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Beware the Camel’s Nose

There’s and old expression, “don’t let the camel’s nose into the tent,” It is in reference to an old tale about an Arab master who let his camel stick his nose under his tent flap to get warm and pretty soon found that the camel had slowly moved completely into the tent and pushed him out. The moral is, don’t let something start that is wrong, no matter how small or innocuous, because it will soon grow large, much to your detriment. I heard this term used in Washington when I began working in public policy in 1996. It was a way for a partisan party or administration to start the process of passing an untenable change to public policy by passing a small seemingly harmless bill and then slowly building on this approach until it only takes a small step to pass the final ultimate legislative goal. I argued 12 years ago that letting an unelected, judicially exempt government panel decide how to ration healthcare in Medicare was dangerous. It was letting the camel’s nose into the tent that would ultimately result in government-controlled healthcare. I think we are seeing this tactic used again.

Lately, our government has begun sticking its nose into our healthcare in ways that scare me. There has been legislation proposed and, in some cases, signed into law, that inserts the government into our healthcare in unprecedented ways. Here are three examples of what I’m talking about.

The recently passed Inflation Reduction Act (IRA) contains some very dangerous precedents. It allows the government’s health agency, Centers for Medicare & Medicaid Services (CMS), to set the price of selected prescription drugs. This is certainly a step toward government control of our healthcare. The law gives CMS no flexibility on which drugs to select, because there is a very stringent method that leaves no agency discretion on which drugs are selected, while expressly denying any judicial review of their actions . . . does this sound familiar? The legislation grants CMS a huge budget increase to add government workers to support the new oversight. This certainly doesn’t sound like a reduction in government control. The nose has found its way into the tent.

There has been a lot of talk about the new Alzheimer’s drug Aduhelm. It was approved by the FDA for broad use and then the Department of Health and Human Services (HHS) restricted the use to only those participating in a trial, which greatly reduced access to the drug. This seemingly innocuous move to save money was a precedent setting move by a government agency, overriding the approval of the FDA, the world’s gold standard in ensuring the safety and efficacy of prescription drugs, to arbitrarily ration your and my access to this approved drug. The Biden administration had the audacity to claim credit for the expected reduction in next year’s Part B premium price, a reduction that was paid for by their denying our access to an FDA approved Alzheimer’s drug. This government rationing was on just one drug but is clearly the first move into the tent.

My last example is a waiver request Oregon submitted to HHS. This request would allow Oregon to deny Medicaid patients access to selected drugs that were approved under the FDA’s accelerated-approval program. By law, states must allow access to all FDA approved drugs, but this precedent setting waiver would change that requirement. In their request Oregon stated that “it will only exclude accelerated-approval drugs with limited or inadequate evidence of clinical efficacy, as determined by state review.” So, the state of Oregon, with all its legions of medical experts, would “wisely” determine if Oregon citizens would have access to an FDA approved drug. This means that, if this waiver was in affect two years ago, Oregon could have denied access to the COVID-19 vaccines, since they were approved under the accelerated approval program. It seems that this waiver request represented not just a nose into the tent but half the body. I’m a champion of states’ rights, but this seems to be a clear over stepping of powers and would be a dangerous precedent. I expect this part of the waiver to be withdrawn, since I would hope that HHS would not approve of this exclusion, but the mere fact that it was included in the waiver request in the first place scares me.

These examples should be red flags to all of us. Is this the camel we want sharing our tent? Do we want more government involvement in our healthcare? While the Oregon accelerated-approval part of the waiver will likely be withdrawn, it will lessen the shock the next time something like this is proposed. Soon, this approach won’t shock us, and we won’t think it’s so bad when they propose that they limit access to a small portion of accelerated-approved drugs, maybe like in the IRA, where it is 10 drugs for the first year and then adding 15 more and then . . .

It is impossible not to see that the government, both at the state and federal level, is moving toward more involvement and more control of our healthcare. We need more competition in all facets of our healthcare not more government oversight and regulations. I’ll continue to stay up-to-date and strive to inform you on the things that impact your healthcare. I hope you realize that you can have an impact if you take the time to stay informed and active as an advocate. Together we can make a difference.

Best, Thair



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Vaccines – The Choice is Yours

Before COVID-19 most of us didn’t know much about how vaccines worked. There were movies I saw in grade school, sponsored by Bell Telephone, that taught us about the world around us (I think you have to be over 70 to remember those movies). I remember they explained vaccines as a bunch of fake soldiers coming into your body, which caused your body to quickly build up real soldiers to blunt the attack. When your body found out the enemy soldiers were fake and didn’t need to be attacked, your body was left with this inventory of real soldiers that could beat back any real enemy soldiers that might attack later. It really wasn’t a bad way to explain vaccines to young people, but I suspect, because of COVID-19, we all know much more about how vaccines work and even how the new mRNA vaccines work. But, even with all this new information, many are still leery of many vaccines and, because of the freedoms we enjoy in this country, everyone has the right to make their choice.

The goal of my blog this week isn’t to try to convince you that vaccines are good or bad. By now, most of us have taken a stand on the vaccine issue and we’ve heard more than we’d like about each side. My goal in this blog is to talk about the choices each of us have and the decisions we need to make as fall and winter approaches. I will disclose that I’m a believer in vaccines, as you probably know from my earlier blogs, but I’ll try to pass on unfiltered information that I’ve gathered about where vaccines fit in as we look forward to the next few months.

