Letters to the Editor is a periodic function. We welcome all comments and can publish a range. We edit for size and readability and require full names.
Lawmakers Must Protect Home Health To Alleviate Hospital Bottlenecks
The stark actuality that numerous seniors lie stranded in emergency rooms throughout the nation ready for care underscores the necessity for fashions of care that higher assist older Americans (“Stranded in the ER, Seniors Await Hospital Care and Suffer Avoidable Harm,” May 6). As KFF Health News stories, even when sufferers have to be admitted, at instances, there are merely no rooms out there.
As famous within the article, the backlog of sufferers ready to be discharged to residence well being care has partly contributed to this drawback in ERs. Medicare’s residence well being care program permits advanced, disabled, and older sufferers to obtain care and rehabilitation in their very own houses after their hospitalization. Not solely is that this the preferred site of care by sufferers and their households, but it surely additionally helps open wanted hospital beds and lessens the burden on emergency rooms and hospital employees.
Unfortunately, years of Medicare cuts are making it tougher for residence well being suppliers to satisfy rising demand and supply important care. The Centers for Medicare & Medicaid Services has repeatedly minimize the Medicare residence well being program, and extra cuts are anticipated in future years, already totaling $19 billion in cuts via 2029. Despite Medicare’s own data displaying that residence well being saves taxpayers cash, the cuts proceed forcing residence well being suppliers to cut back the providers they will present, making it harder to recruit and retain employees, which in the end harms affected person entry.
To shield residence well being and unlock capability in hospitals, Congress should move the Preserving Access to Home Health Act (S 2137/HR 5159), which might stop Medicare from implementing steep fee cuts to the Medicare Home Health Program in 2025 and past.
No affected person ought to have to attend hours in an ER hallway whereas sick or injured. By stopping these cuts to the Medicare residence well being program, Congress can provide sufferers entry to high-quality care whereas additionally assuaging the burden on hospitals in disaster.
— Joanne Cunningham, CEO of the Partnership for Quality Home Healthcare, Washington, D.C.
Your latest article on seniors stranded within the ER was an fascinating learn. However, as a doctor, I wish to level out that you simply uncared for an necessary concern. So many individuals use the emergency rooms as major care services, with nonemergency visits: continual points similar to complications, earaches, coughs, and fatigue which were occurring for weeks and months. Sadly, due to a lack of expertise of the place to go for therapy, or lack of insurance coverage, ERs should see these sufferers, which completely clogs up the ER. If you wish to try to make a change, deal with these points.
— Ira Shivitz, Nashville, Tennessee
On the social platform X, a reader weighed in on an article from KFF Health News-CBS News’ “When Medical Devices Malfunction” investigative sequence, which targeted on a controversial dental equipment:
WHY can we fund the #fda???https://t.co/CMQAaDZUqy
— Me2 (@BCREIGNS) May 14, 2024
— Monica Raybon, Mobile, Alabama
Losing Rights in Oklahoma?
House Bill 3013 in Oklahoma would criminalize abortion-inducing medicine, which might punish an individual who’s intently trafficking these substances (“Anti-Abortion Hard-Liners Speak Up,” May 23). An individual may get a wonderful of as much as $100,000 or imprisonment for as much as 10 years. Medication that’s prescribed for different makes use of however may cause an abortion wouldn’t be thought of an abortion-inducing drug. Plan B just isn’t restricted in HB 3013, and there’s no indication that the use or sale can be prohibited.
Abortion has been made unlawful in lots of states, together with Oklahoma. Since abortion is unlawful, many ladies now look towards abortion capsules. Women have undesirable pregnancies that may be attributable to Plan B contraceptives not working or on account of a sexual assault. As a outcome, girls search abortion capsules since they can’t have an expert carry out an abortion process.
The abortion tablet has an 87%-98% effectiveness, whereas the abortion process is 98%-99% efficient. The abortion tablet can have unintended effects similar to blood clots within the uterus, extreme bleeding, and elevated infertility. Even although a drugs abortion has these results, girls nonetheless resolve to bear it as a result of lots of them wouldn’t have entry to an expert abortion process.
Taking away the one useful resource girls have entry to in Oklahoma can be detrimental. Women have already had their proper to an abortion taken from them. Women ought to be capable of resolve what’s greatest for them and in the event that they wish to finish their being pregnant by taking the abortion tablet. Although many argue that having an abortion results in extreme psychological well being points, each girl has totally different outcomes. Everyone ought to contact their representatives to vote no on payments like these. This invoice would make choices for a lot of girls when each girl ought to be capable of make their very own choices.
— Lizbeth Hernandez, McLoud, Oklahoma
An Ohio reader hopped to a conclusion on the social platform X about an article on the distinction between sunscreens out there within the United States vs. different international locations:
Sunscreens are categorised as medicine within the US and we will’t have the good things the remainder of the world makes use of until somebody squirts it in bunny eyes first.https://t.co/N5kUY3Voh2
— 5chw4r7z (@5chw4r7z) May 8, 2024
— Bob Schwartz, Cincinnati, Ohio
The Backdrop of Dietary Choices
When analyzing the influence of food regimen on well being outcomes, it’s important to interpret the context of dietary decisions. The intersection of socioeconomic standing, entry to nutritious meals, and well being disparities can’t be neglected when investigating particular well being circumstances amongst racial teams (“Dietary Choices Are Linked to Higher Rates of Preeclampsia Among Latinas,” April 5).
