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Who is Really Cutting Medicare?

President Biden’s State of the Union address had a very interesting back and forth concerning either party’s willingness to cut Social Security (SS) and Medicare. The President accused the Republicans of planning to cut these important programs and some in the audience said he was misinformed (OK, some called him a liar). In the end the President determined that neither Republicans nor Democrats would cut these programs. Unfortunately, it seems that neither side is convinced the subject is dead.

While the President is still talking about the Republicans cutting SS and Medicare, he hasn’t identified any direct planning documents or legislation that indicates the Republicans have some concrete plans. On the other hand, the Centers for Medicare & Medicaid Services (CMS) has introduced some proposed rules, that the Biden administration supports, that will cut Medicare beginning next year. Those cuts on will lower the benefits or raise the premiums on almost half of the Medicare recipients. My focus here isn’t on Democrats or Republicans – it’s on Medicare cuts that will affect older Americans in 2024.

We need to have some basic understanding going forward to really understand what this means. As we all know, Medicare is available to everyone over 65 but each of us has a choice on how we will receive those benefits. We can sign up to traditional Fee-for-Service Medicare and, if we choose and pay a premium to enroll in supplementary insurance that will reduce our out-of-pocket costs, or, we can sign up for Medicare Advantage, which is another way to receive our Medicare benefits. The point is, Medicare Advantage is Medicare. If you are cutting Medicare Advantage, you are cutting Medicare.

Bear with me while I explain how Medicare Advantage operates. CMS has authorized private insurance companies to assume the responsibility for covering all the Medicare benefits for seniors, and this is called Medicare Advantage (MA), or sometimes called Medicare Part C. The government pays the insurance company a set amount for providing these benefits. This set amount is determined by determining the average cost for each beneficiary under traditional Medicare and then the insurance companies make competitive bids on what they will charge to provide coverage. This year the average bid was 83% of the traditional Medicare cost. The MA insurance company then will get a rebate of the difference, 17% in this case, to use for added benefits or lower premiums. As you know, there is a lot of competition during the open enrollment season to sign you up to a MA program. This competition has led to some added benefits and low premiums to the extent that almost half of the Medicare eligible seniors have chosen Medicare Advantage.

It’s important to note some important points concerning Medicare Advantage:

  • An estimated 52% of MA beneficiaries live on an annual income of less than $25,000, compared to 38% of fee-for-service Medicare beneficiaries.
  • Almost 34% of MA beneficiaries are minorities, compared to 16% of traditional Medicare.
  • A larger percentage of Latino and black beneficiaries choose MA than the white population.
  • MA beneficiaries with prediabetes were diagnosed nearly 5 months earlier than traditional Medicare.

I’m not here to sell Medicare Advantage. MA isn’t for everyone, but, as you can see, MA serves an important segment of older Americans, and it is Medicare for almost half of America’s seniors and shouldn’t be subject to cuts.  

These cuts will come in a few different ways. One of these is a series of complicated changes in the payment model which will, in the end, reduce the rebate the insurance companies get for charging less than traditional Medicare. Since these rebates are used for added benefits, like gym memberships and dental coverage and/or a reduction in premiums, there will be pressure on the insurance companies to reduce benefits and/or raise premiums. One study estimates the proposed rules will result on average in a 10 to 15% reduction in payments to providers. A different third-party study estimated that these proposed rebate cuts will reduce benefits by $45 a month per beneficiary. When you multiply this by the 30 million seniors that rely on Medicare Advantage you begin to see the impact these cuts will have.

Another way this proposed rule cuts MA is CMS’s proposed elimination of approximately 2,300 diagnostic codes which will have a significant impact on vulnerable populations suffering from diabetes mellitus and their associated complications, rheumatoid arthritis, and depressive disorders. One of the codes eliminated is Peripheral Vascular Disease, which impacts 12-20% of Americans over 60 (8.5M). If not detected and managed early, patients would suffer increased pharmaceutical expenses, specialist costs, hospitalizations, and undesirable patient experience, all of which could easily be prevented. This is just one of the codes to be eliminated. While some health plans may not use these cuts and they and their beneficiaries may not be impacted, the health plans that most beneficiaries have will be negatively impacted.

There is one other thing that bothers me a lot about these proposed cuts. Most of the talk about SS and Medicare cuts had to do with proposed legislation that would go through the normal subcommittee and committee hearings with the input of stakeholders and the checks and balances of passing legislation. The cuts proposed by CMS, with the Biden administration’s blessings, will not be governed by any of these checks and balances and, if not stopped, will happen in 10 months.

The proposed rule will cut rebates for beneficiaries and eliminate payment for 2,300 diagnostic codes, impacting the vulnerable population that the Administration claims to care most about, all with a stroke of a pen and without any legislation. It’s not right and it’s not fair

In the past I have fought when they proposed cuts to traditional Medicare, and I will continue to fight to stop the cuts to Medicare Advantage. These are lifesaving benefits for older Americans that should be strengthened, not cut.

In my last blog I talked about the best ways to contact your Members of Congress and provided some links to make it easy. Go to the blog and see how to best let your voice be heard. Take the time to tell those who represent you in Washington that you don’t want them to cut Medicare.

Best, Thair

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Speaking Out – Does it Work?

