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A Free-for-All From Readers and Tweeters, From Medical Debt to Homelessness

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.

It’s appalling that an article like this even must be written. Our “healthcare” system is damaged.Find out how to eliminate medical debt — or keep away from it within the first place https://t.co/EIo7lHps8k

— Karin Wiberg (@kswiberg) July 1, 2022

— Karin Wiberg, Raleigh, North Carolina

Lifesaving Info

I simply need to thanks from the underside of my coronary heart for the work you do this exposes the utter brokenness of America’s well being system (“Analysis: Debt: Find out how to Get Rid of Medical Debt — Or Keep away from It within the First Place,” July 1). You might be serving to to repair it!

— Ruth Worley, Athens, Ohio

Recovering from being sick or caring for a sick cherished one shouldn’t damage any American’s funds. Listed here are some ways to navigate the system. https://t.co/ykvDkUecj0

— Bayeté (@BayeteKenan) July 10, 2022

— Bayeté Ross Smith, Harlem, New York

Sufferers Left Holding the Bag

Your “Analysis: Debt” articles are attention-grabbing and function additional examples of how the well being care trade is about up for the well being care system and never the individuals who use it.

Within the USA, medical debt shouldn’t be a difficulty, however we don’t educate folks find out how to save or perceive find out how to navigate the system. I’m a nurse blogger/advocate and see the repercussions of what folks undergo who’ve insufficient insurance coverage and lack financial savings or the power to grasp what is going on to them when they’re thrust into the complicated well being care system. However, in actuality, none of us actually take into consideration our well being or the well being care system until we’re in the midst of a disaster. If we’re sincere, none of us are actually ready for a catastrophic occasion, and that is what we have to work on going additional by means of schooling and advocacy.

I’ll proceed to coach the general public in my small approach so folks can perceive their position in our well being care system so they’re ready for a medical occasion and know that they will use their voice to talk up and advocate for themselves.

— Anne Llewellyn, Plantation, Florida

Portland has change into a wasteland! The place are the environmentalists no less than? Oh yeah, they’re all of their gated communities, worrying about local weather change and plastic straws for the remainder of us. (hope you may see this LA Occasions article)https://t.co/WrboM9vtPs

— Bob Beddingfield (@bobbeddingfield) June 23, 2022

— Bob Beddingfield, Houston

Vacation spot: Catastrophe

We visited Portland, Oregon, a yr in the past for a trip and we’ll by no means return: shops that don’t give baskets as a result of folks use them to steal. Shops that put poles on carts to maintain folks from racing out of the shop with them stuffed with merchandise. Closed storefronts. Homeless folks in every single place (“Sobering Classes in Untying the Knot of a Homeless Disaster,” June 21).

It was like a Third World nation. I’m not a Republican, very removed from it, however accepting the concept that anybody who needs can dwell on the streets, dump their trash, and get backed by town can not finish effectively. And this drawback is just not restricted to Portland. San Francisco is in a really comparable scenario with crime, drug abuse, and homelessness.

There isn’t any one-size-fits-all resolution. Throwing cash on the drawback after which ignoring the persevering with unresolved drawback hasn’t labored and, I believe, by no means will.

The concept that a metropolis can host an infinite variety of drug and alcohol addicts at public expense received’t work.

The concept that shoplifting, automotive break-ins, robberies, and many others. are allowed, not arrested, not prosecuted, not punished can by no means work out effectively.

And folks marvel why the Democrats are in such deep, deep hassle regardless of the horrible concepts the Republicans promote.

This is not going to finish effectively.

— David Alexander, Palo Alto, California

Fairly attainable the very best information story about our native homeless challenges I’ve learn not too long ago. ‘Not secure anymore’: Portland confronts the bounds of its assist for homeless companies #homless #Portland https://t.co/Ujr5KzhYAi

— Ben Brown Jr. (@BenBrownJunior) June 22, 2022

— Ben Brown Jr., Beaverton, Oregon

On Wheelchair Repairs, Steering Away from Error

Because the CEO of Nationwide Seating & Mobility (NSM), I applaud the work of KHN in offering in-depth reporting about vital points in well being care, together with the complicated rehabilitation know-how (CRT) trade.