For those of you who have decided that vaccines aren’t something you want for yourself, you should be taking extra precautions as fall approaches. Many scientists expect both COVID-19 and flu infections to increase as winter approaches. At the height of the pandemic, when we were all isolating and wearing masks, the number of flu cases dropped dramatically from their historical average. That will not be the case this year. This especially applies to older people, those who suffer from lung problems, have serious health issues and especially for those who are immunocompromised. The pandemic taught us how to avoid getting exposed and it is important that you take those precautions to protect yourself and your loved ones.

I also recognize that there may be those who have been vaccinated in the past for the flu, pneumonia, etc. but were hesitant about the new COVID-19 vaccines and decided against those vaccines. My hope is that you continue to stay up to date on the traditional vaccines that are available. There is a great web page that asks a few questions and then gives you a recommendation on what vaccines you need. I’ve given out this link before but here it is again  — link. I answered the questions and found out that I needed a dose of tetanus, diphtheria, and pertussis vaccine (Tdap). I thought that was only needed when you are young or stepped on a rusty nail . . . not so, we need the dose every 10 years. The vaccines recommended at this site are all the traditional, time-tested vaccines.

For those of us who have decided that taking advantage of all the vaccines available is right for us, we are faced with many choices about when we should be vaccinated. I’ve read multiple sources that state that the traditional fall flu vaccine, pneumonia and COVID-19 can all be administered at the same time. The most common combination is getting the second COVID-19 booster and flu shot at the same time. Note, if for some reason you are a vaccine believer but have not been vaccinated for COVID-19 do it now, don’t wait. The same goes for those who have received the initial COVID-19 shots and booster but haven’t received the second booster — go ahead and get it now.

Here’s my experience, which seems to be a very common scenario, and the choices I made as to timing. I had the initial two Pfizer shots and the subsequent booster. In January of this year both my wife and I got COVID-19. I felt poorly for about 36 hours. My wife had the shivers and then felt fatigued for around three days. We felt the vaccines did their job by greatly reducing the affect of the virus. Now that the booster has been authorized, we plan on getting it this week. We also decided to wait until late October or early November to get our flu shot so that it would be the strongest during the traditional times that the flu is most prevalent. Again, there is no problem with getting both shots at the same time, even in the same arm at different shot sites. I think some officials have pressed combining the two shots because the uptake on the second booster has been slow and they hoped that those who were in the habit of getting their yearly flu shot would go ahead and get the second booster at the same time since they were already at the doctor’s office. I’m a big fan of not trying to second guess human nature or “tricking” people into certain behaviors. I’d rather have everyone get unfiltered information and leave how people use that information to them. Whether you get them at the same time or not is up to you.

The important point I want to make is the fact that there are lifesaving vaccines available. It is our choice as what is best for each of us. Don’t let a busy life, a lack of transportation or procrastination be the reason we don’t act on our choice.

Best, Thair



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Our Yearly Survey Results

Last week we held a Facebook Live event that reviewed our yearly Medicare Part D prescription program satisfaction survey. Almost from the beginning of the implementation of Part D, the Healthcare Leadership Council, through its Medicare Today coalition, has conducted a yearly satisfaction survey to determine how Medicare’s Part D program is doing. The results of this yearly survey continue to be very positive, in fact the satisfaction level went up in this year’s survey. You can see a summary of the results of the survey here.

Morning Consult, an award-winning Decision Intelligence company, conducted our satisfaction survey. In our Facebook Live event, Matt Monday from Morning Consult and I reviewed the results and discussed the possible impacts of the recent changes to Medicare Part D. I’ll offer a short recap below, but you can click here if you’d like to see the entire event.

I started the review by pointing out that the Inflation Reduction Act, often called IRA, contains policies that seniors said they opposed if it interfered with their Part D plans. I did mention that IRA did contain a good change which limited the yearly out-of-pocket costs that seniors pay for prescription drugs but, unfortunately, it did implement government-controlled price controls which would slow biopharmaceutical innovation. I voiced that this is an example of how lawmakers often ignore seniors’ input on healthcare issues.

I went on to say that the survey showed that seniors remained highly satisfied with their Part D plans, which is not surprising given their access to safe affordable drugs for even the most serious healthcare issues. The survey showed that seniors were happy with the choice and flexibility of their plans. I highlighted the fact that Part D has overperformed from the beginning, coming in 40% below projected costs while premiums remained stable.

I did mention that the new legislation put a six percent cap on yearly premiums causing me to think lawmakers feared the new IRA policies would increase Part D premiums, forcing them to put in some protections so it wouldn’t scare seniors too much.

I then got off my soap box and welcomed Matt Monday to go over the survey in more detail.

Matt started by telling us that the survey was conducted at the end of June and they questioned over 1,000 seniors who have Part D insurance. The survey focused on their satisfaction with their Part D insurance, the perceptions they have around their coverage and the potential impacts of government price setting of prescription drugs. Matt pointed out that many of these survey questions are tracked over many years, making the resulting trends very compelling.

