy” people I know.

People like the 24-year-old who fell down a flight of stairs and ended up in rehab for a year, bankrupting her grandparents; or the numerous women I have seen with unplanned pregnancies and serious complications for mother and child; or the young athlete treated in the emergency room for a life-threatening infection resulting from a minor scrape during a Frisbee game; or my “healthy” teenage son, who developed cancer.

Young and healthy does not mean that one might not need the services of an emergency room, prescription drugs, or mental health or preventive care. Surprises will await those people who fall for this snake-oil sales pitch. I pity them.

Letter #Bonus: Impossible? (50)

In the near future Medicare for all will join the heap of other impossible dreams that came true: women’s suffrage, Social Security, Medicare, integration and gay marriage.

All we need are bold leaders with imagination and a strong grass-roots movement to support them. They are on their way!

[published in the NYT this month]