Nonetheless, the current article “Regardless of a First-Ever ‘Proper-to-Restore’ Legislation, There’s No Straightforward Repair for Wheelchair Customers” (June 2) offered a number of inaccuracies, misrepresentations, and errors in its characterization of NSM and our work.

The article acknowledged that NSM and different CRT suppliers have restricted their investments in service and restore to extend earnings. NSM management has constantly invested in our service and restore enterprise, together with establishing a profession path and certification program to professionalize the service technician position, enhancing onboarding and ongoing coaching applications, reorganizing our funding group to introduce repair-specific funding specialists to higher help purchasers within the restore course of, investing in market evaluation on aggressive wages that resulted in a 15%-20% hourly pay enhance for technicians, and extra. In 2022, NSM has virtually 500 service technicians on workers, which is 22% extra technicians per depend of client-delivered orders versus 2019. Our funding in service and restore is long-standing and can proceed.

The article additionally recommended that Medicare’s use of aggressive bidding favors giant firms, typically on the expense of high quality and customer support. NSM was not a part of the earlier bidding session for sturdy medical gear (DME) to ascertain present charges and was not awarded any Medicare contracts consequently. A lot of the merchandise we offer are thought of CRT and are exempt from the aggressive bid course of and pricing. Because of part 16005 of the twenty first Century Cures Act and Home Invoice H.R. 1865, product codes that can be utilized for CRT or fundamental DME are paid on the regular charge for CRT as a substitute of aggressive pricing.

Lastly, the article makes false assumptions about our firm: that we preserve a restricted stock of elements, and we have now little incentive to rent technicians or pay for coaching as a result of we lose cash with repairs.

Every mobility resolution — and subsequently every restore—is very personalized to a shopper’s wants. This customization means elements which are changed much less regularly throughout our shopper inhabitants aren’t prone to be stocked versus these elements which are regularly changed. The present world provide chain disruption has additionally affected our stock; the quantity of inventory we have now readily available is totally dependent upon availability. Moreover, the labor scarcity our nation is experiencing has created a problem throughout all industries, ours included.

Restore reimbursement is a loss-leader for the CRT trade, exacerbated not too long ago resulting from inflation within the provide chain and labor markets. Whereas different firms are compelled to show down repairs resulting from these challenges, NSM continues to supply repairs as a result of it’s the proper factor to do.

NSM is a customer support enterprise, incomes our enterprise in each shopper interplay. We acknowledge enhancements are wanted, and we’re dedicated to investing in advocacy, applications, and collaborative trade efforts to steer our trade in a brand new path to enhance the lives of these we serve.

— Invoice Mixon, CEO of Nationwide Seating & Mobility, Franklin, Tennessee

This wants to alter! It shouldn’t be so sophisticated to get easy repairs made to #wheelchairs!https://t.co/MpTAyeBEms through @KHNews #DisabilityRights

— W. Ron Adams (@WRonAdams) June 11, 2022

— W. Ron Adams, Erlanger, Kentucky

These people have additionally labored so onerous to get landmark laws handed throughout the nation, together with a extremely vital first step in Colorado on the proper to restore wheelchairs: https://t.co/xaZPRnaYDD

— Hayley Tsukayama (@htsuka) June 3, 2022

— Hayley Tsukayama, San Francisco

Clearing the Air on Vaping vs. Smoking

I simply listened to your piece on the FDA banning Juul (“KHN’s ‘What the Well being?’: The FDA Goes After Nicotine,” June 23). Considered one of your panelists talked about she’d learn (really, she stated she’d learn solely the headline) about diacetyl (she didn’t need to even attempt to pronounce this) and popcorn lung.