There were four main findings:

  1. 88% of seniors were satisfied with their Part D coverage which continues the year over year trend.
  2. Two out of three seniors felt a peace of mind that they were covered and nine out of ten felt their coverage was convenient to use.
  3. 90% agree that they have access to affordable prescription drugs and that their costs would be higher without Part D.
  4. Four out of five seniors said that government price setting would impact access to medicines and reduce choice and options.

At this point I took the opportunity to ask a few questions.

My first question was whether there were any increases or decreases in the satisfaction rates this year from prior years? Matt pointed out that often, when a program has high satisfaction rates, the rate begins to fall. This just hasn’t happened with Part D over the years. Satisfaction rates have stayed consistently high. I pointed out that the many choices in Part D plans have enabled seniors to choose a plan that fits them, which adds to their overall satisfaction.

I then asked Matt if seniors thought their plans were affordable or do they find it difficult to afford their coverage? He replied that nine out of ten seniors find their plans convenient and affordable. I mentioned that, with over 8% inflation, the premium price for Part D is projected to go down next year, which begs the question, why do politicians feel the need to fix something that’s not broken.

I next asked Matt if the survey gave any insight into why the satisfaction level has stayed so consistent? He replied that they didn’t specifically ask that question but there were some metrics they could look at. He said that seniors value that their doctors have options and choices and have access to the drugs they need. They don’t have to jump through hoops or have fail first requirements to satisfy. These all lead to maintaining a high satisfaction level. I pointed out that the VA formulary has about half the number of drugs on their formulary as Part D showing how broad the Part D coverage is.

Next, I asked Matt what most concerned seniors about government interference in Part D? He replied that he thought it had to do with access and their fear that the government would interfere with the doctor patient relationship. It also worried me that this new law would restrict innovation such that I might not have access to a drug that would have helped me because it wasn’t discovered due to the new law.

This led to the next question concerning how worried were seniors about the possible reduction in innovation? Matt replied that seniors were not only concerned about their access to medicines they have now but also equally concerned with the medicines they may not have in the future. 82% are concerned about access to newer prescription drugs and seven in ten were worried that government price setting would lead to less research and development. I pointed out that we are on the verge of many new discoveries, and it concerned me that the new law would hinder this research.

I then asked if there were any other options the government had concerning drug prices? Matt said they used a 1 to 10 scale to see how acceptable other drug pricing options were. These questions centered around,

  • keeping out-of-pocket costs low
  • increasing transparency
  • maintaining predictability

Keeping out-of-pocket costs low – Putting a cap on out-of-pocket costs scored 8.3, a very high score.

Increasing transparency – Garnered a score of 9.02, the highest of any option.

Maintaining predictability – The ability to spread their costs over the year so their costs were predictable scored 7.38, also a high score.

I talked a little about the new IRA legislation and the many implementation details that haven’t been defined, which means that we need to be vigilant in our understanding and advocacy. The devil is in the details and we can have a voice in eliminating the devil that hurts our access and affordability. Matt pointed out that the increased predictability will be extremely important given the impact high inflation is having on fixed income seniors.

I then thanked Matt and Morning Consult for their work and closed the event.

This yearly survey is very important in tracking how seniors feel about Medicare Part D. It is another way for Seniors to Speak out.

Best, Thair



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Do You Know Your Cholesterol Score?

This month is National Cholesterol Education Month which hopefully will turn our attention to learning how we can take some preventative steps toward lowering our risk of heart disease. We’ve heard a lot lately about vaccines . . . OK, maybe I was an author of a portion of the many informational diatribes on how important vaccines are. Probably the main point that I stressed was the fact that vaccines were a way to prevent illness. That same reasoning applies to your cholesterol score, it can give you an early warning to a possible heart disease risk and allow you to take some preventative measures to lower that risk.

A high cholesterol score is bad, doctors would like you to have a score of 200 or below but “normal ranges” are less important than your overall cardiovascular health. Your doctor will take into account your personal health and history and advise you if any steps need to be taken. Remember, over 102 million Americans have total cholesterol levels above healthy levels and 35 million have dangerous levels that put them at high risk for heart disease. It is worth taking the time to have your doctor test your cholesterol levels.

In the spirit of education, here is some information on cholesterol from the Medical West web site:

“Cholesterol is a waxy, fat-like substance made in the liver and found in certain foods, such as from animals, like dairy products, eggs, and meat. The body needs some cholesterol in order to function properly. However, too much cholesterol can increase a person’s risk of developing heart disease. There are several factors that contribute to high cholesterol — some are controllable while others are not. Some of the non-controllable factors include age (men above age 45 and women above age 55), gender (women are at higher risk after menopause), and a family history of high cholesterol. Controllable factors include eating a high fat diet, being overweight, and not getting enough exercise.”

Click here for a great 3-minute video that explains even more about cholesterol.

The next question we should ask is, who needs to get their cholesterol checked and how often?

  • Most healthy adults should have their cholesterol checked every 4 to 6 years.
  • Some people, such as people who have heart disease or diabetes or who have a family history of high cholesterol, need to get their cholesterol checked more often.
  • Children and adolescents should have their cholesterol checked at least once between ages 9 and 11 and again between ages 17 and 21.
  • Talk to your healthcare team about your health history and how often you need to have your cholesterol checked.

