Quite a few years ago, a friend of mine (when a person starts a story saying this, it usually means that it’s really about the person themselves, not their friend), made a decision about which two senatorial candidates he was going to support. One candidate’s stance on issues was more extreme while the other candidate had a more moderate outlook. While my friend favored the more extreme candidate’s views on the issues, he realized that the more extreme approach was never going to make it into law, so he supported the more moderate candidate. This hope for bipartisan solutions seems to be a thing of the past. It seems that the extremists in both parties have much more impact on Washington than the moderates. It seems bipartisanism is a dying attribute. Due to favorable district design (i.e., gerrymandering) more and more House Districts are becoming safe for one party or the other. For a candidate to win the party’s nomination, the candidate needs to move to the far left or far right depending on the party in control. It seems that the only moderates to be found are those in competitive House Districts. While less prevalent in the Senate, the same dynamic prevails. This polarization is a reflection of our divided nation.

Now you may quickly take me to task pointing out the  debt ceiling bill that just passed, but I believe that this forced cooperation only occurred due to the fact that neither party wanted to be blamed for the country defaulting. It was, however, refreshing to witness the negotiations and the give and take in which  both sides participated. It does give me hope that there might be other places where there is enough common ground to pass some bipartisan legislation. So, what does all this have to do with whether your voice has a chance of being heard over the din of the extremists’ voices?

Decades ago, a large group of Americans were labeled the “silent majority”. I think this label applies even more today than it did back then. The only thing we hear, on every form of communication, is the radical, extreme, divisive, and disrespectful voices of those whose only goal is to be heard rather than to solve problems. I think there is a group of people, like “my friend,” who would rather see our politicians generate solutions that don’t completely satisfy either party (or himself) but contain elements championed by each party. I’m not crazy enough to think this has a chance to happen in the short term, but I think it has a chance to slowly bring both parties back toward the middle. But it can only happen if the silent majority speaks up.

As we have done in the past, Seniors Speak Out has prepared a poll that we hope you will take. One of the most powerful ways we can get our opinion to those in Washington is by having large participation in a poll that clearly identifies where we stand on particular issues. We focus on healthcare issues at Seniors Speak Out, so our poll questions focus on how you feel about certain aspects of your healthcare.

The poll asks what your biggest concern about your healthcare is, what should Washington’s healthcare priorities be, what concerns you have concerning prescription drug price controls, what method you use to contact your lawmakers and how convenient and accessible you feel Medicare is. We also give you a chance to add any comments you might have on each question. We really want to know how you feel. Your answers will give us a chance to communicate your feelings to those is Washington who impact your and my healthcare.

We will also be holding a Facebook Live event on June 15^th where I will host a special guest, Mark Gibbons from RetireSafe. We will discuss the poll and your responses to the questions. We will also discuss pertinent healthcare issues including threats to healthcare innovation and access. I hope that this poll and the follow-up Facebook Live event will give you the information you need and inspire you to contact your lawmakers and tell them how you feel. Contacting your lawmakers is a powerful way that you can make a difference.

You can take the poll by clicking here. You can sign up for the Facebook Live event by clicking here, and mark yourself as “going.” You can always go to our contact your lawmaker web page for an easy way to tell those who represent you in Washington how you feel.

I hope that you will take the opportunity to be active in how Washington regulates our healthcare. Take the poll, watch the Facebook live event, and then contact your lawmakers. These are great ways  you can be involved in your healthcare.

Best, Thair

Tomorrow, Wednesday May 31, is National Senior Health and Fitness Day. There will be over 100,000 seniors participating in local health and wellness events in over 1,000 different locations throughout the nation. This is the 30^th year that this national event has been in operation, and it continues to grow. This year’s theme is “Move More to Do More!” which is a nice way of saying to get your butt up off the couch and move. You’ll find the more you move the more things you’ll be able to do.

