Readers and Tweeters Diagnose Greed and Chronic Pain Within US Health Care System

Letters to the Editor is a periodic characteristic. We welcome all comments and can publish a variety. We edit for size and readability and require full names.

U.S. Well being Care Is Dangerous to One’s Well being

Thanks 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 hectic monetary calls for and threats it imposes on so many sufferers. Stress as a consequence 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 alleged to deal with sickness and restore well being can, the truth is, trigger critical sickness and/or exacerbate present medical issues. The upper ranges of stress and the specter of chapter that every one too ceaselessly comply with wanted medical care might be dangerous to people with cardiovascular points similar to hypertension and coronary heart arrhythmia, and might set off panic assaults in those that undergo from nervousness issues. There could also be digestive points related to larger ranges of stress, and the affected person’s sleep could also be adversely affected. The person could have to chop again on necessities similar to meals and drugs due to unpaid medical payments, aggressive calls from assortment companies, and the specter of chapter.

All of this within the identify of “well being care” delivered by professions and organizations that proclaim the significance of beneficence, justice, and malfeasance inside their respective codes of ethics. Healing stress? Therapeutic chapter? The hypocrisy is palpable.

American historical past is replete with examples of discrimination towards sure teams, together with racial discrimination, the disenfranchisement of girls, baby labor, and others. Finally, political measures had been enacted to right these injustices. It’s solely a matter of time till the American well being care system, together with the pharmaceutical trade, is pressured to reform itself for the sake of the boys, girls, and kids in want of important well being care. It’s not a query of if, however when.

— Fred Medinger, Parkton, Maryland

— Jan Oldenburg, Richmond, Virginia

Thanks for the article about hospitals suing sufferers. I simply switched well being plans in New York state. Causes: My earlier insurer raised my premium over 90% final yr, paid little or no of my claims (leaving Medicare to pay a lot of the claims), and despatched me to collections. This, despite the fact 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

— Molly Work, Rochester, Minnesota

Sad New Yr of Deductibles and Copays

Listened to a conversation 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 Inexpensive Care Act plans bought by way of state exchanges would pay a most out-of-pocket quantity of $9,000 a yr. Doubtless Mr. Levey is aware of the precise particulars of the ACA no less than in addition to I, however I had effectively over $20,000 in out-of-pocket bills for my very own care final yr (along with annual premiums of over $15,000). The deductible/copay side of medical insurance is rigged towards people who really use their insurance coverage. The in-network and out-of-network supplier scheme is likewise designed to profit suppliers versus sufferers.

I’ve had medical insurance for about 40 years, since I graduated from school. All the time a plan paid for on my own, by no means by way of an employer. I’ve had my first yr of utilizing a lot of heath care companies (colon most cancers surgical procedure and chemo follow-up), and the payments are fairly astronomical. Nonetheless awaiting the ultimate negotiations between Stanford Hospital and Blue Defend of California for the $97,000 invoice for companies for the surgical procedure and keep within the hospital. Although 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’d like well being care fee reform.

— George McCann, Half Moon Bay, California

— Allison Sesso, president and CEO of RIP Medical Debt, Lengthy Island Metropolis, New York

Grasping 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). Simply as a non-public equity-controlled ophthalmology group tried to influence me to have pointless cataract surgical procedure (three different eye docs agreed it wasn’t crucial), too many orthopedic sufferers can anticipate to be pushed to pointless surgical procedures.

— Gloria Kohut, Grand Rapids, Michigan

— Dr. Amit Jain, Baltimore

The Painful Reality of the Opioid Epidemic

In a latest article, Aneri Pattani and Rae Ellen Bichell mentioned disparities within the distribution of settlement funds from lawsuits towards main pharmaceutical firms, particularly in rural areas (“In Rural America, Deadly Costs of Opioids Outweigh the Dollars Tagged to Address Them,” Dec. 12).

We advise that the advantage of most of the lawsuits that led to those massive settlements stays unproven. Whereas Purdue Pharma clearly overstated the safety of prescription opioids in treating persistent ache, judges in two high-profile circumstances dominated in favor of the pharmaceutical firms stating that prosecutors falsely inflated the danger of opioids and famous that opioids used per FDA tips are secure and efficient, remaining an important means to deal with persistent ache. Additionally, many circumstances involving Purdue Pharma, Johnson & Johnson, and others had been settled based mostly on expediency, moderately than advantage. This will have been as a result of reasoning that persevering with their protection towards prosecutors accessing limitless public funds would result in chapter.

