‘You Decide’ rebuttal

To the editor:

I respectfully rebut Professor Walden’s March 10 “You Decide” column; WE can’t decide. He implies that individual decisions drive economics that can curtail climate change. Perhaps.

But individual decisions are inefficient as shown last year when we “muddled through” COVID-19. Action was delayed because people were misled, with little co-ordination or sense of national emergency.

Similarly, because people have been misled regarding climate change, serious action has been delayed. Like the COVID-19 issue, we need top-down guidance with friendly persuasion. Professor Walden’s approach alone would require decades to take effect.

Economists estimate the cost of preventing the COVID-19 pandemic at 2% the cost of the ensuing global recession. (Compare Texas power/water fiasco.) Similarly, a $10 trillion investment now to halt climate change may save $500 trillion later. But, again, we’re on track to clean up the train wreck rather than prevent it.

There is no “silver bullet.” Revolutionary transformation of our energy infrastructure requires an arsenal of new technologies: safer, more efficient nuclear power; innovative solar energy (photovoltaic and thermal processes, wind and wave power); improved energy storage (batteries, capacitors, fuel cells, etc.); bio-engineering to produce fuels with zero net CO2 emissions; streamlined environmental impact requirements; improved energy utilization (e.g., smarter transmission grids); new construction processes; carbon collection and sequestration; planting, not burning, trees; improved farming techniques; environmentally-safe electric cars; etc. Plus, individual action.

In World War II, America didn’t increase military production until we entered the war. Then, annual production of military aircraft increased 42-fold. We can rise to the occasion.

Climate change poses a crisis equal that of the Axis Powers. Let’s not wait for a Pearl Harbor to finally wake up. Unlike that threat, our military recognizes the dangers of climate change. But not Congress.

Encourage members of Congress to provide federal support for energy restructuring. As a nation, we can restructure. But happenstance and individual “bottom up” mitigation won’t cut it.

I’m not an expert, but a North Carolina native with experience in many energy alternatives. Anyway, people are fed up with “experts” but maybe can abide a little “horse sense.”

Everett Baucom

Cruso

America last, abortion first

To the editor:

America First has become a familiar slogan the last several years, whether or not one approves of it.

Be ready for a new theme now — “America Last.” We are well on our way to the ultimate finish line.

In a few short months we have seen our southern border become a crisis of unparalleled proportions, thanks to the lack of any immigration controls. We have ditched the Keystone Pipeline which means we are back to dependence on Arab oil, not to mention thousands of great jobs lost. Gas prices have surged, and summer travel has not even begun.

The U.S. has rejoined the World (China) Health Organization where we foot the bill and China calls the shots. We’re back in the good old Paris Climate Agreement, so we can again be the punching bag for all, while we again pay the big bucks.

We are so worried about hurt feelings that we canned Dr. Seuss, Dumbo, and Peter Pan, while China is surging ahead with an aggressive military — pressing toward a war that our own military experts doubt we can win.

At least we have HR1319, the $1.9 trillion package to cure all that ails us. This stimulus can indeed help many families and hopefully save some small businesses. But there are a ton of hidden agendas in the package.

The most atrocious of these is the freeing up of billions of dollars to support abortion and the abortion industry. (Nancy didn’t “mention” this and Joe may have “overlooked” it.)

Even three Democrats joined with all the Republicans to try and block this deal. (It was excluded from the last year’s stimulus.)

So, thousands of unborn babies will be murdered as a result of what is included in HR 1319 touted as a family friendly support.

God have mercy on us as a nation murdering our helpless unborn children.

Kerry Cogburn

Clyde

Give new Medicaid system a chance

To the editor:

While the new NC Medicaid program is indeed a test to examine how addressing social determinants impacts the health of people on Medicaid, it seems disingenuous to call it a gamble.

Research has shown that that where people live, work, play and pray, can have either positive or negative impacts on health. Instead, let’s consider this an experiment in system redesign. Prevention efforts can improve health and quality of life.

Consider that vaccinations eliminated smallpox in the U.S. We are on our way out of this pandemic through a mass vaccination effort again. Shepherding by what used to be a strong army of community-based public health nurses, diseases like tuberculosis are nowhere near as prevalent today as they were 100 years ago.

We need to change how we deliver healthcare in this country. Our current healthcare system incentivizes the delivery of high-cost physician-driven healthcare services by hospitals (most of which are for profit entities in our region).

Primary care providers also are incentivized to “see you in the clinic” — more visits mean more money. This new model provides a fixed payment amount to change these incentives to support delivery of cost-effective services while still producing good outcomes.

Opponents of these models argue that there is also an incentive to ration care. Vigilance through oversight as well as a strong emphasis on outcomes is necessary to avoid this from occurring.

Medicare already holds primary care providers accountable in this way, such as showing good management of high blood pressure and diabetes and fully reimbursing preventative services. These are policy strategies designed to influence behavior to improve the quality of care delivered. The new Medicaid model is also designed to hold providers accountable for meeting outcomes.

Nurse-led care coordination and care management has been found to be cost-effective in supporting positive health outcomes. However, few primary care practices in our region have a strong pool of registered nurses (RNs) to serve in this capacity.

Let’s use this opportunity to move beyond our current physician-centric primary care delivery model to care provided by well trained, high functioning interdisciplinary teams that include RNs.

Kae Livsey, MPH, PhD, RN

Waynesville

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