Letters: The Long, Long Wait for Mental Health Care

The Long, Long Wait For Mental Health Care

To the Editor:

“When It Comes to Mental Health Coverage, a Long Line of Patients Is Still Waiting” (Sept. 29) highlights what is sadly a pervasive barrier to recovery for mentally ill children and adolescents. In our emergency program for youth in psychiatric crisis, we commonly see young people who are suicidal, psychotic, dangerously aggressive, traumatized or deeply depressed. We know that for these types of major mental illness, prompt and effective treatment can make the difference between real recovery and a lifetime of disability.

Yet insurance companies routinely balk at paying for such treatment, passing the cost of illness on to families, schools and the children themselves, who without treatment will continue to suffer, often for years. Many go on to be mentally ill adults, often unemployed, homeless or in jail. Effective treatment for childhood psychiatric illness could reverse this course and cut costs in the long run, if our policy makers could ensure that every child has access to the right treatment at the right time.

RUTH GERSON, M.D.

JENNIFER HAVENS, M.D.

Manhattan, Oct. 1

Dr. Gerson is director of the Bellevue Hospital Children’s Comprehensive Psychiatric Emergency Program. Dr. Havens is director and chief of service at the hospital’s Department of Child and Adolescent Psychiatry.

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To the Editor:

Your well-meaning article unfortunately reinforces incorrect and stigmatizing stereotypes that allow insurers to justify withholding care — even though the Mental Health Parity and Addiction Equity Act of 2008 clearly states that this is against the law.

More research is certainly required to reach a “gold standard” of care, but this is true in all of medicine. There is no justification for insurers to prolong patients’ suffering and wait for them to “fail first” before treating their disorder seriously. This is like making patients wait in the parking lot to finish having their heart attacks or strokes, allowing permanent damage, before letting them into the emergency room for treatment.

The article states that “there is often little accepted medical evidence to support the range of treatments for many mental illnesses, like schizophrenia and severe depression.” But, in fact, evidence-based treatments for these two diseases are some of the longest and best established in medicine. Of course, treating mental illness is different than treating a heart bypass or hip replacement, but that doesn’t justify paying for one and not the other.

PATRICK J. KENNEDY

Brigantine, N.J. Sept. 30

The writer, a former member of Congress from Rhode Island, was an author of the 2008 Mental Health Parity and Addiction Equity Act.

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: Change Is Coming to the Repo Market

To the Editor:

In Gretchen Morgenson’s “Five Years Later, the Plumbing Is Still Broken” (Fair Game, Sept. 15), Ms. Morgenson does not note the significant reforms that the financial services industry has carried out or that are under way, and the fact that many large financial institutions have already reduced their reliance on the overnight repo market. As one of the clearing banks supporting the infrastructure of the tri-party repo market, Bank of New York Mellon has been at the center of significant changes.

For example, new service and delivery technologies, combined with significantly enhanced collateral standards, will practically eliminate the need for intraday credit in the tri-party repo market by the end of next year. By the end of this year, 70 percent of intraday credit will have been removed from the market. In addition, further reform initiatives will address the precise risks associated with unwinding repo transactions that the article mentions.

The Basel III Accord introduced, for the first time, quantitative liquidity requirements that stress-test large-bank funding practices and force firms to move from primarily overnight funding to longer-term financing arrangements. We are seeing financial institutions rely on more stable term sources of capital, such as debt and equity, rather than repo financing. In fact, the vast majority of remaining risk in the repo market is against United States Treasuries, the most liquid instruments in the market today.

Additionally, the Federal Reserve and other global regulators are focusing on banks’ reliance on short-term funding and on reform measures to more closely link capital and liquidity regulation. These efforts will materially alter the way banks fund themselves and change the repo market for the better.

As the industry and regulators work to advance reforms, your readers should know that many of the risks mentioned in the article are being addressed.

BRIAN RUANE

New York, Sept. 16

The writer is executive vice president for tri-party services at Bank of New York Mellon.

Letters: The Carbon Tax Debate

To the Editor:

N. Gregory Mankiw’s compelling case for a revenue-neutral carbon tax (“A Carbon Fee That America Could Live With,” Economic View, Sept. 1) was timely, as House Republicans will soon hold a hearing on climate change. Will this be a serious, practical examination of the issue, or just an excuse to attack President Obama’s climate policies for the midterm elections?