The first explanation for America’s overdose disaster isn’t physicians’ “overprescribing” opioids. Dr. Thomas Frieden, former head of the Facilities for Illness Management and Prevention, famous that the rise in prescription opioids paralleled the increase in opioid deaths as much as 2010, main the CDC to create tips in 2016 limiting opioid use to deal with persistent ache. Nonetheless, cause-and-effect relationships between the authentic use of prescription opioids and opioid deaths stay unclear. For instance, the Nationwide Institute on Drug Abuse famous in 2015 that since 2000, misuse of pharmaceuticals preceded using heroin normally. However authentic prescriptions by physicians to sufferers with persistent ache constituted solely 20% of the circumstances resulting in heroin dependancy. Prescribed drugs utilized by heroin addicts had been from relations or pals in 80% of the cases 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 circumstances in 2021. The opioid overdose dying disaster is now pushed primarily by illegally imported fentanyl and partially by a misguided crackdown of the Drug Enforcement Administration towards physicians who legitimately prescribe opioids to persistent ache sufferers, forcing them to hunt out road medication.

Statistics from Michigan point out that almost 40% of primary care clinics will not see new sufferers for ache administration. The CDC, in its 2022 up to date tips, tried to make clear misunderstandings, together with inappropriate fast tapering and individualizing care. Nonetheless, the general public well being disaster of undertreated ache stays. Some states have handed intractable pain laws to revive entry to opioids to persistent 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

— Dr. Joanne Conroy, Lebanon, New Hampshire

We’re preventing to carry accountable the businesses that helped create and gas the opioid disaster so we will help folks battling opioid use dysfunction throughout North Carolina and the nation get sources for therapy and restoration. We’d like this cash now to save lots of lives.

To that finish, I wished to flag one concern concerning the article on rural counties and opioid funding. It appears as if the comparability and the maps about North Carolina funding by county and overdose deaths could not correlate. The reporting appears to mirror overdose deaths on a per capita foundation, however funding is indicated by complete {dollars} obtained.

This spreadsheet may be useful. It ranks every North Carolina county by the quantity of funds they are going to obtain from the distributor and Johnson & Johnson settlements (as posted on 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 probably 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 symbolize and have duties of loyalty to each massive 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 whole variety of folks nationwide with opioid use dysfunction), overdose deaths as a proportion of the nation’s opioid overdose deaths, and the variety of opioids within the county. Click on here for extra data.

Certainly, one of many particular masters appointed by U.S. District Decide Dan Polster within the nationwide opioid litigation discovered that the nationwide allocation mannequin “displays a critical effort on the a part of the litigating entities that devised it to distribute the category’s restoration in keeping with the driving drive on the coronary heart of the lawsuit — the devastation attributable to this horrific epidemic.” (See Web page 5 of this report of Particular Grasp Yanni.)

You’re completely proper that rural counties had been usually the earliest and hardest hit by the opioid epidemic, and it’s important 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 Legal professional Basic’s Workplace, Raleigh, North Carolina

— Kate Roberts, Durham, North Carolina

A Holistic Strategy to Strengthening the Nursing Workforce Pipeline

As we face the nation’s worst nursing scarcity in many years, 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 remedy the foundation of this disaster, we should look earlier within the workforce pipeline.

The whole nation at the moment sits in a dire scenario relating to 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 recent McKinsey report discovered that we have to double the variety of nurses coming into the workforce yearly for the following three years to satisfy anticipated demand. With out assist from policymakers and well being care leaders, we can’t meet that.

As a well being care govt myself, I’ve seen firsthand how impactful apprenticeships might be as a result of they assist maintain the well being care workforce pipeline. From highschool college students to working adults, these “earn when you be taught” apprenticeships enable 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 supplies a framework to assist a competency-based training rooted in real-life abilities and hands-on coaching for key nursing assist roles, all whereas group members earn an earnings.

Training is essential to creating competent, practice-ready nurses. Not simply by way of apprenticeships however early on in college students’ academic journey, too. Based on the most recent knowledge 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 impression the pandemic had on younger learners, it’s essential we make investments extra in remediation and assist, so college students graduate from secondary faculty with a deep understanding of those core competencies and are able to pursue nursing. A recent survey of practically 4,000 potential nursing college students from ATI Nursing Training discovered {that a} lack of educational preparedness was the highest cause for delaying or forgoing nursing faculty.

