Community nurses cut health costs

Amidst dismal news of the finances of Vermont health care, I was pleased to read the front page article highlighting the work of community nurses (“Upper Valley community nurse programs help those in need”; April 5). Their services have a positive effect on health care costs by avoiding unnecessary hospitalizations.

Legislators considering health reform in S.126 should incorporate strong support for community nurses and care coordinators in their work. Windsor County legislators are leading the way with H.140 and S.33. These bills elevate community nurses and community care coordinators by directing grants to local communities.

Home visits and sustained contact are important. Interpreting physician and hospital directives improve patient compliance. It’s a little like agricultural extension agents who make scientific information accessible for farmers and gardeners. By making these local health care extension agents a handy resource for every community, we will reduce the burden on hospitals and guide residents to care that might prevent serious illness.

Locally-supported community nurses could be integrated into the Community Health Teams that are part of the Blueprint for Health for Vermont, fortifying that framework. The Blueprint’s Community Health Workers — who are not nurses — are supported within the Blueprint by nurses. Nurses and non-nurses fulfill similar functions in helping people navigate the health system. With a relatively small investment, we improve Vermonters’ health. At the same time, incorporating the ideas of H. 140 and S. 33 into health reform would improve the health system’s fiscal outlook.

Jon Felde

Norwich

Navigating Medicare

When my wife and I retired in 2012, from DHMC, we weren’t frequent users of medical care. But as to be expected, life changes and things happen. I, a knee replacement, and my wife has been treated for a couple of malignancies. Fortunately, we both have traditional Medicare (TM) and although not perfect, we have been very happy with it. TM, Part A, covers inpatient hospital insurance; Part B, covers outpatient care; Part D covers prescription drugs. Then there are several Supplemental Insurances (Medigap) that cover copays, coinsurance and deductibles.

Medicare Advantage (MA) is Medicare part C, which are private insurance plans. MA is usually run by for-profit insurance companies that are beholden to shareholders who expect a return on their investment. Where does that money come from? The policy holder. You might remember Brian Thompson, the CEO of UnitedHealthcares, who was shot and killed by a disgruntled policy holder. MA plans offer a lot of “bells and whistles.”

Everybody has different needs, but there have been complaints lodged against MA: limited provider networks; need for prior authorizations; unexpected out-of-pocket costs; confusing details of their plans; a change in plan benefits.

You can switch to TM during the annual open enrollment period: Oct. 15 to Dec. 7, but you might face a late enrollment fee in a standalone Part D drug coverage; you might also face higher premiums for Medigap.

Disclosure: I have no conflict of interest. I volunteer as co-medical director at the Good Neighbor Health Clinic, in White River Junction. Any questions, call to make an appointment to talk with your Vermont or New Hampshire Medicare office 1-800-MEDICARE (1-800-633-4227).

Paul Manganiello

Norwich

Trump’s debts

I have read enough analysis and guesswork of why Trump backed off immediate implementation of his idiotic tariffs that it is becoming repetitive. Yet the obvious has escaped every pundit.

Someone got it through Trump’s thick skull that if panic in the bond market got bad enough (and it was getting very bad, very fast), it could crash his enterprises. Interest rates were rising fast. He’s not called the King of Debt for nothing.

Everything he runs is a house of cards depending on borrowed money, and loans must be refinanced from time to time. His family’s businesses are almost certainly among the most vulnerable in the world to an abrupt increase in interest rates.

Duh.

Richard Andrews

Springfield, Vt.

An opinion too far

In my few years as a subscriber I have noticed most bias pieces have been relatively modest from the Valley News contributors. I always felt, at least to a degree, they all generally maintain a respectable tone in reasoning of their bias. Maybe I’ve just been self filtering your site well.

Turns out that’s exactly what I was doing. I went back quickly to read some editorials specifically, and bingo there’s the outlier. Advocating the vice president’s family be accosted because they haven’t earned Vermonters’ respect (“Editorial: If politicians want respect they’d better earn it”; March 8), this idiotic tribalism is the problem, undermining any credible positions the editorial board may share. The piece, “Time is running out for American democracy” (Editorial, April 5), is what sent me down this rabbit hole. A 799-word political propaganda diatribe weaving in and out of both complex topics and awful opinions seamlessly and incoherently; all wrapped in the tired fear-mongering flag of democracy being over.

My suggestion. Don’t publish this crap. By no means is there a dearth of this garbage accessible for those who desire to consume it. At least ask yourselves, who or what is this opinion serving? The service is only to division, animosity, fear, hate and politicizing our existence as neighbors and communities. I open Valley News to remain connected to the community around me I care about and read compelling, respectful and well written perspectives. We do not need these CNN regurgitations where the journalist service to the community turns into grandstanding.

Adam Colby

Etna