Readers and Tweeters Place Value on Community Services and Life-Sustaining Care
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.
A Remedy for Ambulance Sticker Shock
This can be a remark about your latest story on ambulance shock payments (“The Ambulance Chased One Patient Into Collections,” July 27). Within the story, three siblings have been taken from an accident in three separate ambulances, then charged vastly completely different charges.
In Oklahoma Metropolis, we pay $3.65 a month on our water payments to fund EMSA (Emergency Medical Providers Authority), a public ambulance service. Should you want a trip in a single, that premium covers it for anybody in your family. The fee is opt-out, so most everybody pays it. Non-water clients (like these in flats whose hire covers utilities) should buy in, too. It’d nonetheless be costly for out-of-town guests, nevertheless.
The EMSA premium works. You need to report on it.
— Phil Crow, Oklahoma Metropolis, Oklahoma
It is a mad, mad, mad, mad healthcare ‘system’. “The straightforward reply is that these payments are all made up,” https://t.co/4m8X1eMoEO
— Richard Vaughn MD 🚲 (@rvaughnmd) July 27, 2022
— Dr. Richard Vaughn, St. Louis
Robust Lesson on Predatory Lenders
This essay (“The Debt Crisis That Sick Americans Can’t Avoid,” Aug. 2) compares scholar mortgage debt to medical debt however doesn’t appear to know how predatory the scholar mortgage trade is. For instance, I’ve paid again near $70,000 (greater than I borrowed) and nonetheless owe $282,000.
There are hundreds extra in the identical scenario. It’s why we’re pushing for aid from the uniquely predatory and exploitive scholar mortgage debt.
— Brian Galloway, Salem, Oregon
“Have nots” may have even much less! The Debt Disaster That Sick Individuals Can’t Keep away from https://t.co/uFympUpMMO by way of @khnews @JudgeWren @ubswce @RISEhlth @NACHC @equity_center @FCHonline @CAPartnership @AmerCollPhyAdv @ahahospitals @nasw @RACmonitor @Aligning4Health @CHRankings
— Ellen Fink-Samnick (@epflcswccm) August 2, 2022
— Ellen Fink-Samnick, Burke, Virginia
Specializing in FQHCs
This text paints a grossly inaccurate image of federally certified well being facilities (FQHCs) and their work delivering life-sustaining care to 30 million Individuals (“Community Health Centers’ Big Profits Raise Questions About Federal Oversight, Aug. 15).
The piece’s conclusions are primarily based on information representing fewer than 1% of well being facilities. Framing an argument on a cherry-picked handful of facilities out of practically 1,400 nationwide skews the info.
Well being facilities fought on the entrance strains of the pandemic. Fewer folks have been contaminated with, or died from, covid-19 when a well being heart was close by. Such efforts got here at a value: Most facilities function on skinny margins, struggling to retain employees even whereas battling well being crises.
Monetary resilience for facilities is crucial as a result of federal help has by no means been as sure because the challenges related to caring for low-income communities.
The facilities’ monetary reserves should not secreted away however are frequently reported, out there for scrutiny and subjected to annual audits. In some instances, {dollars} go towards web site expansions, staffing, or expanded companies. One lesson discovered from the pandemic is that facilities are the “canaries within the coal mine” of public well being and require funding to nimbly adapt care. Personal donations have additionally helped well being facilities keep afloat, a truth barely talked about in KHN’s reporting.
The common well being heart CEO wage is much lower than what this reporting on outlier facilities suggests. There are way more worthwhile jobs in well being care that don’t contain preventing for each greenback to take care of the underserved. For well being heart employees, it’s about dedication, not {dollars}.
KHN’s reporting amplifies misconceptions concerning the 340B prescription program — which has offered an important lifeline to uninsured and underinsured Individuals who in any other case battle to afford prescriptions. By regulation, all financial savings ensuing from that program have to be reinvested in affected person care. In consequence, well being facilities report vastly improved well being outcomes amongst their sufferers.
Accountability can also be baked into the well being heart mannequin. Website visits by regulators be sure that affected person care and scientific information is according to nationwide requirements. Moreover, well being facilities are ruled by native boards, for which sufferers largely function the administrators.
The well being heart mannequin has been quietly addressing each public well being disaster for greater than 50 years.
When most private-practice physicians restrict or don’t settle for Medicaid sufferers, roughly half of well being heart sufferers are coated by Medicaid and would, with out entry to well being facilities, probably search costlier emergency room companies. As we proceed to battle with public well being threats, well being facilities’ efforts to check, vaccinate and deal with hard-to-reach populations deserve help and funding.
The Nationwide Affiliation for Neighborhood Well being Facilities will proceed to face up for our valued well being care heroes. No different well being system stands as a dwelling legacy that well being care might be patient-driven, efficient, and trusted stewards of federal {dollars}. We stand by this mannequin.
— Rachel Gonzales-Hanson, interim president and CEO of the National Association for Community Health Centers, Bethesda, Maryland
Some FQHCs driving 20+% web revenue margins. “Nobody is monitoring the place all their cash goes” https://t.co/KhScFj44BA
— Bijan Salehizadeh (@bijans) August 17, 2022
— Bijan Salehizadeh, Washington, D.C.
