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Town Hall Recap – 2021 Medicare Part D Satisfaction Survey

On Wednesday, September 15 we held a virtual town hall to review our yearly Part D Satisfaction Survey. We have been doing this survey for 14 years to give seniors across our nation the opportunity to tell us how they feel about Medicare’s prescription drug program. This year, with all the discussion about changing Part D by those who say the program isn’t working, it is especially important to skip over all of the rhetoric and let you, the beneficiary, tell us how you feel about Part D.

You can click here to see the 30-minute video of the virtual town hall. My goal in this blog is to give you the Reader’s Digest version of the Town Hall.

I started off the town hall by giving a short history of the birth of Part D and its subsequent performance. Part D passed Congress by a narrow margin in 2003 after much debate. The debate ranged from creating a single payer government run program, similar to the VA program, to setting up a voucher driven system where patients would use a voucher to buy a prescription drug plan in the commercial marketplace. A public/private partnership was the final program design. When the bill was being debated, the naysayers conjectured that:

  • There wouldn’t be enough competition and choices, especially in the rural areas.
  • Overall plan premiums would increase dramatically.
  • Seniors wouldn’t be able to wade through the complicated sign-up process or the yearly open enrollment.

Part D has proven these predictions to be wrong, today:

  • Montana, a very rural state, has 23 Part D plans to choose from.
  • Premiums have grown slower than the consumer price index; Part D costs are 40% less than predicted.
  • State and local “navigators” helped with initial sign-up and a continually improved website helps with the yearly enrollment.

Not many government programs have been this successful. 1 in 3 Medicare eligible veterans, who have their own prescription drug program, have chosen to sign-up for Part D. The Medicare Prescription Drug program has proven, over the last 15 years, to be very successful.

After my walk down memory lane I turned the time over to Caroline Bye, an Associate Vice President for Morning Consult, to go over the survey offering insights into the survey itself. Caroline leads survey research, advocacy and messaging strategy for multinational nonprofits, advocacy groups, and higher education institutions at Morning Consult.

Caroline began by explaining that the survey was limited to people 65 and over and had prescription coverage through Medicare Part D. The slide below details the three key findings from the survey. You can see Caroline’s entire slide deck here.

The first survey question was how seniors felt about their overall Medicare healthcare coverage. The satisfaction level again this year stayed above 90%. The next question asked the important question of how they felt about Medicare’s prescription drug program. As you can see in the graph below, the satisfaction level stayed strong at 87%. Caroline pointed out that this level of satisfaction was consistent across demographics, race, sex, party affiliation, etc. It is also interesting to note that those who are taking one or more prescription drugs had a higher satisfaction level than those who were not taking any prescriptions.

The survey revealed that over 90% of the seniors feel very fortunate to have a prescription drug program. The next questions were more detailed asking if they felt the program was convenient to use, the copays and/or coinsurance amounts on generic medicines were affordable, the monthly premium was affordable, and whether the plan works well and without hassle. The results were 91%, 86%, 84%, and 86% respectively.

Seniors, to the tune of 83%, thought it was important to have a variety of prescription plans to choose from, while 2/3 of the respondents strongly agree that their out-of-pocket costs would be higher without Medicare Part D. It is also important to note that 62% of seniors said their drug costs had not changed or had gone down over the last year. It’s not surprising that 90% of seniors would recommend Part D to their friends.

The survey asked some questions concerning policy proposals that have been put forth. Respondents were asked to rate their satisfaction with these proposed changes from 0 to 10 with 0 being not at all supportive. The graph below shows the percentage of people that gave the proposal the very low score of 0 or 1. In other words, the number shown is the percentage of respondents who did not want that proposed change implemented.

Remember, these are the percentage of people who gave these proposed changes a 0 to 1 score. There could have been many scores of 5 or lower. It is evident that when the proposed changes included increasing the federal government’s involvement or the possible result of these proposed changes were identified, the proposed changes weren’t as popular as some would have you believe.

The survey then asked the respondents to choose which of the following statements is closer to their own opinion, even if neither is exactly right?

  1. We should keep the current Medicare law so that the government is prohibited from deciding which drugs are available to seniors and people with disabilities, even if that means the cost of some medicines might not go down.
  2. We need to reform the current Medicare law so that the government can negotiate costs with drug companies, even if that means the government will decide which drugs are available to seniors and people with disabilities.

50% chose number 1, keep the current law, while 30% chose number 2, change the current law with 19% having no opinion. That’s a pretty positive vote for keeping the current law.

It is interesting to show the above results broken out in different demographics, as shown in the chart below. As you might guess, Republicans are more likely to want to keep the current law 65% to 19% against keeping the law than Democrats. But, even among the Democrats, 40% still want to keep the current law as opposed to the 39% that want to change.  

The final question presented a list of proposed changes and asked seniors how concerned they were with each change. Out of the 8 proposed changes, over 80% of the people were concerned with 6 of the changes with last two showing 76% and 61% of the people were concerned. Again, a vast majority of seniors are concerned with changing Part D.

Caroline turned the town hall over to Mary R. Grealy, president of the Healthcare Leadership Council, for her comments. Mary put the survey results into context of the present political environment. She pointed out that some in Congress want to move away from the fundamental design of Part D. She wondered if any of the members of Congress, who are proposing these changes, ever stopped to ask America’s seniors what they wanted? The survey showed that there is really no clamor for change among America’s seniors. Mary pointed out that the average Part D premium has stayed between $30 and $35 dollars for several years. Mary summarized her comments with the question, “if Part D is affordable and seniors are satisfied with it, what is the compelling reason for radical change”?

The town hall was then opened up for questions. The first question for Mary asked if she thought there were improvements in Part D that should be considered. Mary replied that there certainly were changes that would improve the program. She said that the proposal to limit out-of-pocket costs was a needed improvement. She also said that value-based negotiations between drug manufacturers and providers would be an ideal direction to take.

The next question was to Caroline asking how the satisfaction numbers compared year over year. She said that year-over-year the general satisfaction has remained very high.

The next question asked why we were seeing these calls for extreme changes in Part D?  Mary thought that the changes were based on a few medicines and anecdotal instances, rather than relying on a broad fact-based experience. The current method of negotiations has resulted in stable, affordable prices.

The next question asked what aspect of this survey jumped out as notable? Caroline indicated that in her work with big companies she has seen surveys that had high satisfaction ratings, like this one, but the willingness of seniors to promote and recommend Part D was unique. Mary indicated that she was impressed with the number of self-identified Democrats who didn’t want to change Part D. I interjected that the slightly lower numbers from last year reflect the white noise and rhetoric that is coming out of Washington, which seeks to confuse seniors. The survey shows that when seniors sit back and ask how Part D performs for them, they are really satisfied. While there are changes that can and should be made, seniors don’t want to make radical changes.

We encourage you to look at the slides that were presented. They are available here or you can watch the entire town hall here.

Best, Thair



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COVID Update – It Is a Life-or-Death Choice

As I looked forward to September, I thought this would be a good time to give an update on where we are in the quest to finally defeat this terrible pandemic. In the last few weeks, it has become abundantly clear that using the word defeat, at least in the short term, is not appropriate. The Delta variant has pushed many communities back into those critical times we experienced in the past when hospitals and caregivers were overwhelmed. There are, however, some big differences with this wave of COVID-19 infections.

The vast majority of new COVID infections are among the unvaccinated. According to MIT Medical you have a .0008 percent of dying from COVID-19 if you are vaccinated. The New York Times stated that vaccinated people take about the same risk with COVID-19 as they do when they venture out in their car. Getting vaccinated can certainly save your life. Also, there is a difference in the age of those getting sick. The age of those getting seriously ill from getting infected has dropped considerably, with children being much more vulnerable than they were early on in the pandemic. These differences have raised some important considerations.

According to most doctors and scientists, if the vast majority (over 80%) of the citizens of the U.S. would have rushed out and been vaccinated, the impact of the Delta variant would have been a fraction of its present infections. The increased infection rate has also raised the fear that the number of unvaccinated people getting infected will increase the chance of another mutation and possibly an even more dangerous variant. The obvious answer to these problems is for everyone to relent and go get vaccinated.

Some institutions, both private and public, have mandated that participants must be vaccinated. Many companies have declared that employees be vaccinated or have weekly COVID-19 tests. Many colleges have said that students must be vaccinated to attend class. Even some concert venues have required proof of vaccination to attend. President Biden, last week, announced some broad vaccination mandates in his effort to raise the percentage of vaccinated citizens. These mandates have triggered a considerable amount of push back from people who say that these mandates threaten their freedom of choice, and some say they go against the guaranteed freedoms in the U.S. Constitution. These mandates may have even threatened the progress they hoped to bolster. The chart below shows that after the final approval of the Pfizer-BioNTech the number of weekly vaccinations rose but in the last few weeks the number has dropped considerably.

These new developments have again served to divide us. Some say we should let the unvaccinated reap the results of their choice. This might be an easy out except for the fact that their choice is loading our healthcare system to the point that important surgeries and treatments for those who are vaccinated and uninfected are being delayed. Their choice also raises the possibility of the birth of a new variant that may threaten even those who are vaccinated. It is a complicated problem.

The real solution is clearly that we all need to get vaccinated. Almost 90% of those over 65 have been vaccinated and their infection rate is low. We have a fully approved vaccine and other emergency approved vaccines that have proven they can save lives. State governments have mandated that children must have certain vaccines to enter school for decades. These mandates have virtually eliminated some diseases and saved countless lives. Mandates are not a new thing. Now is not the time to suddenly push back against mandates and recommendations that can save lives. We need to appeal to those we know who haven’t been vaccinated that they should get vaccinated, if only to help their loved ones and friends. It is a choice that we all can live with.

Best, Thair

p.s. Don’t miss the chance to find out the results of the Medicare Part D survey by joining out virtual town hall. Register Here See details below.

Medicare Today Town Hall
Wednesday, September 15, 2021
2:00 p.m. ET
Guest Speakers
Thair Phillips
former President and CEO of RetireSafe
And
Caroline Bye
AVP of Advocacy and Government at Morning Consult
Register Here

After registering, you will receive a confirmation email containing
information on joining the Town Hall.

You can join on your computer without your camera or you can dial-in as
well – whatever works for you!



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Healthy Aging Month – Are We Supposed to Act Our Age?

It’s September which means it’s Healthy Aging Month. Last year at this time I wrote a great blog about this important month, it was witty and informative (at least I thought it was) and you can read it by clicking here. The same ten helpful points in last year’s blog are still relevant and I hope they give you some food for thought. This year I will offer some new ideas and thoughts on aging that may give you a new perspective on how you see yourself as you get older.

Full disclosure, I turned 73 a week ago and I still wonder how that happened. If I’ve heard it once, I’ve heard it a hundred times, “I woke up one morning and I was old.” While we didn’t get old overnight, our realization of being old probably came when we were surprised by someone’s comment or on a particular birthday. Maybe it was when you were stopped by a police officer who looked as old as one of your kids, or you were surprised in the exam room by a Doogie Houser look alike who claimed to be a doctor? Any of these events may have caused you to reflect on your age. Rather than letting these events get you depressed, think of this – the fact that you were surprised at how old you suddenly became is a very positive thing. You should celebrate that you were surprised at your age, that in your mind you weren’t that old. We can’t let someone else tell us how old we are. We can’t let some event establish our age. It’s our mind and our own picture of ourselves that should guide our perception of our age.

Now I’m not trying to convince you that you should be doing the things you did when you were 30. There is no denying the aches and pains that come when you get older. What I am saying is . . . don’t let the aches and pains keep you from trying new things or finding ways to keep moving and pushing the envelope of your present physical abilities. For instance, I remember when I had to give up playing tennis. My knees and hips just didn’t allow the movement necessary to be competitive and have fun. Then along comes someone’s great idea of pickleball. Maybe you’ve heard of it; it’s a cross between ping pong, tennis, and badminton. It allows someone to be active and be competitive at a sport without requiring the running and movement required in tennis. My friend who’s a year older than I am plays it every day. It keeps him in great shape. He’s going to teach me how to play.

Find something that gets you out and moving; golf has done that for me. Golf often occupies my mind when I’m not actually playing it. I’m thinking of things I can try to improve my game. It’s my happy place where I go when things around me are trying to depress me. Find the activity that motivates you to do better and becomes your happy place.

My point here echoes the first point of my 10-point list from last year – don’t act your age. Much to many people’s amazement, older Americans were not the age group that suffered the most mental problems during the pandemic. Our age group bore the brunt of the deaths, yet, somehow, we held up and soldiered on. We are a strong group; we’ve done hard things during our lives, and we are still strong enough to do more hard things. Don’t let anyone or anything dictate how old you should act.

Best, Thair

p.s. Don’t miss the chance to find out the results of the Medicare Part D survey by joining out virtual town hall. See details below.

Medicare Today Town Hall
Wednesday, September 15, 2021
2:00 p.m. ET
Guest Speakers
Thair Phillips
former President and CEO of RetireSafe
And
Caroline Bye
AVP of Advocacy and Government at Morning Consult

They will discuss: The results of the annual Part D Satisfaction Survey
Register Here

After registering, you will receive a confirmation email containing
information on joining the Town Hall.

You can join on your computer without your camera or you can dial-in as
well – whatever works for you!



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You Spoke! The 2021 Senior Satisfaction Survey

Once again, we gave seniors the opportunity to tell us how they feel about Medicare Part D, Medicare’s prescription drug program. This survey was the 15th year that we’ve asked seniors how the feel about Part D. We do this because it is important to break through all of the rhetoric and posturing that is taking place concerning this vital program. Many politicians think we need to change the program, dictate drug prices, set prices based on those in foreign countries, import drugs from other countries, etc. They are focused on “fixing” Medicare Part D when I’m not sure they have any idea whether those who use the program think it needs to be fixed. We do this survey each year because we want you to have a voice.

I may be revealing how old I am, but I was involved with senior organizations and public policy before Part D was passed in 2003 and implemented in 2006. I know that before Part D, when seniors were responsible for the full cost of their prescription drugs, the financial uncertainty of these costs was deeply troubling and was a constant worry. Most people don’t know that many in Washington were against the program as it was being debated. They thought that there wouldn’t be enough plans competing in each state, especially in rural states. They thought it would be too complicated for seniors to understand. They though that premiums would spiral out-of-control. They thought that seniors would be unhappy. It was a close vote, but it passed.

So, what has happened over the last 15 years? There are many Part D plans to choose from in each state. In Montana, one of our most rural states, there are 23 different plans. With the help of state aids, pharmacists, automation, information from HHS, and the resourcefulness and self-reliance of seniors, they continue to choose the plans that fit them best. The premiums have been 30% lower than were estimated during the debate 15 years ago. These are the indicators of a successful program and seniors have agreed since the program’s inception.

For instance, in 2007, 86% of the respondents said they were very positive or somewhat positive about Part D. In our 2021 survey 87% said they were satisfied with their Part D coverage. We asked a variety of questions in our survey, covering senior’s feelings about things like out-of-pocket costs and their opinions about the changes that are being proposed. There are a lot of interesting facts that have come out of this year’s survey, too many to go into here. Luckily, we have scheduled a virtual town hall on September 15th to discuss the survey in more detail. We hope you can join us. You can click here to register for the town hall. Detailed information about the town hall is below.

I always want you to be the voice I listen to. How well Medicare is serving you is what’s important. I think that sometimes those in Washington forget who eventually pays the bills and who the real customers are. Our yearly survey is one way we try to let you speak out. Join us on the 15th.

Thanks, Thair

Medicare Today Town Hall
Wednesday, September 15, 2021, 2:00 p.m. ET

Guest Speakers
Thair Phillips, former President and CEO of RetireSafe
And
Caroline Bye, AVP of Advocacy and Government at Morning Consult

They will discuss:
The results of the annual Part D Satisfaction Survey
Register Here

After registering, you will receive a confirmation email containing
information on joining the Town Hall. You can join on your computer without your camera and you can dial-in as well – whatever works for you!



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Turbulent Times Ahead

As the summer draws to a close, the citizens of this great nation face a dangerous time, the return of the politicians to Washington after the August recess. All of those who represent us think that they must take action, fix something, change things. It never crosses their mind that leaving things that are working alone might be a valid approach. Medicare, especially Part D, the prescription drug benefit, is something that has been working better than expected. Over the years, it has enjoyed a continued vote of confidence from seniors (we’ll talk about the latest Part D satisfaction poll next month). Washington needs to consider the old adage, “if it aint broke, don’t fix it.” Nevertheless, there is a strong possibility that Congress and/or the President will be predisposed to making changes in Medicare and Part D.

There are two bills that will be at the top of the priority list when Congress returns, the bipartisan infrastructure bill and the 3.5 trillion dollar social policy bill that the Democrats can pass with a simple majority using budget rules. The infrastructure bill, as drafted, does not include substantive changes to Medicare. The bipartisan nature of the bill kept it focused on infrastructure issues. The other bill, often called the reconciliation bill, will most likely contain many proposed changes to Part D. The President has already given the Department of Health and Human Services and Congress some strong guidance on what he wants in the reconciliation bill. He said that he wanted three changes: the first two would allow the Government to set prices on prescription drugs – the so-called negotiation option and the ability to charge penalties if drug prices are raised higher than inflation. The third change would set a cap on the yearly out-of-pocket prescription drug charges for Medicare beneficiaries.

When anyone proposes changes to Part D I always look at how it affects the beneficiaries. . . how does it affect what I pay and my access to medications? There is no guarantee that having the government controlling drug prices will result in any savings for you and me. Drug manufacturers may make less and Medicare may pay less but the convoluted pricing and supply structure may limit any savings from getting down to the patient. The third proposed change, the out-of-pocket cap, is the only change that will benefit the patient. I’ve discussed how important this change would be for those who are saddled with unrestrained out-of-pocket costs. It would correct the problem of requiring the sickest amongst us to bear the burden of huge costs.

I expect there will be a huge amount of pressure to include changes to Medicare in the social policy bill. As you might expect, I have some thoughts that I hope Congress and the President would consider.

First, President Biden has already threatened to use Executive Orders (EO) to accomplish some of the proposed changes. It was wrong when President Trump did it and it’s wrong if President Biden does it. Presidential fiat is not the way we deserve to be governed. There are constitutional checks and balances that are the basis of how changes are made. Circumnavigating these checks and balances is not the way to make changes. These EOs are almost always subject to legal challenges. They are also subject to being rescinded by the next President, as President Biden has already done to some of President Trump’s EOs.

Second, it just doesn’t seem right to use money supposedly “saved” from Medicare costs to fund other initiatives. Medicare is not an ATM to be used to fund other parts of the government.

Third, the pandemic has caused a great deal of chaos in the supply chain for prescription drugs, coupled with President Trump’s Executive Orders and then President Biden’s withdrawal of some of those Orders, the drug manufacturers have found it difficult to keep the research and development and the manufacturing processes efficient. Throwing more change into this system is a prescription for shortages.

Fourth, is now the time we want to insert the government deeper into our healthcare? American’s trust in our government’s ability to advise us on healthcare is at an all-time low. It seems that there is more and more distrust in the accuracy and motivation of the guidance coming from Federal institutions. Somehow, our leaders need to work to regain this trust. Changing a part of our healthcare that produced a life saving vaccine in record time is not the way to accomplish this difficult task.

Fifth, the drug manufacturers and the insurance companies have already indicated their willingness to sit down and talk about improvements that can be made. There are bad players and bad rules and regulations that need to be dealt with. This seems to be a logical way forward.

As you can see there is a lot to consider in the months ahead. We’re at a critical crossroads. I ask that you pay attention as those in Washington consider these important changes to our healthcare. Don’t hesitate to tell them how you feel about these changes. The one thing that everyone in Washington cares about is your vote. Know where your Senators and Representative stand on these changes and don’t hesitate to tell them how you feel.

Best, Thair



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A pop quiz with a reward

I know, you think the lead-in to this blog is a cheap trick to get you to take a stupid quiz with the promise of a reward, that turns out to be a free 30-day trial for something you don’t need. Well, you’re wrong, this quiz concerns your knowledge of Medicare and some of the rules that may well affect your pocketbook. The reward is . . . I’ll give you the answers to the quiz at the end and you’ll be rewarded with some information that hopefully will help you stay healthy and may even save you some money. Some of the questions are multiple choice; others will force you to come up with the right answer without having a choice. So, here we go, good luck!

  1. What is the difference between Medicare and Medicare Advantage plans?
  2. What is the difference between Medicare and Medicaid?
  3. What Part of Medicare covers prescription drugs?
    a. Part D
    b. Part C
    c. Part B
    d. Part A
  4. When is Medicare Part D open enrollment?
  5. Is there a yearly out-of-pocket spending cap on Part D?
  6. This is the very important and more difficult bonus question –

 What is the difference between a co-pay and co-insurance?

The answers are below.

Answer to 1 – Medicare and Medicare Advantage are two different ways that the Medicare benefit is administered. Medicare (also known as Medicare Fee For Service (FFS)) provides beneficiaries 65 and over with healthcare and is paid directly by the government. Medicare Advantage, often called Medicare Part C, is administered and controlled by a private health insurance company which is paid a fixed amount per beneficiary. Most seniors in America have the option to choose between standard Medicare and Medicare Advantage. Most seniors now choose to participate in Medicare Advantage instead of Medicare FFS as they become eligible because it offers additional benefits and predictability in costs. Many seniors who opt for standard Medicare also choose Medicare supplemental insurance that offers lower out-of-pocket costs and expanded benefits but costs extra money. It is worth taking the time, and seeking help when needed, to make the correct choice for your particular health requirements and the different plans offered in your area.

Answer to 2 – As explained in question 1, Medicare is the benefit offered to those turning 65. Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Answer to 3 – Part D is Medicare’s prescription drug program. It was not part of the original Medicare benefit that was signed into law in 1965. Part D was signed into law in 2003 and began offering coverage in 2006.

Answer to 4 – You can change your Part D prescription drug insurance plan every year during the open enrollment period from October 15 to December 7 for the following year. When you turn 65 you need to apply for Medicare Part D sometime between the three months before the month in which you turn 65 until three months after if you aren’t covered by private prescription drug insurance. If you delay signing up for Part D, you will be charged a 1% higher premium for each year you delay. This is a lifetime penalty, so it is important to understand and follow the Part D enrollment rules.

Answer to 5 – Some Medicare Advantage plans have a yearly out-of-pocket cap on prescription drug costs. Regular Medicare does not have a yearly cap on out-of-pocket costs for prescription drugs. One of the changes to Medicare that has been discussed lately is putting a yearly cap on these Part D out-of-pocket costs. As I’ve discussed in earlier blogs, this is a great idea and one I feel seniors throughout America should be urging their representatives in Washington to implement.

Answer to 6 – This bonus question deals with a nuance in healthcare insurance that most people don’t understand but can have a big impact on your out-of-pocket costs.

A co-pay is the amount you may have to pay every time you go to a doctor or the amount you may have to pay when you have some sort of test performed or when you have a prescription filled. It is a fixed amount and is detailed in the Medicare benefit explanations, Medicare supplemental insurance guides or Medicare Advantage plan explanations. These co-pays should be part of your consideration as you choose which plan works best for you. The good part of co-pays is that they remain the same and are not impacted by the amount of the procedure or prescription drug cost. The cost may be more for a visit to a specialist or if the prescription is a generic or a brand name drug, but they will be fixed and will be documented in the plans guidelines.

Co-insurance is an out-of-pocket cost that may be charged every time you use a healthcare service. The difference between co-insurance and a co-pay is that the out-of-pocket cost for co-insurance is calculated as a percentage of the cost of the healthcare goods or service provided. If your co-insurance is 15% then you must pay 15% of the cost of the procedure, test, office visit or prescription drug. This cost is not fixed and could run into large out-of-pocket costs depending on the cost of the goods or service provided. The differences between co-insurance and co-pays need to be understood as you consider different options under Medicare.

I hope you did well on this little pop quiz. More importantly I hope you learned some things that might help you choose the best healthcare for your situation and maybe even save you some money.

Best, Thair



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Summertime and the Living is Easy – – – Maybe

We’re in the dog days of summer and I’m sure we all were thinking this summer we could get back to living easy. Well, because of the COVID-19 Delta variant we are still most definitely feeling uneasy. Well, let’s erase all those worries for a moment and think about ways we can enjoy summer by eating right, keeping ourselves in good health and taking advantage of activities that keep us moving.

First, a little factoid you can use to impress your friends. The dog days of summer have nothing to do with dogs; it recognizes the rising of the star Sirius, often called the dog star, which ancient people linked with heat, drought, lethargy, fever and bad luck.

Now, let’s talk about some activities you may not have taken advantage of but are great ways to combat the dog days, especially that lethargy part.

Many seniors have found that swimming is a great way to exercise without the pounding that running or other exercises give to your lower body. I started a couple of years ago and had to stop due to COVID-19. Maybe that has also happened to you. I found out that when I transferred to Medicare Advantage, I got free membership at a local pool, and I’ve signed up. Check your insurance to see if they offer some free benefits like this. I do know that when I first signed up two years ago the price was really reasonable.

Another fun thing I’ve discovered is electric bikes. My wife and I bought regular bikes a few years ago and we discovered that riding was difficult because our riding speeds were much different. Many of our friends have bought electric bikes (the price continues to drop as more and more people buy them) and they have told me how great they were. They evened out the speed differences and it lets you exercise at whatever level fits you best. The electric bikes also allow you to get out for some long rides. Many electric bikes have a 50 mile or more range. We just bought some and they are proving to be a great way to get out and get moving.

Eating right takes some effort. My son is introducing us to “clean eating” and the keto diet. My wife is following it much more closely than I am, but I can really taste the difference in clean foods. Good and healthy summer recipes may be just the cure for that same food rut we may have gotten into during the pandemic.

The Taste of Home website has a whole bunch of great summer recipes. One that caught my eye was Rosemary Salmon and Veggies.  Go to Recipe.

Another great place for good recipes is the WebMD website. The lemon dill chicken caught the attention of my tastebuds. Go to Recipe.

I always have to give you a link to a CDC website that gives us hints on how to have a healthy and safe summer. You’ve probably heard most of them at a bunch of different places but here they all are in one place.

Now that you are exercising and eating healthy, let me break the dog day spell and return us to the reality of the times. We need to respond to the pleas of everyone around us and get vaccinated for COVID-19. I assume almost all of you have been vaccinated (around 80% of Americans over 65 have been vaccinated so far) so I’m asking you to talk with those friends and relatives you know that haven’t been vaccinated. Listen to them, really listen to them. Listen and empathize with their feelings and fears. Find some things you can agree upon, i.e., we all want people around us to be safe. Spouting a bunch of facts often is counterproductive; they’ve heard all of those before. It’s the fear and distrust that we need to recognize. We’ve all had illogical fears that scared us no matter what others have said. Telling the unvaccinated about your experience and how you felt when you got vaccinated is a good way to help them understand your feelings. COVID-19 has ruined a lot of things over the last year and a half, don’t let it ruin a friendship over getting vaccinated. Just let them know that you’re their friend and you just want them to be healthy and safe.

Stay cool, healthy, and safe and continue to have a great summer.

Thair



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Vaccines – A Different Focus

Over the last year and a half, we all spent a huge amount of time hearing, reading, and watching TV or media about vaccines. We became experts on viruses and how they spread. Most of us complied with the guidance when COVID-19 first hit, we hunkered down, wore masks and, while seniors initially bore the brunt of COVID deaths, a lot of us made it through. We got vaccinated and we were told that finally we didn’t have to wear masks, we could see our kids and grandkids, and even sit down and eat inside a restaurant . . . and then the Delta variant threw us a curve. Once again, we find ourselves wading through voluminous amounts of information, talking to those we trust and deciding how to respond to this new threat. Now, you might think I’m going to begin a long and drawn-out discussion about how to react to this new challenge but you’re wrong, at least mostly. As the title suggests, I’ve decided to focus on a different aspect of vaccinations.

Over the last year and a half, we have been laser focused on COVID-19. This focus, along with the fear of venturing out, even to see our doctor, has caused another health problem that we desperately need to recognize and react to. I’m talking about all the other periodic vaccinations that we may have canceled or postponed, vaccinations that we really need to keep us healthy.

While the flu was virtually nonexistent for the 2020/2021 season, due to our mask wearing and our social distancing, pneumonia was not so lucky. According to CDC statistics from 2017 through 2020 the average number of weekly deaths due to pneumonia was 4,434. I used the first week of January of each year since that seemed to be the height of the flu and pneumonia season. What surprised me was the number of deaths for the first week of January in 2021 (the depth of the pandemic), 16,852 died of pneumonia. I was taken back by this huge increase in pneumonia deaths. Now I don’t know all the reasons for this sudden increase, but I do know that many older people I’ve talked with have put off going to the doctor to get their periodic vaccinations.

Most of the medicine we take is to treat a disease or health issue are for illnesses we already have. The magic of many vaccines is they keep us from getting sick. There are a precious few medicines that can cure a disease. What a gift it is to have access to disease preventing vaccines. We need to refocus on taking advantage of these marvelous discoveries.

I was lucky enough a few weeks ago to be selected to give oral comments to the Advisory Committee on Immunization Practices (ACIP). These are a group of experts that advise our government healthcare leaders on what immunization guidelines should be followed by our healthcare providers. I focused on encouraging them to include recently approved vaccines for pneumonia in their recommendations. My goal then, and my goal now, is to ensure you have access to all the preventative vaccines available and to encourage you to get your required vaccines.