We shall see. But if it’s the former, Professor Mankiw’s proposal should be the star of the show. A truly revenue-neutral carbon tax would combine the proper roles of government and the private sector to get us moving away from fossil fuels.

Conservatives should like it because it does not grow government and would open the door to cutting back some inefficient regulations and subsidies. Liberals should like it because it would incentivize environmentally beneficial behavior without burdening the poor.

RICK KNIGHT

Brookfield, Ill., Aug. 31

The writer is a volunteer with the Citizens Climate Lobby.

To the Editor:

In his column, N. Gregory Mankiw argued for a carbon tax that would require offsetting reductions in other taxes.

But in doing so, he was dismissive of changes in societal values and regulation as paths to reduced carbon emissions. Such paths have been effective in other arenas — curtailing the use of tobacco, for example. And when it comes to gasoline use, social values about driving are already changing in an environment-saving direction, especially among young people.

So instead of dismissing those approaches, I would rather ask, “Where is the leadership in government, in the private sector, and in the media, to help make greenhouse gases as offensive to us as cigarette smoke has become?”

MARK KINNUCAN

Huntington Station, N.Y., Sept. 1

The writer is chairman of the Long Island Group of the Sierra Club.

Letters: Co-Payments and Beyond

To the Editor:

In his Economic View column, “When a Co-Pay Gets in the Way” (Aug. 11), Sendhil Mullainathan argued for the elimination of co-payments for drugs with proven benefits for the recipients. I agree, but even more can be done to improve the odds that patients will always take their medications over the long term.

In addition to the co-pay barrier, other factors can reduce adherence to medication. Receiving just one- or three-month supplies of chronic or maintenance mediations can cause such lapses. And the cost and inconvenience of an office visit, simply to arrange for a new annual prescription, can be burdensome as well. A patient may have to miss work just to have such an appointment.

Perhaps a longer supply of medication, along with the availability of a nurse for consultation by phone, could further drive long-term adherence to proven drugs.

JAMES P. REICHMANN

Marietta, Ga., Aug. 11

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To the Editor:

Co-payments for medications are only part of the problem. Last year, my health plan started charging $40 for any specialist and $200 for an emergency room visit, even with a premium of close to $800 a month. That adds to the stress of deciding when to go to specialists or the emergency room, even when it’s medically necessary.

If a basic level of free health care were funded by all taxpayers, we could solve many problems and change the economic landscape of this country. We wouldn’t have the stress of worrying about how to afford to stay alive — and the nation’s job creators would no longer have to subsidize employees’ health care costs.

SUSAN A. MCGREGOR

North Kingstown, R.I., Aug. 11

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: The Hunt for Melanoma

With the city going through the bankruptcy process, some extremely valuable and world-class artwork is being eyed by creditors.

Wesley Stace asks: How can two versions of the same song be so different?

Letters: Using the ‘Third Ear’

To the Editor:

Re “As Ideas Swirl, It Pays to Use Your Third Ear” (Corner Office, July 21), in which Joyce F. Brown, president of the Fashion Institute of Technology (and a psychologist by training) described her management style:

It’s refreshing to see a college president so productively embracing a concept described by the psychoanalyst Theodor Reik in his book “Listening With the Third Ear” 65 years ago.

Surely, many F.I.T. students and faculty members benefit from Dr. Brown’s use of her “third ear” — listening carefully “to understand the nuances” of others — as do patients when psychoanalysts and other mental health practitioners follow Reik’s lead.

Business and political leaders, like everyone else, have third ears. If ever there was a time to use them, to listen more closely, it’s these economically and militarily perilous days.

MURRAY GELMAN

Manhattan, July 21

The writer is a psychoanalyst.

Letters: Owning vs. Renting a Home

To the Editor:

Re “Owning a Home Isn’t Always a Virtue” (Economic View, July 14), which questioned incentives for homeownership:

Owning a home is one of the best ways to build financial security over the long term, providing equity accumulation and tax benefits. Homeownership strengthens communities, supports the economy and helps families build wealth — and for many people, it means gaining a foothold into the middle class. That is why owning a home has had longstanding government support.

