Letters to the Editor is a periodic characteristic. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.
U.S. Health Care Is Harmful to One’s Health
Thank you for publishing this analysis (“Hundreds of Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds. Does Yours?” Dec. 21). I’m a psychotherapist and have written about this drawback in my weblog. The mercenary American well being care system is hypocritical within the aggravating monetary calls for and threats it imposes on so many sufferers. Stress on account of well being care-related chapter, or the specter of chapter, is dangerous to at least one’s well being. A well being care system that’s purported to deal with sickness and restore well being can, the truth is, trigger severe sickness and/or exacerbate current medical issues. The increased ranges of stress and the specter of chapter that each one too incessantly comply with wanted medical care could be dangerous to people with cardiovascular points resembling hypertension and coronary heart arrhythmia, and may set off panic assaults in those that endure from anxiousness issues. There could also be digestive points related to increased ranges of stress, and the affected person’s sleep could also be adversely affected. The particular person might have to chop again on necessities resembling meals and medicines due to unpaid medical payments, aggressive calls from assortment companies, and the specter of chapter.
All of this within the identify of “health care” delivered by professions and organizations that proclaim the significance of beneficence, justice, and malfeasance inside their respective codes of ethics. Curative stress? Therapeutic chapter? The hypocrisy is palpable.
American historical past is replete with examples of discrimination in opposition to sure teams, together with racial discrimination, the disenfranchisement of ladies, youngster labor, and others. Eventually, political measures had been enacted to appropriate these injustices. It’s solely a matter of time till the American well being care system, together with the pharmaceutical trade, is compelled to reform itself for the sake of the lads, ladies, and youngsters in want of important well being care. It’s not a query of if, however when.
— Fred Medinger, Parkton, Maryland
I discover this infuriating! Especially the nonprofit organizations. Hundreds of US Hospitals Sue Patients or Threaten Their Credit, a KHN Investigation Finds | Kaiser Health News https://t.co/87TTYPVE0P
— Jan Oldenburg ☮️ (@janoldenburg) December 21, 2022
— Jan Oldenburg, Richmond, Virginia
Thanks for the article about hospitals suing sufferers. I simply switched well being plans in New York state. Reasons: My earlier insurer raised my premium over 90% final 12 months, paid little or no of my claims (leaving Medicare to pay many of the claims), and despatched me to collections. This, regardless that I labored two full-time jobs for many of my 46 years of educating. How do insurance coverage firms and hospitals get away with this unethical and outrageous conduct?
— George Deshaies, Buffalo, New York
Great story by @KHNews‘ @NoamLevey, which discovered that no less than 297 hospitals in MN, 56%, sue sufferers for unpaid medical payments. 90, or 17%, can deny sufferers nonemergency medical care if they’ve past-due payments.Mayo is a type of hospitals. See🧵https://t.co/p5dHdbZKou
— Molly Work (@mollycastlework) December 21, 2022
— Molly Work, Rochester, Minnesota
Unhappy New Year of Deductibles and Copays
Listened to a dialog between Noam N. Levey and NPR’s Ari Shapiro, relating to Levey’s article on Germany’s lack of medical debt (“What Germany’s Coal Miners Can Teach America About Medical Debt,” Dec. 14). Levey handed alongside the tidbit that Affordable Care Act plans bought by way of state exchanges would pay a most out-of-pocket quantity of $9,000 a 12 months. Likely Mr. Levey is aware of the precise particulars of the ACA no less than in addition to I, however I had properly over $20,000 in out-of-pocket bills for my very own care final 12 months (along with annual premiums of over $15,000). The deductible/copay facet of medical insurance is rigged in opposition to of us who truly use their insurance coverage. The in-network and out-of-network supplier scheme is likewise designed to learn suppliers versus sufferers.
I’ve had medical insurance for about 40 years, since I graduated from school. Always a plan paid for on my own, by no means by way of an employer. I’ve had my first 12 months of utilizing a lot of heath care providers (colon most cancers surgical procedure and chemo follow-up), and the payments are fairly astronomical. Still awaiting the ultimate negotiations between Stanford Hospital and Blue Shield of California for the $97,000 invoice for providers for the surgical procedure and keep within the hospital. Though my surgical procedure was in September, the 2 had not resolved the invoice by year-end. Now all my copays and deductibles have reset, and I’ll be again on the beginning gate, dollar-wise.