I would be remiss if I didn’t plead with you to get vaccinated immediately for COVID-19 if you haven’t already. According to Axios.com, if you’ve been vaccinated for COVID-19, you have less than a 0.1% of testing positive for COVID-19 and all of its variants. If you know someone who hasn’t been vaccinated, listen to them, listen to why they haven’t chosen to be vaccinated. Tell them how liberated you felt when you got vaccinated.

This month is National Immunization Month. It is an ideal time to make an appointment with your doctor to discuss what vaccinations you need going into the fall flu and pneumonia season. Tell your friends how important it is to get vaccinated. The best defense against all of the viruses out there and the other health problems you may have is to protect yourself from those ailments that are preventable.

Best, Thair



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What’s the Focus?

As we approach the lazy days of August, I want to offer a shopping list of healthcare issues that will be the focus of any action that takes place prior to Washington’s annual August recess. There are two pieces of legislation that may see some action prior to August . . . they may even get signed into law.

The first piece of legislation is the infrastructure bill, a rare attempt at passing some type of bipartisan legislation. I can’t give you any odds on its passage, but I can tell you that it will be a prime place for some last minute backroom dealing, that could involve some of the healthcare issues listed below.

The second possible bill comes under the umbrella of budget reconciliation. This is a somewhat complicated process employed in the Senate, with the main point being that, when this process is used, it only takes a simple majority for the bill to pass and the filibuster is not in play. It is almost certain that this bill will be a partisan, Democrat only, bill. It is very possible that this bill will contain some changes to your healthcare.

There are many proposed changes to our county’s healthcare that have been considered over the years and have become more in play in the last few months. I will list these issues below, most of which I’ve discussed in earlier blogs. I won’t include all the links, but a quick search will yield the blogs that have discussed in more detail the issues you are interested in. The first group of issues are proposed changes that have some bipartisan interest and, therefore, are more likely to be included in one of these two bills.

Some bipartisan support:

  • Price transparency – Unmask some of the prices and costs in the drug business process to encourage competition.
  • Surprise billing – When beneficiaries use out-of-network providers they are often surprised with a huge bill. Proposed legislation would limit the amount to be charged and increase the notification process.
  • Balance co-pay costs – This change would let Medicare enrollees spread out their copays in monthly installments so they wouldn’t be faced with the entire yearly cost in the first few months.
  • A cap on prescription drug out-of-pocket costs – This change would put a beneficiary cap on the yearly out-of-pocket cost for the Medicare prescription benefit, Part D.


Other issues:

  • Drug importation – Allow states to import drugs from foreign countries, primarily Canada.
  • Drug negotiations – This would allow the government to essentially set drug prices.
  • Limit drug prices – Base drug prices on those of a select group of foreign countries.
  • Limit existing drug price increases – Using the Consumer Price Index (CPI)  (inflation indicator), the government will limit the amount certain drug prices could be increased.
  • Expand Medicare eligibility – Possibly lower the entry age to 60.
  • Expand Medicare benefits – Add dental, hearing and vision coverage.
  • Change the prescription drug rebate process – Push rebate savings to the patient at the pharmacy counter.
  • Telehealth – Expand payments and eligibility for telehealth services.


These are the main changes that have been proposed. There could be others that work their way into the discussion.

Finally, there is one change that I haven’t talked about in earlier blogs but has become an important, likely bipartisan, issue. This is the inclusion of diversity in all aspects of our healthcare.

The pandemic highlighted some basic flaws that have existed in our healthcare system for years but have been under reported and, in some cases, ignored. COVID-19 served to shine a light on some of these flaws that have been experienced by minorities. It showed how the lack of diversity, not only in the healthcare workforce but also in communication and in the reporting process, has had a negative impact on minorities in our country. We began to make changes, as trials for new COVID-19 vaccines and medicines were designed with a requirement for inclusion of minorities. Flawed diagnostic processes that altered the validity of the diagnosis for minorities were identified. Our country is finally awakening to the embedded lack of understanding that exists in our healthcare system. I’m pretty sure that some sort of diversity requirements, regulations and oversight will find its way into one of these bills.

It is possible that these bills will not be finalized until the fall but there is a concerted effort to have something done so that the politicians can go back to their home states and districts with something to talk/brag about. It could be an active end of July and early part of August. We’ll try to keep you up-to-speed on what’s going on.

Best, Thair



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The Eyes Have It

This month is UV Safety Awareness Month, which makes a lot of sense, since the summer is when the UV rays are the most damaging. Unfortunately, the only way to get most of us to really pay attention to change our behavior is to scare us into taking action. So, here’s my scare tactic.

The Assistant Secretary for Health, U.S. Department of Health and Human Services (HHS), who just happens to have worked as a skin oncologist for many years, points out that skin cancer is the most commonly diagnosed cancer in the United States, yet most cases are preventable. What???? You mean that the most commonly diagnosed cancer can be prevented without expensive medicine or operations? He also said that despite this fact, skin cancer rates continue to rise and that almost all of the conditions were caused by unnecessary ultraviolet (UV) radiation exposure, usually from excessive time in the sun or from the use of indoor tanning devices. Did you know that almost one out of three young white women between 16 and 25 engaged in some sort of indoor tanning, like tanning booths? The sobering fact is that skin cancer causes 9,000 deaths each year.

OK, I hope you were astounded and maybe even scared a little about reducing your exposure to UV rays. All of us are probably bright enough to understand the ways we can protect ourselves from harmful UV rays, i.e., don’t expose your skin and eyes to direct sunlight. The simple fact is we can all take action to prevent skin cancer. You can read much more about ways to protect your skin in the Call to Action to Prevent Skin Cancer on the HHS website. I would, however, like to spend just a minute talking about sunscreen, an important tool in protecting our skin.

There’s a variety of ways we can apply sunscreen, but the best sunscreen is the one we apply regularly. There are some things to remember about sunscreen, the sun protection factor (SPF) is the amount of protection the sunscreen offers. An SPF of 15 means it would take 15 times longer to burn if you didn’t use that particular sunscreen. The higher the SPF the more protection you get. . . to a point. The CDC says that anything higher than SPF 50 offers only marginally more protection. Sunscreen labeled “Broad Spectrum” offers protection for both UVA rays and UVB rays. It is also important to know that no sunscreen is “waterproof;” if you go in the water, you should periodically reapply your sunscreen.

You’ve probably been wondering about the title of the blog, “The Eyes Have It” When I learned more about UV Safety Awareness Month I realized I had always thought about protecting my skin and hadn’t thought much about the importance of protecting my eyes from harmful UV rays. Exposing your eyes to UV rays heightens the risk of developing cataracts, macular degeneration, and growths on the eye including cancer.

Here are some tips from the American Academy of Ophthalmology:

  • Don’t focus on color or darkness of sunglass lenses: Select sunglasses that block UV rays. Don’t be deceived by color or cost. The ability to block UV light is not dependent on the price tag or how dark the sunglass lenses are.
  • Check for 100 percent UV protection: Make sure your sunglasses block 100 percent of UVA rays and UVB rays.
  • Choose wrap-around styles: Ideally, your sunglasses should wrap all the way around to your temples, so the sun’s rays can’t enter from the side.
  • Wear a hat: In addition to your sunglasses, wear a broad-brimmed hat to protect your eyes.
  • Don’t rely on contact lenses: Even if you wear contact lenses with UV protection, remember your sunglasses.
  • Don’t be fooled by clouds: The sun’s rays can pass through haze and thin clouds. Sun damage to eyes can occur anytime during the year, not just in the summertime.
  • Protect your eyes during peak sun times: Sunglasses should be worn whenever outside, and it’s especially important to wear sunglasses in the early afternoon and at higher altitudes, where UV light is more intense.
  • Never look directly at the sun. Looking directly at the sun at any time, including during an eclipse, can lead to solar retinopathy, damage to the eye’s retina from solar radiation.
  • Don’t forget the kids: Everyone is at risk, including children. Protect their eyes with hats and sunglasses. In addition, try to keep children out of the sun between 10 a.m. and 2 p.m., when the sun’s UV rays are the strongest.

As a golfer I haven’t paid enough attention to protecting both my skin and especially my eyes from harmful UV rays. I got sufficiently scared when I read about skin and eye diseases that are preventable and I’ve vowed to do better. I hope you have also decided to take the action necessary to protect yourself from these cancer-inducing UV rays.

Best, Thair



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Medicare Part B – A Lifesaver

Medicare Part B is the part of Medicare that covers care you receive when you are not a patient in the hospital. The graphic below outlines the basic care covered under Part B. I called Part B a lifesaver because it covers the treatment for some of the most serious diseases . . . like cancer (chemotherapy), kidney failure (dialysis), and transplants (immunosuppressive drugs). While these treatments are often expensive and lengthy, they often save or lengthen our lives. Part B costs are further impacted by the fact that many treatments are provided at a doctor’s office or in a hospital’s outpatient facility.

Part B is partially funded (about 27%) by our monthly premiums, which have increased faster than inflation over the years but increased only $3.90 this year. While those in lower income brackets are protected from some increases, those in higher income brackets will pay much higher premiums. The Part B premium this year for most of us will be $148.50 a month, but some higher income beneficiaries will pay as high as $504.90 a month. The rest of the money for Part B is drawn from the government’s general revenues.

Lately, the Part B costs have increased faster than other parts of our healthcare and have come under pressure by those in Washington as a way to lower government spending on healthcare. Part of the reason for the Part B cost increases is due to the many new discoveries in medicines and treatments for some of these life-threatening diseases. There have been huge steps forward in the treatment of serious diseases; many lives have been lengthened and enriched by these new treatments. It would be a shame if the access to these life-altering treatments were restricted.

There is no doubt that the way the payments are calculated for Part B is convoluted. Payment structures to doctors who administer many of the infused drugs is complicated. There are changes that could be made to make the cost and payments more straight forward. Changes should be made at the process level rather than using a blunt force approach that will only increase the flawed incentives in the process.

Part B is the place for big discoveries that will have huge impacts on our lives. Great discoveries in biologics and other cancer fighting medicines along with breakthroughs in treatments for autoimmune disorders are on the horizon. These are the types of discoveries that deserve our focus and resources. Anything that inhibits this innovation or restricts our access to these treatments is not the direction America’s healthcare system should be headed.

There are changes afoot; this was made very evident by the President’s Executive Order signed last Friday. I’ll work hard to keep you up to date on what’s happening, and hope you’ll also stay informed and be ready to contact those in Washington and tell them how you feel about these changes.

Best, Thair

A visual of which services are covered by Medicare Part B: Doctors visits, outpatient care, lab tests, durable medical equipment and preventative services.


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I Can See Clearly Now

This month is Healthy Vision Month. . . now maybe the blog title makes sense. I’ve talked in earlier blogs about different special days, weeks and months that emphasize different diseases or ways to stay healthy. Each of these may or may not have struck a chord with you but I think having healthy vision is important to virtually all older Americans. One study indicated that 92% of those over 65 wear glasses or contacts and, an astounding 1 in 3 have some sort of vision impairing eye disease. Our eyes and their health should be important to all of us.

Before I jump into information and sources we can use to keep our eyes healthy I’d like to talk about something I’ve observed. My mother had macular degeneration in both eyes and her eyesight deteriorated as she became older. Things became very blurry except for some of her peripheral vision. I noticed this poor eyesight made her somewhat disconnected in large gatherings. She found it difficult to connect with people she couldn’t see. She seemed to withdraw and not participate. She loved to read and when she lost that ability she tried listening to audio books but her mind wandered such that it made it difficult for her to stay focused. Her quality of life declined. Seeing this happen to my mother has motivated me to pay special attention to my eyes. I hope it also motivates you.

There are a lot of resources you can access to maintain your healthy vision. Getting older increases your risk of some eye diseases. You might also have a higher risk of some eye diseases if you:

  • Are overweight or obese.
  • Have a family history of eye disease.
  • Are African American, Hispanic, or Native American.

Other health conditions, like diabetes or high blood pressure, can also increase your risk of some eye diseases. For example, people with diabetes are at risk for diabetic retinopathy — an eye condition that can cause vision loss and blindness.

If you’re worried you might be at risk for some eye diseases, talk to your doctor. You may be able to take steps to lower your risk.

Know your family’s health history. Talk with your family members to find out if they’ve had any eye problems. Some eye diseases and conditions run in families, like age-related macular degeneration or glaucoma. Be sure to tell your eye doctor if any eye diseases run in your family.

It is important to get a dilated eye exam every one to two years. It is the single best way and often the only way to discover many eye diseases. Go here to learn more about a dilated eye exam.

Here are 8 things you can do to maintain your healthy vision.

1. Find an eye doctor you trust.

2. Ask how often you need a dilated eye exam.

3. Add more movement to your day.

4. Get your family talking… about eye health history!

5. Step up your healthy eating game.

6. Make a habit of wearing your sunglasses — even on cloudy days. 

7. Stay on top of long-term health conditions — like diabetes and high blood pressure.

8. If you smoke, make a quit plan.

Go here to find out more about these 8 steps to healthy vision.

We all know that Medicare doesn’t cover most aspects of eye care. There are some efforts to add vision coverage to the Medicare benefits but until then it comes out of our own pockets. If you are having trouble affording eye care, there are programs available to help you pay for it. One program is EyeCare America. They have helped millions get the eye care they need. You can go here to find out about this beneficial program.

As we begin to return to normal this summer let’s strive to take care of our eyes so that we can see every detail of our grandchild’s smile.

Best,
Thair



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Lowering Drug Prices – Two Different Approaches

Last week Senator Wyden, the Democratic Chairman of the Senate Finance Committee, and Senator Crapo, the Republican Ranking Member of the same Committee each released their solutions to lowering drug prices.

Senator Wyden’s letter proposed the following five basic principles (the three page paper can be found here).

  1. Medicare must have the authority to negotiate with pharmaceutical companies, especially when competition and market practices are not keeping prices in check.
  2. American consumers must pay less at the pharmacy counter.
  3. Prices of drugs that increase faster than inflation will not be subsidized by patients and taxpayers.
  4. Drug pricing reforms that keep prices and patient costs in check should extend beyond Medicare to all Americans, including those covered by employer and commercial health plans.
  5. Drug pricing reforms should reward scientific innovation, not patent games.

The letter’s singular author was Senator Wyden and was a stark departure from Senator Wyden’s and Senator Grassley’s bipartisan plan they proposed last year. Senator Grassley disagreed with the principles released last week and dismissed the approach as an effort to placate the progressive side of his party.

The short three-page document consisted of a series of broad statements that could morph into a menagerie of different regulations and controls. It uses the word fair without defining who would define “fair.” Who would decide when prices were not in check? How would a patient’s out-of-pocket costs be lowered? How would you extend these regulations and controls into employer and commercial health plans without changing the basic ways these markets function today? The letter generated many questions with answers that could have a huge negative impact on, not only the healthcare of older Americans, but the healthcare of all Americans.

Senator Crapo also put forth his solution to drug prices last week, the “Lower Costs, More Cures Act” (LCMCA) (you can find a section by section break down of the legislation here). This legislation was introduced last year with nine cosponsors. It is a detailed, free market solution that encourages innovation. The Lower Costs, More Cures Act, among other things, would:

  • Modernize payments for drugs delivered in the doctor’s office under Medicare Part B.
  • Incentivize lower-cost alternatives, or biosimilars.
  • Establish an annual out-of-pocket cap of $3,100 for Medicare Part D enrollees and allow certain patients to pay in monthly installments.
  • Decrease beneficiary cost sharing from 25 percent to 15 percent of costs before the out-of-pocket cap is reached.
  • Allow prescription drug plan sponsors to offer, at minimum, up to four Part D plans per region, spurring competition and innovation.
  • Make permanent the Center for Medicare and Medicaid Innovation model that enables Part D enrollees taking insulin to limit out-of-pocket costs to $35.
  • Allow state Medicaid programs to enter into outcomes-based agreements to pay for life-saving gene therapy treatments.
  • Provide the HHS Secretary with the authority to require drug manufacturers to provide pricing information on all direct-to-consumer advertising.
  • Codify a Trump Administration regulatory action that classifies insulin and other treatments for chronic conditions as preventative care so that high deductible health plans can cover costs before the patient reaches the deductible.
  • Create a trade negotiator solely dedicated to putting American patients first in government trade negotiations related to medicines in order to prevent foreign “free-loading” off America’s investment.

As you have probably figured out, I prefer the second solution. It has the detail required for real solutions. It details ways that this legislation will lower a patient’s out-of-pocket costs while encouraging the continuance of our country’s, best in world, innovation. It focuses on the patient. The Lower Costs, More Cures Act is not perfect, but it offers the basis for real-world solutions.

It is interesting to contrast these two plans offered by the Democratic and Republican leaders of the Senate Finance Committee. I’m convinced that as we move forward this year there will be many more drug pricing proposals. I will work to keep you informed and alert you to any needed action required to either promote those solutions that help the patient or defeat those proposals that hurt our access to healthcare or stifle innovation.

Best, Thair



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Town Hall on Drug Pricing Legislation – A Recap

Last week’s town hall focused on the Elijah E. Cummings Lower Drug Costs Now Act, HR-3. Our special guest was former Vermont governor, presidential candidate and physician, Howard Dean. Governor Dean is a Democrat but is also a fiscal moderate. We thought his perspective would be important as we consider the many proposed changes to our prescription drug program.

Governor Dean gave his initial remarks stating that he thinks something needs to be done about drug prices. He thought HR-3 was a well-intentioned bill but maybe didn’t have all the right solutions. He stated that, in his opinion, we should have first dollar coverage in Medicare, even if it resulted in higher premiums. He pointed out that our present system pays only when you get sick rather than paying for not getting sick. He pointed out that all facets of healthcare have gone up 15% a year. He said that getting healthcare was not like buying a car, we don’t have the opportunity to buy a Cadillac or a Ford; our doctor tells us what healthcare we need whether we can afford it or not.

He talked about the part of HR-3 that directed that we base our drug prices on what other countries pay. He agrees that it is unfair for the United States to foot the bill for all the research and development of new medicines, but the HR-3 approach wasn’t the answer. He stated that this really is a serious trade issue, and it’s like they have to put a tariff on our drugs, but we must be careful how we go about solving this problem.

Politicians like to have villains and the drug companies are easy targets. He pointed out that healthcare innovation is one of a shrinking number of places that the United States is the world leader. It was no accident that the first and highly successful COVID-19 vaccines were produced by American companies. He said that taking away the intellectual property rights of drug manufacturers would not get one dose of the vaccine overseas any quicker.

He talked about, what he labeled, a pretty controversial solution – having drug and procedural solutions compete. He pointed out that years ago when he was practicing medicine a heart attack patient would spend 14 days in the hospital and now that same patient spends 3 days. He said this was because of the advancement in drugs in this arena.

He wants to bring drug prices down, but he does object to simply punishing the drug companies because they are drug companies. We cannot cripple these industries.

He ended his preliminary remarks and opened the town hall up for questions.

At this point I commented that America has this huge pharmaceutical manufacturing asset that we should work hard to preserve. I pointed out that when Part D was implemented, hospital visits were reduced. These savings are often not recognized. I continued on, pointing out that Medicare Advantage is a program that helps keeps us healthy rather than waiting for us to get sick.

Governor Dean talked about the Bayh/Dole Act and how it tripled patents in its first year. He commented that the best way to stifle innovation was to have the government control everything. He said having first dollar coverage on Medicare was much better than the government controlling prices.

I interjected that these other countries used QALYs (quality-adjusted life year) to ration healthcare, something that we don’t want to have invade our healthcare system.

Governor Dean said we should get rid of fee-for-service medicine entirely, bypass the insurance companies and go to a simple premium paid to hospitals system. They would control the healthcare for each patient making them more apt to worry about the health of their clients.

[This is an area where I disagree with Governor Dean’s solution. What he is describing is a Medicare Advantage system for healthcare or a capitated system, like an HMO, where the provider gets one amount for each patient, regardless of the level of treatments the patient receives but letting the hospitals control the premiums and management. This would give the hospitals control of virtually the entire healthcare system. If you bypass the insurance companies, you eliminate the competition and the oversight the insurance companies provide. This competition is the reason that premiums remain low and Medicare Advantage is successful – I can attest to its success as I have experienced both types of insurance and I am most satisfied with my Medicare Advantage program.]

I commented that no matter who is treating us or providing products, doctors, hospitals, medical device manufacturers or drug companies, if their prices are out of line then they should come under review.

Dean again reiterated that there should be no co-payments and I highlighted the fact that HR-3 was focused on how the healthcare system is today and that one way that it focused on limiting out-of-pocket costs was to set a cap on yearly drug costs.

Then someone asked the Governor if he thought that using trade negotiations was enough to get other countries to pay their fair share of research and development costs and if he thought prior administrations had done enough in this area. Governor Dean answered that he thought that trade negotiations were realistic, and he didn’t think prior administrations had done anything in this area. He thought these trade negotiations should be part of the broad negotiations we have.

The next question focused on whether there was a way to limit drug prices but still give the upstart drug companies something to offset the attacks on intellectual property (IP). Governor Dean suggested that if there was even pricing worldwide it would offer the return necessary to maintain innovation. Shortening the patent life was not the solution. He pointed out the number of high salaried jobs are in America as a result of the drug companies. He said that whole industry shouldn’t be punished for a few bad players (he referenced Martin Shkreli). He stated that we shouldn’t attack IP unless there was clear price abuse.

A question came from the Q&A chat box. . . do you expect any other proposals to lower drug prices coming forth this year? He said yes but doesn’t expect anything to get passed since Washington is so divided.

Next question, will there be some other healthcare legislation that will make it to President Biden’s desk?

He pointed out that President Biden has already expanded Obamacare but did this by executive order and that it is much harder to get legislation through. I pointed out that a small thing like smoothing out yearly out-of-pocket payments has bipartisan approval and should be done. The Governor agreed. Governor Dean said that smoothing out of pocket payments would directly help the beneficiary which is an important focus but only if the person could afford the payment in the first place. He said that he liked working with HMOs when he was practicing medicine. He said he liked the coordination of care but also on the focus on preventative care and railed again against the perverse incentives that exist that drives the providers to more procedures.

In response to a question about why his perspective on HR-3 differed from his Democratic colleagues Governor Dean said that he knew what it was like to practice medicine and treating the drug companies as the enemy was not the solution. He said politicians should decide on solutions, not just consider things that will make their constituents mad so they will go out and vote for them.

We then had some final comments:

I said that we need to work together to come up with solutions and that there is no better place that I know of to spend my money than to keep me and my family healthy.

Governor Dean said he was glad to have this time to talk about healthcare and said that he does think something needs to be done about drug prices but, when we consider changes, we shouldn’t do them out of anger but out of careful consideration of the facts.



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Our Medicare Prescription Drug Benefit – It Works PART II

This week’s blog is a follow-up to last week’s blog and is a preparatory blog for this week’s virtual town hall with special guest, former Governor, Howard Dean. I guess that makes this blog pretty important, I’ll try really hard to make it worth your read.

Last week I gave some background on Medicare Part D, highlighting the good parts and identifying some ways it has changed and ways could be made more efficient. If you haven’t had a chance to read last week’s blog you can find it here. As promised, today’s blog will focus on proposed changes to Medicare that have been put forth, specifically focusing on H.R. 3, The Lower Drug Costs Now Act. But, before we jump into H.R. 3,  there is an important point I would like to point out.

It’s been real easy to jump on the “bash the drug manufacturers” band wagon. It’s been  popular to criticize them for the high cost of new drugs that have been introduced and for raising prices on existing drugs. Even the generic drug manufacturers have been criticized for some of their pricing decisions. I think all the negative rhetoric has glossed over an important fact. . .  America has the best drug discovery and drug manufacturing capability in the world. It was America’s drug companies that moved with lightning speed to discover the vaccine that would beat COVID-19 and, just as important, they had the capability, know-how and access to the right raw materials, to quickly manufacture the millions of doses that have saved lives. This capability has been developed over decades and does not exist anywhere else, in either size or level of experience. This capability is tremendously valuable. As we confront the problems of prescription drug prices, we need to make sure that any solutions that are considered should also preserve this valuable asset.

Okay, now I’ve got that off my chest, let’s look at H.R. 3.

As I’ve said in my blog on the hearings concerning H.R. 3 (you can read it here) there are three main components of this bill:

  • Lowering the out-of-pocket costs for patients.
  • Restricting the amount an existing drug’s price can be increased year over year.
  • Allowing government “negotiations” for drugs.

Lowering the out-of-pocket costs for patients – This approach is the most popular and comes the closest to bipartisan support. Having a cap on the yearly Medicare Part D out-of-pocket costs would be a huge relief to those patients who bear the brunt of the huge out-of-pocket payments they must make. It would truly give them a predictable “light at the end of the tunnel.” I think there is even more we can do. We could fix the convoluted business model that supports perverse incentives and inefficiencies that does not result in lower costs for beneficiaries.

Restricting the amount an existing drug’s price can be increased year over year – It seems like a logical way to deal with price increases but this idea is really a one-size-fits all approach which means it really doesn’t fit anything. Manufacturing and raw material costs don’t always follow the CPI. It doesn’t take into account any other business scenarios. What it really doesn’t account for are the times that drug costs are lowered. Tying drug cost increases to the CPI would tend to set the bar for all drugs to increase each year by the yearly CPI. I fear there will be ways that companies would find to “game” the system.

Allowing government “negotiations” for drugs – This approach has proven to be the most controversial. When you actually look at the way the prices are negotiated you realize that there is no negotiation at all. The government will use the price charged in foreign countries as the base to setting the price in the United States. If the manufacturer decides they aren’t going to yield to this price setting, they will be fined up to 95% of their GROSS sales. I don’t think this one-sided declaration fits the definition of negotiating.

Let me try to put these last two approaches into context. If the government inserted itself into the automobile gas business in the manner proposed in H.R. 3 they would dictate that you could only raise the total price per gallon for gas equal to the year’s CPI. So, the cost of prospecting for new sources, seasonal demand, cost of overseas gas, manufacturing interruptions, etc. would not be considered. The government would also force the price of gas to reflect the lowest cost in any region or state in the U.S. And, if you didn’t like the $2.40 a gallon price they set for your gas and you chose to sell it for $2.50 a gallon, you could be fined up to $2.38 for every gallon you sold. It would be safe to say you would be losing a lot of money on each gallon of gas you sold. It would also be safe to say that prospecting for new oil and gas sources would be severely curtailed given the price fixing capabilities the government would have,

There are many different ways to look at the changes proposed in H.R. 3. I can guarantee there will be much discussion this Wednesday as we talk about those changes. Don’t forget to register for the virtual town hall (see below) and come with your questions. And you can dial in. You won’t be seen on screen either way.

Best, Thair

Medicare Today Town Hall

Wednesday, June 16, 2021
2:00 p.m. ET

Guest Speakers

Howard Dean 
Former U.S. Presidential Candidate, former Vermont Governor, and Physician

Thair Phillips 
Former President and CEO of RetireSafe

They will discuss:
H.R. 3 – The Lower Drug Costs Now Act

Register Here

After registering, you will receive a confirmation email containing information on joining the Town Hall.

Prefer to dial-in instead?
Use your mobile phone to click on the number below: 

+13126266799,,93259956293#,,,,*103144#
 

PhRMA, the drug companies association, has recognized that there needs to be changes. They have a real desire to take part in the discussion.



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Our Medicare Prescription Drug Benefit – It Works

I’ve got to admit that I’m not a believer in government programs. They’re often implemented on short sighted political goals, are difficult to respond as times change, are inefficient, and grow bigger and bigger. . . because that’s what government programs do. While the Medicare Prescription Drug benefit, Part D, has exhibited some of these problems, it has turned out to have cost less than expected and become one of the more popular government programs around. Despite its apparent success there are renewed calls to make some very basic changes to Part D. I’ve talked about these proposals in earlier blogs. On Wednesday, June 16th, we’re going to hold a virtual town hall to talk about these proposed changes (see below to register). I thought it would be appropriate in this blog to look back at the origin of Part D and highlight its basic components and how those components have worked over the last 15 years. In next week’s blog I will outline the changes proposed in H.R. 3, the “Lower Drug Prices Now Act,” the broad-based bill that has been introduced in the House and is presently in subcommittee. My goal is to give you some background on Part D and H.R. 3 before the town hall on the 16th.

A Medicare prescription drug benefit has been discussed since Medicare was implemented back in 1965. At that time, it was the hospital and doctor costs that were bankrupting seniors and prescription drug costs were somewhat constant. It is interesting to note that in the early 1960s prescription drugs accounted for 10% of the total healthcare costs, today; over 60 years later, the percentage is 11%. In all the discussions on healthcare costs this fact is often overlooked. There was a prescription benefit signed into law as part of the Medicare Catastrophic Coverage Act in 1988. It was promptly repealed in 1989 as the ways to pay for it became difficult and controversial. Almost every president since the 60s has had some dealings with trying to enact a prescription drug benefit.

