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.
Relating to Relatives of Lonely Dementia Patients
I used to be despatched the article by Judith Graham on older adults with dementia dwelling alone (“Going It Alone: Millions of Aging Americans Are Facing Dementia by Themselves,” Oct. 15). I admire this text. My mother lives alone with dementia. My son lives subsequent door and checks on her, and my daughter comes when she is ready to vacuum flooring and to clean the kitchen and loo. I deal with the payments, clear and alter her garments, wash her garments, seek for mail, and herald groceries. She refused to permit the house well being aide in, which complicates the care schedule. Neighbors be careful for her, together with police on the station throughout the road. It is advanced and complex for caregivers. Applying for Medicaid is a nightmare, as is looking for reminiscence care amenities. The considered really transferring her is heartbreaking and so irritating. Again: Thank you for sharing that others with dementia reside on their very own.
— Gail Daniels, Washington, D.C.
On the social platform X, a reader drew on her personal expertise:
Having cared for my mother towards the top of her journey with dementia, that is terrifying.For many elders, there isn’t any household to cushion the insults of dementia and cognitive decline.https://t.co/LTZ76Ojgwg
— Shava Nerad – @shava23@bluesky 🌻 (@shava23) October 19, 2024
— Shava Nerad, Arlington, Massachusetts
Bonding — To the Letter
Thanks 1,000,000! I learn your article “Going It Alone: Historic Numbers of Americans Live by Themselves as They Age” (Sept. 17) within the Las Vegas Review-Journal and associated to it on a serious degree. As a senior dwelling alone, I’m experiencing among the similar “social isolation” expressed by your interviewees. Since I like to jot down, I believed it will be attention-grabbing to contain among the individuals talked about in a nationwide pen pal affiliation. This would place little or no demand on their price range (apart from postage and stationery), on their time, and with little or no journey concerned.
It is breathtakingly exhilarating to obtain a letter from a good friend or relative, a bundle from anyplace, and expertise the reward of sitting down and studying excellent news from afar.
I admire our advances in expertise and I exploit it relatively sparingly. However, I come from a era that writes in cursive, is aware of the 5 parts of letter writing, and understands what a return handle is and the place it’s positioned on an envelope.
— Gloria Rankin, Las Vegas
A specialist in well being economics and coverage tweeted reward:
Historic Numbers of Americans Live by Themselves as They Agehttps://t.co/lwpfrhJauWImportant, impactful story by excellent @judith_graham
— Paul Hughes-Cromwick (Pooge) (@cromwick) September 17, 2024
— Paul Hughes-Cromwick (Pooge), Ann Arbor, Michigan
On X, a bunch of interdisciplinary school representing Johns Hopkins University shared KFF Health News’ protection about racial bias within the improvement and use of pulse oximeters:
In a @KFFHealthNews article, BDP @iwashyna explains how we transfer ahead from the racial bias of our present pulse oximeters.https://t.co/dmhqzoAfmK
— Bloomberg Distinguished Professors (@JHU_BDPs) October 23, 2024
A Slap on the Wrist for Pulse Oximeters
Between 1983 and 1988, I had 4 sons at Stanford Hospital. I used to be mates with Eben Kermit, who was a bioengineer. He was creating the unique pulse oximeter on infants within the neonatal intensive care unit (“Systemic Sickness: FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias,” Oct. 7). He examined solely white infants. That is as a result of white mother and father may come to the NICU within the daytime, which is when Eben was at work within the NICU. Black mother and father may come solely at night time as a result of their work wouldn’t give them day off to look after a really sick child. Since nobody was there to signal consent varieties, at night time, with the Black mother and father, no Black kids had been included. Discrimination towards Black mother and father by their employers is continuous to cascade by the Black group by the exclusion of Black folks from the event of medical expertise.
— Zoe Joyner Danielson, a toxicology biologist, Woodland, California
This X publish got here from a consulting and coaching agency that focuses on well being fairness points:
Reforms are wanted ASAP—these units have harmed so many #Black sufferers.FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias https://t.co/5R9LH5XyTI by @ArthurAllen202 @kffhealthnews CC: @NohaAboelataMD @mlipnick @iculung @djcantillonmd @iwashyna pic.twitter.com/yliCxMdRvG
— HealthBegins (@HealthBegins) October 10, 2024
What’s All This Fuss About Fluoride?
