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Town Hall on Drug Pricing Legislation – A Recap

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We then had some final comments:

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

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



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Our Medicare Prescription Drug Benefit – It Works PART II

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

Medicare Today Town Hall

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

Guest Speakers

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

Thair Phillips 
Former President and CEO of RetireSafe

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

Register Here

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

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

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

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



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Our Medicare Prescription Drug Benefit – It Works

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

Medicare Today Town Hall

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

Guest Speakers

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

Thair Phillips 
Former President and CEO of RetireSafe

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

Register Here

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

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

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



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Alzheimer’s and the Summer Solstice

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

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

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

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


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

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


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

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

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

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


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

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

Best, Thair



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

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

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

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

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

1. Go to the Park

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

2. Attend a Fitness Class

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

3. Walk to Health

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

4. Work in the Garden

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

5. Dance

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

6. Schedule A Health Screening

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

7. Volunteer

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

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

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

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

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

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

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

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

Best, Thair



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Osteoporosis Month – A Chance to Make a Difference

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

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

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

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

During your visit with your doctor, remember to report:

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair



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Drug Price Hearing

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair



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Medicare Quiz – The Answers May Surprise You

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair



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A Harmful Path on Drug Pricing

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

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

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

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

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

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

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

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

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

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



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Town Hall – Survey Results

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair