Obamacare - Consider the Alternative - NYTimes.com Re "Despite Fumbles, Obama Defends Health Care Law" (front page, Nov. 7): Tens of millions of Americans could soon have health care coverage they don't have now. Obamacare is not great insurance, but it offers so many benefits - financial as well as medical - that could improve the lives of so many people and make our country a healthier, more decent place. Or hostile Republicans and timid Democrats could destroy the promise. Which will it be? Re "This Is Why We Need Obamacare," by Nicholas D. Kristof (column, Nov. 3): Certainly, there are benefits to Obamacare. But did we need the total morass of this legislation to institute these positive changes? President Obama would have received bipartisan support if these changes were presented in a more piecemeal fashion. As an example, it is inconceivable that Republicans would have voted against those changes allowing pre-existing conditions to be covered in Obamacare. Instead, the president chose to pursue this complicated piece of legislation without getting a single Republican vote. In addition, we now know the president was wrong when he said people would be able to keep their existing insurance plans. We are a very diverse society, and people should be able to select whatever insurance is right for them. And can't we figure out a more effective and efficient way to help those people in need? Nicholas D. Kristof is right: We need Obamacare. Some in Congress will do anything to make this president fail. Doesn't matter how many people get hurt or die (talk about "death panels"!). Cut food stamps and education, and withdraw helping hands to those less fortunate. Feed a family on $1.40 a meal. Let their children go to school hungry but never wonder why they can't learn. Do these people have a pre-existing condition? Have they bought a junk policy with a huge deductible and a large co-pay? Have they ever faced not going to a doctor because it was just too much money? Shame on them! We need Obamacare so families don't end up in poverty while struggling against all the other Republican cuts. Nicholas D. Kristof points out that without universal health care, many of us die prematurely. But before we solve this terrible problem, we have to grapple with our confusion and ambivalence as to what, if any, responsibilities we have for one another. Do we just cluck our tongues and blame Richard Streeter, featured in the column, for not buying insurance? Do we let him seek care at a hospital emergency room knowing that it will be far more expensive and far less effective than timely care would have been? Do we construct a Rube Goldberg-worthy health plan to protect the profits and inefficiencies of every powerful lobby group except that of "we the people" who need care? So far, the answer seems yes. So even with the benefits the Affordable Care Act is bringing, we will still have tens of millions without care, we will still be subsidizing health insurance companies, and we will still be throwing money down a rathole. Until we recognize that we are our brother's keeper and build a health care system funded by taxes we all pay and delivered by a regulated health care community - improved Medicare for all - we will continue to read tragic stories like the one Mr. Kristof gave us. The writer is a psychiatrist. In response to critiques of the Obamacare rollout, Nicholas D. Kristof appropriately focuses on the real health care crisis in this country by reminding us of the real suffering and, yes, death that can attend the millions who lack adequate insurance. He also points out that the quality of our health care is abysmal for a country of our wealth and supposed "exceptionalism." He might have added that for that pathetic performance we pay about twice as much per capita as other industrialized countries. Obamacare, a regulated, market-based solution, was intended to address both of those shortfalls, to work toward higher quality and lower costs. It will no doubt require tweaking. But it makes that first, all-important leap toward recovery from our sickness of inertia and tolerance for the status quo. I am somewhat amused that our longstanding free-market health care system resulted in such poor quality and high costs. I thought that free markets were supposed to produce just the opposite. Yet it's the single-payer, more government-centric systems of other countries that have performed much, much better on both counts. Curious.