We want well being care fee reform.
— George McCann, Half Moon Bay, California
Tx @NoamLevey for this essential comparative piece on how Germany’s personal healthcare system doesn’t create #medicaldebt. We must do higher. @RIPMedicalDebt https://t.co/PoAduYljXq
— Allison Sesso (@AllisonSesso) December 14, 2022
— Allison Sesso, president and CEO of RIP Medical Debt, Long Island City, New York
Greedy to the Bone?
In orthopedics, surgical procedure is the place the cash is (“More Orthopedic Physicians Sell Out to Private Equity Firms, Raising Alarms About Costs and Quality,” Jan. 6). Just as a personal equity-controlled ophthalmology group tried to steer me to have pointless cataract surgical procedure (three different eye medical doctors agreed it wasn’t vital), too many orthopedic sufferers can count on to be pushed to pointless surgical procedures.
— Gloria Kohut, Grand Rapids, Michigan
As #personal #fairness companies purchase #physician practices, the problem of non-competes and #restrictive covenants change into much more related in #healthcare @AAOS1 @AmerMedicalAssn @JHU_HBHI @linakhanFTC @KHNews https://t.co/fTfilK4WEX
— Amit Jain, MD, MBA (@AmitJainBackbone) January 8, 2023
— Dr. Amit Jain, Baltimore
The Painful Truth of the Opioid Epidemic
In a current article, Aneri Pattani and Rae Ellen Bichell mentioned disparities within the distribution of settlement funds from lawsuits in opposition to main pharmaceutical firms, particularly in rural areas (“In Rural America, Deadly Costs of Opioids Outweigh the Dollars Tagged to Address Them,” Dec. 12).
We recommend that the benefit of most of the lawsuits that led to those giant settlements stays unproven. While Purdue Pharma clearly overstated the protection of prescription opioids in treating continual ache, judges in two high-profile instances dominated in favor of the pharmaceutical firms stating that prosecutors falsely inflated the hazard of opioids and famous that opioids used per FDA tips are protected and efficient, remaining a significant means to deal with continual ache. Also, many instances involving Purdue Pharma, Johnson & Johnson, and others had been settled based mostly on expediency, reasonably than benefit. This might have been as a result of reasoning that persevering with their protection in opposition to prosecutors gaining access to limitless public funds would result in chapter.
The main explanation for America’s overdose disaster shouldn’t be physicians’ “overprescribing” opioids. Dr. Thomas Frieden, former head of the Centers for Disease Control and Prevention, famous that the rise in prescription opioids paralleled the rise in opioid deaths as much as 2010, main the CDC to create tips in 2016 limiting opioid use to deal with continual ache. However, cause-and-effect relationships between the authentic use of prescription opioids and opioid deaths stay unclear. For instance, the National Institute on Drug Abuse famous in 2015 that since 2000, misuse of pharmaceuticals preceded using heroin usually. But authentic prescriptions by physicians to sufferers with continual ache constituted solely 20% of the instances resulting in heroin dependancy. Prescription medication utilized by heroin addicts had been from relations or mates in 80% of the instances resulting in heroin use.
Since no less than 2010, the amount of prescription opioids dropped by over 60% — but overdose deaths have skyrocketed to over 100,000 instances in 2021. The opioid overdose loss of life disaster is now pushed primarily by illegally imported fentanyl and partly by a misguided crackdown of the Drug Enforcement Administration in opposition to physicians who legitimately prescribe opioids to continual ache sufferers, forcing them to hunt out avenue medication.
Statistics from Michigan point out that just about 40% of main care clinics will now not see new sufferers for ache administration. The CDC, in its 2022 up to date tips, tried to make clear misunderstandings, together with inappropriate speedy tapering and individualizing care. However, the general public well being disaster of undertreated ache stays. Some states have handed intractable ache legal guidelines to revive entry to opioids to continual ache sufferers with a authentic want, indicating the shortfalls of the CDC tips to deal with ache.