We’re named Seniors Speak Out, implying that speaking out is important and it will make a difference. I know that many of you feel like your voice doesn’t count, that you’re powerless, that only the power brokers and big donors have influence in Washington. I certainly understand why you think that. I’ve talked with a lot of people in my years advocating for seniors and when I encourage people to contact their member of Congress, I often hear responses like, “that’s a waste of time,” “my comment will never get to the member,” “unless I’m giving them money they don’t care.” I think one of the tools that these big influencers use is to convince people that their vote doesn’t count, and that they need to join them to make a difference. I’m here to tell you that your voice and vote does count. The goal of this blog is to convince you that your voice does make a difference and give you ways that you can make your voice more effective.

The most powerful leverage you have is your vote. Your member of Congress (I will use that phrase in this blog to refer to the two Senators from your state and the Member of the House from your district) is in that position because people voted for them. Your vote counted just as much as a big donor or a big celebrity. Find out why McDonalds might be a powerful tool in having your voice heard by listening to the latest Seniors Speak Out Facebook live event. I hate it when click bait articles make you wade through 100s of screens to get to the answer so, while I think you might enjoy the whole half hour video, the answer is at the very end starting at 28:20. While TV ads are powerful,  the members of Congress know that the opinion of a committed voter is a clear and unencumbered voice that can be trusted. My point is – your opinion matters.

So, what can you do to make sure your voice is heard? You need to contact your members of Congress. When you contact your members of Congress you have entered yourself into a very exclusive group. I’m not sure what the actual percentage is but you can be assured that very few constituents take the time to contact their congressional representatives. By doing that, the member of Congress identifies you has an important influencer. Whatever the contact method is, there are important ways to have contact be effective:

  • Most important, be short and concise
  • Make sure the member knows that you understand the issue
  • Include a note that other constituents are waiting to hear from you about the member’s response
  • Make clear that you are a committed voter

If the member of Congress is not who you voted for don’t hesitate to still contact them. You may have the chance to influence them even more when you tell them how they can win your vote or at least win your respect.

The way you contact your members of Congress does make a difference. There is no doubt that some methods of contact are more effective than others. In my opinion this is the order of effectiveness and tips on contacting your members of Congress.

Visit their office in Washington D.C. – While this is certainly not the easiest method, it can be very effective. If possible, plan your trip when Congress is in session and call the member’s office to make an appointment. If you are there on vacation with your family, ask for a tour of the Capitol and indicate you’d like to have a short meeting with the member. If you don’t have a particular issue to discuss at that time, take the opportunity to tell them the areas where you agree with their stance and areas where you have disagreed. Make sure they know that you influence other votes besides yourself.

Visit their district office in your state. This is obviously easier, but you should still make an appointment at a time when the member is back in their home state. Along with the tips above, talk about the town hall meetings and other local events you have attended (if you haven’t, start doing it. It’s a great way to become known by the member and their staff).

Call or email the Washington office – I think that phone calls and emails have equal levels of influence. The person taking the call or reading the email will categorize the contact as to the issue or area and record your stance on the issue and/or transfer it to the legislative assistant for that issue area. One thing to mention about a call or email, if your call or email just parrots an advocacy groups stance, i.e., you copy a letter drafted by an advocacy group and email it in, you lose some effectiveness. Make the salient points in your own words. That approach is powerful.

Here’s how to get in contact with your members of Congress. You can click here to find your U.S. House representative and click here to find your two U.S. Senators. Your zip code will almost always get you to the correct House member. If the zip code gives you a choice, click on one of them and call them. They will give you the correct district for your address. The phone number is always on the member’s website, again, call the Washington office. Clicking on the envelope will make it possible to send an email. They will ask you for your name, phone number, address, and email. They need to protect against automated bots and false emails. They often ask for the issue area of your email. Your information will be protected, and they need ways to get back to you. Always include a request for a response.

I encourage you to contact your members of Congress. Remember, your voice matters! Take the opportunity to join that exclusive club of voters who want their voice heard. Seniors Speak Out is here to help magnify that voice.

Best, Thair

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Facebook Live Recap – What’s Happening with Healthcare In 2023

Last Thursday, February 16, Seniors Speak Out held another Facebook Live event to discuss what we can expect from Washington concerning healthcare in 2023. Joining me for this discussion was Shalla Ross, President of The Ross Group. You can watch the entire event by clicking here.

I started out explaining that Seniors Speak Out was created by the Healthcare Leadership Council’s Medicare Today as a resource for older Americans, caregivers, and advocates to encourage seniors to advocate for themselves and ensure seniors are educated on healthcare issues and access needs. I went on to point out that with the new Congress, including seven new Senators and over 80 new House members, there is an opportunity for some new perspectives in Washington. I reminded us all that the Biden Administration passed the Inflation Reduction Act (IRA) via a partisan vote and that the IRA would affect seniors. I pointed out that this bill included government price controls that will restrain the development of the most innovative and successful drugs for seniors. We have already seen drugmakers canceling some of their drug development programs due to the lack of economic incentives to undergo risky and costly research & development. I then turned the time over to Shalla Ross.

 Shalla started out by pointing out that President Biden, in the State of the Union speech and with a spirited back and forth with Republicans, came to the conclusion that Social Security and Medicare cuts were off the table. In looking at this year Shalla said that due to the split Congress she didn’t expect the passage of any big healthcare legislation. She did point out that there are some areas where some progress could be made, including, mental health, the Fentanyl and opioid crisis, healthcare workforce shortages, health IT security, and disaster preparedness. She said that members of Congress will reintroduce some bipartisan bills including one to deal with the payment for vaccines after the COVID emergency legislation ends.