No one appears to handle the truth that not everybody drinks water from public water methods (“Does Fluoride Cause Cancer, IQ Loss, and More? Fact-Checking Robert F. Kennedy Jr.’s Claims,” Nov. 18). I see many individuals shopping for bottled water by the trunkful, or have a water fountain at house with 5-gallon bottles of purified consuming water, or have reverse osmosis water filtration methods put in at their sink.
So even when RFK Jr. removes fluoride from public water methods, I can’t see that there could be a drastic improve in dental points. Also, if you get your tooth cleaned on the dentist, they provide you a fluoride remedy (until you choose out). So on this challenge of eradicating fluoride, would this be a drastic challenge understanding that many now aren’t getting fluoridated water?
— Suzann Lebda, Sun Lakes, Arizona
Hitting the Paywall
Why does your publication hyperlink to articles with paywalls? As an instance:
The Oct. 18 aggregation “Former Medicare Chief Warns About Medicare Advantage Pay Rates” hyperlinks to Stat News, the place the article can’t be learn with no subscription. If you might be doing this as a method to offer subscribers to them, too unhealthy.
In any case, this follow doesn’t characterize your group effectively because it helps the pattern that solely those that can afford it get to be told. I hope you rethink this follow.
The monetary boundaries to accessing essential data are hurting us as people and as a society. It is dear for most individuals to have entry to a mainstream publication, however it will get cost-prohibitive to have entry to a number of factors of view, to be taught, purpose, and make up our personal minds. In most circumstances, the one various obtainable is to get “bites of information” from the “free” social media. The outcomes are as one would anticipate: We develop into much less conscious of what’s actually occurring as we’re guided into silos of ignorance.
Thank you.
— Carl Loben, Bellevue, Washington
On X, a expertise journalist in Spain shared the article about pregnant folks being requested by their suppliers to pay out-of-pocket charges sooner than anticipated:
Pay first, ship later: Some pregnant persons are being requested to prepay for his or her child https://t.co/NLWTeawgnk
— José María López (@gilead1984) November 16, 2024
— José María López, Badalona, Spain
A New Generation of Health Plans Overdue
The current article “Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby” (Nov. 15) successfully highlights the emotional and monetary uncertainty dealing with suppliers and sufferers. I commend the writer for capturing how this uncertainty, rooted in empathy and equity, should be higher understood and addressed.
I write to attract consideration to market tendencies and federal laws aimed toward assuaging this challenge. Until not too long ago, well being plans thought of the out-of-pocket expertise as definitionally out-of-scope, leaving sufferers, and suppliers, to handle this rising uncertainty on their very own.
The proof reveals that it’s doable to construct a extra pragmatic and empathic out-of-pocket expertise right into a well being plan, enhancing care accessibility and affordability with out eradicating affected person accountability. This strategy has been confirmed, throughout 1000’s of employer well being plans, to really feel higher and financially profit everybody — sufferers, suppliers, and plans (employers/insurers).
On Oct. 15, 2024, the Medicare Prescription Payment Plan launched, providing practically 54 million Americans the choice to have their insurer pay their out-of-pocket bills upfront on the level of service giving members time to evaluate and repay the stability — with out curiosity or charges. If the affected person within the article had a well being plan with this functionality, her OB-GYN would have been paid, on her behalf, by her insurer. She would have obtained a easy month-to-month assertion to repay in full or over time from the consolation of her house. Everyone advantages and it’s a higher member expertise.
This new, bipartisan, commonsense enchancment to one in every of well being care’s most acute ache factors is quickly increasing as employers and insurers notice there may be important actuarial worth, supplier financial savings, and member conduct change attributable to enhancing an individual’s capacity to pay for care.
Brian Whorley, Columbia, Missouri
An affiliate professor within the well being care management program at Rockhurst University’s Helzberg School of Management additionally shared the article on X:
Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby https://t.co/QEnX8GA3Ih through @kffhealthnews
— Prof. Jim Dockins (@DrDockins) November 15, 2024
— Jim Dockins, Kansas City, Missouri
On Hospital Gatekeepers and Tolls
In regards to the article “Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby” (Nov. 15): Back in 1992, the hospital the place my son was going to be delivered required that the projected copay be paid to them one month earlier than the supply date or my spouse wouldn’t be admitted (a Catholic hospital, very charitable).