— Richard A. Lawhern, Fort Mill, South Carolina, and Dr. Keith Shulman, Skokie, Illinois
Important reporting from @aneripattani and @raelnb in @KHNews: National settlements are being paid out by #opioids producers, however #rural communities are sometimes getting much less funds to handle the #OpioidCrisis than their city and suburban counterparts. https://t.co/qeoXtqKfpo
— Joanne Conroy (@JoanneConroyMD) December 15, 2022
— Dr. Joanne Conroy, Lebanon, New Hampshire
We’re preventing to carry accountable the businesses that helped create and gasoline the opioid disaster so we may help folks combating opioid use dysfunction throughout North Carolina and the nation get sources for therapy and restoration. We want this cash now to avoid wasting lives.
To that finish, I needed to flag one concern concerning the article on rural counties and opioid funding. It appears to be like as if the comparability and the maps about North Carolina funding by county and overdose deaths might not correlate. The reporting appears to replicate overdose deaths on a per capita foundation, however funding is indicated by complete {dollars} acquired.
This spreadsheet is likely to be useful. It ranks every North Carolina county by the quantity of funds they’ll obtain from the distributor and Johnson & Johnson settlements (as posted on www.ncopioidsettlement.org) per capita, utilizing 2019 inhabitants figures. In per capita rankings, rural and/or much less populous counties are sometimes receiving extra funding per capita than bigger counties. For instance, the ten counties receiving essentially the most per capita funding are all rural and/or much less populous counties (Wilkes, Cherokee, Burke, Columbus, Graham, Yancey, Mitchell, Clay, Swain, and Surry). Wake County, our most populous county, is ranked eightieth.
It’s additionally essential to notice that the components was developed by consultants for counsel to native governments within the nationwide opioid litigation, who characterize and have duties of loyalty to each giant city and small rural native governments. It takes under consideration opioid use dysfunction within the county (the variety of folks with opioid use dysfunction divided by the full variety of folks nationwide with opioid use dysfunction), overdose deaths as a share of the nation’s opioid overdose deaths, and the variety of opioids within the county. Click right here for extra info.
Indeed, one of many particular masters appointed by U.S. District Judge Dan Polster within the nationwide opioid litigation discovered that the nationwide allocation mannequin “reflects a serious effort on the part of the litigating entities that devised it to distribute the class’s recovery according to the driving force at the heart of the lawsuit — the devastation caused by this horrific epidemic.” (See Page 5 of this report of Special Master Yanni.)
You’re completely proper that rural counties had been typically the earliest and hardest hit by the opioid epidemic, and it’s essential that they obtain funds to assist get residents the therapy and restoration sources they want. We’re hopeful that these funds, whose allocation was decided in partnership by native authorities counsel, will assist ship these sources.
— Nazneen Ahmed, North Carolina Attorney General’s Office, Raleigh, North Carolina
This article is a superb instance of equality ≠ fairness relating to opioid settlement funds disbursement. Really considerate article by @aneripattani & @raelnb https://t.co/vRbksffwqP
— Kate Roberts, LCSW (@KateandOlive_) December 14, 2022
— Kate Roberts, Durham, North Carolina
A Holistic Approach to Strengthening the Nursing Workforce Pipeline
As we face the nation’s worst nursing scarcity in a long time, some areas are adopting inventive options to fill within the gaps (“Rural Colorado Tries to Fill Health Worker Gaps With Apprenticeships,” Nov. 29). To really clear up the foundation of this disaster, we should look earlier within the workforce pipeline.
The total nation presently sits in a dire scenario in terms of having an satisfactory variety of nurses — particularly rural communities. With the tripledemic of covid-19, influenza, and RSV tearing by way of hospitals, it’s by no means been extra evident how very important nurses are to the functioning of our well being care system. A current McKinsey report discovered that we have to double the variety of nurses getting into the workforce yearly for the following three years to fulfill anticipated demand. Without help from policymakers and well being care leaders, we can not meet that.
