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It Ain’t Over ‘Til It’s Over – The Final Days of Open Enrollment

That great intuitive saying was muttered by the underappreciated, hall of fame baseball player Yogi Berra as he sought to communicate the unique aspect of baseball that allowed a baseball team to score multiple runs as long as they didn’t make the third out in the ninth inning. Unfortunately, the same can’t be said for the opportunity to change Medicare programs… after December the 7th the open season for choosing a Medicare plan will be over.

I’m sure you’ve noticed that the number and tenor of the insurance ads during this open season have both been dialed down. That has been the result of new rules instigated by the Centers for Medicare and Medicaid Services (CMS). The rules stipulated that the Medicare logo couldn’t be used so people weren’t confused that the ad was sanctioned by, or supported by, Medicare. They also made sure that the brokers were clear about which plans they are selling, and which beneficiaries were eligible for which benefits. For many of us, toning down the ads was a welcome change. But I have to admit, those ads helped me at least realize that there were options available that might benefit me, and they encouraged me to do some research before the open season is over.

So, here it is, Monday, December 4th, with the last day for changing your coverage only three days away: Thursday, December 7th. I’d like to conjecture that most of you have already done your research and made your decision on whether to keep the plan you have or make a change, but I have a feeling that saying “most of you” may not be accurate. I only have to look at myself for proof, since I haven’t finished my research yet. I started over a month ago but got busy. Thank goodness for this blog because it has refocused me, and now I’m actively finishing up my fact gathering. One thing that was helpful was the periodic emails I would get from Medicare indicating that I had started my review but hadn’t finished.

I thought it might encourage you to do some research in the next three days if I told you about my experience with my plan this year. I won’t tell you which plan I have, as I’m not here to promote any plan. What I will describe is my experience, which I’m glad to report was very positive. Hopefully it will expand your knowledge of what’s available. I will tell you that I’m enrolled in a Medicare Advantage plan. I’ve revealed that fact in earlier blogs. I do want to point out that there are down sides to some Medicare Advantage plans. They use in-network providers, which may not be your preferred providers, and there could be extra charges if you go to out-of-network providers. There may be higher co-pays for some specialists and procedures, and there could be prior authorization required for some treatments. As it is with almost every major purchase or decision we make in life, there are pros and cons. Information is the key to deciding what is best for you personally.

With my plan, I pay no premium. I was unhappy with my former primary care doctor and searched within the in-network doctors and found one within a mile from my home, and he has worked out fine. I paid a $180 co-pay for an MRI and a $20 co-pay to see an orthopedic doctor. My prescription drugs have had a zero co-pay. I was taking three drugs and now take two. I have a zero-cost membership to a community swimming pool and exercise facility. I had a root canal and crown, which cost $100 copay. When the bill was submitted by the dentist, my plan paid the entire bill. The dentist even sent me a check for the $100 co-pay. I get a yearly $500 credit card that will pay for co-pays and other charges that my plan doesn’t pay. This card can be used for any hearing, eye, and dental charges. I get $15 dollars a month for over-the-counter items.

That’s my 2023 experience and I’m happy with the plan choice I made this year. I haven’t had any operations or hospital stays, so I can’t tell you about how that would work out. I am eligible for a knee replacement, but my knee hasn’t given me any real pain yet, so I will put it off until it becomes a problem. It is, however, something for me to consider as I evaluate other plans since it looks like a knee replacement is in my future. That is one thing you need to do, take your best guess on what your future health problems might be as you make your decision. Don’t forget to consider those maladies that are common within your family and ancestors.

I’ve included my experience to give you a real-life example of one person’s participation in a Medicare plan. Hopefully, it will spark some interest and questions that will push you toward finding the answers you need to make the choice that is right for you. It is far too common that people underestimate the ability of older Americans to know what they want and to find ways to obtain the information needed for them to make the right decision for themselves. Making the right choice during the open season can often save you a considerable amount of money. You’ve got three days left, and then it will really be over.

Best, Thair

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Just Listening Isn’t Enough

Last week marked the end of the Centers for Medicare and Medicaid Services (CMS) Patient-Focused Listening Sessions. There was a total of 10 sessions, one for each of the 10 prescription drugs that were chosen for the Medicare drug price negotiation program. Before I get to my evaluation of the listening sessions, I want to make sure I explain that I appreciate any time that the government gives its citizens, in this case patients, the chance to have any form of input on how the decisions that the government makes could affect them. My evaluation, while mostly negative, is intended to point out ways that CMS can improve the process of attaining and utilizing patient input to improve the entire healthcare process for those who CMS serves: the patient.

In an earlier blog I discussed why using the word negotiations was a misnomer since the result of the CMS “negotiation” process was simply CMS setting prices for the selected drugs. I bring this up again because I think the patient-focused part of the name given to the listening sessions was also a misuse of the words. There were too many areas where these listening sessions were not patient focused.

There are three areas where I think CMS could improve their communication with patients and by doing so improve the way they serve them.

