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Alzheimer’s and Brain Awareness Month

Last month, June, was Alzheimer’s and Brain Awareness Month – you may have seen some information about it on social media. I wanted to add to those voices before everyone moved on.

Alzheimer’s is the most common form of dementia, accounting for 60 to 80% of dementia cases, it affects over 5.5 million Americans. Alzheimer’s is one of those diseases that is all to common, most of us either have someone close to us with the disease or know someone whose loved one has Alzheimer’s. It has a huge affect on our nation because it requires caregivers with enormous patience, it lasts a long time, has no cure and is one of the nation’s costliest diseases. It is estimated that it will cost our nation over 300 billion dollars this year and the cost is going up. This cost doesn’t even figure in the cost to society of unpaid caregivers. While the death rate of other diseases has fallen . . . the death rate of heart disease, the most common cause of death, has fallen 11% . . . the death rate from Alzheimer’s has risen 123% between 2000 and 2015. Alzheimer’s impacts us all, personally and financially.

So, you might ask, “why haven’t we found a cure? It is obvious that we should be working day and night on a cure for this disease.” Well, we have, but it has been rough going. Alzheimer’s is a complicated and multifaceted disease. There have been many promising medicines that have been tested and failed, some of the failures coming at the very end of the clinical trials. It has been heartbreaking to those impacted by Alzheimer’s to have hope and then be disappointed.

Scientists have identified that plaque buildup in the brain seems to be common in those with Alzheimer’s. They have also discovered that a vital brain cell transport system collapses when a certain protein twists into microscopic fibers called tangles. These discoveries have given hints to the cause, but a solution has been elusive. While there have been medicines created that treat some of the symptoms, there is still no cure. But there is hope. Scientists have joined forces by forming the Coalition Against Major Diseases (CAMD), an alliance of pharmaceutical companies, nonprofit foundations and government advisers, that have forged a first-of-its-kind partnership to share data from Alzheimer’s clinical trials. It will take a combined effort like this to tackle this terrible disease.

As a country we need to ensure that our government allows coalitions like this the freedom to pursue a cure for Alzheimer’s. My math says an Alzheimer’s cure could save our nation 3 trillion dollars over 10 years, to say nothing of the impact on the millions of patients and caregivers whose lives are devastated by this disease.

In these times of isolation my sincere thanks goes to those in the Alzheimer’s units throughout the country who have stayed on the front lines, often at the risk of their own health, to care for the millions of Alzheimer’s patients. Find out more about Alzheimer’s and Brain Awareness Month by going to this website. You might also try wearing a nice-looking purple outfit in hopes that someone will ask you about it and you can tell them about Alzheimer’s and the importance of finding a cure.

In the meantime, stay safe and be joyful.

Thair



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Our Government and the Pandemic

We’ve talked a lot about how the pandemic has affected us, mentally, physically and financially. In our recent Medicare Today/ Seniors Speak Out poll we saw that our healthcare providers had a favorable rating (54% said the healthcare providers performed better than expected) as opposed to the government where only 16% thought they performed betterthan expected. As many states are beginning to open up, I thought it would be beneficial to look at what our government has done so far and the affect it has had on us so far.

There’s been a lot of discussion as to whether the President handled the pandemic correctly or not. It continues to be difficult to separate the truth from the political rhetoric. Did he take the pandemic seriously at the beginning? Did we shut down too early or too late?  Did he take power away from the states or gave them too much power to decide how their state was going to react? It may take years to analyze what actually happened and which actions were right and which were wrong. What we can talk about is what affects the Federal and State policies concerning the COVID-19 pandemic had on older Americans.

Most of us got a stimulus and/or an unemployment check from the government. We hope that the small business loans and Paycheck Protection Program money will help those who were furloughed or laid off. It seemed that every discussion I had with other seniors at some point turned to how our kids’ and grandkids’ employment was affected. It seemed that the government was trying to keep our economy going until it could be opened up again. Finances remain at the top of every discussion concerning the pandemic, but it has also affected us in other ways.

As you might remember the shutdown caught many by surprise. Some seniors were caught on cruise ships and in foreign countries and in many instances had a very difficult time getting back home. Some states even had travel restrictions that hindered travel between certain states. Each state has responded differently as to when and for how long to institute the shutdown of commercial businesses. What this meant for many seniors was the separation from their loved ones and the disruption of their routines. I did notice something else, the further splintering of America. It seemed that rather than pulling together, we spent a great deal of time and effort pointing fingers. At a time when we should have been uniting against a common foe, the pandemic, we talked about who to blame for its spread and who to listen to. It seemed hard to know who to believe. It was very unsettling.

While each of our lives was affected in different ways I want to focus on two aspects of the pandemic that I think will have long term consequences if we don’t address them; the situation at long term care facilities and the ways our government entities communicate with us.

It was quickly ascertained that the people who were most vulnerable to dying from the virus were people over 65. This was due to the fact that this population had more of the other conditions that made them vulnerable, like lung problems, diabetes and other medical conditions that inhibited their bodies from fighting the virus. It should have been very evident that people over 65 and in close quarters at long term care facilities had more of a chance of catching the virus and having poor outcomes.

I think this was the time and place for the government to step in and get masks and other healthcare support to these people as quick as possible. The final statistics will reveal how many seniors died in long term care facilities. There were certainly some facilities that didn’t have a plan in place or didn’t react as they should. Since then state and federal governments have stepped in to assure better protections. When the pandemic is contained and we can reflect on what changes need to be made, the regulations and avenues of support available for long term care facilities in times of crisis need to be reviewed and strengthened.

Our access to information has exploded over the last few years. More seniors found out how to use Zoom in the last few months than anyone could have ever predicted. We had access 24 hours a day to the 15-minute news cycle which, you’d think, would have kept us informed and reassured. Instead we began to distrust institutions that we used to have confidence in. There was misinformation disseminated by the CDC (Centers for Disease Control and Prevention) and the WHO (World Health Organization) has become suspect due to the influence of China in its pandemic recommendations. Dr. Fauci, an expert at the NIH (National Institutes of Health) since 1984, garnered some trust in the daily briefings that were aired on TV, but he was often contradicted by the administration. The result is we had all this information and didn’t have any trust that it was accurate. One of the basic duties of government is to offer reassurance in times of crisis. In my estimation, we didn’t have this reassurance at a time when we needed it most. For seniors, trapped in their homes without close personal contact with their loved ones, this was unsettling. Why is it that more Americans trust the Joe Rogan podcast more than the CDC, the government agency that is supposedly the most informed about pandemics? The pandemic has exposed a vacuum in trust that supersedes this health emergency and may prove to be the biggest problem our nation will face once the pandemic is over.

Our government shouldn’t be responsible for rescuing us from every problem. Our government should be the rallying voice and our most trusted supporter that helps us rescue ourselves. Whether it’s ensuring that long term care facilities are able to effectively take care of those that are the most frail or being a trusted source of accurate information to help us make informed decisions about our lives, the government of the United States of America must somehow regain our trust. This pandemic will have profound impacts on our lives for years to come. I wish I had all the answers to the problems that this pandemic exposed. What I do know is that we will get through this. We are a great country and we have the ability to fix our problems. In the meantime, stay safe and have joy.



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June 13th, National Family Health and Fitness Day

Today is Family Health and Fitness Day and it’s a great time to refocus on the things that keeps us healthy. Since early March we have done nothing but try to keep from getting the coronavirus. We’ve stayed sequestered, we’ve worn masks, we’ve avoided some of the things that give us the most joy, like hugging and visiting with our grand kids. We’ve been extra careful because we know that we are in the most vulnerable age group, those of us that are over 65. This focus on avoiding the coronavirus may have caused us to quit doing the things that have helped us stay physically and mentally healthy, like going to a health club to exercise, going swimming, or walking without friends. The virus made doing these things unsafe and, even though many places in America are opening up, we should stay vigilant. We remain at risk and should remain careful.  There are, however, some things we can do that are safe but will improve our health and fitness.

