Letter: Wichita Abortion Clinic

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To the Editor:

Reading about Julie Burkhart and her team gives me hope ("Four Years Later, Slain Abortion Doctor's Aide Steps Into the Void," news article, Feb. 14).

As a doctor who provides abortions and a colleague of Dr. George R. Tiller, I have worried about the women left behind when he was murdered — not only the patients who came from far and wide for late abortions but the Wichita, Kan., women who depended on him for early procedures and family planning.

Their needs didn't die when he was murdered, and I applaud Ms. Burkhart for her determination to bring reproductive health care back to these women.

She seems unfazed by the anti-abortion furor kicked up around her. Maybe, like me, she finds solace in Dr. Tiller's memory and his conviction that women should be trusted with their health and lives.

WILLIE PARKER
Chicago, Feb. 14, 2013

The writer is a board member of Physicians for Reproductive Health.

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Letters: How Can We Make Health Care Work?

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Re "The Health Benefits That Cut Your Pay" (Sunday Review, Feb. 17):

David Goldhill's solution of catastrophic health insurance would not significantly reduce costs but would leave millions of Americans with inadequate health care.

Health costs are highly concentrated. The top 50 percent of health care spenders account for more than 97 percent of health expenditures. Almost all of their "catastrophic" spending would still be insured, presumably by the government.

The bottom 50 percent account for about 3 percent of spending, hardly enough for Mr. Goldhill's imagined savings. Meanwhile, a large number of Americans would be unable to afford necessary and preventive care. Many would postpone or do without care until their conditions became more expensive or "catastrophic."

About 22 percent of American children live below the poverty line. Imagine what this proposal would do to them.

DAVID SHACTMAN
Siesta Key, Fla., Feb. 17, 2013

The writer is co-author of the book "Power, Politics and Universal Health Care: The Inside Story of a Century-Long Battle." To the Editor:

David Goldhill writes: "Try to imagine what homeowners' insurance would look like if we expected everyone's house to burn down and then added coverage for each homeowner's utility bills and furniture wear-and-tear. This would be insanely expensive without meaningfully reducing anyone's risk. That, in short, is how health insurance works."

His analogy is flawed.

The costs of heating and electricity are predictable and can be controlled by buying smaller houses and turning down the thermostat. But while the costs of chronic illnesses are predictable for large populations, they are highly unpredictable for people and their families.

The maintenance cost of remedying shabby furniture and peeling paint can be balanced against other nonessential spending, and the consequence of delay is born solely by the family, while the cost of inadequate prenatal care and incomplete vaccinations will be paid by society as a whole.

Thus, health policy that covers only catastrophic illness, as Mr. Goldhill advocates, might work well for the healthy middle class but would fail miserably for families with chronic illnesses and discourage preventive medical care.

RACHEL BRONHEIM
Princeton, N.J., Feb. 19, 2013

To the Editor:

With the best intentions, David Goldhill has described a free-market fantasy of health care. Market prices are based on power. In the United States today, hospitals and large doctor groups wield enormous market power, and they exercise it ruthlessly; consumers have none. Hospitals charge whatever the market will bear; uninsured patients pay the highest prices.

Large insurers bargain for "discounts" from prices set high enough so that hospitals still profit, and pass some of the "savings" on to large employers, who also have market power, but not to small businesses or individuals.

Whatever their faults, single-payer systems using government leverage, like the Canadians' — or Medicare — deliver decent quality care to more people at lower cost. Mr. Goldhill makes the best the enemy of the good.

CAROLINE POPLIN
Bethesda, Md., Feb. 17, 2013

The writer is a primary care physician.

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Letter: Financial Transaction Tax

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Re "The 0.03% Solution to Washington's Budget Problems," by Jesse Eisinger (DealBook, Feb. 7):

Decades of academic research show that a financial transaction tax would harm Main Street, not Wall Street, and hardly raise the revenue that proponents claim that it would. The United States, Sweden and Japan have had similar fees in the past and repealed them because the tax hurt average investors, reduced savings and made it harder for America's job creators to grow.