  1. Make it easier for patients to respond – The process for responding, both orally and in written form, was complicated and cumbersome. For instance, the process to register for the listening sessions required you to enter your email address before getting access to the questions or other information. With seniors being the main target of ruthless scammers, the quick request for personal information raises a red flag. All of us encounter multiple instances in the commercial world where the entering of comments is easy and straightforward. I think making it easier to participate would have increased the level of participation in the sessions. While CMS’ capacity per session was 20, the average number of people who actually participated was 11. This, in and of itself, was an indication that the process was a barrier to participation.
  • Be clear as to what is important – Rather than only focusing on the clinical name of the drug, they could have also described what illness it treats. Also, CMS could have outlined what type of information would be most helpful. Even better, hold pre-meetings with patients and patient advocate organizations to get direct input on how the meetings be organized and find out from the advocate organizations what their patients are saying and what questions CMS could ask that would help patients focus on the impact of the medicine on their lives and any barriers to access they might have experienced.

Clearly stating what is important could have also encouraged more diversity in the participants. There was a lack of diversity in both gender and race/ethnicity. Encouraging caregivers to share their point of view would also seem like an important point of view.

It would have also been valuable to have clarity on CMS’ process after the sessions. Clarity was needed to detail how the information gained would be reviewed, how it would be evaluated and, most important, what actions will be taken in response to the patient input? Knowing that there is a process that could result in action is a huge indicator on how important these listening sessions are to CMS.

  • Enable two-way communication – Somehow, some way there has got to be a two-way conversation. I have attended patient-focused sessions with both the Food and Drug Administration (FDA) and CMS. My experience, and those of others I have talked with or read about, has been that the FDA sessions are interactive, and the CMS sessions are not. It seemed that the FDA people asked questions, requested more detailed information, and even followed up with more questions after the session. It would be a great step if CMS would hold post listening session meetings with participants, both patients and those from advocacy organizations, that had key comments and views, to ask questions and give them longer than three minutes to elaborate on their position and experience. That would offer a forum of two-way communication which, I believe, was the most serious deficiency of the listening sessions.   

Where do we go from here? There is a broad range of actions that CMS can take after these listening sessions. While I’m not sure if there is even a requirement for CMS to publicly respond, I can say that I and many others will be watching. The Inflation Reduction Act leaves a great deal of latitude in how the Drug Pricing Negotiation Program is implemented. This latitude offers the chance to have a very positive or very negative affect on the patients who rely on these life changing medicines (to say nothing about all those who could be affected by the damper on innovation that could result from this program).

As you can see, I believe that these listening sessions left a lot to be desired. There just seemed to be so many ways that they could have been more productive. Hopefully, some of these suggestions will be taken seriously. It will be up to CMS to show us how important they perceive these sessions to be and that they are willing to truly have the patient be the center of their focus.

Best, Thair

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Business As Usual? – Not This Time!

The end of the year usually brings an abundance of legislative initiatives at an accelerated if not frenetic pace. The must pass funding bills offer the ideal platform for amendments and additions, especially for healthcare focused legislation. With funding running out for critical government programs, the fast-approaching Christmas holidays, and the campaigning for office in the coming year, lawmakers are especially motivated to get to work. This fast-paced environment can generate good things and bad things. The looming deadlines have historically produced an environment where deal making becomes pervasive, resulting in both good and bad legislation, some of which wouldn’t have had much of a chance of passing during normal order. This has become the normal year end legislative process, but it will not be the case this year.

Out of the bizarre and unprecedented chaos in the House came a continuing resolution (CR) that continues the string of never seen before actions. CRs, which extend funding for critical programs at current funding levels as the new funding bills are debated, have been common in the past, but this year is different. The CR that was signed into law was a never seen before two-tiered stop gap measure that sets up two deadlines, January 19th and February 2nd, with department funding split into two parts. It extended the deadlines past the Christmas recess, removing one of the reasons that usually motivates lawmakers to pass the funding bills with the accompanying healthcare legislation. It also removed the primary vehicle used for attaching proposed healthcare legislation that looked like they had a good chance to become law and stopped Congressional action on existing healthcare processes.

While the delay of action may be a positive thing for some entities, other parties may see it as delaying the enactment of long overdue changes to healthcare.

Some of the actions that were affected by the delay are:

  • How Medicare pays for outpatient care
  • Legislation on changing how Pharmacy Benefit Managers operate
  • Changes to the price of insulin
  • Delaying the looming cuts to Medicare provider payment cuts
  • Continued uncertainty for the funding of the Food and Drug Administration and Health and Human Services

Most D.C. pundits don’t expect any action this year, and many don’t see anything substantial happening next year given the ever-rising cacophony generated by the presidential campaigns.

One of the reasons for this dire prediction is the fact that the clean CR (the bill contained no funding for Ukraine or cuts to government programs) just kicked those high-profile issues down the road without offering any solutions. This fact was demonstrated by the Republicans failure to pass the rule to begin consideration of the Commerce, Justice, and Science Appropriations bill a day after the CR passed. This immediate rebuke was stark evidence of the tough job that is looming for Speaker Johnson. This failure was just another example of the historical nature of these moves in the House given that this is the fourth rule to fail this year. Prior to this year, a rule hadn’t failed in over two decades. Those fights will still need to be fought, especially in the House. Each day without the passage of the funding bills brings lawmakers a day closer to the 2024 elections and the ensuing change in focus.