 In past Family Health and Fitness Days, seniors were encouraged to walk with friends, attend a fitness class, go dancing, have a health screening with your doctor or volunteer. These were all great ways to get healthy and fit but what do we do now when we are trying to stay safe?

Here are some things that we can do that will keep us safe but will increase our health and keep us fit.

  • Going outside and walking is still safe, as long as you stay 6 feet away from everyone. The virus has a much less chance of reaching you when you’re outside. Keep a mask with you in case you meet someone that you want to stop and talk with.
  • Find a yoga or exercise class on-line and make it a part of your daily routine. There are even some exercise classes on the tv that you can tune into.
  • Team up with one of your friends and act as each other’s enforcer to ensure that you stay with your daily exercise routine. It helps you stay on your plan when you know you have to “report” to your friend on your progress.
  • You can still volunteer by calling someone who needs to hear your voice. Encourage someone who is down. Order a gift for someone online and have it delivered to their house as a surprise. Doing something for someone else helps us forget our own troubles.
  • Don’t forget to keep seeing the doctor as required. While this might not be the time for a wellness visit or for some elective procedures, it is important to see your doctor for new or long-term health problems. Your doctor has done everything possible to maintain a germ-free environment and will advise you if keeping an appointment is not necessary. Don’t hesitate to use the telephone or have virtual meetings with your healthcare provider. Medicare and other insurance companies have stated that they will cover telehealth appointments.

These are just a few ways to return our focus to our long-term health and fitness. It’s so uplifting to see things begin to open up. While we still need to be careful, we can be happy that there is a light at the end of the tunnel. The scientists are working hard to find medicines that can lesson or stop the effects of the drug and develop a vaccine that will protect us in the future. In the meantime, stay safe, keep yourself healthy and fit and stay joyful.



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Your Answers to Our COVID-19 Poll

We did a poll concerning the COVID-19 pandemic to give you an opportunity to tell us how this worldwide virus has impacted you. Your answers revealed some interesting information on how older Americans are weathering this unprecedented health emergency.

The first question was:

Concerning the impact of COVID-19 on your physical health – check all that apply.

Below are the choices and the percentage each choice was selected:

  • Has it been more difficult to get your medicine? 27.1%
  • Is it harder to see a doctor? 39.6%
  • Have you had trouble receiving home health? 8.3%
  • Other 25%

As you can see the response selected more often was the difficulty in seeing your doctor. You can understand that the fear of going out to a doctor’s appointment, especially for non-emergency issues, kept many people from venturing out to the doctor’s office. I wonder how many cancer screenings, colonoscopies, blood tests, physicals, etc. were missed and what price seniors will pay for this inability to get both preventative care as well as needed periodic care for existing conditions. I’m afraid that the effects of the pandemic on the health of seniors will be long term and costly.

The second most selected choice was difficulty in getting medicine. One of the fears providers had, with the strict quarantining recommendations, especially for older people, was – it would hinder seniors from getting their prescription medications. It was also worrisome that the supply chain for medications would be interrupted causing shortages. The quick response to expand the number of pills per prescription, the reduction or elimination of out-of-pocket costs and the ingenuity in maintaining adequate supplies all helped to ensure we were able to continue to get our needed prescriptions.

The third most selected choice was “other”. This pandemic affected each of us in a very personal way. We all are different and it affected us in different ways but there is no doubt it is affecting us all significantly.

Only 8.3% said it was difficult getting home health care. I hope this continues to be the case.

The second question was:

Concerning the impact of COVID-19 on your emotional health – What worries you the most?

Below are the choices and the percentage each choice was selected:

Becoming sick with COVID-19 21.6%

Your family members becoming ill with COVID-19 27%

Loss of retirement 5.4%

Loneliness 5.4%

Family members losing employment 18.9%

Access to healthcare 13.5%

Other 8.1%

The top two choices were fear of you or your family getting sick with the virus. As it seems is always the case we had more fear that one of our family members would get the virus rather than ourselves. That was also the case with worrying about our retirement or our family’s employment. We were much more worried about our family losing employment than we were about losing our retirement. It is interesting that only 5.4% chose loneliness as a problem. I think we might be seeing the reduction in restrictions as a light at the end of the tunnel and seeing hope that we can visit our families. It might also be that technology has helped. There our substantially more older Americans that know how to use Zoom than before the pandemic.

