As Mayo Clinic buys and closes down rural hospitals, it opens an overseas mega-hospital (“Mayo rolls out joint venture in the UAE,” Nov. 25). Other hospitals are reducing community care staff like home health nurses and pharmacists while they open other high-tech centers. Hospitals and health corporations always put the patient first and are explicit about this point. But exactly which patient they put first is the question we should be asking.

We don’t discuss the ethics of market-based health care enough in this country. Unfortunately, the concurrence of reductions in hospitals for rural communities and reductions in services for elderly and chronically ill patients as high-tech hospital care expands clearly shows that the patients put first are the ones who generate the right amount of revenue. The patients who come first are the sickest, the ones in need of high-tech rescue and billable services.

Why do we need preventative care when the sickest patients bring in the most dollars? You can’t really blame the hospital; it’s the system it works in, and it has to stay open. For patients or potential patients — all of us — this has some looming consequences. For one, investments in health care seem to go toward rescue from disease rather than prevention of disease. This will not only increase what we pay but also negatively impact our health. This is neither ethical nor fiscally conservative.

As Mayo cuts services to rural Minnesota but expands them to the United Arab Emirates, and while other systems cut back on services aimed at prevention and reduction in hospitalizations, we ought to be asking whether this system is really in our best interest. Do we want a system where the most lucrative patients are put first or where all potential and actual patients are put first? At this point, the hospitals, even the “nonprofit” ones, clearly put their targeted “customers” first.

Ian Wolfe, Minneapolis

MASS SHOOTINGS

Research, then address, the causes

Thanks to the Star Tribune Editorial Board for seeking out good information about mass shootings so we can take action based on facts, and then publishing an editorial about it (“Gathering data on mass shootings,” Nov. 30). Early childhood trauma or exposure to violence appears to lead the list. Not only does childhood trauma teach kids about the use of violence to solve problems, it also impedes brain development, building fear and hopelessness in the place of creativity and strength. It is so important to provide evidence-based mental health treatment to kids who have experienced trauma. Children’s brains have an amazing capacity to heal and recover if given the chance.

In addition, funding for violence prevention is critically needed. Primary prevention that aims to eliminate violence in families requires public information such as what the Editorial Board is providing, with more details needed about what the public needs to know and can do. It starts with knowledge about peaceful parenting and how to build support within our communities that supports families. Beyond that, there are lots of good ideas out there about how to prevent violence in at-risk families, but there is little funding for these programs so they are few and very limited. Targeted education to parents about strengths-based parenting and effective discipline techniques must be supported in many cases by longer-term support and reinforcement so that families can build on that education.

Public information, public policy and focused prevention funding are critical to stopping this key factor in mass shootings.

Barb Klatt, St. Paul

• • •

One additional significant finding of the mass shootings study was also that background checks would have been of little benefit in preventing the majority of these incidents. In 80% of school shooting cases, the attackers got their guns from family members, and most workplace shooters use guns they legally acquire.

I am a supporter of both the proposed expanded background checks and red-flag laws, but I’m not sure of how much impact these proposed laws would have. For additional insight, I’d suggest reading “A Mother’s Reckoning: Living in the Aftermath of Tragedy” by Sue Klebold, the mother of Columbine shooter Dylan Klebold. Many of these mass shooters are very good at concealing their dark thoughts and intentions.

Bruce Burton, Bloomington

• • •

Interesting juxtaposition on the Nov. 30 opinion page. Next to the editorial “Gathering data on mass shootings” is a letter writer’s opinion in support of publicly stamping children’s hands at school if their lunch account is in the red (“Shame can motivate kids, though,” Readers Write). “Shame is a great motivator for all manner of behaviors,” writes the author. Adjacent to that self-proclaimed expertise on raising responsible children is the Star Tribune Editorial Board’s report of the rigorous research from two local professors whose data shows four characteristics of mass shooters. Those characteristics include early childhood trauma and/or exposure to violence as young people, finding validation for their violence either in person or online, a particular grievance or crisis point, and the means to carry out the shooting.

Shaming children, for whatever reason, inflicts mental and emotional trauma that can have lasting impact. Adults are role models to children. Adults who shame children therefore can validate to a child that it is OK to inflict such trauma and violence. We unfortunately learn over and over again how school shooters feel aggrieved from histories of ostracization and alienation, which shaming can cause. Given these facts, one has to wonder if it’s really such a great idea to shame children. What “manner of behaviors” do we really want to motivate?

Eileen Weber, Hastings

POLLUTION

Protect lakes and rivers we have left, but invest in cleanup, too

I fully agree with Peter Sorensen’s Nov. 30 assessment in the Opinion section that Minnesota must do much more to protect our vital state waterways that are currently basically clean or that have only moderate pollution issues (“Minnesota must act to protect vital waters”). But unless I am reading more into his position than I should, it does seem that he is giving up on the 56% of lakes and streams that are already impaired.

I strongly disagree with this position. Granted, there are currently no truly effective ways to address this problem, but to me that only means we must significantly increase our efforts to find solutions for the numerous aquatic invasive species and pollution problems that currently exist. Our lakes, streams, rivers and wetlands are a vital part of our state’s economy and, more importantly, our quality of life. It is incumbent on us to dedicate the resources needed to solve the problems we have created.

Jim Shomenta, Cambridge, Minn.

We want to hear from you. Send us your thoughts here.