There might be a silver lining to the fact that next year is a Presidential election year and the reality that both the Senate and the House majorities are very much in play. This makes the coming elections even more important to the members of both parties, which might motiveate them to pass some positive legislation that they can point to as they go back to their states to campaign. There are always ways to push through legislation or postpone Medicare cuts if it benefits the profiles of enough lawmakers. This will require some bi-partisan cooperation which will only happen if both sides can somehow claim victory for passing the legislation. We’ll wait to see how this plays out.

There is another thing that I want to bring up as we consider the unprecedented actions of the House. As we talk with lawmakers about legislation and rules that affect older Americans, we are careful to use data and logic in our arguments while also serving as a conduit for the voices of seniors throughout our country. We try to highlight the impact, both good and bad, of the proposed solutions that are brought forth by lawmakers. Most members of Congress calmly and thoughtfully consider both sides of the question and decide where they stand on the issue. The problem comes when issues have been kicked down the road, like has occurred here, and they are pushed up against deadlines, like they will experience at the beginning of next year. Often, as the members of both parties seek votes for their favored legislation, the calm and thoughtful decisions they made earlier are replaced by the lure of the deal. I’ve seen it in the frenzy of amendments added to must pass legislation and votes made in support of bills that wouldn’t have been made in calmer times. It’s the nature of Washington these days and it is a dangerous time. The speed at which these back-office deals are made often don’t give stakeholders any time to make lawmakers aware of the proposed legislation’s impact on all facets of providing healthcare to Americans. It certainly doesn’t offer the time for the lawmakers to consider the issues calmly and thoughtfully. It is a time fraught with danger, and I hope that lawmakers hold to their principles during this hectic time.

The situation that lawmakers find themselves in is certainly NOT business as usual. I will work to keep you up to date as this hectic period plays out. I encourage you to take the time to inquire where your Members of Congress stand on those healthcare issues that affect you and your family. Your voice can be powerful as it encourages lawmakers to not let the frantic oratory of the moment and the lure of the deal overcome their calm considerations and decisions.

Best, Thair

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Thanksgiving – A Time for Family and for Learning

Next week is Thanksgiving, and it might be the most normal Thanksgiving since 2020. I remember, as I’m sure you do, that the COVID Thanksgivings were not fun. Even in 2022, many of us were still hesitant to gather together. With the fall temperatures pushing us indoors and the closeness of large groups gathering together, COVID was still on our minds last year. The last thing grandparents wanted, even if their family went over the river and through the woods to get to their house, was to find out that their Thanksgiving gathering was the cause of someone getting COVID. Being able to get together once again, as we did in the good old days prior to 2020, should give us all the chance to renew one of the great traditions in our country.

Lest we think we can throw caution to the wind, let me talk a little about something that should have been part of our fall tradition, getting our recommended vaccinations. While there are many vaccines that we need to stay current on, I’m going to talk about four vaccines that we should pay special attention to during the Thanksgiving season.

I think that probably 90% of Americans will have some type of Thanksgiving gathering, but with just a little over 50% of those 65 and older getting their flu shots, there’s a good chance that the flu will be the thing that gets spread around this fall. If somehow, we could get a 100% of those over 65 to get their flu shot, it would cut the flu deaths exponentially, not just in half. And, lest you think what we do won’t have that big of an impact, consider this: the mask wearing and distancing that occurred during COVID had a huge effect on flu infections. According to the CDC, during the period of September 2020 through March 2021 the number of recorded flu cases was 2,000 as opposed to the historical average of 206,000 over the same period. The flu was almost nonexistent. This same type of exponential effect will happen if we reach a critical number of flu vaccinations.

RSV (respiratory syncytial virus) is a fairly new member of the fall vaccinations we need. I’ve only known about RSV for adults for a couple of years, I always thought it was something reserved for young children. It causes flu like symptoms and is dangerous for older people just like the flu. The RSV shot has about the same impact of keeping people out of the hospital, 65%, as the flu vaccine.

While the threat of COVID shouldn’t hinder us from enjoying Thanksgiving, it is still a threat that we should pay attention to. The latest COVID updated vaccine (we shouldn’t call it a booster since it is updated to handle a new variant rather than to boost an earlier vaccine) gives us protection against the latest variant of the virus. Sadly, a significant number of seniors have said they won’t get this updated vaccine. Maybe we are just getting tired of COVID or think that ignoring it will cause it to go away. Well, it won’t. We need to continue to stay vigilant and use every tool in the toolbox to stay healthy. It’s OK to get the flu shot and the COVID update shot at the same time. I did. Officials aren’t sure how the RSV reacts with the flu or COVID vaccines, so it is probably advisable to get the RSV shot alone.

I do need to say something about vaccine hesitancy. The number of people who refuse to take advantage of vaccines has grown. There are certainly people who have had adverse reactions to certain vaccines. While these anecdotal stories capture our attention, we need to remember that the exceedingly small risk of a bad reaction is worth the large benefit of getting vaccinated. It would certainly be a life limiting decision if we decided to never go outside because we feared getting hit by lightning. There is certainly a chance of getting hit by lightning, but a huge percentage of us have decided that living a fuller life is worth that infinitesimal risk. I do understand that fear, even if to some the fear seems illogical, has a definite impact on every one of us. Information and understanding gained from reliable and trusted sources are two ways to overcome fear and allow us to live fuller and more healthy lives.

