Readers Make Their Wish Lists, Checking Up on Health Care

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

How to Exclude Health Care Politics

More than a decade after the Affordable Care Act took effect, we’re still stuck in a confusing and expensive health care maze (“Readers take Congress to task and propose their own health policy solutions,” Nov. 12). The ACA expanded coverage and protected people with preexisting conditions, but it also added subsidies, narrow networks, and increasing premiums to an already fragmented system. Millions of people still face deductibles so high that “coverage” often equates to financial anxiety rather than security.

The problem is not with our doctors or our hospitals, but with the structure. America spends nearly twice as much per person on health care as other developed countries, but our life expectancy is shorter and our outcomes are worse. We have let a tangle of private insurers, billing rules, and monopolistic pricing replace coordination with chaos.

We don’t need “socialized medicine.” We need organized medicine that ensures coverage, controls costs, and cuts red tape. Other countries have done this – effectively, equitably and without eliminating private choice.

Here’s what would work (with a little help from my friend ChatGPT):

1. Universal and automatic coverage. Everyone should be registered from birth or residency, regardless of employment or income. Basic care would be guaranteed, while private insurance could supplement it.

2. Rational pricing. Hospitals, doctors, and drug manufacturers should follow transparent, regulated pricing schedules – like the full payment systems used abroad – ending the markups and cost shifting that drive up prices in the United States.

3. Streamlined administration. We spend five times more on billing and insurance overhead than our peers. A single set of electronic rules and standards would save billions and free doctors from paperwork.

4. Invest in primary and mental health care. Paying for outcomes rather than volume would improve health and reduce avoidable hospitalizations.

5. Protect families from financial ruin. National long-term care and disaster coverage would prevent medical bills from destroying lives.

These reforms are not radical: this is what almost all successful countries are already doing. The obstacle is not feasibility; It’s politics. Every dollar saved is a dollar someone is making now, and hardcore lobbyists are fighting to preserve this status quo.

The ACA was a step forward, but it left us with a patchwork of unaffordable subsidies, mandates, and premiums. America already spends enough to cover everyone. The challenge now is to spend it wisely – through a rational, universal and efficient system that works for people, not paperwork.

—Luis Alnisu, Warrenton, Virginia

Beat the mold

There are only three ingredients for mold: spores, cellulose and water (“A Hidden Health Crisis Following Natural Disasters: Mold Growth in Homes,” Nov. 19). The spores float in the air during construction work. No exceptions. Cellulose is present in paper and wood. Its most damaging use is in drywall or plasterboard (gypsum board). Just one drop of water, from a roof leak or plumbing/sewer pipe, is enough to start the mold process.

A major culprit was the use of drywall after World War II to quickly build housing. USG and similar manufacturers make an alternative product without a paper coating that will not react with water. USG calls it “Mold Tough” and uses a fiberglass mat instead of paper.

As an architect, I have a simple solution: stop using paper-faced drywall.

—Marc Brewster, Bastrop, Texas

Help is always needed

I’m writing in response to the article “Help Wanted: California Turned to Closing Health Disparities, Then Backtracked” (July 28), in which Vanessa G. Sánchez explained the problems with health disparities among immigrant populations — such as chronic illness, a high rate of uninsurance, and the more serious fact that community health workers who do their best to support these people are paid very little for crucial work. They offer assistance and trust to those who may not be as comfortable asking for it or may not know it exists because they are not from here.

She also wrote about the path that was opening up with the professionalization of these community health workers – about how certification programs were opening up and how funding would increase. But it was reduced due to ongoing budget cuts under the Trump administration, and programs were scaled back or abandoned.

I would like to thank you for shedding light on this issue. These community health workers serve as the health care conduit for many people facing immigration and language barriers. This is the workforce that they are appealing to and catering to, and that in itself is honorable work that needs to be done and should be paid at a higher rate than it currently is. You could even say that it is as important as a visit to the doctor, because even going to the doctor requires insurance. And who helps you and then sends you to the doctor? Community health workers, exactly!

