Readers and Tweeters Ponder Vaccines and Factors of Equity

Letters to the Editor is a periodic function. We welcome all feedback and can publish a range. We edit for size and readability and require full names.

Increased Insurance coverage Charges for the Unvaccinated? Snuff Out That Thought

That is about Dr. Elisabeth Rosenthal’s feedback on “All In With Chris Hayes” (“Evaluation: Don’t Desire a Vaccine? Be Ready to Pay Extra for Insurance coverage,” Aug. 4). It’s extraordinary that anybody would counsel increased medical insurance premiums for individuals who stay unvaccinated for covid. Already well being insurers obtain a bonanza from all the prices paid by the federal government, e.g., free vaccinations (to us).

As soon as the covid vaccines get full approval, these not vaccinated might be excluded from eating places, markets, theaters, sports activities occasions, and so on. We’ll want proof of vaccination as a result of unvaccinated individuals can’t be trusted to be truthful.

Insurance coverage premium surcharges should not the reply, as a result of surcharges may act as inflationary drivers on the medical insurance charges for everybody. I’d not belief firms with medical insurance surcharges. A really unhealthy precedent, even for people who smoke.

— Dimitri Papanastassiou, Pasadena, California

Why ought to (unvaccinated) sufferers be saved financially unhurt from what’s now a preventable hospitalization?’#COVID19 #covidvacccine2021

— Barbara Katz-Chobert (@KatzChobert) August 15, 2021

— Barbara Katz-Chobert, Philadelphia

Unvaccinated However Nonetheless Protected?

You declare to consider in science, then why are you ignoring naturally acquired immunity to covid-19 (“If the Unvaccinated Need to Work, They Face a Sequence of Hurdles,” Aug. 19)? There ought to be a waiver for people who’ve documented checks that show they’re immune. I had covid in March 2020 and was examined for antibodies final month. I’ve IgG & IgM antibodies which are examined at 70 occasions the quantity wanted for prevention of an infection. And my an infection was over a yr and a half in the past.

We may very well be nearer to herd immunity if the variety of people with naturally acquired immunity was calculated into those that are immune. The medical group is losing photographs on individuals who don’t actually need them. If I had been to go to get an MMR, chickenpox or tuberculosis titer take a look at, all I’ve to show is that I’m immune. I’m not required to get a vaccine. 

— Rebecca Vichitnand, Arlington, Washington

Implausible information that 90% of U.S. adults 65+ are vaccinated in opposition to coronavirus–however I might like to see these numbers for everybody 12+ who’s eligible for a vaccine.

— Amanda Davis (@amandad_dc) August 5, 2021

— Amanda Davis, Washington, D.C.

Can’t Maintain a Candle to the ‘Birthday Rule’ for Equity

The birthday rule was a good means for insurers to cowl claims in order that “good” insurers don’t get lopsided or tilted towards paying the entire claims (“Bye-Bye to Well being Insurance coverage ‘Birthday Rule’? Kansas Lawmaker Floats Repair,” July 27). If Firm A has a “Cadillac” plan, they shouldn’t have the burden of paying all of the claims for youngsters. Firm B might have a lesser plan, thereby not having to pay claims for youngsters. Dad and mom lined by two firms each ought to enroll in every plan, and the birthday rule would dictate which insurer pays first. If each plans had been elected, the bottom-line out-of-pocket for the household would be the similar. The advantages would coordinate.

This rule is honest as a result of many giant firms (akin to GM or Walmart) are self-funded, which implies they pay the claims out of their pockets. An insurance coverage firm is employed to pay claims however the cash is the employers’. If the birthday rule is eliminated, giant firms would pay greater than what’s honest to different firms.

Simply because workers or Congress members don’t perceive, nor learn the details about enrolling, doesn’t imply the rule in place is a nasty rule. Dad and mom have 30 days from start to enroll a baby. Particularly if the kid has excessive claims, it will be advantageous to enroll in each plans. Not all guidelines are evil or attempting to reap the benefits of not paying claims. There’s a motive for this rule: equity.

— Kathleen Gallagher, Wilmington, North Carolina

The general public well being division retains observe of issues like mosquito borne diseases and sexually transmitted illness. Behind the scenes however vital work. Possibly they want extra Snapchat channels to be seen these days.

— Emily Deans MD (@evolutionarypsy) August 6, 2021

— Dr. Emily Deans, Norwood, Massachusetts

Heeding Exhausting Classes

This can be a crucial subject for tax-cutting and emergency managers in Michigan (“Exhausting Classes From a Metropolis That Tried to Privatize Public Well being,” Aug. 6). Former Gov. John Engler lower Michigan’s flat tax in steps, past his time period, and compelled large cuts in Michigan’s cities after which emergency managers. This additionally helped result in Flint’s water disaster. Please, KHN, do extra follow-up. Twelve deaths in Flint at the least. In all probability many extra in Detroit from covid-19. This can be a crucial health-planning trigger.

