Enabling Ordinary Moments for Ordinary People

Dear Editor,

At the U.C. Berkeley graduation in May, I saw a paraplegic student cross the stage in an exoskeleton designed by the engineering department, creating an extraordinary, though transitory, moment. I appreciate that the Walk Again researchers in Melissa Healy’s article mention, “drinking a cup of coffee” as a goal of their prosthetic “body suit,” illustrating their aim to enable not extraordinary moments, but commonplace tasks in the lives of ordinary people. However, the cost of this technology isn’t mentioned at all, and would surely be more than today’s prosthetics costing $6,000-$35,000. Instead of ignoring cost, I suggest that the Walk Again researchers, and all biomedical device researchers, consider their devices’ costs to consumers and try to make them more affordable, without sacrificing quality, so that their technology is not only available to the wealthy, but to an ordinary person who might just want to drink a cup of coffee.

Sincerely,

Amy Levier

Berkeley, CA

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In Response to: "Body Suit May Soon Enable Paralyzed to Walk"

http://www.latimes.com/health/la-he-brain-machine-20111006,0,7089239.story

Report on Medicare Cites Prescription Drug Abuse

Dear Editor:

In the article “Report on Medicare Cites Prescription Drug Abuse,” you reported that Medicare beneficiaries have been abusing their access to medications. Patients have received prescriptions from multiple prescribers and filled them up at various pharmacies. This is significant as federal funds intended to aid the sick and elderly are instead used for monetary or addictive reasons by patients. Furthermore, this drug abuse could lead to increased costs to taxpayers. Medicare officials have been slow to recognize the evidence of such abuse.

One thing that could make a difference is to implement a health policy in which pharmacies, physicians, and prescription drug plans better streamline information on medical history, in order to find warning signs of abuse. In addition, both patients and providers could try to better coordinate in the treatment of pain symptoms to remove the need to visit another physician for extra medication. However, through such policy, we must remember that our focus is maintaining patients’ access to care.

Sincerely,

Sarah Youn
Berkeley, CA

The future of electronic medical records

To the editor:

In Sarah Kliff’s article “The future of electronic medical records, in one doctor’s visit,” it shows the potential for electronic medical records to revolutionize record keeping and access to information. Although the idea has been around for several years, there has been no drive towards a complete revamp and it was only recently that the Recovery Act and Affordable Care Act has provided funds and incentives towards “meaningful use” of digital records. Digitization of records, however, has faced much opposition from many practitioners who prefer paper, which they claim is more reliable and efficient. What new studies have found, albeit dependent on more than a pen, digital records have not only improved operational efficiency, but have also resulted in significant system wide reductions in costs. In addition, digital record programs implemented in Emergency rooms have even been shown to aid in quicker diagnosis and treatment. A universal network must be established and incentivized in order for the digital records to be extremely effective. What would foster this transition are larger federal incentives, especially for small practices, ease of access into the universal network, and a deadline to phase out paper records.

Sincerely,

Nicholas Hu

Berkeley, CA

Yet Another Slippery Slope—Drug Shortages Lead to Rationing

Dear Editor:

In “Shortages Lead Doctors to Ration Critical Drugs” (NPR, October 3, 2011), Richard Knox reports that “a growing number of Americans are not getting the medications they need…(including) cancer chemotherapy agents, anesthetics, antibiotics, (and) electrolytes needed for nutrient solutions.”

While approximately half of all drug shortages are due to production quality issues, the other half is avoidable with the help of government intervention. Older generic brands, which are not produced by companies due to their low profit, can be made in larger quantities if the government will offer subsidies or incentives. This is an example of market failure—companies are not keeping up with the demand, so government mediation is necessary in order to protect these susceptible individuals. So far, there have been 15 deaths due to these shortages with no “end in sight.” Without these essential drugs, unnecessary rationing and life and death decisions will be made, raising ethical issues.

As a community member, my perspective is: if these drugs can be cheaply made and lives are depending on its availability, then why can’t people have access to them? For those opposed to government intervention, I leave with you this—if the U.S. government is willing to bail out corporations, why can’t it bail out the health system when it matters the most?

Sincerely,

Leslie Salas

Berkeley, CA

Things May Get Worse For "Worst" Hospitals, Study Warns

Dear Editor:

Yesterday you reported in “Things May Get Worse for the ‘Worst’ Hospitals, Study Warns” that researchers have identified 178 low-quality, high-cost hospitals. Taking into consideration that the Affordable Care Act dictated that money be taken away from these institutions and given to those that provide quality care in a cost-effective way, it begs the question: What type of people will be most impacted by this transition? As this study notes, the “worst” hospitals treat twice as many elderly, black patients as did the “best” hospitals. So it appears we have our answer: the under-privileged will be hurt the most, per usual.