There’s a lot of rumors and myths out there about high cholesterol. Here are some of the more prevalent myths:

  • Myth: I would be able to feel it if I had high cholesterol.
    • Fact: High cholesterol usually has no signs or symptoms.
  • Myth: Eating foods high in cholesterol won’t make my cholesterol levels go up.
    • Fact: We know that foods with a lot of cholesterol usually also have a lot of saturated fat which can make cholesterol numbers higher.
  • Myth: I can’t do anything to change my cholesterol levels.
    • Fact: Exercise, lifestyle changes and medicine can all work to lower your cholesterol score.
  • Myth: All cholesterol is bad for you.
    • Fact: Some types of cholesterol are essential for good health. LDL (low-density lipoprotein), sometimes called “bad” cholesterol, makes up most of your body’s cholesterol. High levels of LDL cholesterol raise your risk for heart disease and stroke. HDL (high-density lipoprotein), or “good” cholesterol, carries cholesterol back to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.

We’ve seen some great strides in the discovery of medicines that can help lower our cholesterol score. A CDC website identifies five medicines that will help us lower our score. You can click here to find out more about these great medicines.

We’ve hopefully imparted some knowledge in the spirit of the National Cholesterol Education Month. For fun, click here to take a quiz that will test your smarts on cholesterol.

As with all my blogs there is always an action required. If you haven’t had your cholesterol checked in the last 5 years call you doctor and get it done. It’s one of those preventative things we can do that can truly change, or even save, our lives.

I want to remind you that we will have a Seniors Speak Out Facebook Live event with Matt Monday from Morning Consult and me this Thursday, September 15, at 2:00 PM ET where we will discuss how seniors feel about their Medicare Part D plans. Click on this link for more information. This discussion will focus on the yearly survey that the Healthcare Leadership Council has been taking since the inception of Medicare’s Part D Prescription Medicine program. This yearly survey helps me keep a finger on the pulse of the important people in this program . . . you, the program’s beneficiary. It should be an especially interesting discussion given the changes to Part D that have just been signed into law. Click here to find out more and how to join what looks to be a spirited discussion.

Best, Thair



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Making Medicare Advantage Even More Advantageous

In an effort to get input on how to improve Medicare’s Part C, better known as Medicare Advantage (MA), the Centers for Medicare and Medicaid Services (CMS) has issued a Request for Information, (RFI) to get input from stake holders on improvements to this important part of Medicare. MA is the fastest growing option for those who are 65 and older, offering an option for a private insurance company to provide your healthcare.

The Healthcare Leadership Council (HLC) is the sponsor for Seniors Speak Out and is in a unique position to offer insightful and balanced suggestions on how to improve MA. This unique position comes from the fact that HLC is a coalition of chief executives from all disciplines within American healthcare. Members of HLC – hospitals, academic health centers, health plans, pharmaceutical companies, medical device manufacturers, laboratories, biotech firms, health product distributors, post-acute care providers, home care providers, and information technology companies – advocate for measures to increase the quality and efficiency of healthcare through a patient-centered approach. This broad membership ensures this balanced approach to the suggestions for improving MA.

While the suggestions offered by HLC covered many aspects of MA, I want to highlight a few that I feel are very important improvements to MA.

Telehealth – While it is difficult to think there was anything good that came out of the pandemic, there was at least one silver lining. The use of telehealth was slowly growing prior to the pandemic and then we were suddenly thrust into the directed isolation of this deadly virus, which was especially dangerous for older people. The very people who historically require more healthcare services were advised to limit their exposure to other people, especially doctor’s offices and hospitals. These healthcare providers were suddenly asked to find alternative ways to treat their patients. Another silver lining of COVID-19 was the crash course seniors went through to learn how to use Zoom and other virtual platforms, since it was often the only way they could see the faces of their loved ones. It shortened the learning curve on using this new technology and enabled doctors to both talk and see their patients, a definite plus in the evaluation of their patient’s condition. Using emergency powers, the administration enabled Medicare to pay for these remote services by waiving certain payment restrictions. It is important now that those payment restrictions be extended and permanent payment options be studied and instituted. For example, studies have shown that Virtual care during the pandemic reduced patients’ risk of overdose and boosted the use of medication-assisted treatment for opioid use disorder, the CDC, CMS, and the National Institute on Drug Abuse found in a new study out in JAMA Psychiatry. Researchers examined data from more than 175,000 Medicare beneficiaries between September 2018 and February 2021. They found that during the pandemic, receiving opioid-use treatment via telehealth was linked to better retention for medication-assisted treatment and a lower risk of medically treated overdose compared to people who didn’t receive opioid use services via telehealth. This specific example shows that telehealth can be very effective. The best practices gleaned from the COVID-19 experience should allow us to reap the savings and efficiencies of providing remote healthcare.

Broadband Access – The pandemic emphasized the need for broadband access and accelerated the upgrading of internet access. Access to a high-speed internet connection has reduced the barriers for those who live in rural areas, reduced the problem of transportation, and even increased the equitable application of healthcare. As states imposed stay-at-home orders, consumers required alternative sources to remain connected with healthcare professionals so they could continue to receive important care – this was particularly critical for people with chronic conditions, who required access to consistent, continuous care to manage their overall health. Additionally, many home digital health products offered today work most effectively with a sufficient and sustained connection. As the Infrastructure Investment and Jobs Act included provisions to advance digital connectivity, CMS should continue to partner with agencies such as the National Telecommunications and Information Administration and the Federal Communication Commission to better target communities in need and work to reduce existing health disparities. CMS needs to pursue options that increase Medicare beneficiaries’ connection to, and use of, digital tools, such as supporting cellular devices programs and incorporating digital literacy.