Since these local events are sponsored by different types of organizations there is no national central place on the internet where I could find what events are going on in my area. Some of you may have already received notices or have seen advertisements in your local sources of news and information concerning groups that are sponsoring events. I did find that when I googled National Senior Health and Fitness Day for my state I found three places that were doing special exercise events or special swimming events. The great thing about these events is they are free and even have some free food and drinks at some. That would be somewhat counterproductive for me, but since it is a special day maybe I can enjoy while exercising some restraint. The best thing about attending is the chance to see new health and wellness places that might interest you.

There were some pickle ball events which makes sense since this is the new rage for getting out and moving. There are new courts opening up and new organizations forming to support local leagues. I have put off trying out this new sport, but I have many friends who play and sing pickleball’s praises. Evidently it has the right amount of movement for older participants, and from what they say, it will help you move more without wearing you down. I’m sure I’ll be getting involved at some point. It does sound like the ideal sport for seniors.

There are some things I want to share that I thought were quite interesting. As I was searching for fitness day events, I used different search phrases and one I used to produce a great list of nation-wide health and wellness information sources by respected sources. I thought it would be useful to share these links and a little explanation with you. I’ve explored each link and they are safe and useful.

You Can Start Exercising After Age 60 — Here’s How

This link and the one below offer good first steps in starting an exercises program. This link offers information about how to get started and what to expect when you exercise after you’re 60.

How Older Adults Can Get Started With Exercise

This is another good source of information on starting an exercise program. It covers the following:

• How much activity do older adults need?
• How older adults can get started with exercise
• Four questions to ask your doctor about exercise
• How to set fitness goals
• Write a plan to add exercise and physical activity to your life

These steps are a great way to get started, a way to commit to turning your good intentions into action.

Exercise Plan for Seniors: Strength, Stretching, and Balance – Healthline

Good balance is a big indicator of good health. I’ve talked about this in one of my earlier blogs. It is a simple but efficient way to start exercising. This link gives some great exercises for improving your balance.

Growing Stronger – Strength Training for Older Adults

This link is a whole book on strength training and as I started to do a quick review, I found myself reading more and more and thinking about the exercises they recommended. It is sponsored by the CDC and was developed at Tufts University. I’m not sure you can find a more comprehensive source of information on increasing strength for older adults anywhere, especially not for free. If you want to get serious about getting stronger, this is the way to go.

What Is SilverSneakers and Does Medicare Cover It? – Healthline

I’m a big fan of SilverSneakers because it offers access to wellness facilities, like gyms and swimming pools, and classes that can help us stay healthy. These benefits are covered by many Medicare Part C (Medicare Advantage) Plans and some Medigap (Medicare supplement) Plans. The SilverSneaker’s web site also offers online exercise classes and a great deal of information on exercise, diet, mental health, etc. Taking advantage of these benefits can be an economical way to accomplish your exercise goals.

I encourage everyone to get up and get involved in some of these fitness day activities. I look at National Senior Health and Fitness Day as another chance for us to be reminded of the importance of physical activity and maybe, just maybe, it will be the spark that motivates us to get off our duffs and start exercising.

Best, Thair  

Both Houses of Congress are scheduled to start their Memorial Day recess on Friday May 26^th, with the Senate coming back on Tuesday May 30^th and the House not returning until June 5^th.  That’s the schedule, but the debt ceiling deadline may throw a wrench into both schedules. Congress must raise the debt ceiling for the country to continue to pay its bills and the estimate for the money to run out if the debt ceiling is not raised is June 1^st. This means that both Houses could be staying longer in Washington or returning earlier than originally scheduled as this legislation is debated and voted on. In the recent past, when neither party has a majority in both Houses of Congress or the Presidency, it has become a time for both parties to try to use this bill to pass other policies that can be attached to this “must pass” bill. This year has been even more “entertaining” given the slim majorities in both the House and the Senate. Here’s where we stand right now.

