A reporter at Just the News shared our article about a man whose organs were nearly harvested while he was still alive:

Disinformed consent is standard operating procedure in the organ donation industry. And much of medicine. "The sisters said hospital staffers told them the movements were involuntary."https://t.co/tDSp4oCNgL

— Greg Piper (@gregpiper) September 13, 2025

— Greg Piper, Washington, D.C.

Too Close a Call With Organ Donation

When I was a third-year med student doing a rotation on the trauma surgery team, we had a patient in the surgical intensive care unit who had arrived 12 hours earlier with bullet holes in his abdomen. We worked to stabilize him all night; the next day, he was still alive. 

The team determined, however, that although his body was alive, he was likely brain-dead and a candidate for organ donations (“A Surgical Team Was About To Harvest This Man’s Organs — Until His Doctor Intervened,” Sept. 12). 

As we prepared for him to become a donor, I noticed he had a bit of movement. Of course, I was the unknowing third-year med student, so my comments were essentially deemed a nuisance, at best, to the team. (I was, by the way, already a globally recognized researcher in a field distant from trauma surgery.)

Nevertheless, after checking on the patient, I told one of the surgeons, “I think he was trying to communicate with us.”

I was told it was just spinal reflex and I didn’t know what I was looking at.

I couldn’t shake the feeling. I was deeply concerned that I knew what I saw, and it seemed like communication. After our rounds, I went back up to the patient’s bedside, stood over him, and simply said, “Are you able to hear me?”

With a tube in his trachea, stopping any air from entering or exiting (required to make sounds with the vocal cords), he attempted to communicate something in response. The poor guy had an endotracheal tube and was on a ventilator, but because he was given a diagnosis of being brain-dead, he was not being provided with appropriate pain meds and was in and out of consciousness — as best as I could tell. 

I asked him again if he could hear me, and again he tried to communicate with the tube in his throat. It was clear he was absolutely not brain-dead.

I ran and got the team. They evaluated him again — after having already spoken in front of both him and his family about harvesting his organs. This time, the surgeon made a more thorough evaluation. It turned out that he was awake and aware. As they looked him over, they realized he didn’t have bullet holes only in his abdomen; he had a bullet hole through the back of his skull, the bullet still lodged in his brain. During the exam, someone had lifted his head to discover a small, round pool of blood underneath. The bullet in his head went entirely unnoticed in the chaos of trying to stabilize his much more severe hemorrhages.

A CT scan showed the bullet clearly, lodged in the middle of his brain. The neurosurgery team did a procedure to reduce the swelling and pressure in his skull, and he sprang back to life.

The young man, surely a victim of gang violence in South Atlanta, began to interact almost normally with his family over the coming days. For his family, it was almost a rebirth of their child. He had heard the entire conversation about harvesting his organs but could do essentially nothing. It turned out his brain death was documented when he was still under anesthesia, masking his conscience and alertness that would eventually return.

Unfortunately, after an elated two or three days, the man ultimately succumbed to his brain injury.

Still, I will never, ever forget how terrible that experience must have been for him, and, honestly, I don’t know what would have happened if some “naive” third-year med student hadn’t pushed to get the considerably busier surgery team to fully recognize what was happening with their patient.

I deeply appreciate your writing, and I hope it is raising significant awareness.

And I say this as someone with an immediate family member on multiple transplant lists: While I want desperately for lists to move faster, it should never happen at the expense of providing the complete and full dignity that every life deserves. 

— Michael J. Mina, Boston

A radiologist in Denver also posted his thoughts about the article on the social platform X:

This is very rare in the world of transplant surgery. But it should be "never", rather than "rare".https://t.co/yJ3BZkLXND

— Paul Hsieh (@PaulHsieh) September 14, 2025

— Paul Hsieh, Denver

Speaking for Kids With Disabilities

I read the article “Parents Fear Losing Disability Protections as Trump Slashes Civil Rights Office” (Sept. 15) with a renewed sense of purpose. Efforts to dismantle the U.S. Department of Education may be imprudent at best, with little or no consideration for the potential that lies within all of us. I know, because I became a recipient of its special education services after flipping over on my three-wheel motorcycle and landing on my head with the bike over me. I was barely 18 years old and not wearing a helmet. I was in a coma for a week and remained in an acute care hospital for a month. I sustained a severe traumatic brain injury — or, to be more precise, a severe cerebral contusion.

I wish the architects of this federal dismantling could know that I received rehabilitation therapy for over a year and received services through a special education program for more than six years before I graduated with a four-year bachelor’s degree from San Diego State University. I continued on to graduate school and earned two master’s degrees from the University of Southern California.

I established a 30-year career — starting as a lobbyist for the National Association of Social Workers in Washington, D.C., before returning to my home state to finish my career as a research scientist for the California Department of Public Health’s Maternal and Child Health Division. I worked there for 16 years before my retirement in 2020.

We — as children with disabilities — have much to offer to society that cannot be foreseen when we are young. I am the product of dedicated care by my therapists and teachers. This is what I believe the current president and elected officials across the country need to understand. We can be productive citizens when given the chance to thrive.

— Brason Lee, Sacramento, California

A Democratic member of Congress weighs in on X:

Disabled kids are facing great challenges in their schools, and the dismantling of the Department of Education will only worsen these struggles. It is vital we support our students of all backgrounds.https://t.co/pN1cAnRXOd

— Grace Meng (@Grace4NY) September 17, 2025

— Grace Meng, Queens borough of New York City

A Hole in ‘Big Loopholes’?

The article “Big Loopholes in Hospital Charity Care Programs Mean Patients Still Get Stuck With the Tab” (Sept. 25) by Michelle Andrews had one glaring omission: The hospitals are supported by government funding for charity care, but private practice providers — such as the specialists in emergency medicine, anesthesiology, and radiology who were mentioned — are not. Do you expect those providers to work for free? I think, to be fair to doctors, there should have been a mention of that in the article.

— Roger Broome, Galena, Ohio

A science writer in New York shared her thoughts on X about our coverage of Trump administration policies:

These clinics were already stretched thin before the new guidance. That seems unlikely to change given the major staffing cuts at HRSA, which directs funding to community clinics and other HHS programs. H/t @sjtribble and @HMLLarweh at @KFFHealthNews https://t.co/ngit8sP9X8

— lauren schneider (@laur_insider) August 8, 2025

— Lauren Schneider, New York City

When HRSA Hurts, Nursing Suffers

The Health Resources and Services Administration, or HRSA, is vitally important to building and maintaining the strength of the pipeline of new nurses and other clinicians entering our health care workforce. With a growing health care shortage across the country, it’s incredibly important that HRSA be maintained and strengthened to meet the growing and more complicated health care challenges of tomorrow (“Deep Staff Cuts at a Little-Known Federal Agency Pose Trouble for Droves of Local Health Programs,” Aug. 1).

One of HRSA’s most important responsibilities is managing Nursing Workforce Development Programs under Title VIII of the Public Health Service Act. These grants help fund everything from education to practice, recruitment, and retention, particularly in rural and underserved communities. As both a nurse and nurse educator myself, I’ve seen how, for decades, Title VIII programs have strengthened the pipeline by covering scholarships and education to support registered nurses, advanced practice nurses, and nurse educators.

As the U.S. population rapidly ages and develops increasingly complex health care needs, we must ensure we have a robust workforce equipped to provide high-quality care in every community. Unfortunately, the Bureau of Labor Statistics projects an average shortfall of roughly 190,000 registered nurses each year from 2024 to 2034. Complicating this issue, faculty shortages, limited clinical sites, and capacity constraints forced nursing schools to turn away over 80,000 qualified applications last year alone.

Our country must do more to graduate enough students to close these gaps. Maintaining funding and staffing for HRSA is essential to sustain a robust health care workforce and ensure patients’ access to care nationwide.

Policymakers must protect and fully appropriate HRSA in the 2026 budget and beyond. There are countless passionate, smart, and dedicated learners out there ready to step into the roles of nurse and nurse educator. We must protect HRSA to open pathways for them to get there.

— Patty Knecht, chief nursing officer of Ascend Learning/ATI Nursing Education, Downingtown, Pennsylvania

A Michigan reader expresses his opinion succinctly on social media:

Make America Ill Againhttps://t.co/DPFJtfB0fl

— Paul Hughes-Cromwick (Pooge) (@cromwick) August 1, 2025

— Paul Hughes-Cromwick, Ann Arbor, Michigan

Keeping PACE With Vulnerable Seniors

Elder homelessness is one of the clearest symptoms of our broken senior care system, as highlighted in the recent article “Health Care Groups Aim To Counter Growing ‘National Scandal’ of Elder Homelessness” (Aug. 18). Today, too many seniors are walking a tightrope, threatened to be tipped off balance when financial or medical issues arise.

This risk of homelessness is especially prevalent in rural communities, where older adults often have lower incomes, higher poverty rates, and greater prevalence of chronic illness. And while homelessness nationwide rose by less than 1% from 2020 to 2022, rural areas saw nearly a 6% increase — clear evidence that rural community members are being left behind by our current system.

Thankfully, the Program of All-Inclusive Care for the Elderly, or PACE, is uniquely equipped to address these challenges. Often, rural PACE programs like ours encounter participants struggling to get through the winter without heat, living in homes with leaky roofs, or lacking safe wheelchair access. In these scenarios, we can authorize heating installation, arrange urgent repairs, or build ramps that make it possible for our participants to remain safely at home.

These are just a few of the many examples that demonstrate how far PACE providers can, and do, go to ensure our participants can stay in their homes. And, by addressing these issues early, the program is saving Medicaid dollars.

To reduce housing instability among older adults, policymakers at both the state and federal levels should expand eligibility and ensure that PACE providers have the flexibility to act quickly when warning signs appear. By investing in PACE, we can reduce homelessness and build a stronger model for community-based care in America.

— Craig Worland, interim CEO and COO of One Senior Care, Erie, Pennsylvania

Saw mention of an idea on Facebook a couple of days ago and then read your PACE article about senior housing and felt compelled to share. Please pass along to your PACE colleagues and anyone else who can help make this possible. The idea was/is to convert the many closed malls, shopping centers, and big-box stores across the U.S. into affordable housing. Rather than leave them as empty eyesores, decaying and becoming havens for vermin and worse, rather than trying to find and fund land purchases and building from scratch, just think how many thousands of people could be housed! Some spaces could be reserved for essential services — groceries, drugstores, coffee shops, restaurants, salon/barber shops, laundry/dry cleaners, etc. Recreate nature with a walking path complete with live trees and plants, and paint the ceiling like the Wienermobile, where “the sky is always blue!” The possibilities are endless. Go for it! Thanks for the opportunity to share. I’ll be out here advocating and watching for this to blossom!

— Brenda Peters, Charlotte, North Carolina

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Sounding the Alarm for Ambulances

Thank you for shedding much-needed light on the exorbitant costs and lack of reimbursement that have become a harsh reality for many ambulance services across Colorado and the nation (“Insurers Fight State Laws Restricting Surprise Ambulance Bills,” July 9). While it’s vital to protect patients from “surprise” bills — something your coverage highlights — it’s equally important to acknowledge the other side of the equation.

Ambulance providers often receive reimbursements well below the actual cost of delivering care. A recent industry report found that ambulance services are under‑reimbursed by an average of $1,526 per transport, with Medicare alone paying nearly $2,334 less than the cost incurred. These shortfalls are unsustainable and threaten the financial viability of emergency responders.

It’s crucial that ambulance companies have a stronger voice in this conversation. Reimbursement rates aren’t just numbers — they determine whether crews can stay on the road, maintain readiness, and invest in vital mobile health care services. Emergency preparedness relies on stable funding, and when that funding falls short, communities suffer.

By spotlighting the reimbursement crisis, this article helps lay the groundwork for policy solutions. But let’s go a step further: We need to elevate the voice of ambulance agencies themselves, so lawmakers and insurers understand that fair payment isn’t a bonus — it’s essential to keep us safe.

— Patrick Fahey, Weymouth, Massachusetts

A DevOps engineer shared the NPR version of the article on social media:

Families hit hard by surprise ambulance bills-some see debts soar even with insurance. More states are acting, but a national solution may be needed for real protection. https://t.co/Efb6me3Png pic.twitter.com/HRSW5mCdiu

— Michael Bennett (@M1keB_77) July 11, 2025

— Michael Bennett, Denver

‘Congress Is Playing Political Hot Potato With My Health’

I’m 60, self-employed, and living with congestive heart failure. My ejection fraction is dangerously low, and the Affordable Care Act is the reason I can see a doctor, take my medication, and stay alive.