I consider it’s irresponsible for so-called scientific specialists to touch upon issues they haven’t learn correctly and issues they clearly haven’t any data about. Diacetyl is current in cigarette smoke in concentrations lots of of instances increased than in vape merchandise and but there hasn’t been a single case of popcorn lung attributed to smoking. Something to do with the toxicity of a chemical current should absolutely make reference to the concentrations, placing it in context. The truth that a chemical is detectable clearly doesn’t imply that it’s dangerous within the concentrations current.

There’s a horrible misunderstanding amongst shoppers and certainly well being care professionals concerning the relative harms of vaping vs. smoking — provided that the overwhelming majority of vapers are ex- or present cigarette people who smoke, that is the related level.

I counsel that the scientific credibility of your program is compromised by such sloppy and inaccurate commentary.

— Mark Dickinson, Twickenham, Middlesex, United Kingdom

Be cautious when huge firms are available to “save” native establishments, whether or not or not it’s the hometown newspaper, native schooling or the hospital.https://t.co/gV4ZJDkR71

— Dave Gragg (@DaveGragg) June 15, 2022

— Dave Gragg, Republic, Missouri

Shoring Up Rural Care

Since 2010, 138 rural hospitals have closed, leaving many communities with out entry to well being care. In rural areas, this will create a domino impact of different hardships — a hospital typically serves as the biggest employer, and when these services shut down, the ironmongery shop or eating places typically face comparable fates. Put merely, when a rural hospital shutters, it turns into more durable for the city itself to outlive (“Sufferers for Revenue: Purchase and Bust: When Non-public Fairness Comes for Rural Hospitals,” June 15).

Then there’s essentially the most vital facet: With out hospitals, rural People lose well timed entry to lifesaving medical care. On common, the gap between a rural hospital and the closest facility with 100 or extra acute care beds is 28.9 miles. Preserving entry to care in our rural communities and guaranteeing hospitals stay the cornerstone of the financial system is crucial. That is why addressing the hospital closure disaster have to be a high precedence in Congress.

To find out what must be completed, it may be useful to look at the reason for the disaster. A number of elements have contributed to the excessive variety of rural hospital closures over the previous decade, with two main elements being slim or unfavourable hospital working margins and workforce shortages. The covid-19 pandemic has additional strained the well being care trade, resulting in elevated ranges of supplier burnout and perpetuating the workforce scarcity.

On high of this, rural suppliers proceed to really feel the pressure of Medicare sequestration, which reduces eligible funds to rural hospitals from Medicare by 2%. Aid from Medicare sequestration in the course of the pandemic expired on April 1, contributing to the monetary burdens rural hospitals already face. With many rural hospitals already working on unfavourable margins, these decreased reimbursements may very well be disastrous.

Additional, resulting from current statutory adjustments, provider-based rural well being clinics affiliated with small rural hospitals usually are not eligible for cost-based reimbursement as they traditionally have been. Except Congress addresses this shortcoming, it is probably not financially possible for small rural hospitals to supply main care in these settings, and care gaps in rural communities might widen.

Reps. Sam Graves, a Republican from Missouri, and Jared Huffman, a Democrat from California, labored collectively to introduce the Save America’s Rural Hospital Act. This laws will assist rural well being care suppliers preserve their doorways open and guarantee rural communities have entry to the care they want and deserve.

For instance, it is going to completely get rid of Medicare sequestration for rural hospitals, permitting these services to be reimbursed for the whole thing of their eligible value. It’s going to make everlasting elevated Medicare funds for floor ambulance companies in rural and tremendous rural areas. Additional, this invoice will reauthorize the Medicare Rural Hospital Flexibility Program to supply new grants to assist eligible rural suppliers transition to new fashions and evolve to fulfill group wants of their altering well being care environments.

To handle potential main care shortages, it is going to additionally create a voluntary high quality measure reporting program for provider-based rural well being clinics. If these services select to take part, they are going to obtain elevated reimbursement in alternate.

Well being care entry is vital to preserving the agricultural lifestyle for greater than 60 million rural People. This laws have to be thought of to make sure stability in our communities, which is able to in the end profit the nation as an entire.