Finally, in 2003, President Bush was able sign the Medicare Modernization Act which finally formally established a prescription drug benefit, labeled Medicare Part D. The legislation:

  • Satisfied those members of Congress who were afraid of implementing a huge government “socialist-like” program by using private insurers to implement the program and to compete for customers.
  • Relied on independent Pharmacy Benefit Managers (PBMs) to negotiate prices with drug manufacturers to keep costs down.
  • Created the “donut hole” to have patients participate to some extent in paying drug costs.
  • Solved the problem some had that there wouldn’t be enough competition in rural states by creating a government run plan that offered another choice if a private one wasn’t avaialble.
  • Reduced the final out-of-pocket costs to 5% of the cost once a patient reached the catastrophic phase.

It was surprising to me that when President Bush signed the Medicare Modernization Act, on December 8th, 2003, 47 percent of senior citizens opposed the bill, and only 26 percent approved it. Among people of all ages who said they were closely following the Medicare debate, 56 percent said they disapproved of the legislation, and 39 percent supported it (ABC News/Washington Post Poll 2003).

It was also interesting that a few months after the bill was signed the Office of Management and Budget (OMB) announced that it projected the new law would cost the federal government $534 billion over ten years—35 percent higher than the estimate of $395 billion that lawmakers had relied on when they voted on the final package.

Finally, while the new law had some intermediate steps, the full law would not be implemented until 2006. It would take over two years for people to begin realizing the benefits of the new law.

Part D had an interesting beginning, a program that was unpopular, wouldn’t be implemented for over two years and was projected to be very costly. So, how did this new program do?

  • Did it have enough competition to keep the cost down? The large number of plans and the diversified choices they offered have worked to keep the premiums low. As you can see in the chart below, the year-over-year price increases have been kept low, even going down in some years.

To put this in perspective, if we just used the inflation index to estimate the present-day premium, the price of a $32 dollar premium in 2006 would be over $42 dollars in 2021. Some estimated the premium would rise to $68 dollars a month by 2016.

  • Did independent negotiators work? Over the first decade of operation Part D came in 45% below the initial estimates, saving almost $350 billion.
  • What about the donut hole? While the donut hole worked to ensure beneficiaries had some “skin” in the game, it limited access for some and was complicated for some to estimate what their yearly costs would be. It was phased out as part of “Obamacare” legislation and has disappeared.
  • Were there enough plans to choose from in every state? The average beneficiary has 30 plans to choose from with a minimum of 24 in each state. The government option was never instituted.
  • How did the reduction in cost in catastrophic to 5% do? Initially it reduced the impact on those with high drug costs but, as more and expensive drugs were discovered, the sickest began to be saddled with the most costs.

All in all, Part D did pretty well. The once leery senior citizens, with 46% initially disapproving of the program, now approve it by a 90% margin. Is there room for improvement? Absolutely! The convoluted business model needs to be streamlined. More transparency would help identify inefficiencies. The perverse incentives that drive up list prices need to be fixed. We need a cap on the beneficiaries’ yearly out-of-pocket costs. We need a way to smooth out the month over month out-of-pocket costs.

There are many things that can be done to make the program better. Changing the basic way it operates is not the way to fix it. The saying, “if it ain’t broke don’t fix it” applies here. One of the reasons that it took so long to get a prescription drug benefit implemented was the fear by many in Congress that we would be turning over more control to the government, that we would be adopting socialistic principles. Part D has proven that a public private partnership works.

I hope this blog has given you a little perspective on Medicare Part D and why it has been successful and how it could be changed. Next week I’ll delve into H.R. 3 and how that proposed legislation wants to change Medicare Part D.

Don’t forget to sign up for our virtual town hall below. Governor Dean and I will dive into H.R. 3 and how we see it impacting Part D.

Best, Thair

Medicare Today Town Hall

Wednesday, June 16, 2021
2:00 p.m. ET

Guest Speakers

Howard Dean 
Former U.S. Presidential Candidate, former Vermont Governor, and Physician

Thair Phillips 
Former President and CEO of RetireSafe

They will discuss:
H.R. 3 – The Lower Drug Costs Now Act

Register Here

After registering, you will receive a confirmation email containing information on joining the Town Hall.

Prefer to dial-in instead?
Use your mobile phone to click on the number below: 

+13126266799,,93259956293#,,,,*103144#



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Alzheimer’s and the Summer Solstice

June is Alzheimer’s and Brain Awareness Month, a time when we show support for those suffering with dementia. While the awareness is spread over the entire month there is a special emphasis on June 20th . . . that’s right, the summer solstice, the longest day of the year. That’s been tagged as, “the day with the most light is the day we fight.”

We all know someone who has fought the debilitating effects of Alzheimer’s but many of us don’t know very much about this terrible disease. Although everyone’s brain changes as they age, it’s important to understand that Alzheimer’s disease is not a normal part of aging. Memory loss is typically one of the first warning signs of Alzheimer’s disease, but occasionally forgetting words or names does not mean a person has Alzheimer’s. There are other signs that someone in the early stages of Alzheimer’s disease may experience in addition to memory problems.

In the early stages of the disease, these can include:

  • Getting lost in familiar places
  • Having trouble handling money and paying bills
  • Repeating questions
  • Taking longer to complete normal daily tasks
  • Displaying poor judgment
  • Losing things or misplacing them in odd places
  • Displaying mood and personality changes


Early diagnosis is important to helping people deal with this disease. Many aspects of Alzheimer’s are not known or misunderstood. Here’s some things you may not know about Alzheimer’s:

  • Many Seniors Living With Alzheimer’s Do Not Know They Have It – the early signs of dementia include problems speaking or finding the right words during conversations, behavioral changes and difficulty with daily tasks like dressing. However according to the Alzheimer’s Association, even after these symptoms are recognized by a health professional, only 45% of patients are told by their doctors of their diagnosis. The failure to disclose the diagnosis to patients and their caregivers can prevent seniors from receiving the early treatment they need.
  • Dementia Impacts More People Ever Year – It is estimated that around 44 million people in the world are currently living with dementia. While this is already a high number, it’s supposed to continue to increase over the years, rising to 135 million people by 2050.
  • Alzheimer’s Often Leads To Premature Death – Many people know that Alzheimer’s disease causes debilitating memory loss that can make daily tasks difficult. However, it’s essential that individuals are aware that Alzheimer’s is actually the sixth leading cause of death among the U.S. population, explained the Alzheimer’s Association. As there is currently no cure for dementia, the disease is the only illness in the country’s top 10 causes of death that can’t be prevented.


I didn’t realize the lack of awareness and diagnosis of this disease or the number of people it affects. I did know that there is no cure. Alzheimer’s is complicated. I remember something that was said during a conference I attended. They said, referring to Alzheimer’s, “Once you’ve seen one person with Alzheimer’s you’ve seen one person with Alzheimer’s.” It is a very complex disease and the search for a cure continues.

There is always the question of when it’s appropriate to have a dementia evaluation. It’s time to consult a doctor when memory lapses become frequent enough or sufficiently noticeable to concern you or a family member. If you get to that point, make an appointment as soon as possible to talk with a primary physician to have a thorough physical examination. Your doctor can assess your personal risk factors, evaluate your symptoms, eliminate reversible causes of memory loss, and help obtain appropriate care. Early diagnosis can treat reversible causes of memory loss, or improve the quality of life in patients with Alzheimer’s or other types of dementia.

You might consider having your loved one screened for dementia if they have begun having difficulty with the following:

  • Remembering new things
  • Dealing with numbers and logical thinking
  • Performing familiar activities
  • Understanding the passage of time: change of months/seasons
  • Changes in vision or perception
  • Carrying on a conversation
  • Losing things
  • Poor decision making
  • Socializing/ hobbies
  • Drastic change in personality or mood


As I’ve worked over the years with national Alzheimer’s organizations, I’ve seen their perseverance and commitment. This month gives us a chance to give of ourselves in the fight to find a cure. June 20th, the longest day, offers us three ways to give of ourselves – donate, fund raise, or volunteer. Click here to get ideas on how you can more effectively help in one of the three areas.

Alzheimer’s can rob us of experiencing some of the greatest joys of our life. Science continues to make strides in understanding how this disease works. We need to help support this work. While we will most certainly be working for those who are experiencing dementia, we may also be working to change our own lives, as many of us will face the life changing effects of Alzheimer’s in the future.

Best, Thair



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National Senior Health & Fitness Day – It’s Important, Now More Than Ever

Every year, for the last 28 years the National Health and Fitness Day has been held on the last Wednesday of May and this year, due to COVID, there will be two fitness days, one in two days, Wednesday, May 26th, and another on October 27th.

Now I know, you are probably saying to yourselves, “if I hear one more person tell me how I should get off my butt and exercise I’m going to hit them with a pair of sneakers”, but hear me out, I may have some predictable advice but very possibly a little different emphasis.

On this health & fitness day local organizations throughout the country will host senior-related health and fitness events at retirement communities, Ys/health clubs, senior centers, park districts, hospitals, houses of worship, local aging groups, and other community locations. The local health and fitness activities will vary widely based on the organization hosting the event and the interests of the local seniors they work with. Activities will be noncompetitive and may include walking events, low-impact exercises, health screenings and health information workshops. You can go to your local news source or the internet to see what activities will go on in your area.

One site, Silver Cuisine, gave seven activities you can do on your own to celebrate health & fitness day that might spark your interest and start an ongoing healthy activity.

1. Go to the Park

Park and Recreational Departments are getting involved in National Senior Health and Fitness Day, posing the opportunity for seniors to get out in nature. Check out local events near you or construct your own day at the park, filled with trail walking and a picnic!

2. Attend a Fitness Class

What more appropriate way to spend National Senior Health and Fitness Day than by attending a fitness class? Whether at a local community center or private gym, look for a structured workout session. Having an instructor helps demonstrate proper technique to prevent injury while a large group of people heightens motivation and energy!

3. Walk to Health

Organizations near you may be organizing walking events, so take advantage of such. But not all fitness activities have to be structured and can include a walk with close friends and family members. Whether walking on your favorite trail or around the neighborhood, enjoy the feeling of walking to health with loved ones.

4. Work in the Garden

Gardening is a leisurely hobby promoting both health and fitness. Attend to a personal or community garden or plant a garden bed or pot filled with fresh produce of herbs. Take gardening a step further, with personal crop or purchased from the grocer, and cook a meal with fresh produce filled with extensive nutrients to nourish the body.

5. Dance

Groove and dance to the music! Whether signed up for a Zumba class or in the comfort of your own kitchen, there are endless possibilities when it comes to dancing, as it can be done just about anywhere.

6. Schedule A Health Screening

Along with being active, be proactive with health. Scheduling a health screening keeps seniors in the know bout their own personal health and offers a chance to take preventative measures or actions, which may also be dependent on the physical results and discussions held with a healthcare professional.

7. Volunteer

Volunteering is a chance to offer health and wellbeing not only to yourself, but the ability to extend it to others. Seek out volunteer options at health fairs to spread the word of good health, food pantries to offer nutrition to individuals in need, or any other opportunities available in your community or area.

Ok, now that you’ve got the list of things that you’d expect from a blog about health & fitness day, it’s time for some unexpected emphasis. I would like to talk a little more about item 7, volunteering.

Over the last year, whether we liked it or not, we were limited in what we could do and where we could go. Our contact with others was extremely limited, it seemed like we were all focused on keeping ourselves from catching the virus. The key word in that last sentence is “ourselves.” We were focused on ourselves, and with good reason. This life-altering and life-taking virus was dangerous. Now that we are breaking the bonds of COVID we have a chance to change our focus.

I think volunteering is an excellent way to regain a sunny outlook. Turning our eyes toward others is a way to forget our own problems and help someone else regain their sunny outlook. Often when we volunteer it helps us exercise in a way that we hardly know it’s happening. I’ve found there is no better feeling than that aching body you have when you’ve shoveled the neighbor’s walks, cut the neighbor’s grass or did all the lifting and carrying required to get a handicapped friend to the doctor or to the park.

My wife’s aunt went over to the assisted living center once a week to push wheelchairs and help some of the women get to the hairdresser who volunteered once a week to do residents’ hair. She finally quit volunteering when she was 97.

I know that during the pandemic my life seemed to shrink to a very tight orbit where everything seemed to revolve around me. We need to expand our orbit and our universe and seek opportunities to serve others. I’ve found it’s a great way to feel good about yourself and your circumstance.

There are many places to volunteer – local senior centers, congregant eating and activity centers and county and state senior programs. Contact your local Area Agency on Aging (click here to find the closest Area Agency on Aging near you), as they have many ways you can volunteer. We all have some skills we’ve developed over our life that we can use to help others. Get involved!

While there will be many important issues that we will require us to raise our voices in unison, volunteering is a personal and immediate way we can brighten the lives of others . . . and maybe even get some exercise while we’re at it.

Best, Thair



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Osteoporosis Month – A Chance to Make a Difference

It’s Osteoporosis Month, which gives us a chance to focus on a debilitating and costly disease that effects a huge number of Americans. We probably all know someone, either a friend or a relative, who has osteoporosis, which is defined as porous bone. I remember, when I was much, much younger seeing old people who were bent over and had what appeared to be a big bump on their upper back. This is one of the symptoms of osteoporosis. My mother in-law suffered from this disease. Our bones are made up of living and growing tissue and are like honeycombs. If the spaces in the honeycomb become bigger over time, we develop osteoporosis and our bones become prone to breaking more easily. We can do things to strengthen our bones when we are younger but, since this is a blog for, and about, seniors, I want to concentrate on what we can do now to combat this disease.

Osteoporosis is often a silent disease; we many times don’t know we have it until we break a bone. It is more common in older women, but men are also at risk. White women and white men are more likely to get osteoporosis than their African American or Mexican American counterparts.

It’s important to assess whether we are at risk for osteoporosis. Take a moment and take the quiz below.

The more times you answer “yes,” the greater your risk of getting osteoporosis. Take this card with you to your next medical appointment and talk to your healthcare provider about what you can do to protect your bones.

During your visit with your doctor, remember to report:

  • Any previous fractures.
  • Your lifestyle habits, including diet, exercise, alcohol use, and smoking history.
  • Current or past medical conditions and medications that could contribute to low bone mass and increased fracture risk.
  • Your family history of osteoporosis and other diseases.
  • For women, your menstrual history.

The doctor may also perform a physical exam that includes checking for:

  • Loss of height and weight.
  • Changes in posture.
  • Balance and gait (the way you walk).
  • Muscle strength, such as your ability to stand from sitting without using your arms.

In addition, your doctor may order a test that measures your bone mineral density (BMD) in a specific area of your bone, usually your spine and hip. BMD testing can be used to:

  • Diagnose osteoporosis.
  • Detect low bone density before osteoporosis develops.
  • Help predict your risk of future fractures.
  • Monitor the effectiveness of ongoing treatment for osteoporosis.

Thankfully, there are some things we can do right now to help us avoid the broken bones.

  1. Get the calcium and vitamin D you need every day.
  2. Do regular weight-bearing and muscle-strengthening exercises.
  3. Don’t smoke or don’t drink too much alcohol.
  4. Talk to your healthcare provider about your chance of getting osteoporosis and ask when you should have a bone density test.

A big part of limiting the impact osteoporosis has on our continuing health and mobility is seeking the necessary treatment after we break a bone or discover we have osteoporosis. Following our doctors’ recommendations to ensure we don’t have another broken bone is very important. Preventing a downward spiral that reduces our mobility and exacerbates other health problems we may have will go a long way toward maintaining our health.

How many times have you heard of an older person who fell and broke his/her hip and just continued to spiral down as that traumatic experience affected their overall health to the point they eventually died? It happened just that way with my mother-in-law. Broken bones put pressure on already fragile organs and can rob us of precious time with loved ones.

This disease has a huge financial effect on our nation. The Bone Health Policy Institute, which is part of The National Osteoporosis Foundation, did a report on the clinical and cost burden of fractures associated with osteoporosis. A great graphic that captures this information can be seen here. You can also see the financial impact in your state by clicking here.

As you know, I’m always looking for ways that we can work to make Medicare more efficient, especially through the use of preventative measures. The Foundation’s study had recommendations on ways we could improve Medicare to avoid the life limiting results of osteoporosis. Here are the report’s recommendations:

  • Leading health systems like Geisinger and Kaiser Permanente have successfully reduced repeat fractures and lowered costs by employing a new model of coordinated care known as fracture liaison services (FLS). But most of those with fractures go without this cost-effective help because Medicare doesn’t incentivize its use.
    • Action – Congress and the Centers for Medicare and Medicaid Services (CMS) should make changes to Medicare payments to incentivize widespread use of model secondary fracture prevention/care coordination practices for beneficiaries who have suffered an osteoporosis-related fracture and are thus at risk for another fracture.
  • Medicare pays for high-quality bone density testing to identify those who are at risk of bone fractures, allowing for early and effective preventive steps and interventions. However, the Milliman report found that only 9% of women who suffer a fracture are screened for osteoporosis within six months of a new fracture. Other analyses have shown that Medicare payment rates have been cut by 70% and in the last 5 years the osteoporosis diagnosis of older women has declined by 18%.
    • Action – These cuts to Medicare payment rates for osteoporosis screening, which have reduced access, should be reversed either administratively or by legislation.
  • Medicare also pays for FDA-approved drug treatments for osteoporosis that can help reduce spine and hip fractures by up to 70% and cut subsequent fractures by about half. But about 80% go untreated, even after a fracture.
    • Action – Congress should mandate and fund a national education and action initiative aimed at reducing fractures among older Americans.

I can almost guarantee that you have osteoporosis or know someone who suffers from it. There are things we can do to reduce its impact on us, both in the steps we take in our own lives and things we can do to encourage those in Washington to improve Medicare’s approach toward preventative care for this debilitating disease. I encourage all of you to be active in improving your own health and by speaking out to those in Washington to let them know that, especially when it comes to osteoporosis, an ounce of prevention is absolutely worth a pound of cure.

Best, Thair



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Drug Price Hearing

Last Tuesday the Health Subcommittee of the Committee on Energy and Commerce held a hearing titled, “Negotiating a Better Deal: Legislation to Lower the Cost of Prescription Drugs.” The main focus of the hearing was U.S. House bill H.R. 3, the “Elijah E. Cummings Lower Drug Costs Now Act” but there were seven other bills, all dealing with drug prices and access in some manner, that were referenced in the hearing. This was the first hearing on drug prices in this congressional session. Historically, hearings are held in special hearing rooms on Capitol Hill with limited seating for the public, but with camera coverage for off site viewing. Due to COVID-19, this was a virtual hearing with all participants connecting on a YouTube live stream. The hearings are led by the committee chair, in this hearing that was Democrat Anna Eshoo of California, in concert with the ranking member of the subcommittee, Republican Brett Guthrie of Kentucky. A letter from the full Energy and Commerce Committee chairman, Frank Pallone, was available prior to the hearing.

This hearing followed the format of these type of hearings, with statements by the chair and ranking member followed by statements by witnesses who are invited to testify.  The witnesses in this hearing were a patient, a caregiver and three experts in the pricing of prescription drugs. Democrats and Republicans each choose people to testify. After the witnesses make their opening statements, the hearing is left open for questions from committee members, who each have five minutes to ask the witnesses questions.

The hearing lasted just over four hours and I watched every minute of it! By my count there were 40 members who asked questions. This hearing was longer than most, especially considering it was a conducted by the subcommittee. Click here if you would like to listen to the entire hearing. Rather than trying to review and summarize each statement and 40 series of questions, which would make this a very long and probably boring blog, I’ll try to capture the essence of the hearing and identify the salient points. If you don’t already know from my previous blogs, I don’t think H.R. 3 is the right approach to lowering drug prices. It quickly became apparent that all of the Democrats were supportive of H.R. 3 and all the Republicans were against it, although there were parts of the bill that the Republicans liked. There were some questions asked about the other seven bills included in the hearing; they dealt with specific aspects of the prescription drug supply chain and business model and ways to make them more efficient or lower costs. As time goes on some of these bills may have hearings of their own or be included in a larger bill. The vast majority of the time was spent on H.R. 3 and that’s where I will focus my comments.

H.R. 3 seeks to substantially change the way prescription drugs are priced and paid for. These changes will have huge impacts on patients and hearings like this one are conducted to identify this impact. It’s not a small bill but there are really three main parts of H.R. 3 that were the main focus of the hearing:

  • Lowering the out-of-pocket costs for patients.
  • Restricting the amount an existing drug’s price can be increased year over year.
  • Allowing government “negotiations” for drugs.

Lowering the out-of-pocket costs for patients – This part of the bill gained the most bipartisan acceptance. It propose a yearly out-of-pocket cap for prescription drug costs. The amount discussed was $2,000 but there were some questions and discussions about the amount and how it should be applied. There was also some discussion about how the increased cost of the cap should be split between the drug manufacturers, insurance company and the government. There were some questions concerning rebates and whether some of the money retained by middlemen in the supply line could be used. This proved to be a popular approach for both Democrats and Republicans, but the Democrats repeatedly indicated in their questions and statements that this was just one part of the solution.

Restricting the amount an existing drug’s price can be increased year over year – This part of the bill would limit the amount an existing drug’s price could be raised each year to the percentage indicated in the consumer price index (CPI), which measures the average amount of inflation year-over-year. There were many questions and statements on this approach, some by the expert witnesses and some by the patient witness. There did seem to be a few Republicans that thought this was a problem, though they weren’t convinced that a blanket solution of tying the increase to the CPI was a viable solution. I know that some increases are due to the increased cost of some ingredients or increased manufacturing costs. There were questions asked concerning some of the other bills that dealt with this problem in other ways, like identifying the “bad players” and their use of loopholes to increase prices. It was evident that this part of the bill will be discussed further.

Allowing government “negotiations” for new drugs – This part of the bill garnered the most discussion and questions. It dealt with the government getting involved in (negotiating) the price of selected drugs. The government would use the average price charged in six foreign countries – Australia, Canada, France, Germany, Japan, and the United Kingdom – as the basis for their negotiations. If a manufacturer was not willing to accept this price, they would be charged anywhere from 65% to 95% of their gross sales to continue to sell the drug in the U.S. There were many statements and questions from the Republicans on whether this was really negotiation. No drug manufacturer could continue to sell their product if they had to pay 65% of their gross sales to the government. One Republican said that this was not negotiation but a take it or leave it ultimatum which reduced the negotiations to simply price fixing. A Democrat made the point, which some Republicans agreed with, that America shouldn’t bear the cost of the research and development of new drugs. A Democrat made the statement that free market advocates should embrace the concept of negotiations with the Republicans indicating that price fixing is not a valid part of the free market. One member brought up the point that this approach may not be constitutional.

There were statements that some of the 6 countries used quality adjusted life years (QUALY) to ration healthcare and to negotiate drug prices. Republicans were nervous that this approach would make its way into America’s healthcare system. They pointed out that some patient groups had written letters to Congress stating that using this international pricing approach would help promote the use of QUALY which they deemed discriminatory to both the disabled and to the older population.

The biggest discussion on the use of these pricing approaches centered on their impact on the discovery of new medicines. The counterpoint to these approaches was the fear that they would greatly reduce the amount of money investors would be willing to risk on new drug discovery if the return on their investment was limited. It was pointed out that 9 out of 10 drugs discovery failed at some point in their development, making investment in drug research a risky endeavor. The proponents of H.R. 3 indicated that the decline in the number of new drugs would be minimal. One of the expert witnesses made an interesting statement He said, in essence, why limit drug research and development when we’re at the dawn of the golden age of health changing discoveries. Other members pointed out that the research and development business would move from the U.S. to other countries costing the loss of tens of thousands high paying jobs.

This hearing produced many comments and interesting questions and answers. The issue of drug prices has been at the center of many political campaigns, Presidential Executive Orders, demonstration projects and proposed legislation. This is not a new issue. H.R. 3 was proposed in an earlier Congressional session but was never advanced. Now, holding the majority in the House, the Democrats are working to advance the bill. One interesting thing that caught my attention was some statements by Republican members that they were convinced that this bill, even if it passed the House, would not pass the Senate. They wondered why the committee was wasting time on this bill rather than sitting down and working out compromises that would produce a bill that could pass the Senate. I’m convinced that there will be much more talk and more hearings on this subject.

One last thing. . . as you know, I’m a fan of instituting a yearly cap on patient’s out-of-pocket prescription drug costs. People shouldn’t go bankrupt or not have access to prescription drugs because of cost. We need to fix this part of our healthcare. Using international prices to fix the price of drugs is not the answer. The question I ask is, what better place should we spend our money than finding life changing and lifesaving medicines that could save your life or the life of your loved one? The government has spent trillions of dollars to help us through a pandemic that was caused by a virus that was first contained by a vaccine that used a new method for creating vaccines. This new method was discovered because research was funded years earlier, enabling it to be brought to bear in a short period of time to combat this life taking and economy crippling virus. Why wouldn’t we be willing to spend money to continue to make these types of discoveries? The drug manufacturers understand there’s a problem, and they have indicated they want to be part of the solution. More government involvement is not the solution. At least that’s my opinion.

We’ll keep you informed as these bills move forward, keeping you informed, highlighting their effect on you and your health. As always, I’d appreciate your opinion. Take the opportunity to leave a comment.

Best, Thair



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Medicare Quiz – The Answers May Surprise You

Medicare was launched as a basic healthcare program that older Americans could count on when they reached age 65. It provides:

  • Part A – Inpatient hospital coverage.
  • Part B – Outpatient/doctor care and doctor administered drugs.
  • Part C – Another choice for obtaining Medicare coverage (see below).
  • Part D – Prescription drug coverage, added in 2003.

Part C was introduced late in the 1990’s and was labeled Medicare+Choice; in 2003 the name was changed to Medicare Advantage (MA). This new Medicare option allowed private insurance providers to be paid a set fee for taking full responsibility for the healthcare needs of Medicare enrollees. This approach incentivized the MA provider to offer programs that helped keep their customers healthy since they were responsible for their long-term healthcare costs. Medicare Advantage offered seniors another choice, a choice that has had rapid growth in the last decade. Over 36% of Medicare beneficiaries have chosen Medicare Advantage. Historically, MA programs offer many added benefits, like reduced or free gym memberships. And they often include some eye, dental and hearing aid benefits. While there is often no cost for these added benefits there can be higher premiums and some limited choices of healthcare providers, limiting them to providers that are in the plan’s network. However, people can have more predictability in their healthcare expenses and budgeting.

As Medicare usage grew, private insurance providers then stepped in to offer Medicare supplemental insurance to further reduce out-of-pocket costs and increase benefits for Medicare beneficiaries. This offered even more choices for those over 65, although this insurance must be fully covered out of pocket.

As you can see, Medicare has gone through some changes over the years and has added more choices. It seems like this simple healthcare benefit has become more and more complicated. I thought maybe a short quiz may help shed some light on different aspects of Medicare. You may even learn some things you didn’t know about this important benefit.

I’ll ask 4 questions; the answers are below . . . don’t cheat and look at the answers before you answer the questions!!!!

Question 1 – True or false, everyone pays the same over the years for Medicare.

Question 2 – True or false, you don’t have to be 65 to be eligible for Medicare.

Question 3 – True or false, you can switch back and forth between Medicare Advantage and basic Medicare with minimal impact.

Question 4 – True or false, Medicare has a cap on how much a beneficiary will spend out-of-pocket each year.

Answer 1, False – For Medicare Part A, the actual dollars that you pay into Medicare depends on how much you earned and your tax status. If you are self-employed, you paid 2.9% of your income; otherwise your employer paid 1.45% and you paid 1.45%. Also, if you make over $200,000 ($250,000 if you’re married) your share goes up .9%. Your Part B premium is also based on your income, if you earn more than $85,000 ($170,000 if you’re married) your premium can go up substantially. Part D premiums can also go up based on your income. The government also contributes a portion of the cost of Medicare when you are retired. The bottom line is that the more you earn, the more you contribute to Medicare, both in your earning years and after you turn 65.

Answer 2, True – There are situations where someone who is younger than 65 will be eligible for Medicare. In 1972 Medicare was expanded to cover people younger than 65 with certain disabilities.

Answer 3, False – There are important rules that can come into play when you want to switch from Medicare Advantage back to basic Medicare and Medicare supplemental insurance. With Medicare supplemental insurance, the insurance company can require a physical and health history that can result in significantly higher premiums . . . in all but four states you may not be eligible for guaranteed coverage. Do your homework and ask questions as you make changes to your Medicare coverage.

Answer 4, False – Unlike the great majority of health insurance we had before we turned 65, which had a maximum amount we would have to pay a year for our healthcare, Medicare has one segment of healthcare that is not capped, Part D, the prescription drug benefit. If your total out-of-pocket costs for the year reach $6,550 you reach the catastrophic stage where your portion is 5% of the list price of the drug. While this seems like a small percentage there are serious, often rare diseases where the price of the drugs is extremely high. A drug that costs over $100,000 a year can add over $5,000 to the $6,550 that has already been paid. Seniors Speak Out has continually lobbied for a yearly cap on Part D. We just don’t think it’s right for the sickest among us to carry the largest financial burden.

Medicare can be complicated, each of us needs to ask questions, do research, get help from trusted sources like our doctor and access the help offered by our government. It seems like we get bombarded with ads, phone calls, emails and internet ads urging us to buy a specific supplementary insurance or Medicare Advantage program. Remember, each of us has unique circumstances and health requirements. Seeking trusted sources who know us and our situation, is the best way to make the right choice when it comes to Medicare.

