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Readers and Tweeters Weigh In on America’s Medical Debt, Obesity Epidemic, and Opioid Battles ImpRead

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- Advertisement -

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Readers and Tweeters Weigh In on America’s Medical Debt, Obesity Epidemic, and Opioid Battles

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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.

So, you are American, you will have a awful medical insurance plan, you get most cancers. You survive most cancers. But are you able to survive your huge medical $$$ debt?https://t.co/e6Jzw9W4SR

— Laurie Garrett (@Laurie_Garrett) June 17, 2022

— Laurie Garrett, New York City

Medical Debt because the Ultimate Medical Mystery

I learn your investigation about well being care and debt on NPR’s website (“Diagnosis: Debt: 100 Million People in America Are Saddled With Health Care Debt,” June 16). However, it appears the story’s focus is unsuitable. It shouldn’t be about how we pay for these astronomical medical payments however why are they so excessive to start with? How do hospitals get away with their charges? For instance, my daughter, who’s 7, has been to the hospital/emergency room 5 occasions in her life. Each invoice has been utterly completely different with no rhyme or purpose. The newest one was $7,000 for a couple of three-hour ER go to and for 2 IVs! It’s the very best invoice we have now ever seen, and that features a two-night keep at a hospital. In addition to this invoice, collections known as us — and it hadn’t even been 60 days since our go to and had been just a few weeks for the reason that hospital go to. So now our credit score rating could possibly be affected, and we haven’t even had an opportunity to overview or determine how one can pay this invoice. Would love all this defined.

— Ilyssa Block, Kansas City, Missouri

A Hard-Learned History Lesson

Although I favored the article by Noam N. Levey and Aneri Pattani on individuals burdened by medical debt (“Diagnosis: Debt: Upended: How Medical Debt Changed Their Lives,” June 16), it makes use of the time period “grandfathered in.” This time period was used as a rule to stop Black individuals from voting after the Civil War. Please make an effort to chorus from utilizing this offensive time period.

— MB Piccirilli, Portland, Oregon

Upended: How Medical Debt Changed Their Lives https://t.co/IbJwJoOt3N @khnews This has to cease! NFP healthcare methods destroying the lives of the individuals they’re designed to serve?!? Unethical. STOP! #healthcare #UniversalHealthCare #MedicareForAll #bankruptcy

— Andrew Gallan PhD ⛳️🇺🇦 (@agallan) June 20, 2022

— Andrew Gallan, Boca Raton, Florida

Steering Clear of Predatory Billing

Every month I see and listen to these “Bill of the Month” tales on NPR’s webpage or broadcast on the NPR affiliate station in my space (“Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?” May 31). Every month I pat myself on the again for having determined that there is no such thing as a approach I’m ever going to place myself by way of so-called screenings, that are only one extra avenue for the U.S. well being supply system to screw individuals over as that well being supply system is properly conscious that there is no such thing as a oversight for one of these predatory billing. I can inform you at my age and with solely Social Security retirement as sole earnings, I couldn’t ever hope to rent authorized assist to dispute a invoice like these featured in “Bill of the Month” — a invoice like that might both trigger me to have a direct coronary heart assault or file chapter or each. Nope. No screenings. I even have determined that, if I’ve any selection within the matter, I’ll merely forgo any so-called medical care. Obviously, if I keel over and cross out and somebody hauls my sorry self into the emergency room, I gained’t have the selection (besides to stroll out as soon as “revived”). Given the state of well being care and the predatory behaviors of the bottom-lining money-hungry hospitals, clinics, and even simply medical doctors, my selection is just to decide out. KHN wants to make use of its voice to inform the U.S. medical neighborhood that individuals are so uninterested in the rubbish that they merely refuse care.