The third question was:

Who do you turn to for reliable COVID-19 information?

Below are the choices and the percentage each choice was selected:

TV news 24.3%

The daily Coronavirus Task Force briefings 27%

Internet 21.6%

Radio 2.7%

Newspaper 2.7%

Other 21.6%

The daily Coronavirus Task Force briefings was the top choice. I know I appreciated hearing Dr. Fauci’s insights and developed a trust for his opinions. We still go to the TV for our news and the daily briefing, the TV is our window on the world. The internet is moving up the ranks and the distinction between the “TV” and the “internet” is blurring. We are nearing the world where our internet is the conduit to news, radio, newspaper and any other information we seek. I do wonder where the 21.6% who selected other got their information? I suspect it is friends or family who visit with us and talk about the pandemic.

The fourth question asked:

In their response to COVID-19, do you think healthcare industries (hospitals, drug and device manufacturers, insurers) have:

The choices and the percentage selected are:

Performed better than expected 54.1%

Performed as expected 27%

Performed worse than expected 18.9%

It might have been a little difficult to evaluate the healthcare industries’ performance given none of us had ever experienced a pandemic like this. Given that, over half of us said they did better than expected and only 19% said they did worse than expected. I think three things impressed us:

  • the bravery of the healthcare workers as they exposed themselves to danger as they cared for us
  • the quick reaction of our insurance providers to cut our out-of-pocket expenses so that cost did not hinder our access to care and medicines (I just a received a card from my Medicare Advantage insurer that waived all out-of-pocket costs for primary care visits, outpatient behavioral health visits and telehealth visits)
  • The willingness of pharmaceutical manufacturers to band together and spend millions of dollars to look for medicines that will reduce the severity of the COVID-19 and to produce an effective vaccine.

Sometimes adversity brings out the best in us.

The final question asked:

In their response to COVID-19, do you think the federal government (Congress and the Administration) has:

The choices and the percentage selected are:

Performed better than expected 18.9%

Performed as expected 18.9%

Performed worse than expected 62.2%

It seems we don’t think our government responded very well to this pandemic.  We did have other countries’ response that we could use as we compared the effectiveness of our country’s response. There is still a lot we don’t know about what actually happened. Some countries that started out with lower infections were later inundated. State governors responded very differently and the resulting number of COVID-19 infections varied widely. As time goes on we’ll know more about what methods worked and what didn’t. We’ll also know what information our government had and when they had it and how they responded to it. But right now, there is no doubt that we aren’t happy with the government’s response.

We’re glad you chose to speak up and participate in our poll. We will continue to do surveys and polls to give you a chance to speak out. In the meantime, stay safe and have joy.

Thair



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What Healthcare Issues Do You Care About Most During COVID-19?

I hope this communication finds you safe and finding ways to have joy in these trying times. I have faith that we will emerge stronger and smarter from this experience.

First of all, I want to thank everyone who has participated in our survey and encourage anyone who hasn’t to click here and give us your input. The survey asks about your experiences with the COVID-19 pandemic, your health, your healthcare, how the government and drug manufacturers have performed so far and how you get your information about the pandemic. It is important for you to speak out about these important health issues. Those in Washington, that have such an impact on our lives in these stressful times, need to know how you feel about these issues. Please participate.

