Letters to the Editor is a periodic characteristic. We welcome all comments and can publish a range. We edit for size and readability and require full names.
Sounding the Alarm for Ambulances
Thanks for shedding much-needed mild on the exorbitant prices and lack of reimbursement which have develop into a harsh actuality for a lot of ambulance companies throughout Colorado and the nation (“Insurers Fight State Laws Restricting Surprise Ambulance Bills,” July 9). Whereas it’s important to guard sufferers from “shock” payments — one thing your protection highlights — it’s equally vital to acknowledge the opposite facet of the equation.
Ambulance suppliers typically obtain reimbursements effectively under the precise price of delivering care. A latest industry report discovered that ambulance companies are below‑reimbursed by a median of $1,526 per transport, with Medicare alone paying practically $2,334 lower than the associated fee incurred. These shortfalls are unsustainable and threaten the monetary viability of emergency responders.
It’s essential that ambulance corporations have a stronger voice on this dialog. Reimbursement charges aren’t simply numbers — they decide whether or not crews can keep on the highway, preserve readiness, and spend money on important cellular well being care companies. Emergency preparedness depends on steady funding, and when that funding falls quick, communities undergo.
By spotlighting the reimbursement disaster, this text helps lay the groundwork for coverage options. However let’s go a step additional: We have to elevate the voice of ambulance companies themselves, so lawmakers and insurers perceive that honest cost isn’t a bonus — it’s important to maintain us secure.
— Patrick Fahey, Weymouth, Massachusetts
A DevOps engineer shared the NPR model of the article on social media:
Households hit onerous without warning ambulance bills-some see money owed soar even with insurance coverage. Extra states are appearing, however a nationwide resolution could also be wanted for actual safety. https://t.co/Efb6me3Png pic.twitter.com/HRSW5mCdiu
— Michael Bennett (@M1keB_77) July 11, 2025
— Michael Bennett, Denver
Individuals Pay the Value for a Sick Well being Care System
I’m positive your readers can be involved in how American well being care prices examine with these of the European Union and Switzerland (“Bill of the Month: A Texas Boy Needed Protection From Measles. The Vaccine Cost $1,400,” June 30).
In France, the non-public value for the MMR vaccine is round $13 (in U.S. {dollars}), supplied you have got a prescription. Any pharmacy can administer the jab for about the identical.
Right here in Switzerland, the costliest nation in Europe, this vaccine prices below $40, as a personal buy.
I’ve moved 18 instances with household throughout Western and Jap Europe and have had expat workers in 35 international locations on 4 continents.
It’s very clear to me now that the majority nationwide makes an attempt at well being care are a expensive failure, with few notable exceptions: Germany and, surprisingly, Spain. Then there’s Switzerland, which has among the many greatest well being care programs on the earth — near good. Fundamental protection phrases are federally mandated and price round $430 a month with a $2,500 annual deductible, regardless of age, after 26. And with a $300 yearly deductible, the premiums are about 40% larger.
One thing could be very off within the USA. It’s not that difficult.
— Clement Cohen, Geneva, Switzerland
A registered nurse shared his resolution for taming Medicaid fraud in a put up on X:
“They’ll provide you with a bone should you keep within the mud.It’s comparatively simple to repair the profit cliff: simply part in a graduated premium for Medicaid based mostly on earnings above the brink. If we had political will to do that, it could prompted self-sufficiency.https://t.co/4fxSnmETRd
— Jacob Larsen 🇺🇸 🇩🇰 🇺🇦 (@SLCPaladin) July 22, 2025
— Jacob Larsen, St. George, Utah
Why ‘Begin From Scratch’ Vaccine Testing Can Be Harmful
I anticipate we’ll be listening to extra dialogue round using “inert” placebos — like saline options — because the Advisory Committee on Immunization Practices and the Facilities for Illness Management and Prevention method new vaccine suggestions (“Kennedy’s Vaccine Advisers Sow Doubts as Scientists Protest US Pivot on Shots,” June 27). Such a messaging appears poised to achieve traction with the general public, regardless of its moral implications.
More and more, I’m seeing criticism that vaccine growth doesn’t depend on inert placebos. This argument is commonly used to advocate for brand new medical trials — even for vaccines already confirmed efficient — and to justify starting booster growth from scratch.
Whereas inert placebos might have been used and have been acceptable in early phases of analysis for vaccines, their use turns into ethically problematic when a secure, efficient vaccine already exists. In such instances, withholding safety from members in a placebo group can put them at actual danger, particularly in the course of the growth of up to date or booster doses of vaccines.