While it’s important to learn about vaccines that we should take advantage of this time of the year there is one more thing we can do while we are gathered together at Thanksgiving. It is a great time to share historical health information. I don’t mean encouraging grandpa to tell everyone about his latest health problems (heaven knows he doesn’t need any encouragement). What I’m talking about is spending some time talking about the diseases and maladies that are common among your families and their progenitors. I’ve just visited with a friend who years ago was diagnosed with a heart problem that couldn’t be detected with a stethoscope or EKG but only through an echocardiogram. It was serious enough that the doctor encouraged him to alert his siblings and have them checked. It has allowed some of his siblings and their children to be treated for this problem that had been unidentified prior to him alerting them. This sharing of family health information has allowed me to avoid some serious eye problems. Take the time and have someone document your findings. You’ll be amazed at how many common health problems you have among your family and what solutions have been found.

I hope you have a great and NORMAL Thanksgiving celebration and that the good food and good discussion bring you closer to your loved ones.

Best, Thair

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Alzheimer’s – It Impacts More Than Just the Patient

This month is Alzheimer’s awareness month, and I’m going to focus my blog on someone who is often forgotten in the battle of this awful disease – the primary caregiver. We’ve all heard the preflight briefing on an airline when the flight attendant says that we should put our mask on first before helping our children with their masks. It is often the case that caregivers forget that they must take care of themselves in order to take care of their loved one who has Alzheimer’s. We should be the ones that recognize the importance of caring for the caregiver and offer our help.

This disease is unique in the broad effect it has on everyone associated with the patient. I don’t want to, even for a second, downplay the awful debilitating affect Alzheimer’s has on those affected. It robs them of who they are and of skills they developed over a lifetime. We have all seen the decline of an Alzheimer’s patient as the disease slowly progresses, but I think it is important to take some time to focus on the primary caregiver and the huge personal impact it has on them as they take care of their loved one. This huge service often goes unrecognized and unpaid.

Our country’s healthcare system reaps a huge benefit from those who give care, and many think we could do more to encourage and support caregivers. The National Association of Caregivers says –

The lack of support for caregivers is causing negative ripple effects for the health, financial, and mental well-being of America’s caregivers, with 12 million Americans reporting that caregiving has made their health worse and nearly 20 million reporting high levels of emotional stress due to caregiving. The economic impacts can be staggering. Nationally, unpaid care is valued at $600 billion annually.

600 billion is a lot of money. As far back as 1996, in my work advocating for older Americans, I pushed for legislation that would grant tax breaks for people caring for loved ones. Little has been done in that arena. but there are still lawmakers who see the value of compensating caregivers in some way. I think anything our government can do to encourage caregivers will be money well spent. I’ve always lobbied for laws that will support aging in place. Older Americans want to stay in their homes. They don’t want to be moved to institutions, and supporting them in their desire to age in place is a money-saving proposition. I encourage you to support legislation and regulations that support caregivers.

As I try to do in my disease focused blogs, I want to give you some actions you can take right now to help caregivers who are caring for a loved one with Alzheimer’s. I found an interesting blog on the Alzheimer’s Universe ( web page that discussed 5 things NOT to say to an Alzheimer’s caregiver. I thought it was very informative and would be helpful as we seek to help those who give care to Alzheimer’s patients. I’ll give you the short, condensed version, you can go to their website for the complete article and for other information and help Alzheimer’s caregivers.

Five things you shouldn’t say to an Alzheimer’s caregiver.

“You really look like you need some rest.”

Caregivers are often overwhelmed and don’t have time to care of themselves, but they don’t need to hear how bad they look. What would help is to take action. Offer to help. You will see this hint a few more times.

“I know your mom would have been thankful for all your help, she was such a lovely person.”

Referring to the Alzheimer’s patient in the past tense is disrespectful to both the patient and the caregiver. While the personality of the patient has often changed, the caregiver is still helping a person that needs their love and help.

“On a spiritual level, just know that God will never give you more than you can deal with.”

It’s not uncommon for caregivers of those in the later stages of Alzheimer’s to feel that they are taking on more than they can handle. Try not to give a caregiver reason to doubt their spiritual source on top of everything else they may be going through. Better to roll up your sleeves and simply offer to fill in for a few hours next week.

“How can I be of assistance?”

This question goes hand in hand with the, “call me if you need anything” statement. You are putting more work on the caregiver by asking them to find out what you can do, what your schedule is, and how willing you are to really help. A better approach would be to ask the caregiver about their tasks – what things takes the most time, what is the hardest for them to do? Then tell them what you can do, when you can do it, and set up the time and day when you will be there. Be sure and leave a phone number in case schedules change.

Making small talk and avoiding the huge burden that the caregiver is carrying.

Don’t avoid the thing that consumes most of their time. Let them know that you care about them. Action statements like these can really help:

  • “Can I help by driving to a medical appointment next week?” 
  • “I’m available if you would like to talk about it.”  
  • I can help with house cleaning once a month on any Saturday
  • “Please tell me how you are really feeling.”

These are things that are positive and immediate forms of help to the caregiver.

I think that one of the deepest forms of love is giving care to someone who needs our help. I hope that as we strive towards a cure for Alzheimer’s, we also recognize the burden of the caregiver and strive to lighten their load through legislative and personal positive actions.

Best, Thair

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Will CMS Really Listen and More Importantly – Respond?