— Dave McAninch, South Haven, Michigan

Katrina. Zika. Ebola. Sandy. Flint Water Disaster. COVID.After we underinvest in public well being, notably on the native stage, unhealthy issues occur throughout crises. After we will cease repeating these errors?

— Dr. Chris Friese, RN (@ChrisFriese_RN) August 6, 2021

— Chris Friese, Ann Arbor, Michigan

Thanks a lot for the latest story concerning the historical past and present standing of public well being companies in Detroit. I hope it’s learn by many public well being officers, and that the teachings from Detroit are heeded.

I’m a just lately retired neonatal nurse practitioner and have been licensed in 12 states, and due to this fact have seen the significance of public well being points in a number of areas through the years. A lot of my sufferers had been depending on public well being sources after their discharge from the neonatal intensive care unit.

Households are in determined want of public well being companies, and these companies are so vital for sustaining the well being of communities within the U.S. It appears there are all the time new public well being points to be addressed. Once more, thanks!

— Patricia Basto, Tucson, Arizona

I’d like to see a medical residence like this for our refugees and immigrants in Missoula

— Doug Odegaard (@dodegaard) July 30, 2021

— Doug Odegaard, Missoula, Montana

Good Information for a Change

Your story “How a Physician Breaks Norms to Deal with Refugees and Current Immigrants” (July 27) by Markian Hawryluk is among the most inspiring articles I’ve ever learn. Thanks a lot!

— Jan McDermott, San Francisco

I simply got here throughout this story and needed to share it! What an superior human! He is additionally an important physician. I do know as a result of I really feel higher simply studying about him. I imply, I am all teary-eyed, however I really feel higher.

— Loretta Sue Ross ⚖ (@lorettasueross) July 27, 2021

— Loretta Sue Ross, Clinton, Missouri

Growing a Tolerance for Outrageous Drug Costs?

This was an excellent story (“Girls Say California Insurer Makes It Too Exhausting to Get Drug for Postpartum Melancholy,” July 28), though Massachusetts already requires insurers to “conform to usually accepted requirements of care, together with scientific literature and knowledgeable consensus, when making choices about psychological well being therapy” in addition to medical therapy (California is just not essentially within the vanguard there). I agree that the Kaiser Permanente standards are effectively past the pale of acceptable medical administration of postpartum melancholy; in impact, they’ve declared that they won’t pay for this agent, ever. Because it seems to work comparatively effectively, whereas it’s cheap to require a trial of 1 or two much less intensive brokers first, 4 medication and electroconvulsive remedy are an unacceptable response to medically managing the usage of this drug.

My query is that this: Why is there no more outrage concerning the value of the agent? $34,000?! That’s merely indefensible. The rationale insurers react on this means is as a result of the costs are outrageous, particularly as a result of they can’t be deliberate for when making budgets. I acknowledge that the corporate that makes it has prices to recoup, however within the age of 1,000+% markups and generic takeovers elevating the value of medicine which have been round since earlier than I used to be a doctor, that is merely not cheap. To paraphrase Uwe Reinhardt (when explaining why U.S. well being care is so costly): It’s the costs, silly. And it’s the costs. Insurers do underwriting in order that they’ll plan how a lot cash to put aside for medical bills. This sort of value enhance shocks each the conscience and the funds, and provokes the sort of backlash seen right here.

I may even draw your consideration to some efforts right here in Massachusetts to cushion the value shock, involving amortization of high-cost, single-use brokers like this one over time, with a clause mainly saying that if it was not efficient, the insurer slides out of the “mortgage.” This was first proposed for the CAR-T class of biologic brokers. Search for the FoCUS Venture on the MIT Middle for Biomedical Innovation/NEWDIGS.

— Dr. Thomas A. Amoroso, Harmony, Massachusetts

This story is heartbreaking.

— Jessica Wakeman (@JessicaWakeman) July 30, 2021

— Jessica Wakeman, Asheville, North Carolina

Ice-Stuffed Drill: Been There, Performed That

This isn’t a singular thought (“A Chilling Remedy: Dealing with Killer Warmth, ERs Use Physique Luggage to Save Lives,” July 22). As an intern in 1969, I labored with Dr. Brian Dawson on the Mayo Clinic. Every so often, he would conduct an emergency drill within the working room to simulate care of a hyperthermic affected person underneath anesthesia. He would yell, “Dawson dinghy drill!” Employees members would rush in a rubber dinghy, rapidly inflate it and fill it with ice, by which to immerse a affected person reproduction, whereas Dawson timed the drill on his stopwatch.