Best, Thair



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A Harmful Path on Drug Pricing

You may have seen in the news last week that the majority leadership in the U.S. House of Representatives had decided to make prescription drug affordability a priority and introduced new legislation that they say will reduce what you’re paying for medicine.

Well, it’s not exactly new legislation.  It’s actually the same bill that the House passed in 2019 but that didn’t receive action in the then-Republican Senate.  H.R. 3 was a bad idea then and it remains a bad idea now.

H.R. 3 is a piece of legislation that would fundamentally change the way we determine pharmaceutical pricing in the United States. It would replace our market-based approach that utilizes private sector negotiations with a much heavier regulatory hand and a reliance on the government price controls used in other countries.

The sponsors of H.R. 3 talk almost exclusively about reducing prices, but they don’t address the consequences of their approach. The Congressional Budget Office has said that there will be fewer new medicines developed over the next 20 years if this government-centered philosophy toward pricing becomes the law of the land.  We shouldn’t have to choose between lifesaving medical progress and an unproven pricing method.

I want to focus on two of the primary components of H.R. 3. One provision would use the prices of six other countries as a baseline to determine the U.S. price for many drugs in the Medicare Part B (which covers drugs injected or infused in healthcare settings) program. Another would empower the Secretary of Health and Human Services to “negotiate” prices in the Medicare Part D program that millions of seniors use for their prescription drug coverage.

Let’s put all of the rhetoric aside and deal with the facts.  There are three reasons why this legislation would be bad for seniors:

  1. The notion that we should base our prescription drug prices on six countries – Germany, the United Kingdom, France, Canada, Japan, and Australia – whose healthcare systems are fundamentally different than ours is incomprehensible. Because the United States is the world’s hotbed of biopharmaceutical innovation, we have more access to new medicines than citizens in those countries.  For example, 96 percent of new cancer drugs developed in the last decade are available to Americans.  In Australia, only 49 percent of those drugs are available.  Yes, our government should be tougher in pressing those countries to pay their fair share for medical innovation, but we shouldn’t undermine our system in order to emulate theirs.

  2. Giving the Secretary of Health and Human Services “authority” to negotiate Medicare Part D drug prices is a flawed premise.  Government doesn’t negotiate, it sets prices.  This is a solution in search of a problem.  Medicare Part D average monthly premiums have remained steady and affordable for several years now.  Medicare Part B average prices aren’t going up any faster than any other commodity in healthcare. Private sector negotiations are working.  Why throw that out for government price setting that could have severe ramifications for our access to drugs?

  3. COVID-19 has taught us that we need a robust innovative pharmaceutical sector that can produce breakthrough vaccines, treatments, and cures.  HR 3 would take $1.5 trillion out of this industry over the next decade.  As I mentioned earlier, CBO says this would result in dozens of fewer new medicines being produced. At a time in which we’ve seen the rapid production of COVID-19 vaccines and we need more, not less, research and development to fight cancer, Alzheimer’s, diabetes, future infectious viruses and other diseases, undermining innovation would be a terrible direction to go.

There are ways Congress can pursue greater affordability that don’t involve these terrible consequences.  Keep an eye on this battle that will be unfolding over the upcoming months and make sure your Senators and Representatives hear your opinions on the matter.



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Town Hall – Survey Results

Seniors Speak Out conducted a poll to give America’s seniors a chance to speak out about the impact that the COVID pandemic has had on them and their attitudes concerning vaccinations. We had over 400 responses and reviewed those responses at a virtual town hall last Wednesday, April 14. I was joined on the town hall by Nona Bear, a trusted colleague and an experienced senior advocate who has worked on issues concerning older Americans for over 40 years. You can click here to view the recorded town hall.

Since Nona and I have been vaccinated and have waited the appropriate time after our second shot we, in compliance with CDC guidelines allowing us to “Visit with other fully vaccinated people indoors without wearing masks or physical distancing,” did the town hall sitting next to each other without wearing masks. It was exhilarating to communicate directly back and forth with Nona during the town hall. People commented afterwards how different it was to have two people in the same screen box actually speaking back and forth without unmuting (or forgetting to unmute) themselves. It seemed like a first step on the road back to normalcy.

We do these polls periodically to check the pulse, and understand the attitudes, of older Americans on relevant issues. We’ve all been inundated with information from a multitude of sources concerning COVID-19. This poll gave seniors a chance to reveal how they digested all this information and how they personally feel about the pandemic and the vaccines that will give us a chance to return to normal. Seniors Speak Out focuses on older Americans — and those who completed the survey reflected that focus, 90% were over 65 and 30% were over 75.

We went through the questions as they were presented to the poll takers, discussing the results, and adding any insight we might have.

Question – Have you tested positive for COVID-19 or has a healthcare professional told you that you had COVID-19?

  • Yes à 7.2% (29 respondents)
  • No à 92.8% (376 respondents)

Discussion – Only 7.2% of our poll takers caught the virus compared with just under 10% for America as a whole. I pointed out that 80% of the deaths from COVID occurred to those over 65. Seniors bore the brunt of this virus. I recounted that an assisted living facility near me, which had been absolutely off limits to visitors since the pandemic began, now has a big banner that proclaimed, “we are all vaccinated, come visit.” That is literally a sign of progress.

Question – Have you received the COVID-19 vaccine or are you scheduled or on a waiting list to receive the vaccine?

  • Yes, I’ve received or waiting to get vaccinated à 81.7% (308 respondents)
  • No, I have not received the vaccine, nor do I plan on getting vaccinated à 18.3% (69 respondents)

Discussion – Both Nona and I recalled what a sense of relief and empowerment we felt when we got our vaccinations. Our poll went on to ask those who had replied no to this question some follow-up questions.

Follow-up question – Why haven’t you received the vaccine or signed up to receive one?

  • Getting an appointment was too hard à 5.8% (4 respondents)
  • Getting to the vaccination site was too hard à 5.8% (4 respondents)
  • I’m waiting to see if there are side effects or other health issues with the vaccine à 34.8% (24 respondents)
  • I am not planning on getting the vaccine à 53.6% (37 respondents)

Discussion – We pointed out that getting appointments should improve each day and with pharmacies beginning to give vaccinations it should be easier to get to the inoculation site. The people in the third category were the “wait and see” people. That category of vaccine hesitancy has been steadily shrinking. In last week’s blog I encouraged people in this group to talk with someone they trust to get their advice. Nona talked about some of her friends who had been hesitant. A total of 9% of our poll respondents fell into the fourth category, they were not going to get vaccinated. Nationally, 14% of us are in this category. This percentage hasn’t changed over the last months. We felt like these people, for whatever reason, were not going to change their mind. It will be up to the rest of us to get our country to herd immunity.

The poll then stopped the follow-up questions and asked everyone the following questions.

Question – Do you think a vaccinated person needs to still wear the mask?

  • Yes à 75.3% (305 respondents)
  • No à 24.7% (100 respondents)

Discussion – The 75% who responded ”yes” were echoing the CDC guidelines for being with non-vaccinated people, in big groups, in public places and indoors. I pointed out that maybe the other 25% were thinking about the situation like this one, meeting with vaccinated people or were just willing to take the risk. Nona and I then discussed how each of us have our own level of risk that we are willing to tolerate. This level of risk is a very personal thing and should be based on the science but remains a product of our own experience and our personality.

Question – Do you think a vaccinated person’s chance of getting hospitalized or dying of COVID-19 is?

  • 0% à 14.8% (60 respondents)
  • 5% à 43% (174 respondents)
  • 10% à 26.9% (109 respondents)
  • Higher à 15.3% (62 respondents)

Discussion – When it was revealed that the first two vaccines that gained emergency authorization were 95% effective, it seemed natural that 5% would be the logical answer to this question. Actually, in the trials, of the people who tested positive after being vaccinated, none were hospitalized or died. We have experienced some hospitalizations and even a few deaths in the over 75 million vaccinations that have been given but the odds of getting seriously ill after getting vaccinated remain very, very low.

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

  • It has been more difficult to get my medicine à 8.5% (39 respondents)
  • It has been harder or I’ve been hesitant to see a doctor or other healthcare professional à 41.6% (190 respondents)
  • I’ve had trouble receiving home healthcare à 2.4% (11 respondents)
  • I’ve had trouble receiving home services (cleaning, food delivery, etc.) à 9.2% (42 respondents)
  • Other à 38.3% (175 respondents):

Discussion – Nona talked about the importance of returning to see our doctor if we have delayed or cancelled appointments. We discussed later in the town hall how important it is to follow-up on our other vaccines, shingles, pneumonia, flu, etc. We hope that there wouldn’t be an increase in some illnesses, like colon cancers due to people delaying their colonoscopies due to the pandemic. We were encouraged by the increase in the use of telemedicine. 

Question – In their responses to COVID-19, do you think the healthcare sector (hospitals, drug and device manufacturers, insurers, Medicare, Medicaid, VA) has:

  • Performed better than expected à 40% (162 respondents)
  • Performed as expected à 42.5% (172 respondents)
  • Performed worse than expected à 17.5% (71 respondents)

Discussion – 82% said the healthcare sector performed as expected or better than expected. That’s a rousing vote of confidence. We felt like it was a recognition of the heroes that have helped us through this pandemic and quickly developed a vaccine to combat it.

Question – In their responses to COVID-19, do you think the Biden Administration and new Congress has:

  • Performed better than expected à 43.5% (176 respondents)
  • Performed as expected à 20.2% (82 respondents)
  • Performed worse than expected à 36.3% (147 respondent

Discussion – While the Biden administration’s numbers are better than the last poll of the Trump administration (64% to 46%), it is important to note that much of the initial successful research and response to the pandemic occurred under the Trump administration. The main point is that America senses that the momentum to conquer the pandemic has strengthened and will continue.

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

  • Becoming sick with COVID-19 à 13.1% (75 respondents)
  • The COVID-19 vaccine not working à 13.5% (77 respondents)
  • Family members becoming ill with COVID-19 à 27.1% (155 respondents)
  • Loss of retirement income à 7.2% (41 respondents)
  • Loneliness à 21% (120 respondents)
  • Access to healthcare à 8.4% (48 respondents)
  • Other à 9.6% (55 respondents)

Discussion – Nona noted that the second most popular response was loneliness and that it certainly impacted a lot of seniors. She also noted that it seemed that older people have found ways to cope with their loneliness . . . that maybe their life experiences helped them weather this storm. The number one response (27%) was fear that a family member would get COVID, in true selfless fashion they were twice as worried about their family than they were about their own health (13.5%).

Question – What top two healthcare priority issues are you concerned with this year?

  • Prescription drug costs à 27.1% (185 respondents)
  • COVID-19 treatments and research to prevent another pandemic à 25.8% (176 respondents)
  • Problems with Medicare coverage and/or costs à 25.8% (176 respondents)
  • Making healthcare more accessible à 17.6% (120 respondents)
  • Other à 3.7% (25 respondents)

Discussion – We thought it was interesting that concern over how much we were paying for prescription drugs and treatment and research were at the top of our concerns. A significant portion of our drug costs pays for research on new drugs. We discussed how critical it will be to reach a balance in these two areas. Another top concern was problems with the cost and coverage of Medicare. We can expect proposals to change Medicare to be submitted sooner rather than later. It will be important for us to understand those changes and the impact they could have on each of us. 

Question – Do you have family members helping you make healthcare decisions?

  • Yes, a spouse, other family member, or home healthcare worker helps me make healthcare decisions à 18.8% (76 respondents)
  • No, I handle my healthcare decisions on my own with my doctor’s consultation à 81.2% (329 respondents)

Discussion – We were amazed at the self-reliance of the respondents. We conjectured that maybe the emergence of Zoom and other electronic methods that let us stay in contact with our families helped us to be better on-line researchers and find our own answers to questions. There is no doubt that we have become better informed.

Question – Are you worried the new Administration will restrict your access to care?

  • Yes à 41.7% (169 respondents)
  • No à 58.3% (236 respondents)

Discussion – 42% is not a small number of people that are worried about their access to healthcare. The pandemic has magnified how important healthcare is to each one of us. I’ll keep this in mind as we discuss existing and future proposed changes to Medicare.

Question – What do you think the Biden Administration should prioritize?

  • Lowering prescription drug costs à 53.3% (247 respondents)
  • Reforming health insurance à 34.3% (159 respondents)
  • Other à 12.3% (57 respondents)

Discussion – Prescription drug costs was at the top of the list. I always point out that the true impact of prescription drug costs is the out-of-pocket money each of us pays for our prescription drugs. As I’ve discussed in my blogs, one solution that has gained some bi-partisan support in the past has been putting a yearly cap on our Medicare Part D out-of-pocket costs. We pointed out that we have had caps on these costs as part of our private insurance when we were younger and introducing this cap in Medicare could really help the sickest amongst us.

We purposedly spent very little time during the town hall discussing the pause in the Johnson and Johnson vaccinations. It happened the day before our town hall and there wasn’t very much information available. We know that it is a concern for all of us and because of that we will be re-releasing the survey in the next few weeks to ascertain if this pause has changed your attitudes. We hope it will not.

As always, we left some time for questions. The first question was:

  • How do we obtain a balance between lowering prescription drug prices and maintaining the robust research and development environment that discovers new medicines?

I replied that if I had the exact answer everyone would be seeking my opinion on a variety of topics. I commented that we need to somehow find this balance and that the drug manufacturers want to come to the table and find a solution. Nona pointed out that all the progress in oncology treatments were made possible because investors were willing to invest in the research and development. The two German scientists who worked for 5 years to pioneer the science for the vaccines that will conquer the COVID virus were financed by someone who was willing to take the risk.

  • A follow-up question was asked to expand on why it is a bad idea to import drugs from other countries.

I pointed out that some states have passed legislation to allow drugs to be imported from Canada, but nothing has happened because the Canadian government couldn’t or was unwilling to support it and that the drugs that would come through Canada would be manufactured in other countries and would be outside of the pipeline that the FDA and HHS monitors in order to guarantee the drugs are safe. For decades, the secretary of HHS has had the ability to authorize the importation of drugs. No secretary, whether it was under a Republican or Democrat administration, has allowed importation, simply because they couldn’t guarantee the safety. There are ways to solve this problem so America doesn’t bear the brunt of the cost for R&D, importing drugs is not a viable solution.

  • Nona was asked a question about how we would know when it was safe to go back to the doctor.

She said that it is vitally important that you feel comfortable going to see your doctor. She recommended that you call the doctor and ask as many questions as needed about how they will keep you safe until you feel comfortable. She encouraged everyone to use telemedicine as much as possible. I pointed out that Medicare quickly authorized payment for the use of telemedicine. We also touched on the importance of preventative care, we may have got behind on some of our vaccines and we need to get back on schedule.

  • The last question was about loneliness and how it has affected older Americans and whether there was a chance to learn from our experience of the last year?

Nona pointed out that the impact of loneliness on our health is often under recognized and that all age groups are impacted. We added that there might be some silver linings to this experience because we became much better at using technology to combat loneliness and that we experienced huge strides in expanding the use of telemedicine.

We closed by reminding everyone that there will be another virtual town hall in June and that we will be sending out the survey again in a few weeks to gauge if there has been any changes in our attitudes on vaccines and the pandemic. We will also be asking for ideas for the subject of the June town hall. I will publish the link to our follow-up survey on my weekly blog.

Best, Thair



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Who Do We Trust?

One thing the pandemic has highlighted is a general lack of trust in our government when it comes to how to stay healthy. We have been instructed by two presidents, by multiple federal agencies and by the governors of our states as they sought to influence us on how best to make our way safely through this pandemic. We heard that masks weren’t important and then they were, that we needed to wipe everything down and then that it wasn’t that critical, that it would take over two years to get a vaccine and then it took 6 months, that we needed to get 60% of Americans vaccinated to reach herd immunity and then 70% and maybe higher. I don’t know if any of this contradictory guidance was politically motivated, was done to guide public behavior or resulted from the lack of good information. What I do know is that each of us had to decide for ourselves who we trusted.

We are fast approaching the time when there will be vaccines available for all who want them – many states already have opened up their vaccines to anyone 16 or above. This means that soon the only thing keeping us from vaccinating everyone will be those who are refusing to get vaccinated. Our government has started a campaign to convince those that are hesitant to get vaccinated, to step up and get their shot. There have been advertisements, speeches, and blogs (like this one I authored), encouraging people to get vaccinated. It quickly became evident that the best was to influence people to get vaccinated was to get them to talk with people they trust . . . their doctor, their religious leader, or a close friend or relative.

While I hope that if you are hesitant to get vaccinated you talk to someone you trust for advice on getting vaccinated, I have another reason for making this point – the people that know us and our individual health status, especially our doctors, are bound to be the most accurate when they give us advice on what will keep us, each one of us, healthy. We are correct in trusting those people.

While the federal government handled the coordination of finding an effective vaccine and providing stimulus money to help our economy, it was up to the governors of each state to decide how their state would guide its citizens on mask mandates, business openings, and the distribution of the vaccines. It just is logical that the closer those who advise us or make decisions on our behalf are to us, both physically and individually knowledgeable, the better those decisions will be.

I’m afraid that our government has forgotten this powerful fact and continues to try to control our healthcare from Washington through one-size-fits-all solutions. The most powerful approach we can have for our health is to give our local health providers more choices so they can treat us as individuals. For instance, our healthcare shouldn’t be subjected to the price control strategies like importing prescription drug pricing schemes from foreign countries. When we control prices, we chill investment and stymie innovation. Scientists continue to give us tools to personalize our healthcare; what we need are more choices, not fewer. Our doctors and local healthcare providers shouldn’t have fewer choices because they are hesitant to prescribe prescription drugs that have been imported without the tracking and safety guarantees that we rely on.

One method of price fixing is for the government to insert itself into the negotiations between insurance companies and drug manufacturers. This once again is an approach that seeks to negate the free-market functions that have been working in Medicare for 15 years. If it ain’t broke, don’t fix it.

It is evident that our trust in the government has suffered during this pandemic, it seems foolish to sit back and let this same government have more control over our healthcare. As you hear about proposals to change our healthcare, ask yourselves whether their proposed change will give those we trust the most, your doctors and other local healthcare providers, more choices and tools to treat your individual health needs most effectively. We’ll work to keep you informed about proposed changes that affect your healthcare.

One more thing, at Seniors Speak Out we periodically survey seniors and find out how they feel about healthcare issues that affect them. We recently sent out a survey and got over 400 responses. We will be talking about the results of that survey at a virtual town hall webinar this Wednesday at 2:00 pm ET. You can register for the town hall here. You don’t have to turn on your camera on if you join on your computer and there is also a phone option if you prefer that. Hope to talk with you then.

Best, Thair



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National Minority Health Month

The blog this week puts the spotlight on National Minority Health Month, and it couldn’t be timelier. Before I get into the details, I want to offer a little background. It’s evident that the mere fact that there is a minority health month, and an Office of Minority Health (OMH), created in 1985, within the U.S. Department of Health and Human Services, indicates that there has been and remains a disparity in the treatment of minorities within our healthcare system. This fact is confirmed by the mission statement of OMH, “The Office of Minority Health is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities.”. The facts show that minorities have not received the same level of care within the U.S.

The reasons for this disparity in treatment are many and varied — they can be financial, level of education, housing, the lack of adequate insurance, biological differences, and discrimination. The COVID-19 pandemic has brought many of these disparities to the forefront and, hopefully, will hasten the resolution of these disparities.

The OMH has worked unceasingly to ensure that minorities receive the same care as the rest of America. They provide grants, create programs, sponsor research, and establish guidelines, all toward eliminating disparities in care.

National Minority Health Month is especially important during this critical vaccination phase of our battle with COVID-19. It has been shown that some minorities have been more reluctant to get vaccinated than the general population. The OMH offers information about how you can ensure you are #VaccineReady when the time comes.

  1. Understand how the COVID-19 vaccines work.
  2. Learn more about what to expect after getting the vaccine.
  3. Check with your doctor if you have questions or concerns about side effects.
  4. Use VaccineFinder to find out where you can get vaccinated.
  5. If you have questions about receiving the vaccine at a specific location, please contact that location. Vaccine availability is subject to change and appointments are required at most locations. Follow instructions for each provider listed on VaccineFinder Exit Disclaimer.
  6. Get the vaccine when it is your turn.

I know this is good information for those of us who have already decided to get vaccinated. For those of you, especially minorities, who are still undecided I offer a few items of advice.

  • Do your own research – Get your information from trusted sources. There are two videos that might help you understand more about the vaccine or give you links to obtain more information. Those videos are here and here.
  • Talk to someone you trust – Ask them why they got vaccinated and what their experience was, both during and after they were vaccinated.
  • Talk to your doctor or healthcare provider – They are the ones that will know what is best for you.
  • As shown below, minorities were included in the clinical trials.
  • Consider the success so far – over 51 million Americans, about 15%, have been vaccinated with minimal side effects.
  • Consider your loved ones and your community – The more people who get vaccinated the quicker your community and loved ones will reach herd immunity and will be able to return to normal.

We are making great strides toward reaching our goal of vaccinating 70% of our population. We have increased the daily vaccinations to over 3 million and it looks like every state will open vaccinations to all age groups before May 1. I am looking forward to returning to some sense of normalcy by July.

The National Minority Health Month this year is concentrating on helping America’s minorities get vaccinated. It is critical that all Americans have the opportunity to be protected from this virus and to return to normal.

Register now for our next Medicare Virtual Town Hall on April 14 at 2PM ET. And take the poll on issues of importance to you. We will be reviewing the results at the Town Hall.

Best, Thair



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American Diabetes Alert Day

I’ve talked about kidney disease in an earlier blog and discussed its close relationship with diabetes. This week I’ll concentrate more directly on diabetes and ways we can identify our risk in getting diabetes and healthy steps we can take to prevent the onset of type 2 diabetes or ways we can minimize its affect.

First, a few facts. Diabetes impacts over 30 million Americans or about 10% of our population. Surprisingly, about 7 million of us don’t even know we have it. The older we get the more likely we are to get diabetes, but our ethnic background may also increase our chances of getting the disease. Consider the following percent of people with diabetes depending on ethnic group:

  • non-Hispanic whites: 7.4 percent
  • Asian Americans: 8.0 percent
  • Hispanics: 12.1 percent
  • non-Hispanic blacks: 12.7 percent
  • American Indians and Alaska Natives: 15.1 percent

As you can see, your ethnic group has a big impact on your chances of getting diabetes.

Diabetes is a killer! Almost 80,000 Americans die of diabetes; it is the 7th leading cause of death in the U.S. and has a huge impact on the overall health of those living with diabetes.

  • Adults with diabetes are significantly more likely to die from a heart attack or stroke.
  • More than a quarter of all Americans with diabetes have diabetic retinopathy, which can cause vision loss and blindness.
  • Each year, nearly 50,000 Americans begin treatment for kidney failure due to diabetes. Diabetes accounts for 44 percent of all new cases of kidney failure.
  • Each year, diabetes causes about 73,000 lower limb amputations, which accounts for 60 percent of all lower limb amputations (not including amputations due to trauma).

This month I lost a long-time friend and fellow scouter to the ravages of diabetes. Most of us know someone who has died of diabetes or is living with it.

So, the question is, can we do anything about this deadly disease? There are two types of diabetes, type 1 and type 2. Type 1 diabetes usually occurs in children and young adults, and there are ways to live with type 1 diabetes but there is no cure. Type 2 diabetes is preventable and there are steps you can take to lesson or eliminate its effects on your health. The first step is to see if you have the disease or are at risk to contract it.

March 23rd is American Diabetes Association Alert Day. This one-day “wake-up call” informs the American public about the seriousness of diabetes and encourages all to take the diabetes risk test and learn about your family’s history of diabetes. You can take the test here. I took the test and, because of my age and especially because of a history of diabetes in my family, I have some risk of contracting diabetes.

There are steps we can take right now that will lower our risk of contracting diabetes. By

  • Eliminate sugar and refined carbs
  • Work out regularly and avoiding a sedentary lifestyle
  • Make water the primary beverage
  • Maintain a healthy weight
  • Quit smoking
  • Eat a high fiber diet
  • Optimize Vitamin D levels
  • Take natural herbs, such as curcumin and berberine, that increase insulin sensitivity

Now I know this sounds like the same advice we get from our doctor no matter what is ailing us. The important thing here is that rather than just making us feel better these steps could prevent the onset of diabetes. It is especially important to maintain a healthy weight. Obesity and diabetes have a strong correlation . . . losing weight when you’re overweight can have a huge impact on preventing or controlling diabetes.

You can even find a certified diabetes educator who can help you find practical solutions that fit your personal needs. Click here to find a Diabetes Education Program near you.

In reading about diabetes and being involved with different diabetes groups over my years in public policy, I have been struck with the lack of focus and resources we allocate to the prevention and treatment of diabetes. We have greatly reduced the deaths attributed to AIDs and we have many, many fund raisers and money spent on research for breast cancer, but diabetes kills more people in the U.S. than AIDs and breast cancer combined. It’s an area that would benefit from more government funds. The National Institutes of Health (NIH) should evaluate its allocation of resources to ensure these resources are focused where they could have the most impact on our country’s health. I’m sure this reevaluation would result in more resources devoted to the study of the prevention of and possible cures for diabetes.

I encourage all of you to take some time and evaluate your risk for diabetes and become smarter about things you can do to lower your risk. I know that’s what I’m going to do.

Best, Thair



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COVID-19 – What We Know, When is Normal Coming, What Risks Remain?

A year’s worth of pandemic has changed all of our lives in one way or another. Each day we’ve had to wade through a mountain of information, filtering it the best we could so we could decide what we should do that day to protect ourselves from the virus. There have been many advisements, directives, guides, even mandates, but in the end, each of us had to decide for ourselves what the true risks were and how much risk we were willing to take. It was so difficult to ascertain what the true risks were. I remember in the beginning that masks were deemed not too important and wiping off your Amazon delivery boxes was. It’s evident now that wearing a mask is far more important than sterilizing surfaces. Many were wary of even the CDC’s advisements, fearing they might be politically motivated. We had conflicting information on vaccine development, some thought scientists were cutting corners and vaccine hesitancy was high, some, including me, trusted the process and the FDA. It was a confusing time.

So, here we are, a year into the pandemic and things are certainly not back to normal or even the “new” normal. What do we know, when is normal coming and what risks remain?

Here’s what we know:

  • The fact remains that a vaccinated person will not go to the hospital and, more importantly, will not die from COVID-19. That has been proven in the tests and in the real world.
  • So far, the virus has killed 531,855 people in the United States. I remember when there were dire predictions of 200,000 deaths. Who would have thought we would have over double that number and still counting?
  • The numbers have dropped precipitously since the highs in the first part of January, but the drop has moderated in the last few weeks.
  • Vaccinations have accelerated, going from a goal of 1 million per day to almost 3 million a day.
  • President Biden set a goal of everyone over 16 having the chance to get vaccinated by May 1st. Many states will begin vaccinating everyone over 16 in the next few weeks. It seems the May 1st goal will be easily met.

When is normal coming?

  • Some have predicted that this July 4th holiday will be much more “normal” than the last July 4th.
  • Some states have begun talking about loosening mask wearing mandates.
  • My prediction is that by June 1st we’ll feel safe to meet and greet without masks (remember, I’m not an expert, I didn’t even spend a night in a Holiday Inn, it’s just my personal prediction.)

There’s the facts and some predictions. The big question now is,

What risks remain?

There are two reasons that would delay our return to normal – people choosing not to get vaccinated and one of the variants being resistant to one or more of the vaccines.

The biggest threat is people choosing not to get vaccinated. This problem slows down our progress toward herd immunity (the state where enough people have developed immunity through either contracting the virus or having been vaccinated so that the virus doesn’t have enough new people to infect to spread.) The quicker we reach this state the less time the virus has to mutate and develop a resistant variant. It is critical that people understand that refusing to get vaccinated not only threatens their well-being, but also threatens the well being of all of us (the herd). There are studies and polls that indicate that politics has played some part in this vaccine resistance. Getting vaccinated should not be a political decision; it should be like obeying traffic laws – something we do so we all can be safe. Scientists are already working toward ways to combat virus variants, but it won’t do any good if people choose not to not vaccinated.

I am a big fan of choice, but the consequences of that choice should be borne by the chooser. Choosing not to get vaccinated affects the health of all of us. People are still dying everyday; they should not continue to die as a consequence of our choice. We all need to study the facts and make the choice to speed up America’s march toward normalcy by getting vaccinated.

Some final notes. Seniors Speak Out is conducting a poll. We want to know how the pandemic has affected you and how you feel our government and healthcare providers have performed. We’d love for you to take the poll. Click here to give us your valuable opinions. Also, we will be holding a virtual Town Hall on April 14th from 2:00 pm to 3:00 pm ET to discuss the results of the poll. You can register for that town hall here.

Spring always promises a rebirth, I hope this spring includes a chance to once again be physically close to those we love.

Best, Thair



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SPECIAL ALERT: Adopting Foreign Price Controls is a Destructive Way to Address Drug Affordability

Some bad ideas, no matter how harmful they are, just keep coming back around. We’re seeing that now with an ongoing effort on Capitol Hill to tie drug prices in the United States to those of foreign countries that rely on heavy-handed government price controls.

Just months after the Trump Administration tried to advance regulations that would have linked Medicare Part B (drugs that are administered by a physician) prices to those of other nations – that effort is currently placed on hold by the Biden Administration and now Senator Bernie Sanders (I-VT) is pushing an even more damaging version of this approach through legislation.

