Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

— Martha Carter, Culloden, West Virginia

Fractured Communication Compounded

I wanted to thank and praise Nick Ehli for his touching, poignant, well-written and necessary article homing in on covid through the lens of a Billings, Montana, hospital (“Postcard From Montana: At an Overrun ICU, ‘the Problem Is We Are Running Out of Hallways,’” Sept. 22). Sadly, American’s moral compass has been smashed by the pressure of divisive and narcissistic propaganda. We are now splintered into tribes filled with anger, hate and distrust toward those who don’t share or respect our values.

The time when Democrats and Republicans once could laugh and talk about their differences and similarities is gone. It is as if we cannot love.

— David Miller, Normandy Park, Washington

— Jennifer Boeder, Los Angeles

Examining the US Health Care System

I just wanted to chime in on the article on covid tests in the U.S. (“Bill of the Month: A Covid Test Costing More Than a Tesla? It Happened in Texas,” Sept. 30). I am an expat living in Germany. When I read about these stories about the exploitation of the health care industry in the U.S., it does make me boil. It doesn’t have to be this way, really.

In Germany everyone pays into a “bucket,” then the costs are distributed. It is true that doctors here don’t make Hollywood salaries, but they make enough to own a Mercedes and a house in Tuscany.

“Me, me for myself, and I” culture in the U.S. is making lives harder for everyone. The media and policymakers should study the German health care model. It works and works well.

The covid test here? The PCR tests are free, and I can find them pretty much in every corner of the neighborhood. The rapid tests you find in every supermarket or drugstore. They cost less than 1 euro (about $1.16) per box.

The result? A healthy and happy society. Everyone benefits.

— Helen Antebi, Bonn, Germany

Bill of the Month’: Don’t Add to Billing Confusion

I would avoid calling an EOB (“explanation of benefits” notice) a bill. It’s not and says as much on the document. The public is already confused when it comes to managing their health care/insurance and your reporting inaccurately is not helping. We all expect more from NPR and KHN.

— Rory R. Stark, Garrison, New York

— Kori Tichenor, Scottsdale, Arizona

Time to Think of Covid as We Do Herpes

I’d like to comment on Will Stone’s great article about his breakthrough case of covid (“I Got a ‘Mild’ Breakthrough Case. Here’s What I Wish I’d Known,” Sept. 20). He said how after he got the vaccine he relaxed his protective standards and that is most likely the reason that he ended up getting covid. I’d like to say that what is not being communicated properly to the public is the difference between infection and disease. Infection is when a type of bacteria or a virus enters your system and starts to multiply, creating an immune response. Disease is when this causes cell breakdown or bodily damage leading to sickness. The covid vaccines are effective against disease, not infection.

Most people have been infected with the herpes virus. But not everybody gets the disease. The virus is dormant in your nervous system unless it’s stimulated to come out and cause a disease like a cold sore or other types of lesions. Similarly, with covid, you can get the infection and not know it, but the vaccine will protect you, for the most part, against severe disease and possibly death. That is why protective precautions such as masking and avoiding crowds, etc., are still required, especially because the delta variant is so much more contagious than previous iterations of the virus. You can become infected with the covid virus and remain asymptomatic and still be very contagious. So it’s great that you will likely not end up in the hospital, but someone you spread it to may not be so lucky.

And the more spread there is, the more likely that the virus will mutate and become even worse. There’s no way to stop this right now, but vaccination and social precautions are still needed in the near future.

It must be stressed that the vaccine can protect you against disease, not infection. And although the covid virus is expected to be cleared from your system like most respiratory viruses, possible latency and long-term effects are still being researched.

— Len Baskin, Montreal

— Dr. Jay Gordon, Santa Monica, California

Careful Not to Add Fuel to the Anti-Vaccine Fire

The articleFederal Vaccine Program Hasn’t Helped Those Whose Lives Were Altered by Covid Shot” (Aug. 18) is going to be front and center of my talk at the huge anti-vax rally in Orange County. Thank you for taking some of the wind out of the sails of those vaccine zombie makers. You couldn’t have run this at a better time. The lies about the delta and lambda variants were gaining traction. More people were getting vaccinated — can you believe that?! Thank you for being a beacon of truth against the so-called Scientific Community.

Seriously, this is an important topic, but do you really think that, during this new surge and the incredible importance of getting the population vaccinated, this was the proper time to publish this article? Do you ever consider the influence of your stories and your responsibility to the broader public? Or is it all about filling up content and the byline?

— Michael Dalali, Los Angeles

— Joel Suiter, Minneapolis

Will Covid-19 Usher in a Single-Payer System?

I wanted to weigh in on last month’s opinion piece “Analysis: Don’t Want a Vaccine? Be Prepared to Pay More for Insurance” (Aug. 4).

The current utilization of emergency rooms, hospitalizations and intensive care units for covid-19 cases has been largely dedicated to unvaccinated individuals who prioritize personal freedoms above government mandates related to vaccination. Unfortunately, what anti-vaxxers seemingly don’t realize is that their refusal to get vaccinated is only supporting the political agenda to push for a single-payer health care system in the U.S.

As long as variants of covid are rampant, hospitals will continue to financially suffer due to limited utilization of elective profitable service lines, while our aging communities simultaneously suffer as covid drives down needed interventions for the burgeoning amount of new and existing chronic illnesses.

Clinicians’ lack of revenue coupled with America’s aging population, the worsening state of chronic illness and lack of personal accountability creates a perfect storm where employers will no longer be able to afford to offer insurance benefits to their employees.

Employers are already paying for health care in at least three ways: employee health care benefits, Medicare tax and now the cost of lost business due to the pandemic. The cost of commercial health insurance will continue to rise as employer-sponsored health insurance is typically used to cover a clinician’s financial losses from government-funded insurance. And those rising costs are correlated with the imbalanced growth of the government-funded patient population compared with those on employer plans. None of this is mathematically sustainable, and there will be only one option to choose when the system nears implosion — single-payer.

Unvaccinated individuals who demand less government involvement in today’s health care sector are ultimately supporting a political and mathematical agenda that will lead to more government involvement in the future of health care.

— Jeb Dunkelberger, CEO of Sutter Health-Aetna, Sacramento, California

— Grey Parker, Evanston, Illinois

Seeing Clear to Loosen Prior Authorization Policies

Even before hospitals had to delay surgeries due to covid-19 (“Covid-Overwhelmed Hospitals Postpone Cancer Care and Other Treatment,” Sept. 17), many patients were already experiencing care disruptions due to restrictive insurance prior-authorization policies.

On July 1, Aetna hastily rolled out a new policy requiring insurance preapproval on all cataract surgeries. The policy wreaked immediate havoc, causing as many as 20,000 cataract operations to be delayed in July alone. For Aetna to delay these sight-restoring surgeries at any time, but especially during a pandemic that has upended surgical operations in hospitals across the country, is dangerous and irresponsible.

With hospitals’ surgical backlog growing, Aetna must reverse its prior-authorization policy immediately. Further, Congress must put reasonable guidelines on the prior-authorization process to hold insurers accountable. I urge all our lawmakers in Washington to support the bipartisan Improving Seniors’ Timely Access to Care Act of 2021.

— Dr. Kevin M. Miller, chair of the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Clinical Committee, Los Angeles

— Dr. Vincent Rajkumar, Rochester, Minnesota