TASK DEFINITION: Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
PROBLEM: Central to the plan to protect the city, some or all of the 78 barriers will one day be raised when the sea rises more than 110 centimeters (43 inches), to prevent damaging high tides from pushing into the lagoon city, a world heritage site built picturesquely — but somewhat precariously — upon more than 120 islands. Concerns that high tides are becoming more frequent because of climate change have increased the urgency. While the concept is simple, its realization has been anything but. The system of movable underwater barriers, dubbed Moses, has been beset by corruption, cost overruns and delays. Projected at 1.8 billion euros ($2 billion) and meant to be completed by 2011, the project has so far cost 5.5 billion euros and is running a decade behind schedule. In the wake of last month’s flooding of Venice, the worst in 53 years, the consortium that oversees construction of Moses is eager to demonstrate that the project — after years of bad news — is on track and will be fully operational by the end of 2021. Venetians say they cannot afford to be wrong. Skeptics and critics say they may be. A recent test of the deepest expanse of barriers — at the Malamocco entrance to the lagoon — was declared a success by the New Venice Consortium. It was the last of the four sections of barriers to be completely raised — but so far only in calm seas. The real test will come when all four are raised at once, and not only in serene waters, but under flood conditions. That isn’t scheduled to take place until the end of next year. It took six years to test each of the four movable sea walls covering the three openings to the lagoon, partly because work was slowed by a 2014 corruption scandal that implicated the three main contractors and sent 35 people to jail. Work is continuing largely with the original subcontractors now contracting directly with the consortium, which itself has been placed under government control as a result of the scandal. The fact that the barriers have not yet been physically tested in rough seas is a concern to critics. Paolo Vielmo, an offshore marine engineer who has long criticized the project, said that tests carried out in a laboratory in the Netherlands in the 1990s indicated that the barriers, under certain conditions, would oscillate out of control — possibly even breaking apart. “Its behavior is not predictable,’’ Vielmo said. He said that the trials so far declared successful have been under only modest sea conditions that fail to represent anywhere near the threat of the phenomenon of extreme oscillation called subharmonic resonance. Vielmo and two other offshore engineers have compiled a report for the Codacons consumer and environment protection advocacy group, which is asking officials to run additional calculations to see if the project is indeed viable. And if it is not, Codacons says Moses should be stopped. “We don’t want to delay by one minute the possibility to make Moses operational. But we say we cannot make it operational until we are sure it will work,’’ said Franco Conte, president of Codacons in Venice. “Naturally, the Venetian community is exasperated and they say, ‘If we did 95%, let’s do 100% and see if that works.’ But that is unconscionable. If we don’t know if it works, we cannot experiment.”  The barrier system is made up of giant flood gates, each 20 meters (66 feet) long. The gates are attached by hinges to giant cement blocks placed on the seabed along the three openings from the sea into the lagoon, Malamocco, Chioggia and the Lido. The gates can be lifted to create a temporary barrier in high tides. Once the water has receded, they can be lowered again — allowing shipping traffic to continue and for the tidal system to flush out the lagoon. The idea behind the project was to create a mobile system that would not impede views of the unique and protected landscape. But Moses has suffered criticism from the start that there were simpler, cheaper systems that could have been deployed. Venetians have been waiting since the record 1.94-meter (6.36-foot) flood of 1966 for a system to protect them from regular inundations. The flooding in November, the second-worst recorded, proved the urgency. In the 150 years that they have been recording the tide levels in Venice, two high tides above 1.5 meters have never been recorded in a year. In November, there were three in one week. Climate scientists note that exceptional tides — those over 1.4 meters — have become much more frequent in the past two decades, with more than half of all recorded occurring since 2000. “One has to realize the kind of existential question that that serious flooding has given rise to,” said Jane Da Mosto, an environmental scientist and executive director of the non-profit group We Are Here Venice, which is working to defend the city against myriad issues, including depopulation, cruise traffic through St. Mark’s basin and overtourism. “People are asking: will Venice be defendable against these kinds of episodes?’’  It’s not just the still-uncalculated damage to landmarks like St. Mark’s Basilica, where corrosive salt water creeps through porous brick and tile. It’s also the boxes of ruined belongings and piles of soaked mattresses discarded in alleyways and loaded onto motorboats and trash barges for disposal. The relentlessness of the Venetian fall and winter tides make one-third of ground floors uninhabitable in the historic canal city. “I am very old, I cannot say that I want to die, but I certainly do not want to be witness to the fact that it does not work,” 84-year-old resident Paola Scarpa said of the Moses barriers, as she walked to check on a family property in the Canareggio neighborhood on a recent December morning. “It would be a pain too great.”  ___  Associated Press journalist Trisha Thomas contributed to this report.