Senator Sanders – and Representative Ro Khanna (D-CA) in the House – is recruiting cosponsors for his “Prescription Drug Relief Act.” Under the Sanders bill, market-based negotiations would be thrown out the window and the government would mandate that prescription drugs in the U.S. could not cost more than the median price of those drugs in five countries – Canada, the United Kingdom, France, Germany, and Japan. If the U.S. price exceeds that ceiling, the government could swoop in and wipe out the manufacturer’s patent exclusivity.

Senator Sanders and Representative Khanna are selling this as a pro-patient idea. Actually, it’s anything but. Trying to make our healthcare system imitate those of Europe and Asia is an extreme apples-to-oranges comparison. There is a reason that the lion’s share of biopharmaceutical innovation – and, with it, pharmaceutical access – takes place in the United States. Over the last 10 years, 90 percent of all new medicines developed are available to patients in the U.S. In France, that number is only 50 percent. In Canada, even less than that. Our current system enables us to benefit from the development of new and more effective pharmaceuticals.

If the Sanders bill became law, it would have a devastating effect on the innovation taking place to develop new treatments and cures for diabetes, heart disease, Alzheimer’s, cancer, and many other health conditions. Investors will not devote dollars to the development of therapies that will be subject, directly or indirectly, to harsh government price controls.

It’s right to pursue greater affordability but not at a tradeoff that includes a diminished ability to fight disease. Government can take steps to address patient out-of-pocket costs and can also use trade negotiations to push other countries to pay more of their fair share toward drug development, but we shouldn’t sacrifice our current level of medical innovation. It’s important that we encourage our Senators and Representatives to NOT cosponsor the Sanders or Khanna bills.

Best, Thair



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Springtime Medicare Refresher

The pandemic has demanded our undivided attention for a year, and rightfully so, but it doesn’t mean that other important things should be ignored. It’s time to review one of our most important benefits . . . Medicare.

Medicare is a government program that affects a large number of Americans, including those who care for those of us who are over 65, those that are approaching 65, younger people who are planning their retirement and those who are disabled. Spring is probably a good time for a Medicare refresher. It seems that some of us get caught up in the minutia of Medigap plans or Medicare Advantage before we really understand the basics of Medicare. While I’ll try to keep it simple, and some of you will know a lot of the Medicare basics that I cover, you may be surprised when you find that there are things you didn’t know or had forgotten about Medicare.

Anyone who is 65 in America, even permanent residents who have lived here at least 5 years, qualify for Medicare. People who have qualified for 24 months of disability under Social Security are also eligible. When you turn 65 you qualify for Medicare, even if you haven’t started taking Social Security benefits. Original Medicare was signed into law in 1965 and consists of Part A and Part B and are provided by the federal government. You will enroll in these two parts (and only these two parts) through the Social Security office. The third part is a benefit that was added later, in 2006, which is Part D, your prescription drug benefit. You must sign up for this benefit when you turn 65 unless you have private health insurance, like insurance through your employer.

Medicare Part A is your inpatient hospital coverage. It supplies a room and meals along with medications, lab services and medical supplies required while you are hospitalized. Part A also covers medically necessary short term home healthcare and skilled nursing. And It covers hospice services and some relief care for caregivers. Medicare does NOT cover long-term care or long term stays in a nursing home. There are some things, like outpatient surgeries, that don’t fall under Part A. It is always good to get guidance as you determine what is inpatient and outpatient services.

If you are already receiving Social Security benefits when you turn 65, you will automatically receive your Medicare card. If you have postponed your Social Security benefits then you must sign up for Part A; you can do this on the Social Security website. If you have worked for at least 40 quarters (10 years) then Part A has no cost to you.

Part B is the outpatient benefit and usually involves services provided by your doctor. This benefit covers things like doctor office visits, ambulance rides, MRIs, cancer treatments (like chemotherapy), and dialysis. While some of these procedures may be performed in a hospital setting, they will fall under Part B because doctors perform the service. This benefit does come with a cost to you; the base rate in 2021 was $148.50. You may have to pay more depending on your income. Again, if you are already getting Social Security, you will automatically be enrolled in Part B. If not, you can sign up on the Social Security website, over the phone or in person. It is important that you sign up for Part B when you turn 65 unless you have other credible coverage since you could pay a lifelong monthly penalty if you fail to sign up. Part B does NOT cover routine dental, vision, hearing or foot care.

Part D is your prescription drug benefit. It covers many prescription drug costs and is purchased from private insurance companies. There are often 20 different insurance plans in each state to choose from. You are not automatically signed up for Part D and must sign up yourself. By going to the Part D plan finder (here) you can select a prescription drug insurance plan based on whether they cover the drugs you use, the premium cost and the estimated out-of-pocket costs. You could face a monthly penalty if you do NOT sign up for Part D when you are 65 or when you no longer have approved private prescription drug coverage.

There is a fourth part of Medicare, Part C. This part is the identifier for Medicare Advantage which is a program that allows those who qualify for Medicare to purchase Parts A, B and sometimes D through private insurers. This option is often less expensive than traditional Medicare and offers a predictable healthcare expense but can have higher out-of-pocket costs. This option often covers wellness benefits, vision and other services not provided through original Medicare. When you become eligible for Medicare, you can choose whether you would like original Medicare or Medicare Advantage.

Many people choose Medicare Supplemental (Medigap) insurance to cover some or all of the out-of-pocket costs of original Medicare.

Medicaid is sometimes confused as a part of Medicare. Medicaid is healthcare administered by the states primarily for low-income beneficiaries. Medicare is a federal program for everyone who qualifies by age or disability. Some people are eligible for both programs.

As with any health insurance, Medicare can be complicated depending on your unique circumstances. Medicare’s website, Medicare.Gov, offers more details and can help you as you make decisions about your Medicare. A basic overview can be found here.

Now for my soapbox. Medicare has worked well for a long time, the newest part of Medicare, Part D, has beat all of the initial premium estimates and remains one of the most popular parts of Medicare. Hospital costs went down substantially after Part D was implemented. It is up to us, the users of Medicare, to remain vigilant as Washington proposes changes to Medicare. The addition of choices and competition and the infusion of increased transparency can lower costs. The transition from fee for service healthcare to value-based care is another way to more closely match cost with benefit. There are ways that Medicare can be improved without limiting access. Many of the changes proposed by our government sacrifice access for cost savings.

There are proposals that could (will) have a negative impact on Medicare. For instance:

  • Government controlled single payer healthcare – a proposed change that would eliminate private insurance and any free market competition. While this healthcare option historically was not considered to be feasible, it lately has become an often discussed approach and was considered as a real option in the last presidential debates. It would have a huge impact on our freedom to choose.
  • The public option – This proposal purports to offer a choice of a government run public health insurance option as an insurance choice. This approach would only cause a downward spiral in access and quality which would end up in the government “rescuing” our healthcare system by instigating the single payer option.
  • Raise the Medicare enrollment age – This proposal has some validity but requires more studies to ascertain its impact on retirement planning.
  • Proposals to control prices – Using foreign prices, limiting price increases based on inflation, and setting new drug entry prices are all blunt instrument solutions that have proven to be ineffective and limit innovation.
  • Executive orders and regulations – The increased use of executive orders and intrusive regulations are simply ways to avoid the checks and balances of government and to govern by fiat. Not the way our democracy should function. 

My point is there has never been a time when our basic Medicare benefits have come under such a sustained attack. It’s up to us to remain vigilant, to speak out, and to combine our voices in the preservation of this basic benefit. In reviewing the parts of Medicare, we begin to understand how important these benefits are to our lives. It’s up to us to make sure they are preserved.

Best, Thair



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National Kidney Month – Find Out if You’re at Risk

As you might have noticed, almost every month I tell you about a special month/week/day that has been chosen by a health support organization in the hopes they can get people to think about their health issue. Over the last year we’ve talked about National Heart Month, Glaucoma, National Diabetes Month, Bone and Joint Action Week, Healthy Aging Month, National immunization Awareness Month, Alzheimer’s and Brain Awareness Month, and National Family Health and Fitness Day. I do this because these reminders can help us learn how we can avoid getting sick or how we can discover the health problem early and outline how we can treat the problem effectively. I’m a big believer in self reliance and accountability and it is important that we take charge of ourselves by knowing what our personal health risks are and making informed decisions on how to keep ourselves healthy. While there continues to be huge advances in healthcare treatments and cures, the biggest impact on our own wellbeing is how each of us understands and treats our body. I hope you have found, and continue to find, these periodic health blogs helpful.

As the title says, this month is National Kidney Month. The National Kidney Foundation has chosen to focus on the connection of type 2 diabetes and kidney disease. Diabetes is a leading risk factor for developing kidney problems. By controlling the glucose (sugar) level you can help prevent kidney disease. Their campaign is titled, “Are you in the 33%” that is at risk for kidney disease. They have a tool, a one-minute quiz, that enables you to determine if you are in a risk group for developing kidney disease. You can click here to take the quiz.

Kidney disease is especially hard on minorities. African Americans are almost 4 times more likely to get kidney disease than white Americans. Hispanics or Latinos are 1.3 more likely to get kidney disease as non-Hispanics or Latinos. It is especially important for these ethnic groups to take steps to identify and treat diabetes that often leads to developing kidney disease.

It is estimated that 37 million Americans have kidney disease and an astounding 90% don’t know it! You are especially at risk for getting kidney disease if you have diabetes, high blood pressure, heart disease, obesity, or have a family history of diabetes.

There are resources for treating and caring for those with kidney disease, everything from dialysis to transplant. You can access helpful information here.

I’m amazed that 90% of those estimated to have kidney disease don’t know it. As with almost any disease, early detection is especially important. I urge everyone to take the one-minute quiz to determine your risk of developing kidney disease. I took it and the only risk factor I have is a family history of diabetes. I’m going to watch my diet and talk to my doctor at my next physical about diabetes and kidney disease. Hopefully, this month will help us focus on kidney health, and we’ll all live longer and healthier as a result.

Best, Thair



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H.R.3 – Legislation That Will Suppress Innovation

While COVID-19 has engulfed our lives and demanded our almost undivided attention, we can’t ignore pending legislation that is lingering in the wings just waiting for its chance to jump back into the spotlight. I’m referring to H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act, named in honor of the late Maryland congressman who fought for price controls on prescription drug prices.

The legislation was introduced in September of 2019 and passed the House along party lines (Democrats for and Republicans against) in December of 2019. The Senate, to this point, has never brought the bill up for consideration. President Trump issued some Executive Orders toward the end of his term that resembled parts of H.R.3, but they have been suspended or faced court injunctions. My fear is that the new administration, with the Senate and House majorities of the same political party, will open the path for H.R.3 to become law.

This legislation sought to implement regulations that would control drug prices and modify some of the benefits of Medicare. It consisted of three main sections.

  • Drug Price Negotiation – A free market term that in reality was nothing more than price fixing, a control mechanism that is anything but a free market process. The government would apply their pricing regulations on a minimum of 25 drugs and a maximum of 50 single-source drugs with high spending, including all insulins and any newly introduced high priced drugs. The prices would be set somewhere between the minimum and maximum prices of 6 comparator foreign nations. I’ve talked a lot about the International Price Index (IPI) and Most Favored Nation (MFN) pricing approach which is what this pricing method emulates (you can read more about IPI here and MFN here.) If a company does not accept the set price, they would face huge fines equaling up to 95% of their gross sales. Fixing prices is a sure-fire way to limit innovation.
  • Inflation-Based Rebates – Requires manufacturers to pay a rebate to the federal government if a drug’s price increases faster than the rate of inflation. This is just another way to fix prices with no consideration to the cost of development or the value that the drug brings to the patient or the long-term health care costs.
  • Medicare Part D Benefit Restructuring – Restructures the Part D benefit by establishing a yearly spending cap on a patient’s out-of-pocket costs. This is a positive, sensible approach – one I have proposed for almost 10 years.

It is estimated that using this legislation to fix prices will extract over a trillion dollars from drug manufacturers in the first five years, a move that will severely reduce the drug innovation that has saved millions of American lives. Consider this, countries with price controls also suffer a decline in pharmaceutical research and development.

In 1986, European firms led the U.S. in spending on pharmaceutical research and development by 24%. After the imposition of price control regimes, they fell behind. By 2015, they lagged the U.S. by 40%. It just seems wrong for us to trade some short-term savings for the lifesaving drug innovations that will benefit our kids and grandkids.

There is something else that strikes me as a strange dichotomy. A little less than a year ago we began to understand how dangerous this pandemic could be. Estimates at that time for developing a vaccine for COVID-19 ranged from a low of one and half years to four years. Nine months later we had two vaccines approved and being distributed. Manufacturing numbers continue to be increased, goals of one million shots per day have been exceeded, new estimates indicate that improvements in manufacturing could support 3 million shots per day. These great accomplishments were possible because America’s regulatory environment had enabled the creation of the most efficient innovation industry in the world. Over half a million Americans have died due to COVID-19. What would have happened if a strapped and weakened pharmaceutical industry would have needed the low-end estimate of a year and a half to develop the vaccines? With the new variants invading our shores, how many more people would have died if our vaccines would have taken twice as long to be developed? With the imminent passage of another 1.9 trillion-dollar rescue and stimulant package, our government will have spent 5.3 trillion dollars this year on COVID-19. Adding this to the lost wages and company income and the financial impact is staggering. Is the loss of the innovation that brought us a vaccine in nine months really worth the 200 billion this legislation would extract each year from the pharmaceutical industry?

The bad parts of H.R.3 are really bad. They will hobble an innovation environment that is on the verge of many breakthroughs in many diseases. I will keep my eye on H.R.3 and will keep you informed on its status and the status of any moves the Administration makes toward implementing any part of H.R.3 through Presidential edict or under the guise of a nationwide “test.” This will certainly be a situation where we will need to “Speak Out” loud and clear.

Stay safe and healthy, Thair



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Virtual Townhall on Vaccinations – Recap

Last Wednesday, Seniors Speak Out and Medicare Today held a virtual town hall focusing on the importance of being vaccinated against COVID-19. For this townhall I was joined by Janet McUlsky from the COVID-19 Vaccine Education and Equity Project. The entire virtual townhall can be viewed here.

I started off by giving an update on my own experience with getting vaccinated. I stated that I had received my second Pfizer-BioNTech COVID-19 vaccine six days earlier and, like my first vaccination, the only side effect that myself and my wife had was a slightly sore arm at the injection site for a day. I mentioned how I felt relieved and hopeful after both of my shots. I finally felt like I was finally doing something, taking some action rather than being at the mercy of the virus. I did describe the convoluted scheduling process. There is no nationwide app that would offer one place to schedule your shots. This means it will take time and effort in most cases to schedule.

I then introduced Janet McUlsky, from the COVID-19 Vaccine Education and Equity Project. I mentioned I have known of Janet for over 20 years and worked closely with her for the last 12 years. She has spent most of her career working with advocacy organizations to ensure their constituents have access to prescription drugs.

Janet began her presentation with slides about the COVID-19 Vaccine Education and Equity Project. She discussed how they started in late August and now have over 150 partners who have joined the Project. She then discussed the core objectives of the vaccine project which are to:

  • Provide education.
  • Raise awareness.
  • Promote the impact.
  • Lead a conversation.

Janet then talked about the many resources available on the project’s website, https://covidvaccineproject.org. They offered a series of one pagers discussing different aspects of the virus, most also in Spanish, and infographics that offer information in concise and easy to understand formats. The information discussed things like how to talk to your families about the vaccine and the process the vaccine went through to get approved. I encourage you to go take a look at this great website.

Janet then reviewed a webinar that was completed earlier that day with the CNBC D.C. affiliate. This webinar brought together renowned experts to discuss building vaccine confidence in diverse communities. You can see this special webinar here.

Janet ended her presentation by discussing the Count Me In project which will be the statements and photos of individuals and organizations stating why they want to get vaccinated. I have already sent my statement and photo to the Project. This project will be released later this month and she encouraged everyone to participate when that project is kicked off.

The town hall was then opened up for questions and I took participant privilege and jumped in for the first question. I referenced Janet’s statement that no one that received the Pfizer vaccine in the clinical trials died from the virus. She verified that it was true I stressed the need for that to be emphasized in the news. I stated that there should be two-inch headlines or breaking news headline runners on my internet news feed declaring, “Get vaccinated and you won’t die from COVID!”

The next question dealt with whether we have to pay for getting vaccinated. Janet stated that no one will pay out-of-pocket for the vaccine. Your insurance company or the government will pay the full price.

The next question asked if there was a difference between the two vaccines and should we be concerned with which one we receive? Janet commented that the health professionals she’s talked with have all said, take which ever one you can get the quickest. They are both based on the same mRNA science.

I then asked if there was a supply problem that might keep people from getting their second shot? Janet said that she had not heard of problems with people getting their second shot. Many states are scheduling the second shot at the time people get their first shot. She mentioned that other pharma manufacturers who have not developed a vaccine are stepping up to help manufacture both vaccines.

Someone had a question about her father. She stated that her father was allergic to penicillin and his doctor recommended that he not get vaccinated. She asked if there was a place to get a second opinion. Janet said that she would call the manufacturers’ 800 help lines. There would be doctors standing by who could give her more detailed information. Janet said that the CDC was another place to go to get answers to her questions.

Another listener asked if this vaccination would become a yearly requirement and, if so, will the access migrate to the primary care provider? Janet said that it was possible but that the mRNA technology is easier to modify and we might have a booster that covers any variants that come along.

I asked Janet if it was OK to get together with other vaccinated people in a closed environment without wearing our masks? She said that Doctor Fauci, the guy we all seem to listen to, said that if everyone had been vaccinated it was OK to meet together inside without masks.

Debbie Witchey from the Healthcare Leadership Council stated that it seemed that people were having problems getting appointments. She asked Janet if she had any tips for people trying to get appointments. Janet said her solution was to sign up everywhere. The state handles the appointments but there could be multiple sites giving the vaccinations. It was certainly the situation in my case. Janet thought that there would be more opportunities as the logistics get ironed out.

I then asked Janet about how we are going to get the vaccine to minority communities. She mentioned that the people in the Project have been thinking about this. They wanted to go into the churches in minority communities and in the rural areas that also have been adversely affected. The Project will be going to the historically African-American sororities and fraternities to encourage their involvement. She said that it would be a challenge, but she knew that our country would be up to it. Everyone should have the opportunity to get this life saving vaccine.

I hope that you get the opportunity to review the town hall and the webinar mentioned above. We will continue to bring you informative blogs and townhalls.

Best, Thair



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Medicare – What Can We Expect Under the Biden Administration

While it’s a new year with a renewed hope for a return to normalcy, we also have a new President with new power, given that the Democrats hold the majority in both the House and the Senate. The big question is, what impact will this administration and control of both Houses of Congress have on Medicare?

As you might remember, one of the big discussion issues among the Democratic Presidential hopefuls had to do with healthcare. Some of the more progressive candidates pushed for a single payer, government-controlled healthcare system. The more moderate candidates, President Biden being one of them, campaigned for an expansion of Affordable Care Act (sometimes called Obamacare) and some cuts to some parts of Medicare and an expansion of benefits to others.

One of the changes to Medicare that President Biden has talked about is adding a public health insurance option to the healthcare choices for those under 65. It would be administered by the traditional Medicare program. It is opposed by hospitals and many doctors because it would likely fix many of the prices of healthcare at or below the already low Medicare prices. This would especially impact rural hospitals since many are already teetering on insolvency. With the small majorities in both houses this approach will be one of the harder ones to get passed.

The President has also proposed that the Medicare age be lowered to 60. This is just another way to open the way for more people to rely on the government for their healthcare; some say it is merely a steppingstone to a single payer system. It just doesn’t seem logical to lower the Medicare age, putting more pressure on an already financially strapped program, when people are staying healthier longer. This will also be difficult to get done.

Drug prices is another area that President Biden has promised change. This is one area where he and former President Trump were most alike. He also wants to use methods like using foreign prices to set our drug prices and allowing the unregulated importation of drugs. I’ve discussed in further detail these and other approaches in earlier blogs, here and here. There is one place where President Biden differs from the former President on drug pricing. President Biden wants to allow the government to negotiate the drug prices in Medicare Part D. Now this sounds like something that every free-market advocate would embrace, but what it really means is the government would merely be setting the prices and would not save much money according to the government’s own non-partisan accounting office, the Congressional Budget Office.

One area that might get some renewed attention is a change that could help older Americans immensely. That change would put a cap on a Medicare beneficiaries yearly out-of-pocket prescription drug costs. This change would help those who are the sickest amongst us and who are often in no position to afford huge drug costs. I hope that a new bipartisan effort to consider this needed change will be one of the positive things that this administration champions. 

It will be interesting to see if President Biden uses the Executive Order route favored by President Obama and President Trump or the legislative route to enact his administration’s policies. I have said many times that our Representatives on Capitol Hill need to be involved in issues that have such a profound effect on our lives. Whatever happens, we will help you stay informed on any proposed changes to your healthcare and continue to be a conduit for your voices to those on Capitol Hill.

A reminder, tomorrow we will hold another virtual town hall. We will be focusing on our country’s COVID-19 vaccination effort. The information below will discuss the town hall in more detail and how you can register for the event.

Best, Thair

Medicare Today Town Hall
Wednesday, February 17
2:00 p.m. ET

Guest Speakers
Thair Phillips
former President and CEO of RetireSafe
And
Janet McUlsky

COVID-19 Vaccine Education and Equity Project
They will discuss:

  • The latest information on COVID-19 vaccines
  • The impact of vaccination uptake
  • Efforts to ensure equitable access to authorized
    and approved vaccines

Register Here

After registering, you will receive a confirmation
email containing information on joining the Town Hall.



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National Heart Month – A Chance to Take Control of Our Health

Some of you may remember the infamous photograph in 1964 of President Johnson lifting his pet beagle, Him, by his ear. It caused an outpouring of concern from dog lovers everywhere and caused the President much embarrassment. I was only 16 years old at the time but still remember the debacle. It’s unfortunate that I remember that fact about President Johnson but had no idea that also in 1964 he started a great tradition that has had much more impact on people’s lives than the unfortunate dog incident. He issued the first proclamation that February would be National Heart Month and every President since then has continued that tradition. It has helped America focus on important steps we can take to keep our hearts healthy.

This month may be the most important National Heart Month since 1964. The COVID-19 pandemic has been a huge negative impact on America’s heart health. For instance, many people, especially the more vulnerable older population, have:

  • Postponed or cancelled important doctor appointments.
  • Developed or reverted back to unhealthy eating.
  • Stopped or reduced exercise routines.
  • Become more anxious about the threat this virus has become to our health and our very lives, a threat that we have had little control over.

This month, National Heart Month, is a great time to come out of the darkness of the last 11 months and see the light of hope and renewed effort to keep our hearts healthy. While we still have a long way to go to rid ourselves of this terrible virus, we need to remember that we have highly effective vaccines that have already been administered to many healthcare workers and older Americans (I get my second shot in two days). This vaccine will free us to not be afraid to go to the doctor, get off the couch and get outside and get back together with our vaccinated friends. We can even start planning a trip for later this year. We still need to listen to what are scientists are saying, there could be setbacks, but I’m convinced we have every reason to be hopeful that we’re on the way back.

Our heart is our bodies’ most important organ and National Heart Month gives us an opportunity to focus on the things that can help us stay heart healthy. According to the American Heart Association (AHA) heart disease is still the greatest health threat to Americans and is the leading cause of death worldwide. The sad thing is there are many things we can do to avoid this deadly disease. According to the AHA, in most cases, heart disease is preventable when people adopt a healthy lifestyle, which includes not smoking, maintaining a healthy weight, controlling blood sugar and cholesterol, treating high blood pressure, getting at least 150 minutes of moderate-intensity physical activity a week and getting regular checkups. This year the pandemic has prompted the AHA to create “Don’t Die of Doubt,” a national awareness campaign that reminds people that hospitals are the safest place to go when you have symptoms. High blood pressure is the enemy of our heart health. The Centers for Disease Control and Prevention (CDC) has some great tools that help us identify and control our blood pressure. There are many places that we can get the information we need to get and stay healthy.

It’s time for us to get back control of our lives and our health. Unfortunately, I think this pandemic has caused us to sometimes think we have lost control of our lives, that we are slaves to the restrictive rules and regulations that are needed to keep us safe. We need to decide that we are the masters of ourselves and we can decide to be healthy, pandemic or no pandemic. We now have the hope of highly effective vaccines. Let’s use National Heart Month as the launching point to better health.

Best, Thair



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Why I Got Vaccinated

People all across the United States, and the world, are getting vaccinated, not as fast as we had hoped, but the momentum is building. In America, each state is given a quota of vaccine doses depending on the number and makeup of their population, but it is up to each state to determine how and to whom the vaccine is given. Some of the problems with getting people vaccinated has been that the states’ overworked and understaffed public healthcare workers were given this added responsibility. It has also been reported that some people are still reluctant to get vaccinated. I thought it might be helpful to explain why I made the decision to get vaccinated and the somewhat convoluted path I took to get my first vaccination.

I have written here before about all the logical and scientific reasons everyone should get vaccinated. You can click here to read that blog. There are other reasons that made me even more motivated to get vaccinated. I’ve been very careful for almost a year, I’ve worn a mask, stayed away from my kids and grandkids, and stayed home. I was getting sick and tired of all of it. I’m sure there are a lot of you that feel the same way. Getting vaccinated has been a glimmer of hope that has kept me from saying to heck with all of it and letting down my guard. When I finally got scheduled for my first shot (more about that later) my mind set was . . . keep staying safe, you don’t want to blow it now. I think looking forward to getting vaccinated may help us to continue to do the things that keep us safe.

The other thing that has motivated me was my take on how getting vaccinated was going to change my life. Now, this is my opinion, I’m not a scientist, I’m just a guy who believes in science, and I think the government and the media have been overly cautious and undersold the fact that getting vaccinated will, both in the short and the long term, change our lives.

After getting the second shot and waiting the appropriate amount of time so I get the full protection of the vaccine, I’m going to go to a restaurant and sit down and enjoy a meal with my wife and another couple who have also been vaccinated. I’ll enjoy a meal that isn’t cold from delivery or eaten while battling with the steering wheel of my car (a car that has witnessed so many meals in the last months that I could survive for a week on just the food that has dropped down between the seats.) We’ll then go back to our house and sit down and enjoy each other’s company without masks and social distancing, we might even play cards. I’ll go to a movie, go see a play, go to a concert, travel, and stay in a hotel. When I’m doing these things, I will wear a mask, as instructed by health officials, when I could come in contact with people who may not have been vaccinated. I think there is a small chance that someone who has been vaccinated can pass the virus. I do hope that the scientists are looking at the data and doing whatever they need to do to ascertain if a vaccinated person can infect someone. The sooner we know the answer, the better off we’ll be.

We need to somehow get better at getting people vaccinated. I know we wanted to get the most vulnerable people vaccinated first, but we should also be getting as many needles in arms as possible. The war will be ultimately won when the virus can’t infect anymore people . . . herd immunity. My sense is that there has been very little overall organization in getting people vaccinated. Take my experience for instance. I happened to be in southern Utah away from my home in northern Utah when our Governor said that people 70 and older would now be eligible to be vaccinated. I quickly signed onto the southwest Utah health department site only to find that all the appointments for weeks ahead were already taken and I had to try again next week. The next day, my friend texted me that a friend of hers had seen on a Facebook page that the local hospital had obtained a few thousand doses and there was a link to get scheduled. I clicked the link and there was a sign-up calendar on a well-known scheduling software with some available times. I was able to get appointments for my wife and me for the next day. My point here is that a friend of a friend had found a link and I got scheduled. My older friends in northern Utah will get their first shot two or three weeks after me. This example was certainly not the most equitable or efficient way to vaccinate the older people in Utah. Somehow, we need to get better at this, put emphasis on getting the most people vaccinated as quickly as possible. Establish a single place for vaccination information and make it accessible by computer and by phone and broadcast it to everyone.

An article came out today from the New York Times that focuses on the good news about vaccines. This is exactly the kind of article that puts things in the correct perspective.

I do want to tell you that I walked away after getting my shot with a real deep feeling of relief, a feeling of hope that I was finally on the road to normalcy and the only side affect was a slightly sore arm for a day. Our government and the media need to tell some of those stories, they need to tell us that getting vaccinated can give us relief and hope. We need to tell our friends to trust the science and recognize how getting vaccinated will change our lives. I’m due for my second vaccination on February 10th and I’m making a reservation at a nice restaurant on the 24th. For me that will be a huge change in my life.

Get vaccinated so that all our lives will change, and we can all hug our loved ones again!

Best, Thair



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Looking back, Looking forward

George Santayana, in 1905 said, “Those who cannot remember the past are condemned to repeat it.” This is a good reason for us to look back since many of the proposed changes to healthcare going forward will resemble those of the past, but with some new twists. While the new Administration will probably take some different paths, they will still be focusing on healthcare costs, especially prescription drug prices, and Medicare and Medicaid costs and benefits. They will also be looking to revitalize the Affordable Care Act (often called Obamacare) along with increased transparency in the healthcare supply chain. Some of these changes could be good and some could be bad; it will be my goal in 2021 to parse out the details of each change, explain the impact of each change in plain and simple terms and then identify the best ways we can speak out to encourage the enactment of the good changes and what we can do to stop the bad changes. As always, my focus will be on how these changes affect older Americans.