Admittedly, lax lending and risky mortgages led to the housing market crash, but Americans have justly called for a return to safe, sensible underwriting standards. But the people have also spoken clearly and consistently about the importance of policies that promote responsible, sustainable homeownership, like the mortgage interest deduction.

Further, comparing homeownership rates in the United States to those in Switzerland, as the column did, is comparing apples to oranges; there are too many variables that influence those rates to make a fair comparison.

LAWRENCE YUN

Washington, July 16

The writer is chief economist of the National Association of Realtors.

Letters: Incentives for Homeowners (and Protection for Renters)

Incentives for Homeowners (And Protections for Renters)

To the Editor:

In “Owning a Home Isn’t Always a Virtue” (Economic View, July 14), Robert J. Shiller looked to Switzerland’s relatively low homeownership rate to make the case that the United States should rethink policies that promote owning a home — and should strengthen laws related to renting.

There is a better, closer-to-home example of a place with relatively favorable landlord-tenant rules: New York City. Many of its rental units are covered by rent controls, and many tenants have strong protections against rent gouging and eviction. By contrast, renters in many other cities are at the mercy of landlords who may wish to take advantage of a strengthening market to force them out through a large rent increase or a refusal to renew a lease.

Professor Shiller lauds the flexibility that renting provides families, allowing them to relocate easily for better jobs. But for tenants facing a rent increase or worse in many American communities, good commutes to work can be lost, advantageous child care or schooling options can be disrupted, or a social support network can be upended — all at a landlord’s whim.

I agree with Professor Shiller that we need to review our landlord-tenant law to help families plan their futures.

RAY BRESCIA

Albany, July 15

The writer is an associate professor of law at Albany Law School.

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To the Editor:

Professor Shiller asks: “In today’s world, is it wise for the government to subsidize homeownership?” Two prominent Americans of vastly different political views apparently have an answer for him.

The first said: “A nation of homeowners, of people who own a real share in their own land, is unconquerable.”

The second said that “an ownership society” is being created in our country, “where more Americans than ever will be able to open up their door where they live and say, ‘Welcome to my house, welcome to my piece of property.’ ”

Who are these two Americans? The first was Franklin D. Roosevelt, and the second was George W. Bush.

RICHARD S. COLMAN

Orinda, Calif., July 15

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: Incentives for Homeowners (and Protection for Renters)

Incentives for Homeowners (And Protections for Renters)

To the Editor:

In “Owning a Home Isn’t Always a Virtue” (Economic View, July 14), Robert J. Shiller looked to Switzerland’s relatively low homeownership rate to make the case that the United States should rethink policies that promote owning a home — and should strengthen laws related to renting.

There is a better, closer-to-home example of a place with relatively favorable landlord-tenant rules: New York City. Many of its rental units are covered by rent controls, and many tenants have strong protections against rent gouging and eviction. By contrast, renters in many other cities are at the mercy of landlords who may wish to take advantage of a strengthening market to force them out through a large rent increase or a refusal to renew a lease.

Professor Shiller lauds the flexibility that renting provides families, allowing them to relocate easily for better jobs. But for tenants facing a rent increase or worse in many American communities, good commutes to work can be lost, advantageous child care or schooling options can be disrupted, or a social support network can be upended — all at a landlord’s whim.

I agree with Professor Shiller that we need to review our landlord-tenant law to help families plan their futures.

RAY BRESCIA

Albany, July 15

The writer is an associate professor of law at Albany Law School.

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To the Editor:

Professor Shiller asks: “In today’s world, is it wise for the government to subsidize homeownership?” Two prominent Americans of vastly different political views apparently have an answer for him.

The first said: “A nation of homeowners, of people who own a real share in their own land, is unconquerable.”

The second said that “an ownership society” is being created in our country, “where more Americans than ever will be able to open up their door where they live and say, ‘Welcome to my house, welcome to my piece of property.’ ”

Who are these two Americans? The first was Franklin D. Roosevelt, and the second was George W. Bush.

RICHARD S. COLMAN

Orinda, Calif., July 15

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: The Data Quandary

To the Editor:

Re “If My Data Is an Open Book, Why Can’t I Read It?” (Technophoria, May 26):

The column pointed out that some companies sell information about consumers to marketers but won’t provide the consumer with information about his or her own activities:

This situation exists because laws do not specify what a privacy policy must contain — so companies that don’t compete on the basis of privacy are free to provide as little to consumers as they wish. A downside of self-regulation is that companies that don’t want to provide consumer protections can avoid doing so.

