Readers and Tweeters Place Value on Community Services and Life-Sustaining Care

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

A Remedy for Ambulance Sticker Shock

It is a remark about your latest story on ambulance shock payments (“The Ambulance Chased One Affected person Into Collections,” July 27). Within the story, three siblings have been taken from an accident in three separate ambulances, then charged vastly totally 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. In case you want a experience in a single, that premium covers it for anybody in your family. The cost is opt-out, so most everybody pays it. Non-water clients (like these in residences whose lease covers utilities) should buy in, too. It’d nonetheless be costly for out-of-town guests, nonetheless.

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,”

— Richard Vaughn MD 🚲 (@rvaughnmd) July 27, 2022

— Dr. Richard Vaughn, St. Louis

Robust Lesson on Predatory Lenders

This essay (“The Debt Disaster That Sick People Can’t Keep away from,” Aug. 2) compares scholar mortgage debt to medical debt however doesn’t appear to understand how predatory the coed 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 state of affairs. It’s why we’re pushing for reduction from the uniquely predatory and exploitive scholar mortgage debt.

— Brian Galloway, Salem, Oregon

“Have nots” could have even much less! The Debt Disaster That Sick People Can’t Keep away from through @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 People (“Group Well being Facilities’ Huge Income Increase Questions About Federal Oversight, Aug. 15).

The piece’s conclusions are primarily based on knowledge 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 traces of the pandemic. Fewer individuals 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 workers 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 will not be secreted away however are often reported, obtainable for scrutiny and subjected to annual audits. In some circumstances, {dollars} go towards web site expansions, staffing, or expanded providers. One lesson realized from the pandemic is that facilities are the “canaries within the coal mine” of public well being and require funding to nimbly adapt care. Non-public donations have additionally helped well being facilities keep afloat, a reality barely talked about in KHN’s reporting.

The typical well being heart CEO wage is way lower than what this reporting on outlier facilities suggests. There are way more worthwhile jobs in well being care that don’t contain combating for each greenback to look after the underserved. For well being heart workers, it’s about dedication, not {dollars}.

KHN’s reporting amplifies misconceptions concerning the 340B prescription program — which has supplied an important lifeline to uninsured and underinsured People who in any other case battle to afford prescriptions. By legislation, 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 be baked into the well being heart mannequin. Website visits by regulators be certain that affected person care and medical knowledge is according to nationwide requirements. Moreover, well being facilities are ruled by native boards, for which sufferers principally 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 lined by Medicaid and would, with out entry to well being facilities, possible search costlier emergency room providers. 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 Group 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 will be patient-driven, efficient, and trusted stewards of federal {dollars}. We stand by this mannequin.

— Rachel Gonzales-Hanson, interim president and CEO of the Nationwide Affiliation for Group Well being Facilities, Bethesda, Maryland

Some FQHCs driving 20+% web revenue margins. “Nobody is monitoring the place all their cash goes”

— 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 providers for a medium-sized (round 800 inmates) jail in Indiana. I’ve been coping with this irritating drawback for the previous 5 years (“When Psychological Sickness Results in Dropped Fees, Sufferers Typically Go With out Stabilizing Care,” Aug. 4). We frequently run into this concern when police/prosecutors fail to file fees, and we’re caught coping with an inmate who’s psychotic and homeless with no household. The native hospitals received’t take somebody on an emergency detention order, or EDO, except the person is verbally saying they’re suicidal. With regard to the await 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 usually caught in a state of affairs through which we now have to launch somebody who’s psychotic and the hospital received’t take them. They normally don’t have any household to assist. That is extraordinarily harmful, particularly within the winter months when it could actually drop under zero (all the warming shelters in my space have closed since covid began). Sadly, the most effective consequence 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 fees, 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.

— 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 disillusioned to see that the creator of the story “Social Media Posts Criticize the 988 Suicide Hotline for Calling Police. Right here’s What You Have to Know.” (Aug. 11) implied that psychiatric hospitalization causes dying by suicide within the following paragraph: “Analysis exhibits suicide charges enhance drastically within the months after individuals 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 individuals much less more likely to disclose their suicidal emotions sooner or later.”

Whereas is it true that the interval after psychiatric hospitalization is a key danger interval for dying by suicide, there isn’t any causal proof to exhibit that the hospitalization causes dying by suicide. In reality, there is a crucial third variable which will clarify this discovering: Solely people who find themselves severely sick, and sometimes at excessive danger for suicide, are psychiatrically hospitalized. Certainly, for me, as a licensed psychologist, involuntary psychiatric hospitalization is a final resort for individuals at imminent danger of dying by suicide.

It’s possible you’ll want to learn a latest meta-analysis through which the researchers synthesized knowledge from randomized management trials, or RCTS. RCTs are the gold customary for evaluating causality as a result of they will rule out third-variable explanations, akin to severity. Their article states: “Certainly, a small variety of RCTs have examined means restriction/security applications and acute psychiatric hospitalization. Notably, these interventions produced results which can be just 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, medical psychologist and assistant professor at Ohio College, Athens, Ohio

Very a lot recognize 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 means.

— Kathy Flaherty (@ConnConnection) August 11, 2022

— Kathy Flaherty, Middletown, Connecticut

“Say abortion” looks like a nasty slogan, however wdik.

— Frank Bednarz 🇺🇸 🇺🇦 (@FrankBednarz) July 6, 2022

— Frank Bednarz, Chicago

Anti-Vaccine Mandate Is Not the Similar as Anti-Vaccine

An necessary remark relating to your article “‘My Physique, My Alternative’: How Vaccine Foes Co-Opted the Abortion Rallying Cry” (July 6). It’s purposely misleading. You say “anti-vaccine” activists — which is inaccurate. The individuals gathering in Los Angeles (and elsewhere throughout the nation) are anti-forced vaccine — not essentially “anti-vaccine,” as your article repeatedly insists. To be towards being pressured to undergo an experimental drugs shouldn’t be the identical as being towards a vaccine — or those that select to take it. You, in fact know this: No drugs is true for everybody. Why are you intentionally selecting to deceive individuals by your cautious, not-accidental alternative of phrases?

— Kathleen German, Nashville

However the “COVID precautions” have ended. It’s extra like white nationalists making an attempt to recruit new members.

— Derrick E Jones (@deuceohsixx) July 12, 2022

— Derrick Edward Jones, Seattle

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