Highly liquid markets allow retail investors to get the best price and pay dramatically lower transaction costs when they buy and sell stocks and bonds, fueling the capital needs of businesses to expand and create jobs.

Proponents and opponents of the financial transaction tax agree that it would double trading costs, reduce the number of financial transactions by at least 50 percent, and reduce the liquidity that benefits investors and businesses.

The wisdom of Presidents John F. Kennedy and Lyndon B. Johnson in repealing this job-killing tax still holds true today.

THOMAS QUAADMAN
Vice President, Center for
Capital Markets Competitiveness
U.S. Chamber of Commerce
Washington, Feb. 7, 2013

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Letter: Patent System Isn’t Broken

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Re "Innovation Nation at War," by Joe Nocera (column, Feb. 9):

Judge Richard A. Posner is a brilliant jurist, but I respectfully disagree with his view of our patent system. It is far from broken. It has been the key to multiple revolutions in technological advancement throughout history. And its vital function continues today.

Litigation costs are indeed in need of reform, but that is the case across the board in our litigious society. But patent litigation is declining as a percentage of issued patents. The so-called smartphone wars are a myth propagated by those with an economic interest in tipping the scale toward those who build on inventions versus those who invent.

Innovations in communications have dramatically changed our lives. Our patent system has played a critical role in attracting investment and protecting the fruits of these efforts. Let's not overreact to a momentary uptick in commercial disputes as competitors seek to outmaneuver one another. If we do, we risk irreparable harm to our knowledge-based economy.

DONALD J. ROSENBERG
Executive Vice President
and General Counsel, Qualcomm
San Diego, Feb. 11, 2013

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Letter: Don’t Judge a College’s Value by Graduates’ Paycheck

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Re "Scorecard for Colleges Needs Work, Experts Say" (news article, Feb. 14):

The focus in federal policy making and rhetoric on earnings data as the indicator of the value of higher education will further the growing perception that a college degree should be simply a ticket to a first job, rather than a passport to a lifetime of citizenship, opportunity, growth and change.

I graduated from Bryn Mawr College in 1968, and my first job was working for the Department of Housing and Urban Development. My starting salary was low, but I was inspired by the civil rights movement and the War on Poverty to regard public service as an important calling. I went on to graduate school, joined the faculty at the University of Pennsylvania and ultimately became the president of Harvard University. Should Bryn Mawr have been judged based on what I was paid in my first year at HUD?

When I speak with students today, I encourage them to pursue those interests that enable them to make their particular contribution to the world. A graduate working to begin a start-up or one pursuing a career in the creative arts would likely not score high on the proposed federal scale of educational worth. Nor would the nearly 20 percent of our graduates who each year apply to Teach for America and numerous other teacher-residency programs.

Making college more affordable for students and families is a fundamental goal that we in higher education are dedicated to support. When we decide what to measure, we signal what counts. Equating the value of education with the size of a first paycheck badly distorts broader principles and commitments essential to our society and our future.

DREW GILPIN FAUST
President, Harvard University
Cambridge, Mass., Feb. 15, 2013

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Editorial: Immigration Reform and Workers’ Rights

Members of Congress and President Obama have been working in earnest to deliver on their promise to overhaul immigration this year. Mr. Obama would clearly prefer a bipartisan bill, and last week the Senate Judiciary Committee held its first hearing on possible changes in immigration law. News reports last weekend suggested that the White House would fashion its own bill should negotiations between Republican and Democratic supporters of reform collapse.

Yet, in all the talk of providing a path to citizenship for millions of undocumented workers while tightening border security, one important issue has, so far, received only passing mention: stronger protections for immigrant workers against exploitation and abuse. Such protections, essential to any reform plan, would help rid the system of bottom-feeding employers who hire and underpay and otherwise exploit cheap immigrant labor, dragging down wages and workplace standards for everyone.

Such abuses are easily visited on immigrant workers by unscrupulous employers who use the threat of deportation to force their victims into silence. This imbalance of power harms workers who toil in the shadows. But the system that recruits legal temporary workers is also a mess. In the event that an immigration overhaul greatly expands the number of guest workers — even hard-line Republicans have been talking about adding temporary visas in agriculture and in high-tech industries — it is crucial to avoid making the mess even bigger.

