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.
Behind The Bloodshed
In 2018 alone, there have been more than 300 mass shootings in the United States ('Gun Control Vs. Mental Health Care: Debate After Mass Shootings Obscures Murky Reality,'
Nov. 19). That's almost equivalent to the number of days in the year. When so many shootings occur in such a short period of time, it's clear there's at least one common reason behind them. But many people assume there's only one reason and are divided over what that reason is. Some people say the underlying problem is gun control. Others say the underlying problem is mental health. Statistics prove that mental health is definitely one of the problems. In that case, why are the people, including the people in power, who blame mental health as the issue so hesitant to make reforms to the health care system and the way mental health is handled? They could at least attempt to fix the problem. Gun violence is becoming a prevalent issue in American society, one that simply can't keep being ignored. We need to stop debating and start doing something to protect the lives of innocent civilians. How many more deaths will it take before people in power take action?
— Srija Ponna, San Jose, Calif.
An Untenable Solution On Mental Health Care?
So the family becomes the untrained caregiver ('With Hospitalization Losing Favor, Judges Order Outpatient Mental Health Treatment,'
Nov. 13). From experience, it's impossible to find good, timely assistance for a person with bipolar disorder. The patient can just disappear for days, wreak havoc in the community, hurt themselves or others. By the time the patient has reached the point of mandatory outpatient treatment, a lot of damage has probably already occurred and both the patient and family are desperate. How can they be certain a person with bipolar disorder is properly taking medicine? Such patients often shun their medicine, especially when experiencing mania. This is an unrealistic option for treatment of some mental health disorders. I think it places the patient, family and community in danger of further damage.
— Glenn McGahee, Fort Lauderdale, Fla.
More research couldn't hurt, tweeted Daphne Chakurian of California:
Interesting concept. This needs research to evaluate cost to benefit for patients vs. some other model of care that is desperately needed.
— Daphne Chakurian (@DaphneChakurian) November 14, 2018
— Daphne Chakurian, Roseville, Calif.
Excellent piece about air quality ('Smoke-Filled Snapshot: California Wildfire Generates Dangerous Air Quality For Millions,'
Nov. 21). Once auto emissions plummeted, I never thought about any planetary forces except earthquakes. This raises awareness exactly as everything you do should. ;-) Thanks.
Lucy Johns MPH, San Francisco
Casting A Wide Net On Fish Oil Study
NPR and ABC covered these studies, and included positive results at the end of the articles. KHN didn't even mention benefits ('Fish Oil And Vitamin D Pills No Guard Against Cancer Or Serious Heart Trouble,'
Nov. 10). UPI reported
an “overwhelming benefit of fish oil supplements for black participants, who had a 77 percent reduction in their risk of heart attack.” I think this shows a lack of thorough reporting on KHN's part.
— Joy Thomas, Foster City, Calif.
Mixed messages about the study were prevalent online, one tweeter noted:
Everything is conflicting these days. Earlier today I heard the opposite
— Matt Jade (@matthewhochstra) November 12, 2018
— Matt Jade, New York City
Echoing an expert in the KHN story, that's what happens when researchers slice data into smaller segments, with fewer patients in each group. The results can prove unreliable when zeroing in on specific outcomes such as heart attacks among blacks.
Have A Whole Look At Medical Records, Holes And All
Not likely to be revealed in a medical record: any complication from treatment that results in harm or death to a patient and is not owned up to by the physician/surgeon or hospital ('In Days Of Data Galore, Patients Have Trouble Getting Own Medical Records,'
Oct. 25). Thus, a medical record can be used as documentary evidence of not reporting an adverse medical or surgical event that should have been reported to the Centers for Medicare & Medicaid or other patient safety organizations. In my opinion, that is the primary reason for providers' reluctance to furnish medical records related to a harmed/killed patient.
— Lars Aanning, Yankton, S.D.
Quality not quantity is what matters when collecting health data, one tweeter observed:
Large part of the failure of EHRs to improve care is 'data galore'. Too much clinically irrelevant data for reimbursement not care. Ten pages of documentation from ER visit often contain little or no clinically important data. Need good data not galore.
— Edward T Chory (@DrEdMDBFD) October 25, 2018
— Dr. Edward Chory, Lancaster, Pa.
It's not as if solutions don't exist; the challenge is executing them, reader Michael Millenson suggested on Twitter.
'In Days Of Data Galore, Patients Have Trouble Getting Own Medical Records.' All true, but CMS proposals to make it easier drew little support, except those of us @S4PM
. industry opposed. https://t.co/vxF7yMIeII
— Michael Millenson (@MLMillenson) October 26, 2018
— Michael Millenson, Chicago
Monster Bills Only Scratch The Surface
This is the tip of the iceberg (Bill of the Month
's 'That's A Lot Of Scratch: The $48,329 Allergy Test,'
Oct. 29). Medicine has become a medical-Industrial complex ever as powerful as the military-industrial complex that President Dwight Eisenhower warned us about. Hospitals all over the country use this same “scam” to maximize their profits. Recent schemes by private individuals involve the billing for medical laboratory studies done by private labs, but billed through rural hospitals such that a drug screen urine test costs $2,500. Other hospitals bill insurance companies up to $10,000 for an outpatient sleep study, for which Medicare allows $180.
Two hospitals here in San Antonio bill $8,000-$10,000 for inpatient sleep studies for which Medicare allows $950. A local, private cardiac catheterization laboratory bills $99,999 as a facility fee for a cardiac pacemaker change that literally takes 30-45 minutes — and they manage to collect $75,000.
Most private emergency room facilities bill out-of-network for thousands of dollars for routine visits. Medicare patients who go to these facilities are billed outside of Medicare and held responsible for all charges. Almost all ER facilities “upcode” to a higher level of care to maximize profit. Emergency rooms historically have been operated at a loss. They are now among the most profitable centers for hospitals.
This is a national scandal and costs the insurance companies and American patients hundreds of millions of dollars a year. No one does this to Medicare, because they might go to jail. But outside of Medicare, it is a civil matter.
— Dr. Michael Wooley, San Antonio
Exorbitant bills could be avoided altogether if prices for medical treatment were standardized and publicized, David Vuk argued on Twitter.
STOP STOP STOP letting insurance companies be the middle man!! Standard prices for just about everything can and should be posted nationwide. Doctors should not have to charge insurance companies $400 to accept $150!
— David Vuk (@doesnotcompute0) October 29, 2018
— David Vuk, Eastsound, Wash.
And some aspects of the convoluted health care system may simply be above a patient's pay grade.
Why is a dermatologist or allergist in a hospital outpatient clinic? Stanford is absolutely 100% aware that this is not patient-friendly. Patients should not be expected to understand provider-based regulations for an encounter like this one.
— Ben Carver (@bencarverclt) October 29, 2018
— Ben Carver, Charlotte, N.C.