Data Interoperability – The ability for different computer systems to communicate with each other is extremely important when it comes to healthcare. There are many initiatives, like the Trusted Exchange Framework and Common Exchange, that support a common baseline for quickly sharing information among stakeholders while ensuring that healthcare information receives robust privacy and security protections. We all fill out many forms during our visit to different healthcare providers, many times entering the same information over and over. Some of this duplicity is due to the inability of different information systems to share a common standard which would ensure the quick and accurate sharing of information. I have personally advocated for years for the establishment of a standard and secure way to share information. It is imperative that we consider the needs of healthcare stakeholders to ensure a smooth and successful transition to an efficient secure standard.

The improvements detailed above are a few of the improvements mentioned in the HLC letter but I feel they are key in turning the silver linings that came from the COVID-19 pandemic into permanent improvements in the MA program. It’s an opportunity for improvement that we can’t let slip away.

Best, Thair



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Vaccines, a Lifesaving Miracle

According to an Imperial College of London study, the COVID-19 vaccines saved almost 20 million lives around the world in the first year. I can’t comprehend the deaths of 20 million people. Each one of those 20 million have people who loved them and people they loved. They each had people who depended on them. They each had a purpose on earth that would have been cut short if it weren’t for the vaccines. We were so lucky to have those lifesaving vaccines.

While these new vaccines were developed in an unprecedented short period of time, we have had other vaccines that have been around for a long time that we seem to be taking for granted. Remember the days when vaccinations were for newborns and kids getting ready for school. Measles, diphtheria, smallpox, and polio have largely become diseases of the past because of vaccines but they were primarily for children. I want to focus on important vaccines that protect adults.

Pneumonia, the disease that in the past was a killer of the elderly, can be controlled and prevented by a vaccine. Shingles, a painful disease, can be controlled with a vaccine. Older adults are encouraged to get the tetanus, diphtheria, and pertussis vaccine booster to renew their resistance to those maladies. Another killer of older people is the flu. The estimate for deaths caused by the flu for the 2017/2018 season was 61,000. Each year we can get a vaccine that greatly reduces the impact of the flu, yet less than 50% of us get that lifesaving shot. This goes against what happened during the pandemic.

94% of the adults between the ages of 65 and 74 were fully vaccinated against COVID-19 during the pandemic. What changed, why did 94% of us choose to get the COVID-19 shot but, historically, 50% of us chose not to get vaccinated against the flu? It doesn’t seem to make sense. It is true that we reduced our visits to the doctor as we sequestered ourselves and our mask wearing during the pandemic reduced the spread of the flu, but what is going to happen this fall? We’re mostly not wearing masks so we are more vulnerable. Will we come to our senses or will we return to that embarrassing condition where half of us don’t get vaccinated?

Here’s an idea, since it looks like we will get another booster approved in the next few weeks that will protect us against the COVID-19 variants, why don’t you just ask your healthcare provider to give you the flu shot also? And if you want to get real crazy, why don’t you review your vaccination history with your doctor and catch up on all your vaccinations? So, how do you know what vaccines you need . . . glad you asked.

Here is a link to a website that asks you questions and generates what vaccinations you need. I went through the process, and it has given me a great start on what vaccinations I need but it also brought up more questions. What vaccinations have I already had? I’ve changed my primary physician three times in the last three years, once when I moved and a second time when I found a doctor that better met my needs. Where are my immunization records? What about when I got my flu shot last year at a pharmacy? Did they pass my immunization record to my primary doctor? I don’t recall if they even asked the name of my doctor. This brings me to something else we need to do to keep us on track – keep our own record of all of our immunizations. I bet you have been like me and carried you COVID-19 immunization record with you over the last two years. Mine is kind of worn around the edges from being in my wallet. I even took a picture of my record in case I lost my wallet. We need to use this same dedication in keeping track of all of our immunizations. It may be the only place where a complete and accurate record of all your immunizations exists. Think back, when was the last time your doctor asked you to go over all your immunizations? As of five years ago some doctors’ computer systems didn’t have a place for tracking adult immunizations. It’s a valuable thing to have.

If you’re like me, you can’t remember all of your past vaccinations. Here is another web site with some hints on how to find past health records and also a place to download a form that you can use to track you immunizations. Whatever you do, begin now to track your shots. If you get poked, write it down. It will be so fun the next time you cut yourself or step on a nail and the doctor asks when you last had a tetanus shot and you can tell her/him the exact date.

It’s National Immunization Awareness month. Let’s build on the momentum of being the best COVID-19 immunized age group and become the best immunized age group for all of our recommended immunizations, along with having the best record of our immunization history. It’s a lifesaving goal.

Best, Thair



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Inflation Reduction Act – How and When It Will Affect You

The Senate and the House passed the Inflation Reduction Act (IRA) and President Biden signed it into law six days ago. As I’ve said before (in this blog) it has some good things and some bad things. It was passed on a purely partisan vote, with the 50 Democrat Senators voting yes and the 50 Republican Senators voting no, and Vice President Harris voting yes to break the tie. It was a party line vote in the House with 220 Democrats voting yes and 207 Republicans voting no. Once again, our government chose to pass a purely partisan piece of legislation that will have a huge impact on seniors in this nation. I’ve written previously about the evils of partisan governing here. It’s not good when a small majority can pass such important legislation.

So, before we get into the new law, I’m going to rant a little. Maybe some math will highlight the reason for my displeasure. The vote was 50 for and 50 against the bill in the Senate so, from the Senate perspective 50% of us had Senators that were against the IRA. There were 13 more House members (all Democrats) that voted for the IRA than voted against it. The average size of a House district is 761,000 so the difference in citizens represented by the 13 yes votes was 9,893,000. With the population of the United States at 329.5 million the ratio of those 9,893,000 yes votes to no votes of citizens represented was 3%. That 3% made the difference and they were all in districts of Democrats. A bill of this magnitude should not pass on such a slim majority. Somehow, our country needs to figure out how to work together to develop laws that are bipartisan.

Ok, let’s talk about this new law. I’m only going to talk about the healthcare portions of the law and only those that affect older Americans. I’ll go year by year since many of the changes won’t go into effect for a few years. I’ll try to keep it short and to the point.

2023

  • The price of some drugs may not increase as fast since the manufacturer must pay a rebate if they raise prices above inflation. I wonder how much a benefit this will be if inflation stays high.
  • Out-of-pocket costs for insulin is capped at $35 a month.
  • Reduces the cost for adult vaccines.

2024

  • If you reached the catastrophic phase of your Medicare Part D coverage, which means you spent $7,050 on drugs, that’s all you’ll have to pay. Eliminates the 5% coinsurance that you used to pay.
  • Expands the eligibility for the Part D low-income subsidy.
  • Starting in 2024 and continuing through 2030 Part D premium growth is capped at a maximum of 6% per year.

2025

  • Part D 0ut-of-pocket costs are capped at $2,000 per year.
  • The payment of drug costs can be smoothed out over the entire year.

2026

  • Government price controls will be implemented on 10 selected drugs. This may affect what you pay depending on the drugs you take.

2027

  • Government price controls will be implemented for 15 more drugs, for a total of 25.
  • The Trump Administration’s drug rebate rule, which had been delayed until 2027, will be further delayed until 2032.

2028

  • Government price controls will be implemented for 15 more drugs, for a total of 40.

2029

  • Government price controls will be implemented for 20 more drugs, for a total of 60.

The amount of savings generated by government price controls for any one individual will depend on a lot of variables. The Kaiser Family Foundation, a non-partisan information source on healthcare, said the following about possible savings.

“The number of Medicare beneficiaries who will see lower out-of-pocket drug costs in any given year under this provision will depend on how many beneficiaries use drugs whose prices increase more slowly than would otherwise occur and the magnitude of price reductions relative to baseline prices.”

These are the pocketbook impacts of this new law for seniors. What hasn’t been discussed much since this bill was signed into law is the other impacts of this new legislation, like the constraint to the development of new drugs. This will be especially felt by the small bio firms which produce many of the new scientific break throughs. This law doesn’t do anything to add more transparency and efficiency to the drug supply line. There were many improvements that could have been done that would have saved money and improved access that were not considered.

As with all big changes to our healthcare system, the real impact will depend on how the law is implemented and how the providers, drug manufacturers and insurance companies react to the changes. There is much more to understand about this bill, and we must still stay involved as it is implemented. The devil is in the details and the details will reveal the real impact these big changes will have on each of us. We’ll stay involved through the process and we hope that you will stay involved also.

Best, Thair



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A Balancing Act That’s Important to Your Health

I read an article recently that made me jump out of my chair . . . no it wasn’t a notice that I won the Master’s lottery and would be going to Augusta to watch the golf tournament next year. It was an article about a recent study that said if you can balance on one leg for 10 seconds it’s an indicator of your overall health. So, before you jump up, here’s a picture of how you stand to take this simple test. I tried it immediately, both with and without shoes, it didn’t seem to make a difference. I did find that I did better if I stood on my dominant foot. I’m right footed, but you are allowed to use either leg. You can take three tries to successfully complete the test. The thing that really grabbed my attention was the statement that, “The inability to stand on one leg for 10 seconds might indicate an increase in the risk of death within the next decade.” Now that seems like an ominous prediction for a simple test but the study (click here to read about the study in more detail) seemed thorough and legitimate. The fact does remain that as we age, our flexibility and balance diminish. Balance begins to be more difficult beginning in our 50s and can quickly go downhill. According to the World Health Organization problems with balance increase the risk of falling, which is troubling as falls are the second leading cause of unintentional injury deaths worldwide. More than 37 million falls are severe enough to require medical attention each year.

Now I’m a few years past 50, OK, I’m a few years past 70, but I have never had a balance check at any of my physicals. I’ve pressed my hands and legs against the opposing pressure from the doctor and the doctor has tested the strength of my grip, both important tests of physical health, but no one has tested my balance. The authors of this balance study recommend that this balance test be included when the doctor evaluates the overall health of a patient over 50.