A new report by a coalition of labor, immigrant and human-rights groups has identified and examined "disturbingly common patterns" of abuse in America's guest-worker programs. They are an alphabet-soup of visas with names like H-1B, H-2A, H-2B, J-1 and A-3, all having their own rules and little in common except, the report said, workers who are frequently victimized by "fraud, discrimination, severe economic coercion, retaliation, blacklisting and, in some cases, forced labor, indentured servitude, debt bondage and human trafficking."

The abuses begin overseas, where workers pay recruiters steep fees and start their new lives in deep debt. Unable to leave abusive employers and with little access to the legal system, they suffer in silence. Those who do speak out are threatened, fired, deported, blacklisted. They have little opportunity to complain about unsafe working conditions, to sue for stolen wages or to assert their rights to overtime and time off.

Overhauling visa programs to ensure workers' rights should be in the thick of the immigration discussion. For one thing, it's a way to move past the deep divisions that have stalled reform. Labor unions have been wary of bills that include guest-worker programs because they don't want the competition. But in a promising shift, the A.F.L.-C.I.O. and Service Employees International Union have joined forces with an old adversary, the Chamber of Commerce, in the current push for reform. The unions recognize that deporting 11 million undocumented immigrants is a delusion, and that the benefits of legalizing them far outweigh keeping them outside the law.

And if immigrant workers are free to assert their rights without fear, to bargain collectively and blow the whistle on bad employers, American workers can only benefit, too.

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Letter: Testing Cosmetics for Safety

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Re "The Cosmetics Wars" (column, Feb. 6):

Mark Bittman writes that there are "questionable ingredients" in cosmetics, "many of which haven't been tested." In fact, federal law mandates that every product be substantiated for safety before it is brought to market, and the Food and Drug Administration has the authority to enforce this. Animal testing is not the only valid method to assess the safety of cosmetic ingredients.

But the globalization of the marketplace, new technologies and evolving science support the need for modernizing the F.D.A.'s statutory authority and oversight. The industry has long called for additional money for the agency's cosmetics program and supports legislation to enhance its authority to assess safety.

While cosmetics are an easy target, they remain one of the safest categories regulated by the F.D.A. Any suggestion of serious health problems related to their use is without any basis in sound scientific research or medical reality.

HALYNA BRESLAWEC
Chief Scientist
Personal Care Products Council
Washington, Feb. 7, 2013

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Letters: Online U.: A Look at the Rankings

"The Trouble With Online College" (editorial, Feb. 19) is too quick to discredit online higher education.

We sit at the dawn of an education revolution; advancements in the means of distribution provide instructors instant feedback on their teaching methods from thousands of students, allowing teachers to adapt instruction in real time. This feedback loop generates an evolving education landscape quick to converge on effective instructional methods.

The state of online education may not suit all students, but it is important to avoid conflating present means with the future of the art.

AARON B. KROLIK
Durham, N.C., Feb. 19, 2013

The writer, a sophomore at Duke, is enrolled in "Introduction to Genetics and Evolution," a Duke course taught on Coursera. 

To the Editor:

For years, we have been hearing about the coming wonders and efficiency of "distance learning," "online education" and other names for the same pipe dream. The trumpets have usually been blown by administrators wanting to save on faculty salaries. But humans are not designed to get their basics from computers, at least not without so much interaction with faculty that the technique loses its advantage.

Recorded or live videos are O.K. for learning more about something we already know, but they are not much use in the beginning stages. For example, they don't watch students' faces and see the slack jaws that say, "We don't get that; can you explain it from another angle?"

HARRY J. WYATT
New York, Feb. 19, 2013

The writer is teaching professor emeritus, SUNY College of Optometry.

To the Editor:

A 2010 Department of Education review found that "students in online learning conditions performed modestly better than those receiving face-to-face instruction." How can this be? Because lecture classes, which make up a substantial percentage of undergraduate credit hours, are less engaging, interactive and supportive than most online classes.

Online courses can enhance learning opportunities for nontraditional students and those not well served by lecture classes. High-quality, next-generation online courses incorporate personalized adaptive learning, problem-solving activities, interactive laboratories, animations, simulations, educational gaming, virtual reality environments, social networking and data analytics.