This week begins a series of “Listening Sessions” concerning the 10 drugs selected for “negotiations” under the Inflation Reduction Act (IRA). These sessions, labeled the “Medicare Drug Price Negotiation Program Patient-Focused Listening Sessions”, were put in place to, “provide an opportunity for patients, beneficiaries, caregivers, consumer and patient organizations, and other interested parties to share input relevant to drugs selected for the first round of negotiations”. Sounds like a great opportunity for those  affected by the IRA to have their voices heard. Maybe a chance to actually have an impact on how these changes to the immensely popular Medicare Part D prescription drug program are implemented, but I have reservations. The following, in no particular order, details those concerns.

I’m concerned with the narrow focus of the sessions. Their guidance states that, “CMS is interested in patient-focused input relevant to the selected drugs”, nothing on the impacts of other parts of the IRA that affect Americans, especially seniors. I’ve talked in earlier blogs about the importance of how a piece of legislation that is passed and signed into law can have widely different impacts depending on how the law is implemented. These listening sessions are limited to comments on the 10 drugs chosen for price controls. At the very least, wouldn’t it seem logical to invite comments prior to the selection of the 10 drugs? Let alone the chance to broaden the sessions to allow comments on the  implementation of other parts of the law. For example, the Centers for Medicare & Medicaid Services (CMS) put the 5-star rating system in place after the initial 2006 implementation of the new Part D benefit. CMS decided it was a good way to give seniors information on how the different prescription drug plans were performing. The rating system was not directed by the law; it was a CMS decision on how to implement the program. Over the years, this rating system has had a huge affect on the Part D program (many believe it has had a positive effect, some believe it was detrimental). The point here is that this implementation approach was a CMS decision. I can’t find any documentation where CMS conducted listening sessions before they decided to implement the 5-star rating process. I’m concerned with the power CMS has to decide what rules and regulations the IRA will operate under.

I’m also concerned with the small amount of time allotted for each comment. Three minutes only allows an extremely short time for speakers to present to any depth their concerns or possible solutions. It also bothers me that CMS will have no comment or interaction with the commenters during the sessions. This brings me to another concern.

CMS allowed for written comments, which had to be submitted 28 days prior to the first listening session. The process for submittal was cumbersome, driven by questions and not user friendly. It was especially difficult for people who are not used to submitting documents to CMS. For instance, you have to enter your email address before you could see the questions or start the process. This isn’t conducive to seniors who have been warned about submitting personal information, especially when it is prior to seeing any questions or even deciding whether they want to continue with the process. It was also noted that you couldn’t save a work in process which means you must finish in one sitting. Again, an unnecessary roadblock to submission.

From my point-of-view, requiring the submittal of comments earlier would have allowed CMS to respond to some of these comments before or around the scheduled sessions so that we could have a feel for where CMS stands on some of these comments and questions. There is no announced schedule when or if CMS will respond to any of the written or oral comments. This seems like a decidedly one-way flow of information . . . no interaction or response.

I’m also concerned with which questions or comments that CMS will deem meaningful. We have no idea how the submitted information, either written or oral, will be interpreted and if it will be acted upon. I’ll be really interested on what comes from CMS after the listening sessions are over.

I understand that I’ve been pretty negative about these opportunities to communicate with CMS. I’ve been involved in many meetings, comment opportunities and discussions with CMS people and I’ve found some to be constructive but many that were just CMS checking a box to satisfy in their mind that they have heard from the patients and those that advocate for patients. Having said that, I do hope that there are many written comments submitted and a large participation in the oral listening sessions. The worst outcome is for the participation to be small, giving CMS the chance to conclude that giving patients and the private sector a chance to speak out is a fruitless endeavor. I hope the sessions are informative and those that participate are well prepared and meaningful. I truly hope that CMS takes the time to evaluate closely all of the oral and written communication and shares the written submissions with us. It would be a real breakthrough to see changes to the IRA implementation as a result of the private sector communication.

Finally, I hope these listening sessions result in more chances for patients and the private sector to comment on a broader range of topics concerning implementation of the IRA, even to include changes that might directly help Part D beneficiaries. Changes like eliminating the terrible restrictions on small molecule innovation which I’ll write more about in later blogs.

Look for a follow-up blog in a few weeks that will give my views on how the listening sessions went.

Best, Thair

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National Breast Cancer Awareness Month – A Focus That Could Save Lives

October is National Breast Cancer Awareness Month, and it brings into focus how important early detection is to surviving breast cancer. It is difficult to find someone who doesn’t know someone who has been affected by breast cancer. 1 in 8 women in the United States will be diagnosed with breast cancer in her lifetime. In 2023 it is estimated that over 297,000 women and 2,800 men will be diagnosed with breast cancer. The good news, and the reason we focus on detecting the cancer early, is that the 5-year survival rate is 99% when the cancer is diagnosed in its early, localized stages. It is evident why it is important to adhere to the recommended processes and schedule for detecting breast cancer. We also should be vocal advocates for ensuring that the regulations and funding are available to continue the development of more advanced detection tools and the discovery of new treatments for the cancer itself.