— Jan Baldwin, Coburg, Oregon

First colonoscopy: $0Second colonoscopy: $2kAnother instance of how the nice print can put sufferers on the hook for payments that needs to be coated, particularly on this case of a preventative screening. Patients deserve higher.https://t.co/v55XVdGAeB

— Terry Wilcox (@Terrilox) June 2, 2022

— Terry Wilcox, Vienna, Virginia

In Michelle Andrews’ story about sudden prices after a polyp elimination throughout a colonoscopy, she states the anesthesiologist “merely administers a sedative.” This is an understatement. Anesthesiologists carry out a overview of the affected person’s chart, see the affected person pre-procedure, monitor their vitals in the course of the process, and assess them post-procedurally. Furthermore, anesthesiologists are ready to handle sudden emergencies, together with sudden aspiration, allergic reactions, cardiac arrest, and many others. This is greater than “merely administering a sedative.”

We preserve people from dying or having problems and practice a very long time to take action. The flippant method during which our actions are framed within the article is unlucky.

— Dr. Elizabeth Leweling, Chicago

Preventive care, like screening colonoscopies, are freed from cost to sufferers underneath the Affordable Care Act. @DrLindaMD @AlexMMTri @EvanKirstel @FriedbergEric @nkagetsu @rstraxMDhttps://t.co/qLP9l5SSPl

— Ian Weissman, DO (@DrIanWeissman) June 1, 2022

— Dr. Ian Weissman, Milwaukee

As president of the American Society for Gastrointestinal Endoscopy, I listened with curiosity to a current phase on “All Things Considered” concerning affected person price sharing for a screening colonoscopy. The phase featured affected person Elizabeth Melville, who acquired a invoice for her screening colonoscopy that concerned a elimination of a polyp.

I used to be dismayed by the phase, which included a number of factually incorrect and deceptive statements by Dr. Elisabeth Rosenthal, and which have been extremely damaging to efforts to eradicate impediments and misinformation about screening colonoscopy. ASGE has been on the forefront of coverage efforts to eradicate affected person out-of-pocket prices for screening colonoscopy, together with these screenings that contain the elimination of a polyp or different tissue. As the phase accurately famous, the Affordable Care Act gives for protection with out affected person price sharing of preventive companies which have an “A” or “B” ranking from the U.S. Preventive Services Task Force, which incorporates colorectal most cancers screening. Recognizing that colonoscopy is the one most cancers screening modality that additionally permits for precise elimination of precancerous lesions in actual time (and thus stopping the most cancers), it’s significantly vital that sufferers and shoppers perceive the information.

Following passage of the ACA, legislative and regulatory corrective actions have been obligatory to make sure that sufferers who endure a screening colonoscopy that features a polyp elimination usually are not caught with a shock invoice. As famous, screening colonoscopy is a novel preventive service in that it not solely detects most cancers, however it could possibly stop it by way of elimination of suspicious or probably precancerous polyps or lesions. In 2020, Congress handed laws that might part out by 2030 price sharing for Medicare beneficiaries when a screening colonoscopy turns diagnostic in the course of the screening encounter. That means, if a Medicare beneficiary has a screening colonoscopy in the present day and a polyp is eliminated, that affected person is more likely to have an out-of-pocket fee obligation.

The distinction in cost-sharing guidelines for commercially insured sufferers and Medicare beneficiaries has created confusion for sufferers, and the adjustments in regulation have created advanced billing eventualities. Dr. Rosenthal referred to billing for colonoscopy as a “gray area.” This isn’t a grey space to ASGE, as coding guidelines are clear. But there are eventualities that might affect whether or not a affected person has an out-of-pocket obligation for a colonoscopy. For instance, typically insurers is not going to cowl a screening colonoscopy with out price sharing if the screening happens lower than 10 years after the affected person’s earlier colonoscopy. These shorter screening intervals sometimes happen when a affected person is taken into account high-risk, or if there was a discovering in the course of the earlier colonoscopy, comparable to a polyp, as utilized in your illustration. Many insurers regard these colonoscopies as “surveillance” or “high-risk” colonoscopies and won’t cowl them as a preventive screening with out price sharing. This isn’t the choice of the doctor or hospital; it is a determination made by the insurance coverage firm.