I will reveal that I passed the test but found it harder than I thought it would be. I guess this goes along with the realization that I don’t get up off the ground as easily as I used to and my wife’s insistence that I don’t go up more than three rungs on ladders. I’ve also lost distance on my drives when I golf. My son says that it’s because my core strength isn’t as strong as it used to be. In doing some further research I found that core strength is directly related to balance, the stronger the core, the better the balance. For me, taking a little more time to get up off the floor, or not climbing too high on a ladder are not big problems, but when I lose distance when driving a golf ball – now you have my attention. If strengthening my core muscles will increase my driver distance and, as an added bonus, keep me from falling, then sign me up. My next question is how do you do it?

A little more research and advice from my son pointed me toward doing “planks.” I didn’t do those in high school gym class but evidently, they are the way to strengthen your core muscles. A plank is a simple, but effective core exercise that helps you build stability and strength throughout your entire body. The plank is achievable in a number of different ways, but the main position of the plank exercise is with your body perpendicular to the ground, stomach facing down, elevating your torso off the ground with either your elbows or hands. This will position you as if you were stuck in an extended push-up pose without actually moving your body weight up or down. This may sound much nicer and more forgiving than a set of push-ups, but the plank can become a strenuous exercise very quickly as you continue to hold that position. You can go online and find a multitude of different types of planks. An excellent article I found talked about how the plank helps build core strength, the benefits of doing them and some variations that can further build strength. You can find that article here.

As mentioned above, the exercise can become very strenuous and may not be the best way to exercise our core muscles as we grow older. Luckily there are other ways to build these muscles that will fit all levels of mobility. Remember, the goal here is to improve your core muscles and therefore your balance. It doesn’t matter where on the range of muscle strength we start, it only matters that we do something that makes our core muscles stronger.

I found a place that offers some great non-plank core muscle exercises for older adults. It’s on the SilverSneakers web site. Click here for these non-plank exercises. These are great exercises that help you improve no matter where you start on the strength spectrum.

One of the great things about all these exercises is that they don’t require special equipment or a membership to a gym. They just require some time and effort. It will be time well spent. Whether you passed the 10 second test or not, it’s worth doing the exercises just to improve your balance. How many times have you heard that an older person fell and broke their hip and died a short time later. It happened just like that with my mother in-law. Maintaining your balance is a great way to keep yourself healthy and it might even help your golf game.

Best, Thair



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The Good the Bad and the Ugly

While the blog title is a good one for a great spaghetti western it’s not so good when it applies to pending legislation that will have a long-range effect on our lives. I’m talking about the Inflation Reduction Act that survived Saturday night and early Sunday’s gauntlet of voting on amendments to the bill, affectionally known as the vote-a-rama, and was passed by a partisan 50 to 51 vote with the Vice President breaking the tie. It will now go to the House where they will most assuredly pass it, probably on Friday. So, how did we get to this point on this ominous piece of legislation?

Since the massive Build Back Better bill failed to gain traction, the Democrats have worked feverishly to try to find a narrow bill that they could pass before the midterm elections. This meant they needed to broker a deal with two moderate Democrats, Senators Joe Manchin III (W.Va.) and Kyrsten Sinema (Ariz.), who were the ones that held up the passage of the larger bill. When Senator Manchin abruptly changed his stand opposing legislation that would impact inflation and raise taxes, and Senator Sinema got her changes to the bill, the door was open for a pared-down bill that they named the Inflation Reduction Act, an obvious nod to Senator Manchin. The only way to pass this bill was through a process called reconciliation. I discussed this process and my disdain for using legislative maneuvers like it to pass such important legislation in a recent blog. Suffice it to say that this bill, if it passes, and it probably will, will be a purely partisan law. In essence, a bill that affects 100% of us will only have the support of 50% of those who represent us. It took the vote of the Vice President to break the tie. This bill certainly contains some good, some bad and some ugly parts.

The good –I think that capping the out-of-pocket costs for prescription drugs at $2,000 a year is definitely good for seniors. I’ve been advocating for this change for more than a decade. It gives older Americans some sense of security knowing they won’t be bankrupted by drug costs, and it gives younger people a definite ceiling on out-of-pocket costs as they plan their retirement.

The bad – This bill allows the government to fix the price of some of the highest priced drugs. I’ve talked ad nauseum about the problems of allowing the government to insert itself into our healthcare when it’s not needed. Drug prices have not risen faster than inflation for years and they have risen slower than the other parts of healthcare. There are parts of our prescription drug system that need to be changed. Having the government set the prices for important drugs is not the answer. Many have talked about the negative effect this change will have on innovation and the discovery of new life improving and lifesaving drugs. It is difficult for many of us to understand how this will dampen the willingness of investors to risk their money on new research. Maybe this example will help.

The movie industry and prescription drug business have a lot in common. For starters, the drug industry calls a very successful drug a blockbuster, the term was taken from the same moniker enjoyed by a very financially successful movie. Thousands of movies are made each year with very few of them breaking even or making a profit. Small independent movie makers have an idea and develop a script and work to find money to make the movie. Likewise, there are many small biotech firms that have a scientific idea about a new drug and work to find the money to continue their research. Both of these businesses rely on investors who are willing to wait years, some over a decade, for a return on their investment, with the understanding that about 9 out of 10 will be failures. They are still willing to invest because of the chance for the financial windfall of a blockbuster, whether it be a movie or a drug. If the government gets the power to limit the price of the expensive blockbuster drugs, it will be like the government limiting the number of movie tickets that can be sold for a successful movie. In both of these scenarios the number of new movies and the number of new drugs will both be limited because the reduced reward will not be worth the risk. Investors will take their money elsewhere. This same scenario plays out for big movie producers and big drug manufacturers – they won’t be willing to purchase these smaller companies if the big payoff is not available.