JEFF SOVERN

Jamaica, Queens, May 26

The writer, a professor at the St. John’s University School of Law, is a coordinator of the Consumer Law and Policy blog.

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To the Editor:

The column highlighted the fact that businesses collect data on individuals, often without their genuine consent, then profit from the data and treat it as their own property. A leitmotif is that many Americans have accepted the idea that the rights of consumers to data about themselves should be regarded as a gift from the data-collecting entities.

To gain perspective on this situation, imagine that the federal government collected data on visitors to its Web sites, sold it to companies, otherwise shared the information with favored organizations and yet refused to share it with the individuals. Surely an uproar would result.

Yet Americans act like sheep when corporations do these very things.

MICHAEL N. ALEXANDER

Lexington, Mass., May 26

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: Coffee Rituals at the Office

Those Caffeine Rituals

To the Editor:

“Coffee Rites, and the Stories They Tell” (Workstation, May 19) captured a variety of workers’ arrangements for the daily fix of caffeine.

Recently, a couple of co-workers and I pooled our coffee resources — one brought a coffee maker, I brought mugs, and the third has been bringing the coffee. Oh, and I started taking the coffee grounds to a compost drop-off site. We like saving money, not creating trash with disposable paper cups, and knowing our enjoyment will live on as organic matter for somebody’s garden.

But I confess to secretly stopping at the corner cart once a week because I need the connection. “Five sugars?” the proprietor teases me, because he knows I like plain black coffee. I always leave smiling — and that feels better than the caffeine.

RUTH GROEBNER

Sunnyside, Queens, May 19

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To the Editor:

Several years ago, during a particularly challenging transition while at a nonprofit organization in Minneapolis, I worked in an off-site, windowless office where I couldn’t speak with many staff members I supervised. I was generally unhappy in a career I had always loved.

My one daily treat was my six-block walk to a coffee house called Betty’s Bikes and Buns. The owner and his daytime barista became my friends, and I always looked forward to chatting with them. And my daily small skim latte kept me going through each difficult day. Now I am retired and using my kitchen latte machine — but I would probably be healthier if I had a great coffee place to walk to each day!

MARIBETH HITE

Lafayette, Colo., May 20

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: When Medical Bills Weigh on Job Applicants

Archives at the New York Public Library cross-referenced with long-awaited 1940 data provide eye-opening results.

Stuck without a lyric in sight, a songwriter ponders the intricacies of a little bird’s brain.

Letters: The Right Corporate Directors

Archives at the New York Public Library cross-referenced with long-awaited 1940 data provide eye-opening results.

Stuck without a lyric in sight, a songwriter ponders the intricacies of a little bird’s brain.

Letters: What’s ‘Pro-Business’?

Archives at the New York Public Library cross-referenced with long-awaited 1940 data provide eye-opening results.

Stuck without a lyric in sight, a songwriter ponders the intricacies of a little bird’s brain.

Letters: Prizes With a Message

A co-creator of “Game of Thrones” on Caesar, songs about killers and compost cookies.

Malaysian voters have a historic opportunity to throw out the long-ruling National Front.

Letters: A Simpler Bank System

A co-creator of “Game of Thrones” on Caesar, songs about killers and compost cookies.

Malaysian voters have a historic opportunity to throw out the long-ruling National Front.

Letters: Household Debt, vs. the Government’s

Household Debt, vs . the Government’s

To the Editor:

Re “A Sustainable Budget Should Survive Any Storm” (Economic View, March 31), in which N. Gregory Mankiw said that the federal budget should be built to withstand catastrophic events:

The column made a point that is too rarely mentioned in Republican circles: that a household budget is unlike the budget of the federal government, which “has been granted the presumption of immortality by its creditors” and thus faces “no final day of reckoning on which all debts need to be repaid.”

But a more nuanced — and politically relevant — point might be made. Many individuals die insolvent, which means that they did not balance their lifetime budgets. For all practical purposes, many of your debts die with you.

Moreover, few people start from zero. Even if they do not inherit money, most enjoy assorted forms of “income” courtesy of their parents for the first 18- to 20-odd years of life.