I’m going to stop here for a minute to talk to the men. The women in our lives historically are the ones that ensure our families get the medical attention we need. Men are the knuckle heads (I include myself here) that put off seeing a doctor. We’re the idiots that prescribe the highly effective, “rub some dirt into it” as the treatment for a skinned knee. Most of us have at least 8 women who are especially important to us. With the knowledge that one of those 8 will get breast cancer, we should be the ones who know what the process and schedule is and encourage our loved ones to do their own self-examination, get their mammograms as recommended and have regular doctor visits. By the way, men can also get breast cancer, so it is important for us to have thorough physicals once a year.

I’m going to give you some good links at the end of the blog to get you to the information you need concerning breast cancer, but first I want to share a few things that jumped out at me as I did the research on breast cancer. It’s important to note that finding a lump during the personal examination doesn’t in and of itself indicate that there is a tumor, benign or otherwise (see myth below). There are small grape sized pockets that are mostly water that can be discovered during your self-examination that are not tumors and may or may not be removed. Many myths have invaded the information around breast cancer. Here are a few myths that need debunking.

Myth: A breast injury can cause breast cancer.
Truth: Injuries to the breast do not cause cancer.

Myth: Breast cancer is more common in women with bigger breasts.
Truth: There is no connection between breast size and cancer risk, although it can sometimes be more challenging to examine larger breasts.

Myth: Breast cancer only affects middle-aged or older women.
Truth: While most cases of breast cancer do occur in middle-aged or older women, a breast cancer diagnosis can happen at any age or any time.

Myth: Breast pain is a definite sign of breast cancer.
Truth: Interestingly, breast pain is usually not a sign of breast cancer.

Myth: Carrying a phone in your bra can cause breast cancer.
Truth: While carrying your cell phone in your bra may not be the most comfortable choice, it does not cause breast cancer.

Myth: All breast cancers are the same.
Truth: There are many different types of breast cancer—which are determined by the specific cells in the breast that become cancer—and each type has different features and considerations.

Myth: Bras with underwire can cause breast cancer.
Truth: No matter what the type, bras do not cause cancer.

Myth: Finding a lump in your breast means you have breast cancer.
Truth: Only a small percentage of breast lumps turn out to be cancer.

Myth: A mammogram can cause breast cancer or spread it.
Truth: A mammogram, or x-ray of the breast, currently remains the gold standard for the early detection of breast cancer. Breast compression while getting a mammogram cannot cause cancer nor does it spread it. In fact, tighter compression during a mammogram leads to clearer images that are easier for the radiologist to read.

Myth: If you have a family history of breast cancer, you are likely to develop breast cancer, too.
Truth: While women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. Statistically only about 10% of individuals diagnosed with breast cancer have a family history of this disease.

Myth: Breast cancer is contagious.
Truth: You cannot catch breast cancer or transfer it to someone else’s body.

Myth: Antiperspirants and deodorants cause breast cancer
Truth: Researchers at the National Cancer Institute (NCI) are not aware of any conclusive evidence linking the use of underarm antiperspirants or deodorants and the subsequent development of breast cancer.

There are two web sites that I found to be informative with the option to read in depth on many subjects concerning breast cancer. The first is – Breast Cancer Information and Support and the second is the National Breast Cancer Foundation. Both these sites are excellent trustworthy sources of information. I hope this focus on breast cancer helps you commit to being vigilant in taking the steps necessary to assure you the best chance of detecting breast cancer early.

Best, Thair

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Medicare Open Enrollment – A Process That’s Worth Your Time

As of October 15 (that’s right, it’s that time of year again) it’s another Medicare open enrollment period. It lasts until December 7th — an easy date to remember for those of us who are a little older. This is the time when we can reconsider how our Medicare supplemental or Medicare Advantage (MA) plans are working for us, and, maybe more critical, how our Part D prescription plans are working. If I’ve said it once, I’ve said it more than once, many of us pass up this chance to save ourselves a lot of money. Here are the dismal facts from past years: only 30% reviewed their supplemental insurance plans and about 50% reviewed their MA plans. Even more troubling, only about 20% reviewed their MA prescription drug plans and 30% reviewed their stand-alone drug plans. It is often the case that the way we can save the most money and get access to the particular prescription drugs we need is by choosing the drug plan that fits us best. I do realize that when our prescription drug plan is included as part of our overall plan, which is the case with most MA plans, you feel like you don’t have many options to change. That often isn’t the case. There are sometimes other drug plans to choose from or the option to opt out of the MA’s prescription drug plan and find your own stand-alone plan. It might even make sense to change to another MA plan with similar Medicare benefits but with a drug plan that fits you better. The key here is not to assume you are stuck. Find out about your options.

There are a couple of situations that are strong indicators that you should review your coverage. First, if you have had a change in your health, require new medicines or stopped taking some medicines, you need to explore your options. Expensive cancer treatments and medication are examples of situations that could require significant out-of-pocket costs. Auto immune diseases also often require expensive medicines. Even a small change can have a large impact on the bottom line. Second, a change in your insurance coverage may impact your access and cost. Your plan may decide that the doctors and specialists that you see on a regular basis are no longer in their preferred provider network. Suddenly paying out of network costs could have a substantial financial impact. The same goes for your prescription drugs, your plan may change the cost and even your access to the prescription drugs you currently take. It is important to review the 2024 plan descriptions that your current plan sends out this time of year to see if any of their changes affect you. There is one Important thing to remember: the insurance company has the option at the end of the year to completely cancel the insurance plan you currently have, and, if you don’t select a new policy by the close of the open registration period (December 7th), they can select a policy that, at their discretion, matches the plan you had before. While I see this happening more often next year when the full impact of the Inflation Reduction Act changes go into effect, it’s still a good idea to not get caught letting some other entity decide what’s good for you.