Shalla then discussed the implementation of the IRA which included price negotiations and the identification of the first 10 drugs that will face these negotiations. The number of drugs facing price fixes will expand to 60 drugs by 2029. She echoed the belief that drugmakers are already cutting their plans on developing new drugs due to the IRA and doesn’t see lawmakers changing the legislation to avoid this reduction in the development of new medicines. She pointed out that through Presidential executive order CMS is looking to expand some of the models with the goal to cut drug prices. She then talked about the Administration’s plans to change the Medicare Advantage program, even in the face of high inflation. Last year there were 346 members of the House that sent a bi-partisan letter to the administration telling them not to cut payments to Medicare Advantage and there is a similar letter being circulated this year.

After Shalla’s remarks I asked a few questions, the first one being . . . what did she really think could get done concerning healthcare this year and how could seniors get their voice heard on these important issues? Shalla said that she thought the workforce issue could see legislation, along with small fixes and implementation details of the IRA. She said that sending emails, calling, and scheduling meetings with members of Congress is vitally important. I echoed her sentiments pointing out that a member of Congress will drop everything to meet with a constituent.

I then asked Shalla if she thought the Republicans would try to reverse the IRA. She indicated that she didn’t see that happening. She did say that there would be multiple oversight hearings and there could be some smaller changes as it is implemented. She did point out that the IRA implementation isn’t following the normal rules of communication and that many stakeholders won’t be given the opportunity to give their input on the IRA implementation. I added that this departure from the normal communication methods robbed stakeholders of the right we have to give input on issues that affect us. I also voiced my displeasure concerning executive orders because they tended to sidestep the normal discussion and checks and balances that is an important part of how the government operates.

The next question concerned Senator Ron Wyden’s interest in expanding Medicare coverage to include non-medical services for people with chronic conditions. How would this impact seniors and their access to healthcare, such as telehealth and at-home care? Shalla said that finding the money to fund some of these non-medical services could be difficult, but she said that historically there has been a bipartisan push in areas like home services, nutrition, and transportation. She reminded us that even though it might cost money for these services it would certainly save money in the long run by keeping people out of the hospital and other more expensive institutions. Telehealth is an example of a place that has shown it can save money. I interjected that COVID-19 required us to take a “crash course” in telehealth, but it let us experience many of the efficiencies and money saving aspects of telehealth.

I then commented that President Biden didn’t give much detail in the State of the Union speech on his healthcare goals. I asked if she had an idea of what the Biden administration’s healthcare objectives were and what policies could be coming down the pipeline? She said that the President took a “victory lap” on his accomplishments and said he wanted to expand Medicaid in those states that have yet to expand. He highlighted the fentanyl crisis and how we absolutely needed to find a way to fight this serious threat. The President’s budget is coming out soon and it will shed some light on his objectives but overall, he was fairly light in the details around his healthcare priorities. She said that she thought there would be more executive orders. The President also mentioned surprise billing and how that law hasn’t worked as we thought it should.

I then stated that I would be remiss if I didn’t talk about the whole “we won’t cut Social Security and Medicare” part of the State of the Union speech. I pointed out that almost 50% of seniors have Medicare Advantage – which is Medicare! If we reduce the payments to Medicare Advantage, especially in these times of high inflation, we are cutting Medicare. The President can’t have it both ways. Shalla interjected that this is the place where our voices can have an impact by getting in touch with our members of Congress and telling them where we stand. I got back on my soap box about how important it is to tell Washington where we stand on the issues and, as a constituent, how important you are to your Senators and House Representative.

I ended by reiterating that Seniors Speak Out will work to keep you updated on the issues that affect you and will be a conduit to those in Washington who make the decisions that affect our healthcare. 

Best, Thair

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Which State of the Union Was the President Talking about?

The President’s State of the Union (SOTU) address last Tuesday contained some interesting statements and some interesting reactions. There were even some back-and-forth reactions with members of Congress, but I don’t want to get involved in all that. My goal here is to focus on the portions of his remarks that dealt with healthcare, specifically drug pricing, and its effect on older Americans.

As I listened to the President, I heard him describe drug manufacturers in two different ways depending on the context and the issue he was discussing. Some would say this is just how politicians talk but it seemed to me to be duplicitous and even disingenuous.  The far-ranging impacts of what Washington has already put into law and the direction they are headed make this a very serious matter that could have a huge impact on us. Here’s a few places where I think the President tried to have his cake and eat it too.    

The President touted the portion of the Inflation Reduction Act (IRA) that dealt with drug prices and described drug manufacturers as “Big Pharma,” amassing huge profits. He talked about drug prices and how they have skyrocketed. That statement garnered some of the biggest applause of the evening. In another part of his talk, he touted how “science” had saved millions of lives by developing and manufacturing the COVID-19 vaccine. The “science” he identified was developed by the same “greedy” drug manufacturers he described above. These same drug manufacturers who had spent millions, if not billions, over decades to identify the basis for the mRNA science which they then used to develop the lifesaving vaccine in record time. In fact, the first company to get approval turned down any government help for the vaccine’s development. I was certainly confused on which one he was referring to, the greedy “Big Pharma” or the lifesaving vaccine developers.

More than once the President presented us with some facts that he challenged us to “look it up” if we didn’t believe them to be true, so I did, for the umpteenth time. Here’s the data on the last five years on drug prices.

There are two types of drug prices that will show who profits and who does not:

List price – The price that is used to calculate rebates to insurance companies and the patient out-of-pocket portion.

Net price – The actual money that the drug manufacturer gets from the sale of their prescription.