SOLUTION: Venice tide barriers pass another test but skeptics remain.

PROBLEM: "Crediting conservation in Austin, the Save Our Springs Alliance said in an Aug. 16, 2011, entry in its online newsletter: ""Ten years ago the Austin Water Utility used a total of 240.3 million gallons. Every summer since then our peak day of water use has been lower."" After noting that this year’s peak water use in a day was 217 million gallons, the entry continues: ""So raise a tall glass of ice water in honor of our success: water conservation gains have outpaced population growth for a decade. Add a ‘Salud!’ to another 10 years of flat or declining water use — easily achieved with cost-effective conservation measures and an emerging ‘culture of conservation,’ one that recognizes that we can thrive and be happy without oversized, overwatered New England-style turf grass lawns."" We can’t check on the next decade, but we can check if peak water usage has been less every year than what it was in 2001. Indeed, the Austin Water Utility sent us figures indicating that on the peak days of water consumption from 2002 through August 2011, customers used less water than the 240.3 million gallons used on Aug. 13, 2001, though that was barely so in one year. The greatest peak use day since 2001 was Aug. 26, 2006, when usage was 240.17 million gallons — about 5/100ths of a percent shy of the amount gulped, flushed and otherwise used in 2001. The lowest peak-use amount in the 10 years after 2001 was 176.98 million gallons on Aug. 13, 2007. Put another way, the average peak water use in a day in the period was about 214 million gallons, 11 percent off the 2001 peak. The utility’s director, Greg Meszaros, told us in an interview that conservation helps explain the lower peak-use amounts, though he said consumption generally bounces around year to year partly due to variations in the weather — rainy summers reduce demand — and the economy. Per-capita water consumption has been relatively flat, Meszaros said, since the utility instituted a conservation program in 2007 that, among features, encourages customers to use low-water appliances and limit lawn watering. According to the utility, customers have used less water per person lately than individuals did in past years. Per-capita daily use has averaged 190 gallons or more four times since 1990, the last time being 2006. Average per-person consumption slid to 151 gallons in 2007, reached 170 gallons in 2008 and then dipped two straight years, reaching less than 140 gallons in 2010. Daryl Slusher, an assistant director for the utility, said the average will approach 160 gallons for the year that ends Sept. 30. Save Our Springs maintains the area’s conservation successes demonstrate that a water treatment plant slated for Northwest Austin won’t be needed for many years. Meszaros told us Austin needs the new plant because two current plants can’t be relied on indefinitely. Also, he said, the new project will include a vital water transmission main easing the delivery of water to the fast-growing northern third of the utility’s service area. ""We’re not doing (the new plant) just to meet a peak water demand,"" Meszaros said. In an interview, Bill Bunch, SOS’s executive director, expressed skepticism about strains in the existing water delivery system. He also said there’s not sufficient water demand to justify the new one and forwarded an April 2002 recommendation from city staff about preliminary engineering for the new plant. The document states the plant would be needed by 2009 to meet increasing water demands, predicting too that the utility’s peak one-day demand in summer 2009 would be 281 million gallons; the peak amount that year turned out to be 228 million gallons. Utility spokesman Kevin Buchman later told us by email that in 2002, the ""main reason for moving forward with the construction of a new plant was to meet the projected demands."" He said, though, the utility’s mid-decade focus on conservation allowed the city to postpone the plant’s completion by more than five years. ""Also,"" Buchman said, ""since 2002 we have had one of our (originally three) plants decommissioned and our other two water plants have been expanded as much as possible."" We won’t try to settle the water plant debate here. But the alliance’s statement about peak water use rates ."

SOLUTION: Ten years ago the Austin Water Utility used a total of 240.3 million gallons. Every summer since then our peak day of water use has been lower.