One of the first things I would like the new Administration to do is to quit using Executive Orders (EOs) to make policy changes. The use of the EO has thrust itself into prominence as a way to change our healthcare. It has been overused and I feel it’s a threat to some of our basic rights. With a sweep of the pen, past presidents have instituted changes that have changed some of the basic tenets of laws that have been passed or have circumvented the rightful legislative process. The elimination of checks and balances is never a good path. When former President Trump issued the Most Favored Nation EO (you can click here and here to read more about this in some earlier blogs) he ventured into a legal gray area that has been stopped by injunction in the courts. It shows another weakness of using EOs.

The misuse of a positive aspect of the Affordable Care Act is another example of a way that past Administrations have bypassed the acceptable path for change. I discussed this in a blog last year. You can click here for more detail. This process, enacted through the Center for Medicare and Medicaid Innovation (CMMI), was meant to test new ways to improve healthcare by developing small, short term, test projects. Past Administrations have tried, and sometimes succeeded, in enacting huge changes by pushing through projects that were nationwide, long term and mandated provider participation. This program misuse needs to stop. We need our elected representatives, our voices in Washington, to be part of any changes that have such a huge effect on our lives.

Drug prices have become the scapegoat for healthcare costs. It has been easy to focus on “rich” drug companies and the list price increases that have resulted from the convoluted business model that supplies our prescription drugs. Past proposals have tried to use foreign prices to force drug prices down. Allowing the importation of unregulated prescription drugs or basing our drug prices based on the drug costs in foreign countries were both ideas that have yet to be implemented. The real solution is simplifying the prescription drug supply line and allowing new ways to price new drugs, like pricing based on the medicine’s success or what savings the medicine produced in the whole healthcare system.

One past change involved setting the price of some Medicare Part B drugs. These expensive drugs are often infused by a doctor in a doctor’s office for sicknesses like cancer and autoimmune deficiencies. Again, this is a sledge hammer approach that will impact many local clinics but will most likely not result in savings for the patient. I think the cost of medicines in Medicare Part B will be a target going forward.

One change that we hope is considered going forward is a yearly cap on a patient’s out-of-pocket-costs for Medicare Part D. This change will eliminate a huge variable that has troubled people as they plan for retirement. It will also help reduce the impact of drug costs on the very sickest among us.

While one party holds the Presidency and the majority in both Houses, the path to legislative changes will be tenuous given the slim majorities in both the House and the Senate. We need to return to the process of having sub-committees and committees debate issues, hold hearings, and have active floor discussions of legislation. It will require some give and take by both sides to pass legislation – that’s the way it should be. We should be able to have our say, have the chance to tell our Representative and Senators how we feel about an issue. We shouldn’t allow changes that use the gray areas of the law, gray areas that can be challenged by injunctions, like the Most Favored Nation Executive Order.

As we look forward to 2021, I hope it will be with a new sense of civility, a return to an open discussion of the merits or faults of an issue. The battle to overcome the COVID-19 pandemic will consume a lot of time and effort, but the battle to ensure that we have access to life improving and lifesaving healthcare will continue. It will be up to each of us to get involved in the process and make our voices heard.

Best, Thair



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Glaucoma – The Secret Sight-Stealing Disease

As a fan of the Eagles in my younger days I knew all the words to their hit song, Hotel California. I can relate to one line, “my head grew heavy and my sight grew dim,” much more now that I am older. I do get tired more easily and old age has dimmed my sight somewhat. Glaucoma is much more serious than the incremental sight dimming of old age; it is an insidious disease that can steal our sight without much warning.  

January is National Glaucoma Awareness Month, a time for us all to spread the word about this sinister disease that affects many of us. Here are some facts about glaucoma:

  • Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and even blindness.
  • About 3 million Americans have glaucoma. It is the second leading cause of blindness worldwide.
  • Open-angle glaucoma, the most common form, results in increased eye pressure. There are often no early symptoms, which is why 50% of people with glaucoma don’t know they have the disease.
  • There is no cure (yet) for glaucoma, but if it’s caught early, you can preserve your vision and prevent vision loss. Taking action to preserve your vision health is key.


Anyone can get glaucoma, but certain groups are at higher risk. These groups include African Americans over age 40, all people over age 60, people with a family history of glaucoma, and people who have diabetes. African Americans are 6 to 8 times more likely to get glaucoma than whites. People with diabetes are 2 times more likely to get glaucoma than people without diabetes.

One big reason that this year may be especially important to think about our eyes is the COVID pandemic. Almost all of us have postponed some type of healthcare appointment due to the pandemic. Sometimes, it has even been our healthcare provider that has cancelled or postponed an appointment. I suspect that a yearly eye examine is a prime candidate as an appointment that might have been postponed. This isn’t good since the best way to detect glaucoma is through an optometrist-administered comprehensive dilated eye exam. This is especially important of those who fall into any of the high-risk categories.

This pandemic has forced us to all make some hard, often heart wrenching choices. Everyone has been telling us to not touch our faces so venturing out to a doctor’s office to have someone touch our eyes and face doesn’t sound like a wise move. Here are a few things to consider: everyone in healthcare wears masks and masks have been shown to be a big deterrent to COVID-19; and the transmission by surface infection has shown to be much less of a risk. There are other things we can do to reduce the risk as we visit the doctor. This link gives us some excellent guidance about visiting the optometrist during the pandemic.

One other thing to consider, some of you may have already been vaccinated. I am scheduled to receive the first of the required two vaccinations later today. Two weeks after receiving your second COVID-19 vaccination your chances of catching COVID is greatly, and I mean GREATLY, reduced. After receiving your first vaccination think about making an appointment with your optometrist. You can calculate when your body will be protected, for the Pfizer-BioNTech it is three weeks between vaccinations, add two weeks for your body to get fully protected and you can make your appointment five weeks after receiving the first vaccination. For the Moderna vaccine it will be six weeks after the first vaccination. Your eyesight is worth it!

As we grow older our head might grow heavy and our eyesight my seem a little dimmer but there are some things we can do to guard against glaucoma stealing our sight. Spread the word during National Glaucoma Awareness Month that now is the time to look ourselves, and our friends and families, in the eye (pun intended) and get checked for glaucoma.

Best, Thair



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Who Do You Trust?

A long, long time ago there was a TV show called “Who Do You Trust.” The basic premise was whether the contestant thought he or she knew the right answer to the question the game show host asked (which happened to be Johnny Carson for most of the show’s run) or trusted that their partner had the correct answer. It was up to the contestant to analyze what they knew about their partner to guide them on whether they should trust that their partner knew the correct answer. I think the question on everybody’s mind these days centers around the fact that we are not sure who we can trust to answer today’s critically important questions?

How we overcome this pandemic is probably the biggest question we needed answers to. The COVID-19 pandemic was a big unknown in the beginning; no one knew how it came to be, how it spread, what the symptoms were or how sick it was going to make us. Our elected officials often contradicted the advice given by government scientists. The vaccine approval process was rumored to be influenced by political motives. We really didn’t know who to trust.

As we begin the rollout of the two vaccines that gained emergency use authorization to date, there are many that still don’t know if they can trust the vaccine to be safe. Here are some points that have helped me decide that the vaccine is safe.

  • The breakthrough science that is the backbone of this new vaccine has been actively studied for over 5 years.
  • This new approach does NOT use a weakened portion of the virus to induce the body to produce antibodies.
  • The vaccine was approved in Europe weeks before it was approved here and people in Europe have been vaccinated with minimal adverse effects.
  • Over 40,000 people participated in the phase three study.
  • I have attended many, and testified in some, of the FDA’s advisory committee meetings to evaluate prescription drugs. I have found them to be thorough and unbiased.
  • While it sells papers (or these days gets clicks) to highlight any adverse reactions, the fact of the matter is that any prescription drug or vaccine will have some adverse reactions. So far, any risk of adverse reactions has been far outweighed by the benefits.

The only real chance we have to return to normal is for enough people to be vaccinated that the virus has nowhere to spread. I hope that we can trust the facts and use our own deductive powers to see that the vaccine is safe and effective.

Best, Thair



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Speaking Out in 2021 is Critical

Happy new year. I hope we all can, as the old song says, “accentuate the positive and eliminate the negative” as we go forward into 2021.

I think it will be critical for you to make your voices heard in 2021 as we support the positive changes to healthcare and fight against the negative changes that will hurt older Americans.

No matter what happens tomorrow in the Senate races in Georgia there will be slim majorities in both the House and the Senate. Legislation may pass or fail by just a few key votes. Your informed voices could have a huge impact on the outcome of legislation, regulation and executive orders that come out of Congress and the new administration.

I cannot overemphasize the impact of a constituent’s opinion on each of your senators and representative. The politics of many states and congressional districts are changing and that fact just magnifies the importance of a well-informed constituent. At Seniors Speak Out we will work hard to wade through the rhetoric and “Washington speak” to give you the facts on how proposed changes will affect older Americans. The pandemic has accelerated many changes to how our healthcare is administered. Seniors Speak Out will work hard to keep you informed and amplify your voices as we face the proposed changes that are sure to come.

Best, Thair



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It Just Makes Me Mad!

I know I was supposed to take the holidays off and start fresh in January, but this Most Favored Nation (MFN) thing that is supposed to go into effect in January has been simmering in the back of my mind and finally just boiled over. As you might remember, “this MFN thing” was an Executive Order signed by President Trump shortly after the election. Some feel it was in retaliation for the timing of the release of the Phase 3 vaccine results, but whatever the reason, it finalized a concept that has been kicked around for over a year. It is an attempt at lowering drug prices by basing the price we pay for a particular drug on the average price a group of foreign “MFNs” pays for that drug. You can click here to read more about this approach in one of my earlier blogs.

While there are many details of this executive order that are complicated and convoluted, it’s the overall approach that really bothers me. Rather than exporting our successful innovation methods that makes us the world leader in discovering medicines that save and improve our lives, we are choosing to import the rationing and price control methods of countries that don’t share the same level of concern for the patient that we do. It just seems crazy that we have suddenly decided that looking to other countries is a solution to our healthcare costs.

I know the comparison might not be the same, but I can’t help but think of the oil cartel that has a big influence on oil prices. The Organization of the Petroleum Exporting Countries (OPEC) was formed by five founding countries: Iran, Iraq, Kuwait, Saudi Arabia, and Venezuela. Their goal was, and continues to be, the control of the price of oil to their advantage by controlling their production, much to the disadvantage of the United States and other countries. OPEC has a level of control over the price of oil and it has an impact on what we pay for gas. Why would we allow this same type of control to creep into our healthcare system? Why would we turn over the control of the prices of some of our prescription drugs to a group of foreign countries? Why does this seem to be a logical solution?

Is it fair that foreign countries should pay less for certain medicines than we do? No, but the solution certainly isn’t the capitulation of our responsibilities to foreign countries. This surrendering of control makes me mad. There are problems with how we receive and pay for our healthcare. There are changes that need to be made, but we need to look inward and correct the inefficiencies, streamline the processes, base cost on results, reward preventative care, and encourage innovation . . . rather than depend on knee-jerk reactions and superficial solutions.

Thanks for listening to my tirade. I’ll try to calm down and get back into the holiday spirit. Let’s hope for some well thought out solutions in 2021. Have a happy new year.

Best, Thair



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20/20 Hindsight

You’ll probably read a lot of year end missives talking about how bad 2020 was, probably because it was really, really bad. Think of the babies born in 2020 who will forever be asked about the year they were born as if they could remember their first year on earth. It will be remembered as a year of challenges and heartache and hopefully a year of solutions. I’m not going to dwell on all the bad things that happened in 2020; I want to look forward, using our perfect 20/20 hindsight to guide us as we venture into 2021.

We found out in 2020 that there really are things that can happen that will bring the whole world to its knees. Hopefully, going forward, we will put more effort into studying these viruses so we can be better prepared.

We found out that trusting our scientists makes sense. As Aaron Burr says in the musical Hamilton, we should “talk less, smile more.” Talking less would have helped us listen to what our scientists were saying, and smiling more would have helped everyone’s attitude as we made our way through the pandemic. Keeping our scientists free from political influence should be a priority going forward. The trust in our institutions that exist to keep us safe has been compromised, we need to rebuild that trust and independence.

We reaffirmed the power of our country’s innovation machine. America has built an environment that enables innovation by limiting government regulations while maintaining government oversight. This balance enabled the creation of a COVID-19 vaccine in less than a year, a feat that was deemed impossible in February. I don’t think it was a coincidence that the first vaccine to gain emergency use authorization was created by a partnership of companies that didn’t accept any funds from the government. They feared at the outset that any government interference would slow their progress, and it looks like they were right. As we look to 2021, our government should realize how powerful America’s innovation machine is and find ways to further encourage innovation . . . finding cures saves lives and saves money.

And finally, in 2020 we found how divisiveness stagnates us — how it hinders progress. I hope that the new Administration, coupled with narrow majorities in the House and the Senate will require Washington to cooperate. We might even find that less rhetoric and more discussion will produce progress.

I hope that our perfect 20/20 hindsight gives us a clearer vision of how we can move forward in 2021. I look forward to continuing to speak out for seniors. Have a safe holiday and I’ll see you in January.

Best, Thair



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How Did Your Medicare Open Season Go?

Well, open season for changing Medicare insurance is over (although you can still change your prescription drug insurance, Medicare Part D, until tomorrow). How did it go? Did you keep the insurance you had? If you did you would be in good company, historically over 80% of us don’t change our insurance. Did you take the opportunity to really evaluate your options or did you just take a cursory review, or did you let the opportunity go by and just keep the insurance you had continue for another year? Many people I have talked with didn’t take the time to review their insurance, a dangerous approach given the changes that are going on, to say nothing of the changes to your health that might occur. I warned, cajoled, even begged everyone in earlier blogs to take the time to review their coverage. I hope some of you listened. Let me tell you what steps I went through as I reviewed my insurance and how I made my final decision.

I moved last year and, for the first time, chose a Medicare Advantage (MA) plan. Generally, a MA plan offers more benefits, usually some discounts or free memberships to health clubs, often some hearing benefits, maybe even dental and eye benefits. Surprisingly, these often come with no premiums. For me this was a big change from the premiums I was paying with my old supplementary insurance. As you might imagine these benefits and low or no premiums are offset by some stipulations and rules that need to be considered. Often their network of doctors and hospitals is more restricted, and your copays and other out-of-pocket costs are larger. Many MA plans include prescription drugs, but their formulary may be more tightly controlled. Since MA plans get paid a fixed cost for each member of their plan, they are incentivized to keep you healthy, hence the focus on fitness, healthy living, and preventive care. They are also focused on keeping costs down. Those are the tradeoffs I looked at going into the open season.

I first read my insurance company’s Annual Notice of Changes. I was pleased to find that my copayment for a specialist dropped 20% and for hospital specialists and treatment dropped $110 dollars or 25%. That was big for me since I had paid both of these copays for some tests that I had. The tests turned out fine, but it was pleasing to see that I will pay less in 2021 if I need that sort of healthcare. My drug plan stayed the same except for a big reduction in the cost of insulin in 2021 which was capped due to legislation and rules instigated by Washington. This will have a big impact on many diabetics. Given the healthcare needs of my wife and myself we found that staying with are current MA plan continued to save us money and fit our situation.

I hope that increased competition gave you more choices and more opportunity to save money in 2021. I will be really interested to see what next year’s open season brings. With the hope of vaccines allowing us to return to normal by the second half of 2021, we could see many changes in how healthcare is administered. Telehealth, in-home tests, more sophisticated medical devices to monitor our health, may all lead to changes to how we receive and pay for healthcare.

The new administration will certainly be pressured to control healthcare costs. I hope they see how competition is the quickest and best way to balance access with cost. I’m convinced that the reason my MA plan dropped their copays was not because they had a banner year — many doctors and hospitals saw a big drop in revenue due to the pandemic. What these plans do see in 2021 is a big increase in healthcare demand due to our country’s return to normal as we emerge from the pandemic and an increase in competition to satisfy that demand. A system that is based on cost controls and limited access would not respond as quickly, or at all, to this increased demand.

Keep track of your costs and access to care in 2021. Document the changes in your health. Know where you stand with your prescription drug costs. These are all things that will help you make an informed choice when next year’s open season rolls around. It could have a big impact on your cost and level of care going forward.

Stay Healthy, Thair



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COVID-19 Vaccine – It’s Use or Lose

The great news of how effective the first two vaccine candidates were in the phase three trials gave all of us a burst of hope. Finally, we began to believe that this demoralizing pandemic would finally end. However, there is a hurdle that we need to get over to make this come true, the surprising hesitancy of many in America to take the vaccine. The fact of the matter is, we need somewhere between 60 and 70% of a community to be vaccinated to obtain herd immunity, the point where the virus quits spreading. A poll a few weeks ago showed that less than 50% of the people polled said they were going to get vaccinated as soon as it came available. A more recent poll showed the number increased to above 50%, a step in the right direction but not the participation numbers we need to stop this pandemic. There has been much discussion about why people are hesitant, with many possible reasons put forth. There are two oft sited reasons that deal with the safety of the vaccine that seem to be at the top of the list that I would like to discuss. Hopefully, it will shed some light on why these vaccines are safe.

1. The Vaccine was developed to quickly.

Historically, vaccine development has taken four or more years to be approved for human use. While we have had vaccines for hundreds of years, the science behind vaccines has been slow to progress but in the last few decades it has accelerated at a breathtaking speed. While the approach taken by these first two COVID-19 vaccines is new, it wasn’t discovered this year. Two married scientists, Ugur Sahin and Ozlem Tureci, co-founders of BioNTech, the firm that has teamed with Pfizer, have been working on this vaccine approach since 2001 and have been working on a COVID-19 vaccine since January. With the funding and worldwide logistical support of Pfizer and the commitment of the FDA to cut through the bureaucratic red tape, the new vaccine has gone through all of the required testing in record time. Their phase III testing had over 40,000 participants. They had to jump through all the hoops any new vaccine was required to accomplish. They proved that it works and that it’s safe.

2. The FDA was pressured by politicians to cut corners.

The FDA is recognized worldwide as the gold-standard in the process of approving the safety and efficacy of prescription drugs. The FDA is made up of career scientists who have maintained this reputation for decades and they did it from a commitment to excellence, not through a commitment to any administration or political party. America is the leader in drug development because of the high standards required by the FDA. One of the ways the FDA assures the absence of any political influence is the approval review by an advisory committee made up of external scientists and experts. The committee that will meet on December 10th to review the Pfizer/BioNTech vaccine is the Vaccines and Related Biological Products Advisory Committee (VRBPAC). These committees are thorough and transparent. I have personally testified many times during the public comment portion of various advisory committee meetings and can attest to their attention to detail and their commitment to transparency. The FDA is not about to jeopardize their gold-standard reputation, to say nothing of the health and wellbeing of the whole world, due to the pressure of a lame duck administration.

Three past United States presidents have committed to getting vaccinated as soon as it becomes available. They, more than anyone, understand the workings of the FDA and they trust them to protect us, as we should. The only way we can beat this virus is to take advantage of the great scientific minds and amazing manufacturing capabilities that have made this vaccine a reality. Let’s all get vaccinated as soon as we can, so we don’t lose the chance to once again gather together.

Best, Thair

p.s. I would be remiss if I didn’t recognize the importance of this day of infamy and those who made the ultimate sacrifice at Pearl Harbor. In the space of six months, while serving as a B-52 crew member in the Air Force, I lost fellow aviators and friends in two separate airplane crashes. I am honored to have served with these heroes and I use December 7th as a time recognize and remember all who serve or have served.



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Drug Price Interim Final Rule Order – Two Reasons It Is the Wrong Approach

The President, through the Centers for Medicare and Medicaid Services (CMS), issued an interim final rule after the election that finalizes his prior approach to dealing with the cost of prescription drug prices. It is called the Most Favored Nation approach and amended earlier EO’s, one of which used the term International Price Index. All of these EOs were attempts to lower drug prices by using the prices that foreign countries pay for specific Medicare Part B drugs. You can read some more background on these EOs or rule changes in some of my earlier blogs, here and here.

It only seems fair that we shouldn’t pay more than foreign countries for some prescription drugs, but this new regulation will set the price based on countries with single payer healthcare systems, where the government dictates who gets what medicine. The patients in these countries wait years for new medicines. Of the 74 cancer drugs launched between 2011-2018, 95% are available in the United States, compared with 74% in the UK, 49% in Japan, and 8% in Greece. These facts bring me to the first reason this is the wrong approach.

Foreign countries use many methods to negotiate lower prices, they lower competition by telling the competition that only one class of drug will be available in their country and that one will be the one with the lowest price. There’s no thought to those in their country who may do better on another drug in that class. They may even delay the entry of a particular drug, sometimes for long periods of times, until the manufacturer lowers the price. One of the ways governments dictate the rules and use of healthcare is through rationing, controlling patient access. If we import these foreign countries prices, we are importing their practices of price fixing, rationing, and controlling access. The Executive Order’s own language recognizes this fact. The first notice of this approach to lowering drug prices was released over two years ago with the promise that the new approach would operate “without any restrictions on patient access.” The government’s own advisory group, the Medicare Payment Advisory Commission, expressed doubts this could be accomplished without making some products unavailable to patients. The latest regulation finalized the government’s approach, with the actuary at CMS stating that their estimate is that 19% of the Part B drugs (the drugs that this EO targets) will be unavailable to the patients. The final recognition of denying access comes from the EO itself which states, “a portion of the [Medicare] savings is attributable to beneficiaries not accessing their drugs through the Medicare benefit, along with the associated lost utilization.” This approach saves money by denying access, which is one of the ways foreign countries save money. When we import their prices, we import their ways of doing business.

The second reason this regulation is the wrong approach focuses on a much larger and more troubling scenario, the use of healthcare proposals for political reasons. Why was this approach unveiled two years ago just prior to the med-term elections? Why was this again released in an unfinished state hoping for negotiations, two months before the presidential election and then finalized after the negotiations failed and then released after the election, by a lame duck President. Some have indicated that the release of this EO was solely as retribution for drug manufacturers not releasing the results of the vaccine trials until after the election. Whether these accusations are true or not, just the optics of the releases troubles me. Executive Orders, rule changes and legislation should only be done for the betterment of the American people. The timing of these actions leads one to conjecture that these actions were taken for political reasons. Do we want to give our government more control over our healthcare when we see these types of questionable actions?

There are many ways to make our healthcare more efficient and less costly, it’s my belief that giving more power to the government is not the path to either of these outcomes. I’m a believer in the free market with the umbrella of government oversight accomplished through the checks and balances established in our Constitution. Look how our country responded to the COVID-19 pandemic. I don’t think it’s a coincidence that the first company that completed successful COVID-19 vaccine trials and will most likely get the first emergency authorization, was one of a few, if not the only company, that didn’t take any government funds.

This proposal imports the methods of foreign countries that uses government controls to set prices and limit access. I think we need to rethink how to tackle this problem, because giving more power to the government is not the solution.

Best, Thair   



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Thanksgiving – A Tough Year to Give Thanks

Thanksgiving is usually a time for families to gather together and remember the things we are thankful for. Instead, as the pandemic rages, many states are encouraging their citizens to not gather with anyone that lives outside of their house. What kind of Thanksgiving is this going to be?

I’m not going to tell everyone to soldier on, we’ve done about as much soldiering as we can stand. We’ve been avoiding getting together with our loved ones for almost 9 months and now, on the one day of the year when we all look forward to gathering with our loved ones, we are asked to keep to ourselves. In the vernacular of a younger generation, “this stinks,” or something like that. So . . . what do we do? What can possibly be salvaged from this terrible situation. I’m going to talk about two things that might help us as we strive to get through this tough time.

My first suggestion is, be grateful. We finally have some good news and can finally begin to see a time when this will all be over. The recent great news concerning two vaccines gives us hope that the virus will be contained. We have hope that by next Thanksgiving we will again be able to gather. How grateful we should be that our healthcare system continues to rise to the challenge of this pandemic. How grateful we should be that we will probably have an approval of two vaccines sometime next month and that they could be 95% effective. At the beginning of the pandemic, no one at the CDC had any hope that a vaccine would be developed this fast and would be this effective. In keeping with our healthcare theme, showing gratitude, according to one spiritual leader, “is a fast-acting and long-lasting spiritual prescription.” Showing gratitude is an excellent way to keep us positive.

There is another thing we can do this Thanksgiving that could have a long lasting and lifesaving impact on our families. Thanksgiving Day is National Family Health History Day. This is an ideal day for assessing the health risks for illnesses known to run in your families. Here’s a couple of reasons why we should share and document this family health assessment:  

  1. Some family members may have died young

If you have chronic conditions that run in your family, it’s important to discuss the family’s health history, especially if there were family members who died before the conditions became evident.

  • Many families tend to get these diseases

The most common conditions that occur in families are heart disease, diabetes, and cancer (including colon, stomach, endometrium, lung, bladder, breast, and skin) as well as high blood pressure.

The CDC has a great web page (click here) on how to collect and how to act on your family health history. This information could be invaluable as you and your doctor work to diagnose and effectively treat you or your loved ones. It could guide the doctor to look for specific conditions prior to them becoming a big health problem.

Now, you may ask, how can I do this great thing when our Thanksgiving gatherings are going to be small or non-existent? Well, consider this, use zoom or some other video conferencing software to virtually gather your family together. Tell them what you are planning and why and give them some time to gather information. A big requirement of these health information meetings is to document the results. By recording the session, you can ensure that you (or your assigned recorder) can go back and review the recording to ensure you don’t miss anything of importance.

This Thanksgiving will be different, but if we step back and think of the things that we are grateful for and then share those thoughts with those around us, we can create some positive vibes for us and those around us, and, if we document our family health history we will create a valuable tool that could have life changing impacts on those we love. We really could have some things to be thankful for and, best of all, we could have something positive to say when someone asks us how we spent the COVID Thanksgiving of 2020.

Stay healthy, Thair



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Our Latest Virtual Townhall – A Recap

Last Thursday, November 12th, we held a virtual townhall to share some thoughts on the election and its impact on healthcare in America, and then discuss the importance of America’s caregivers, especially in our current COVID-19 environment, and to offer some resources that are available to caregivers. If you want to see a recording of the townhall click here.

I started out by pointing out that there are three ways to institute changes to our healthcare; legislation, Executive Orders (EO) or rule changes. On the legislative front, the Democrats, rather than increasing their majority in the House, lost seats, with the final tally looking like they will have just a five to ten seat majority. That leaves a lot of room for the Republicans to have influence over legislation in the House.

The Democrats were also hoping to gain a majority in the Senate but now, the best they can do, depending on the outcome of the two Georgia senate runoffs, is a 50/50 tie, which gives them the chance to choose the majority leader and for the Vice President to break any tie votes but the Senate calendar and priorities will have to be done in conjunction with the Republican leaders. Many pollsters are saying that the Republicans are more likely to win the Senate seats in Georgia, but we’re not to keen on pollsters right now so we’ll just have to wait and see. What all this means is it will be tough for the President Elect to pass any large healthcare legislation.

I then reviewed some of the proposed healthcare changes and discussed their chances of being implemented in the near future:

  • Medicare for All – Won’t happen.
  • Biden’s plan, lower age to 60, offer younger people the choice of joining a government healthcare plan – Not this year and probably not for at least two years.
  • Let government negotiate drug prices – Some bi-partisan interest but not by itself, could be part of a “deal” that gets negotiated.
  • Importation of drugs – Already an EO, logistically won’t work, probably will die as an option.
  • IPI (international pricing index) or most favored nation pricing method – Already an EO – Hard to implement, I don’t think it’s a change that the President Elect wants to pursue.
  • Limiting the amount of drug price increases over a year – Has some bipartisan support, might be part of a “deal”
  • The ACA – The President Elect will work hard to expand, may be a place for some of the other changes to get done.
  • Telehealth – Will be have bipartisan support to expand its use.
  • Cap on yearly Medicare Part D out-of-pocket costs – May be something that would gain bipartisan support.
  • Fee-for-service versus value-based care – The migration to value based care will be accelerated.

Covid-19 has put near term changes to healthcare on the back burner, but President Elect Biden promised healthcare changes and he could use budget reconciliation to pass some items. We need to be vigilance to identify those changes that help and those that hurt the patient’s access to, and the cost of, their healthcare.

I then turned the time over to John Schall. He is the CEO of the Caregiver Action Network (CAN) and has over 30 years’ experience both on the Hill and with advocacy organizations.

John started out by pointing out how much the Senate has changed since he worked for Bob Dole and how hard it was to predict what changes would happen going forward.

John reminded us that this month was National Family Caregivers Month and that CAN’s theme this year is caregiving in crisis. He said that every caregiver and their loved one should be involved in reviewing their Medicare coverage during the open enrollment period that we are currently in, not just because Medicare and insurance plans change but that the beneficiary’s health changes. A link to an informative webinar on Medicare that John recommended is here.

John then discussed that the historical profile of the caregiver is a 49 year old women with kids and a job, caring for her mother or mother-in-law. He said that caregiver is still on the job but there has been a huge increase, over a million, in millennials becoming primary caregivers. This has had an impact during the COVID-19 pandemic because many of them have had a reduction in income and their financial burden has increased. They are experiencing the toll that caregiving extracts. The facts are, caregivers have a higher chance of depression, high blood pressure, diabetes and having a stroke. COVID has magnified these problems.