I imagine it’s vital that organizations like KFF Well being Information assist make clear this problem for the general public. KFF is a extremely revered, nonpartisan supply with highly effective communication attain. I’m a subscriber to KFF Well being Information and admire the best way your reporting attracts in readers with accessible, participating headlines — and that your articles can be found for syndication to different retailers.
Two key factors I discovered buried in an American Academy of Pediatrics article stood out:
- “Many childhood vaccines have been examined initially in randomized medical trials that included placebo or comparability teams. If the vaccine is for a illness that at present has no vaccine, the placebo could also be saline or one other substance identified to be secure. If the vaccine is a possible alternative for an current, older vaccine, the comparator group might obtain the older vaccine that has already been examined slightly than an inert placebo.”
- “When a secure, efficient vaccine already exists towards a illness, giving kids within the placebo group no safety towards that illness is unethical. Unvaccinated kids can contract harmful sicknesses. Dad and mom of kids within the placebo group wouldn’t know they didn’t get the vaccine and that their youngster is unprotected.”
That brings up one other vital query: Who would volunteer for a randomized, double-blind, managed trial involving an inert placebo for an current vaccine? Folks hesitant about vaccines are unlikely to take part, for worry they are going to obtain the vaccine. And people who assist vaccination could also be reluctant to danger receiving an inert placebo as a substitute of testing the present, older confirmed model towards a brand new proposed model.
— Alice Henneman, Lincoln, Nebraska
A virologist and podcaster chimed in on the June installment of our “Invoice of the Month” sequence:
A put up doctoral fellow at UTMB couldn’t afford the college’s insurance coverage possibility for his household so he purchased a separate plan. It price him $1400 to get his youngster the measles vaccine. Throughout an outbreak. Get your vaccines now, earlier than they don’t seem to be lined. https://t.co/f3wWRouevA
— Heather McSharry, PhD (@PathogenScribe) July 1, 2025
— Heather McSharry, Austin, Texas
A Premium Shell Recreation?
I learn Michelle Andrews’ article at present, revealed within the San Francisco Chronicle (“Have Job-Based Health Coverage at 65? You May Still Want To Sign Up for Medicare,” June 18). Thanks for reporting on this vital problem.
You describe as contributing components: ignorance of the worker, the dearth of any requirement that Medicare notify the worker, and the failure of the dealer to inform.
Maybe I missed it, however I imagine there’s an vital further issue you didn’t point out: the revenue of the industrial insurance coverage service. In my expertise, of us don’t discover that their major insurance coverage has modified to Medicare primarily as a result of their employer continues to be deducting the premium for his or her industrial group medical health insurance.
Isn’t it fraud for the insurance coverage service to gather premiums for a coverage for which the subscriber is visibly not eligible by legislation?
There’s a monetary incentive for the industrial service to not inform the subscriber that their protection has ended, and they’re now eligible for a Medicare Benefit supplemental coverage (with a a lot decrease premium) in the event that they join Medicare: The industrial service can acquire excessive premiums, then decline to pay advantages.
You point out that Medicare representatives notice they don’t seem to be required to inform subscribers. Why? Coincidence? Extra doubtless, the industrial insurance coverage corporations actively foyer towards notification.
Additionally, there’s a monetary incentive for hospitals to carry out procedures on sufferers who’re 65 or older and nonetheless on a industrial plan. Fairly positive the hospital billing workplace is aware of fairly effectively they are going to finally have the ability to invoice the affected person the retail charge, which is usually 10 instances as a lot (or extra) than the Medicare-discounted charge.
In my expertise, this isn’t a physician problem, because the doctor not often pays any consideration to insurance coverage particulars. Nevertheless it’s very a lot a billing workplace problem.
— John S. Smolowe, Menlo Park, California
A reader in Connecticut tweeted his opinion on the dangers of hashish for an growing old inhabitants:
Normalized hashish use now will yield a giant public well being drawback later and all the info factors in that course…👇🏼“As Hashish Customers Age, Well being Dangers Seem To Develop” https://t.co/xNrqqz1k1L through @kffhealthnews
— Brandon M. Macsata 🎗️ (@Purple_Strategy) June 9, 2025
— Brandon M. Macsata, New Haven, Connecticut
Getting Forward of Recognized and Unknown Threats
As highlighted in your article “‘MAHA Report’ Calls for Fighting Chronic Disease, but Trump and Kennedy Have Yanked Funding” (July 2), proposals to get rid of the Nationwide Middle for Continual Illness Prevention and Well being Promotion don’t align with efforts to deal with our nation’s continual illness disaster. These plans additionally additional underscore the significance of strengthening America’s public well being infrastructure not solely to avoid wasting lives, but additionally to make sure taxpayer {dollars} are used correctly.