My spouse was born on the similar hospital in 1963; at the moment, my father-in-law was knowledgeable by the hospital that he couldn’t take her house till the invoice was paid in full. He contacted a good friend who was an lawyer who instructed him to let the hospital know that may be thought of kidnapping and that he could be calling the police in the event that they didn’t launch her.
— Andrew McGovern, Great River, New York
Taken Advantage Of?
I belong to a Blue Cross Blue Shield Medicare Advantage plan and, for the previous a number of years, it has provided a house evaluation with a reward of $25. I’ve participated in this system previously however declined this yr since I didn’t assume there was a lot worth to this system. I’m a retired registered nurse, and I felt that the nurse who did my evaluation didn’t do an particularly thorough job, and any questions I requested of her, she couldn’t reply. The nurse was additionally from out of state.
After studying your article on “The Medicare Advantage Influence Machine” (Sept. 30), the explanations for the evaluation appear to be greater than enhancing the beneficiary’s well being and well-being, which is what I believed. I’m comparatively wholesome and energetic, so it will not seem that BCBS discovered any new diagnoses that it may invoice Medicare for, however I assume that that’s not the case with different seniors.
— Bruce Gilman, Millis, Massachusetts
An economist in Florida had this to say on social media:
Thank you @KFFHealthNews for mentioning the failed paperwork @CMS I’ve been speaking about for years. You can’t learn this and never conclude DC bureaucrats are “captured” and coverage makers are beholden to Medicare Advantage foyer cash. #WhoWillCarehttps://t.co/rDGg8juoop
— Luke Neumann (@pglukeneumann) September 30, 2024
— Luke Neumann, St. Petersburg, Florida
In Defense of Deloitte
On March 12, 2024, in good religion and with respect for KFF Health News, Deloitte’s well being and human providers follow chief offered a 90-minute interview with two reporters for a narrative they stated was about “problems with Deloitte’s eligibility systems across the country.”
We agreed to the interview as a result of we had heard from a number of of our state shoppers that they, too, had been contacted, and that the questions being raised confirmed a misunderstanding of built-in eligibility methods, the expertise that sustains them, and the complexity of the well being and human providers applications they assist.
The eligibility methods are owned by the states, not Deloitte; they’re uniquely constructed for every state (in some circumstances, by different distributors a long time in the past); and we work on the course of our shoppers to take care of and improve these methods to adjust to state-specific insurance policies, guidelines, and processes, and evolving federal rules.
Two tales subsequently ran: “Medicaid for Millions in America Hinges on Deloitte-Run Systems Plagued by Errors” (June 24) and “Errors in Deloitte-Run Medicaid Systems Can Cost Millions and Take Years To Fix” (Sept. 5).
Many of the problems reported as “widespread” are remoted to particular conditions or contain delicate information that can’t be refuted by Deloitte because of consumer confidentiality obligations. That stated, there are various the reason why somebody could lose protection or not be eligible for a profit they as soon as obtained.
Not each “issue” a constituent faces is the results of a system “error,” and challenges with particular person circumstances in particular person methods aren’t because of some basic downside in the way in which Deloitte helps state Medicaid applications.
On the difficulty of contract modifications, Deloitte rejected the declare in March that our state shoppers ship us a “change request … when a fix is needed.” We stated that was inaccurate and defined that when there are coverage or rule modifications — or a worldwide pandemic — that require modifications to a state’s expertise, change orders aren’t solely vital however applicable.
They don’t characterize errors in a system that should be fastened.
Throughout the unwinding of the covid-19 public well being emergency — as applied sciences developed and insurance policies modified — Deloitte labored carefully with states to attenuate challenges for these going by the Medicaid redetermination course of. The improvements and human-centered design processes we helped our shoppers implement enhanced the digital expertise for his or her constituents and made it simpler for caseworkers, workers, and group companions to assist the 34 million folks of their care.
Our shoppers perceive that enormous system implementations are difficult because of the complexity of the applications they assist, and that every one IT methods require ongoing upkeep, periodic enhancements and upgrades to software program and {hardware}, and database administration.