I used to be significantly struck by Dr. Rosenthal’s remark that “it is not OK to change the game in the middle of the test,” which ends up in a affected person getting a invoice. I need to be very clear that when a affected person is scheduled for a screening colonoscopy, the doctor performing the colonoscopy has no thought whether or not a polyp or tissue shall be discovered and can must be eliminated. This isn’t a “gotcha” sport that physicians are enjoying with sufferers, as insinuated by Dr. Rosenthal’s remarks; there are coding and billing guidelines that should be adopted when amenities and physicians are submitting claims to insurance coverage corporations. ASGE frequently works to make sure that we educate and promulgate coding guidelines and up to date steering for our 15,000 members worldwide.

The cost-sharing coverage for colorectal most cancers screening, and screening colonoscopy particularly, is advanced and complicated. We are dissatisfied that NPR didn’t use the phase as a possibility to work by way of the complexity to supply shoppers with a greater information of inquiries to ask their insurance coverage firm earlier than scheduling a colonoscopy, together with whether or not a screening colonoscopy carried out at an interval of lower than 10 years shall be coated underneath their well being plan with out price sharing.

— Dr. Bret T. Petersen, ASGE president, Rochester, Minnesota

Great Bill of the Month reporting in the present day by @mandrews110 for @KHNews. Nobody likes getting a colonoscopy. Patients should not be penalized for doing the correct factor and getting beneficial most cancers screenings: https://t.co/cNlEj85IZ4

— Ryan Holeywell (@RyanHoleywell) May 31, 2022

— Ryan Holeywell, Washington, D.C.

Taking the Doctor’s Advice

Dr. Taison Bell was great to take heed to (“Watch: UVA Doctor Talks About the State of the Pandemic and Health Equity,” May 26). I actually appreciated his presentation and the dear issues he needed to say. Thanks for together with it in your KHN mailing!

— Jan McDermott, San Francisco

I spoke with ⁦@hnorms⁩ from ⁦@KHNews⁩ concerning the state of the pandemic and well being fairness. There remains to be rather a lot to be performed to motion sensible insurance policies that assist excessive threat communities of colour. https://t.co/LAf2WCIN0X

— Dr. Taison Bell (@TaisonBell) May 26, 2022

— Dr. Taison Bell, Charlottesville, Virginia

Mad Over ‘New MADD’ Coverage

This article is grossly inaccurate and insulting (“The New MADD Movement: Parents Rise Up Against Drug Deaths,” May 23). Most fentanyl customers usually are not all-star athletes or honor college students. Their mother and father usually are not extra educated than the mother and father of addicts. And the mother and father of addicts have been mobilized for years, with many feeling that the fentanyl motion has distracted consideration away from wanted well being care. The article says that the medication are being launched by Mexican cartels that search vengeance in opposition to low-level sellers, a lot of whom are simply pals getting issues for each other. The article distinguishes between drug customers and fentanyl “victims,” creating and reinforcing the stigma these teams declare to be attempting to eradicate. It does an amazing disservice to these of us who misplaced kids to dependancy and overdose, and is insulting to our kids and to us as mother and father. Thank you.

— Susan Elamri, Detroit

Interesting learn detailing the dearth of accountability for drug sellers promoting fentanyl laced counterfeit drugs leading to demise/overdoses. Consequences and rehabilitation shouldn’t be mutually unique options, we are able to do each. https://t.co/KlvBH3O1kq

— Chief Paco Balderrama (@BalderramaPaco) May 23, 2022

— Paco Balderrama, chief of police, Fresno, California

When ‘Overweight’ Is ‘Normal’

Quoting from the article “‘Almost Like Malpractice’: To Shed Bias, Doctors Get Schooled to Look Beyond Obesity” (May 24): “Research has long shown that doctors are less likely to respect patients who are overweight or obese, even as nearly three-quarters of adults in the U.S. now fall into one of those categories.”