As a well being care govt myself, I’ve seen firsthand how impactful apprenticeships could be as a result of they assist maintain the well being care workforce pipeline. From highschool college students to working adults, these “earn while you learn” apprenticeships permit college students to make a dwelling whereas working towards their diploma, and my system’s apprenticeship program has even lowered our turnover by as much as 50%. It gives a framework to help a competency-based training rooted in real-life abilities and hands-on coaching for key nursing help roles, all whereas group members earn an earnings.
Education is essential to creating competent, practice-ready nurses. Not simply by way of apprenticeships however early on in college students’ academic journey, too. According to the most recent information from the nation’s report card, college students in most states and most demographic teams skilled the steepest declines in math and studying ever recorded. As we proceed to see the devastating affect the pandemic had on younger learners, it’s essential we make investments extra in remediation and help, so college students graduate from secondary college with a deep understanding of those core competencies and are able to pursue nursing. A current survey of practically 4,000 potential nursing college students from ATI Nursing Education discovered {that a} lack of educational preparedness was the highest motive for delaying or forgoing nursing college.
Without intervention now, our nursing workforce scarcity will solely worsen sooner or later. We want our leaders to face these challenges head-on and spend money on a holistic strategy to strengthen our nursing pipeline. There’s no time to waste.
— Natalie Jones, govt director of workforce improvement at WellStar Health System, Atlanta
1 resolution to the staffing disaster: Apprenticeship packages put college students instantly into long-term care professions. Rural areas profit essentially the most since they’ve extra residents who’re 65 or older & fewer direct care employees to assist folks w/ disabilities. https://t.co/vnbHAJYWvY
— OK Health Action (@ok_action) November 30, 2022
— Oklahoma Health Action Network, Oklahoma City
Planning Major Surgery? Plan Ahead
I learn Judith Graham’s good article “Weighing Risks of a Major Surgery: 7 Questions Older Americans Should Ask Their Surgeon” (Jan. 3) on CNN. Thought I ought to add some private expertise. At age 78, my mom had again surgical procedure in 2016. When she was getting prepped, she was given a number of paperwork to signal. Once signed, she was instantly taken to surgical procedure. There was not sufficient time to learn any of them. In hindsight, we’re sure the paperwork had been principally for launch of legal responsibility if one thing goes incorrect. After surgical procedure, she had “drop foot” — complete lack of use of her left foot. Never heard of it. She was advised she would regain use in about six months. Never occurred. She had to make use of a walker and nonetheless had quite a few falls by which her head had hit the bottom a number of occasions. She slowly slid into long-term “confusion” that was attributed to her falls and handed away at age 84.
My story is about my belly aorta aneurysm surgical procedure in 2022 at age 62. I didn’t have an in a single day restoration — tube taken out of my throat, catheter eliminated, and was instantly transferred to a room. An IV pump of saline was left on and my arm swelled up — I assumed my arm was going to burst. Five days later, I used to be discharged. Everything appeared rushed. The solely postsurgical “instructions” I acquired had been to maintain the incision clear and to not play golf, and I don’t even play golf. I recuperated at dwelling, and after 5 months I nonetheless have belly ache that I’ll all the time have.
Both of our surgical procedures had been carried out on a Friday. I’m sure our experiences had been on account of hospital workers wanting to go away early on Friday, and weekend staffers are principally the “B” group. So, my recommendation is to recommend to the aged to not have surgical procedure scheduled on a Friday until there’s absolute urgency in selecting the date.
— Paul Lyon, Chesapeake, Virginia
Reality bites, doesn’t it.https://t.co/sHe0EV1DQG
— suzette sommer (@suzette_sommer) December 28, 2022
— Suzette Sommer, Seattle
I’m writing to specific my considerations over the numerous misinformation within the article about what older Americans ought to ask their surgeon earlier than main surgical procedure.
Most belly aortic aneurysms are handled with endovascular strategies. These minimally invasive procedures nonetheless require basic anesthesia (with a respiration tube), however most sufferers have the tube eliminated earlier than leaving the working room, and plenty of sufferers depart the hospital the following day with minimal practical limitations on account of surgical procedure being carried out by way of half-inch incisions in every groin.