That is why so many states proceed to pick Deloitte to assist them preserve their mission-critical methods, and why business analysts like Forrester and Gartner constantly rank Deloitte as a frontrunner in system integration and enterprise transformation.
— Karen L. Walsh, Government & Public Services, Deloitte Consulting LLP, Harrisburg, Pennsylvania
[Editor’s note: KFF Health News stands by its reporting on Deloitte and the state eligibility determination systems that Deloitte supports.]
An assistant professor at Harvard voiced her opinion on X:
This is such a grim abstract of the state of Medicaid eligibility and enrollment methods https://t.co/3hpVnJdPOm pic.twitter.com/Gdi2AF1pyr
— Adrianna McIntyre (@adrianna.bsky.social) (@onceuponA) September 5, 2024
— Adrianna McIntyre, Boston
Far Less Than Meets the Eye
I learn your article concerning the new $2,000 restrict for out-of-pocket funds for Medicare Part D (“Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More,” Oct. 21). As somebody with very excessive drug prices, I used to be very enthusiastic about this alteration. However, as soon as I researched the completely different drug plans obtainable for me and my husband, I noticed that the cash we spend on medicine which are prescribed by a health care provider however not coated by our plan won’t rely towards the $2,000 restrict. Therefore, our price for vital medicine will proceed to be exorbitant.
I feel that there are various seniors who will likely be very disenchanted as soon as they notice this.
— Pia Stampe, Eureka, California
In sharing the article on X, a Florida lawyer merely shared their contact data:
“Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More:”https://t.co/9uEjVxTSGb Grady H. Williams, Jr., LL.M., Attorneys at Law P.A. 1543 Kingsley Avenue, Building 5 Orange Park, FL 32073 Tel: 904-264-8800 • Fax: 904-264-0155
— Grady H. Williams (@floridaelder) November 9, 2024
— Grady H. Williams, Orange Park, Florida
Shedding Light on Fluorescence in Dental Care
Congratulations on a extremely impactful publication (“Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn,” Nov. 1). The info introduced are harrowing for a retired practitioner with a number of specialties who tried a lifetime to protect tooth and promote human well being.
As you may know, oral biofilm is the largest enemy of oral well being and even normal well being. Dental clinicians haven’t been in a position to visualize and establish the presence of pathogenic oral microbiome till not too long ago. Pathogenic oral micro organism are among the many important turbines of exhausting and gentle tissue deterioration, comparable to tooth decay, gum ailments, and even an infection of dental implants. The most trusted and used analysis process continues to be the X-ray.
X-rays can establish solely established ailments. Unfortunately, radiologic analysis continues to be essentially the most trusted diagnostic software used and taught in dental schooling.
Microbiology, the microbiome science, makes use of fluorescence as its main identification process. Some of essentially the most aggressive oral micro organism, turbines of caries, gum ailments, and many others., generate so-called porphyrins, which, as soon as excited by a particular wavelength, emit gentle at a distinct wavelength. Highly dependable and simple-to-use applied sciences have been created not too long ago to assist direct visualization and point-of-care identification of this pathogenic micro organism by the above-described process. These units assist the diagnostic course of and assist the dental clinician by guiding the remedy execution and figuring out when the remedy objective has been achieved. Dental remedy protocols using “Fluorescence-Enhanced Theragnosis” have develop into dependable and fewer invasive.
The excessive lack of human lives within the ICUs through the pandemic because of ventilator-associated pneumonia may have been dramatically diminished utilizing the above protocol.
Wound-care science has already carried out fluorescence and is present process an incredible protocol change. Tumor surgical procedure celebrates fluorescence-guided surgical procedure as a milestone in its improvement.
Academic dental schooling is due for an pressing renewal. We should open the doorways and facilitate science translation to learn humankind!
— Liviu Steier, Needham, Massachusetts
A reader who manages an internet site predicting the collapse of the American well being care system commented on X:
https://t.co/JTFn1h12rc 🙄😠👎Technically, American dentistry was as soon as ranked as one of the best on the planet. Unfortunately, It has a historical past of mismanagement and negligence. It’s a “reputational good” that’s been flooded with scams. Now it’s payback time. It’s demonstrating the…
— Francis Anthony Toto (@francisatoto) November 2, 2024
— Francis Anthony Toto, San Diego
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