As a student interested in the ethics of resource distribution, I believe extra attention needs to be given to what we call “social determinates of health.” While I too am concerned with national health expenditures nearing 18% of the GDP, I believe we must take a second to consider who will be impacted during the changing payment process. One way to decrease the pressure put on the under-privileged is to make policies in which increasing education, creating jobs, and combating racism is the end goal. If this were the primary focus of health care reform (guidelines of care and cost effectiveness secondary), we would likely see drastic improvements in health outcomes as well as other aspects of social life.

Sincerely,

Lindsay Forbes

Study: Worst hospitals treat larger share of poor

October 5, 2011

Dear Editor,

In the article on the government’s “reward and punishment” system under the Affordable Care Act, the writer expresses a strong concern on the “worst hospitals” being at risk of financial failure because of the policy in the reform law that punishes hospitals that do not improve their patients’ health overall. However, although there are fears that the policy will push out hospitals that usually serve a very sick and poor population and therefore “increase health disparities for minorities,” this is a pessimistic view of the impacts of this policy. Hospitals that serve low-income, minority communities face unhealthier patients, but at the same time they also probably have low quality of care because of poor management or regulations that are usually as a result of minimal incentives. The government is taking a tactful market approach that gives it some power that it lacked before to incentivize hospitals to try to improve their care. However, the policy should clarify “improvement.” But feeling pressured to improve, hospitals can become more active in implementing new management tools and care approaches that they otherwise did not adopt because of the absence of any financial incentive. The “worst hospitals,” actually have more room to improve.

Sincerely,

Karla Vasquez

"Fight for Social Programs Looms Anew in the House"

Dear Editor:

Monday’s article, “Fight for Social Programs Looms Anew in the House,” describes a bill that would eliminate federal grants for Planned Parenthood clinics. Proponents argue that this would save money, and that taxpayer dollars should not be used to perform abortions. In reality, government grants are not used for abortion procedures, since the Hyde Amendment demands federal funding not be allocated for this purpose. Furthermore, abortion comprises only three percent of services that the clinics provide. Ninety-seven percent is preventive care including breast exams, pap smears, health education, contraceptives, and STD testing. A decrease in this preventive care would likely mean an increase in expensive emergency care and treatments later, so it’s doubtful that the proposed cuts would actually save money overall. Instead of disinvesting in affordable, preventive care for low-income and uninsured patients, the government should financially support these programs.

Sincerely,

Alexis Captanian

Berkeley, CA

Pressing for better quality across healthcare

Dear Editor:

In an article on October 4^th, Noam N. Levey wrote about how errors and excess care bring about significant costs to the Medicare and Medicaid programs. I agree that in order to improve the condition of our healthcare system, the true sources of excess spending need to be identified before any helpful changes, monetary or systemic, can occur.

What people don’t understand is that simply cutting back healthcare spending will only diminish the quality and reliability of our healthcare system. Instead we need to eliminate wastefulness and increase efficiency. As a student studying public health, my perspective stems from a preventive health standpoint. Both forms of preventive medicine strategies, inside and outside of the hospital, need to be improved to cut back unnecessary healthcare spending; strategies such as improving coordinated care through renovated electronic records and increasing maternity care coverage could lead to positive change.

Sincerely,

Lacie Wilson

Berkeley, CA

U.S. Supreme Court hears Medi-Cal fee-cut case

Dear editor,

In your paper’s article, “U.S. Supreme Court hearsMedi-Cal fee-cut case”, the ones hardest hit by the meteoric rise of medical costs and the poor economy are undoubtedly the patients under the United States healthcare plans. The government must immediately enact policies that will reverse the rising cost of healthcare and the bankrupting of California citizens. The federal government can start by enacting legislation that would broaden the responsibilities of accredited healthcare workers. We currently overpay for simple health services that can be done at lower costs and by doing so we can have doctors deal with complicated treatments and conditions. The government can also tackle rising costs by standardizing the information systems of healthcare. States currently cannot share medical information across state borders but a nationally standardized database would save patients costs of redundant tests. I believe that these two approaches as well as other initiatives will help alleviate the financial burden on the budget and free up some money to reimburse our doctors. Although these are just stop gap measures aimed at tackling the immediate deficit in healthcare but it will at least buy us some time to create a sustainable solution during a time of financial peril.