In this environment the caregiver has to weigh the risk of even being around their loved one, taking them to the doctor or helping them in other ways. These are tough decisions that weigh heavily on the caregiver. John spoke as to the financial cost that often accompanies care giving and that it can cost as much as $10,000 a year to give care to a loved one.

John pointed out the huge increase in the use of telehealth but reminded us that it also has its challenges. If that caregiver is not part of the discussion then they don’t get the doctor’s guidance first hand and they also can’t share the knowledge they have of their loved one’s condition.

National Family Caregivers Month has always been a good time to check up on those we love. The Thanksgiving edition of USA Today will have a special insert sponsored by CAN that will offer tips and help to caregivers. John mentioned that there is now a Family Health History day on Thanksgiving Day. This is a day to share and obtain health history from your family and information about your ancestors. Health history is becoming very important as treatments become more and more personalized. This important information has the chance to save a life.

After John’s discussion the meeting was opened up for any questions. I started off by stating how important vaccines were in keeping our loved ones healthy and that the just  announced good news about a COVID-19 vaccine may open the door for older Americans to get their other life improving and even life saving vaccines. I asked John if this is important for caregivers. John stated an emphatical yes, and stated that because of the reduction by the CDC in their recommendation for some vaccines it is very important for the caregiver to do all they can to ensure that their loved ones get the various vaccines that can have such an impact on their life.

A question from a viewer stated that they were struck by the statistics on depression and asked if there were any tips or helps that John had. John stated that the caregiver needed to keep themselves healthy, both physically and mentally, so they can continue to giver care rather than becoming unhealthy and needing their own caregiver. He also pointed out that CAN has a help desk, tasked with professionals, that could be a resource for caregivers. The link to that help desk is here.

Another question was directed to me asking if I thought that a cap on Medicare Part D might be a candidate for bipartisan cooperation and get implemented. I said that President Elect Biden might try to pass and infrastructure bill first, which could have a lot of bipartisan support, and then go to a Part D cap. The cap could be an excellent candidate since it shows Biden accomplishing something in the healthcare arena.

The final question concerned a Biden proposal which allowed support and payments for services that kept patients out of institutional care. John said that CAN enthusiastically supports this approach, and he was especially pleased with the multi-pronged approach this proposal championed.

It was honor to be on this townhall with John. Please look for more of these virtual townhalls as we cover topics that affect older Americans.

Best, Thair



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Veteran’s Day – Ways We Can Honor Our Countries Veterans

November 12th is Veterans Day, a time we reflect on the sacrifice and service of those that served. As a veteran myself, I’ve observed a change over the years in the way the public has honored our veterans. As a B-52 bombardier I spent a few years sitting nuclear alert and had a tour in southeast Asia toward the end of the Vietnam War. I don’t remember anyone thanking me for my service during that time frame, and I know of others who even endured negative reactions toward them for serving in that controversial war. It is different now. I often am thanked for my service, which sometimes makes me a little uncomfortable because I feel the ones that really deserve the honor are those who made the ultimate sacrifice or were injured either physically or mentally during their service. These veterans have earned the best healthcare our country can provide, yet there are many veterans who face barriers in getting the healthcare they need.  Here are just two ways we can honor our veterans.

First, don’t quit thanking veterans for their service. While it might make some uncomfortable, the bottom line is that every veteran took an oath to protect and defend our country, even to the sacrifice of their own life. Whether they were injured or not they were willing to give the ultimate sacrifice and that deserves our thanks. Something that many people do not know is that the oath a veteran takes when they join the service does not expire. They make a lifelong promise to defend our country.

Second, do all you can do to get the veterans the healthcare they deserve. There have been conditions that have come to light of some of the deficiencies in healthcare our veterans have faced. There has been substandard hospital care and a lack of access to convenient healthcare services that have plagued veterans. Here are just three of the areas that need to be improved:

  • The patient’s voice needs to be part of the dialogue as we consider improvements to veteran’s healthcare. Many of the past and present problems could have been avoided if they would have listened to the patient.
  • Better transparency and accountability is needed when it comes to the limitations of the veteran’s prescription drug formulary. The VA has 1,745 prescription drugs listed on its formulary; a common Medicare Part D prescription drug plan has 3,104. You can understand why many veterans choose to pay the extra premiums and join Medicare Part D. Veterans shouldn’t be short changed when it comes to the availability of prescription drugs.
  • Speak out on the need for increased support for veterans mental healthcare. An alarming number of veterans are returning from war with serious mental health conditions. It is sad that these heroes survive the perils of war only to take their own life due to untreated PTSD. They need and deserve the best help available as they fight to overcome the mental impact of their war experiences.

It’s up to us to not only thank them for their service but to also fight for their healthcare like they fought for our freedoms.

I’m thankful to the veterans who fought so that we could vote for the candidates of our choice. It is just one of the freedoms that they have fought to protect for almost 250 years. I will continue to thank them for their service and fight to get them the healthcare they deserve.

Best, Thair

P.S. Don’t forget to join our virtual town hall this Thursday, November 12th at 2:00 pm ET. I’ll talk about some of the changes to healthcare we can expect in the new administration and our special guest speaker, John Schall, CEO of Caregiver Action Network, will talk about caregiving in the COVID-19 environment, the National Family Health History day and the yearly Medicare open enrollment. Please RSVP at the link below:

https://zoom.us/webinar/register/WN_mYE6Zz4TQmyCWsGmLUE-hQ



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November Is National Diabetes Month – This Year We Need to Pay Attention

November is diabetes month, and the COVID-19 pandemic should encourage us to pay attention . . . our lives may depend on it!

In 2019 there were over 48 million Americans 65 or older. Of that population around 28% had diabetes or prediabetes. Just think about it — when you get together with your friends (back when there wasn’t a pandemic and you could get together), almost 3 out of 10 people in the room had diabetes or prediabetes. That’s a lot of your friends, it may even be you. As with most diseases early detection is key to maintaining an active lifestyle and avoiding complications. There are 34 million people in America with diabetes and 1 in 5 of the 34 million are unaware they have it. The bottom line is there are a lot of older Americans with diabetes and the preliminary data indicates that people with diabetes are much more likely to have complications if they catch COVID-19.

So, either you or, most likely, someone you care for or know has diabetes. The question is, what can you do? If we’ve heard it once we’ve heard it a hundred times — wear a mask, social distance, and stay away from large groups indoors. Those are the added steps over and above what we should be doing as diabetics. In fact, some of the COVID-19 restrictions may make it harder for a diabetic to stay healthy. For instance, the CDC highlights the 3 common mistakes diabetics make in controlling their disease.

  1. Not testing enough – Each individual is different. Their testing regime is designed for them and the intervals are important. Testing is critical.
  2. Not moving enough – Here is where the pandemic could cause problems. Self-isolating is a great way to avoid getting the COVID-19 virus. It’s also a great way to turn into couch potatoes. Here’s my catch phrase, find a way to isolate and invigorate. Get up and move, exercise, walking outside is OK and the fresh air will help. Find a way to move every day.
  3. Not checking up – You may think that everything is going well with your diabetes and you don’t need to keep your regular appointment with your doctor, especially with the virus running rampant. Don’t skip your appointment. Follow all of the safety rules but go to the doctor. It’s your best defense against problems.

There’s another important step you can take to keep you healthy, get your flu shot. Now’s the time, if you haven’t had your shot yet, get it this week. This link takes you to a great article on flu and people with diabetes. A couple of important things from the article, for those of us over 50, we should get the shot rather than the nasal spray vaccine. Also, when you go to get your flu shot see if you’re up-to-date on your pneumonia vaccination. Both the flu and pneumonia can be devastating for diabetics or people with prediabetes and is really harmful for those that don’t even know they have diabetes.

This year especially, if you have diabetes, you need to pay attention to the effects the pandemic, flu and pneumonia can have on you. If you are a caregiver to someone with diabetes, or have a friend or loved one with the disease, help them understand how important it is this year to pay attention to your doctor’s directions and observe the recommendations concerning the COVID-19 pandemic. It truly can be a matter of life or death.

Finally, today we will select who will be our President for the next 4 years. I hope you voted. It is the loudest and most effective way seniors can speak out. There are, however, other more frequent ways we can speak out about how we feel on issues that affect us. We only vote for federal offices every two years but we can advocate and speak out as many times as necessary to let those in Washington know how we feel. Just recently, in the diabetes arena, the price of insulin was reduced for many who suffered from diabetes. I feel that our representatives heard loud and clear about how we felt about insulin prices and it had an effect. I urge you to vote and then to stay involved, it’s the only way we can have a say in how our healthcare is administered.

So, pay attention, follow the suggestions on staying healthy with diabetes, including following the guidelines concerning the pandemic and getting your flu and pneumonia vaccinations. And finally, stay involved — you really can make a difference.

Stay healthy, Thair



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Vote – But Be Safe

You’re probably sick of hearing people say – Don’t forget to vote! I’ve joined that chorus in encouraging you to vote in almost all of my recent blogs. It is a fact that a higher percentage of older Americans vote than any other age group. Given that statistic it makes us a powerful voting bloc, even more reason to make our voices heard.

I know many of the reasons that people don’t vote, I’ll list some of them here and include my rebuttal:

  • My state always goes to the Democrats or the Republicans, so my vote doesn’t make a difference.
    1) The percentage of the vote that the dominant party gets makes a difference. You hear all the time about how many percentage points a candidate won by in a previous election. That percentage means something.
    2) What about all those state and local races, amendments, propositions, bonds, etc. that are on your ballot? Those races and changes may have more impact on you personally than the national elections.
  • I don’t feel like I know all I should about the issues to make an educated vote.
    1) There are non-partisan web sites and educational information available that helps you understand where the candidates stand and the estimated impact of the different propositions, etc.
    2) Talk with someone who you trust and who has the same beliefs and political stance as you and ask them how they are voting and why.
  • I’m not sure if I’m registered, or where to vote, or how to vote without going to the actual polls.
    1) have a great link that will answer the questions above. It’s a New York Times link that covers every state, since each state often has different rules. Click here to make sure you’re registered or, if you’re not registered, how you still can register, the different methods you can use to vote and where, depending on your address, the nearest polling and ballot drop boxes are located.

The last reason that people may not vote this year is the COVID-19 pandemic. It is a valid fear, given the spike in the number of people testing positive for the virus. I’ve got some advice on how to stay safe while exercising one of the greatest freedoms we have.

The safest way is to vote without leaving your house. Most states have already mailed ballots out that can be filled out and mailed. Mail them early just to make sure they arrive in time. There’s been a lot of political posturing about the Post Office being overwhelmed or delaying the delivery of your mail. Don’t let it keep you from mailing in your ballot, the Postal Service says it can handle the expected volume.

The next safest approach is to drop your ballot into one of the ballot collection stations. The link above will give the location of those stations. It is easy and reduces the number of hands that your ballot passes through before it gets counted.

If you go to vote on November 3rd there are some steps you can take to keep you safe. First wear a mask . . . not under your chin, not under your nose. Wear a mask that covers your nose and mouth and seals around your face. Multiple layers and N95 materials make the most efficient masks. When you go to the polls:

  • go at off-peak times, like midmorning.
  • monitor the voter line from your car and join when the line is short.
  • fill out any needed registration forms ahead of time.
  • review a sample ballot at home to cut down on time spent at the polling location.
  • take your own black ink pen, or stylus to use on touchscreen voting machines.

Many have said this may be the most important election for decades. I think our founding fathers would say that every election is the most important. It seems like lately there are a lot of things that are out of our control, the pandemic, the negative divisive tone of our politicians, the magnifying of our differences rather than the unity of our common hopes and dreams. Voicing our personal opinions by voting is something we can control, it’s a way we can participate and become involved.

So, for probably not the last time you’ll hear it, be sure and vote. Hopefully, I’ve suggested some tools that will help you to vote efficiently and, most importantly, safely.

Best, Thair



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Bone and Joint Action Week

We all have bones and joints but most of us didn’t pay much attention to them when we were young, we might sprain an ankle or wrench a knee, but it didn’t keep us down too long. Well . . . it’s different now, most of us have joint aches and a lot of us have different degrees of arthritis. As many of you already know these types of aches and pains can have a big effect on our quality of life. Bone and Joint Action week, was last week, October 12th to October 20th. This special week’s goal is to raise the awareness of how bone and joint problems affect a huge number of us and highlights the need for more research and focus on this area of our health.

We’re living longer and that brings these types of bone and joint conditions into play at a steadily increasing rate. Did you know that 54% of Americans over 18 have musculoskeletal (bone and joint) conditions and a 33% went to the doctor or hospital to be treated? There has been an almost 20% increase in the last 10 years in these types of conditions. These bone and joint conditions effect a lot of people and cost our healthcare system a lot (to say nothing about the out-of-pocket costs we pay)  and yet these musculoskeletal conditions make up only 2% of the research budget of the National Institute of Health, and it’s shrinking! This action week is a great way to shine a much-needed light on these conditions that affect so many of us.

There are a number of special days in the Bone and Joint action week, I would like to focus on two of these days, October 12th, World Arthritis Day and October 20th, World Osteoporosis Day.

World Arthritis Day – One of the resources offered during this day is The United States Bone and Joint Initiative (USBJI). They provide Experts in Arthritis, an educational program for people with arthritis. There are sessions by rheumatologist, physical therapists, orthopedic surgeons, nurses, and occupational therapists, offering information and help for both the patient and the caregiver. Another resource is ControlArthritis.org, which offers videos with tips on how patients can control their arthritis.

World Osteoporosis Day – This day, with the theme “That’s Osteoporosis,” will seek to improve the understanding of osteoporosis and its outcome, with the focus on the link between osteoporosis and broken bones and the human and socio-economic costs of fractures. They encourage the public to check their personal risk for osteoporosis through the use of the new IOF Osteoporosis Risk Check. You can learn more at www.worldosteoporosisday.org.

The other special days in the Bone and Joint Action Week are, October 15th, World Spine Day, October 17th, World Trauma Day and October 19th, World Pediatric Bone and Joint (PB&J) Day.

I have one other piece of advice that I feel is important. I’ve been part of panels, listened to presentations and conferences and moderated panels on numerous healthcare subjects and the pain that results from different diseases. Through all of these different forums I have noticed a common piece of advice that has almost always been offered – – – keep a journal of your symptoms and pain. When we get old our memory isn’t as good as it once was. Write down things like, when did a symptom present itself, in the morning or the evening? Was it after a good night’s sleep or a poor one? When the pain got worse what was I doing, was it better or worse than the last time the pain hit? Etc., Etc. These are the things that we can bring to our doctor, information that can help in our diagnosis. It is a powerful tool we can bring to bear as we seek to be our own best advocate.

I have seen the impact of arthritis on my wife’s mother and grandmother as they were forced to give up their lifelong passion of quilting and needlepoint due to the ravages of arthritis. We’ve all seen the impact of osteoporosis as older people fall and break their hips with often life taking results. When so many of us are impacted by these diseases why is so little research being funded? Let’s be active advocates, both of our own health and the health of our loved ones, by encouraging our government to focus on bone and joint health, something that would help a large number of older Americans.

Stay healthy and safe, Thair



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Medicare Open Enrollment – Important Options to Consider

Medicare open enrollment time is fast approaching, it starts on October 15th and goes through December 7th. This year especially, we should make sure we are prepared to make smart decisions concerning our healthcare. It can make a difference in our access to the care and how much we pay for that care.

First, some background – we really have two choices in selecting our healthcare –  standard Medicare and Medicare Advantage (MA). Standard Medicare is based on the old fee for service model. People often add supplemental insurance to standard Medicare to reduce or eliminate out-of-pocket costs. The MA model is based on the insurance company getting one fee for each Medicare enrollee, which encourages the insurance company to emphasize preventative care and offer programs to keep us healthy. With MA there are often no premiums and there are often more benefits, such as prescription drug coverage, dental, hearing and health clubs, etc. The tradeoff is higher out-of-pocket (OOP) costs for many services and some limits on choices of doctors. If your situation enables you to take advantage of the added benefits that MA offers and the doctors you use are part of the MA network, then MA may be a good choice for you. I changed from standard Medicare to Medicare Advantage last year and found that I saved money, even with a battery of tests I had done.

Part D, the prescription drug program, is another place where careful consideration can be very beneficial. Part D is often included in a MA plan but you should pay special attention to your choice of your Part D provider no matter which Medicare plan you choose.

While I can’t tell you which type of Medicare you should choose, I can give you some things to consider as you get ready for open enrollment. They are, in no particular order:

  • While historically less than 10% of us change our Medicare plans, statistics show that the average person can save $300 or more when they review their coverage.
  • Your options for Medicare plans have increased 20%. You will have an average of 47 different health plans to choose from.
  • There are two main areas to consider when you are evaluating different plans, can I get easy access to the care and products I need and what will my OOP costs be? For Part D, for instance, you first need to make sure the plan you are considering offers the medicine you take and then determine what it will cost.
  • Evaluate how your current plan did, were you happy?
  • Your insurance companies are required to send you an explanation of any coverage changes that will affect your plan. These changes can have a big impact on next year’s access and cost. They may have dropped your doctor or the medicine you take, they may have increased OOP costs.
  • Research if you qualify for Medicare assistance under the Social Security Disability Insurance (SSDI) benefit or the Patient Assistance Program.
  • Pay attention to the Medicare Star ratings on Part D and MA plans.
  • If you plan on traveling next year, especially if it’s out of the U.S., review what your plan will cover when you are traveling.
  • Research what your maximum yearly OOP maximums will be. For MA plans the maximum OOP costs for 2020 was $6,700, some plans are less.
  • It is often to your benefit to get a separate Part D plan than your spouse. Your medicines may be available and cost less under a different plan than your spouse’s.
  • There are situations when you can change or apply for Medicare outside of the open enrollment period:
    • Loss of health coverage: The loss of a job or qualification for Medicare or Medicaid services, or aging out of your parents’ plan.
    • Changes in household: A birth, adoption, death, marriage, or divorce in the family.
    • Changes in residence: Moving to a new region outside of your current insurer’s coverage.
    • Other qualifying events: Becoming a U.S. citizen, leaving incarceration, joining or leaving the AmeriCorps.

These are a few things to consider as you evaluate your coverage. You do have places you can go to get help with choosing your coverage. Here are four great places to get help:

1.Contact your local SHIP office.

The State Health Insurance Assistance Programs (SHIPs) give free, in depth, one-on-one insurance counseling and help. A SHIP counselor, who understands Medicare and Medicaid can guide you to smart options for your personal situation. You can trust them because SHIPs are government programs funded by the federal U.S. Department of Health and Human Services. Find your state’s SHIP office .Contact your local Area Agency on Aging. The local Area Agency on Aging has programs that help with Medicare Open Enrollment. Find your local Area Agency on Aging

2.Use Medicare’s online plan finder.
Medicare has an online plan finder and comparison tool. Answer a few quick questions and the tool will show available plan options for 2021.

3.Use Medicare’s online plan finder. There’s a separate place to find supplemental insurance: Medigap Policy plan finder

4.Call 1-800-MEDICARE (1-800-633-4227).
You could also call the Medicare office and ask a representative to run a search for plan options and mail you the results. This takes extra time, so call ASAP if you want to use this method.

I hope this helps you as you consider your healthcare options during this open enrollment period.

Don’t forget to register to vote!

Stay healthy, Thair



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A Questionable Way to Change Medicare

With so many significant changes to the Medicare program being discussed right now, I thought it would be a good idea to take a step back and examine the way changes in Medicare policy get made. It would be good to understand, for example, what tools are used to make it possible for any president’s administration to unilaterally change the program.

As you know, there is a defined process that allows our government to spend money and to change programs that have been legislated into law. A tool that presidents are using more frequently to get around these conventional processes involves the Center for Medicare and Medicaid Innovation (CMMI).

CMMI was created within the Affordable Care Act (Obamacare) as a testing ground for new ways to implement and pay for healthcare in our country. It was a great idea, have providers or payers or academia propose new ways to increase the efficiency and lower the cost of healthcare. Let them get a small number of representative healthcare providers signed up and test a new concept outside of current regulations and restrictions. If there is a positive result from the small test, then the changes to the existing laws can be proposed and the normal legislative processes are followed to implement the changes. What a great idea, test ideas to find the best way to administer healthcare before you change the existing laws. Unfortunately, this great idea began to be used instead as a way to circumvent the usual process and change Medicare policy, by both the Obama and the Trump administrations.

This misuse began with the administration proposing ideas directly to the CMMI that were so large in scale they were similar to an actual policy change. These proposed tests were not limited; they were designed to include virtually all the providers in America. And the test mandated participation, no provider could opt out. There is no legislative input and no judicial review. This is not how the CMMI has usually done business, it ignores the checks and balances that historically have been part of the CMMI process. Whether you believe the changes proposed by a president are good or not, this is not the way we should be changing programs that have been voted into law by the legislative process.

Misusing designed testing programs is not limited to the CMMI. The $200 card that the President proposed to send to 33 million Medicare beneficiaries to help pay for prescription drugs uses a program in the Social Security Act that allows Medicare to test out new money saving programs. These tests are usually proposed by state governments, Congress or the private sector and go through a rigorous, methodical approval process. Again, it isn’t for implementing a payment to 33 million Americans within a few weeks. This program is primarily for saving money so it must be at least budget neutral. The proposed source of funds to offset the cost of this $6.6 billion program is the savings from the “most favored nation” Executive Order, a program that hasn’t been implemented and any proposed savings are suspect. This onetime payment does nothing to lower the long-term costs of our healthcare. A yearly cap on the out-of-pocket payments on Medicare Part D would be a much more effective long-term solution to those who really need help with the tens of thousands they pay each year for their prescription drugs.

Somehow, we must put safeguards around these various testing programs. They should be transparent, have continued congressional oversight, have clear goals and published updates, be available to testify at congressional hearings, and have committee hearings before a rule is finalized. Unilaterally changing Medicare is not the way we should be operating. The checks and balances inherent in our government have worked for over 200 years. As you communicate with those who represent you, either directly or through your vote, remember how important it is to make sure that any changes to Medicare go through the same approval process that brought us this great benefit.

Get your flu shot and stay healthy, Thair



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The President Releases a Hurtful and Ill-timed Executive Order

As we all feared the President released an Executive Order (EO) last week that imports foreign drug pricing, an ill-advised and shortsighted method to lower drug costs. This EO is even worse than the proposed order that was released in July in that it also includes Medicare Part D drugs. It expanded from targeting drugs administered at the hospital or doctor’s office to those Part D prescriptions you get at your local pharmacy. This is a dangerous escalation.

This EO uses the term favored nation as a way to identify the foreign nations used for setting American drug prices. What it really does is import the socialistic, government dictated, access-controlled, pricing schemes of these so called “favored nations”, nations we have historically condemned for these very practices. I have said it before and will say it again, price controls don’t work, no matter what foreign country we seek to emulate.

It amazes me that the President has decided to release this innovation-limiting EO at the very time that we need all the innovation we can get to battle the COVID-19 pandemic. Even worse, it will depress innovation long term, meaning the new cures and vaccines we will need for the next pandemic-causing virus may not be available when we need them.

I don’t like the fact that Americans have been footing most of the bill for innovation but there are many other tools that can be used to accomplish this goal. This hurtful and ill-timed EO capitulates to the heavy-handed schemes used by foreign countries rather than using other tools, like proven free market policies and trade agreements, to level the playing field.

I’m asking you to speak out. Use whatever communication method you feel most comfortable with to tell your Senators and your Representative that this Executive Order is ill-timed and hurtful to older Americans. I like the fact that America is the center for new drug discovery, and we are often the first to get access to these lifesaving and life changing treatments. This Executive Order threatens the very foundation of this innovation that has changed our lives. Washington needs to know now how you feel. I urge you to make your voices heard.

Thair



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Upcoming Webinar/Tele Town Hall

Latest Survey Results, Medicare Part D, Prescription Drug Program
This Wednesday, September 16th, at 4:00 p.m. ET, Medicare Today’s Seniors Speak Out will conduct another webinar town hall. This virtual town hall will discuss the results of our yearly survey on Part D, the Medicare prescription drug program. We have always thought it was important, through a survey each year, to take the pulse of seniors concerning their feelings about Part D, a program that continues to have a huge impact on the wellbeing of older Americans.

Those of us that were around in 2002 and 2003, when this new program was hotly debated, remember the doubters who predicted that the new program wouldn’t offer enough choices in rural areas and that the costs would balloon out of control. Today, in one of our most rural of states, Montana, there are 17 different plans to choose from. As for the cost, Part D is the only government program, that I know of, that not only came in under its initial estimate but 30% below that estimate.

There have been, over the years, changes to Part D, some good and some bad, but it remains a success in improving the health and well being of seniors. There continues to be proposed changes . . . we have worked hard to keep you informed about the impact on you of these proposed changes. We also know that we need to continually let you speak out, through seminars, surveys, tele town halls, etc. so we can monitor your feelings about Part D. We don’t want to become complacent in safeguarding this life saving and life changing program.

Our tele town hall this Wednesday, September 16th, will discuss our latest Part D survey. We’ll cover the results, especially as they relate to the current crazy times we are living in. It will also give you a chance to ask questions about the survey and the program itself. It will give you a chance to speak out and tell us how you feel about how Part D is working for you.

I will be one of the presenters at the tele town hall along with Jennifer MacDonald, a Director at Morning Consult, a data intelligence company. It will start at 4:00 p.m. ET on Wednesday, September 16, 2020. We hope you can attend. You can register by clicking the link below:
https://zoom.us/webinar/register/WN_vmMKJHrPQNm7LIjNk4hx4A
After registering, you will receive a confirmation email containing information on joining the webinar.

Don’t miss out on this chance to speak out about this important prescription drug program.

Best, Thair



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This month is Healthy Aging Month

This focus on healthy aging started over 20 years ago as the baby boomers began to turn 50 and it became evident that getting old had a bad reputation. The ornery, bent over, lap blanket, picture of anyone over 50 needed to be changed. Everyone’s attitude toward getting old needed to be updated. I’ve had the patch below hanging in my office for a long time.

I’ve always looked at it as a testament to a great plane, one that I happen to have over 2,000 hours in as an Air Force bombardier, but it’s also an indication of the understood distrust most people had in people over 50. It was this type of attitude that needed to be changed. President Reagan’s age, he was 69, became quite a discussion item during his campaign for President. The average age of the two candidates running for President right now is 75.5. Hopefully, America’s attitude about age is becoming more positive but the most important attitude about getting older is our own. Healthy aging is much more than our physical health, it’s how we look at each day when we rise in the morning and how we evaluate our day as we go to sleep at night.

I always enjoy getting tips about how to play better golf and I found these great 10 tips on the healthy aging website. I liked the straightforward way they presented the 10 ways we can change to live a more positive, healthy life. So, here are 10 tips for reinventing yourself:

1. Do Not Act Your Age

Do not act your age or at least what you think your current age should act like. What was your best year so far? 28? 40? Now? Picture yourself at that age and be it. Some people may say this is denial, but we say it’s positive thinking and goes a long way toward feeling better about yourself. (Tip: Don’t keep looking in the mirror, just FEEL IT!)

2. Be Positive

Be positive in your conversations and your actions every day. When you catch yourself complaining, check yourself right there and change the conversation to something positive. (Tip: Stop watching the police reports on the local news).

3.  Ditch the Negativity

Have negative friends who complain all of the time and constantly talk about how awful everything is? Drop them. As cruel as that may sound, distance yourself from people who do not have a positive outlook on life. They will only depress you and stop you from moving forward. Surround yourself with energetic, happy, positive people of all ages and you will be happier too. (Tip: Smile often. It’s contagious and wards off naysayers.)

4. Walk Tall

Walk like a vibrant, healthy person. Come on. You can probably do it. Analyze your gait. Do you walk slowly because you have just become lazy or, perhaps, have a fear of falling? (Tip: Make a conscious effort to take big strides, walk with your heel first, and wear comfortable shoes.)

5.  Stand Tall

Stand up straight! You can knock off the appearance of a few extra years with this trick your mother kept trying to tell you. Look at yourself in the mirror. Are you holding your stomach in, have your shoulders back, chin up? Check out how much better your neck looks! Fix your stance and practice it every day, all day until it is natural. You will look great and feel better. (Tip: Your waistline will look trimmer if you follow this advice.)

6. How Are Your Pearly Whites?

How’s your smile? Research shows people who smile more often are happier. Your teeth are just as important to your good health as the rest of your body. Not only is it the first thing people notice, but good oral health is a gateway to your overall well-being. (Tip: Go to the dentist regularly and look into teeth whitening. Nothing says old more than yellowing teeth!)

7. Lonely?

Stop brooding and complaining about having no friends or family. Do something about it now. Right this minute. Pick up the phone, landline, or cell and make a call to do one or more of the following: Volunteer your time; take a class; invite someone to meet for lunch, brunch, dinner, or coffee. (Tip: Volunteer at the local public school to stay in touch with younger people and to keep current on trends, take a computer class or a tutorial session at your cell phone store to keep up with technology, choose a new person every week for your dining out.) [You may have to be creative during these times of COVID-19 but there are many safe ways we can volunteer and touch other people’s lives.]