Now Congress is playing political hot potato with my health. If they don’t extend the ACA’s enhanced subsidies by August, my $30 premium could jump to over $800. That’s over 25 times as much. I’m not a hedge fund manager — I’m an independent contractor. Unless I start selling organs (not ideal when your heart’s the issue), I can’t keep up.

I’m too young for Medicare and have no employer plan. I’ve worked, paid taxes, and managed my condition responsibly. So why am I being priced out of care?

If Congress won’t listen, I’m asking you — the press — to help. Tell this story, or one just like it. Millions of Americans are quietly panicking, walking the same tightrope. These policy changes aren’t just math — they’re about human lives.

Because if nothing changes, a lot of us won’t be around to write letters next year.

— Kevin Bahn, Tamarac, Florida

Americans Pay the Price for a Sick Health Care System

I am sure your readers would be interested in how American health care costs compare with those 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 private price for the MMR vaccine is around $13 (in U.S. dollars), provided you have a prescription. Any pharmacy can administer the jab for about the same.

Here in Switzerland, the most expensive country in Europe, this vaccine costs under $40, as a private purchase.

I’ve moved 18 times with family across Western and Eastern Europe and have had expat staff in 35 countries on four continents.

It’s very clear to me now that most national attempts at health care are a costly failure, with few notable exceptions: Germany and, surprisingly, Spain. Then there’s Switzerland, which has among the best health care systems in the world — close to perfect. Basic coverage terms are federally mandated and cost around $430 a month with a $2,500 annual deductible, irrespective of age, after 26. And with a $300 yearly deductible, the premiums are about 40% higher.

Something is very off in the USA. It’s not that complicated.

— Clement Cohen, Geneva, Switzerland

A registered nurse shared his solution for taming Medicaid fraud in a post on X:

“They’ll give you a bone if you stay in the mud.It’s relatively easy to fix the benefit cliff: just phase in a graduated premium for Medicaid based on income above the threshold. If we had political will to do this, it would prompted self-sufficiency.https://t.co/4fxSnmETRd

— Jacob Larsen 🇺🇸 🇩🇰 🇺🇦 (@SLCPaladin) July 22, 2025

— Jacob Larsen, St. George, Utah

Why ‘Start From Scratch’ Vaccine Testing Can Be Dangerous

I anticipate we’ll be hearing more discussion around the use of “inert” placebos — like saline solutions — as the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention approach new vaccine recommendations (“Kennedy’s Vaccine Advisers Sow Doubts as Scientists Protest US Pivot on Shots,” June 27). This type of messaging seems poised to gain traction with the public, despite its ethical implications.

Increasingly, I’m seeing criticism that vaccine development doesn’t rely on inert placebos. This argument is often used to advocate for new clinical trials — even for vaccines already proven effective — and to justify beginning booster development from scratch.

While inert placebos may have been used and were appropriate in early stages of research for vaccines, their use becomes ethically problematic when a safe, effective vaccine already exists. In such cases, withholding protection from participants in a placebo group can put them at real risk, especially during the development of updated or booster doses of vaccines.

I believe it’s critical that organizations like KFF Health News help clarify this issue for the public. KFF is a highly respected, nonpartisan source with powerful communication reach. I’m a subscriber to KFF Health News and appreciate the way your reporting draws in readers with accessible, engaging headlines — and that your articles are available for syndication to other outlets.

Two key points I found buried in an American Academy of Pediatrics article stood out:

• “Many childhood vaccines were tested originally in randomized clinical trials that included placebo or comparison groups. If the vaccine is for a disease that currently has no vaccine, the placebo may be saline or another substance known to be safe. If the vaccine is a potential replacement for an existing, older vaccine, the comparator group may receive the older vaccine that has already been tested rather than an inert placebo.”
• “When a safe, effective vaccine already exists against a disease, giving children in the placebo group no protection against that disease is unethical. Unvaccinated children can contract dangerous illnesses. Parents of children in the placebo group would not know they didn’t get the vaccine and that their child is unprotected.”

That brings up another important question: Who would volunteer for a randomized, double-blind, controlled trial involving an inert placebo for an existing vaccine? People hesitant about vaccines are unlikely to participate, for fear they will receive the vaccine. And those who support vaccination may be reluctant to risk receiving an inert placebo instead of testing the current, older proven version against a new proposed version.

— Alice Henneman, Lincoln, Nebraska

A virologist and podcaster chimed in on the June installment of our “Bill of the Month” series:

A post doctoral fellow at UTMB couldn’t afford the university’s insurance option for his family so he bought a separate plan. It cost him $1400 to get his child the measles vaccine. During an outbreak. Get your vaccines now, before they are not covered. https://t.co/f3wWRouevA

— Heather McSharry, PhD (@PathogenScribe) July 1, 2025

— Heather McSharry, Austin, Texas

A Premium Shell Game?

I read Michelle Andrews’ article today, published in 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 important issue.

You describe as contributing factors: ignorance of the employee, the lack of any requirement that Medicare notify the employee, and the failure of the broker to notify.

Perhaps I missed it, but I believe there’s an important additional factor you didn’t mention: the profit of the commercial insurance carrier. In my experience, folks don’t notice that their primary insurance has changed to Medicare primarily because their employer is still deducting the premium for their commercial group health insurance.

Isn’t it fraud for the insurance carrier to collect premiums for a policy for which the subscriber is visibly no longer eligible by law?

There’s a financial incentive for the commercial carrier not to tell the subscriber that their coverage has ended, and they are now eligible for a Medicare Advantage supplemental policy (with a much lower premium) if they sign up for Medicare: The commercial carrier can collect high premiums, then decline to pay benefits.

You mention that Medicare representatives note they are not required to notify subscribers. Why? Coincidence? More likely, the commercial insurance companies actively lobby against notification.

Also, there’s a financial incentive for hospitals to perform procedures on patients who are 65 or older and still on a commercial plan. Pretty sure the hospital billing office knows quite well they will eventually be able to bill the patient the retail fee, which is typically 10 times as much (or more) than the Medicare-discounted fee.

In my experience, this is not a doctor issue, as the physician rarely pays any attention to insurance details. But it’s very much a billing office issue.

— John S. Smolowe, Menlo Park, California

A reader in Connecticut tweeted his opinion on the risks of cannabis for an aging population:

Normalized cannabis use now will yield a big public health problem later and all the data points in that direction…👇🏼“As Cannabis Users Age, Health Risks Appear To Grow” https://t.co/xNrqqz1k1L via @kffhealthnews

— Brandon M. Macsata 🎗️ (@Purple_Strategy) June 9, 2025

— Brandon M. Macsata, New Haven, Connecticut

Getting Ahead of Known 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 eliminate the National Center for Chronic Disease Prevention and Health Promotion do not align with efforts to address our country’s chronic disease crisis. These plans also further underscore the importance of strengthening America’s public health infrastructure not only to save lives, but also to ensure taxpayer dollars are used wisely.

For each dollar invested in disease prevention, the Trust for America’s Health estimates, $5.60 in downstream costs can be saved nationwide — and this figure is even higher in some states.

But just as cuts to chronic health research will hamper the federal government’s goals of preventing diabetes, heart disease, and obesity, so too do cuts to broader public health funding streams inhibit state and local health departments’ ability to stop outbreaks of measles, drug overdoses, or hepatitis, among many other preventable conditions.

Investments in public health have saved lives and strengthened our country. Identifying emerging threats quickly — whether they come from infectious diseases, zoonotic illnesses, accidents, or injuries — is vital to mitigating them. Unfortunately, federal cuts to vital public health funding streams and programs make it increasingly difficult for our nation’s leaders to understand the threats facing their communities and make the most informed decisions possible to help their communities.

Across the country, public health departments are scaling back staff and delaying plans to adopt better technology due to funding constraints; therefore, many departments lack the resources to detect and respond to threats in a timely manner. Rural and underserved communities that have fewer resources to sustain or replace federal investment are at greatest risk.

Without continued investment in public health infrastructure — from the federal government as well as state, territorial, local, and tribal governments — the impact of future health risks will be multiples higher on both the national health care system and the resources (including government investment) needed to address whatever may be coming next.

To truly improve public health, our leaders at every level of government should be doubling down on public health systems, both infrastructure and technology, as the foundation and path to keep America healthy.

— Eric Whitworth, CEO of InductiveHealth, Atlanta

The CEO of 4sight Health had this advice, posted on X:

Don't listen 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 must pick up the chronic disease prevention torch. https://t.co/SgWYe3KCtp

— David Johnson (@4sighthealth_) July 8, 2025

— David Johnson, Chicago

Preventive Physical Therapy Can Spare You From Injury — And Rehab

Thank you for recently highlighting the critical need for quality physical therapy (“How To Find the Right Medical Rehab Services,” July 15) and providing a comprehensive guide on navigating rehabilitation services after hospitalization. It is also important to note the preventive power physical therapy has before an acute injury strikes.

Physical and occupational therapy services are not just a form of post-accident care but are also proactive, non-pharmaceutical strategies to preserve strength, balance, and independence — especially for our aging population. And research shows that when physical therapy is the first line of treatment for certain conditions like lower back pain — rather than injections or surgery — Medicare Part A/B costs drop by 19% compared with patients choosing injections first and by 75% compared with surgery-first cases.

Moreover, physical therapist-led fall prevention programs have been shown to reduce fall risk, while also cutting emergency room visits, hospitalizations, and opioid use among older adults. These numbers matter deeply in an aging America where 30 million older adults fall each year and the lifetime medical cost of treating falls is over $100 billion annually. And yet, the Medicare system often prioritizes post‑injury treatment over preventive care, delaying access to essential physical therapy until after damage occurs.

In light of our nation’s need for more preventive care, it is time for our Congress to enable easier, earlier access to physical therapy. One way lawmakers can help is by supporting and passing the bipartisan Stopping Addiction and Falls for the Elderly, or SAFE, Act (H.R. 1171). This commonsense legislation would allow Medicare beneficiaries to access no-cost falls risk assessments from the fall prevention experts: physical and occupational therapists.

Incorporating physical therapy into primary and preventive care has the potential to decrease hospital visits, lower health care spending, and preserve our seniors’ independence — goals we all share. It’s time to shift the policy spotlight upstream. Physical therapy has already proved it saves money and improves lives.

— Nikesh Patel, executive director of the Alliance for Physical Therapy Quality and Innovation (APTQI), Sugar Land, Texas

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A podcast producer and director emeritus of WOUB Public Media zeroed in on our article about restless doctors, sharing his thoughts on X:

This must be Trump and Kennedy's idiotic plan to make American Healthy Again…https://t.co/jABfhALnXI

— Tom Hodson (@thodson) May 29, 2025

— Tom Hodson, Athens, Ohio

Oh, Canada Welcomes American Doctors!

The article “American Doctors Are Moving to Canada To Escape the Trump Administration” (May 30) presents us Canadians with welcome news. In every part of Canada, in every province, there are not enough doctors. In our city of Victoria, for instance, many people do not have a family doctor because so many doctors have retired; those who are left are unable to take new patients because their lists are full. Walk-in clinics are overbooked, the emergency rooms at the hospitals all have overfull waiting rooms and doctors and nurses are doing 12-hour or longer shifts. We need doctors and will welcome American doctors here with wide-open arms.

There are many aspects of Canada’s health system that could help lure American doctors to join us. The mortality rate for infants and mothers in the USA is worse than in Cuba. Ours is much better. We do not have a director of national health preaching against the use of vaccination. Our national record for health care during the covid pandemic emergency was second to none. Our women’s clinics are not plagued by political ideology. Our society has always been more open than that of the USA to immigrants and others of all races.

Doctors who agree to work for the armed forces receive special benefits. The experience is known to be valuable and rewarding.

I would also recommend Quebec as a great place to live and work. This would present a valuable opportunity for doctors and their families to learn French. France has a wonderful health service and would be a great place for family members to study and work. Germany is also a great place for medicine and health care. An added plus, besides learning the German language, is that the medical schools and universities, once they accept students, including foreigners, do not charge tuition. No post-graduation debt in Germany. That has proved to be a great policy for Germany. It attracts brainy students from all over the world and ensures the continuing high level of the German health system.

American doctors, Canada is an excellent option for escaping from the threat of autocracy. It can be a very positive step to leave the USA after realizing that the world is open to you and your family. Canada fits Americans comfortably. As our Prime Minister Mark Carney told President Donald Trump in his Oval Office, “Canada will never, never, never be your 51st state.” So, American doctors, pack your luggage, come on over and join us. We will welcome you very warmly and help you in every way we can!

— Philip Maxwell, Victoria, British Columbia

A Seattle reader delivered a diagnosis on X:

So I guess this article and the Dr. Interviewed are far left progressive. The US is better off without them.https://t.co/N7e3UZrb6A

— Daniel Arroyo (@danielarrmaga) May 29, 2025

— Daniel Arroyo, Seattle

Tellin’ It Like It Is, Baby

The article “The New Old Age: Honey, Sweetie, Dearie: The Perils of Elderspeak” (May 9), hit home for me.