Second, I want to talk about importation. This is an issue that I’ve talked about before. It has been trumpeted by Washington at different times over the years as a way to lower costs. The importation of prescription drugs has some basic flaws:

  • It lacks the basic safeguards to guarantee the safety of the medicine
  • The approach is resisted, or is outright rejected, by the very countries who would be counted on to support this approach
  • The Congressional Budget Office (CBO) has calculated that importation would result in minimal savings, if any at all


I can’t help but think that the COVID-19 pandemic has highlighted another flaw, our reliance on other countries for our medicine. I’m not talking about the raw materials or manufacturing that are supplied or accomplished by foreign countries and certified by the FDA. I’m talking about legislation that circumnavigates these established, inspected and approved supply lines and opens up pathways for counterfeit drugs. We see today countries arguing about who would get COVID-19 vaccines or medicine first, deals being made between countries that might ignore the priority of getting medicines or vaccines to those who need it most. It highlights another reason that importation legislation is not the solution. When push comes to shove a foreign country’s priorities will come before ours and any agreement that is not based on economics and competition will be driven by political priorities that will not be to the safety and benefit of the patient.

As I have said before, as the elections get closer, the politicians will begin to focus on schemes to get elected. Importation may again be presented as a solution to drug prices. We all need to understand the real dangers of this flawed solution.

Stay safe and be joyful, Thair.



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Tele town hall

I want to thank everyone who joined our Seniors Speak Out tele town hall yesterday. We discussed the impact on senior’s healthcare that the COVID-19 pandemic has had, and could have, in the future. We also discussed what might happen with healthcare issues and legislation in this election year. I appreciated the questions, both written and expressed during the tele town hall. In response to one of the questions I am including the link to the IRS’ Get My Payment web site where you can check on the status of your stimulus check. Just click here to get to the site.

We also announced the broadening outreach of the new Seniors Speak Out. The use of polls and surveys, of webinars and tele town halls, and, when appropriate, visits to expos, seminars and anywhere mature Americans gather. Our goal is to find out how seniors truly feel about their healthcare and what their stance is on the issues that affect their lives. We are looking forward to this journey as we face this trying but important year.

Our first poll is ready on our web site – just click here to take the poll and participate in this process of speaking out.

I look forward to working with you as we seek to speak out and be heard.

Thair



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The COVID-19 Virus – Our Government’s Response

Here we are, hunkered down and wondering when, or if, we’ll be back to normal. It is a strange juxtaposition we are involved in . . . a national disaster that, in the past, has brought us together now forces us apart. I hate that we can’t gather our families together to weather this storm, but it is best, especially for us older folk, to stay isolated and wait for the “all clear” message. I’ve included some links below that will give you access to health and financial information concerning the COVID-19 pandemic. Here are a few updates on how our government is working to help out and guide us.

The 2 trillion-dollar stimulus legislation has been signed by the President. It contains a multitude of economic fixes. I will highlight a few of what is in the bill and a few things that were left out:

  • The bill allows us to have the medicine we need while we are quarantined (see my last blog) by allowing doctors to prescribe up to 90-day prescriptions without any restrictions by pharmacies or insurance providers.
  • The bill also includes provisions to expand telehealth, a great idea to get help from a health care provider without leaving the safety of your house.
  • Any costs related to getting tested for COVID-19 will be done with no costs to the patient.
  • We will be getting as much as $1,200 in a one-time check. It will be based on our 2018 Adjusted Gross Income. If you made too much money in 2018 your check could be reduced or eliminated.
  • Some changes affect your retirement funds. Talk to your financial advisor to see if any of the changes will help you.

One thing that wasn’t included in the bill was the ability to have some Medicare Part B drugs, primarily those that were injectable or infused, be provided in the home if the patient and physician think that’s the best option. It would have allowed much safer access to these life altering and life saving drugs. Many organizations fought for this change, but it wasn’t included. We hope that some later legislation will recognize the importance of this provision.

Another change that might help is the IRS has delayed when you need to file your 2019 taxes. Both the filing date and, more importantly, when any taxes you might owe are due has been extended to July 15th. Click on the IRS link below to get more information.

While the just passed legislation dealt with the immediate financial problems of those that were suddenly laid off and small and large businesses that were impacted by the pandemic, I want to remind our government that many seniors will also be affected financially. As we saw in the great recession, many older Americans found that they were the ones that rescued their children by letting them move back in with them or offering free childcare as their kids weathered the recession. We all know that we will do anything for our kids, but we’re older now and our retirement funds have been decimated. I’ll work to keep Washington apprised as this pandemic and its effects on the economy plays out, making sure they know how it affects the seniors in our country.

