Readers and Tweeters Ponder Vaccines and Points of Fairness

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Higher Insurance Rates for the Unvaccinated? Snuff Out That Idea

This is about Dr. Elisabeth Rosenthal’s comments on “All In With Chris Hayes” (“Analysis: Don’t Want a Vaccine? Be Prepared to Pay More for Insurance,” Aug. 4). It is extraordinary that anyone would suggest higher health insurance premiums for those who remain unvaccinated for covid. Already health insurers receive a bonanza from all the costs paid by the government, e.g., free vaccinations (to us).

Once the covid vaccines get full approval, those not vaccinated can be excluded from restaurants, markets, theaters, sports events, etc. We will need proof of vaccination because unvaccinated people cannot be trusted to be truthful.

Insurance premium surcharges are not the answer, because surcharges can also act as inflationary drivers on the health insurance rates for everyone. I would not trust companies with health insurance surcharges. A very bad precedent, even for smokers.

— Dimitri Papanastassiou, Pasadena, California

— Barbara Katz-Chobert, Philadelphia

Unvaccinated — But Still Protected?

You claim to believe in science, then why are you ignoring naturally acquired immunity to covid-19 (“If the Unvaccinated Want to Work, They Face a Series of Hurdles,” Aug. 19)? There should be a waiver for folks who have documented tests that prove they are immune. I had covid in March 2020 and was tested for antibodies last month. I have IgG & IgM antibodies that are tested at 70 times the amount needed for prevention of infection. And my infection was over a year and a half ago.

We could be closer to herd immunity if the number of folks with naturally acquired immunity was calculated into those who are immune. The medical community is wasting shots on people who don’t really need them. If I were to go to get an MMR, chickenpox or tuberculosis titer test, all I have to prove is that I am immune. I am not required to get a vaccine. 

— Rebecca Vichitnand, Arlington, Washington

— Amanda Davis, Washington, D.C.

Can’t Hold a Candle to the ‘Birthday Rule’ for Fairness

The birthday rule was a fair way for insurers to cover claims so that “good” insurers don’t get lopsided or tilted toward paying all of the claims (“Bye-Bye to Health Insurance ‘Birthday Rule’? Kansas Lawmaker Floats Fix,” July 27). If Company A has a “Cadillac” plan, they shouldn’t have the burden of paying all the claims for children. Company B may have a lesser plan, thereby not having to pay claims for children. Parents covered by two companies both should enroll in each plan, and the birthday rule would dictate which insurer pays first. If both plans were elected, the bottom-line out-of-pocket for the family will be the same. The benefits would coordinate.

This rule is fair because many large companies (such as GM or Walmart) are self-funded, which means they pay the claims out of their pockets. An insurance company is hired to pay claims but the money is the employers’. If the birthday rule is removed, large companies would pay more than what is fair to other companies.

Just because employees or Congress members do not understand, nor read the information about enrolling, does not mean the rule in place is a bad rule. Parents have 30 days from birth to enroll a child. Especially if the child has high claims, it would be advantageous to enroll in both plans. Not all rules are evil or trying to take advantage of not paying claims. There is a reason for this rule: fairness.

— Kathleen Gallagher, Wilmington, North Carolina

— Dr. Emily Deans, Norwood, Massachusetts

Heeding Hard Lessons

This is a very important topic for tax-cutting and emergency managers in Michigan (“Hard Lessons From a City That Tried to Privatize Public Health,” Aug. 6). Former Gov. John Engler cut Michigan’s flat tax in steps, beyond his term, and forced massive cuts in Michigan’s cities and then emergency managers. This also helped lead to Flint’s water crisis. Please, KHN, do more follow-up. Twelve deaths in Flint at least. Probably many more in Detroit from covid-19. This is a very important health-planning cause.

— Dave McAninch, South Haven, Michigan

https://twitter.com/ChrisFriese_RN/status/1423666917542400001?s=20

— Chris Friese, Ann Arbor, Michigan

Thank you so much for the recent story about the history and current status of public health services in Detroit. I hope it is read by many public health officials, and that the lessons from Detroit are heeded.

I am a recently retired neonatal nurse practitioner and have been licensed in 12 states, and therefore have seen the importance of public health issues in several regions over the years. Many of my patients were dependent on public health resources after their discharge from the neonatal intensive care unit.

Families are in desperate need of public health services, and these services are so important for maintaining the health of communities in the U.S. It seems there are always new public health issues to be addressed. Again, thank you!

— Patricia Basto, Tucson, Arizona

— Doug Odegaard, Missoula, Montana

Good News for a Change

Your story “How a Doctor Breaks Norms to Treat Refugees and Recent Immigrants” (July 27) by Markian Hawryluk is one of the most inspiring articles I’ve ever read. Thank you so much!

— Jan McDermott, San Francisco

— Loretta Sue Ross, Clinton, Missouri

Developing a Tolerance for Outrageous Drug Prices?

This was a good story (“Women Say California Insurer Makes It Too Hard to Get Drug for Postpartum Depression,” July 28), although Massachusetts already requires insurers to “conform to generally accepted standards of care, including scientific literature and expert consensus, when making decisions about mental health treatment” as well as medical treatment (California is not necessarily in the vanguard there). I agree that the Kaiser Permanente criteria are well beyond the pale of acceptable medical management of postpartum depression; in effect, they have declared that they will not pay for this agent, ever. Since it appears to work relatively well, while it’s reasonable to require a trial of one or two less intensive agents first, four drugs and electroconvulsive therapy are an unacceptable response to medically managing the use of this drug.