Several years ago, my health plan referred me to an ophthalmologist’s practice. After one appointment, the woman who was supposed to schedule me for my next one called me “Sweetie.” I don’t remember what I said, but I took umbrage and walked out.

There were other problems (the doctor who examined me didn’t introduce himself, for one thing). I went home and wrote a complaint letter to my health plan. They gave me another referral and reported the practice to Medicare.

I only wish I had read this article a month ago. I had a biopsy in a hospital last month, and one of the nurses spoke to me as if I were a 2-year-old. I would have been prepared to deal with this then.

— Sue Kamm, Los Angeles

The director of the Pitt Band at the University of Pittsburgh threw down the gauntlet on X:

Any who addresses me with "Elderspeak" will be dealt with harshly. You've been warned.https://t.co/iaHAfVlCqN

— Harry Bloomberg (@pittbandphoto) May 3, 2025

— Harry Bloomberg, Pittsburgh

Don’t Gamble With Children’s Lives

Concerning Health and Human Services Secretary Robert F. Kennedy Jr.’s recommendation that healthy children needn’t receive the covid vaccine (“Trump’s Team Cited Safety in Limiting Covid Shots. Patients, Health Advocates See More Risk,” May 23), have pre-vaccine complications such as multisystem inflammatory syndrome in children been forgotten? A western Michigan child lost both hands and both feet to MIS-C and will go through life with prostheses. Please remind people of these serious complications which, though infrequent, cannot be reversed. Not vaccinating is playing Russian roulette with your child!

— Gloria Kohut, Grand Rapids, Michigan

An upbraiding on X came from a reader Down Under:

This decision – apparently made without any expert consultation – will have international ramifications, especially among the vaccine sceptical. https://t.co/hOaOuWBX3T

— Lesley Russell Wolpe (@LRussellWolpe) May 27, 2025

— Lesley Russell Wolpe, Sydney, Australia

Core to California’s Prosperity: The Fruits of Immigrant Labor

I found your article to be incomplete when it comes to offering the perspective of undocumented immigrants (“After Promising Universal Health Care, California Governor Must Reconsider Immigrant Coverage,” May 13). According to the Institute on Taxation and Economic Policy, undocumented immigrants contribute $8.5 billion to the California economy. It is disingenuous to present the cost of medical expansion to undocumented immigrants as a type of handout, when it is widely known that undocumented immigrants work without any prospect of receiving the benefits of their work in social programs. The fact that Gov. Gavin Newsom made the effort to expand benefits to undocumented workers was the right thing to do, and we should work toward rearranging funding to continue the expansion and not retrench during a time when unidentified people are apprehending undocumented workers on their way to work and more than ever face the possibility of suffering human rights abuses. If you, as a news organization, don’t do them justice by inserting their contributions into the discussion, then you are being complacent to their dehumanization.

I grew up in Oxnard, California, and my entire life was surrounded by the fruits of farmworkers’ labor, many of whom were undocumented. If you drive up and down Rice Road at 5 a.m. every day, you will see hard-working people who, during the wintertime, have to stay during the night to warm up the crops. That type of love and dedication to their work — not for their benefit, but for their families and the state of California — should be recognized. I invite your readers to look for “Fresh Fruit, Broken Bodies” by Seth Holmes to start understanding the physical toll that working in the fields takes on young immigrants, even when they arrive as healthy bodies. Still, after years of working in the fields, they face a multitude of health problems and overall physical deterioration. They give their bodies in exchange for an American dream that may or may not materialize.

Undocumented farmworkers fill just one essential sector of the American labor economy that does not stop even during fires or pandemics, so please do better in highlighting the humanity of folks who are more than just the work they produce. It is essential to state that if it weren’t for their cheap labor, the Golden State would not be so golden. Look at Florida, where the criminalization of undocumented workers is leading to labor shortages now intended to be filled by children.

Health care is a minimum that can be provided for undocumented workers, not because of any other reason than health care is a human right, and undocumented workers pay their fair share in unclaimed social benefits. Health care for all!

— Jennifer Diana Figueroa, Oxnard, California

A sociologist who directs social policy at the Niskanen Center, a nonpartisan think tank, weighed in on X:

No matter what advocates told themselves and policymakers, it was never politically sustainable:“It’s making people look at the health care that they can’t afford and ask, ‘Why the hell are we giving it for free to people who are here illegally?’” https://t.co/uOUIqhJJKJ

— Josh McCabe (@JoshuaTMcCabe) May 14, 2025

— Josh McCabe, Lowell, Massachusetts

Improving a Prisoner’s Life Sentence

I was very impressed with “Prisons Routinely Ignore Guidelines on Dying Inmates’ End-of-Life Choices” (May 15), authored by Renuka Rayasam. I have visited prison twice: once to San Quentin as a member of the Berkeley YMCA wrestling team in 1963.

Then, in 1999, I was privileged to be appointed to a new American Hospital Association committee, the Circle of Life Awards Committee, which was created to recognize the most outstanding and innovative hospice and palliative care programs in the country. Among the many applicants in the first year was the Louisiana State Penitentiary Hospice, and it was selected as one of five finalists for a site visit in 2000. I indicated my interest in being a member of the site visit team. This prison, commonly known as Angola, is the nation’s largest maximum-security facility, and we were told prisoners sentenced to life will die there because there was no parole in Louisiana for such a sentence. We were also informed that there was a long waiting list of inmates wanting to be hospice volunteers because the program was so highly valued.

My most distinct memory of our visit was a conversation with a volunteer who said he had just come from bathing and feeding a terminally ill inmate who said, “I love you.” The volunteer was visibly emotional when noting he had never heard these words before, not from his father whom he never met nor even his mother. These comments clearly demonstrated the beneficiaries of the program were not just the patients; they were also the volunteers.

— Paul B. Hofmann, Moraga, California

On X, another reader from Australia dove into a discussion about fluoridation of drinking water in response to our coverage:

https://t.co/Um9QawAqKDRFK making tooth decay great again

— Dan Jago (@dj1au) March 28, 2025

— Dan Jago, Melbourne, Australia

How Fluoride May Hijack Thyroid Health

Stories about fluoride seem not to mention the chemical’s impact on thyroid health (“With Few Dentists and Fluoride Under Siege, Rural America Risks New Surge of Tooth Decay,” March 27). This seems an oversight because it’s estimated that 10%-20% of the population will have thyroid issues in their lifetimes.

When I was an unmedicated hypothyroid person — not taking any supplemental thyroid hormone — I frequently had cavities. After filling the cavity, my dentist would do me the favor of treating my teeth with fluoride. And then followed a period of lassitude so severe I felt my job was at stake, definitely placing me in the “fat and lazy” category, as described by Ozark Mountain Regional Public Water Authority Chairman Andy Anderson in your article. It took me several treatments to make the connection.

I don’t get cavities now and haven’t for about 20 years. I think my now-appropriate dosage of supplemental thyroid plays a role in that.

Studies about thyroid and fluoride vary in their conclusions. Thyroid deficiencies can have widely varied effects on our widely varied population. There may never be widely accepted guidelines. But people should be careful about what they put in their bodies.

— Joy Mullett, Houston

A self-described information technology health care entrepreneur stated his opinion simply while sharing the article on X:

FLOURIDE is poison!https://t.co/Oaw0p1JG4N Daily Health Policy Report&utm_medium=email&_hsenc=p2ANqtz–TOtkdDDnhvAyd8nDZIAFejJobpsKBnLP5smKnlslyZjSC6tT9BHFfvtjE8tnngMhNn7huZCl4MKi1CdAi0QtZkvWmew&_hsmi=353879828&utm_content=353879828&utm_source=hs_email

— Earl Winter (@EarlWinter8) March 27, 2025

— Earl Winter, Nashville, Tennessee

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Trump Team’s Rhetoric Doesn’t Match Actions

The recent KFF Health News article “Beyond Ivy League, RFK Jr.’s NIH Slashed Science Funding Across States That Backed Trump” (April 17) struck a nerve. The rapid succession of suspended National Institutes of Health grants that swept the country shortly after President Donald Trump’s election have left us struggling to understand why such vital research — the bedrock of our ability to support the public’s health — would be treated as unnecessary or, worse, harmful.

People often think research, per se, doesn’t directly affect them. But research forms the basis for what we know will best work to treat, prevent, and manage illness, from chronic diseases such as diabetes, hypertension, and HIV, to mental health disorders. In addition to basic and applied research, NIH grants provide services directly to individuals and families, and they build community-based systems of care for its residents. We all benefit.

One area where federally funded research and programs have been especially impactful is in addressing the substance use crisis in America. With relatively modest investments, addiction science has led to enormous personal, societal, and economic benefits. Accomplishments include the treatments we use to break the cycle of addiction for millions of people, strategies for communities to support families with substance-related problems, prevention programs that divert youth away from substance use, and policies that reduce crime, suicide, overdose, and substance-related conditions like hepatitis and liver disease. Although we’re not done yet by any measure, these accomplishments have produced considerable returns on investment in personal and economic terms that are now at risk.

Out of a high level of concern, a group of career scientists formed the Addiction Science Defense Network to protect addiction research and evidence-based practice from actions by this administration. The number of researchers, practitioners, people with lived experience, and national organizations expressing their support for ASDN’s mission is growing into the hundreds. The Trump administration touts its commitment to reducing addiction, but its action don’t match the rhetoric. By curtailing research and funding for science-based solutions, we are practically assuring that the problem will continue to worsen over time. And, as underscored in Rae Ellen Bichell and Rachana Pradhan’s article, given that rates of drug overdose are highest in red states, predictions are that Trump supporters may suffer most of all.

— Diana Fishbein, Nova Institute for Health scholar, ASDN Coordinating Committee member, and University of North Carolina senior scientist, Chapel Hill, North Carolina

Staying Afloat Amid Federal Funding Cuts

Your article “Moms in Crisis, Jobs Lost: The Human Cost of Trump’s Addiction Funding Cuts” (April 25) mentioned that the Niyyah Recovery Initiative may be affected by losing federal funding. But it has been provided a state grant not associated with federal money in the sum of $200,000 a year through 2027. Presumptive speculation on how its services would be affected should have been disclosed.

— John Smythe, Fort Lauderdale, Florida

[Editor’s note: A bill to provide Niyyah Recovery Initiative a one-time $200,000 appropriation was introduced in the Minnesota Legislature in April 2025. As of May 12, it had not received a hearing or vote, meaning the payment had not been made.]

Count the Blessings of Direct Primary Care

While I am almost always a fan of the work that KFF Health News and NPR publish, particularly together, the article “In Rural Massachusetts, Patients and Physicians Weigh Trade-Offs of Concierge Medicine” (April 16) contained a mischaracterization that was pretty disappointing.

The author suggests, and a photo caption states, that “direct primary care is similar to concierge medicine but does not accept insurance.” While it’s true DPC patients and concierge patients both pay membership fees, they couldn’t be more different. The membership fee for concierge practices just gets you in the door — patients still pay copays/coinsurance or, in some cases, full out-of-network price, for every service. With direct primary care, your monthly cost — typically (I’ll hedge, though I haven’t seen any exceptions) — includes unlimited visits, in-house procedures and tests, and telemedicine appointments. Many even offer the ability to text-message your doctor when you need medical advice on a more urgent basis.

I’m not affiliated with the DPC industry in any way, I’m just a former patient. DPC changed my life. I felt for the first time as an adult (I am 33) as if I had actual, genuine health care. Not worrying about the drudgery of fee-for-service meant I didn’t hesitate to get, say, tested for flu and covid-19 when I had a respiratory illness, have skin issues looked at, or finally get care for long-standing issues. The fact that I had a high-deductible health plan only rarely mattered. For $100 a month, it was an absolute steal, and I was a cheerleader for everyone in my area who could afford it. At least a few folks who were uninsured or severely underinsured got health care thanks to that practice, which unfortunately is no longer serving primary care.

DPC has its thorns. Certainly, not everyone can afford a monthly fee. Access can be limited by capped patient loads. But, on the whole, DPC is a blessing for many people, and it’s simply unfair to paint it with the same brush as concierge medicine. I hope to see better from KFF Health News and its partners in the future.

— James Joyce, Opelika, Alabama

I got fed up with the feeling of being on a medical hamster wheel and switched to a concierge doctor. I feel like a patient instead of a name on a chart.