Perhaps the reply is to vary the size of weight. Why do 25% of adults get to be known as “normal” and 75% of adults are “overweight”? Let’s base the choice on reality-based remark!

— Leslie Rigg, Lake Worth Beach, Florida

1) Anti-fat bias is actual and positively a problem. For physicians and others who deal with individuals with #weight problems, the query turns into the place to attract the road. ‘Almost Like Malpractice’: To Shed Bias, Doctors Get Schooled to Look Beyond Obesity https://t.co/ap127widIs through @khnews

— Stewart Lonky, MD (@LonkyMD) May 24, 2022

— Dr. Stewart Lonky, Los Angeles

Innocent Until Proven Otherwise

I wished to boost a priority concerning the story “‘Desperate Situation’: States Are Housing High-Needs Foster Kids in Offices and Hotels” (June 1) — and it’s definitely not distinctive to your story. It says:

“These children already face tremendous challenges, having been given up by their parents voluntarily or removed from their homes due to abuse, neglect, or abandonment.”

Sometimes, after all, that’s true. But no reporter would write that each particular person in jail is a prison. Many are awaiting trial and might’t make bail. Similarly, kids might be in foster take care of weeks, even months earlier than any courtroom ever determines if they’ve been “abused” or “neglected.” Until then, they’re in foster care as a result of their mother and father have been *accused* of abuse or neglect.

(Also, by the way in which, neglect legal guidelines are so broad and imprecise that always what the mother or father actually is responsible of is poverty — however that’s one other difficulty.)

— Richard Wexler, government director of the National Coalition for Child Protection Reform, Alexandria, Virginia

[Editor’s note: Thanks so much for your insight. The article has been updated to reflect that the parents are absent “due to accusations of abuse, neglect, or abandonment.”]

.@sclaudwhithead appears to be like at “hoteling,” Georgia’s apply that makes high-need foster children typically sleep in lodges or places of work. The pandemic made the issue worse, however state lawmakers spent extra to attempt to pay additional for foster mother and father to take children. #gapol https://t.co/xRXbKCSVEM

— Jeff Amy (@jeffamy) June 1, 2022

— Jeff Amy, Atlanta

Key to Harm Reduction: Buy-In From People With Addiction

With overdose deaths skyrocketing to never-before-seen ranges, the United States wants hurt discount methods to guard the well being and wellness of Americans. In 2020, 41 million Americans wanted substance use remedy throughout the earlier yr; nonetheless, of those that wanted such remedy however didn’t obtain it at a specialty facility, a staggering 97.5% didn’t really feel they wanted it. Although America has a troubling remedy hole exacerbated by systemic authorized and regulatory limitations to evidence-based dependancy care, most individuals who want substance use remedy don’t need this remedy as it’s at the moment being supplied.

To assist our family and friends members residing with dependancy, our system should additionally embrace hurt discount approaches that interact individuals who use medication (PWUD) earlier than they’re prepared for abstinence-based remedy (“As Biden Fights Overdoses, Harm Reduction Groups Face Local Opposition,” June 14).

Harm discount saves lives. Drug checking companies and naloxone distribution stop overdose deaths, whereas syringe and associated service packages assist cease the unfold of infectious illnesses comparable to HIV/AIDS and hepatitis. These are all worthy ends in themselves, however hurt discount has the additional advantage of constructing a significant alliance between well being care professionals and PWUD. With this therapeutic relationship, PWUD have facilitated entry to high-quality, evidence-based remedy and companies after they turn out to be prepared for this assist. It’s an apparent level, however too many individuals overlook the truth that an individual can’t obtain remedy or enter restoration in the event that they’re useless.