Psychological Well being for the Incarcerated: When Arms Are Tied
I’m a psychologist and the director of psychological well being companies for a medium-sized (round 800 inmates) jail in Indiana. I’ve been coping with this irritating drawback for the previous 5 years (“When Mental Illness Leads to Dropped Charges, Patients Often Go Without Stabilizing Care,” Aug. 4). We regularly run into this concern when police/prosecutors fail to file prices, and we’re caught coping with an inmate who’s psychotic and homeless with no household. The native hospitals gained’t take somebody on an emergency detention order, or EDO, except the person is verbally saying they’re suicidal. With regard to the look forward to a state psychiatric mattress, we’re averaging 4 to 5 months now for forensic beds, and 11 months for civil dedication beds. I’ve seen inmates serve 9 months or extra (together with time on the hospital) for a trespassing cost.
We’re typically caught in a scenario through which we’ve to launch somebody who’s psychotic and the hospital gained’t take them. They often don’t have any household to assist. That is extraordinarily harmful, particularly within the winter months when it will possibly drop under zero (all the warming shelters in my space have closed since covid began). Sadly, one of the best end result is that the affected person refuses to go away the jail foyer and is arrested for trespassing and introduced proper again into the constructing.
Anyway, I wished to say thanks for writing this text.
— William Mescall, Crown Level, Indiana
As #courts lose jurisdiction with dismissal of #criminal prices, they lose management over defendants with #mentalillness and now not be capable to present or mandate #mentalhealth care. This creates a quickly revolving door to #arrest and #criminalcourt. https://t.co/rrOFjSqme7
— Paul R Gormley LP.D. (@prgormley) August 9, 2022
— Paul R. Gormley, Boca Raton, Florida
On Psychiatric Hospitalizations and Suicide Threat
I used to be upset to see that the writer of the story “Social Media Posts Criticize the 988 Suicide Hotline for Calling Police. Here’s What You Need to Know.” (Aug. 11) implied that psychiatric hospitalization causes loss of life by suicide within the following paragraph: “Analysis exhibits suicide charges improve drastically within the months after persons are discharged from psychiatric hospitals. Those that have been despatched involuntarily usually tend to try suicide than those that selected to go, and involuntary commitments could make younger folks much less prone to disclose their suicidal emotions sooner or later.”
Whereas is it true that the interval after psychiatric hospitalization is a key threat interval for loss of life by suicide, there isn’t any causal proof to reveal that the hospitalization causes loss of life by suicide. In truth, there is a vital third variable that will clarify this discovering: Solely people who find themselves severely in poor health, and infrequently at excessive threat for suicide, are psychiatrically hospitalized. Certainly, for me, as a licensed psychologist, involuntary psychiatric hospitalization is a final resort for folks at imminent threat of loss of life by suicide.
You could want to learn a recent meta-analysis through which the researchers synthesized information from randomized management trials, or RCTS. RCTs are the gold commonplace for evaluating causality as a result of they will rule out third-variable explanations, corresponding to severity. Their article states: “Certainly, a small variety of RCTs have examined means restriction/security packages and acute psychiatric hospitalization. Notably, these interventions produced results which might be much like these of extra generally studied interventions.” General of their meta-analysis, they didn’t discover proof that interventions for suicidality are iatrogenic or trigger elevated suicidality.
— Okay. Jean Forney, scientific psychologist and assistant professor at Ohio College, Athens, Ohio
Very a lot respect that this text included non-carceral assets. When you’ve survived involuntary “care” you’ll by no means take a look at the system the identical approach. https://t.co/pg3aOcbqjx
— Kathy Flaherty (@ConnConnection) August 11, 2022
— Kathy Flaherty, Middletown, Connecticut
“Say abortion” looks like a foul slogan, however wdik. https://t.co/RPC0i5BPvB pic.twitter.com/tli16AcCJL
— Frank Bednarz 🇺🇸 🇺🇦 (@FrankBednarz) July 6, 2022
— Frank Bednarz, Chicago
Anti-Vaccine Mandate Is Not the Similar as Anti-Vaccine
An essential remark relating to your article “‘My Body, My Choice’: How Vaccine Foes Co-Opted the Abortion Rallying Cry” (July 6). It’s purposely misleading. You say “anti-vaccine” activists — which is wrong. The folks gathering in Los Angeles (and elsewhere throughout the nation) are anti-forced vaccine — not essentially “anti-vaccine,” as your article repeatedly insists. To be in opposition to being compelled to undergo an experimental medication is just not the identical as being in opposition to a vaccine — or those that select to take it. You, in fact know this: No medication is true for everybody. Why are you intentionally selecting to deceive folks by your cautious, not-accidental selection of phrases?
— Kathleen German, Nashville
However the “COVID precautions” have ended. It’s extra like white nationalists attempting to recruit new members. https://t.co/UViycE926A
— Derrick E Jones (@deuceohsixx) July 12, 2022
— Derrick Edward Jones, Seattle