The average increases for list prices fell from an increase of over 7% in 2018 to an increase of only 5% in 2022. The net price, the money a drug manufacturer gets, went from a decrease of over 2% in 2018 to a decrease of around 1% in 2022. So, in looking at the data as the President directed, the “Big Pharma” has received less money per drug each year since 2018. If you figure in what the inflation was in 2022, the inflation adjusted decrease in revenue was 8.7%. Profits have actually decreased.

The President described himself as a capitalist and said he was a champion of competition. He said that “capitalism without competition is extortion.” In another part of his talk, he bragged about the drug price “negotiation” part of the IRA. When the government sets the price of a drug and the drug manufacturer is faced with either accepting that price or paying up to a 95% of the list price back to the government if they don’t charge the price the government set, there is no negotiation. It is capitalism without competition. This is not competition or capitalism.

The President announced a reenergized cancer moonshot, a recommitment to the discovery of ways to fight and cure cancer. These discoveries will not be made by the government. They will be primarily the result of the research and development of drug manufacturers who will invest billions into these projects.  To me the President’s commitment to the cancer moonshot seemed hollow when the price setting portion of the IRA will lower the investments in discovering these new cures. Again, it seems the President is pushing solutions that are at odds with each other.

It bothers me when politics gets in the way of sound, fact-based solutions. I understand that President Biden was using the SOTU platform to begin his run for reelection but making statements that seemed to be at odds with each other, especially when they deal with life extending and lifesaving medicines, seems to be a dangerous and ill-advised approach. I want to unleash the power of discovery that exists in America. We are at the cusp of a golden era of innovation when it comes to our health. We should be finding ways to double down on our investment, not passing legislation that hinders innovation.

To that end, I hope you can join Shalla Ross, President of The Ross Group, and me this Thursday, February 16 at 2:00 pm ET for a Facebook Live event to discuss some of the things I’ve touched on here. We’ll talk about healthcare policy in the 118th Congress, the Biden administration’s policies that affect seniors’ healthcare and the Inflation Reduction Act implementation. It promises to be a down to earth discussion about the issues that affect you and me. You can click here and mark yourself as going. You can tune in to the event once it is live with the same link. I hope you can make the Facebook Live event.

Best, Thair

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Your Heart – Maybe the Most Important Organ in Your Body

It’s February and it’s American Heart Month. I think the heart is the most important organ in the body. I’ve come to that conclusion by using my own grading criteria . . . based on which organ causes us the most harm the quickest if it suddenly quits working. The lungs are a close second, but I feel like there are two of those so simultaneous failure is unlikely. On a more serious note, whether the heart is the most important organ or not, the fact that heart disease is the number one cause of death in America, over 700,000 a year, makes it important enough that it should capture are attention, not only this month, but every month.

In past years I’ve talked about things we can do to make us more heart healthy. While there are some things we can’t change, like age, gender or genetics, there are many things we can do improve our heart health. 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. There isn’t anything in that list that should surprise us or is something we don’t understand. I can guarantee that there are multiple places on the internet, at the library, or at your doctor’s office that can explain in more detail how to accomplish each one of the healthy lifestyle recommendations. It is a fact that an ounce of prevention is worth avoiding a heart attack and I encourage each of you to take the steps necessary to improve your heart health. There is, however, another aspect of your heart health that will be my focus for this blog.

While taking the steps to keep your heart healthy for the long run will add years to your life, there are important things to know that could have an immediate impact on saving your life. Recognizing the signs of a heart attack and taking immediate action can absolutely save someone’s life.

As I was doing research for this blog, I found out that the major warning signs of a heart attack are often different for women than men. I had no idea there was a difference. That knowledge could be invaluable when we are evaluating signs of a possible heart attack.

According to the CDC, the major warning signs of a heart attack for men include:

  • Chest pain, intense pressure and squeezing fullness in the center or left side of the chest that spans a couple minutes and can re-occur
  • Upper body pain, particularly your arms and left shoulder
  • Irregular heartbeat
  • Shortness of breath
  • Dizziness and faintness
  • Cold sweats

The major warning signs for women include:

  • Fatigue lasting multiple days or coming on as suddenly severe
  • Upper back, shoulder, throat and jaw pain
  • Shortness of breath
  • Lightheadedness
  • Indigestion pain
  • Anxiety
  • Pressure or pain in the center of your chest, which may spread to your arm

One of the first things to know when we are evaluating possible signs of a heart attack is that time is critical. The basic rule is, if you suspect someone is having a heart attack call 911, get the person to the hospital. Some of the signs can be slow in presenting themselves and will absolutely reveal themselves differently depending on the patient’s basic health and other ailments she or he may have.

We’ve all known friends or relatives who didn’t recognize they were having a heart attack, relegating the symptoms to an upset stomach or muscle aches and pains or a bad night’s sleep. A hint that I read made a lot of sense – if the pain doesn’t change when you change positions, or the ache doesn’t feel differently when you exercise your arm, for instance, it should raise your suspicions. If you’re out of breath or lightheaded but it doesn’t get better when you lay down and rest, then those symptoms could be an indication of a heart attack.

If a person has had a heart attack, they are more apt to have another. Remembering your personal symptoms of your past heart attack and, more importantly, making sure that your loved ones or caregivers know those symptoms can save your life. Having a record of the medicines you are taking, including doses and frequency, can help the doctor who first treats you when you’ve had a heart attack be more efficient in knowing how best to treat you. Again, time is of the essence. When in doubt, go to the hospital.

While quick recognition and getting people to the hospital is key, there may be a situation where more immediate action is required, cardiopulmonary resuscitation (CPR). Most of us have seen people in films or even observed in person someone performing CPR, and some of you may have even done it yourself. Knowing how to perform CPR can save lives. There are classes available that teach CPR. Many of you may have taken a class at one time, and some employers offered courses at work. That knowledge can save lives.