All of these can diagnose and remediate learning deficiencies, enhance student-instructor interaction and improve student learning outcomes.

STEVEN MINTZ
Sunnyvale, Calif., Feb. 20, 2013

The writer is founding director of the University of Texas System's Institute for Transformational Learning and a professor of history at UT Austin.

To the Editor:

Innovation in online delivery is one of the few bright spots in the future of our country's community colleges. Meeting chronic unmet educational need with additional face-to-face instruction (always of uneven quality) is no longer an option for most tax-strapped public systems.

Rather than decrying the inevitable rocky start of this digital revolution, we should be thoughtfully encouraging its growth and improvement.

MITCHELL L. STEVENS
Stanford, Calif., Feb. 19, 2013

The writer, an associate professor of education, is a co-convener of the education's digital future program at Stanford.

To the Editor:

Your conclusion — "that poorly designed courses can seriously shortchange the most vulnerable students" — is obviously correct. But this applies to all courses, not simply online instruction.

Earlier, you note that often online courses have little interaction between professors and students. When we see this, it is clearly a result of poor course design and inadequate faculty training and preparation.

There is no inherent reason online instruction cannot be interactive, especially with students of this generation, who are used to interacting online. I am not speaking about the massive open online courses (MOOCs), which try to enroll many thousands of so-called students.

Indeed, these are overrated, even though other forms of online learning, including "hybrid" courses, which include a mix of face-to-face and online interactions, are quite promising and even transformative if designed appropriately and with care.

LAWRENCE LIPSITZ
Englewood Cliffs, N.J., Feb. 19, 2013

The writer is the editor of Educational Technology Magazine.

To the Editor:

The most obvious weakness of the online college is the relative absence of laboratory courses. In other words, there is little place for the experimental sciences in the curriculum. And no exciting introductory physics course with lecture demonstrations!

One cannot ignore the influence of higher education on the national economy. The crying need is for a work force replete with employees with the skills that come from the laboratory experience at the university level.

ARTHUR R. QUINTON
Amherst, Mass., Feb. 19, 2013

The writer is emeritus professor of physics at the University of Massachusetts, Amherst.

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Letter: Guns and Suicide

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To the Editor:

"With Guns, Killer and Victim Are Usually Same" (front page, Feb. 14) justifiably focuses the relationship between gun laws and psychiatry on suicide prevention.

Psychiatrists see people who are suicidal with a treatable mental illness far more frequently than those who are homicidal. 

I, like many other psychiatrists, frequently evaluate people who have a new lease on life after surviving pill overdoses and knife wounds. 

One reason they may use less lethal methods is the ambivalence about the wish to die, resulting in a cry for help. Since suicidal behavior often has an impulsive component, those who are more determined can be saved if the method is made more difficult. This can be aided by reduced access to guns.

JEFFREY B. FREEDMAN
New York, Feb. 14, 2013

The writer is a former president of the New York County branch of the American Psychiatric Association.

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Letter: Targeted Killings Court

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Re "A Court for Targeted Killings" (editorial, Feb. 14):

You rightly recognize that judicial review of the Obama administration's targeted killing program is necessary, but a new secret court, using secret evidence, is not the answer.

Our existing federal courts deal every day with national security and terrorism cases while protecting sensitive military and intelligence information. More fundamentally, your "kill court" proposal might be intended to limit the executive branch's claimed killing authority, but threatens instead to legitimize it.

The Obama administration is already relying on unlawfully expansive interpretations of executive power, due process and even what the word "imminent" means.

The way to ensure that the executive's actions are in line with the Constitution, our laws and our values is — as it has always been — for a federal court to decide what the law is and for Congress to exercise meaningful oversight.

To that end, the Obama administration needs to stop hiding the memos including its legal rationale for extrajudicial killing from the courts, Congress and the American public.

HINA SHAMSI
CHRISTOPHER ANDERS
New York, Feb. 16, 2013

The writers are director of the American Civil Liberties Union's National Security Project and the A.C.L.U.'s senior legislative counsel, respectively.

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