As a doctor, I swore an oath to do no hurt — to not do nothing. Failing to embrace and increase hurt discount efforts, by definition, leaves too a lot of our pals, members of the family, and family members at an unacceptable threat of dying. The dichotomy between providing extra dependancy remedy and offering PWUD with the instruments they should reside more healthy lives is a false selection. The United States should concurrently spend money on remedy enlargement and enhance the provision of low-threshold hurt discount companies; in any other case, I worry the nation’s dependancy and drug overdose disaster will proceed to worsen.

— Dr. Brian Hurley, president-elect of the American Society of Addiction Medicine’s Board of Directors, Los Angeles

. @POTUS needs to increase #harmreduction packages as a part of technique to cut back #drug #overdose deaths, however thought faces sophisticated actuality on the bottom as packages function on fringes of legality, w/ scant budgets, & fierce opposition. @renurayasam @khnews https://t.co/qbSBtMkn38 pic.twitter.com/pYV8mB1nEc

— Deni Carise (@DeniCarise) June 21, 2022

— Deni Carise, Philadelphia

How to Beat the Opioid Epidemic

Do you need to management the scourge of fentanyl in America (“The Blackfeet Nation’s Plight Underscores the Fentanyl Crisis on Reservations,” May 25)? There are two choices:

1. Distribute the drug solely by the federal government, guaranteeing its purity, correct dosage, and protected setting for the consumer, offering real-time overdose care and elective consulting for anybody who needs to stop, all at no cost.

2. Make some nonaddictive antidepressants (typically SSRIs, or selective serotonin reuptake inhibitors) much less restrictive. You know, how well being care in your nation is dear, visiting a psychiatrist or psychologist, refilling, blah-blah. I do know, the nation who can’t agree on banning AR-15s from being offered to 18-year-olds gained’t agree on this.

What should you let individuals have some SSRIs over-the-counter? These usually are not leisure, are typically protected (approach safer than opioids), and do assist with nervousness. Hey, what drives individuals to opioids? Aren’t nervousness ranges at their highest all throughout the globe?

Also, the drugmaker mafia will assist it.

Just as we have now embraced over-the-counter medication for widespread illnesses like colds, we’d undertake the identical idea in psychological well being care as properly. Anxiety is turning into extra widespread in contrast with colds (my intestine says).

— Alireza Mohamadi, Tehran, Iran

Fentanyl spreads west, together with to the Blackfeet Nation.https://t.co/ZrykuZQ06c

— Keith Humphreys (@KeithNHumphreys) May 25, 2022

— Keith Humphreys, Stanford, California

Dust-Up Over Pollution Coverage

This article seems written from a lopsided viewpoint (“Some People in This Montana Mining Town Worry About the Dust Next Door,” June 8).

Very few cities cross the World Health Organization’s unrealistic threshold of 5 micrograms per cubic meter, and why would you get a mechanical engineer to supply enter on environmental points? Why, as a result of the actual environmental specialist mentioned this was not a problem? As for mud on a picnic desk, that could be a horrible instance. We get mud on our picnic desk anytime the wind blows, and we don’t reside by a mine. Maybe WHO ought to suggest that the wind cease blowing as a result of it causes mud.

From the WHO’s web site: “In 2019, 99% of the world population was living in places where the WHO air quality guidelines levels were not met.” This is not an affordable normal and was chosen by bureaucrats which are out of contact with life and the actual world. All of the actual data and statistics say there may be not an issue, however your article makes an issue the place one doesn’t exist and people who find themselves not keen to fact-check you’ll assume there is an issue. All these individuals with well being points are unlucky and that’s very unhappy, however individuals in all places have unhappy well being points. Stick to the scientific information and actual monitoring numbers, and don’t drag “The Sky Is Falling” individuals into information articles. Facts matter!

— John Utaz, Salt Lake City

Cultivating an curiosity in ‘dusts’ in the intervening time and this text consists of extractive industries/ mining. https://t.co/JsXCA7rxkD

— Cat Rushmore (@CatRushmore) June 9, 2022

— Cat Rushmore, Glasgow, Scotland



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