The American Heart Association is the leader in resuscitation science, education, and training, and publisher of the official Guidelines for CPR. They’ve developed classes at many levels and have identified classes worldwide. Using their web page, I found five classes within eight miles of my house. Click here to find more details about CPR classes. There are many ways to get trained. They include on-line classes, combination on-line and classroom, and classroom-only classes. Your willingness to get trained may save a life.

Taking steps to improve your heart health can reduce the risk of having a heart attack. Knowing the signs of a heart attack and getting the patient to the hospital quickly can save a life or reduce the damage caused by a heart attack. Knowing CPR can truly make you a life saver. On Valentine’s Day this month take the time to give some thought about how you can improve your heart health or recognize heart attack symptoms and take action.

Best, Thair

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Do We Need One More New Year’s List of How to Age Well?

Ok, so it’s the new year and it’s the standard time for everyone to make new year’s resolutions. I’ve been flooded with lists and surveys which only serve to make me feel terrible about what a slug I am. It seems I should be wearing a fit bit and counting every step I take with the appropriate disappointment when I find that I haven’t taken what seems to me to be a huge number of steps. These lists and surveys also remind me what my healthy weight is for my height, which tells me I need to be 2 inches taller. This is especially cruel given that I’ve lost ¾ of an inch from what I was in my younger years. So, what to do? Do I just throw up my arms and give up, with the excuse that these people are not talking about the average senior and are out of touch with the real older generation or, do I try to glean something from these lists and survey results that might benefit me? If you’ve stayed with me this long, I assume you’ve decided to stay with me at least for a little while longer so, surprise . . . I’ve got another list.

My goal in writing this blog was to identify the common threads that appeared in the lists. I found that almost every list had something about a positive attitude so I will spend more time on that suggestion. If you only take action on one of the suggestions on my list, choose keeping a positive mindset.

Keep a Positive Mindset I know you’re thinking, wow, why didn’t I think of that? Hold on a minute so I can change my mindset . . . there, now I have a positive mindset, I feel so much better! I know it’s not that easy, but there are ways we can improve our mindset. I found a 10-minute video on Ted Talks that focuses on aging and how a positive attitude makes a difference. Click here to watch it, it’s worth your 10 minutes.

In my survival training in the Air Force the instructor cited a military study that studied why some soldiers survived, and some died when faced with similar survival situations. They concluded that a positive attitude kept some soldiers alive while others just gave up. They pointed out that those who survived didn’t dwell on why they were put into the survival situation but instead they focused on what assets they had that would help them stay alive. They didn’t focus on the things they couldn’t change but on the things that they had some control over.

One of the positive attitude suggestions counseled that we shouldn’t ignore our negative feelings completely, and we need to deal with them at some level. They advised us to set aside a time when we faced our problems, determined what we could change and what we couldn’t, and then decided what steps we could take to deal with the things we could change. They suggested that we treat ourselves like we would treat a friend, by asking, “What would a good friend say to me right now?” In other words, we need to cut ourselves some slack. Once the time for confronting our negative feelings is over, physically remove ourselves to somewhere nice and move to positive thinking.

Make a gratitude list. Think of the things that bring you joy. Write them down. Focus outside yourself, find someone to help – don’t ask someone what you can do for them, invariably they will say they’re fine. Observe them and find something they need or something they need help with and just do it. Don’t ask, just do it. Even if you made a wrong guess about what they need they will appreciate that you tried to help. I think that a positive attitude is the most important thing we can do to age well.

Here are some other things that will help us age well.

Commit to 10 Minutes of Exercise Daily 10 minutes isn’t long. Find something that makes you breath hard. I’ve found 3 flights of stairs will do it for me. Do it three times, walking down the stairs after each trip up so you can catch your breath. Presto, your 10-minute exercise is done.

Make Better Dietary ChoicesHere’s a quick video on shopping healthy. It teaches some ways to make better choices as you shop.

Quit SmokingI know what you’re saying, “I’ve smoked two packs of cigarettes a day for 40 years — what’s the use of quitting now? Will I even be able to quit after all this time?” It doesn’t matter how old you are or how long you’ve been smoking, quitting smoking at any time improves your health. When you quit, you are likely to add years to your life, breathe more easily, have more energy, and save money.

Play With Your Grandkids2016 study found that half of the grandparents who occasionally participated in their grandchildren’s lives were alive five years post-study compared to individuals who had no involvement. Playing with your grandkids is not a hard ask.

Stimulate Your MindRegularly challenging your brain is one of the best ways to stay mentally sharp as you age. It’s also one of the best ways to reduce your risk of memory loss or developing dementia. Simple things such as reading daily, doing crosswords, or joining a book club are great and fun ways to ensure your body’s most important muscle receives an adequate workout.

Reach Out to Old Friends and Make New OnesStudies show that socially active older adults have better cognition, lower risks of disability and depression, and overall better health.

It’s a list, but it’s doable. Stay positive and make 2023 the best year yet, I’m positive you can do it.

Best, Thair

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Being Aware Is the First Step to Action

This month is National Glaucoma Awareness Month, which begs the question, “why aware?” Why not National Glaucoma Prevention Month or National Glaucoma Treatment Month? Awareness seems like a pretty weak modifier for something as serious as glaucoma, but in researching further I think I’ve found the reason. While there are three million Americans who have glaucoma, 50% of them don’t even know they have open-angle glaucoma which is the most common form of the disease. The first huge step in treating glaucoma is becoming aware that you have it.

Glaucoma is a group of diseases that damage the eye’s optic nerve and can result in vision loss and is the second leading cause of blindness worldwide. There is no cure (yet) for glaucoma, but if it’s caught early, you can preserve your vision and prevent vision loss. Taking action is key.

If you’re like me, I’ve often taken the short cut to eye health. I’ve gone to the cheapest eye doctor I could find to see if I need a prescription change so I can go on-line and get my low-cost contacts (I’ve worn contacts for 30 years). There are 5 tests that can be done to identify varied forms of glaucoma and I can almost guarantee that a quick eye exam isn’t going to include some of these tests. My point here is . . . you need to periodically make an appointment with your ophthalmologist. They are trained to test and identify medical problems with your eyes and are the ones that can accurately diagnosis glaucoma.

I know from experience that an ophthalmologist can help save vision. My family has a history of detached retinas. I don’t know how a detached retina can have genetic or a hereditary basis, but I did know that two of my brothers and one of my sisters have had a detached retina, so I was quite aware of the symptoms of the beginnings of a detached retina. I experienced a symptom and went to an ophthalmologist who worked and worked until she found a slight horseshoe shaped tear which I had fixed by a surgeon that day. When I saw her on a follow-up exam, she tested quite vigorously for glaucoma since a retina detachment can lead to glaucoma. Glaucoma can also be hereditary, so knowing what eye problems your relatives have had can be a reason for added vigilance in testing for glaucoma.

I’m going to pause here for a short commercial. If you’d read many of my blogs you know that I’m a fan of maintaining a file, either hard copy or digital, of all your health to examine you over your lifetime. It can show a rise in your pressure from your baseline and, even though the pressure may be within acceptable limits, it shows a change for you and may be a sign that you need more frequent exams to monitor the change. I’ve moved since my retina tear but I have pictures of the tear and can alert a new ophthalmologist of my condition so they can pay special attention to that eye and that condition.

There are other groups that have a higher risk of glaucoma. Those of African, Asian or Hispanic descent, people over 60, people with diabetes and those with high blood pressure, are all at a higher risk of glaucoma. It should be noted that glaucoma is a leading cause of blindness in African Americans. I would be remiss if I didn’t include some symptoms of glaucoma that you should be aware of.

  • Hazy vision
  • Eye and head pain
  • Nausea or vomiting
  • The appearance of rainbow-colored circles around bright lights
  • Sudden sight loss

While these are symptoms that deserve our attention, we need to remember that often we could have glaucoma without symptoms. Here is a link to a great booklet on glaucoma that will give you all the details about all facets of the disease.

In keeping with the theme of last week’s blog and my visit to the Consumer Electronics Show where I saw all the new innovations in healthcare devices, I will note that there are two new devices that will enable the home monitoring of eye pressure. A smart contact lens that gives continuous pressure readings and a home testing device that can be used to give up to 6 pressure readings a day. These new devices will be extremely valuable to monitor the impact of different treatments.

As always, our government should work to remove barriers to innovation and discovery so we may soon find a cure for this sight stealing disease. The legislation passed at the end of last year was a step in the WRONG direction. We all need to work toward opening the paths to the discovery of new treatments and cures.

Finally, if there is one thing to take from this blog it’s to become aware of eye health and glaucoma and don’t put off your regular visit to an ophthalmologist, especially if you fall into one of the high-risk categories.

Best, Thair

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Do We Need More Gadgets in Our Life? (A Report from the Biggest Electronics Show in the World)

I’ve heard more than one person complain about how many remotes it takes to watch TV, not to mention the problems that arise when someone, usually their kids, decides they need a new computer or a new phone, just when they had finally figured out how to operate the ones they had. Their well-meaning kids tell them about all the new capabilities the new gadget has, as if that was reason enough to get it, whether you really need all those new features or not. It’s a crazy, quickly changing world and some of us might feel like jumping off the merry-go-round and just let well enough be good enough. I agree, but there is one reason that I believe it’s worth allowing more gadgets into our lives – aging in place.

In my almost 25 years of talking with seniors the one thing I’ve heard over and over is their desire to age in place. Almost without exception, seniors don’t want to be forced to leave their homes and go to some type of assisted living situation. That happens because, as the name implies, they need assistance with their everyday living. Whether it’s moving around safely, taking medicine, requiring frequent tests, transportation, or not having someone close who can check on them. If there are “gadgets” that can efficiently perform some of these duties, we have the chance to extend the time we can remain in our homes or a place we choose. . .to age in place. That’s the reason I attended the Consumer Electronics Show (CES), to see what new innovations are coming available that will allow us to age in place.

Every year, early in January, the electronics manufacturers from all over the world descend on Las Vegas to showcase what the future of electronics looks like. It’s called CES and it has been attracting electronic innovators for decades. Over 115,000 people attended the conference this year and I thought it was an ideal chance to see which of these innovations would help older Americans age in place. I won’t mention the manufacturers’ names, because I don’t want to promote one innovation over another. What I will try to do is explain how a particular item will help us age in place.

There were some standalone health innovations that seemed very interesting in their own right. The one thing that seemed to gather an enormous amount of attention was a urine testing toilet. This gadget fits into your toilet and will collect a urine sample as you urinate and tell you things like, whether you are getting enough protein, are hydrated, or getting enough vitamin D. There’s more than one of these testing toilets and some had even more advanced features. One doctor speculated that as the testing matured it could even give an early warning of possible cancer. This type of ongoing testing might certainly reduce doctor visits.