My question is this: Why is there not more outrage about the price of the agent? $34,000?! That is simply indefensible. The reason insurers react in this way is because the prices are outrageous, especially because they cannot be planned for when making budgets. I recognize that the company that makes it has costs to recoup, but in the age of 1,000+% markups and generic takeovers raising the price of drugs that have been around since before I was a physician, this is simply not reasonable. To paraphrase Uwe Reinhardt (when explaining why U.S. health care is so expensive): It’s the prices, stupid. And it is the prices. Insurers do underwriting so that they can plan how much money to set aside for medical expenses. This kind of price increase shocks both the conscience and the budget, and provokes the kind of backlash seen here.

I will also draw your attention to some efforts here in Massachusetts to cushion the price shock, involving amortization of high-cost, single-use agents like this one over time, with a clause basically saying that if it was not effective, the insurer slides out of the “mortgage.” This was first proposed for the CAR-T class of biologic agents. Look up the FoCUS Project at the MIT Center for Biomedical Innovation/NEWDIGS.

— Dr. Thomas A. Amoroso, Concord, Massachusetts

— Jessica Wakeman, Asheville, North Carolina

Ice-Filled Drill: Been There, Done That

This is not a unique idea (“A Chilling Cure: Facing Killer Heat, ERs Use Body Bags to Save Lives,” July 22). As an intern in 1969, I worked with Dr. Brian Dawson at the Mayo Clinic. On occasion, he would conduct an emergency drill in the operating room to simulate care of a hyperthermic patient under anesthesia. He would yell, “Dawson dinghy drill!” Staff members would rush in a rubber dinghy, quickly inflate it and fill it with ice, in which to immerse a patient replica, while Dawson timed the drill on his stopwatch.

— Dr. Frederic Grannis, Duarte, California

— Caitlin Place, Jackson, Minnesota

Great idea for heatstroke. We had the luxury of ice-filled tubs for heatstroke recruits at Parris Island’s Marine Corps Recruit Depot in the early ’70s. With an average temperature of victims over 106 degrees Fahrenheit, after immersion in ice and vigorous rubbing, all temps fell under 101 in less than 20 minutes. No renal failure, etc. All returned to active duty within a week. I can’t believe that was almost 50 years ago! Good luck and Godspeed.

— Anthony Costrini, Savannah, Georgia

— Katy Backes Kozhimannil, Minneapolis

Nurses Needed to Shore Up Care

The most informative angle was not covered in your story about maternity care deserts: the registered nurses who choose not to work there (“12,000 Square Miles Without Obstetrics? It’s a Possibility in West Texas,” Aug. 2). Interview them. Health systems and hospitals that respect registered nurses usually do not have recruitment and retention issues. Read about me and my colleagues in “The Nurses: A Year of Secrets, Drama and Miracles With the Heroes of the Hospital” by Alexandra Robbins.

— Jan Marty, Vancouver, Washington

— Marie Myung-Ok Lee, New York City

The Benefit of Home Health Care

As KHN recently pointed out, expanding Medicare benefits to meet seniors’ changing health care needs is tremendously popular among older Americans and their families (“Why Doesn’t Medicare Cover Services So Many Seniors Need?” Aug. 11). While Congress is discussing plans to add benefits to Medicare, efforts to expand senior access to home-based care following hospitalization are also picking up steam.

The program is called Choose Home, and it would create a cost-effective, patient-centered additional option for Medicare beneficiaries to safely recover at home after being discharged from the hospital. As the covid-19 pandemic has shown us, the ability to receive health care at home is more important than ever. If passed, the bipartisan Choose Home Care Act of 2021 (S. 2562) would empower more eligible seniors to receive skilled nursing, therapy services and additional personal care and support with activities of daily living in the comfort and safety of their own homes upon a physician recommendation. In addition, Choose Home would train and educate family caregivers to provide continued support for their loved ones.

By providing add-on payments for additional services such as continuous remote patient monitoring, meals and nonemergency transportation, Choose Home would help improve patient outcomes and save the Medicare program an estimated $144 million-$247 million per year, according to an expert analysis. By all accounts, Choose Home is a win-win for seniors and America’s health care system at large. Further, efforts to improve patient choice when it comes to post-hospital care are broadly supported by American voters.

To meet the needs of America’s growing senior population more safely — while saving precious taxpayer dollars — I urge lawmakers in Congress to support the bipartisan Choose Home Care Act.

— Joanne Cunningham, executive director, Partnership for Quality Home Healthcare, Washington, D.C.

— Barbara DiPietro, Baltimore

Making the Podcast Accessible

I am not commenting on a particular podcast, but rather about the presentation of your “What the Health?” podcast. I have looked for written transcripts (very important for hearing-impaired persons to have access to a transcript) but was unable to find one. Was I looking in the wrong place, or do you not provide accessibility to your podcasts for those with hearing impairments?

— Dr. Katherine Phaneuf, Westford, Massachusetts

[Editor’s note: We are in the process of making transcripts available for future “What the Health?” podcasts. Please keep your eyes peeled.]

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