My fellow Americans, it shouldn’t be easier for us to imagine the apocalypse than a future with free healthcare

Please send your letters to letters@independent.co.uk

Hope Howard’s article (“Yes, I want universal healthcare in America – but not through Medicare-for-All”) suggested capitation budgets (payments given to providers on a per-patient basis rather than a per-visit basis) as a potential alternative to Medicare-for-All. Howard did not mention that capitation already exists in the state of Maryland, where I live. While our “all payer” model has saved money in comparison to other states struggling to finance healthcare within a for-profit system, it has also exacerbated racial and economic disparities in health.

Poor people in my state – especially children in Baltimore City – have higher levels of asthma, diabetes and permanent brain damage caused by lead paint poisoning (Freddie Gray, whose death sparked the 2015 Baltimore Uprising, was one such child). This population utilises healthcare services more often, and as a consequence of capitation in a for-profit environment, Maryland hospitals have closed less profitable areas of treatment that tend to be heavily utilised by poor people (eg, there are few remaining pediatric A&E wards in Baltimore), replacing them with more profitable new surgical centres.

Global budgeting is already an important component of the House Medicare-for-All bill recently introduced by representative Pramila Jayapal. Capitation itself isn’t the problem here – the problem is that adjustments within a for-profit system tend to have a punitive impact on human beings around the familiar lines of race, class, gender identity, disability and immigration status.

For too long, it has been easier for my fellow Americans to imagine the end of the world than an end to for-profit healthcare. The only demonstrated alternative is a single payer system – if we have the heart to fight for it.

Brittany Shannahan
Baltimore

No local elections in Northamptonshire

As you go or don’t go to the polling station today to express your commitment to and disgust with local politicians, please spare a thought for the electorate of Northamptonshire.

We are being denied the opportunity to express our solidarity and frustration with our local politicians at county and district level.

Our county council has effectively been declared unfit for purpose but reform is hanging fire. We are in a state of suspended animation and have no local elections.

“Never mind” I hear you say. “You can make up for it by recording the highest or lowest turnout on record for the European elections!”

Geoff Baguley
Wellingborough

We’re at war with climate change

Presuming Andy Brown’s letter (30 April), in which he decried “hysterical green fantasists” for advocating carbon neutrality, was actually serious, I think a brief reply is in order.

Drastic times call for drastic measures – just look at how nations respond in terms of research, development and manufacture during wars. We should now see ourselves in a state of war against climate change … and sorry for the bellicose metaphor, but the situation merits it.

Does Mr Brown believe that carrying on as normal and hoping this furore all blows over is really an option? There’s near unanimity in the scientific community that catastrophic climate change is happening and it’s accelerating. The vested interests and demagogues that oppose that view presumably believe their privilege will somehow insulate them from the fallout.

Countries will take action because they have to take action, and they’ll pay for it for the same reason. If they do so in time – the big question – we’ll hopefully be left with far more sustainable and equitable societies.

Paul Halas
Stroud

In reply to Andy Brown’s last paragraph, many people can travel to work on foot, by bike or on public transport. Most people can keep warm by putting on an extra layer.

Rachel Greenwood
Bewdley