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.
How To Pay For ‘Medicare-For-All’
I would like to know why, in all of the stories about the notion of “Medicare-for-all” and its potential bankrupting costs (“For 2020 Dem Hopefuls, ‘Medicare-For-All’ Is A Defining Issue, However They Define It,” Feb. 20), no one is introducing the fact that this sort of a program would eliminate the need for employers to pay for insurance for employees and would allow them to eliminate a large section of their human resources departments that are involved with researching, selecting and administering current health care schemes. I have worked in both private and government agencies, and these costs are significant. They could be replaced with a tax on employers that would be lower than the costs currently faced and would reduce the cost of health care overall in the country. Simply talking about the potential cost to government is looking at only a portion of the financial picture.
— Tonie Brovont, Perry Township, Mich.
— Jeffrey Flier, Boston
Selling ‘Fountain Of Youth’ Research Short
Marisa Taylor’s scorching report entitled “A ‘Fountain Of Youth’ Pill? Sure, If You’re A Mouse” (Feb. 12) is an undeserved criticism of American entrepreneurship. It presumes Dr. David Sinclair is somehow unethical for having commercial ties to new ventures in the anti-aging arena.
Anti-aging researchers face a problem — how to provide conclusive proof that some practice will result in super-longevity? The only conclusive proof would entail a 100-year-long human study costing an impossible amount of money and would be totally impractical. Short of that, biologists use short-living mammals like mice that have a similar genome to humans.
There is no question from a scientific standpoint that NAD (shorthand for nicotinamide adenine dinucleotide) is the holy grail of aging. Niacin-like molecules and resveratrol are the best-tested anti-aging molecular interventions. Robust NAD research continues.
To mischaracterize Dr. Sinclair as some kind of charlatan selling snake oil is not substantiated or deserved. MIT and its Elysium venture is the first time a noted scientific institution has embraced a dietary supplement over a drug — making such a product affordable to the masses rather than an elitist remedy available only to the super wealthy.
There is sufficient evidence humans can begin to practice anti-aging strategies before all the evidence is in. An option would be to practice calorie restriction that the molecules mimic, which doubles the life span and “health span” of animals. But not many would have the discipline to eat one meal a day to accomplish that. Best available evidence shows these are wonder molecules (from nature) that exhibit profound biological action.
— Bill Sardi, La Verne, Calif.
On Twitter, a California doctor bemoaned that a human study would be unrealistic: “How does one complete a longevity study in a timely fashion?” mused Dr. Tom Wallach. And though science journalism is plagued with “breathless” headlines, he let KHN off the hook and suggested that marketing anti-aging “cures” is reckless.
— Dr. Tom Wallach, San Francisco
Your “‘Fountain Of Youth’ Pill” article was thorough and enlightening. Lots of work. Journalism at its best. Thank you.
— Jim Scherer, San Rafael, Calif.
— Dr. Liza Dunn, St. Louis
‘Bill of the Month’: The True Takeaway
While the article “Hope You’re Sitting Down: Hospital Charges $4,700 For A Fainting Spell” (Jan. 28) brings up many important problems with health insurance and medical costs, the audio portion of the story offered up what I, as a physician, think is poor medical advice for patients.
Drawing upon her own personal experience with an injury, KHN Editor-in-Chief Elisabeth Rosenthal suggested it is appropriate to decline an emergency room visit due to financial considerations, even after someone calls 911.
I agree emergency rooms are too expensive and at times overused, but their expense is due to the type of technology and expertise necessary to treat a true emergency. Also, primary care office visits often lack the necessary tools to address a significant medical emergency. Hospital costs and charges are circuitous and therefore it is difficult to discover the true costs of care depending on actual stated costs and/or insurer-negotiated rates for hospital care.
The major problem in this patient’s care is the mistaken belief that a healthy person can buy cheap insurance because they are basically well and therefore will not encounter any major medical expenses or that they should carry no insurance at all. This view is not realistic. In the USA these days, the most common cause of death for young folks is trauma and, in recent days, drug overdose. In the inner city, it is murder and suicide. Trauma is a major reason for emergency room visits, and these visits are costly. This story would not have been done if the patient had paid $50-$100 for this visit.
The Affordable Care Act, while imperfect, had as one of its tenets the definition of what is good insurance. This includes appropriate coverage and catastrophic health insurance. It also included measures that attempt to reduce health care costs on the supply side of the equation. It recognized the fact that it is the nature of insurance to have some degree of higher costs to the healthy to lower the costs to those who are ill. In the USA, hospital costs still account for the major amount of the health care aggregate bill. No amount of bean counter ability, or shopper acumen or computer AI will change the present reality of present health care costs.
It is my feeling the conclusions of your story should not have been “don’t go to the emergency room even if necessary,” or that emergency room visits are too expensive, but rather that presently it is prudent to get adequate health insurance including catastrophic insurance. On a more global level, if you believe that medical care is a right and not a privilege, support initiatives like the Affordable Care Act that increase population insurance, measures to control insurance, drug and medical costs, and true competition in the world of medical care.
— Dr. Richard N. Hellman, Indianapolis
— Dave Cotie, New York City
— Jlyne Hanback, Plano, Texas
What Goes Around Comes Around
Three and a half years ago, I was told I had two years to live or get a double-lung transplant. A year ago, I was dying in a hospital bed. Today, I have new lungs and a new lease on life, thanks to the Affordable Care Act and Medicaid.
I have spent months in the hospital and months recovering and years interacting with doctors, nurses, insurance providers, as well as my state’s Health and Human Services department when my insurer refused to pay claims. In the process, I’ve identified a major bottleneck in the health care industry that delays and denies care to patients and costs — by my rough estimation — over $1 billion per day nationally in just wages for everyone who must deal with prior authorizations. (That’s one hour to process a single prior authorization, multiplied by three man-hours for the insurance person and the pharmacy, lab or hospital staffer who processes it, multiplied by an average of $35 per hour, equaling $105. With 330 million folks in this country, I figure there are some 10 million prior authorizations being processed each day.) This does not include the lives lost and put at risk because insurance companies stand between the doctor-patient relationship.
The prior-authorization system supposedly was instituted to prevent waste and fraud and to keep costs down by the insurance companies, but it has become a millstone around the health care industry’s neck. And you wonder why pharmaceuticals cost so much? All that labor cost is transferred in one way or another to the patient and absorbed by his/her insurance. What goes around comes around. You wonder why premiums and deductibles are so high? The insurance company is passing the cost on to the patient.
In jettisoning the prior-authorization system, insurance companies also would benefit by eliminating policies that adversely affect their members’ access to health care in a timely manner. Health care delayed is health care denied.
— Eric Jette, Santa Fe, N.M.