— Nailyard (@nailyard.bsky.social) 2025-04-16T16:34:19.766Z

— Ian Carter, Hillsboro, Oregon

Some Medical Debt Is Clearly Fraud

Be aware that false unpaid medical bills are sold to collection companies in bulk along with legitimate paid charges (“Diagnosis: Debt: Blockbuster Deal Will Wipe Out $30 Billion in Medical Debt. Even Backers Say It’s Not Enough,” April 7).

I went through cancer treatment in 2023. I paid all my legitimate charges after my Medicare Advantage plan paid. I paid regularly and on time. But I made sure I received my explanation of benefits (EOB) from my insurance company before I paid any additional fees. Those EOB statements list legal charges and billing.

In February 2024, I received new statements from SSM Healthcare for the infusion center, doctors, and hospital. These statements were for charges that were a year old and listed as paid in full in 2023. The SSM system sold some of that fake debt to a collection agency. I sent that collection company proof of payment and the paid-in-full statements that were still in the MyChart billing system.

Patients who go through chemotherapy, surgeries, and treatments for severe disabling conditions often also have cognitive deficits afterward. These cognitive problems may be short-term, but they can be extreme. False medical billing and fraudulent charges are often purposely used in these situations to take advantage of patients’ cognitive deficits. The medical systems utilize the false debt scam to sell it to collection companies to make a profit on essentially nonexistent debt. This system defrauds patients and the debt collection industry.

The elderly and disabled patients end up paying the legitimate debt and the fraudulent debt. The “unpaid” medical debt is bundled in such a way as to be impossible to identify as fraudulent or legitimate. Disadvantaged individuals aren’t capable of managing the documentation to prove their debt was paid, and the collection companies frighten and bully those individuals.

How much of the debt written off by Undue Medical Debt was legitimate? No one will ever know. But there’s a much larger issue than the simple belief that people don’t pay medical bills. Organizational fraud is likely responsible for a large percentage of the debt that companies like Undue purchase and utilize for profit.

— Diana Rickles, Ballwin, Missouri

Blockbuster Deal Will Wipe Out $30 Billion in Medical Debt. Even Backers Say It’s Not Enough. — yes, it's not enough, but it's something https://t.co/0G06f8DoHh via @kffhealthnews

— Ellen Andrews (@cthealthnotes) April 7, 2025

— Ellen Andrews, Hamden, Connecticut

Don’t Hesitate To Sound the Alarm

I am a regular watcher of “CBS Mornings” and always appreciated Dr. Céline Gounder’s reports during the covid-19 pandemic. But I found her report March 28 on CBS much too meek in the face of a devastating effort on the part of Robert F. Kennedy Jr. to slash the Department of Health and Human Services workforce by 25%.

This is catastrophic for disease prevention and future medical science — as well as the flight of talent from the U.S. to other countries. Dr. Gounder mentioned people from Yale leaving for Toronto. But Dr. Gounder should have been more assertive and sounded a greater alarm than just saying the impact of these cuts “remains to be seen.” For heaven’s sake! These cuts are catastrophic — not only for America’s health, but for the 20,000 talented people who have been shown the door. Dr. Gounder: You need to be more assertive and alert Americans that this is a tragedy.

— Uldis Kruze, El Cerrito, California

Today in NIMBY Land: Neighbors are now stopping hospitals in SIX different states from opening up psychiatric centers for children amidst a psychiatric bed shortage. Ugh. Great story from @EricLBerger @KFFHealthNews: pic.twitter.com/5XrHy2Zqjt

— Lawson Mansell (@lawsonhmansell) April 23, 2025

— Lawson Mansell, Washington, D.C.

We Must Prioritize Children’s Mental Health

As a concerned member of our mental health support community, I write to highlight an urgent issue that too often goes unnoticed: the mental health of our children (“More Psych Hospital Beds Are Needed for Kids, but Neighbors Say Not Here,” April 11). With rising rates of anxiety, depression, suicide, and behavioral challenges among youth, it is imperative that we take collective action to prioritize mental well-being just as seriously as we do physical health.

Children today face a unique set of stressors — from academic pressure and social media to family instability and global uncertainty. These factors can significantly affect their emotional development and overall well-being. Yet, despite the growing need, access to qualified mental health professionals, school counselors, and community support services remains limited or unaffordable for many families. Not all hospitals are equipped for mental health cases, and the number of psychiatric beds available is often little to none. A child in mental health crisis should not have to wait days or weeks to find treatments. Parents shouldn’t have to watch their child struggle and not have their concerns taken seriously. If a child goes into a hospital with a broken bone, it is immediately treated; the parents aren’t given numbers for places to call in hopes that they can be seen in a few days.

We must advocate for policies that ensure mental health screenings in schools, expand funding for youth-focused services, and promote training for educators to identify early signs of distress. Hospitals and mental health facilities need to be prepared and equipped to take in patients, not turn them away. Children should never be unable to receive treatment because of a lack of a bed. Our children should be our priority, not an afterthought of what a care facility will do to the neighborhood. No child should suffer in silence due to a lack of resources or awareness.

Investing in children’s mental health is not just compassionate — it’s smart. Healthy, supported children are more likely to succeed academically and socially and, ultimately, become well-adjusted adults. Let’s ensure that every child has access to the help they need.

— Jennifer Groseclose, Leeton, Missouri

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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What’s Up With Our Wheat?

Great article (“How the FDA Opens the Door to Risky Chemicals in America’s Food Supply,” March 10). Another topic that needs more research is the fact that the FDA allows glysophate to be sprayed on wheat for human consumption to kill it off before harvest. It is then harvested seven days later and processed for food. In beans and corn, it is applied months before the food portion is developed, so it’s not as big of a concern. The question would be: How much residual glyphosate is still in the wheat when harvested? Does the FDA know, or care? What are the health ramifications?

— Irving Geary, St. Croix Falls, Wisconsin

A small farm in North Carolina’s Forsyth County that shuns herbicides, pesticides, and chemical fertilizers shared the article on the social platform X:

What reasonable (not corrupt) person thinks it’s a good idea to let food companies determine whether their ingredients & additives are safe. Companies don't have to tell the FDA about those decisions, and they don't have to list all ingredients on labels. https://t.co/ndRTNXDKmD

— Amber Lake Farm(stead) 🕊️ (@AmberLakeFarm) March 13, 2025

— Amber Lake Farm, Lewisville, North Carolina

CT Scans, Done Safely, Are Worth the Radiation Risk

Together with our colleagues, we read with great interest your recent article “Some CT Scans Deliver Too Much Radiation, Researchers Say. Regulators Want To Know More” (March 12). We share the crucial concern of patient safety, a mandate that has driven and can further drive technological innovation in imaging. But we note that there is an even more important mandate that should concern us all: imaging benefit.

We believe that the article overemphasized the risk associated with medical radiation exposure, and that such a fear-inducing approach to radiation protection is harmful to patients. We agree that extra care should be exercised when prescribing a diagnostic imaging study, especially in vulnerable groups, like pediatric and pregnant patients. However, once an exam is deemed medically necessary, its benefit is already judged to outweigh any potential risk. With the justification of the exam settled, the main challenge is how to perform the exam as best as possible for the medical need at hand. In that task, prioritizing radiation dose reduction over other considerations can potentially be detrimental to the patient. Radiation safety is a priority but only together with the quality of the diagnostic information for the clinical need.

We recently published a study in Nature Communications Medicine on a population of 1 million digital twins simulating the U.S. population, and we found that the clinical benefit associated with a radiological procedure largely outweighs the radiation risk, by at least a factor of 4. The finding, that the benefit of detecting a problem is worth the small potential risk of radiation, is contrary to common belief. This study shows that putting so much emphasis on radiation safety to the tune of avoiding exams or reducing dose to make the exam “safe” would make the overall procedure less safe by negatively impacting patients’ path of care. Exaggerated dose reductions can harm patients. That is not safe!

Diagnostic imaging exams are prescribed with the specific purpose of finding information that’s essential in improving patient’s life, and to diagnose or rule out pathologies. As health care professionals, it is our duty to offer the best care to patients, and to achieve the best diagnostic performance while exposing patients to the lowest risk possible. Excellence does not arise from spreading irrational fears. Excellence can be attained only with the careful assessment and balance of risks and benefits. And the successes of modern medicine are the irrefutable proof of the irreplaceable diagnostic imaging benefits.

— Francesco Ria and Ehsan Samei, Duke University Health System, Durham, North Carolina

A reader who manages a website predicting the collapse of the American health care system commented on X:

It’s careless work. This is more sobering proof of the huge management knowledge gap that’s ruining US healthcare from within. Medical errors are the same carelessness that is killing more than 400K patients each year, harming millions, and costing about $80 billion annually.

— Francis Anthony Toto (@francisatoto) March 12, 2025

— Francis Anthony Toto, San Diego

I’d Take Mushrooms Over Pills Any Day

Your article “The Colorado Psychedelic Mushroom Experiment Has Arrived” (March 24) states: “Psychedelic mushrooms and their psychoactive compound psilocybin have the potential to treat people with depression and anxiety, including those unresponsive to other medications or therapy.”

In my experience, they work for a couple of months after just one use, and they do not have the lasting side effects of prescription drugs, which rarely work as intended for depression or anxiety. I wish I had been given the option of microdosing mushrooms instead.

I’ve never met an antidepressant that worked for me and didn’t require multiple other medications to offset the side effects of the first pill, and it took two weeks or more to start working. Then, another 30 days or more are required to stop the ill effects, and you figure out that the side effects are far worse than any benefit.

You can’t just stop taking the pills, or you risk psychosis. Been there, done that. The type of craziness these pills unleashed on me and my family was due to my having to stop them abruptly, leaving scars on our entire family. Following the doctor’s advice to start antidepressants is the biggest regret of my life.

— Lori Muir, Helena, Alabama

I could become a psychedelic healer. Vermont is not good for my head. https://t.co/ee3q3pw1eQ

— Cassandra Carbee (@blackeyedcat69) March 20, 2025

— Cassandra Carbee, Wells River, Vermont

What’s in a Name?

What does KFF stand for? Is it Kaiser Family Foundation? Something different? I just want to understand what KFF stands for. Thank you.

— Margaret Chinn, Alameda, California

Editor’s note: Years ago, the organization was known as the Kaiser Family Foundation, but since it’s not part of Kaiser Permanente, nor a foundation, and doesn’t make grants, it’s clearer to simply say KFF, which is how many people already know and refer to it. KFF is a unique health policy information organization that brings together policy research, polling, journalism, and public information campaigns. KFF Health News is one of its core programs. You can read more about the organization’s history here.

Three Timely Levers for Addressing Disparities in Cancer Care

Over the past decade, the United States has witnessed a revolution in the development and approval of cancer-fighting drugs. From 2017 to 2021, the FDA approved an average of more than 50 new cancer drugs each year — an increase of about 40% from the previous five years. FDA approvals for cancer treatments are expected to accelerate as artificial intelligence further speeds up drug discoveries and trials.

While this rise in treatments is promising, disparities in access to cancer care are widening.

As foreign-born cancer doctors from low-income countries who have practiced in both urban and rural areas in the U.S. for nearly three decades and are particularly sensitive to equity issues, we call on the U.S. medical ecosystem to work toward eliminating disparities in access.

These new drugs provide hope for the 2 million Americans diagnosed with cancer each year and their loved ones. Thanks to the dedicated and brilliant researchers, pharmaceutical companies, and funders — including nonprofits and government — for identifying and rigorously testing these novel drug discoveries.

Given the rapid increase in FDA-approved drugs, we must now work toward ensuring that these breakthrough treatments improve outcomes for all patients. This is not a given. Especially in the U.S., which suffers from great disparities in access to quality cancer care and outcomes.

Rural, low-income, and minority patients typically experience cancer at a higher rate, receive a diagnosis at a later stage, and face geographic and financial barriers to accessing cutting-edge, quality care.

At the moment, the most powerful three levers for addressing these unconscionable disparities lie in Washington, D.C., not your doctor’s office.

First, it is critical for the Trump administration to expand, not roll back the Affordable Care Act, also known as Obamacare, which has played a crucial role in reducing disparities by expanding Medicaid in rural and poor communities and ensuring coverage for preventive services. If the ACA is trimmed or eliminated, we can expect cancer disparities to grow quickly and dramatically.

Second, Congress must act quickly to permanently extend the coverage of telehealth and telerehab services, which can help patients in rural areas access equitable, convenient cancer care and support cancer survivorship. Medicare coverage for telehealth, which was extended during the pandemic, was set to expire this month.

Third, counterintuitively, the exponential rate of innovation in the cancer drug development sector is itself a threat to equity. The American Society of Clinical Oncology has warned, “Rapid advances in cancer care will worsen existing disparities in outcomes for rural patients.”