PROBLEM: "On January 12 2020, the Facebook page “Lower Drug Prices Now” shared what appeared to be a screenshot of a tweet, which claimed that “500,000 Americans will go bankrupt this year” due to medical bills:Claims referencing “this year” can be difficult to fact-check, as images like the one above could circulate for several years in perpetuity, muddying the timeframe of “this year” (or “this week,” or most commonly, “yesterday.”)A search for the phrasing used in the screenshot led back to its ostensible source, an August 20 2019 tweet by Sen. Bernie Sanders (I-Vermont) on Twitter. The tweet’s origin was unsurprising, as Medicare for All was a major plank of Sanders’ 2020 presidential campaign platform:500,000 Americans will go bankrupt this year from medical bills.They didn't go to Las Vegas and blow their money at a casino.Their crime was that they got sick.How barbaric is a system that says, ""I'm going to destroy your family's finances because you had cancer""?— Bernie Sanders (@BernieSanders) August 20, 2019Both the tweet and the screenshot contained four lines, and read:500,000 Americans will go bankrupt this year from medical bills.They didn’t go to Las Vegas and blow their money at a casino.Their crime was that they got sick.How barbaric is a system that says, “I’m going to destroy your family’s finances because you had cancer”?Although the Facebook post was shared in January 2020, the “this year” clearly referenced 2019 — the year in which Sanders published the tweet. No source was shared alongside the claim, but a fairly specific figure of 500,000 medical bankruptcies was mentioned.A cursory search revealed both a possible underlying source for the figure, as well as what appeared to be a controversial fact-check. On August 28 2019, a Los Angeles Times op-ed asserted that Sanders had reiterated the “500,000 medical bankruptcies” claim in a debate — and that the Washington Post fact-checked the claim and scored it as “mostly false” or “three Pinocchios.” (The article displays a date of September 4 2019, indicating that it was updated; additional commentary is marked, but changes to the article remained unmarked and impossible to identify via the article itself. )Diving in, the article explained:You’ve got to hand it to Sen. Bernie Sanders for his ability to keep hot-button issues in the forefront of the presidential race.The latest example is his assertion, made at least twice in the last month, that medical bills drive 500,000 Americans into bankruptcy every year. The Washington Post’s fact-checker column examined the numbers and concluded that Sanders deserved “three Pinocchios” for the statement, which means the Post found it “mostly false” and that Sanders was, basically, lying.The Post blundered, as the authors of the study on which Sanders based his claim point out. In the real world, Sanders’ assertion that “500,000 Americans will go bankrupt this year from medical bills” is “mostly true.” Medical bankruptcy is an American scandal, and possibly even more common than he or the study’s authors calculate.On the same date as the Los Angeles Times editorial, the Washington Post published a fact-check of Sanders’ assertion. It was indeed rated “mostly false” or “three Pinocchios” as the op-ed said.We noticed two familiar names in the paper’s examination of the claim — David U. Himmelstein and Steffie Woolhandler. Himmelstein and Woolhandler were researchers credited with a study referenced by our January 13 2020 fact-check about the cost of Canadian healthcare versus that of the United States.In a section titled “The Facts,” the Washington Post reported:Sanders said 500,000 people were driven to bankruptcy by medical bills. A Sanders campaign aide said he was relying on an editorial published by the American Journal of Public Health (AJPH) in March [2019].That study, led by David U. Himmelstein, took a sample of bankruptcy court filings from 2013 to 2016, identified 3,200 bankrupt debtors and mailed them a survey. The response rate was 29.4 percent, with 910 responses and 108 surveys returned as undeliverable.Debtors were asked whether medical expenses, or loss of work related to illness, contributed to their bankruptcies. Of those who responded, 66.5 percent said at least one of those factors contributed “somewhat” or “very much.”Sixty-six percent of 750,000 is 500,000, so Sanders’s math adds up at first glance.The study referenced, “Medical Bankruptcy: Still Common Despite the Affordable Care Act,” was accepted by the American Journal of Public Health in November 2018 and published in February 2019. Sanders’ campaign website also hosted a page (“Medical Bankruptcy is Real, Even if the Washington Post Refuses to Believe it”) about the claim, controversy, and fact-check; the page was written by the study’s authors, Himmelstein et al.The Washington Post fact-check noted that as an editorial, that particular AJPH article “did not undergo the same peer-reviewed editing process as a research article.” We were unable to find how they were able to make the determination that the article was not peer-reviewed.The paper also posited that while the 66 