For all these reasons, the tired notion that a government budget is just like a business or a family budget ought to be called out as balderdash more often. DAVID TALLMAN

Atlanta, March 31

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To the Editor:

Late in his column, Professor Mankiw says that “military and economic catastrophes are, by their nature, unpredictable,” and, as such, should be reasons for budgetary prudence by the federal government.

A third catastrophe, however, is the political kind — like that of the George W. Bush administration he advised. That’s the administration that decided, amid huge national debt, to use budget surpluses to give tax breaks to the wealthy.

KELLEY S. WILLIS

Venice, Calif., April 1

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

Letters: The Financial Future of Veterinarians

The Financial Future of Veterinarians

To the Editor:

“The Vet Debt Trap” (Feb. 24), about the veterinary student debt crisis, hit the nail on the head. It should be required reading for all prospective veterinary students, regardless of age, to temper their passionate pursuit of the profession with a sobering dose of financial realism before they commit.

I am a 28-year veteran of the profession. My demographic of private-practice owners will also suffer the consequences of this vicious debt cycle, since the eventual sale proceeds of our practices represent a significant portion of our potential retirement nest egg. Good luck finding a qualified buyer among our debt-ridden younger colleagues in the next 5 to 10 years and beyond, especially in the face of falling practice revenue. Some newly minted veterinarians won’t be able to qualify for a home mortgage, let alone the financing to buy a practice.

JEFFREY T. KRYSINSKI, D.V.M.

Grosse Pointe, Mich., Feb. 24

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To the Editor:

The article shed light on a subject that is hugely overlooked and underreported.  Before I applied to veterinary school, it was my understanding that there was a lack of veterinarians, especially in large-animal practice. Now I face the challenge of paying off student debt when jobs are few and far between.

I will most likely have to take an internship that may pay about $26,000 a year — $13 an hour for a 40-hour week, working 50 weeks a year. Considering that an intern may work 60 to 70 hours a week, that’s about $8 an hour. I made more money when I worked shoveling horse manure.

 I entered veterinary school with the best intentions — I love animals and can’t imagine a career that would make me happier. We are all young, starry-eyed animal lovers with dreams of saving lives; we are not accountants or business people. I hope that veterinary schools, the government and, most important, our future clients will take into account the sacrifices we make to live our dreams.

LAUREN PETERSON

Baton Rouge, La., Feb. 26

The writer is a third-year veterinary student at Louisiana State University.

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To the Editor:

I bought my veterinary practice in 2005, just two years out of school.  And while the economy in my area has not been kind to veterinary practices, I am still here.

But I have seen a change in the face of veterinary medicine, as more pet owners want low-cost, online, do-it-yourself medicine for their pets.  Sometimes I foresee the field becoming a trade, rather than a profession — even as so many veterinarians have student loans to deal with.

It’s hard to compete, and I have had to resort to coupons and lowering my own costs to get business in the door.  I hope that it will be enough to finish paying off my loans.

ANDREA MAYBERRY, D.V.M.

Grove City, Ohio, Feb. 25

The writer is owner of Grove City Veterinary Hospital.

Letters for Sunday Business may be sent to sunbiz@nytimes.com.

NPE: The Scarlet Letters of Patent Ownership

The continuing outrage against patent owners deemed nonpracticing entities (NPEs, aka trolls) appears to be part of our schizophrenia over wanting an economy dominated by creative business types and hating the creative business models that foster that domination. It now appears that there are further factures in what should be deemed a bad NPE and what should be considered a good NPE. In a recent congressional hearing, there were distinctions made among patent owners that just buy patents, patents owners that may have done research for some patents and may buy other patents and university research that produces patents that are commercialized by technology transfer departments.

NPE: The Scarlet Letters of Patent Ownership

The continuing outrage against patent owners deemed nonpracticing entities (NPEs, aka trolls) appears to be part of our schizophrenia over wanting an economy dominated by creative business types and hating the creative business models that foster that domination. It now appears that there are further factures in what should be deemed a bad NPE and what should be considered a good NPE. In a recent congressional hearing, there were distinctions made among patent owners that just buy patents, patents owners that may have done research for some patents and may buy other patents and university research that produces patents that are commercialized by technology transfer departments.