There are some preparations that you can do that will make it easier to do this once-a-year review. The first thing you need is a list of the medicines you take. Write out how much out-of-pocket you spend on each prescription and whether you expect to take them for all of next year. I’ve often mentioned that having a list of your prescription and non-prescription medicines and their dosage is a good thing to have with you. It seems that I fill out that information many times a year as I visit providers, over and over, it makes me crazy but it’s easier if you have the info easily available. Just recently, I was able to attach a copy of my medicine information when I checked in on-line prior to my appointment. If you keep track of your out-of-pocket costs as you create and update your list, you will have all the info you need when you review prescription drug plans during the open enrollment period. The second thing is to know what your yearly premiums, co-pays, max out-of-pocket, and coinsurance requirements are for your current plan. The last item you need is a list of the doctors and providers that treat you. This will be valuable when you review the list if providers that are considered in network for the 2024 plans.

While there are many things to consider, there is help available to get you through the process. The best way is to click here which takes you to If you haven’t already created an account, you can do it there. After you sign on, it will bring up information about your current plan. It’s also an excellent place to add or update the information they have with the info you gathered as outlined above. I would still keep a copy of your data, both digitally and in hard copy (I just don’t want a glitch in the government’s system to cause you to lose all your info). This plan finder tool will be a big benefit in showing you your options. Another help is your local State Health Insurance Assistance Programs (SHIP), which exists in every state. You can find how to contact them in your state and get help by clicking here. The good thing about these two sources is they are both unbiased. They aren’t trying to sell you anything. They aren’t perfect, and I would contact the plan itself once you narrowed down your choice just to confirm the facts.

Well, there it is, another chance to let you sleep soundly for another year knowing you have chosen the best plan for you . . . although for many of us, it takes more than that for us to get a good night’s sleep. Happy hunting!

Best, Thair

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My Way or The Highway Is Not the Way to Govern

It has been an almost universal adage that those inside the interstate beltway that circles Washington D.C. are out of touch with the rest of America. I first heard that phrase when I talked with seniors after I began working in the public policy arena in 1996 and the usage has only increased over the past 27 years. There was always a reference to “inside the beltway thinking” that many believed was driven by incentives that had nothing to do with the needs of Middle America seniors. It’s hard to convince them otherwise when year after year we come to the brink of default, as we did over the debt ceiling debate, and now to the brink of shutting down the government, as we just witnessed when Congress failed to pass the funding bills that finance our country. Some have said that our country has grown accustomed to chaos in the capital, that we have come to expect crisis, that dysfunction is the new normal. I disagree. People I talk to (especially seniors) are really worried about what Congress is doing and aren’t willing to accept this as the new normal. This is borne out by the fact that nearly 3 out of 4 Americans have an unfavorable opinion of Congress. My focus today is not on who’s fault this chaos is but how this chaos affects older Americans.

I’m sure you get the same click bait ads that I get on your phones or computer, headlines that are tailored toward your age, your interests and where you live. The minute there was word of a possible government shutdown, I began to get notices on my different feeds wanting me to click on a link to find out if my Social Security check would be stopped or that Medicare benefits would be curtailed because of the shutdown. While these web sites are almost never a good source of information, it is true that this government funding impasse could cause delays in some government programs which causes stress and anxiety, especially among those who rely heavily on their monthly Social Security check.

The recent debt ceiling debacle did threaten to stop or delay Social Security checks and the current funding impasse would furlough many government workers. While seniors would continue to receive their social security checks during a government shutdown, about 15% of the Social Security Administration’s staff would be furloughed. This could mean the delay or suspension of benefit verifications, replacement of Medicare cards and determinations on disability. Veterans (which includes me) could be affected since regional offices could be closed if the government shutdown occurs. These are just a few of the possible impacts on older Americans that came awfully close to becoming a reality.

Just a few days ago everyone was convinced that a shutdown was inevitable. It was only through a last-minute deal that included both Republican and Democrats that the shutdown was delayed in hopes that final funding legislation before the middle of the November deadline. I was relieved, as I think other seniors were that Congress could reach a deal that would fund are nation… I was wrong. The Speaker of the House was going to be punished for preventing the government shutdown, since it required a few votes from Democrats.

After I finished watching the historic debate and final vote that removed the current Speaker of the House, I  realized that the House would be spending at least a fourth of the 45-day extension trying to select another speaker. Nothing else can get done until that happens, and it could become a long-drawn-out affair. Whether you believed the representative from Florida and his allies or those in the Republican Caucus who wanted to retain the Speaker during the debate, the final vote assured that the next days or weeks will be spent, not working on the important funding legislation, but trying to elect a new Speaker who will inherit the almost impossible task of bringing together a fractured House of Representatives to ensure our nation continues to operate. All this accomplishes is to continue the stress and worry of those older Americans who depend on our government to support them in their later years.