percent of bankruptcies cited medical bills as a factor, other factors may have been involved:This study includes a range of people for whom medical expenses or illness contributed “somewhat” to bankruptcy. What does “somewhat” mean? It’s broad enough to mean “slightly,” “fairly” or “moderately.” Sanders’s claim works only by erasing this ambiguity and taking “somewhat” to mean “mostly.”In Sanders’ tweet, no qualifiers (like “mostly”) were used. He said “500,000 Americans will go bankrupt this year from medical bills,” a statement that could reasonably be framed to mean either that medical bills were a defining factor in bankruptcies, or that medical bills caused bankruptcies, or that medical bills were a contributing factor in bankruptcies.Himmelstein was quoted by the paper in its attempt to assign a truth rating to the claim, and he explained that a number of confounding factors made sweeping statements difficult. Of note is that Himmelstein cited circumstances in which illness and mounting medical bills could drive other bankruptcy-exacerbating circumstances, such as work missed due to illness or compounding debt again related to health issues:“We did not ask about the sole or main reason for bankruptcy, because our past experience indicates that this is a meaningless question,” Himmelstein, a professor at CUNY’s Hunter College who supports single-payer health care, wrote in an email. “The vast majority of debtors suffer multiple problems that bring them to file, and cannot identify a single problem among them. Thus, if an illness led to lost work time (and hence income) and medical bills, debtors cannot separate out these different problems; they are of a piece.”Critics of Himmelstein and his colleagues’ research into medical bills and bankruptcy proposed different approaches, like “[instead of] looking at a sample of people who go bankrupt and see how many have medical debt, look at a sample of a bunch of people who have medical debt, and how many of them go bankrupt [to get an] idea of causality.” Another study cited a far lower number, while at the same time noting that the figure only involved debtors who had been hospitalized:“Based on our estimate of 4 percent of bankruptcy filings per year and the approximately 800,000 bankruptcy filings per year, our number would be much closer to something on the order of 30,000-50,000 bankruptcies caused by a hospitalization,” one of the co-authors of the NEJM study, economist Raymond Kluender of Harvard Business School, wrote in an email.“This would lead us to be skeptical of the 500,000 medical bankruptcies statistic, but that very much depends on how one defines a medical bankruptcy.…  An enormous share of households have some amount of medical debt, so any survey of individuals will report a high share of them have medical debt but this does not imply that the debt caused them to file for bankruptcy.”Some people could still face high levels of medical debt without ever going through a hospital, and they wouldn’t be counted in the NEJM study.The Washington Post asked Himmelstein directly if Sanders had accurately represented the findings of his and his colleagues’ editorial, to which he replied in the affirmative:Himmelstein wrote: “37 percent of filers said medical bills ‘very much’ contributed to their bankruptcy. Even if you use that restricted definition, then Sanders’s statement is accurate — or an underestimate. There are about 700,000 bankruptcy filings each year. Many filings are joint husband/wife filings, and based on our past research, we estimate that on average 2.71 persons reside in each debtor’s household. So the total number of persons who undergo bankruptcy is about 1.9 million annually.“37 percent of 1.9 million is a bit over 700,000. Even if you only count the husband and wife in a filing, the number suffering a bankruptcy to which medical bills ‘very much’ contributed is about 500,000.”The fact-check then concluded that the claims constituted politically motivated “cherry-picking” over the researchers’ objections:This is a classic case of cherry-picking a number from a scientific study and twisting it to make a political point.An undated response from Himmelstein and Woolhandler appeared at the bottom of the post. The authors pointed out several objections to the fact-check and factors cited in it, writing:An August 28 [2019] Fact Checker article in the Post assigned a “Three Pinocchios” rating to Sen. Bernie Sanders’ statement that 500,000 Americans are bankrupted by medical bills annually. Sanders’ estimate relied on an editorial by David Himmelstein and colleagues in the American Journal of Public Health (AJPH) reporting findings from a Consumer Bankruptcy Project (CBP) survey that asked debtors about causes of their bankruptcy. The editorial (which the Post falsely implied had not undergone peer review) updated previous CBP studies carried out by Himmelstein, along with then-Harvard Law Professor Elizabeth Warren, Steffie Woolhandler and Deborah Thorne that reached similar conclusions and appeared in leading medical and policy journals.The Post’s denigration of Sanders’ statement rests