For every greenback invested in illness prevention, the Trust for America’s Health estimates, $5.60 in downstream prices could be saved nationwide — and this determine is even larger in some states.
However simply as cuts to continual well being analysis will hamper the federal authorities’s targets of stopping diabetes, coronary heart illness, and weight problems, so too do cuts to broader public well being funding streams inhibit state and native well being departments’ skill to cease outbreaks of measles, drug overdoses, or hepatitis, amongst many different preventable situations.
Investments in public well being have saved lives and strengthened our nation. Figuring out rising threats shortly — whether or not they come from infectious ailments, zoonotic sicknesses, accidents, or accidents — is significant to mitigating them. Sadly, federal cuts to important public well being funding streams and applications make it more and more troublesome for our nation’s leaders to know the threats dealing with their communities and take advantage of knowledgeable selections potential to assist their communities.
Throughout the nation, public well being departments are scaling again workers and delaying plans to undertake higher expertise attributable to funding constraints; due to this fact, many departments lack the assets to detect and reply to threats in a well timed method. Rural and underserved communities which have fewer assets to maintain or change federal funding are at biggest danger.
With out continued funding in public well being infrastructure — from the federal authorities in addition to state, territorial, native, and tribal governments — the influence of future well being dangers might be multiples larger on each the nationwide well being care system and the assets (together with authorities funding) wanted to deal with no matter could also be coming subsequent.
To really enhance public well being, our leaders at each stage of presidency needs to be doubling down on public well being programs, each infrastructure and expertise, as the inspiration and path to maintain America wholesome.
— Eric Whitworth, CEO of InductiveHealth, Atlanta
The CEO of 4sight Well being had this recommendation, posted on X:
Do not hearken to what the regime says. Watch what it does. What this story calls “contradictions” and “inconsistencies” are lies and diversions from its anti-health agenda. The market should decide up the continual illness prevention torch. https://t.co/SgWYe3KCtp
— David Johnson (@4sighthealth_) July 8, 2025
— David Johnson, Chicago
Preventive Bodily Remedy Can Spare You From Harm — And Rehab
Thanks for just lately highlighting the vital want for high quality bodily remedy (“How To Find the Right Medical Rehab Services,” July 15) and offering a complete information on navigating rehabilitation companies after hospitalization. Additionally it is vital to notice the preventive energy bodily remedy has earlier than an acute damage strikes.
Bodily and occupational remedy companies are usually not only a type of post-accident care however are additionally proactive, non-pharmaceutical methods to protect energy, steadiness, and independence — particularly for our growing old inhabitants. And analysis exhibits that when bodily remedy is the first line of treatment for sure situations like decrease again ache — slightly than injections or surgical procedure — Medicare Half A/B prices drop by 19% in contrast with sufferers selecting injections first and by 75% in contrast with surgery-first instances.
Furthermore, bodily therapist-led fall prevention programs have been proven to scale back fall danger, whereas additionally chopping emergency room visits, hospitalizations, and opioid use amongst older adults. These numbers matter deeply in an growing old America the place 30 million older adults fall annually and the lifetime medical price of treating falls is over $100 billion annually. And but, the Medicare system typically prioritizes put up‑damage therapy over preventive care, delaying entry to important bodily remedy till after injury happens.
In mild of our nation’s want for extra preventive care, it’s time for our Congress to allow simpler, earlier entry to bodily remedy. A technique lawmakers may help is by supporting and passing the bipartisan Stopping Dependancy and Falls for the Aged, or SAFE, Act (H.R. 1171). This commonsense laws would enable Medicare beneficiaries to entry no-cost falls danger assessments from the autumn prevention specialists: bodily and occupational therapists.
Incorporating bodily remedy into major and preventive care has the potential to lower hospital visits, decrease well being care spending, and protect our seniors’ independence — targets all of us share. It’s time to shift the coverage highlight upstream. Bodily remedy has already proved it saves cash and improves lives.
— Nikesh Patel, govt director of the Alliance for Bodily Remedy High quality and Innovation (APTQI), Sugar Land, Texas