Everyone can, and will, blame either the Republicans or the Democrats, but the fact of the matter is, it’s the whole Washington political ineptness that has devolved into a state of chaos such that our lawmakers cannot accomplish the basic task of funding our government. Us older Americans can remember when our government could pass critical legislation when needed and wasn’t castigated for reaching across the aisle. When was the last time you heard the phrase, “we didn’t let perfect be the enemy of good”? This phrase referred to a time when both parties and ultimately both houses would work together and compromise to pass legislation that didn’t completely please everyone but could please enough people to be voted into law. I don’t see this happening anytime in the near future due to our polarized government.

OK, my temper tantrum is now over, at least for a few minutes. My point here is… we elect those law makers, and our vote is really powerful. There are also things we can do that makes a difference between votes. Let your voices be heard. Find good people who will support your values at the county, state and federal levels and volunteer for them. Let them know you support them. I’m tired of standing by and seeing our lawmakers do, or not do, things that increase the anxiety of seniors. These are times we should be worrying about what to get our grandkids for Christmas, not whether our Social Security check is going to show up in our mailbox or checking account. We may be old, but we have the time and the inclination to still make a difference. I for one am going to get involved.

Best, Thair

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Still Satisfied – Again: The 2023 Medicare Part D Satisfaction Survey

Last Thursday, Seniors Speak Out held a Facebook live event to go over our annual Medicare Part D satisfaction survey. It once again showed the continued pattern of overwhelming support for this crucial public/private partnership that has played such an important part in the wellbeing of seniors since 2006. Our survey was conducted by Morning Consult, a highly respected polling organization. They who asked a broad cross section of 1,000 seniors what they thought of Medicare’s Part D prescription drug program. The results were once again incredibly positive. For this Facebook live event I teamed with Matt Monday from Morning Consult to go over the survey results. If you would like to see a recording of the event you can click here.

I opened the event by reiterating that the results were similar to past years with 90% overwhelmingly satisfied with their Medicare healthcare coverage. I pointed out that Part D has been a success since 2006 when it was first implemented. I then commented that almost 80% of the respondents did not support increased government intervention in Part D, primarily out of a fear it would restrict their access to cutting-edge treatments.

I wondered how our elected officials could continue to ignore these worries and support policies that increased government intervention. This increased governmental control was evidenced by the release of the first 10 drugs that would be subject to “negotiations.” I conjectured that our latest survey offered an interesting counterpoint to our lawmakers’ assertion that there was widespread support for the government’s price setting policies. I then turned the time over to Matt Monday to discuss the results of our survey.

Matt began by pointing out that this was his second year working with me on the results of our annual survey but the fourth year that Morning Consult has conducted this survey, which gives them more data to back up the compelling results. Matt focused his review on four main findings. The first being that 95% of seniors were satisfied with their healthcare coverage, this included their Part D coverage where 91% were satisfied, a 3% increase over last year. The second finding was that seniors found their Part D coverage was convenient, of good value and affordable. Matt commented that he wished he could describe any other healthcare research  Morning Consult does that  has such  high levels of satisfaction. The third finding was that seniors felt they had access to the drugs they needed through their Part D coverage. One interesting data point was that seniors felt their out-of-pocket costs would be higher without Part D coverage. The fourth point focused on legislation that allows the government to negotiate the price of prescription drugs. Seniors were against the legislation if it inhibited their access to existing medicines or limited the discovery of new medicines.

After Matt’s review of the survey, I asked a few questions. I first asked if satisfaction rates had evolved over the years and why. Matt replied that one indicator of satisfaction was participants’ intensity of satisfaction, which is manifested by those who were very satisfied with their coverage. Those who were very satisfied increased 12% since 2021. Matt attributed some of this increase to seniors realizing how important Part D was during the COVID pandemic.

My next question dealt with why satisfaction rates have remained high. Is it premium prices, ease of use, or perhaps some other factor? Matt pointed out that the low premium price is certainly important, but he thought the findings show indicate that the ease of use and feeling comfortable with your plan makes a big impact on how satisfied you feel with this program.

I then asked if he thought that even though seniors found the program to be convenient, did they think it had high costs? He said that they found that seniors continued to think their costs weren’t high and he pointed out that 3 out of 4 seniors would recommend their plan to a friend or family member. I commented that one good thing that came out of the Inflation Reduction Act (IRA) was the cap on out-of-pocket costs, and it will be interesting to see if it lowers the number of survey respondents who say their out-of-pocket costs are too high in future surveys.

I went on to ask what are the primary concerns seniors express regarding government involvement in Medicare Part D? Matt said that seniors were really concerned about the price setting portion of the IRA because this increased government involvement would put the government between them and their doctor and would limit their access to new medicines. He referenced the recent news that several drug manufacturers indicated this new legislation will limit their research and development on certain types of drugs.

My last question was whether he thought the IRA will impact the integrity of Part D? Matt said the data shows that seniors perceive that government involvement will have a direct impact on access to drugs and that this new legislation will not be in the best interest of patients.

My last comment resurrected an old saying that applied to Medicare Part D: if it ain’t broke don’t fix it. I expressed my fear that our government has begun a journey on a path that is going to negatively affect a program that has worked extremely well for 17 years.

I closed the event by thanking Matt and the Morning Consult people for conducting this survey and thanking those who joined us for this event.

Again, if you would like to see the entire Facebook live event you can click here.

Best, Thair