I am part of the Hispanic community and I care about the health disparities that exist within it, such as diabetes, and I am also very aware of the language barrier that exists in the hospital field. Working together, is there a way to reinstate certain certifications or training to promote higher wages and improve the health of all Hispanics/immigrants?

—Avelino Cortes, San Leandro, California

Where do we draw the line when it comes to “urgent” care?

As a pediatric emergency physician who works regular shifts at a community hospital, I read with interest and horror the article about a short “non-emergency” but expensive ambulance ride for a child (“Bill of the Month: Not serious enough to turn on the siren, a toddler’s 39-mile ambulance ride still costs more than $9,000,” Nov. 25). I couldn’t have guessed that an Advanced Life Support, or ALS, ambulance would cost over $9,000. Often, patient costs vary depending on which ambulance company arrives, their insurance plan, whether they are uninsured, etc. We, at least as doctors, rarely have this information available to us.

I try to ask parents to take their children to the referral hospital when it is safe and feasible, but this is not always possible. What risk of death for your child would you accept if you took the car? 10%? 1%? 0.1%? 0.01%? Just because no treatment was administered during this ambulance ride does not mean the ambulance was not necessary.

What makes us good at our work in medicine is worrying about worst-case scenarios. Do providers sometimes overreact and send children by ambulance who don’t need it? Absolutely. But there are also too many cases in which children die or become seriously ill because someone failed to recognize their condition and the risks. If we send you by ambulance or admit you to the intensive care unit because we are concerned that you are at risk of shock or respiratory failure, this does not mean that you will definitely need intensive care. But if you go into shock or stop breathing in your parents’ car, you are much less likely to survive than if we monitor this problem and treat it immediately. The same way that when we tell you it’s a virus, after we’ve done a lot of testing, that doesn’t mean we didn’t need to do those tests. The absence of treatment does not mean that the admission or the tests we recommended were unnecessary.

Perpetuating the impression that this is an unnecessary treatment just because everything is working well is a luxury one has when one does not regularly see how quickly children can go from looking relatively well to being critically ill and at risk of death. Those of us who are good at what we do know when to worry and when not to worry. Please don’t disparage our caution or treatment without even asking for our justification. Ask that doctor why he said the baby absolutely had to go in an ambulance. Maybe he didn’t have a good reason. But maybe he did. Perhaps if a similar child had been sent for a ride and gone into shock, this article would instead be about their incompetence in missing the risk of sepsis and causing the child’s death by letting the parents drive him to the hospital.

We are doing our best to provide good care in a broken and overburdened system. If we want to work together to solve this problem, we must all work to understand each other’s perspectives. Please help us understand these unexpected and incredibly burdensome costs our patients are facing. Try to understand that prudence may not be about ignoring the burden or cost, but about knowing the risks.

—Samantha Rosman, Boston

Investing in your own healthcare

About 20 years ago, I switched to a high-deductible health plan and health savings account. It was the best health care decision I ever made for my family (“Trump’s idea for health accounts was tried. Millions of patients found themselves in debt,” Dec. 9).

Today, after years of contributions (made up of investment gains), dividends and earnings yield more than our healthcare withdrawals. We also continue to contribute the maximum family amount per year.

We are about to retire now and will continue to select an HDHP and maximize our HSA contributions. Once under Medicare, our premium payments can be made with our HSA account. Also, it is another form of IRA once we reach age 65. This is a double tax account.

I don’t understand the resistance to switching to an HDHP and HSA. The more you insure, the more you save. In the long run, this translates into significant money. At my workplace, I try to convince as many people as possible to choose an HDHP. They are all very grateful years later.

I believe people are simply afraid of change – not realizing that it seriously may be the best health care decision they ever make.

—Tim Eckel, Toledo, Ohio