With out intervention now, our nursing workforce scarcity will solely worsen sooner or later. We’d like 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 growth at WellStar Well being System, Atlanta

— Oklahoma Well being Motion Community, Oklahoma Metropolis

Planning Main Surgical procedure? Plan Forward

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. As soon as 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 fallacious. After surgical procedure, she had “drop foot” — complete lack of use of her left foot. By no means heard of it. She was informed she would regain use in about six months. By no means occurred. She had to make use of a walker and nonetheless had quite a few falls wherein 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 stomach 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. 5 days later, I used to be discharged. Every thing appeared rushed. The one postsurgical “directions” I obtained had been to maintain the incision clear and to not play golf, and I don’t even play golf. I recuperated at residence, and after 5 months I nonetheless have stomach ache that I’ll all the time have.

Each of our surgical procedures had been completed on a Friday. I’m sure our experiences had been as a consequence of hospital employees wanting to depart 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 may be absolute urgency in selecting the date.

— Paul Lyon, Chesapeake, Virginia

— Suzette Sommer, Seattle

I’m writing to specific my considerations over the numerous misinformation within the article about what older People ought to ask their surgeon earlier than main surgical procedure.

Most stomach 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 go away the hospital the following day with minimal purposeful limitations as a consequence of surgical procedure being carried out by way of half-inch incisions in every groin.

The “finest case” surgical state of affairs described in your article describes open stomach aortic aneurysm restore, which is beneficial 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.

Stomach aortic aneurysms are nonetheless undertreated within the U.S., with many sufferers not receiving screening beneficial by Medicare since 2006. Your article misrepresents the “finest case” state of affairs and will dissuade sufferers from receiving lifesaving care.

— Dr. David Nabi, Newport Seaside, California

I learn, with curiosity, Judith Graham’s article about older People making ready for main surgical procedure. However you failed to say the life-altering results of anesthesia. My impartial 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 ceaselessly altered. Was there a alternative to not have hip surgical procedure? I didn’t hear one. Did anybody clarify the problems that might (and infrequently do) happen with an aged mind as a consequence of anesthesia? No. And now we’re coping with this consequence. And what occurs once you don’t have cash (like most individuals within the U.S.) for twenty-four/7 care? I hope you’ll take into account writing about this.

— Nancy Simpson, Scottsdale, Arizona

— Dr. Madelaine Feldman, New Orleans

The Excessive Bar of Medicare Benefit Transparency

Sadly, KHN’s article “How Medicare Advantage Plans Dodged Auditors and Overcharged Taxpayers by Millions” (Dec. 13) offered a deceptive, incomplete depiction of Medicare Benefit fee.

This story focuses largely on audits that, in some circumstances, are greater than a decade outdated. Whereas 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 moderen analysis demonstrates Medicare Benefit’s affordability and accountable stewardship of Medicare {dollars}. For instance, an October 2021 Milliman report concludes “the federal authorities pays much less and will get extra for its greenback in MA than in FFS,” whereas the Division of Well being and Human Companies’ fiscal yr 2021 report exhibits that the web improper fee price in Medicare Benefit was roughly half that of fee-for-service Medicare.

KHN’s article is correct about one factor: Solely a small fraction of Medicare Benefit 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’s the reason Better Medicare Alliance has known as for regulators to conduct Danger Adjustment Knowledge Validation (RADV) audits of each Medicare Benefit plan yearly.

There are alternatives, as outlined in our latest coverage suggestions, to additional strengthen and enhance Medicare Benefit’s excessive bar of transparency and accountability, however that effort isn’t effectively served by this deceptive article.

— Mary Beth Donahue, president and CEO of the Better Medicare Alliance, Chevy Chase, Maryland

Concentrating on 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 purple flag regulation (“Colorado Considers Changing Its Red Flag Law After Mass Shooting at Nightclub,” Dec. 23). Particularly, it didn’t report that the suspect on this case used a “ghost gun” to execute the crime in Colorado Springs, and extra importantly what impression any purple 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? Fairly frankly, that is the underlying explanation for unlawful firearms use and nobody desires to step as much as the plate and handle the problem at any in-depth degree. It’s categorically embarrassing for American journalism.

— Steve Smith, Carbondale, Colorado


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