on an econometric study that found only a modest uptick in bankruptcy filings among persons hospitalized in California between 2003 and 2007. As Himmelstein, Woolhandler and Warren noted in their response to that study in the New England Journal of Medicine, the study excluded most persons with frequent hospitalizations (a group at high risk of medical bankruptcy); assumed that anyone not hospitalized could not suffer medical bankruptcy; that a child or partners’ illness couldn’t lead to bankruptcy; and that potentially bankrupting illnesses always commence at the moment of hospitalization – an assumption contradicted by the study’s own data.Rather than checking facts, the Post has chosen one side in an ongoing and unsettled scholarly debate, and labeled those on the other side (and public figures who cite their research) “liars”.More than 200 readers commented on the fact-check, most objecting to the paper’s dismissal of both the underlying research and the researchers’ responses. One commenter wrote:I’m not a political supporter of Senator Sanders, I’m a retired former CEO of several significant medical device companies and the former Co-Chairman for eight years of the National Council for Healthcare Technology. The authors of the original editorial and its supporting peer reviewed studies, are the widely acknowledged preeminent experts in the field of medical bankruptcy, which they’ve been studying and publishing peer reviewed articles on for many years. The Washington Post’s reporter has substituted his uninformed judgement for the expertise, acquired over many years, by the authors of the original editorial and its supporting studies. As the authors pointed out in their rebuttal, Senator Sanders’s estimate of medical debt related bankruptcies is, if anything, to conservative. Medical debt related bankruptcies are a huge problem in the US, the only developed country in the world where they occur. The Washington Post is flat out wrong on this issue.Another echoed:How hard is it to retract this? I think we are being generous when we say the author made some mistakes here, I think it is pretty clear to anyone who pays attention what the intent of this “fact check” was, and that is to try and discredit Bernie Sanders in any way possible.But you got called out on it by both Senator Sanders and the authors of the study he cited, now own up to it and retract it. If the WaPo had one shred of journalistic integrity, they would admit they were wrong and seek to correct it. All this does is damage the Post’s credibility going forward the longer they remain obstinate about this.A third addressed a conclusory claim by the Post that Himmelstein somehow moved the goalposts on his own original claim, remarking on the inferences underlying the “mostly” aspect:Is the WaPo serious here? The entire article is based on the fact checker’s claim that Sanders implied with his tweets “solely caused” instead of “one of the causes”. But him also saying “people(/Americans)” instead of “cases” isn’t relevant? The study refers to different contributions to bankruptcy. Which one are you proving false? If you are going off of the peer reviewed editorial it is talking about contribution and cases. If you are going off of Sander’s tweet, it’s cause and people. Himmelstein even gave you an easily verifiable fact as to how many people are experiencing bankruptcy per case. This article has many more basic logical inaccuracies, I just wanted to point out this blatant disregard of parallelism in fact checking.That commenter’s critique was not restricted to one comment:So…what is your point? Because health care costs may not be the sole reason for a person’s financial difficulties, it is wrong to point to them as a burden? Has WaPo never heard of the straw that broke the camel’s back?We were unable to find commenters defending the amended fact-check, but we did find an additional comment signed by Himmelstein:Although the Post agreed to post our brief letter responding to their column, it refused to include the names of the 101 additional colleagues who were signatories of that letter. David U. Himmelstein, MD and Steffie Woolhandler MD MPHClearly, Sanders’ claim (depicted in the January 12 2020 Facebook post above) that “500,000 Americans will go bankrupt this year from medical bills” (referencing 2019) was a point of contention, worsened by a widely-disputed Washington Post fact-check originally published on August 28 2019 — after Sanders’ tweet and a Democratic debate in which he referenced the same statistic. Normally, we turn to the source material to verify such debate — in this case, research published in a medical journal.In a very odd turn of events, the authors of the article in the medical journal spoke up to insist their figures were accurately represented by Sanders in both places. In turn, the Washington Post added some of their objections (but not all), did not correct a claim that the editorial was not subjected to peer-review, and left out important elements of the authors’ response. Although the paper retained its “mostly false/three Pinocchios” rating, we were hard pressed to