— Dr. Frederic Grannis, Duarte, California

We bodybaggin’ ATs had been forward of our time! #CoolFirstTransportSecond #CWIforEHS

— Caitlin Place (@CaitrATC) July 23, 2021

Caitlin Place, Jackson, Minnesota

Nice thought for heatstroke. We had the luxurious of ice-filled tubs for heatstroke recruits at Parris Island’s Marine Corps Recruit Depot within the early ’70s. With a mean temperature of victims over 106 levels Fahrenheit, after immersion in ice and vigorous rubbing, all temps fell underneath 101 in lower than 20 minutes. No renal failure, and so on. All returned to lively responsibility inside every week. I can’t consider that was nearly 50 years in the past! Good luck and Godspeed.

— Anthony Costrini, Savannah, Georgia

Rural maternity care entry is vital. Should you’ve ever had a child and you reside in an city space or near a hospital, take a minute to consider this….. Are you able to think about?

— Katy Backes Kozhimannil, PhD, MPA (@katybkoz) August 2, 2021

— Katy Backes Kozhimannil, Minneapolis

Nurses Wanted to Shore Up Care

Essentially the most informative angle was not lined in your story about maternity care deserts: the registered nurses who select to not work there (“12,000 Sq. Miles With out Obstetrics? It’s a Chance in West Texas,” Aug. 2). Interview them. Well being methods and hospitals that respect registered nurses often shouldn’t have recruitment and retention points. Examine me and my colleagues in “The Nurses: A Yr of Secrets and techniques, Drama and Miracles With the Heroes of the Hospital” by Alexandra Robbins.

— Jan Marty, Vancouver, Washington

My novel is on this subject; what occurs if there aren’t any hospitals round? Effectively, our for-profit healthcare system doesn’t assure there shall be. Obstetrics is definitely an enormous cash loser for a hospital btw — that and ER (h/t @meganranney )#medtwitter

— Marie Myung-Okay (명옥) Lee (@MarieMyungOkLee) August 2, 2021

— Marie Myung-Okay Lee, New York Metropolis

The Good thing about Residence Well being Care

As KHN just lately identified, increasing Medicare advantages to fulfill seniors’ altering well being care wants is tremendously widespread amongst older Individuals and their households (“Why Doesn’t Medicare Cowl Companies So Many Seniors Want?” Aug. 11). Whereas Congress is discussing plans so as to add advantages to Medicare, efforts to develop senior entry to home-based care following hospitalization are additionally choosing up steam.

This system is known as Select Residence, and it will create an economical, patient-centered extra choice for Medicare beneficiaries to soundly get well at residence after being discharged from the hospital. Because the covid-19 pandemic has proven us, the flexibility to obtain well being care at house is extra vital than ever. If handed, the bipartisan Select Residence Care Act of 2021 (S. 2562) would empower extra eligible seniors to obtain expert nursing, remedy companies and extra private care and assist with actions of day by day residing within the consolation and security of their very own houses upon a doctor advice. As well as, Select Residence would prepare and educate household caregivers to supply continued assist for his or her family members.

By offering add-on funds for added companies akin to steady distant affected person monitoring, meals and nonemergency transportation, Select Residence would assist enhance affected person outcomes and save the Medicare program an estimated $144 million-$247 million per yr, in keeping with an knowledgeable evaluation. By all accounts, Select House is a win-win for seniors and America’s well being care system at giant. Additional, efforts to enhance affected person selection in relation to post-hospital care are broadly supported by American voters.

To fulfill the wants of America’s rising senior inhabitants extra safely — whereas saving treasured taxpayer {dollars} — I urge lawmakers in Congress to assist the bipartisan Select Residence Care Act.

— Joanne Cunningham, government director, Partnership for High quality Residence Healthcare, Washington, D.C.

Don’t be fooled: Medicare has been taken over by for-profit #Medicare Benefit personal plans. The entitlement half is absolutely, actually slim. Individuals deserve higher. Increase #Medicare to everybody, cowl all wanted companies, and pay suppliers a good fee.

— Barbara DiPietro (@BarbaraDiPietro) August 11, 2021

— Barbara DiPietro, Baltimore

Making the Podcast Accessible

I’m not commenting on a selected podcast, however fairly concerning the presentation of your “What the Well being?” podcast. I’ve regarded for written transcripts (crucial for hearing-impaired individuals to have entry to a transcript) however was unable to search out one. Was I trying within the flawed place, or do you not present accessibility to your podcasts for these with listening to impairments?

— Dr. Katherine Phaneuf, Westford, Massachusetts

[Editor’s note: We are in the process of making transcripts available for future “What the Health?” podcasts. Please keep your eyes peeled.]

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