Letters to the Editor is a periodic feature. We聽聽and will publish a selection. We edit for length and clarity and require full names.
Savings For All?
Your criticism about former Vice President Joe Biden’s 鈥淢edicare for All鈥 cost estimates is spot-on but leaves out important savings (鈥KHN & PolitiFact HealthCheck: Would 鈥楳edicare For All鈥 Cost More Than U.S. Budget? Biden Says So. Math Says No,鈥 Feb. 14). Under Biden’s plan, private insurance stays intact, meaning there are premiums and point-of-service costs that do not appear as taxes but are added to the nation’s health care expense. Medicare for All, on the other hand, is zero at the point of service, meaning Americans would have no financial qualms seeking comprehensive care. Public options add bureaucratic costs, are subject to personal income fluctuations and have deductibles and copays. We depend on organizations like yours to present the full picture. Here’s hoping you will, in the public’s interest.
鈥 Dr. Donald Green, Pennington, New Jersey
鈥 Manuel Freire, Fort Lauderdale, Florida
For Alzheimer鈥檚 Patients Like Me, Knowing Is Half The Battle
I want to thank Judith Graham for her piece discussing the uncertainty and fear patients feel when faced with the potential onset of Alzheimer鈥檚 disease or dementia (鈥Stalked By The Fear That Dementia Is Stalking You,鈥 Feb. 21).
As an Alzheimer鈥檚 patient with a confirmed diagnosis, I know all too well how unsettling it can be to suffer from cognitive decline without knowing the nature of your condition. For me, it started with little things like forgetting a name or misplacing a set of house keys. Still, it wasn鈥檛 until I applied to participate in an Alzheimer鈥檚 clinical trial and received a PET scan identifying amyloid protein buildup in my brain did I definitively know I had the disease.
Like many of the patients discussed in the article, dealing with these early warning signs can be an enormous source of anxiety 鈥 especially when it鈥檚 unclear whether or not the cause is Alzheimer鈥檚 or another cognitive issue. That鈥檚 why getting a precise diagnosis was such a critical step for myself and my husband, Jim.
As mentioned in the article, amyloid PET scans are not fully covered by Medicare, a critically important detail, which I believe must be remedied. As the prevalence of Alzheimer鈥檚 continues to grow as our population ages, expanding access to diagnostic tools that can identify this disease will become ever more critical. I remain optimistic that our representatives in Washington can come together and address this issue 鈥 so more patients like me don鈥檛 have to live under a cloud of uncertainty.
鈥 Geri Taylor, New York City
An Infusion Of Debt
Glad you are pointing this out (鈥Patients Stuck With Bills After Insurers Don鈥檛 Pay As Promised,鈥 Feb. 7). It’s happening again, post-Affordable Care Act. For us, it’s my husband’s battle with multiple sclerosis, but more the battle with his insurer. It approved his treatment cost for a new drug, sent a letter saying everything was covered. Then, lo and behold, we get a bill for $4,000 that it said we had to pay. No reason or rationale given. So now we are on a payment plan with the hospital that gave him his infusion. Not sure why we even bother with paying our premiums in the first place, considering the out-of-pocket expense and worthlessness of preapprovals; it doesn’t really matter. Please keep writing these articles 鈥 it helps.
鈥 Margaret Paez, Los Angeles
When Choice Of Hospitals Is A Life-Or-Death Choice
Thanks so much for your coverage of death-with-dignity situations (鈥Terminally Ill, He Wanted Aid-In-Dying. His Catholic Hospital Said No,鈥 Jan. 29). We all need to know as much as possible about the institutions and structures that may prevent patients from choosing a dignified death. Please consider linking to the Catholic ethics rules so readers can read them for themselves. Please make us a map of Colorado showing the hospitals that are abiding by these rules. Please explain that emergency services in rural areas may have no choice but to take patients to the nearest (possibly non-law-abiding) hospital. Rewired has written about Eastern hospitals where serious pregnancy issues were poorly treated by Catholic hospitals.
Many of us do not understand that hospital choice may become a life choice and doctor choice may also become a life choice. And, please, also feature regularly and loudly all the practitioners and organizations being formed to protect patients鈥 legal right to die. Thanks so much for the good work that you do.