replicate those findings based on extensive comment from researchers whose peer-reviewed work had been published in medical journals.Update, January 14 2020, 4:28 PM: Himmelstein responded quickly to our request for additional information, forwarding two documents. One was published to Sanders’ website and linked above.The second was a letter to the editor — signed, as Himmelstein noted — by several parties. We are including both in their entirety. The first:Medical Bankruptcy is Real, Even if the Washington Post Refuses to Believe it David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.HThe Washington Post has broken new ground, calling a presidential candidate a liar for citing a statistic from research published in the world’s leading public health journal. ThePost’s Fact Checker column labeled Bernie Sanders a “three pinocchio” level liar for saying that 500,000 Americans are bankrupted by medical bills each year. Sanders’ statement relied on research that we and three colleagues published in the American Journal of Public Health (AJPH). Dozens of politicians and publications (including the Post itself!) have cited that study as a reliable source.Our AJPH study was part of an ongoing research effort by the Consumer Bankruptcy Project (CBP). For decades, the CBP has been surveying debtors about the causes (including medical ones) and consequences of their bankruptcy. In our 2019 research, 37.0% of bankrupts “very much” agreed that medical bills were an important factor, while another 21.5% “somewhat agreed”. Many others cited lost wages due to illness, and overall, two-thirds cited illness-related bills, income loss or both. As we wrote in the AJPH, that’s “. . . equivalent to about 530 000 medical bankruptcies annually.” That figure is in line with estimates based on our earlier CBP studies (carried out with then-Harvard law professor Elizabeth Warren and sociologist Deborah Thorne), which were published in leading medical and policy journals.But even the 530,000 figure is an underestimate of the number of people affected by medical bankruptcies. Most bankruptcies involve more than one person – an average of about 2.7 people, often including a spouse/partner and children. That means that the 750,000 bankruptcies last year involved more than 2 million people. And even if you usethe most restrictive definition of medical bankruptcy – i.e. including only debtors who “very much” agreed that medical bills were a cause of their bankruptcy – Sanders’ 500,000 figure is, if anything, too low. The right number is more like three quarters of a million.And our studies aren’t the only indictor that many American families suffer a crushing burden of medical bills. A Nobel Prize winner was forced to sell his medal to pay medical bills. More than 250 000 people sought to raise funds for medical bills through GoFundMe campaigns last year. According to the Consumer Financial Protection Bureau,medical bills account for more than half of all unpaid bills sent to collection agencies.And in a New York Times/Kaiser Foundation survey, more than one quarter of respondents said they or someone in their household had a problem paying medical bills, and of them, 11% said they’d declared bankruptcy due, at least in part to medical bills.So why did the Fact Checker claim that Sanders told a whopper? That claim rests on an econometric study that found only a modest uptick in bankruptcy filings among persons hospitalized in California between 2003 and 2007. But that study appeared tailor made toundercount medical bankruptcies. As we and Elizabeth Warren noted in our response to it in the New England Journal of Medicine, it excluded most people who were frequently hospitalized (a group that’s at high risk of medical bankruptcy); it assumed that anyone not hospitalized could not suffer medical bankruptcy (even though people who aren’t hospitalized in the course of a year account for four-fifths of all out-of-pocket medical bills); that no one is bankrupted by bills for a child’s or partners’ care; and that potentially bankrupting illnesses never start before the moment of hospitalization – an assumption contradicted by the study’s own data.Yet despite these flaws, the economists behind the study insisted (and the Post believed) that their math was a more reliable indicator of what caused financial ruin than the testimony (and court records that we’ve used as cross-check) from the thousands of debtors surveyed and interviewed by the CBP.At this point everyone agrees that many thousands of Americans suffer medical bankruptcies each year, but there’s still scholarly debate over exactly how many; economists and business school professors (including some funded by the health insurance industry) generally offer lower estimates, and medical and legal researchers find higher numbers, We’d be happy to see the Post report the facts and nuances of that debate. But instead it’s chosen a side and labeled those on the other side – researchers, public figures who cite their research, and the debtors who shared their painful stories – “liars”.David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H. are