Another very interesting device was an automatic pill dispenser. The pill bottle was inverted and fastened on top of the dispenser. The dispenser was programmed to dispense the appropriate dose at the appropriate interval and, through a fingerprint identification process, only to the correct person. It would link to the internet so it could send reminders and alerts if the patient hadn’t dispensed the medicine at the prescribed intervals. Taking medicine appropriately is one of the biggest reasons that patients require assistance. This device certainly helps from that point of view.

A boon to staying at home is the development of a remote patient monitoring system. One system made it possible to monitor a patient’s weight and blood pressure remotely through a simple blood pressure device and a connected scale. The patient would step on the scale and use the blood pressure monitor which would immediately send the information to the doctor and, if desired, the care giver. It provides peace of mind and allows instant notice and intervention if required. It also supplies a baseline of information that can be helpful with future diagnosis.

Another remote device was what I called a remote stethoscope and EKG. The device was the size and shape of a large cucumber and when held close to the chest you could hear the heartbeat with surprising clarity and then see an EKG output in real time on a remote screen. It seemed to me like this amazing device could give real time actionable data to a remote doctor.

One of the biggest areas of remote monitoring at CES was the smart home. The smart home to me was a way that you could turn lights off and on remotely (a little more advanced than clap on clap off) or see who was at the front door or control the heat and AC. For those who might be away for extended periods of time you could get monitors that emailed or texted you if you had water in the basement because a pipe burst or install sensors in the freezer in the garage to tell you if the freezer temperature gets too high. There are motion detectors and listening devices that detect people in the house and can even identify if they are friend or foe. You have a programmable robot vacuum that cleans your floor. All of these started out as stand-alone devices, but tech firms are finding ways to link them together so they can share information.

For instance, your robot vacuum senses a large form on the floor where the vacuum’s routing information says there shouldn’t be anything. While its job is to clean and go around obstacles, it can be programmed to send data to a central hub that gets alerted and then checks to see if medicine has been taken, if there hasn’t been movement detected for a while, it can then activate video cameras that can focus on the correct area and send pictures to care givers and/or emergency response personnel. This type of coordination is made possible by linking these different devices through a central hub. One way this is accomplished is through software called Matter. Matter is an open-source interoperability standard that allows smart home devices from any manufacturer to talk to other. It is the key to making your house a smart home.

There were updated and advanced self-driving cars at the show. While this great addition to allowing us to age in place is taking longer than expected to come to fruition, it is clearly something that will happen in the future.

As I talked with different people at the show, I continued to inquire how they were going to make these gadgets simple to operate. I often used the phrase, “we don’t need one more remote.” They assured me that the older population were the ones who could benefit the most from the smart home and they were committed to making them simple to operate.

I could write a lot more about all the new innovations I saw. There were over 3,200 exhibitors, but the most important thing I came away with was the belief that these great innovations are going to help us stay self-reliant and living longer in the place we choose.

Best, Thair

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A New Year and Some New Healthcare Changes

First, I hope that all of you had a great holiday and I wish you all a happy, healthy and prosperous new year. It continues to be my honor to communicate with you each week as I work to keep you informed on what’s going on with your healthcare and occasionally, give you some tips and tricks on keeping yourself healthy.

While it is usually the case that nothing gets done in Washington toward the end of the year, especially during a midterm year, that wasn’t the case this year, especially in the healthcare arena. The 1.7 trillion-dollar spending bill was passed by Congress and signed by President Biden on December 29, 2022. While the 4,155-page bill funded our country for the current fiscal year, the real interesting parts of the bill, at least from my focus, were the parts that impacted our healthcare.

Most of the healthcare provisions of the funding bill dealt with the unwinding of the special regulations that were enacted in reaction to the COVID-19 pandemic. These special regulations were part of the Coronavirus Aid, Relief, And Economic Security (CARES) act and the American Rescue Plan, which were instituted to help people receive care as they weathered the pandemic. These two bills also allowed providers the ability to bill for these new care options. While the return to normal patterns of care was expected, there were some aspects of the funding bill that sought to leverage the knowledge and experience we gained during the pandemic to expand our use of remote care, especially telehealth.

Unfortunately, the change with the biggest impact had nothing to do with the pandemic but everything to do with cuts to payments to Medicare providers, especially doctors. Congress was faced with an impending 4% cut to physician payments this year and ended up reducing those cuts to 2%. This is a 2% reduction in the face of 8% inflation. This is on top of no payment increases over the last 20 years, which equates to a 22% reduction when physician cost increases over those years are factored in. Does this encourage more doctors to accept Medicare patients? Does this encourage your doctor to spend more time with you? I think not! It is a travesty that Congress and this administration continues to allow these draconian cuts at this crucial time. This is an issue that we need to focus on and get fixed.

To ensure that lower income citizens didn’t bear the brunt of the pandemic the emergency bills allowed the states to relax the acceptance qualifications for Medicaid in exchange for federal funds to offset the increased costs. The Medicaid rolls ballooned to over 90 million low-income adults and children and one report estimated that over 18 million would lose their coverage when the states returned to the old criteria. The funding bill gave the states time to transition and hopefully to help people find other coverage.

