Opinion editor's note: Star Tribune Opinion publishes letters from readers online and in print each day. To contribute, click here.

•••

Few public servants, elected or appointed, have had the positive impact that retiring Health Commissioner Jan Malcolm has had on the lives and welfare of all Minnesotans ("Malcolm says the time is right for 'fresh energy' in COVID's wake," front page, Nov. 17). Her leadership in reducing the harm caused by tobacco created a national model for effectiveness, especially among young people. Malcolm, with the support of then-Gov. Jesse Ventura, made sure that the state's proceeds from tobacco litigation were not siphoned off to other programs but devoted to reducing tobacco use. The result was a reduction of almost one-third in tobacco use among young people. That reduction translates directly into tens of thousands of Minnesotans and their families who will not suffer the devastating losses of death and disease from tobacco.

Likewise, Malcolm, this time with the support of Gov. Tim Walz, stood up to enormous pressure to identify and support the difficult but lifesaving public health interventions during the COVID pandemic. One measure of her success: If Florida's death rate from COVID was comparable to Minnesota's, about 30,000 fewer Floridians would have died. Throughout her career — including her enormous contributions in leadership positions with some of Minnesota's most important private-sector health organizations — Malcolm has led with collegiality and grace, with science and facts, and with courage and diligence. She is the model of citizen leadership.

Tom Horner, Edina

The writer was the Independence Party of Minnesota's 2010 candidate for governor.

•••

Peg Birk, Minneapolis

The Star Tribune article on the proposed merger of Fairview and Sanford Health systems ("Sanford, Fairview revive merger," Nov. 16) raises the question of how this is better for health care in Minnesota. Since health care became an "industry" around 1970 or so, the following has occurred: 1) We have significantly outpaced other countries in per capita health care costs. 2) We are now ranked last among high-income countries in health care equity and outcomes per a "Commonwealth" study. 3) Our life expectancy is decreasing compared with similar countries. 4) We have frequently limited access of patients to the doctor or hospital of their choice. 5) The work environment has deteriorated, causing over 50% of doctors and nurses to experience burnout with increasing shortages of doctors and nurses due to them leaving the profession and retiring early.

Since 1970 the per capita percentage of GDP spent on health care has doubled. The cost of billing consumes a third of the health care dollar. The number of health care administrators has increased by 3,000%.

The CEOs of Fairview and Sanford state that this merger will "inspire innovation, improve patient care, and protect them against mounting economic challenges." How are they going to do this? Mergers and growth of huge systems have been the trend since 1970 with the results listed above. It is common knowledge that you do not fix a failed effort by doing more of the same. It is very difficult to imagine how another huge merger will repair the damage already done by our bloated, inequitable, poorly performing health care industry.

It is time for our country to walk away from the current failed system and work together to find a system that is affordable, high-quality and equitable. Other countries have done this successfully.

Ron Jankowski, Anoka

The writer is a family physician and board member of the Coalition for Health Equity Minnesota.

A letter writer ("Abortion trumped all else," Readers Write, Nov. 15) claims the election was won by voters who "want to be able to kill babies." Seriously, no one wants to kill babies. I doubt that writer has ever seen a woman die from complications of pregnancy; as a labor and delivery nurse, now retired, I did see that, multiple times. Early in my career, I took care of a woman who was told by her physician that she would almost certainly die if she continued her pregnancy; she did die, and her fetus died with her. Importantly, the choice was hers to make, and she made that choice based on her personal religious beliefs, not on the beliefs of others, and certainly not on the beliefs of legislators. Another time, I cared for a woman who barely survived complications from her fifth Caesarean delivery. Her religion forbade both birth control and abortion; when her doctor told the couple that another pregnancy would prove fatal, her husband answered, "It is in God's hands." Again, that was their choice; it was not imposed on them by law. She did die, leaving five motherless children.

Pregnancy and childbirth are not without risk. There is no other situation in which a person is required, by law, to risk their life, even to save the life of another living, sentient, person. We don't even compel organ donations from dead people, yet there are those who would legally require pregnant women to risk their lives and their health for the sake of a potential person. If abortion is against your religion, I can respect that, but do not try to impose your religious practices on the rest of us; let us make our own choices, based on our own situations, our own priorities and our own religious, or lack of religious, beliefs.

Joyce Denn, Woodbury

A Nov. 14 letter about a premature baby with trisomy 13 was heartbreaking. The pain of losing a child is beyond words. Yet the writer has responded to that pain by resolving that it must be avoided in the future by whatever means possible, including identifying and eliminating a child with potential genetic abnormalities before "such a child" is born. "Such a child," as defined by the writer, includes one who "would not have known who he was or who we were. He would never have been potty trained or know how to feed or care for himself." May the writer have the good fortune to avoid a future health crisis, accident, or aging process that renders him unable to recognize loved ones or care for himself. If he ever becomes "such a person," may he find a caregiver much more compassionate than he is.

Michelle Smith, Arden Hills

•••

What may have trumped abortion as an issue in the midterm election was the desire by the electorate to preserve our imperfect democracy in order to enable our legitimately elected representatives to enact laws that humanely and justly tackle difficult issues. In the case of abortion, most citizens feel that this decision needs to be a private one between a woman and her doctor. In frustration with abortion rights, the writer of "Abortion trumped all else" calls upon her God to "have mercy on us all," although it seems she feels no mercy or compassion for the plight of the pregnant woman desiring an abortion.

Is it "merciful" to expect a 12-year-old rape or incest victim to carry her pregnancy to term, as some Republicans have proposed? Is it "merciful" to prevent by law a pregnant woman with a cancer diagnosis from receiving lifesaving treatment, thereby ending the fetus' existence, so that the woman can live to take care of existing children? Is it "merciful" to force a young college student unexpectedly pregnant to become a mother when parenthood is the furthest thing from her mind?