8. Walk 10,000 Steps A Day

Start walking not only for your health but to see the neighbors. Have a dog? You’ll be amazed how the dog can be a conversation starter. (Tip: If you don’t have time for a dog, go to your local animal shelter and volunteer. You will be thrilled by the puppy love!) Make it a goal to walk 10,000 steps a day. Want to lose some weight or belly fat? Make it 15,000. You can do it!

9. Get Those Annual Check-Ups

Make this month the time to set up your annual physical and other health screenings. Go to the appointments and then, hopefully, you can stop worrying about ailments for a while. [Also, make sure you get your needed vaccinations.]

10. Find your inner artist.

Who says taking music lessons is for young school children? You may have an artist lurking inside you just waiting to be tapped. Have you always wanted to play the piano, violin, or tuba? Have you ever wondered if you could paint a portrait or scenic in oil? What about working in wood? (Tip: Sign up now for fall art or music classes and discover your inner artist!)

I think these are great ways to reinvent ourselves. It’s a good time to disprove the negative saying, “you can’t teach an old dog new tricks.” It’s a good time to show everyone that your lifetime of experience is a good reason that they can trust someone over 50, over 60, over 70, etc. Fall is the time that the kids go back to school, it’s a good time for us to get busy and reinvent ourselves.

Best, Thair



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A Birthday Check List

It’s the end of the summer and for me that means another birthday. In fact, my birthday is today. As I was musing about how old I’ve become I thought there had to be something productive I could do other than wish I was younger. And, as you might have guessed, I thought that maybe a birthday was a good time to do some things that will help us stay healthy and happy and might make a for a helpful blog. We all know to change the batteries in our smoke detectors when we change the clock to, or back from, Daylight Saving Time. It’s a great way to keep our houses safe. So why not use our birthday as a reminder to do some other things that not only keeps us safe and healthy but also maybe a little bit richer. You might have some more things to add to the list, I’m always open to comments with suggestions. Here’s my list . . .

Get your yearly physical – This reminder is almost as common as the smoke detector batteries, but I think it might be the most important item on the list. Many of us have been self-quarantining, which has kept us away from the doctor’s office. I just got my physical and our care givers are really good at keeping us safe. They take everyone’s temperature, we go through a check list to see if we might be a COVID-19 risk, and everyone wears a mask and makes sure we are wearing ours. They clean everything between patients. I felt safe wherever I went. Getting a yearly physical exam is the best thing we can do for our long-term health.

Review your immunization needs – Part of our yearly physical should include gathering and reviewing our immunization records and finding out what immunizations we might still need. Click here to go to my recent blog about immunizations. It has links to some great sites to help you determine what vaccines you need. If you don’t have your immunization records, request them when you visit the doctor. Many doctors’ offices have online portals that give you access to your health records. One way or another, get a copy and keep it in a safe place.

Review your Medicare Part D drug coverage – While your birthday may not coincide with the Part D annual enrollment period (October 15 to December 7), your birthday is not a bad time to get your prescription drug information together. It’s a good time to update your information with any changes you’ve had to your medications.

Actions required on important birthdays – As we get older there are some important birthdays that needs special scrutiny and possible important action. The important date for Medicare is 65, that’s when we need to sign up and register for Medicare and decide whether we want to use Medicare fee-for-service or Medicare Advantage. Even if we are still working and have private insurance there are still actions that we must take.  Go to CMS.gov to find out about your Medicare benefits. There are other important birthdates, 62, 66 and 8 months to 67 (depending on your birth year), and 70. These are birthdays when you can elect to begin receiving Social Security (SS). There are a lot of variables that go into when you should begin taking Social Security. Before your 62nd birthday make an appointment to talk with a SS representative. In these times of the COVID-19 virus, it might be difficult to meet in person but don’t put off finding out all about this important benefit.

Inventory your medicine cabinet – Your birthday is a great time to inventory your medicine cabinet. It’s a good time to get rid of old medicine, both prescriptions and over the counter medicines. Many pharmacies will help you dispose of old medicine. Don’t flush it down the toilet or throw it in the garbage. We want to safely remove it from the environment. Now, I need to talk about a touchy but important topic. Many people suffer from drug addictions. We have all heard of the alarming increase in opioid addiction in our country. Unfortunately, a common way these drugs are obtained are by friends and relatives stealing prescription drugs from someone’s medicine cabinet. Having a medicine cabinet lock helps prevent this problem while also keeping these medicines from unsuspecting children. At the very least, monitor who has access to your prescription medicines.

Review your financial health – Being financially secure helps both our physical and mental health. You should review your finances with a trusted advisor. It’s up to you who you deem trustworthy, but it is a place to be very careful. Unfortunately, there are people out there who prey on older people and find ways to rob them of their savings. It’s always a good idea to have a third party, unconnected with your trusted advisor, independently review any actions with your savings. Due to the COVID-19 impact on the economy and investments it is especially important to review your finances. It’s also a good time to go over your non liquid assets, like property, jewelry, etc. A balance sheet to identify your net worth helps you understand your financial standing.

Inventory your passwords – This might seem like a trivial item but many people’s identity and ultimately their money are stolen because a person used common passwords or made access to their passwords easy. Find a smart computer person to help you set up a secure password vault and, after it is set up, change all of your passwords. There are vaults that only require you to remember one password to get into the vault, and they have all of your other passwords.

I’m sure you can think of other things that should be done at least once a year. I suggest creating a check list. Unlike my keys or my cell phone, my birthday is one thing I don’t forget. Use that fact to help you remember some things that may be even more important than your birthday.

Be safe and register to vote, Thair



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Our Legislative Focus

As summer wanes and fall begins to come into focus, it’s time to look ahead to the healthcare legislative issues that could come into play. With campaigns heating up and the debates beginning, you can guarantee that promises will be made and accusations leveled concerning your healthcare. Some of the issues that will be brought up might have a small chance of actually being implemented, but this doesn’t mean that we shouldn’t pay attention. In the past, seemingly long shot proposals have become late night trading fodder when politicians make deals on far reaching legislation. Many of the issues I’ll talk about today were thought to be not-starters a few years ago and now they are political realities. What I will do is offer a simple explanation of each issue, give you an idea on how it could affect you and how likely I think it will be to be implemented. I’ve written an earlier blog about many of these issues. You can look through recent posts to get a more detailed explanation of some of the issues.

International Pricing Index/Favored Nation Pricing

Background – In an effort to lower drug costs some in Washington (most recently the President) have proposed that we fix the cost of a drug to the lowest price a “favored nation” paid. As I’ve explained before, price fixing has never been a long-term solution to any cost problem. There are better ways to have other nations share in the costly research and development that goes into discovering and manufacturing prescription drugs.

Impact – If this approach is implemented the supply line safety that we have enjoyed over the years will be jeopardized with no guarantee that any savings will make its way to you.

Chance of Implementation – While this idea has been around for at least a couple of years, its chances of becoming a reality have gone up. It would be difficult to implement and the chance of unintended consequences high. This makes its implementation politically unpopular but a great thing to talk about during debates.

Importation

Background – This issue has some of the same characteristics as the international pricing index. The goal is again to lower drug prices by allowing importation of these drugs from Canada. I talked about this proposal in my earlier blog explaining how it bypasses the safety net we now enjoy without any proof that the patient will see any savings while counting on Canada to implement a program that they have already said they can’t support.

Impact – While you or someone you know has gone across either our southern or northern boarders to purchase medicine at a lower price, this is not what this proposal is about. This importation proposal is at a much higher-level involving suppliers and transporters and large volumes. Some states have passed laws allowing importation but none of them have been implemented.

Chance of Implementation – This approach has been around for many years and no one yet has found a way to safely implement it. A pilot program of some sort may be started but it will take some real political will to make it happen.  Canadian officials have indicated they will not support it. However, the chances of it happening are much more likely than they were just a few years ago. This is one of those solutions that may gain some traction.

Changes to Medicare Part B

Background – The price of drugs administered and paid for under Medicare Part B have increased substantially. These are drugs that are often injected at a doctor’s office for serious diseases like cancer and many types of autoimmune diseases. A proposal to fix the cost of these medicines has been put forth. This approach would go against the market-based approach that is now in place. It would impact many of the doctors who perform these services and upend and regulate this vitally important portion of our healthcare. Again, fixing prices has never been and efficient, long range solution.

Impact – If implemented, this approach would change the economics of this vital service. Any savings to the patient has been hard to quantify but it would most certainly put pressure on already pressured neighborhood practices. Losing these close, more accessible, services would have serious consequences.

Chance of Implementation – Part B drug prices have become a focal point for people seeking solutions to increased costs. We need to correct the underlying parts of the system rather than using a sledgehammer to bludgeon one part of the business.

Part D Cap

Background – Almost all of us, either in private insurance or Medicare or Medicare supplemental insurance, have experienced caps on our healthcare out-of-pocket costs. It helped us budget our money, we even decided what type of insurance to buy based on the yearly cost caps. Medicare Part D has no such caps. Depending on what prescription drugs, we need we may have out-of-pocket costs that balloon to the tens of thousands a year.

Impact – While we have been against the other proposed changes, a Medicare Part D cap would have a huge impact on those of us who are already retired and everyone younger as they plan for their retirement. I’ve known people, maybe you have also, who were living comfortably until an illness struck and their drug costs forced them to tap into their retirement. The peace of mind that a cap on our drug costs would give all of us, whether planning for or already retired, would be immense. This a change that is worth fighting for.

Chance of Implementation – This change is gaining some traction. While it probably won’t be something that is done on its own, it is a change that could be incorporated in some larger legislation as a balance or concession to reach final approval on the bigger legislation. It would be a most welcome change.

It is guaranteed that there will be other changes to our healthcare put forth as we near election day. We will keep you up to date on each one, explaining in simple terms what the change is and its impact on you. There is one over all criteria that I would like you to consider. Making short term, knee jerk, politically popular, changes is not the answer. Trying to band aid or quick fix a broken process never ends well. We need to fix the underlying problem, simplify the process, and let the free market drive us to the most effective, cost efficient solution. I believe the reduction of administrative overhead and regulations is a big step toward this goal. Measure each change to see if it offers simplicity and transparency in its solution.

Let’s stay informed as we approach this critical election. Get involved, tell those in Washington how you feel. Also, get registered to vote and then vote! It’s one of the most powerful things we can do.

Thair



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News Break!

NEWS Break!

A new bill has been introduced that focuses on the very thing yesterday’s blog talked about, the importance of getting your immunizations this fall. It is heartening to know that some in Washington understand the importance of getting immunized for flu, pneumonia, etc. during the pandemic. This bill is H.R. 8061, the Community Immunity During COVID-19 Act. We ask you to encourage your Senators and Representative to support this initiative.



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National Immunization Awareness Month

This month is National immunization Awareness Month. For over twenty years, in one capacity or another I’ve been encouraging mature Americans during this month to get their shots, especially their flu and pneumonia shots. It has always been difficult to get people interested in getting vaccinated for sicknesses that become prevalent in the fall, so it’s pretty strange that this year all we’ve been talking about is vaccines and when one will be available for COVID-19. While this is good, I’m worried that we might forget that there are already vaccines available for other illnesses and we need those even more this year.

We’ve been sequestered and socially distanced for almost 6 months. We’ve delayed or cancelled non-emergency doctor visits and it looks like we’ll continue on this path into the fall. What we can’t lose sight of is the increased importance of getting your needed vaccinations this year. The worst outcome I can think of is catching the flu or pneumonia and then catching COVID-19. The CDC (Centers for Disease Control and Prevention) makes the following statement about your flu shots and COVID-19.

“There is no evidence that getting a flu vaccine increases the risk of getting COVID-19. There are many benefits from flu vaccination and preventing flu is always important, but in the context of the COVID-19 pandemic, it’s even more important to do everything possible to reduce illnesses and preserve scarce health care resources.”

For you who get your required shots every year, good job, continue on. For those of you who just couldn’t seem to find the time each year to get your shots . . . change your ways. This is the year that you need to get protected. Call your doctor and talk with him/her about what immunizations you need and then discuss the best social distanced way for you to get immunized.

As always, I have links to information to help you. These links are all on the CDC web site. The first link, click here, is to a page that tells you all about vaccines that adults need. One of the important links on this web page is to the adult vaccine self-assessment tool that can help you find out what vaccines you may need.

If you want even more detailed information about vaccines, you can click here. This link should satisfy even the most detailed oriented amongst us.

We’ve done a lot of things to stay healthy during these interesting times. Now is not the time to let our guard down. While we hope that a vaccine for COVID-19 will soon be available, we shouldn’t pass up the chance to get inoculated with vaccines that are already available and are critical to keeping us healthy in these unhealthy times.

Call your doctor, get scheduled for your shots in September or October at the latest. It’s important and can save your life or the life of a loved one.

Thair  



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Medicare Today – Tele Town Hall Overview

On July 29 we had another Medicare Today town hall. Our guest was Shalla RossPresident of the Ross Group, LLC.  We shared our perspectives on likely legislative and regulatory action for the remainder of the year related to Medicare and provided an overview of the electoral atmosphere concerning healthcare and how it might impact Medicare after the election.

Shalla went through a few slides as she discussed what we might expect from Washington both before and after the election. She offered some great insights on what changes were and were not in play. I won’t recap that portion of the town hall. You can click here to see the entire town meeting; it’s a little over 30 minutes long. I will spend some time talking about the questions that were asked and expanding on the answers when appropriate. We had some excellent questions, and is evident that the preservation and efficacy of our healthcare is on everybody’s mind.

The first question asked if the President’s executive order directing the use of the International Pricing Index (where the price of a drug is fixed at the lowest price that a foreign country pays) will have an adverse effect on small pharmaceutical companies. We answered that it would have a chilling effect on all research and development and pointed out that price fixing never has worked. On reflecting more on this question, I would like to note that the world’s reaction to the COVID-19 pandemic is an indication of how important the private, free market is to the development of new drugs. To date 661 unique drug programs have been launched to combat COVID-19. Over half of these programs originated within the United States and 70% of these were started by small biopharmaceutical companies. If, through price fixing, our government imposes itself into the private, free market drug development system, this type of responsive innovation will be lost, and the first to be impacted will be the small companies.

The second question asked about the importation portion of the President’s executive orders. I answered by saying that importation is now and always was a bad idea. Importation has always been an option if the secretary of Health and Human Services would certify to guarantee its safety. No HHS Secretary, under any administration, has done that. This approach would bypass that safe, established supply line. Canada, the country from which we would import these drugs, has said that they couldn’t guarantee the safety of the drugs and they couldn’t logistically support this type of importation. Finally, our own accountants, the Congressional Budget Office could not find there to be any substantial savings through importation. There just seems to be a bunch of reasons not to attempt this dangerous approach.

A question was asked about changes to Medicare. The person said they had heard that there were changes coming to Medicare. We answered that there were many proposed changes but no substantial changes so far. We did acknowledge that more flexibility has been given to Medicare Advantage programs as Medicare tries to transition from a fee for service approach to a value-based approach. I do want to add that as we get closer to the November elections you will hear more and more rhetoric about our healthcare. Candidates will make promises and accuse their opponents of cutting Medicare. We will stay up to date on the rhetoric here at Seniors Speak Out and sift the wheat from the chaff and help you identify what is important and what is election year hot air.

A question was asked about any positive changes to Medicare Part D, Medicare’s prescription drug program. I answered that the biggest improvement that I could see was to put a cap on the yearly out-of-pocket costs for drugs. It makes so much sense. It would give people the peace of mind they deserve as they plan for, or are already in the midst of, retirement. We’ll talk more about Medicare Part D in our next town hall on September 16 now at 4:00 PM ET. You can register here.

The final question asked if the cost of getting a drug approved by the FDA was a reason that drug prices were high. We pointed out that the FDA was the gold standard for drug safety. We feel safe in taking new drugs because of their reputation. Getting a drug approved in this country is a billion-dollar undertaking but the safety and efficacy of these new and ever more complicated drugs is worth it. Investors wouldn’t invest money if there was something more than a very small chance of problems after approval. The FDA is recognized and respected worldwide. Having said that, there is administrative red tape that is costly and could be improved. An increase in transparency could speed up approvals. There are unique pipelines that could be developed that would speed up approvals and lower costs. These types of improvements should be explored. Reducing costs anywhere in the research and development cycle could have a positive impact on drug costs.

I appreciate your interest and great questions at these tele town halls. I wish I could get out to talk to you in person and listen to your opinions and questions face to face. The sooner we can beat this pandemic the quicker that can happen. Thanks for your interest, I hope your summer is going great.

Thair



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Happy Birthday Medicare

A few days ago, July 30 to be exact, we celebrated the 55th anniversary of Medicare and Medicaid. Most of us were pretty young to remember this important even,t but it has had a tremendous impact on our lives.

Before Medicare, about half of those 65 and older did not have any health insurance; they were one illness away from bankruptcy. Today, over 99% of seniors have health insurance. The signing of the amendments to the Social Security Act, on July 30 1965, gave birth to Medicare, and was the culmination of almost a decade of effort to give older Americans the safety of health insurance. It was signed into law by President Lyndon Johnson in the Harry S. Truman library. President Truman and his wife, Bess, were present at the signing and were the first to sign up for the new program. One important and often overlooked fact about the Medicare program was its role in spurring integration. Medicare would not pay providers, hospitals, physicians, etc. unless they were desegregated. This had quite an impact on our society in 1965. Medicare has been changed and expanded over the years. One of the biggest changes was the addition of prescription drug coverage, Medicare Part D, in 2003, by President George W. Bush.

Medicare consists of four main areas:

  • Part A, Hospital/Hospice Insurance – This covers most inpatient hospital services when the patient is admitted to the hospital.
  • Part B, Medical Insurance – Covers outpatient costs including doctors, medical equipment, tests and medicine administered by the doctor.
  • Part C, Medicare Advantage – This addition to Medicare was passed in 1997 and gave beneficiaries a choice to move from fee-for-service insurance to a coordinated care approach that now incorporates health and prescription drug insurance.
  • Part D, Prescription Drug Insurance – Covers most self-administered prescription drugs.

You can find out more about Medicare by clicking here to go to our short Medicare 101 video on the basics of Medicare.

Over the years, Medicare has made a huge impact on our quality of life. It has allowed us peace of mind as we neared retirement, helped us stay active and sometimes even saved our life. By having this insurance, we can get the care we need before our health problems become serious. One example of this improvement is the reduction of trips to the hospital that occurred when Part D was passed and people had increased access to prescription drugs. It is important that we encourage our government to continue to support this critical program. As we continue to live longer, the demand on the program has increased. Medicare is not sustainable unless we make the necessary financial arrangements to ensure it is there for our children and grandchildren.

At the risk of telling you how old I am, I’ll tell you that I turned 17 a month after Medicare was born. I don’t think I paid any attention to its birth, but I did notice pretty quickly, as I started working, that there was this sizable deduction in my pay check, part of which went into the trust fund to finance Medicare. As I found out more about the program, I came to think this money I was giving the government was like a contract. If I gave them part of my hard-earned money every month, they promised that when I turned 65 they would provide me with basic high quality healthcare that was reliable and accessible. We should expect our government to remember this promise 55 years later.

As health costs increase, politicians, especially as they run for office in the next 100 days, will offer many changes and so-called improvements to Medicare. It will be difficult, but important, to wade through their rhetoric and ascertain the true nature of their proposals. We should expect everyone that runs for office to remember the promise they made 55 years ago. We count on Medicare and expect it to be there when we need it.

I think we all can say happy 55th birthday to this life improving and life saving program. It made an immediate impact to my grandparents’ lives in 1965, to my parents’ lives 15 years later and to my life 48 years later. We all need to tell those who represent us in Washington that we need them to maintain this critical program. We also need to tell those who are running for office that we expect them to preserve the reliability, accessibility, and quality of Medicare.

I hope you’re staying safe and finding joy in these unique times.

Thair



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Executive Orders on Drug Prices

Last Friday President Trump signed four executive orders aimed at lowering drug prices. These executive orders are not small tweaks, they are big changes, changes that could have a long-term effect on both the safety and future innovation of your prescription drugs.

Many have already questioned both the timing and rhetoric surrounding the signing of these four executive orders. I will let others delve into those issues. I will go over the executive orders with an emphasis on their likely impact on you.

These changes were not a sudden brainstorm of the White House, they have proposed some form of three of the four approaches to lowering drug prices for over two years. It is worth noting that the President altered some of the earlier approaches in these latest executive orders. If you’d like some background information on who the players are in our healthcare system you can click here to access one of my earlier blogs.

Now, let’s dive into these four executive orders –

Importation – This proposal would give states, pharmacies, and drug wholesalers the right to import drugs from Canada. The administration thinks this would offer lower prices to the states, pharmacies, and drug wholesalers. Our own Congressional Budget Office (the bi-partisan government agency that calculates the economic impact of proposed government legislation, regulations, and executive orders) found, when this approach was first proposed, that there were no savings resulting from this type of importation. Furthermore, the Canadian government said that they would not and could not support this type of importation and would not guarantee the validity of the drugs obtained this way. It is also unsettling to know that this approach would bypass the United States’ established and proven safe supply lines. We know how many scammers have sprung up during the coronavirus pandemic, can you imagine what would happen if these same criminals could infiltrate our prescription drug supply lines through this type of importation? It seems that this approach threatens our safety without offering any savings. This doesn’t sound like a good idea to me.

Rebates – This executive order would resurrect an approach that would move rebates paid by drug companies closer to the patient. While there are perverse incentives in our drug supply line that have produced higher list prices without necessarily lowering the cost to patients, this may not be the best way to solve this problem. The drug supply line is complicated, and this approach would be extremely difficult to implement and there is no guarantee that any of the savings would reach you, the patient. President Trump introduced this approach last year and then rescinded it. It is interesting that it suddenly has reappeared.

International Pricing Index – This is another approach that has been around for years and this latest approach, called “the most favored nation” in the executive order, is even worse than the original proposal. It fixes the price of a drug at the lowest price of one or more of the “favored” nations. This is price fixing at its worst. We are setting a price based on countries with single payer systems, where the government dictates who gets what medicine. The patients in these countries wait years for new medicines. Of the 74 cancer drugs launched between 2011-2018, 95% are available in the United States, compared with 74% in the UK, 49% in Japan, and 8% in Greece. While it is wrong for these countries not to help pay for the research and development of drugs, there are other ways to approach this problem rather than disrupting an industry that has year over year produced lifesaving and life altering drugs and is right now in an all-out effort to find medicines and vaccines to treat the COVID-19 virus. Fixing prices is short sighted and has never worked as a viable economic solution. The industry disruption and the projected reduction in innovation will affect us all. This lack of new drugs might have a direct effect on you or your loved ones. The one thing we shouldn’t limit is our hope for future cures.

Insulin Discounts – This program requires drug manufacturers to give huge discounts to hospitals and community centers who serve the poor. Insulin prices have skyrocketed and has jeopardized the access to this life saving drug. One proposed solution is the Part D Senior Savings Model (see my recent blog here). A program to limit the cost of insulin to the poor and indigent could be added and tested in this model rather than relying on the 340b program to administer this approach. The 340b program, is a government entity that grants huge discounts for providers who serve the poor and indigent. There are solutions to providing diabetics with affordable insulin. An executive order dictating this implementation may not be the best solution, especially at this time.

As you can see, these proposed solutions are not what we need to improve our healthcare. There are workable solutions that could be developed in the arena of bi-partisan cooperation, one of the few areas where this might be the case. An approach that includes more than just the executive branch of our government might produce the workable solutions we are looking for. We need to tell those that represent us in Washington that the four executive orders are not the solutions we need to improve our healthcare.



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The Medicare Part D Senior Savings Model

Lowering drug prices has been a lot like Charles Warner’s quote, “Everybody complains about the weather, but nobody does anything about it”. Doing anything about drug prices has been as difficult as changing the weather, primarily because it is complicated. I have always been a champion of the free market, it was this market competition that has kept Medicare’s drug insurance costs low. But, as always is the case in healthcare matters, there must be regulations and guard rails established that will ensure safety and access. Part D, Medicare’s drug insurance program, is a government program and the government, through legislation, regulation and rulemaking, is responsible for maintaining the safeguards and guard rails in Part D. Access, as it pertains to prescription drugs, has often been impacted by the out-of-pocket costs paid by the consumer. It was this out-of-pocket cost that caused the consumer to walk away from the drug store counter without their prescription drugs.

Often the drug price rhetoric focuses on a drug’s list price, or the rebates paid by different entities in the supply line, or what percentage of the cost that manufacturers and insurance companies pay during the different phases of Medicare Part D . . . but my focus, as it always will be on Seniors Speak Out, is on you, the patient. What will any proposed change do to the amount of money you spend on your healthcare. There is such a change that has been proposed that will address the out-of-pocket costs paid by consumers for insulin, it is the Medicare Part D Senior Savings Model.

This Savings Model addresses a problem with the rapidly escalating consumer cost of insulin. These rising costs have forced patients to make difficult decisions on what to eliminate from their life to pay for their insulin or, in some cases, forced them to ration or curtail their insulin use. Controlling diabetes is essential for the overall health of those with this disease. Uncontrolled diabetes threatens every other aspect of a patient’s health. Ensuring a diabetic had access to his/her required insulin will have a huge effect on their overall health and save money in the long run. It made sense to attack these suddenly skyrocketing costs quickly.

CMS, the Centers for Medicare and Medicaid Services, proposed the Savings Model as a test of a change to the pricing of insulin that would lower the cost to the patient. It would cap the out-of-pocket costs for insulin to $35 per month, regardless of which phase of Part D coverage the patient is in and is predicted to save $446 dollars a year. This is significant and especially important given the fluctuations in cost that patients have seen depending on which phase of coverage they are in. The chart below shows that a patient may see big out-of-pocket costs early in their year of coverage. This front loading in cost would be the logical point where insulin use would be rationed or stopped. This interruption could have long range effects on health that might not be alleviated later in the year when the costs would come down and usage would return to normal. The long-term damage to the patient’s health would have already occurred. The proposed model would smooth the costs into a predictable, affordable, monthly outlay that could be budgeted.

There has been widespread acceptance of this model. As of now, an estimated 58% of people currently enrolled in Medicare Part D are covered by plans that will institute the Senior Savings Model. The model is scheduled to be implemented starting January 1,  2021, which means it will be important for those who use insulin to review their coverage during this year’s open enrollment or sign-up period (October 15 to December 7, 2020) and ensure they enroll in a Part D plan that is participating in the Senior Savings Model.

While this model will test that the desired outcomes are realized, it is important that significant information is gathered so that changes can be made and opportunities for increased efficiencies recognized when the final policy is implemented.

I hope that those of you who use insulin will see your costs reduced, smoothed out and predictable as this model is implemented next year.

Thair



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Reopening – Staying Safe and Healthy

The pandemic is still with us . . . I’m not sure any of us thought that statement would be in our vocabulary in January, but it is and it will be true for a while more. Now is a good time to review where we are with COVID-19, what should we be doing to stay safe and how do we continue to stay healthy.

Shutting down our economy seemed to work initially but the often talked about resurgence, as we reopened, has come true. Many states are breaking records for new cases and the resulting deaths, while lagging somewhat, have begun to rise. Our Government, both at the Federal and State level, have been trying to balance the reopening of our economy with the risk of citizens catching the COVID-19 virus. They realized that keeping our economy shut down ran the risk of pushing many to poverty and the ensuing health risks that always followed. The stimulus checks and other programs cannot be sustained, and if the shutdown were continued it wouldn’t be long before the economy was irreparably damaged. These are unknown waters that our country has been thrown in; there are no operator’s manual on pandemics, at least not yet. So . . . what should we be doing as we continue down this long road back to normalcy.

We all should know by heart the pandemic safety mantra, wear a mask, social distance, wash your hands often. This still applies and is even more important as things begin to open up and some of those around us have let their guard down and aren’t practicing these safety measures. As things open up we might be asking ourselves, “what is safe to do? are some things safer than others?” The Texas Medical Association ranked nearly every activity—from opening your mail to going to a bar—by their risk level. In their calculations they assumed that everyone was following the three safety measures listed above. Click here to see the chart. As you can see, gathering indoors in large groups is the most unsafe activity, and anything outdoors is much safer. You might consider small outdoor gatherings for you and your family, still following the safety rules, as a way to finally see loved ones. One of the first activities to reopen was golfing. I know personally that being able to go out and golf saved my sanity. Hopefully, the low risk things on the chart will offer us some small sense of normalcy.

 Finally, I want to remind everyone that keeping yourself healthy should be priority one. That means taking your medicine as instructed and seeing your doctor. The chart showed the risk level of going to the doctor as a level four, relatively safe. Seeing your doctor, when necessary, should not be postponed. Having said that, there are alternatives available that might accomplish the same thing as a doctor visit without leaving your home. Next time you need to talk to your doctor, ask about the possibility of a telehealth appointment. Many health processes can be done over the phone or through video conferencing. A few months ago, Zoom was what the grandkids did when they came to visit. Now, many of us found out it was a way we could see and talk to them while we are quarantining. Whatever you do, don’t miss seeing your doctor, either in person or on the phone or through video conferencing.

A lot is happening in our country. As you try to make sense of it all, don’t forget that your health is priority one. Keep healthy and stay safe.

Thair



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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.