The “best case” surgical situation described in your article describes open belly aortic aneurysm restore, which is advisable for fewer than 20% of sufferers requiring aortic aneurysm repairs.
In essence, you’re threatening everybody who is available in for a tuneup with an engine rebuild.
Abdominal aortic aneurysms are nonetheless undertreated within the U.S., with many sufferers not receiving screening advisable by Medicare since 2006. Your article misrepresents the “best case” situation and will dissuade sufferers from receiving lifesaving care.
— Dr. David Nabi, Newport Beach, California
I learn, with curiosity, Judith Graham’s article about older Americans making ready for main surgical procedure. But you failed to say the life-altering results of anesthesia. My unbiased 82-year-old mom had a minor fall in July and broke her hip. After present process anesthesia, she is required to have 24/7 care as her short-term reminiscence has been without end altered. Was there a alternative to not have hip surgical procedure? I didn’t hear one. Did anybody clarify the problems that might (and sometimes do) happen with an aged mind on account of anesthesia? No. And now we’re coping with this consequence. And what occurs while you don’t have cash (like most individuals within the U.S.) for twenty-four/7 care? I hope you’ll contemplate writing about this.
— Nancy Simpson, Scottsdale, Arizona
Shouldn’t extra folks surprise why MA plans are worthwhile whereas our personal gov’t MC is shedding cash. Only 5% of MA plans are audited yearly. Yet they’re getting 8.5% enhance in fee & docs (the oldsters caring for the pts) are getting minimize. https://t.co/UiFiiQ9wre by way of @khnews
— Madelaine Feldman (@MattieRheumMD) December 15, 2022
— Dr. Madelaine Feldman, New Orleans
The High Bar of Medicare Advantage Transparency
Unfortunately, KHN’s article “How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions” (Dec. 13) offered a deceptive, incomplete depiction of Medicare Advantage fee.
This story focuses largely on audits that, in some instances, are greater than a decade outdated. While KHN’s focus is on alleged “overpayment,” the identical audits present that many plans had been underpaid by as a lot as $773 per affected person.
More current analysis demonstrates Medicare Advantage’s affordability and accountable stewardship of Medicare {dollars}. For instance, an October 2021 Milliman report concludes “the federal government pays less and gets more for its dollar in MA than in FFS,” whereas the Department of Health and Human Services’ fiscal 12 months 2021 report exhibits that the web improper fee charge in Medicare Advantage was roughly half that of fee-for-service Medicare.
KHN’s article is correct about one factor: Only a small fraction of Medicare Advantage plans are audited annually — denying policymakers and the general public a fuller understanding of this system’s distinctive worth to seniors and the well being care system. That is why Better Medicare Alliance has known as for regulators to conduct Risk Adjustment Data Validation (RADV) audits of each Medicare Advantage plan yearly.
There are alternatives, as outlined in our current coverage suggestions, to additional strengthen and enhance Medicare Advantage’s excessive bar of transparency and accountability, however that effort shouldn’t be properly served by this deceptive article.
— Mary Beth Donahue, president and CEO of the Better Medicare Alliance, Chevy Chase, Maryland
Targeting Gun Violence
I’m curious why KHN uncared for to truly get into all of the “meat and potatoes” relating to its report on Colorado’s pink flag regulation (“Colorado Considers Changing Its Red Flag Law After Mass Shooting at Nightclub,” Dec. 23). Specifically, it did not report that the suspect on this case used a “ghost gun” to execute the crime in Colorado Springs, and extra importantly what affect any pink flag regulation goes to have on an individual who manufactures their very own unlawful firearm. Lastly, why is it the nationwide dialog relating to the unlawful use and possession of firearms curiously avoids any in-depth, substantive dialog of entry to firearms by mentally sick folks? Quite frankly, that is the underlying explanation for unlawful firearms use and nobody desires to step as much as the plate and tackle the problem at any in-depth degree. It’s categorically embarrassing for American journalism.
— Steve Smith, Carbondale, Colorado