both Distinguished Professors of Public Health, City University of New York at Hunter College and Lecturers in Medicine at Harvard Medical School, and the founders of Physicians for a National Health Program.As Himmelstein’s comment in the comments section of the Post article maintained, all of the many additional signatories of the letter had been stripped in the appended portion. We have included them below, in the full text of the second document:To the Editor:An August 28 Fact Checker article in the Post assigned a “three pinocchios” rating to Sen. Bernie Sanders’ statement that 500,000 Americans are bankrupted by medical bills annually. Sanders’ estimate relied on an editorial by David Himmelstein and colleagues in the American Journal of Public Health (AJPH) reporting findings from a Consumer Bankruptcy Project (CBP) survey that asked debtors about causes of their bankruptcy. The editorial (which the Post falsely implied had not undergone peer review) updated previous CBP studies carried out by Himmelstein, along with then-Harvard Law Professor Elizabeth Warren, Steffie Woolhandler and Deborah Thorne that reached similar conclusions and appeared in leading medical and policy journals.The Post’s denigration of Sanders’ statement rests on an econometric study that found only a modest uptick in bankruptcy filings among persons hospitalized in California between 2003 and -2007. As Himmelstein, Woolhandler and Warren noted in their response to that study in the New England Journal of Medicine, the study excluded most persons with frequent hospitalizations (a group at high risk of medical bankruptcy); assumed that anyone not hospitalized could not suffer medical bankruptcy; that a child or partners’ illness couldn’t lead to bankruptcy; and that potentially bankrupting illnesses always commence at the moment of hospitalization – an assumption contradicted by the study’s own data.Rather than checking facts, the Post has chosen one side in an ongoing and unsettled scholarly debate, and labeled those on the other side (and public figures who cite their research) “liars”.Sincerely,David U. Himmelstein, MD Distinguished Professor Hunter College at City University of New York Lecturer in Medicine, Harvard Medical SchoolSteffie Woolhandler MD MPH Distinguished Professor Hunter College at City University of New York Lecturer (formerly Professor) in Medicine, Harvard Medical SchoolMary T. Bassett MD MPH Director, FXB Center for Health and Human Rights, Harvard Former New York City Commissioner of HealthRobert Pollin, PhD Distinguished University Professor of Economics and Co-Director Political Economy Research Institute University of Massachusetts-Amherst.David H. Bor, MD Chief Academic Officer Cambridge Health Alliance Professor of Medicine Harvard Medical SchoolSteven B. Auerbach, MD MPH Retired-CAPT U.S. Public Health Service/ Dept. of Health & Human ServicesAshwini Sehgal, MD Duncan Neuhauser Professor of Community Health Improvement Co-Director, Center for Reducing Health Disparities Case Western Reserve UniversityMarion Nestle, PhD, MPH Paulette Goddard Professor of Nutrition, Food Studies, and Public Health New York UniversityArthur MacEwan Professor Emeritus of Economics University of Massachusetts BostonHoward Waitzkin, MD, PhD, FACP Distinguished Professor Emeritus University of New Mexico Visiting Professor, Fulbright Senior Fellow Seoul National University School of Public Health Division of Health Care Management and PolicyKaren Lasser, MD, MPH Professor of Medicine and Public Health Boston UniversityJoia S. Mukherjee, MD, MPH Chief Medical Officer, Partners In Health Associate Professor, Harvard Medical SchoolPriyank Jain, MD Cambridge Health Alliance/Harvard Medical SchoolMardge H. Cohen, MD Boston Health Care for the Homeless Boston UniversityGordon Schiff, MD Associate Professor of Medicine Brigham and Women’s Hospital/Harvard Medical SchoolSonali Saluja, MD, MPH University of Southern California School of MedicineSabrina A. Esbitt, PhD Assistant Professor Department of Family & Social Medicine Montefiore Medical Center/ Albert Einstein College of MedicineZinzi Bailey, PhD University of Miami, Miller School of MedicineKaren A. Becker, MD, MPH Associate Professor, Albert Einstein College of MedicineIman Hassan MD MS Montefiore Health System/Albert Einstein College of MedicineCarles Muntaner MD, PhD, MHS. Professor of Public Health, Nursing and Psychiatry University of Toronto Toronto, CanadaHenry S Kahn, MD, FACP Professor Emeritus Emory University School of MedicineScott Goldberg, MD Bronx, NYLara Goitein, M.D Santa Fe, NMVikas Saini, MD, F.A.C.C. President, Lown InstituteJoe de Jonge Medical Student, Columbia UniversityDavid Ozonoff, MD, MPH Professor of Environmental Health Boston University School of Public HealthLinda Prine MD Professor of Family Medicine Icahn Mount Sinai School of MedicineMerlin Chowkwanyun, PhD Assistant Professor of Public Health Mailman/Columbia University School of Public HealthMatt Anderson, MD Montefiore/Albert Einstein School of MedicineSheba Sethi, MD Montefiore/Albert Einstein School of MedicineChristopher J. Wong, MD