Sincerely,

Jisu Youm

Employers face higher health care costs for next year

Dear Editor:

Yesterday, you reported that employers faced higher care costs for next year and workers will be asked to pay a larger share of the plan. To save money some companies have opted for high deductible plans to make their employers more responsible for their health. This is interesting because at first glance, it can seem like a great deal because employees are paying lower premiums and employers pay less because they require workers to take care more of their own health care costs. However what people don’t realize is: there are plenty of pitfalls in these, including out-of-pocket expenses they cannot afford. As a student my perspective is: that when it comes to health there is no one plan that fits all. High-deductible plans work only for young, relatively healthy people who do not spend a lot on health care. When people with chronic diseases or people who just constantly get sick are faced with paying high out-of-pocket costs for medical bills or simply go without the care they need. One thing that could really make a difference is for the government to help implement the insurance exchanges in all 51 states as soon as possible.

Sincerely,

Telo Pablo

Report on Medicare Cites Prescription Drug Abuse

To the Editor:

In an article on October 3, Robert Pear reported that congressional investigators had evidence of Medicare “subsidizing drug abuse.” 170,000 Medicare beneficiaries had received prescriptions from 5 or more practitioners for any of 14 types of frequently abused drugs. The investigators recommended “limiting patients who abuse...to one prescriber,” but Medicare officials, reluctant to limit accessibility of care, proposed improving the coordination of care between insurers.

Although that is a viable alternative, the appropriate challenge, in my opinion, is using health policy as a boundary between accessibility and abuse, or, liberty and anarchy. If the investigators' definition of drug abuse is reasonable, why not restrict prescriptions only with regard to that list of frequently abused drugs? Why not cap prescriptions from that list to 1 or 2 per beneficiary instead of capping all prescriptions? This policy would be a simpler and easier solution that values accessibility while guarding against abuse.

Sincerely,
Steven Chang

Report on Medicare Cites Prescription Drug Abuse

To the Editor:

Your recent article about Medicare Cities Prescription Drug Abuse provides important insight into the affects of Part D of Medicare. Your article mentions that about 170,000 Medicare beneficiaries received prescriptions from five or more medical practitioners for 14 types of drugs that are frequently abused. Additionally, you mentioned that Dr. Donald M. Berwick should consider limiting patients who abuse prescription drugs to one prescriber or one pharmacy. However, officials were reluctant to make these changes since they did not want to jeopardize access. What alternative do you suggest? Could it be possible to increase the monthly premium of Medicare Part D in order to decrease the incentive of abuse? Since you also mention that even if an insurer detects misuse of prescription drugs a beneficiary can often get medications from another insurance company. Could another solution be to increase cooperation and access to information across insurance companies?

Sincerely,

Partow Zomorrodian

Berkeley, CA

Report on Medicare Cites Prescription Drug Abuse

Dear Editor:

In Robert Pear's article, "Report on Medicare Cites Prescription Drug Abuse," it was indicated that due to privacy rights hindering clear communication between physicians, beneficiaries can obtain extraneous doses of their prescriptions from multiple doctors. This is disappointing because Medicare is a system designed to help those in need, but tax dollars are instead flowing into the hands of drug addicts and dealers.

I agree with Blum that there should be an electronic system that logs a patient's medication history, confidentially, but alerts a physician or pharmacist when the same medication has already been prescribed. This seems to be the best way to maintain a close watch on patients' use of medication without breaching their privacy rights. Limiting them to one prescriber may appear to be a good short-term solution but ends up restricting patient access to care, which hurts other beneficiaries who are not taking advantage of the system.

Sincerely,

Michelle Leu

Berkeley, CA

Contraceptive Used in Africa May Double Risk of H.I.V.

Dear Editor,

Injectable contraceptives are twice as popular in sub-Saharan Africa as they are in the United States not only because they are long-lasting and convenient, but because they are almost always unable to be detected by male partners. For women whose reproduction would otherwise be controlled by their partner, injectables offer a safe and discrete method of pregnancy prevention.

Well, almost safe. As "Contraceptive Used in Africa May Double Risk of H.I.V." (news, Oct. 4) illustrates, more research is needed to evaluate the risks associated with injectables. Simultaneously, though, as Dr. Lavreys emphasizes in the article, it is imperative that W.H.O. recommend and make available other methods of contraception before changing its position on injectables.

For W.H.O. to simply promote abstinence or condom-use would not address the lack of reproductive control that women in sub-Saharan Africa face. The agency has an opportunity to address this obstacle and recommend other virtually undetectable methods of birth control, such as implants and intrauterine devices.

Sincerely,

Kate Troja

Berkeley, C.A.