— Alan Morgan, CEO of NRHA, Kansas Metropolis, Missouri

Briefly, our system is just not arrange for the distinctive wants of rural hospitals, making them financially stretched. Non-public fairness swoops in, buys the hospital, takes the COVID-19 reduction cash, closes the hospital, then runs. #ruralhealth https://t.co/qZBHG7yeeH

— Whitney Zahnd (@WhitneyZahnd) June 15, 2022

— Whitney Zahnd, Iowa Metropolis, Iowa

A Pitch for Built-in Behavioral Well being

I’m a medical psychologist who works at a big, safety-net tutorial well being middle in Colorado. I’m writing about your current article “Sufferers Search Psychological Well being Care From Their Physician however Discover Well being Plans Standing within the Approach” (June 8). I recognize the main target of this text on a number of the boundaries sufferers face in making an attempt to entry psychological well being care within the U.S. Nonetheless, I used to be a bit of involved that your article didn’t point out the quickly rising discipline of built-in behavioral well being. Though I perceive that not all main care suppliers’ places of work make use of an built-in behavioral well being clinician, the numbers are rising rapidly throughout the nation. For instance, within the hospital the place I work, there’s no less than one IBH clinician in each group main care middle, and in a lot of the specialty clinics (e.g. oncology, OB-GYN) as effectively.

Whereas I believe PCPs are actually capable of dispense basic-level psychological well being recommendation (e.g., belly respiratory workout routines for anxiousness), I don’t assume the reply is to show over psychological well being care to medical professionals, any greater than I consider it could be a good suggestion to show over a affected person’s diabetes administration to a psychologist, even when that psychologist had some fundamental coaching in find out how to deal with diabetes. As an alternative, I consider it’s in sufferers’ finest pursuits to proceed to advocate and nurture a team-based method that features each medical and psychological well being specialists throughout the identical clinic.

— Trina Seefeldt, Denver

This insanity should cease. Most of us in main care do tackle/deal with psychological well being issues. #insurance coverage #healthcare #SinglePayer would resolve this. Sufferers Search Psychological Well being Care From Their Physician However Discover Well being Plans Standing within the Approach https://t.co/YyAzJ0GylL through @khnews

— Andrea DeSantis DO (@adesantisb) June 10, 2022

— Dr. Andrea DeSantis, Charlotte, North Carolina

In Protection of Free Clinics

I used to be studying with curiosity — after which dismay — at your article revealed June 23 on the Hispanic insurance coverage hole (“Trump’s Legacy Looms Massive as Colorado Goals to Shut the Hispanic Insurance coverage Hole”). Within the opening paragraphs, you reference a person who had signs that “free clinics informed him have been hemorrhoids however have been really colon most cancers.”

In that one phrase, you single-handedly and forcefully implied that free clinics ship poor care and are to not be trusted. With the subsequent sentence about his tragic demise, you solidify that implication.

As a charitable clinic with greater than 26 years of serving the uninsured in our group, I take nice exception to this careless mischaracterization of a sector that has delivered high-quality care to tens of millions of people that have fallen by means of the cracks.

Most free and charitable clinics look after folks with completely no insurance coverage. This may considerably restrict the quantity of out of doors testing and diagnostics that may be completed with sufferers, even when they’re symptomatic. Up till this yr, our clinic had completely no choice for sending somebody to a gastroenterologist for a colonoscopy until they have been keen to pay out-of-pocket — upward of $5,000. We have now to usually inform folks that we should not have any good choices for them as a result of we can not entry sure specialists or checks. Do they want it? Sure. Can we offer it to them? No. Does this unimaginable inequity and frustration with the well being care system that forestalls our sufferers from getting the superior care they want weigh on us daily? Completely.

Free and charitable clinics usually are not a part of the issue. They’re a part of the answer. And the broad generalization you made impacts how the general public perceives this extremely vital piece of the well being care sector.

For extra info on free and charitable clinics, I invite readers to be taught in regards to the Nationwide Affiliation of Free and Charitable Clinics at https://nafcclinics.org/.

— Suzanne Hoban, govt director of Household Well being Partnership Clinic, Crystal Lake, Illinois

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