鈥 Diane Curlette, Boulder, Colorado
Taking Pains Over Statistics
In stories about the opioid crisis (鈥No Quick Fix: Missouri Finds Managing Pain Without Opioids Isn鈥檛 Fast Or Easy,鈥 Feb. 13), I always see total death statistics but never a breakdown of how many of the fatalities represent responsible legal users vs. illegal users.
A lot of us elderly folks have a very hard time getting our pain meds nowadays. Thirty used to last me five to seven months, and I took them only when I couldn’t get to sleep due to pain throughout my body. We have discussed it on our seniors鈥 webpage in our rural area and many of us used to get them. Overdoses and addiction aren鈥檛 the norm and aren鈥檛 even in the realm of our experiences. Why do we have to pay for others鈥 mistakes? They don’t outlaw cars even though many people die from wrecks caused by bad drivers!
鈥 William Scriven, Valley Springs, California
Such treatments are more time-consuming and involved than simply getting a prescription. A limited number of providers offer alternative treatment options… And perhaps the biggest problem? These therapies don鈥檛 seem to work for everyone.
— Nicolas Terry (@nicolasterry)
鈥 Nicolas Terry, Indianapolis
Collateral Damage From Insurers鈥 Dispute
When I read Brian Krans鈥 article about the Dignity-Cigna dispute (鈥Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer,鈥 Feb. 6), I was reminded of my own situation: In California, Oscar dropped coverage for all UCLA care facilities in its Covered California (Affordable Care Act) plans, as of this year. I don’t know how many people use Oscar, but the UCLA system is a major health care provider here in West L.A. There’s no indication that there’s a dispute 鈥 this is represented as a final decision. UCLA is gone!
I figured I could get similar care from the Providence network, but my first choice for a primary care physician proved a bit odd: On our first visit, he presented at least four ideas that seem outside the medical mainstream. With some embarrassment, I asked for a different PCP. That physician ordered lab work but said no one in the building was authorized by Oscar to do blood draws, so I was sent to a facility in another city 鈥 which turned out to be out of business. I was finally referred to a third facility, which turned out to be more convenient than the last 鈥 but the inconvenient run-around for something as simple as a blood draw and the penny-pinching by my insurance company do not bode well for the future of American medicine.
This is the second disruption I’ve had in insurance providers since the ACA began, and another indication that our current health care system is still very broken.
鈥 Gary Davis, Los Angeles
鈥 Scott Gordon, Fennimore, Wisconsin
Raising A Red Flag On Animal Rights Group
As a registered dietitian, I do not promote the keto diet. Mentioned in the article 鈥As VA Tests Keto Diet To Help Diabetic Patients, Skeptics Raise Red Flags鈥 (Feb. 3) is the group Physicians for Responsible Medicine, which is an extreme animal rights group with ties to PETA. About 3% of its members are physicians. Attending a seminar on nutrition for cardiovascular disease, I was dismayed to see the speaker had ties to Physicians for Responsible Medicine. After hearing about all the terrible effects of eating animal products, when the speaker could no longer contain himself and shouted out, “You don’t eat dead animals, do you?鈥 I walked out and called my professional association to complain. Please do not give credibility to this organization.
鈥 Mary Lucius, Beavercreek, Ohio
This sounds pretty fishy as to the relationship. no comment on the diet aspect. lobbying by former Rep on the Veterans' affairs committee. As VA Tests Keto Diet To Help Diabetic Patients, Skeptics Raise Red Flags via
— nancy coney (@nsconey)
鈥 Nancy Coney, South Bend, Indiana
Price-Gouging At Its Core
I read your most recent story on surprise medical billing (鈥When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills,鈥 Feb. 12) and found it to be largely one-sided against physicians and, somewhat, hospitals. Although private equity certainly is an influence in the conversation, very little to any time was spent discussing the efforts of insurance companies to continually drive down reimbursements. Furthermore, when we look at Medicare rates, which insurance companies rates are based on, the actual reimbursement has not significantly increased over the past few decades when you account for inflation or the consumer price index. So to paint the picture that physicians are trying to gouge patients does not seem very fair. While there are always a few bad apples and opportunists, the majority of physicians simply want to be paid fairly. Remember: Over the past few years, insurance companies have reported record profits 鈥 . Why are we not talking about why more of our premiums are not going to the provision of health care and instead to shareholders? I think the article fails to paint the entire picture for a lay audience. Nowhere does it report the amount of money spent on lobbying by the insurance industry.