There is one other consequence of this price fixing legislation. In the late 1980s and 1990s many prominent scientists left companies in other countries, especially Europe, and came to America where the environment for pharmaceutical innovation was much better. If that environment worsens, that migration is sure to reverse itself and we will lose those great scientists. Having new discoveries in our country proved to be very valuable during the pandemic. I would hate to lose that advantage to other countries.

The ugly – I’ve already talked about the ugliness of the process used to pass this bill here and in an earlier blog. The reason this bill was forced through had everything to do with politics and the upcoming midterm elections and very little to do with the long-term health and the wellbeing of older Americans. I wish it didn’t have to be this way.

I’m sure there will be more to say as this law is passed by the House at the end of the week and as it is implemented. We will continue the fight to lessen the impact of this bill and we will continue the fight for better healthcare for you and me.

Best, Thair



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Survey Says . . .!

Most of us have watched or have heard about Family Feud. They ask members of a family how they would answer certain questions and then compare those answers to how a group of 100 people answered those same questions. Sometimes the family member matches many of the same answers the survey group came up with; often they don’t, which leads to some very entertaining situations. I think the producers of the show realize that a family of four people may have some quirks and unusual experiences that leads to entertaining answers. In fact, I think they’re counting on it.

It seems to me that Washington, in its feverish haste to look like they are doing something for older Americans, has forgotten to find out how their older constituents feel about Medicare’s prescription drug Part D program. They are letting political quirks and their own small view of the issue cause them to come up with answers that are a far cry from what their older constituents want. It may make for entertaining campaigning, but it doesn’t really solve the problems.

Every year since 2007 the Healthcare Leadership Council has conducted a survey of older Americans to ascertain how they feel about Part D. The satisfaction in 2007 was at 86%. That is unheard of when referencing a new broad government program. Now, 15 years later, our latest survey shows that seniors in our nation are still very satisfied with Medicare Part D. The nationwide survey of 1000 seniors found that 88 percent of senior enrollees are still satisfied with their Part D coverage and 86 percent agree that their plan is a great value. That’s not bad for a government program that has come in almost 40% under the budget estimates calculated at the program inception. I challenge anyone to identify a government program that has come in 40% under budget with an almost 90% satisfaction rating. A satisfaction rating that’s not from those who run the program, not from the providers or insurance companies, not from the politicians in Washington, but from those who are directly served by the program. One of the basic questions I need to ask is, “why do we need to fix a program that is under budget and wildly successful?” My father always said, “if it ain’t broke don’t fix it.”

While these satisfaction numbers continue to be excellent, year after year, there is another part of this survey that is extremely important given the current Part D changes that are being proposed. These proposed changes would allow the government to set the prices of an ever-expanding number of drugs. It would enforce prohibitive fines against price increases that go over the Consumer Price Index (CPI), which is a measure of inflation. Just as an aside, given the current rate of inflation the drug manufacturers would be allowed to raise their prices three times above what the average price increase has been in the last three years. Again, Congress wants to insert themselves into a successful program that will most assuredly cause unintended consequences, to say nothing of the intended consequences that will limit choice and access and have very little to do with saving out-of-pocket costs for seniors. Given these proposed changes I think it is extremely important to hear what those that will be impacted by these changes have to say.

Here’s what the survey said:

  • Two-in-three Part D enrollees said prescription drug plans should negotiate prices directly with the biopharmaceutical manufacturers instead of letting government set prices and determining which drugs will be covered under Part D formularies.
  • 83 percent of seniors are concerned that federal involvement in pricing could reduce choice and options for prescription drugs for seniors and individuals with disabilities in the Medicare program.
  • 82 percent of seniors are concerned government price setting policies would limit access to newer prescription medicines.
  • 81 percent said it is important to them to have a variety of plans from which to compare and choose.

It should be evident to even the most casual observer that the people who are impacted by the proposed changes aren’t convinced that they are in their best interest. Political expediency and leverage are not reasons to make these types of basic changes to a very successful program.

I do want to point to one positive part of the proposed changes. While fixing prices would not lower out-of-pocket costs, capping the yearly drug out-of-pocket costs to $2,000 will most certainly give a great relief to those who were suffering the most from high prices and the impact of high deductibles or co-insurance. There’s no middleman or arbitrary selection process or other regulations to be gamed, it’s a simple benefit that is applied to those who have been impacted the most. It takes away the worry of wondering what would happen if you suddenly needed some lifesaving expensive medicines. It takes a huge variable out of retirement planning. I have advocated for this change for over 10 years.

We all listen intently when Steve Harvey says, “survey says!!!” Why don’t those who represent us in Washington take a moment to listen intently to what their older constituents say? We have many government programs that don’t work. It doesn’t seem logical to try to fix one that is working just fine.

Click here if you want to tell your Representative or your Senators how you feel about these proposed changes. Your voice is powerful when you choose to speak out.

Best, Thair