In the meantime, stay safe and stay involved, our country needs your steady spirit as we work to weather this storm.

Thair

HELPFUL LINKS

SENIORS

The CDC has guidance for older Americans on COVID-19 which can be found here.

For questions about receiving Social Security benefits during the COVID-19 national emergency, visit the SSA’s updates and frequently asked questions page here. If you need to get in touch with your local Social Security Office, use the office locator here to find their phone number.

Mental Health and Other Wellness Resources

The National Alliance on Mental Illness (NAMI) has a resource guide on dealing with anxiety related to COVID-19 and some frequently asked questions, which can be found here.

The National Suicide Prevention Lifeline is free, confidential, and available 24/7 at 800-273-8255.

The National Domestic Violence Hotline has resources and recommendations for staying safe during COVID-19, which can be found here. If you or a friend needs help, call the hotline at 1-800-799-SAFE(7233).

VETERANS

Updated information on COVID-19 from the Department of Veterans Affairs can be found here.

What should veterans do if they think they have COVID-19?

Before visiting local VA medical facilities, community providers, urgent care centers, or emergency departments in their communities, veterans experiencing COVID-19 symptoms—such as fever, cough, and shortness of breath—are encouraged to call their VA medical facility or call MyVA311 (844-698-2311, press #3 to be connected). Veterans can also send secure messages to their health care providers via MyhealtheVet, VA’s online patient portal. VA clinicians will evaluate veterans’ symptoms and direct them to the most appropriate providers for further evaluation and treatment. This may include referral to state or local health departments for COVID-19 testing.

What about routine appointments and previously scheduled procedures?

VA is encouraging all veterans to call their VA facility before seeking any care—even previously scheduled medical visits, mental health appointments, or surgical procedures. Veterans can also send secure messages to their health care providers via MyhealtheVet and find out whether they should still come in for their scheduled appointments. VA providers may arrange to convert appointments to video visits, where possible.

Can visitors still access VA medical facilities?

Many VA medical facilities have cancelled public events for the time being, and VA is urging all visitors who do not feel well to postpone their visits to local VA medical facilities. Facilities have also been directed to limit the number of entrances through which visitors can enter. Upon arrival, all patients, visitors, and employees will be screened for COVID-19 symptoms and possible exposure.

IRS

The IRS has established an updated resource section on steps to help taxpayers, businesses, and others affected by the coronavirus, which can be found here.



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Something You Might Have Missed Concerning the Coronavirus

A few days ago, I received information from Healthcare.gov, a website created by the part of our government that oversees Medicare, concerning the Coronavirus.  It offered the following guidelines to help us as we combat this serious health risk:

To prevent the spread of this illness or other illnesses, including the flu:

  • Wash your hands often with soap and water,
  • Cover your mouth and nose when you cough or sneeze,
  • Stay home when you’re sick, and
  • See your doctor if you think you’re ill.

Good information but I think they missed something that is key in this battle . . . ensuring each of us have ample medication or required medical supplies to last through a 14-day quarantine period or weeks longer if required.

Many of us take daily medicine or require medical supplies that enable us to live normal lives and, in some cases, keeps us alive.  If we are quarantined because we contract the virus or to keep us from coming in contact with someone who has, we quite possibly won’t have the chance to renew our prescription or obtain enough medical supplies to last through the quarantine period or weeks longer if required.  Now is the time to think about this possibility and take the needed steps to be prepared.

Determine what medicine and medical supplies you may need and contact your doctor or pharmacist as well your medical supplies company to obtain the medicine and supplies you need to make it through at least a quarantine period and even a few weeks longer.  If you are a caregiver take the needed steps to protect those you care for.

These are strange times and we need to take care of ourselves and our loved ones by being prepared.