That’s because new treatments are more quickly integrated into standard care regimens in large cancer centers in urban areas — accessed by higher-income patients. The government needs to prioritize addressing the systemic knowledge gaps and economic factors that drive these disparities and initiate preventive and corrective measures.

We know this will take time to untangle. But our leaders in Washington, D.C., can protect the ACA, support telehealth and telerehab, and lead the way toward reimagining the health system that delivers lifesaving care for us all.

— Binay Shah, a Seattle-based hematologist-oncologist and the co-founder of the nonprofit Binaytara, and Manish Kohli, a professor of oncology at Huntsman Cancer Institute

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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A chronic-pain patient advocate, who has been featured previously in KFF Health News coverage, spoke out on the social platform X about our “Payback: Tracking the Opioid Settlement Cash” project:

Oh, look an entire investigation, of course partly by shatterproof, looking at where the settlement funds are going, and where they should go. Not one mention of pain patients as forgotten victims. Because we’ve actually been erased from the entire thing. https://t.co/LsHFs9tFwu

— Bev Schechtman🇮🇱 (@ibdgirl76) December 17, 2024

— Bev Schechtman, Clayton, North Carolina

Rooting Out the Root Cause of the Opioid Crisis

I read with interest your detailed coverage of how states are spending billions of funds from the opioid crisis (“Payback: Tracking Opioid Cash: How Are States Spending Opioid Settlement Cash? We Built a Database of Answers,” Dec. 16). The bigger story is health advocates and policymakers need to march upstream if we are to beat the “illness industry” players in illicit drug-making, distribution, and sales on our streets.

What should not be overlooked by those interested in solving this public health crisis (legislators, health department officials, and law enforcement and court system leaders) is that such downstream efforts, even when supported by unimaginable funding, does little to prevent those pushing our citizens into the quicksand of individual, family, and community destruction and death. Certainly, such mitigating and treatment programs and services are needed, but little attention is given to rooting out the root cause of the opioid/fentanyl epidemic.

It is easy and popular to damn the corporation, but it takes courage, real work, and much risk to confront Mexico’s drug cartels, Mexico’s government officials, the Chinese Communist Party, and any of their ostensible “leaders.” Furthermore, it is embarrassing to have to confront our own public officials, from the president on down, to stop aiding and abetting this carnage!

If no serious action is taken to work on upstream causes of our opioid crisis, no amount of lifeguarding and posting of warning signs will prevent bodies from struggling in this rip current of drug addiction. The silence and omission of any action from those who have taken the oath to defend and protect the public is creating a moral hazard for all citizens. Consequently, many more people will die, with nary a word against who is pushing them to such destruction.

— Stephen Gambescia, Philadelphia

A retired assistant surgeon general and epidemiologist weighed in on X about an article on the nation’s shortage of primary care providers:

Misdiagnosis. Young people choosing not to become primary care physicians after leaving med school will not be fixed by free tuition for the highest paid profession in America. Fix govt incentives about graduate medical education & reimbursementhttps://t.co/tPgeFVrzql

— Dr. Ali Khan (@DrAliSKhan) January 14, 2025

— Ali Khan, Omaha, Nebraska

Osteopaths Have Big Hand in Filling Primary Care Needs

I appreciate Felice J. Freyer’s insightful Jan. 13 article, “Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline?” As an osteopathic physician and medical educator, I can confidently answer this question with a resounding “Yes!” Osteopathic medical schools have long been at the forefront of this issue by emphasizing core principles of primary care as they train future physicians, a mission embedded in our philosophy since 1874.

Osteopathic medicine is founded on four key tenets that emphasize the interconnected nature of the body, mind, and spirit and the importance of whole-person care. These tenets have guided many of this country’s nearly 150,000 DOs (doctors of osteopathic medicine) into primary care roles. More than half of DOs enter residencies in the primary care specialties of family medicine, internal medicine, and pediatrics.

As mentioned in the article, “Many medical students start out expressing interest in primary care. Then they end up at schools based in academic medical centers, where students become enthralled by complex cases in hospitals, while witnessing little primary care.” This is a major part of the problem. Most Americans, more than 80%, will never be treated in a large academic medical center. Osteopathic medical schools have flipped the script.

Osteopathic medical schools, as well as some newer MD-granting schools, employ a community-based distributed education model, training students in settings such as rural clinics, community health centers, and physician offices where they will encounter underserved populations benefiting from primary care treatment. Training in underserved areas makes medical students almost three times as likely to stay in those areas to practice, and four times as likely to practice primary care in those locations.

I thank Freyer for shining a spotlight on the essential role of primary care and the contributions of osteopathic medicine. The osteopathic medical education community remains committed to working to ensure that underserved communities receive the care they deserve, and that primary care continues to thrive as the backbone of our health care system.

— Robert A. Cain, CEO and president of the American Association of Colleges of Osteopathic Medicine, Bethesda, Maryland

A family doctor and teacher shared the article on X:

The answer is that they can, but they won't try. Financial and public good incentives for schools are not there. Can Medical Schools Funnel More Doctors Into the Primary Care Pipeline? https://t.co/REsfJtfmmh via @kffhealthnews

— John Frey (@jjfrey3MD) January 14, 2025

— John Frey, Grayslake, Illinois

On Immunity for Vaccine Makers

When discussing vaccination in general (“Childhood Vaccination Rates, a Rare Health Bright Spot in Struggling States, Are Slipping,” Jan. 16), please address the federal legislation surrounding this topic.

According to 42 U.S. Code § 300aa–22, vaccine producers have immunity in civil court. It reads: “No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after October 1, 1988, solely due to the manufacturer’s failure to provide direct warnings to the injured party (or the injured party’s legal representative) of the potential dangers resulting from the administration of the vaccine manufactured by the manufacturer.”

And there is only one federal National Vaccine Injury Compensation Program, also known as “vaccine court,” to hear all vaccine-related injury cases involving children. And its case backlog is at least a decade long.

In everything else, when a product or service causes harm, there is accountability through the process of civil suits. What other manufacturer of a product has such legal immunity?

The issue with this is there is no true measure to create accountability with vaccine products. And vaccine makers aren’t required to display ingredient labels. So, we may be injecting our children with unknown substances, from a manufacturer who has no judicial accountability if harm results from the use of the product.

Now, what parent wants to subject their child to this? This is a big deterrent to parents vaccinating their children. Emotional appeal will not dissuade parents, but correcting this legal fallacy will.

— Alesia Wright, Tulsa, Oklahoma

An Indiana dad expressed his opinion on X:

Indiana's childhood vaccination rates have dropped significantly since the pandemic too.Some people are just going to have to learn the hard way, apparently. Sad that the only way that happens, however, is by gambling with their kid's health.https://t.co/S9UgXAlAc6

— Steve Garbacz (@Steve_Garbacz) January 14, 2025

— Steve Garbacz, Fort Wayne, Indiana

As a retired primary care physician, I was often frustrated that my management of complex medical conditions was reimbursed at lower rates due to a required treatment code (“Perspective: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery,” Dec. 13). Blaming the physician for the discrepancy is inappropriate. The Centers for Medicare & Medicaid Services has strict regulations on billing. We are mandated to code per the regulations. We cannot give “discounts” for procedures. To do so would be problematic in the bizarre catch-22 world of Medicare billing. We are mandated to report our services accurately using only the codes available. To do otherwise is considered fraud by Medicare. When a physician is accused of fraud, he/she is presumed guilty and pays significant financial penalties until innocence is proven. Even a murderer or thief has more rights in the judicial system.

Medicare determines the lowest reimbursement rate; the other carriers pay a higher rate based on that rate. If an individual physician accepts Medicare, he/she must accept that rate. Only a non-participating physician (not accepting Medicare) can offer a lower rate. The exception is if the service is provided at no cost. Should the patient demand the service be provided free?

I’m reminded of the plumber charging $100 to replace a washer: 10 cents for the washer and $99.90 to know how to replace it.

— Robert Sullivan, Adairsville, Georgia

On X, a New England surgeon summed up his views:

We have lost “caring” – "How Everything Became Surgery" from The Washington Post. Read on @Doximity https://t.co/msHja8wsg5

— Rafael Grossmann, MD, MSHS, FACS 🇻🇪🇺🇸 (@ZGJR) December 20, 2024

— Rafael Grossmann, Bangor, Maine

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

‘Solo Agers,’ Join the Crowd!

Enjoyed your panel discussion (Watch: ‘Going It Alone’ — A Conversation About Growing Old in America, Dec. 12). I am 85, retired at 55. Traveled (birding) in 65 countries. In 2010, I created the First Friday Ideas Salon. We just had our 171st gathering, via Zoom. I curate each gathering. Last month, we hosted a conservator and a scientist from the Getty Museum. The month before: a Caltech professor on robotics. I have had many professors, a Nobel Prize winner, MacArthur Foundation “genius grant” recipients, a presidential candidate, etc.

Recently, I became interested in the issue of how retirees whose professions defined their persona can, after age 80, as a “senior senior,” continue to be a person of substantiality. I created the Glorious Age of Aging to look at this issue over six hourlong meetings over three months. The focus was on “action steps.”

So, for me, as a “solo ager,” the key has been to take action. That said, I worry about the time when my body does not keep up with my mind. Actually, I would say my body has declined and my ability to take care of things required in my life. So, I have prepared food delivered. I hire people to help with my beloved succulent garden and with other chores — so far, young people in my neighborhood. I live in Los Angeles with famously poor public transportation. I use Uber as well as drive. So I wonder if I will be able to continue to find services that will support my living alone. And the real worry is the process of dying — not death — I do not worry about that. Recently, I have decided that I need to create an “intentional community,” which will be there when I need it. I am just beginning to think about how to do this.

— Edna R.S. Alvarez, Los Angeles

A social services agency that has been delivering meals to homebound seniors in all five of New York City’s boroughs for 43 years weighed in on X:

“It’s hard to be by myself so much of the time. It’s lonely." It's vital to understand how isolation increases the risk of health problems for older adults: https://t.co/uQDBysqmQW

— Citymeals on Wheels (@Citymeals) December 14, 2024

— Citymeals on Wheels, New York City

Keeping Pace With Solo Agers

As Judith Graham makes clear (“Going it Alone: Homebound Seniors Living Alone Often Slip Through Health System’s Cracks,” Dec. 2), more Americans are living on their own as they age, relying on a patchwork of health care services to get by.

That’s why the Program of All-Inclusive Care for the Elderly (PACE) is so critical to this conversation. PACE helps older Americans — 91% of whom are 65 or older and have chronic health conditions — stay safe and healthy in their own homes.

The program offers at-home assistance with daily tasks, like dressing, bathing, and eating, and transportation to the PACE day center, where participants can socialize and receive medical care. Unlike other settings, the PACE program coordinates all aspects of a participant’s care, from scheduling medical appointments to providing meals and nutritional advice.

PACE physicians and nurse practitioners’ comprehensive approach to care benefits those who are homebound and may not otherwise have an in-home caregiver to rely on. PACE is also a particularly promising option for those with dementia, as the program allows older adults to receive memory care in the comfort and familiarity of their homes.

It’s also more affordable than many alternative care options. States have reported that PACE costs taxpayers 13% less than the cost of other Medicaid services, all without copays, deductibles, or out-of-pocket expenses for participants.

The program has been quietly transforming our nation’s senior care system, but it remains underutilized. Only a fraction of older Americans are currently eligible for the program, but its benefits can extend far beyond this group. It’s critical for lawmakers to advance policies that expand access to PACE services so that we can set more older Americans up for success as they age at home.

— Jerry Wilborn, chief medical officer of One Senior Care, Erie, Pennsylvania

Gone But Not Forgotten

In February 2023, I came across an article by Tony Leys about the closing of Iowa’s Glenwood Resource Center, which left me reflecting deeply on both the residents who still lived there and those who had passed away and are now buried at the institution. Among them is my great-grandmother, Margarita Hedlund. As I read, I couldn’t help but think about the many people like her, who spent more of their lives at Glenwood than they ever did with their families, and who now rest in the cemetery there.

Nearly two years later, I read another article by Mr. Leys expressing concern for the over 1,300 residents buried in the Glenwood Cemetery and who will take responsibility for maintaining their graves (“After Institutions for People With Disabilities Close, Graves Are at Risk of Being Forgotten,” Nov. 21). The thought of my great-grandmother’s grave and the graves of so many others being neglected is deeply troubling.

Margarita Petterson was born in Sweden in 1866. She came to America as a young child and married Erik Hedlund, also from Sweden. They had five children together, but Erik passed away in 1900, just months before their youngest child was born. My great-grandmother lived with her oldest daughter, but in 1912, for reasons unknown to me, she was sent to Glenwood. She remained there until her death in 1949. Although I knew she had lived at Glenwood, I was never told why, and when I reached out to the institution for information, I received only a brief record. It stated she had a moderate intellectual disability (IQ between 35-49) and died of cirrhosis of the liver. The only other detail I learned was that her son had decided to have her buried in the cemetery there.