鈥 Dr. Shamie Das, Atlanta
Why are bicycle deaths rising? One serious reason is the stupid goonerment goonsquad rule that says they must follow automobile rules and ride on the RIGHT side of the road. When I was young we specifically rode on the LEFT so we could see threats…
— Christian Anarchist #CloversForAssange 馃崁 (@AnarChristian)
鈥 Gene Christian, Memphis, Tennessee
Health Care鈥檚 High-Cost Formula Goes Beyond Drug Prices
What patients care about more than drug prices is how much they have to pay out-of-pocket for their critical medications (鈥Watch: Let鈥檚 Talk About Trump鈥檚 Health Care Policies,鈥 Feb. 4). Because of high-deductible health plans and tiered formularies, what patients pay at the pharmacy counter often has less to do with the list price of the drugs they need and more to do with the design of their health benefits. It is especially troubling that high-value drugs for chronic conditions like diabetes are often subject to unaffordable cost sharing that hits disproportionately at the beginning of the benefit year. Employers and health plans need to exempt these drugs from high deductibles as now permitted by the IRS. The same goes for Medicare Part D, which hugely penalizes seriously ill patients at the start of each year when they have yet to reach the catastrophic threshold.
Clearly, the problem of high drug prices needs to be addressed, but this will require a systematic and comprehensive approach that is certain to be resisted by one vested interest or another. In the meantime, patients need immediate relief from unaffordable out-of-pocket costs. Some steps that should be taken immediately include exempting high-value care from plan deductibles and capping and smoothing out-of-pocket costs in Medicare Part D. Much, if not all, of the cost associated with these measures can be offset by not paying for low- and no-value care that costs billions per year.
鈥 Daniel Klein, president & CEO of the Patient Access Network (PAN) Foundation, Washington, D.C.
Cause For Investigation
The example you give presents an illegal activity by the home health agency (鈥Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients,鈥 Feb. 3). At a minimum, that agency should have a complaint registered against them, if not investigated by the Office of the Inspector General. The agency lied about Medicare not covering the patient鈥檚 needs. And they should have had the patient sign an ABN/NOMNC (Advance Beneficiary Notice/Notice of Medicare Non-Coverage) and explained it to the patient as required, so he could choose to appeal with the Quality Improvement Organization (QIO) for coverage of medically necessary care.
Kaiser Health News needs to provide education for the elderly and families to make sure they don’t fall prey to this type of behavior. If the agency simply says 鈥淚 don’t have the staff to cover you,鈥 they are responsible to assist the patient in finding another agency. But they cannot elect to just stop providing a medically necessary service, just as they cannot keep seeing someone when it is not medically necessary. Key here is to get people to know their rights as a Medicare beneficiary.
鈥 Edward Dieringer, Salt Lake City
Q for & individual candidates: PDGM is just one of numerous regulatory remedies that drive changes in plans of care each year for Medicare FFS. Why is it a good idea to expose the nation to M4All when this is a norm for the program? HT
— Tom Cassels (@Tom_Cassels)
鈥 Tom Cassels, Arlington, Virginia
Let's not confuse changes in the payment system with bad implementation decisions by Home Health Agencies. I'm glad that Judith Graham [no relation] ended her article with the message that Smart, High Quality Agencies continue鈥
— Peg Graham (@kbbtr)
鈥 Peg Graham, Washington, D.C.
Privacy Concern: I Lack Seamless Access To My Own Records
I work in a medical center and have taken HIPAA training repeatedly over the years. I have also noted the staggering amount of money spent on medical electronic records. Yet in four attempts over a 20-year period, I have yet to get my medical records sent from one doctor or practice to another. I could not get records of my husband’s hospital stay sent to his primary physician, dental records sent from one dentist to another and, this fall, the pertinent records when my rheumatologist changed practices. My insurance paid for blood tests four times a year and X-rays over a five-year period. I have contacted the facilities and submitted a complaint to HHS Office for Civil Rights, which appears to be the correct office.
I find it unacceptable that, with all the talk about how expensive medical care is, tests over time are not easily available to patients when requested. I read Kaiser Health News regularly and at least I feel informed about what can go wrong. Thank you.
鈥 Susan Klimley, New York City
鈥 Dr. Sarah Nguyen, Los Angeles