Young Adults Make Gains in Health Insurance Coverage

Dear Editor:

In “Young Adults Make Gains in Health Insurance Coverage,” Kevin Sack concludes that there are “900,000 fewer uninsured adults in the 19-to-25 age bracket” due to the Affordable Care Act, which covers dependents until they turn 26. As a student with incurring debts from tuition hikes and plans for graduate school, I am grateful for the Affordable Care Act, which helps alleviate the cost burden of healthcare for a longer period of time. People may argue that others must bear the additional cost that the provision entails, but this does not take into account that young adults will no longer forgo needed care. According to the Centers for Disease Control, chronic diseases are common and costly, yet preventable. Diagnosing diseases at an earlier stage through preventative care and regular checkups will lead to greater savings in the long run by reducing costs spent on treating future chronic illnesses.

Sincerely,
Stephanie Lee
Berkeley, CA

Report on Medicare Cites Prescription Drug Abuse

Dear Editor:

In your article, “Report on Medicare Cites Prescription Drug Abuse,” you reported that some Medicare beneficiaries are abusing their privilege of Plan D by getting prescriptions on painkillers and narcotics in unnecessary amounts for any person. Officials have been investigating this issue but seem uncertain on what actions to take such as limiting patients to one pharmacy or doctor because they do not want to “jeopardize patients’ access to care.”

This is interesting because Plan D of Medicare is funded through general tax revenues, which is currently a hot topic at the White House. Legislators want to raise taxes to fund programs such as Medicare but they don’t seem to realize that some beneficiaries are unfairly spending their coverage on unnecessary items.

One way to avoid this issue is to limit the number of pharmacists and doctors that beneficiaries can see within a reasonable time frame to ensure that patients won't abuse the system. Patients will be more tightly reined in in terms of access to care, but at least it can prevent the funds from being abused.

Sincerely,

Jennifer Nam

Dear editor,

In the “Closing SF health care loophole debates heat up” article, it was reported that last year 860 businesses combined paid “$62.5 million into reimbursement accounts, but only $12.4 million was disbursed” to uninsured employees. However, the new proposal which allows employees better access to the money in their health insurance accounts is unlikely to pass since it “would hurt businesses that rely on the unused money to help keep their operations afloat.”

This is ironic because the San Francisco law mandates that businesses provide funds for health care costs of uninsured workers, but it seems as if the focus of this law is for businesses not to lose money. My perspective is that this is a health care legislation to provide uninsured employees with insurance, so the priority should be the employees and their health insurance. Therefore businesses incentives should not be taken into account. Also the law should regulate how businesses notify their employees of the insurance money accessible to them, since by the numbers, it’s obvious that employees are unaware of the health care money they are provided with. Therefore the solution is more regulation on how businesses provide health care coverage.

Sincerely,

Sarah Jara-Padilla

Berkeley, CA

Young Adults Make Gains in Health Insurance Coverage

Dear Mr. Feyer,

In “Young Adults Make Gains in Health Insurance Coverage,” Mr. Sack writes that there were 900,000 fewer uninsured 19-to-25 year-olds in the first quarter of 2011 than in 2010. Although the number of new enrollees under dependent coverage fell short of the 1.2 million 19-to-25 year olds estimated by the Health and Human Services, Mrs. Sibelius declared, “The Affordable Care Act is working.”

To be fair, better access to high quality and preventive care should lead to a healthier population. Expanding coverage to 19-to-25 year-olds, many of whom are healthy, should also help spread the share of health care costs generated by the sickest people.

But children of parents whose plans do not offer dependent coverage are still left uninsured. So are children of dependents. Until coverage is expanded to those who stand to benefit the most, Mrs. Sibelius cannot truly say that the Affordable Care Act is working.

Sincerely,

Zeyu Xu

Berkeley, CA

"Did Health Reform Drive Up Insurance Premiums? Depends on the Plan."

Dear Editor:

In Sarah Kliff’s article, “Did Health Reform Drive Up Insurance Premiums?” it is shown that ACA mandates have caused health insurance premiums to generally rise across the board, as the ACA requires greater coverage. More coverage, naturally, equates to greater premiums; however, this is not an accurate representation of the impacts on overall healthcare costs which must be considered on a lifetime basis. For example, coverage of a child who previously could not be insured due to a health issue may preempt the unbearable amount a surgery that the child needs down the line may have cost had the child been uninsured. Or, higher premiums due to preventative care may avoid expensive health treatments in the future that would have resulted in medical debt.

Saying that premiums have increased due to the ACA (as unsubstantiated Republican ideological rhetoric does) is not a sufficient analysis of the cost impacts of the legislation. There are many lifetime benefits that cannot be determined at the moment. However, it would be interesting to see if studies can be done to predict these benefits.

Sincerely,

Nikita Khetan

Berkeley, CA