I can’t help but feel sadness and frustration that she was buried so far from her husband, who passed away nearly half a century earlier. There are likely many more families with similar stories — of loved ones abandoned or forgotten in a place like Glenwood, with little more than a name and a grave marker to honor them.

Reading about the fate of Glenwood’s residents and the ongoing concern about the cemetery maintenance only deepens my desire to know more about my great-grandmother’s life and her time there. When it’s your own family member, the need for answers is personal. I hope others who may be in the same situation find ways to learn more about their relatives’ lives at Glenwood and that we, as a community, remember and care for those who were forgotten too long.

— Marlys Adkins, Clare, Iowa

Disability Scoop, a 16-year-old news site that offers daily coverage of autism, intellectual disability, cerebral palsy, Down syndrome and other issues vital to the developmental disability community, shared the article on LinkedIn.

ER Care Goes Beyond Doctors

This is an excellent story to remind people to think ahead and utilize urgent care facilities (“Bill of the Month: A Toddler Got a Nasal Swab Test but Left Before Seeing a Doctor. The Bill Was $445,” Nov. 27). But why is this family’s bill surprising? I find it reasonable. There was the all-important initial screening by trained personnel — a child may be more ill than the parent appreciates. The medical history was obtained, temperature and other vitals taken, and swabs for the noted tests. That’s all time and effort that could have been spent on another patient. That’s supposed to be free? Surely you’re not implying that ER staff other than the doctors are worthless.

I remember the ’50s, when our local hospital’s ER staff was “on call.” No charge then if you left before you were seen.

— Gloria Kohut, Grand Rapids, Michigan

An emergency physician in Ontario chimed in on X:

A Toddler (in Canada) Got a Nasal Swab Test but Left Before Seeing a Doctor. The Bill Was $0. If the swab was positive they'd get a phone call by a doctor again costing $0. https://t.co/NPaPUWASTq via @kffhealthnews pic.twitter.com/qkVuZZFFr0

— Raghu Venugopal MD (@raghu_venugopal) December 12, 2024

— Raghu Venugopal, Toronto

Watch Your Language

It is too bad that an inflammatory article was written like the one titled “How Measles, Whooping Cough, and Worse Could Roar Back on RFK Jr.’s Watch” (Dec. 6). “Could” is just a speculative word and may be associated with fear-mongering. Your bias seems clear. It’s difficult to find unbiased health-related articles nowadays. I request that you write an article concerning RFK Jr. that is not biased — that is not from Big Pharma’s viewpoint. You aren’t aware that the Centers for Disease Control and Prevention, FDA, and other government agencies are industry-captured?

— Wayne Carpenter, Omak, Washington

An infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security had this to say on X:

“Vaccine development requires millions of dollars. Unless there is prospect of profit, commercial companies are not going to do it.” — why would companies even invest in vaccines if there reward is demonization https://t.co/F6jAv5cdhe

— Amesh Adalja (@AmeshAA) December 9, 2024

— Amesh Adalja, Pittsburgh

Gathering Intel on Plant-Based Diets

I just wanted to say how much I appreciated your roundup of news about prioritizing plant-based proteins (“Morning Briefing: Eat More Plant-Based Foods, According To Dietary Guidelines Advisory Panel,” Dec. 11). The idea that our food choices can come from a place of ethical consumption seems so removed from much of the world today. So many people have questions and concerns about becoming plant-based — is it healthy? What will my friends and family think? etc. But what your newsletter clearly shows is it’s not about what leaving animal products off one’s plate takes away but instead how much trying a plant-based meal gives to the individuals, the animals, and the environment.

Thank you for inspiring change without creating fear. Our future depends on more coverage like this.

— Sara Crane, Toronto

A Slice of Real Life

I really enjoyed your article “Perspective: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery” (Dec. 13). The exact thing happened to our family, and I thought we were an anomaly. My daughter got a 1-centimeter cut above her eye after falling out of bed. I took her to MUSC Children’s Health After Hours Care in Mount Pleasant, South Carolina (basically a doctor’s office that is open late). It’s not an ER or urgent care. When we arrived, the receptionist said, “We don’t do stitches here.” I checked in my daughter anyway since the receptionist said the doctor might be able to apply glue to help keep the cut closed. The doctor cleaned the cut with sterile saline, applied glue, and placed a few Steri-Strips. We were billed for “minor surgery” despite no scalpel, no stitches, no lidocaine. I looked up the ICD-10 code, and sure enough “application of tissue adhesive” is a “minor surgery” code. Our out-of-pocket was around $830 with UnitedHealthcare. I still have all the bills. “Liquid bandage” and Steri-Strips can be purchased at Walgreens.

I’ve never emailed the writer of an article, but this got me fired up! Thanks for bringing this to light.

— Cailin Lutz, Charleston, South Carolina

Continuing the surgical thread on X was a professor of medicine and pharmacy at the University of Pittsburgh:

I'm glad this is being looked at: Removing a Splinter? Treating a Wart? If a Doctor Does It, It Can Be Billed as Surgery https://t.co/YVUR9B8BkO via @kffhealthnews

— Bernie Good (@CBGood23) December 13, 2024

— Bernie Good, Pittsburgh

As a retired primary care physician, I was often frustrated that my management of complex medical conditions was reimbursed at lower rates than the illustrated splinter, or other “surgical treatments” as mentioned in Elisabeth Rosenthal’s article. However, blaming the physician for this discrepancy is inappropriate. The Centers for Medicare & Medicaid Services has strict regulations on billing. We are mandated to code per the regulations. We cannot give “discounts” for these procedures. To do so would be problematic in the bizarre catch-22 world of Medicare billing.

We are mandated to report our services accurately using only the codes available. To do otherwise is considered fraud by Medicare. When a physician is accused of fraud, he/she is presumed guilty and pays significant financial penalties until innocence is proven. Even a murderer and thief have more rights in the judicial system.

Medicare determines the lowest reimbursement rate; the other carriers pay a higher rate based on that rate. If an individual physician accepts Medicare, he/she must accept that rate. Only a non-participating physician (not accepting Medicare) can offer a lower rate. The exception is if the service is provided at no cost. Should the patient demand the service be provided free?

I’m reminded of the plumber charging $100 to replace a washer: 10 cents for the washer and $99.90 to know how to replace it.

— Robert Sullivan, Adairsville, Georgia

No Free Pass for Drug Ads

After reading this article by Elisabeth Rosenthal, “Perspective: With TV Drug Ads, What You See Is Not Necessarily What You Get” (Sept. 9), I wanted to share an opinion about the federal court’s decision to deem price disclosure on pharmaceutical advertisements a violation of the First Amendment. Commercial advertising has less protection under the First Amendment than individual speech. According to the Central Hudson Test, commercial speech, at baseline, must concern a lawful activity and not be false, deceptive, or misleading. Even if the speech meets all these criteria, the government can intervene if there is “substantial” government interest. If there is further regulation from the government on commercial advertising, it must be no more extensive than necessary to serve the government’s interest. Essentially, if there is intervention, it must be warranted, and the regulation must be reasonable when compared to the restriction (U.S. Constitution, Amendment 1.7.6.2).

In the case of pharmaceutical ads, especially those that promote oncology medications, they do not meet the baseline qualifications to be considered “not false, deceptive, or misleading.” It has been shown that pharmaceutical ads can rely on emotional response over rational appeal (Main, et al., 2004). If the ad is going to target an emotional response of a vulnerable population, then what is being sold must be accurate. If they are going to sell a chemotherapy that may not be the best option (but possibly have the most adverse side effects), then there is a government responsibility to protect this population and to be more discerning when determining what is truthful. Furthermore, even if the ads met the basic qualifications, they could still be regulated further due to the government interest in both public health and health care cost. Requiring that the drug cost be shown on pharmaceutical ads is appropriate federal intervention that I believe is more than reasonable when compared to the restriction.

— Molly Hilliard, New York City

A national drug safety advocate and public speaker tweeted on X:

Did you know drug companies spend over $1B a month on drug ads in recent years? Last year, the top 3 advertising spenders on TV were drug companies.I have spent my entire career in advertising and Big Pharma is keeping our industry afloat. https://t.co/0cTHTAOSAt

— Kim Witczak 💜 (@woodymatters) September 9, 2024

— Kim Witczak, Minneapolis

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

Relating to Relatives of Lonely Dementia Patients

I was sent the article by Judith Graham on older adults with dementia living alone (“Going It Alone: Millions of Aging Americans Are Facing Dementia by Themselves,” Oct. 15). I appreciate this article. My mom lives alone with dementia. My son lives next door and checks on her, and my daughter comes when she is able to vacuum floors and to scrub the kitchen and bathroom. I handle the bills, clean and change her clothes, wash her clothes, search for mail, and bring in groceries. She refused to allow the home health aide in, which complicates the care schedule. Neighbors watch out for her, including police at the station across the street. It is complex and complicated for caregivers. Applying for Medicaid is a nightmare, as is searching for memory care facilities. The thought of actually moving her is heartbreaking and so stressful. Again: Thank you for sharing that others with dementia are living on their own.

— Gail Daniels, Washington, D.C.

On the social platform X, a reader drew on her own experience:

Having cared for my mom toward the end of her journey with dementia, this is terrifying.For many elders, there is no family to cushion the insults of dementia and cognitive decline.https://t.co/LTZ76Ojgwg

— Shava Nerad – @shava23@bluesky 🌻 (@shava23) October 19, 2024

— Shava Nerad, Arlington, Massachusetts

Bonding — To the Letter

Thanks a million! I read your article “Going It Alone: Historic Numbers of Americans Live by Themselves as They Age” (Sept. 17) in the Las Vegas Review-Journal and related to it on a major level. As a senior living alone, I am experiencing some of the same “social isolation” expressed by your interviewees. Since I love to write, I thought it would be interesting to involve some of the persons mentioned in a nationwide pen pal association. This would place very little demand on their budget (other than postage and stationery), on their time, and with little or no travel involved.

It is breathtakingly exhilarating to receive a letter from a friend or relative, a package from anywhere, and experience the reward of sitting down and reading good news from afar.

I appreciate our advances in technology and I use it rather sparingly. However, I come from a generation that writes in cursive, knows the five elements of letter writing, and understands what a return address is and where it’s positioned on an envelope.

— Gloria Rankin, Las Vegas

A specialist in health economics and policy tweeted praise:

Historic Numbers of Americans Live by Themselves as They Agehttps://t.co/lwpfrhJauWImportant, impactful story by superb @judith_graham

— Paul Hughes-Cromwick (Pooge) (@cromwick) September 17, 2024

—  Paul Hughes-Cromwick (Pooge), Ann Arbor, Michigan

On X, a group of interdisciplinary faculty representing Johns Hopkins University shared KFF Health News’ coverage about racial bias in the development and use of pulse oximeters:

In a @KFFHealthNews article, BDP @iwashyna explains how we move forward from the racial bias of our current pulse oximeters.https://t.co/dmhqzoAfmK

— Bloomberg Distinguished Professors (@JHU_BDPs) October 23, 2024

A Slap on the Wrist for Pulse Oximeters

Between 1983 and 1988, I had four sons at Stanford Hospital. I was friends with Eben Kermit, who was a bioengineer. He was developing the original pulse oximeter on babies in the neonatal intensive care unit (“Systemic Sickness: FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias,” Oct. 7). He tested only white babies. That is because white parents could come to the NICU in the daytime, which is when Eben was at work in the NICU. Black parents could come only at night because their work wouldn’t give them time off to care for a very sick baby. Since no one was there to sign consent forms, at night, with the Black parents, no Black children were included. Discrimination against Black parents by their employers is continuing to cascade through the Black community through the exclusion of Black people from the development of medical technology.

— Zoe Joyner Danielson, a toxicology biologist, Woodland, California

This X post came from a consulting and training firm that focuses on health equity issues:

Reforms are needed ASAP—these devices have harmed so many #Black patients.FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias https://t.co/5R9LH5XyTI by @ArthurAllen202 @kffhealthnews CC: @NohaAboelataMD @mlipnick @iculung @djcantillonmd @iwashyna pic.twitter.com/yliCxMdRvG

— HealthBegins (@HealthBegins) October 10, 2024

What’s All This Fuss About Fluoride?

No one seems to address the fact that not everyone drinks water from public water systems (“Does Fluoride Cause Cancer, IQ Loss, and More? Fact-Checking Robert F. Kennedy Jr.’s Claims,” Nov. 18). I see many people buying bottled water by the trunkful, or have a water fountain at home with 5-gallon bottles of purified drinking water, or have reverse osmosis water filtration systems installed at their sink.

