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

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

A Treatment for Ambulance Sticker Shock

It is a remark about your current story on ambulance shock payments (“The Ambulance Chased One Affected person Into Collections,” July 27). Within the story, three siblings had 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 Companies Authority), a public ambulance service. When you want a journey in a single, that premium covers it for anybody in your family. The fee is opt-out, so most everybody pays it. Non-water prospects (like these in flats whose lease covers utilities) should buy in, too. It would nonetheless be costly for out-of-town guests, nevertheless.

The EMSA premium works. You must 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

Powerful Lesson on Predatory Lenders

This essay (“The Debt Disaster That Sick People Can’t Keep away from,” Aug. 2) compares pupil mortgage debt to medical debt however doesn’t appear to understand 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 reduction from the uniquely predatory and exploitive pupil mortgage debt.

— Brian Galloway, Salem, Oregon

“Have nots” may have even much less! The Debt Disaster That Sick People 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 People (“Group Well being Facilities’ Large Earnings Increase Questions About Federal Oversight, Aug. 15).

The piece’s conclusions are based mostly on knowledge representing fewer than 1% of well being facilities. Framing an argument on a cherry-picked handful of facilities out of almost 1,400 nationwide skews the info.

Well being facilities fought on the entrance strains of the pandemic. Fewer individuals had 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 assist has by no means been as sure because the challenges related to caring for low-income communities.

The facilities’ monetary reserves aren’t 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 companies. 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 preventing for each greenback to look after the underserved. For well being heart workers, it’s about dedication, not {dollars}.

KHN’s reporting amplifies misconceptions in regards to the 340B prescription program — which has supplied a vital lifeline to uninsured and underinsured People who in any other case wrestle to afford prescriptions. By regulation, all financial savings ensuing from that program should 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. Web site visits by regulators make sure that affected person care and scientific knowledge is in line with 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, possible search costlier emergency room companies. As we proceed to wrestle with public well being threats, well being facilities’ efforts to check, vaccinate and deal with hard-to-reach populations deserve assist 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 could 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+% internet 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 downside for the previous 5 years (“When Psychological Sickness Results in Dropped Prices, Sufferers Usually Go With out Stabilizing Care,” Aug. 4). We regularly run into this challenge when police/prosecutors fail to file costs, 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 scenario during which now we have to launch somebody who’s psychotic and the hospital received’t take them. They normally haven’t any household to assist. That is extraordinarily harmful, particularly within the winter months when it may possibly drop beneath 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 depart 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 costs, they lose management over defendants with #mentalillness and now not have the ability 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 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 Must 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 persons are discharged from psychiatric hospitals. Those that had been despatched involuntarily usually tend to try suicide than those that selected to go, and involuntary commitments could make younger individuals 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 dying by suicide, there isn’t a causal proof to display that the hospitalization causes dying by suicide. The truth is, there is a vital third variable which 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 individuals at imminent threat of dying by suicide.

Chances are you’ll want to learn a current meta-analysis during which the researchers synthesized knowledge from randomized management trials, or RCTS. RCTs are the gold normal for evaluating causality as a result of they’ll rule out third-variable explanations, similar 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 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, scientific 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. 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 vital remark concerning your article “‘My Physique, My Selection’: 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 medication is just not the identical as being towards a vaccine — or those that select to take it. You, after all know this: No medication is correct for everybody. Why are you intentionally selecting to deceive individuals by your cautious, not-accidental selection of phrases?

— Kathleen German, Nashville

However the “COVID precautions” have ended. It’s extra like white nationalists making an attempt to recruit new members. https://t.co/UViycE926A

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

— Derrick Edward Jones, Seattle