University of Washington School of MedicineRichard J. Pels, MD Chief of Medicine Cambridge Health Alliance/Harvard Medical SchoolKathleen Hanley, MD Associate Professor NYU School of MedicineMark Eisenberg, MD Assistant Professor of Medicine Massachusetts General Hospital/Harvard Medical SchoolAdam Gaffney, MD MPH Division of Pulmonary and Critical Care Medicine, Cambridge Health Alliance/Harvard Medical School President, Physicians for a National Health ProgramJoel Lexchin MD Professor Emeritus School of Health Policy & Management York University Toronto Ontario, CanadaPaul Song, MD Los Angeles, CAPieter Cohen, MD Associate Professor of Medicine Cambridge Health Alliance/Harvard Medical SchoolLipi Roy, MD, MPH, FASAM New York CityHeather Paladine, MD Residency Director Family Medicine Residency Program New York Presbyterian/ Columbia University Medical CenterMartha Livingston, PhD Professor and Chair, Public Health State University of New York, Old WestburyMartin F. Shapiro, MD, PhD Professor of Medicine Weill Cornell Medical CollegeDan O’Connell, MD MPH Asst. Prof Family Medicine, Albert Einstein School of MedicineVictoria Gorski, MD, FAAFP Associate Clinical Professor Department of Family and Social Medicine Montefiore Medical Center/Albert Einstein College of MedicineAlec Feuerbach Medical student Icahn Mount Sinai School of MedicineGabriel Silversmith, MD, MS New York CityA.H. Strelnick, MD Associate Dean and Professor, Family & Social Medicine Albert Einstein College of Medicine Montefiore Medical CenterGordon Guyatt, MD, MSc, FRCP, OC Distinguished University Professor McMaster University Hamilton, Ontario, CanadaLew Pepper, MD MPH Newton, MANancy Krieger, PhD Professor of Social Epidemiology American Cancer Society Clinical Research Professor Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public HealthMichael A. Zingman, MPH MD Candidate, Columbia University College of Physicians & SurgeonsGarrett Adams, MD, MPH Past President, Physicians for National Health Program Louisville, KYEllen Benoit, PhD New York CityJoanna Watterson Medical StudentPhilip Verhoef, MD University of Chicago School of MedicineDeborah Thorne, PhD Associate Professor Department of Sociology and Anthropology University of IdahoLeo Eisenstein, MD Bellevue Hospital/NYU School of MedicineVikas Gampa, MD Cambridge, MAMargot Smith, DrPH Berkeley, CACatherine DeLorey, PhD Women’s Health Institute Boston, MAMartin Donohoe MD FACP Portland State UniversityRichard N. Gottfried Chair, New York State Assembly Health CommitteeRachel Madley PhD Candidate Columbia University Medical CenterTom Lieb, MD Portland, OR 97213William M. Fogarty, Jr., MD Webster Groves, MOEd Weisbart, MD, CPE, FAAFP St. Louis, MissouriKenneth D. Rosenberg, MD, MPH Oregon Health & Science University-Portland State University School of Public HealthAirín D. Martínez, PhD Assistant Professor School of Public Health and Health Sciences University of Massachusetts-AmherstMark S. Krasnoff, MD FACP St. Louis, MOAndrew Goldstein, MD. New York, NYAaron D. Fox, MD MS Associate Professor of Medicine Montefiore Medical Center/Albert Einstein College of MedicineSam Dickman, MD University of California San FranciscoChristine Jacobs MD Professor and Department Chair Family and Community Medicine St. Louis UniversityRachel Kreier, PhD Associate professor, health economics Saint Joseph’s College Patchogue, NYRobert E Aronson, DrPH, MPH Professor and Director, Public Health Program Department of Environmental Science, Public Health and Sustainable Development Taylor University Upland, INMichael Hochman, MD, MPH Director, USC Gehr Family Center for Health Systems Science Keck Medicine of USCKevin Grumbach, MD Hellman Endowed Professor and Chair Department of Family and Community Medicine University of California San FranciscoOlveen Carrasquillo, MD MPH Professor of Medicine and Public Health Sciences Chief, Division of General Internal Medicine University of Miami, Miller School of MedicinePaul O’Rourke-Babb, MSN, FNP-C Chico, CAWilliam Honigman, M.D. Orange County, CATom Koren, PT San Francisco, CANoralou Roos, O.C., PhD Professor, University of MannitobaHarvey M. Weinstein, MD, MPH Senior Research Fellow, Human Rights Center, Berkeley LawCorinne Frugoni M.D. Humboldt County, CAMarc Sapir MD, MPH Hayward, CAHenry L. Abrons, MD, MPH Berkeley, CAJay Bowman-Kirigin MD/PhD student, Washington University, St. LouisJessica Schorr Saxe, MD Charlotte, NCLeonard Rodberg, PhD Professor Emeritus, Queens College/City University of New YorkMarce Abare, MD San Jose, CARuth Wangerin, PhD, MPH Lehman College, City University of New YorkJ. Wesley Boyd, MD, PhD Associate Professor of Psychiatry, Harvard Medical SchoolJudy Norsigian, Board Chair, on behalf of Our Bodies and OurselvesRussell Phillips, M,.D. William Applebaum Professor of Medicine; Professor of Global Health and Social Medicine and Director of the Center for Primary Care, Harvard Medical SchoolMarcia Angell, M.D. Former Editor-in-chief, New England Journal of MedicineAffiliations are for identification only"

SOLUTION:
500,000 Americans will go bankrupt this year from medical bills.