So even if RFK Jr. removes fluoride from public water systems, I can’t see that there would be a drastic increase in dental issues. Also, when you get your teeth cleaned at the dentist, they give you a fluoride treatment (unless you opt out). So on this issue of removing fluoride, would this be a drastic issue knowing that many now are not getting fluoridated water?

— Suzann Lebda, Sun Lakes, Arizona

Hitting the Paywall

Why does your newsletter link to articles with paywalls? As an example:

The Oct. 18 aggregation “Former Medicare Chief Warns About Medicare Advantage Pay Rates” links to Stat News, where the article cannot be read without a subscription. If you are doing this as a means to provide subscribers to them, too bad.

In any case, this practice does not represent your organization well since it supports the trend that only those who can afford it get to be informed. I hope you reconsider this practice.

The financial barriers to accessing important information are hurting us as individuals and as a society. It is expensive for most people to have access to a mainstream publication, but it gets cost-prohibitive to have access to multiple points of view, to learn, reason, and make up our own minds. In most cases, the only alternative available is to get “bites of information” from the “free” social media. The results are as one would expect: We become less aware of what is really going on as we are guided into silos of ignorance.

Thank you.

— Carl Loben, Bellevue, Washington

On X, a technology journalist in Spain shared the article about pregnant people being asked by their providers to pay out-of-pocket fees earlier than expected:

Pay first, deliver later: Some pregnant people are being asked to prepay for their baby https://t.co/NLWTeawgnk

— José María López (@gilead1984) November 16, 2024

— José María López, Badalona, Spain

A New Generation of Health Plans Overdue

The recent article “Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby” (Nov. 15) effectively highlights the emotional and financial uncertainty facing providers and patients. I commend the author for capturing how this uncertainty, rooted in empathy and fairness, must be better understood and addressed.

I write to draw attention to market trends and federal legislation aimed at alleviating this issue. Until recently, health plans considered the out-of-pocket experience as definitionally out-of-scope, leaving patients, and providers, to manage this growing uncertainty on their own.

The evidence shows that it is possible to build a more pragmatic and empathic out-of-pocket experience into a health plan, improving care accessibility and affordability without removing patient responsibility. This approach has been proven, across thousands of employer health plans, to feel better and financially benefit everyone — patients, providers, and plans (employers/insurers).

On Oct. 15, 2024, the Medicare Prescription Payment Plan launched, offering nearly 54 million Americans the option to have their insurer pay their out-of-pocket expenses upfront at the point of service giving members time to review and repay the balance — without interest or fees. If the patient in the article had a health plan with this capability, her OB-GYN would have been paid, on her behalf, by her insurer. She would have received a simple monthly statement to repay in full or over time from the comfort of her home. Everyone benefits and it is a better member experience.

This new, bipartisan, commonsense improvement to one of health care’s most acute pain points is rapidly expanding as employers and insurers realize there is significant actuarial value, provider savings, and member behavior change caused by improving a person’s ability to pay for care.

Brian Whorley, Columbia, Missouri

An associate professor in the health care leadership program at Rockhurst University’s Helzberg School of Management also shared the article on X:

Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby https://t.co/QEnX8GA3Ih via @kffhealthnews

— Prof. Jim Dockins (@DrDockins) November 15, 2024

— Jim Dockins, Kansas City, Missouri

On Hospital Gatekeepers and Tolls

In regards to the article “Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby” (Nov. 15): Back in 1992, the hospital where my son was going to be delivered required that the projected copay be paid to them one month before the delivery date or my wife would not be admitted (a Catholic hospital, very charitable).

My wife was born at the same hospital in 1963; at that time, my father-in-law was informed by the hospital that he could not take her home until the bill was paid in full. He contacted a friend who was an attorney who told him to let the hospital know that would be considered kidnapping and that he would be calling the police if they didn’t release her.

— Andrew McGovern, Great River, New York

Taken Advantage Of?

I belong to a Blue Cross Blue Shield Medicare Advantage plan and, for the past several years, it has offered a home assessment with a reward of $25. I have participated in the program in the past but declined this year since I didn’t think there was much value to the program. I am a retired registered nurse, and I felt that the nurse who did my assessment did not do an especially thorough job, and any questions I asked of her, she could not answer. The nurse was also from out of state.

After reading your article on “The Medicare Advantage Influence Machine” (Sept. 30), the reasons for the assessment seem to be more than improving the beneficiary’s health and well-being, which is what I believed. I am relatively healthy and active, so it would not appear that BCBS found any new diagnoses that it could bill Medicare for, but I assume that that is not the case with other seniors.

— Bruce Gilman, Millis, Massachusetts

An economist in Florida had this to say on social media:

Thank you @KFFHealthNews  for pointing out the failed bureaucracy @CMS I’ve been talking about for years. You can’t read this and not conclude DC bureaucrats are “captured” and policy makers are beholden to Medicare Advantage lobby money. #WhoWillCarehttps://t.co/rDGg8juoop

— Luke Neumann (@pglukeneumann) September 30, 2024

— Luke Neumann, St. Petersburg, Florida

In Defense of Deloitte

On March 12, 2024, in good faith and with respect for KFF Health News, Deloitte’s health and human services practice leader provided a 90-minute interview with two reporters for a story they said was about “problems with Deloitte’s eligibility systems across the country.”

We agreed to the interview because we had heard from several of our state clients that they, too, had been contacted, and that the questions being raised showed a misunderstanding of integrated eligibility systems, the technology that sustains them, and the complexity of the health and human services programs they support.

The eligibility systems are owned by the states, not Deloitte; they are uniquely built for each state (in some cases, by other vendors decades ago); and we work at the direction of our clients to maintain and enhance these systems to comply with state-specific policies, rules, and processes, and evolving federal regulations.

Two stories subsequently ran: “Medicaid for Millions in America Hinges on Deloitte-Run Systems Plagued by Errors” (June 24) and “Errors in Deloitte-Run Medicaid Systems Can Cost Millions and Take Years To Fix” (Sept. 5).

Many of the issues reported as “widespread” are isolated to specific situations or involve sensitive data that cannot be refuted by Deloitte due to client confidentiality obligations. That said, there are many reasons why someone may lose coverage or no longer be eligible for a benefit they once received.

Not every “issue” a constituent faces is the result of a system “error,” and challenges with individual cases in individual systems are not due to some fundamental problem in the way Deloitte supports state Medicaid programs.

On the issue of contract changes, Deloitte rejected the claim in March that our state clients send us a “change request … when a fix is needed.” We said that was inaccurate and explained that when there are policy or rule changes — or a global pandemic — that require modifications to a state’s technology, change orders are not only necessary but appropriate.

They do not represent errors in a system that need to be fixed.

Throughout the unwinding of the covid-19 public health emergency — as technologies evolved and policies changed — Deloitte worked closely with states to minimize challenges for those going through the Medicaid redetermination process. The innovations and human-centered design processes we helped our clients implement enhanced the digital experience for their constituents and made it easier for caseworkers, staff, and community partners to support the 34 million people in their care.

Our clients understand that large system implementations are challenging due to the complexity of the programs they support, and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.

That is why so many states continue to select Deloitte to help them maintain their mission-critical systems, and why industry analysts like Forrester and Gartner consistently rank Deloitte as a leader in system integration and business transformation.

— Karen L. Walsh, Government & Public Services, Deloitte Consulting LLP, Harrisburg, Pennsylvania

[Editor’s note: KFF Health News stands by its reporting on Deloitte and the state eligibility determination systems that Deloitte supports.]

An assistant professor at Harvard voiced her opinion on X:

This is such a grim summary of the state of Medicaid eligibility and enrollment systems https://t.co/3hpVnJdPOm pic.twitter.com/Gdi2AF1pyr

— Adrianna McIntyre (@adrianna.bsky.social) (@onceuponA) September 5, 2024

— Adrianna McIntyre, Boston

Far Less Than Meets the Eye

I read your article about the new $2,000 limit for out-of-pocket payments for Medicare Part D (“Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More,” Oct. 21). As someone with very high drug costs, I was very excited about this change. However, once I researched the different drug plans available for me and my husband, I realized that the money we spend on drugs that are prescribed by a doctor but not covered by our plan will not count toward the $2,000 limit. Therefore, our cost for necessary drugs will continue to be exorbitant.

I think that there are many seniors who will be very disappointed once they realize this.

— Pia Stampe, Eureka, California

In sharing the article on X, a Florida attorney simply shared their contact information:

"Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More:"https://t.co/9uEjVxTSGb Grady H. Williams, Jr., LL.M., Attorneys at Law P.A. 1543 Kingsley Avenue, Building 5 Orange Park, FL 32073 Tel: 904-264-8800 • Fax: 904-264-0155

— Grady H. Williams (@floridaelder) November 9, 2024

— Grady H. Williams, Orange Park, Florida

Shedding Light on Fluorescence in Dental Care

Congratulations on a highly impactful publication (“Dentists Are Pulling ‘Healthy’ and Treatable Teeth To Profit From Implants, Experts Warn,” Nov. 1). The facts presented are harrowing for a retired practitioner with multiple specialties who tried a lifetime to preserve teeth and promote human health.

As you might know, oral biofilm is the biggest enemy of oral health and even general health. Dental clinicians have not been able to visualize and identify the presence of pathogenic oral microbiome until recently. Pathogenic oral bacteria are among the significant generators of hard and soft tissue deterioration, such as tooth decay, gum diseases, and even infection of dental implants. The most trusted and used diagnosis procedure is still the X-ray.

X-rays can identify only established diseases. Unfortunately, radiologic diagnosis is still the most trusted diagnostic tool used and taught in dental education.

Microbiology, the microbiome science, utilizes fluorescence as its major identification procedure. Some of the most aggressive oral bacteria, generators of caries, gum diseases, etc., generate so-called porphyrins, which, once excited by a specific wavelength, emit light at a different wavelength. Highly reliable and simple-to-use technologies have been created recently to support direct visualization and point-of-care identification of this pathogenic bacteria through the above-described procedure. These devices support the diagnostic process and help the dental clinician by guiding the treatment execution and identifying when the treatment goal has been achieved. Dental treatment protocols utilizing “Fluorescence-Enhanced Theragnosis” have become reliable and less invasive.

The high loss of human lives in the ICUs during the pandemic due to ventilator-associated pneumonia could have been dramatically reduced using the above protocol.

Wound-care science has already implemented fluorescence and is undergoing a tremendous protocol change. Tumor surgery celebrates fluorescence-guided surgery as a milestone in its development.

Academic dental education is due for an urgent renewal. We must open the doors and facilitate science translation to benefit humankind!

— Liviu Steier, Needham, Massachusetts

A reader who manages a website predicting the collapse of the American health care system commented on X:

https://t.co/JTFn1h12rc 🙄😠👎Technically, American dentistry was once ranked as the best in the world. Unfortunately, It has a history of mismanagement and negligence. It’s a “reputational good” that’s been flooded with scams. Now it’s payback time. It’s demonstrating the…

— Francis Anthony Toto (@francisatoto) November 2, 2024

— Francis Anthony Toto, San Diego

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Clarifying the FDA’s Role and Authority Over Direct-to-Consumer Drug Ads

While several inaccuracies in the recent opinion piece about direct-to-consumer prescription drug advertisements by KFF Health News’ Elisabeth Rosenthal have been corrected in response to FDA’s direct requests, in this letter the FDA seeks to provide additional information about the agency’s oversight to readers and correct any misimpressions that may remain (“Perspective: With TV Drug Ads, What You See Is Not Necessarily What You Get,” Sept. 9). The FDA is strongly committed to protecting public health by ensuring prescription drug promotion by or on behalf of a drug manufacturer, distributor, or packer is truthful, balanced, and accurately communicated.

Federal law has long required prescription drug advertisements to present a true statement regarding the side effects, contraindications, and effectiveness associated with the advertised prescription drug (with information relating to major side effects and contraindications referred to as the “major statement” in TV or radio ads). This requirement has been in place for many decades and helps to ensure a truthful and non-misleading presentation of information about the prescription drug, as well as a balanced presentation of safety and efficacy information.

In 2023, the FDA issued a final rule establishing five standards to help ensure that the major statement in ads for human prescription drugs in TV/radio format is presented to consumers in a clear, conspicuous, and neutral manner. The aforementioned article suggests it is unclear how to determine whether an advertisement complies with this rule. However, the rule and the FDA’s plain language guidance pointedly outline specific criteria for each standard in order for the ad to be considered compliant. The FDA believes these standards will help consumers better understand the advertised drug’s side effects, so they are better informed when they participate in health care decision-making. Companies have until Nov. 20, 2024, to bring ads into compliance.