Another big change in the COVID-19 bills dealt with hospital-at-home and rural health. During the pandemic hospitals were allowed to handle emergency and inpatient cases outside of the hospital facilities. If there was a silver lining to the pandemic it was the experience gained from using remote methods for treating patients. The ability to have Medicare pay for these new treatment options was extended. Some providers are leery of implementing these new options because there is no guarantee that Medicare will continue the payments past the extension period, despite their being data that shows the efficacy of the new methods in certain cases. On top of that hospitals were facing an almost 4% pay cut in January and Congress delayed this cut as well. However, hospitals are facing serious financial instability because patients are not coming back to hospitals for regular treatments and surgeries, and providers are facing tremendous unfunded costs as flu, COVID-19 and RSV cases have surged.

Telehealth was another place where the pandemic greatly accelerated our acceptance of remote healthcare. We’ve all heard that necessity is the mother of invention and the necessity of quarantine or isolation due to COVID-19 certainly accelerated the training and identification of best practices in the use of telehealth. The waivers enacted because of COVID-19 extended the ability to provide telehealth services, allowed more types of providers to use telehealth, and continued the practice of not requiring an in-person meeting for mental health providers. With the advancement in visual, audio and data transfer devices the accuracy of remote diagnosis and treatment has increased tremendously and has increased the viability of telehealth. The funding bill extended those waivers to the end of 2024.

I think it is extremely important that we embrace these new efficient methods for remote care. Older Americans living in rural areas and people who can work at home are migrating away from readily available healthcare providers. There are medical devices and connectivity that make remote diagnosis and treatment plausible, I have seen the possibilities in the last few days at the Consumer Electronic Show in Las Vegas (tune in next week for my blog detailing what I saw at the show). We need to encourage Washington to remove the barriers that will inhibit the acceptance and utilization of these new treatment options.

There are other things in this huge bill that could impact our healthcare and I can almost guarantee there will be some unintended consequences. It has proven to be difficult to unwind some of the knee jerk responses that were initiated by the pandemic, but we need to sort through the data from the last three years and glean out the expertise and knowledge that was gained from this unique global experience and use it to not only prepare for the next pandemic but to also improve and lower the cost of our own healthcare, and remove the barriers to efficient, affordable care.

One more thing. I’ve always worked to improve older Americans’ access to healthcare, especially for those living in rural areas. Some of the innovations that will improve remote care require broadband internet access, which very often is not yet available in some rural areas. These are the very patients who would benefit the most from not having to drive long distances and are often the ones that would be the happiest to age in place. Ensuring broadband internet access for seniors, especially those in rural areas should be a priority for those in Washington.

Best, Thair

p.s. Don’t miss next week’s blog to find out about the exciting innovations that will make aging in place easier.

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Christmas Gifts and New Year’s Resolutions

Reading a blog less than a week before Christmas probably isn’t the top thing on your priority list. It also happens to be the last blog for this year which automatically switches us into reviewing this year. I’m not going to get long winded and go into a full blown auld lang syne, but I will reminisce a little and then cover a few gifts that we should be asking for this Christmas and resolutions we should make.

It was an eventful year from both a healthcare and political perspective. The Inflation Reduction Act (IRA) became law and changed Medicare in some very basic ways. While some of the changes won’t be implemented for a few years, the impact of those changes could be felt much sooner. How those changes are implemented will also determine who is impacted and the severity of those impacts. It will ultimately come down to how much we allow the government to dictate prices and our access to medicines. The change in control of the House might allow some moderation of the impact of price controls but it’s difficult to predict what will happen since both the House and the Senate will be working with very small majorities. I most certainly will be discussing some of these questions next year. It was a year for returning to almost normal and if we decide to take advantage of the preventive medicines available to us, we have the ability to remove the almost from the statement above. It has certainly been an eventful year.

There are a few gifts and end of year resolutions that we can give to ourselves this Christmas and resolve to do starting this new year.

  • Life improving and life saving vaccinations – We owe it to ourselves and as a gift to our families that we will be seeing this holiday season to get the latest COVID-19 booster and flu shot. We need to protect both ourselves and our families. The older among us are once again enduring the brunt of those who are dying of COVID-19 and the flu. It doesn’t have to be that way – get vaccinated.
  • Get involved in your own health – One of the basic gifts Americans often fail to recognize is the gift of choice. We have great power over who provides our healthcare and the level of care we receive, but it takes action on our part to exercise this power of choice. It takes research and information gathering but it can make a big difference as we face the health changes that come with getting older.
  • Know how the changes proposed by our government will affect you – Is the government getting more involved in our healthcare or less? The changes to Medicare that are part of the IRA very plainly point to an increase in government involvement. Is that good? Has more government involvement in our healthcare in the past helped our access? We once again need to get active in promoting those things that increase our access to life saving medicines and procedures and reject those changes that reduce choices and present barriers to access.
  • Return to your healthcare providers – Many of us put off going to the doctor or other providers during because of the pandemic. It’s time to take inventory and identify what you need to do to catch up and keep up with those preventative measures that keep us from getting sick and help identify health problems quickly and early so we can take quick action.

One last thing, I’m convinced there are astounding discoveries on the horizon that will have the power to cure. I have high hopes that we are close to some huge life improving and life saving breakthroughs. I’m going to have the opportunity to go to the Consumer Electronics Show (CES) in Las Vegas. There has been a big increase in the number of medical devices that have been created and are in the process of being developed that could have a huge impact on how and where our healthcare is provided. Think of your Fitbit with the ability to provide a 24-hour EKG. I will report on the interesting things that I see at the show.

I look forward to next year and keeping you informed on the impact of both proposed changes and the implementation of existing laws. Information is power and I hope we can use that power to influence those who represent us in Washington.

Merry Christmas and Happy New Year, Thair

p.s. We won’t have a blog next week or the week after. It’s a good time for a break. See you next year.