The article identified the correlation between preeclampsia and circumstances similar to weight problems, hypertension, and continual kidney illness. While true, it’s essential to underscore that weight problems charges are disproportionately higher amongst Black and Hispanic populations within the United States, in accordance with the Centers for Disease Control and Prevention. This disparity just isn’t merely a mirrored image of cultural dietary preferences however is deeply intertwined with the structural boundaries that restrict entry to wholesome, reasonably priced meals choices for these communities.
Moreover, these well being disparities are exacerbated by socioeconomic components. Data from the U.S. Census Bureau signifies that 25.8% of Black Americans and 23.8% of Hispanic Americans lived beneath the poverty line in 2019, in contrast with 10.1% of non-Hispanic whites. This financial divide considerably impacts the power of those communities to entry contemporary produce and nutritious meals choices, additional entrenching well being disparities.
Addressing this concern requires greater than advising people to change their consuming habits. It necessitates systemic adjustments to make more healthy meals choices extra accessible and reasonably priced. Initiatives just like the “Sugar-Sweetened Beverages” tax, which has been applied in a number of U.S. cities, exhibit a proactive strategy to discouraging unhealthy dietary decisions by making sugary and overly refined meals costlier. A study revealed simply months after this was enacted in Berkeley, California, in 2015 discovered a big lower in SSB consumption coupled with elevated water ingesting. In a larger study finished throughout a number of cities, it was discovered that tax implementation resulted in a 33% decline in SSB purchases. However, parallel efforts should be made to subsidize and decrease the price of nutritious meals, making certain that wholesome choices are inside attain for all, no matter revenue or ZIP code. Other widespread concepts on this house embrace growing agricultural subsidies to decrease the price of produce. In conjunction with growing the costs of sugary meals, this might function an efficient technique to advertise more healthy consuming habits.
While cultural preferences certainly play a big position in dietary habits, we should not overlook the structural boundaries that stop many from making more healthy decisions. By addressing these systemic points, we will take a big step towards decreasing the prevalence of preeclampsia and different diet-related circumstances, significantly amongst our most weak populations.
— Lillian Levy, Berkeley, California
A New Yorker shared insights on the social platform X about an article in our sequence monitoring the spending of opioid settlement funds:
Lots of curiosity in how #opioidsettlement funds are getting used nationwide to handle influence of #addiction. Flexibility permits for artistic and culturally numerous responses, like this #tribal sweat lodge on Mi’kmaq land in #Maine. Story through @KFFHealthNews https://t.co/TNiHaRYGmJ
— Lilo Stainton (@LiloStainton) May 15, 2024
— Lilo Stainton, Brooklyn, New York
Put an End to Picking Patients’ Pockets
In 2022, U.S. residents spent $471.4 billion on out-of-pocket prices for well being care and pharmaceuticals. This was a 6.6% increase from the earlier yr. Several methods will be applied to cut back Americans’ out-of-pocket prices (“A Battle Between Drugmakers and Insurers Hits Patients in the Wallet,” March 20). First, Congress should move HR 830, the HELP (Help Ensure Lower Patient) Copays Act. The invoice grants enrollees the chance to use sure funds (coupons, vouchers, prescription help packages, and so forth.) towards cost-sharing necessities, permitting enrollees to achieve their deductibles and out-of-pocket prices a lot sooner. There is a perception that coupon packages will improve the utilization of pricy medicine; that is incorrect. Drug producers negotiate with pharmacy profit managers to position their medicine on an insurer’s formulary. PBMs then record these drugs as most popular or put them on a tier system; formulary medicine will price an enrollee lower than a non-formulary drug. Some PBMs allow insurers to formulate their formulary or have an open formulary. However, the insurer will incur additional costs for these strategies.
Secondly, legal guidelines designed to control PBM operations are loosely enforced. This has to vary. Some states (Arkansas, California, Louisiana, Maine, and New York) have handed laws requiring transparency from PBMs; in these states, PBMs report drug pricing, charges charged, and the quantities of rebates obtained and retained. If PBMs don’t adhere to the rules, penalties will be enforced. The federal authorities ought to take the lead from these 5 states to enact a federal regulation requiring transparency of PBMs, and mandate flat-rate rebates for generic and brand-name medicine. The flat charges ought to mirror the market.
Thirdly, patent reform. Currently, drugmakers can lengthen their preliminary exclusivity interval by submitting extra patents on the identical medicine in several varieties and totally different administration routes, what’s referred to as a “patent thicket.” Manufacturers will patent the medicine’ generic variations as effectively. Patent thickets improve drug costs and delay generics from getting into the market. Additionally, the federal authorities ought to cap drug costs. Manufacturers use analysis and improvement as an excuse to overcharge. In different developed international locations, well being know-how assessments decide the worth for innovation, retaining prices decrease.
Now, some would say that’s an excessive amount of authorities and it’s affecting our capitalist society, however what’s extra necessary than one’s well being? These restrictions won’t stop the producer from making a revenue.
Lastly, the U.S. may leverage its bargaining energy and negotiate instantly with drugmakers. How? Turn over the negotiations to the Department of Health and Human Services. This regulatory physique would symbolize U.S. residents with business and federal insurance coverage and negotiate cost-effective rates for pharmaceuticals.
— Tameka Houston, Baltimore, Maryland
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