Additionally, the article does not discuss one of the agency’s crucial post-marketing surveillance tools for prescription drug ads. Federal law generally does not require companies to submit promotional communications prior to use, but companies are required to submit ads at the time of initial dissemination. These submissions, in addition to other tools like the Bad Ad program, greatly aid the FDA’s surveillance of promotional activities.

The FDA takes seriously its responsibility to monitor prescription drug ads and to ensure they are compliant with FDA’s applicable laws and regulations. We will continue to monitor and take appropriate action if prescription drug advertisements are found to contain false or misleading information.

— Catherine Gray, director of the FDA’s Office of Prescription Drug Promotion, Washington, D.C.

Jerry Berger, formerly the director of media relations at a Harvard Medical School teaching hospital, shared the article on the social platform X:

And then there's the matter of how much all that's spent on these ads affect the pricingWith TV Drug Ads, What You See Is Not Necessarily What You Get https://t.co/HGxkg949UA via @kffhealthnews

— jerrymberger (@jerrymberger) September 9, 2024

— Jerry Berger, Boston

How to Raise the Cybersecurity Bar

I just finished reading the article “Cyberattacks Plague the Health Industry. Critics Call Feds’ Response Feeble and Fractured” (Sept. 19), and while it is on point in terms of the inadequacy of the federal cybersecurity management, I think it should have gone deeper into outlining other creative options to raise the cybersecurity bar among all health care providers. Similar to the adoption of electronic health records, provider cyber-preparedness needs an economic infusion of technology and resources; a “Meaningful Use”-like program if you will (but, hopefully, better defined and implemented!). The federal government also needs to take a more active role in applying “offensive resources” to neutralize threats when they arise and before they expand across the health care ecosystem.

— Robert Swaskoski, vice president of enterprise risk management for Heritage Valley Health System, Sewickley, Pennsylvania

An employee benefits specialist outside Atlanta chimed in on social media:

"Responsibility for the nation’s #healthcare #cybersecurity is shared by three offices within two different agencies." Maybe that's part of the problem? Ya think? https://t.co/PF8Sa2F5Ou

— Catherine Collingwood Estes 🕊️🧡🇺🇸 (@collingwest) September 19, 2024

— Catherine Collingwood Estes, Duluth, Georgia

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Debunking Abortion Myths

I want to send a big THANK YOU to Matt Volz for writing a fact-checking article on the nonsense rhetoric around “abortion up until and after birth” that has run wild and unchallenged in the media (“GOP’s Tim Sheehy Revives Discredited Abortion Claims in Pivotal Senate Race,” July 9). Thanks for putting abortion later in pregnancy in context and debunking false assumptions.

I am a near-third-trimester abortion patient (nonviable pregnancy, terminated at 26 weeks), and I am so sick of hearing politicians like Tim Sheehy talk about something they have never experienced or bothered to learn about. It is as though I am watching the entire nation maliciously gossip about me and other parents like me. Those of us in the termination for medical reasons (TFMR) community have walked through hell only to have our voices, at best, be ignored or, more commonly, be insulted and threatened.

And I imagine watching this political circus is just as hurtful for parents who lost an infant shortly after birth and had to provide palliative care. That is who they are talking about with “abortion after birth”; they are talking about comfort care for infants who will not survive.

Thank you again for bringing a dose of reality to a conversation that never should have become political. These are impossible decisions that only parents should make. It was really refreshing to read Volz’s article and know that some journalists are still willing to fact-check the absurd claims floating around. It was encouraging to know that someone does see us.

— Anne Angus, Bozeman, Montana

A physician and Yale professor of radiology and biomedical imaging took to the social platform X to share feedback:

.@SenatorTester is a great Senator. And his opponent is a great liar. Both the GOP presidential candidate and Tim Sheehy have perpetuated this lie. Please push back every time you hear it. https://t.co/1LBGPgOA2u

— (((Howard Forman))) (@thehowie) July 9, 2024

— Howard Forman, New Haven, Connecticut

I just read your article at PolitiFact on Republican Senate candidate Tim Sheehy’s statement about abortion, and I would like to point out (what I believe) are a couple of errors.

1. In paragraph 10, you quote KFF’s Alina Salganicoff saying that “in the good-faith medical judgment of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient’s life or health.” Now, you may know that almost at the same time that the Roe v. Wade decision was released, there was a decision called Doe v. Bolton that interpreted “health” to mean almost anything. That broad interpretation of health is found in your article in paragraph 24: “Women have abortions later in pregnancy either because they find out new information or because of economic or political barriers,” [Katrina] Kimport said.

When a woman can have an abortion after viability because she offers any reason that can be interpreted as “health,” then abortion would be legal throughout all nine months of pregnancy. I believe that you are wrong in your interpretation. Democrats do not want to name any restriction on abortion during all nine months, and every mention of “health” is a fig leaf that does not restrict abortion at all. Every abortion advocate knows that.

2. Whether late-term abortions are rare or not is logically irrelevant to whether late-term abortions should be restricted.

Why don’t you know these things?

— Darryl A. Linde, Tahlequah, Oklahoma

An Air Force veteran added his two cents on X:

Dems have the facts. Republicans spread fear and lies.https://t.co/6CWfKhqxJZ

— James Knight (@jamesUSAF_vet) July 12, 2024

— James Knight, Reno, Nevada

Making a Healthy Difference for the Homeless

Thank you for printing this story (“A California Medical Group Treats Only Homeless Patients — And Makes Money Doing It,” July 19). It really piqued my interest and portrayed a positive solution for getting care to the people.

Up here in the Bay Area, I believe there are a couple of groups who go out and find what needs doing instead of waiting for people to come to them — but nothing like this. Makes me curious about what we actually have going on here.

— Laurie Lippe, El Cerrito, California

A self-described “nurse turned health tech nerd” commended the effort on X:

"They distribute GPS devices so they can track their homeless patients. They keep company credit cards on hand in case a patient needs emergency food or water, or an Uber ride to the doctor"This is healthcare at its best 💕https://t.co/UhM1dgTPH7

— Rik Renard (@rikrenard) July 22, 2024

— Rik Renard, New York City

A senior policy director at the National Health Care for the Homeless Council shared the post on X — while stressing that her tweets reflected her own opinions and not those of her organization:

I’m with ⁦@DrJimWithers: “I do worry about the corporatization of street medicine and capitalism invading what we’ve been building, largely as a social justice mission outside of the traditional health care system.” https://t.co/IOjazvrvqP

— Barbara DiPietro (@BarbaraDiPietro) July 19, 2024

— Barbara DiPietro, Baltimore

On X, a physician who says she champions “physicians, patients, public health, and the patient-physician relationship” reacted to our coverage surrounding the Federal Trade Commission’s rule banning the use of noncompete agreements in employment contracts: 

FTC #noncompete crackdown may not protect doctors and nurses at ~64% of US community hospitals that are tax-exempt nonprofits or government-owned.But, ⁦@FTC⁩ said some nonprofits could be bound by the rule if they do not operate as true charities. https://t.co/9fDbfVflTH

— Marilyn Heine (@MarilynHeineMD) May 28, 2024

— Marilyn Heine, Langhorne, Pennsylvania

Without a Noncompete Ban on All Employers, Rural Access to Care Suffers

When news broke that the Federal Trade Commission would be banning noncompete agreements in employment contracts, many of us in the medical profession celebrated. However, until nonprofit hospitals and health care facilities benefit from the same ban, access to care — particularly in rural regions — will suffer.

As reported in “Health Worker for a Nonprofit? The New Ban on Noncompete Contracts May Not Help You” (June 5), about two-thirds of U.S. community hospitals are nonprofit or government-owned. This means that most hospitals nationwide may continue to enforce noncompete agreements among their employees, a practice that will have an outsize impact on rural medical professionals.

As a rheumatologist in a rural area, I’ve seen how detrimental limited access to care is for patients. Noncompete agreements serve only to further limit access to much-needed care. Due to the physician shortage being particularly acute in rural America, there are oftentimes only a few specialty physicians servicing a large region. Suppose one of these specialists is employed by a large health system and wants to transition to a private practice. It reduces the number of accessible specialists in the area when their noncompete agreement prohibits them from practicing near any of the health care facilities associated with the system. And increasing consolidation across health care means many rural regions may have only a single health system that operates across the entire state and surrounding areas. A geographically limiting noncompete agreement essentially stops a physician or medical professional from practicing entirely in the area, or they must uproot their life and move away from the major health system.

I hope the FTC takes further action to include nonprofit health care employers in its noncompete ban. I also urge nonprofit employers to consider their rural patients’ access to care when requiring providers to sign noncompete agreements. It’s in the best interest of our patient’s health to get rid of these agreements entirely.

— Chris Phillips, chair of the American College of Rheumatology’s Committee on Rheumatologic Care, Paducah, Kentucky

The president of the Texas Medical Board also posted on X with feedback:

Is it a coincidence that this affects everyone, except those who work for nonprofit hospitals and health care facilities, which employs the largest number of medical professionals?The FTC and it's selective enforcement and rules is blatantly obvious! https://t.co/RzXInqiJ8D

— Sherif Zaafran, MD (@szaafran) June 16, 2024

— Sherif Zaafran, Houston

Repurposing Newspaper Boxes for Public Health

I recently read your article by Mara Silvers regarding the state’s intended use of public health vending machines (PHVMs) to help fight the opioid overdose epidemic (“Montana’s Plan To Curb Opioid Overdoses Includes Vending Machines,” July 18). Working on the covid-19 response for almost four years now, and with our American Rescue Plan Act funding coming to an end, we recently used a byline in our equipment budget to purchase and place “resource kiosks” in the community.

In 2022, after researching the use of vending machines for test distribution, we discovered vending machines have high barrier-to-entry costs and high maintenance costs. And even if purchasing isn’t possible, rental contracts come with high fees. We decided it was better to use a lower-cost resource that could be purchased in greater quantity, easily placed with community partners, and required no maintenance: the refurbished newspaper kiosk.

We decided to purchase double-decker boxes, which have a secondary door, creating another shelf, for roughly $410 apiece and stocked them with covid tests, nasal naloxone, injectable naloxone, fentanyl test strips, xylazine test strips, various types of condoms, and lubrication packets. We are in the process of securing a supply of gun locks and adding links to our pilot landing page for individual free gun lock deliveries, as well as links for free sexually transmitted infection test kits. We have investigated providing dental supplies and other items, but long-term funding is a constant concern. Grant money for most programs (likely all ARPA dollars) is running out, so the viability of these types of pilot programs is tentative without a buy-in from state or federal agencies.

Mara’s article hinted at criteria for possible placements and, similarly, we didn’t use locational overdose data, which can be “othering” to communities, but instead placed these kiosks with community partners that have been accomplished supporters of their at-risk populations throughout the covid response. Each community partner helped protect the communities they served through increased access to resources and provided information as trusted messengers. Truly meeting people where they are.

While money quickly appeared to fight the covid pandemic, and states spirited away dollars for pet projects, that sea of funding has dried up, and there doesn’t seem to be a plan for any continued funding. Covid-related functions have all been folded back into communicable disease epidemiology programs, which were already underfunded; in our state, the money funding the naloxone bulk fund is also drying up. Covid deaths might be down, but there is always a new bug (H5N1), STI infections are up, and gun-related deaths grow year over year. Funding population-level health interventions is our next pandemic.

With enough funding, kiosk-sized PHVMs could be swiftly added to any public health agency’s or community program’s quiver of tools to help increase access to resources and information for the most vulnerable residents.

Thank you for publishing a great article about the emerging opportunities to respond to changing public health needs!

— Christopher Howk, Arapahoe County Public Health’s covid-19 testing and logistics coordinator, Greenwood Village, Colorado

A retiree with a PhD in quantum chemistry tweeted his surprise over the news:

Montana’s Plan To Curb Opioid Overdoses Includes Vending Machineshttps://t.co/kNxYjnIOEO(What???!! Vending machines for opioids?)

— John Lounsbury (@jlounsbury59) July 18, 2024

— John Lounsbury, Lake Frederick, Virginia

Misappropriation of Opioid Settlement Funds

OK, so I see how all these states got all these lump sums of money for people like us who became addicted and whose lives were devastated by Purdue Pharma, Vicodin, and all the pharmacies (“Lifesaving Drugs and Police Projects Mark First Use of Opioid Settlement Cash in California,” July 12). How come all these states got all the money but those of us who have suffered have to wait, hire lawyers, and wait years for the money that was just handed over to these states? We’re the ones whose lives were devastated. My son was hooked, I was hooked, and my wife, and yet we must sit here penniless after the addiction, while all these states take the money — and they don’t do what they’re supposed to with it, and everyone knows it.

— Michael Stewart, Des Moines, Iowa

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).