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A Chance to be Heard

As you might notice the name of this blog is, “Seniors Speak Out”. That means that somehow, I need to tap into what older Americans find important. I can’t do that unless I find a way to get out and actually talk with those of us who can be classified as seniors . . . and that’s exactly what I’m going to do.


The idea of a listening tour is not new, I did one a few years ago when I ran a senior advocacy organization. I found it was a great way to really understand how seniors felt. I was somewhat limited in how much of the nation I could get to on that listening tour, but I’m not limited this time. I am committed to getting to all corners of our nation. I know that there are state and regional differences in healthcare, and it will be important to listen to, and convey, those differences. I will focus on getting in front of small groups at assisted living and senior centers, to get on radio programs to invite comments, to go to senior fairs and expos and to go to important senior conferences. My goal will be to find out what is important to you, what keeps you up at night, how you feel about the proposed changes to health care and what solutions you might have. I then will assemble your comments, views and solutions into simple and common-sense statements that I can deliver to Capitol hill. Something that will convey to them how seniors really feel.


Just recently, I had a chance to speak to a group in Virginia. We spent about an hour and a half discussing healthcare. One of the things they brought up was the difference in the price of their prescription drugs when they go to the pharmacist and use their insurance as compared to when they use a discount card and finally when they go someplace else, like Costco, and pay cash. The question was asked, “why does the cost to the patient differ”. We had quite a discussion and I won’t go into it here, but it is the type of discussion that America needs and one that the people in Washington need to hear about.


I would like your help. If you would like to have a chance to tell me and your members of Congress how you feel about your healthcare please click here and tell me when and where. I might not be able to accommodate all the requests, but I’ll do my best.


This blog is about you, the patient, and I’m looking forward to getting to know exactly how you feel.



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Innovation that Works

When the Affordable Care Act (also known as Obamacare) was passed into law there were those who liked it and those who didn’t. There were, however, some parts of the law that people on both sides liked. One of those parts that found a large following of fans was the creation of the Center for Medicare and Medicaid Innovation (CMMI).

CMMI was set up to be a petri dish for trying out new and more efficient ways to administer health care. To do this, CMMI was allowed to be free of many government regulations, use ideas from many sources, sign up providers who wanted to try out these new approaches and carefully analyze the results. What a great idea . . . rather than the government overhauling a huge part of a health care process with an untried approach and the accompanying unintended consequences, you could run a test, see what works and what doesn’t and then take the proper steps to implement the tested approach.

CMMI tests were intended to be small and specific and to have a definite end. They were tasked to be well planned with well-defined criteria for success. This program was a new and powerful tool, and as it grew, it began to be used beyond its original intent. Rather than a testing platform it was used, in some instances, to implement nation-wide changes to Medicare and Medicaid, without Congressional oversight. Both the Obama administration and the Trump administration used CMMI to make some test programs permanent, effectively changing the health care system without Congressional approval. This was done by making the size of the test large, so it impacted a large swath of the nation or by having a very fast phased rollout, faster than the results of the initial test could be effectively evaluated. They also made provider participation mandatory to ensure large participation. All of these approaches went way beyond the basic intent of the CMMI.

While this approach was a great way to quickly initiate change, it avoided the checks and balances of both the judicial and legislative branches of the government. The most egregious of these tests were opposed by patients and providers alike and these groups were often successful in stopping the widespread adoption of the changes, but it became evident that legislation was needed to ensure that the constitutional checks and balances were maintained.

Congress has acted . . . legislation has been created and introduced in the House. The Bill, HR 5741 (IH) – Strengthening Innovation in Medicare and Medicaid Act, (a bi-partisan effort) mandates that certain “rules of the road” must be in place to ensure that any tests have a defined duration and that any final changes to our health care system are put in place with Congressional approval.

CMMI is a powerful tool that can have both good and bad impacts on our access to quality health care. This new legislation will establish safeguards that will ensure CMMI stays within the initial intent of the program. It will protect both providers and patients and will allow innovation to be implemented within the checks and balances of our government.

I will keep you apprised of its progress and urge you to encourage your Senators and Representative to support this legislation.