The House, much to everyone’s surprise, passed a debt ceiling bill – the 2023 Limit, Save and Grow Act – that included long term debt reduction language and a reduction in funding for many civilian agencies. House Speaker Kevin McCarthy (R-CA) said his party’s plan would “prune” the “bloated, overgrown bureaucracy.” The Senate, where the Democrats hold a slim majority, said the bill was dead on arrival and the President said he would veto it if it passed both Houses. What the Housed-passed bill did do was bring the leaders of the House and the Senate into a meeting with the President to see if they could come to a compromise, since no one in Washington wants to bear the responsibility of our country defaulting on its debts. Defaulting would cause an economic implosion that would reverberate in all the world’s financial markets and would have a huge negative economic impact on our fragile economy as we try to tame inflation. While there have been signs that a compromise might be in the works, there have been pauses and posturing that prove a default is not out of the question. It seems unfathomable to me that our elected officials would allow our country to default but politics and the deep divisions in Washington and our country often cloud the vision of those who lead us and leads to illogical actions. I hope that reason prevails.

As our lawmakers try to find a way to avoid defaulting while also lowering our debt, I feel the need to get on my soap box about two things that this bill has reminded me concerning problems I’ve seen in the past. First, one of the sticking points in the negotiations is Republicans pressing for government aid recipients to be seeking work or working or participating in educational training of some kind, so-called “work requirements.” This has long been a much-debated policy, one that I have watched and even participated in. While it seems logical that if a person receives government aid but is able to work then they should work. Work requirements for Medicaid beneficiaries is one of the places where these requirements have proven to be a sticking point. When someone is receiving state supplied Medicaid benefits, where the Federal government supplies the bulk of the funding, then Washington can impose these type of eligibility requirements. It boils down to making sure the aid is given only to those who really need it. Regulating who should be required to work without withholding aid to those who really need it, is a hard and costly proposition but one that I feel should be pursued. Ronald Reagan once said, “I believe the best social program is a job.” It is simple in concept but difficult to implement. I think there must be a compromise that encourages people to use the aid they receive as a steppingstone to a job that frees them from requiring aid.

The other point I want to make is how proposed legislation is financed. As our country has dealt with our huge debt or big healthcare legislation, we have passed bills that often were paid for by changes in Medicare and/or reductions in drug prices. The Affordable Care Act did it and the recent Inflation Reduction Act also used healthcare savings as a way to pay for other programs. My position has always been, if you do things that eliminate waste and abuse or increase the efficiency of our government healthcare programs then the money saved should be used to improve healthcare programs such as lowering the out-of-pocket costs for the program beneficiaries or lowering our nation’s debt. It shouldn’t be used to pay for other programs.

Ok, I’ll climb down from my soap box and talk about a piece of legislation that really has a chance of coming up for a vote once the debt crisis is passed. This legislation deals with Pharmacy Benefit Managers (PBMs). These PBMs are third-party administrators who negotiate with drug manufacturers on behalf of health plans. Over the years they’ve gone from contractors that processed claims to powerful entities in the prescription drug supply chain. Some have said that the rebates negotiated by PBMs are not benefiting the ultimate beneficiaries. There have been multiple hearings and there is bi-partisan support to make the dealings of the PBMs more transparent. While this all sounds great, we must be careful that we don’t throw the baby out with the bath water and overlook the benefits that having these PBMs have provided. As always, the devil is in the details, but this legislation that deals with PBMs seems like it has the most chance of moving forward.

The other workings in Washington that I’ll be watching is the implementation of the Inflation Reduction Act. This will continue to be an area of focus that I’ll continue to watch. In the meantime, I hope you have some fun things planned for summer.

Best, Thair

Many of us, prior to the pandemic, never thought much about the Food and Drug Administration (FDA). Most of us knew they were the ones that approved drugs but that was about it. We didn’t have strong feelings about them one way or the other. They just did their job in the background, and we enjoyed safe medicine. The pandemic and the rapid accelerated approval of the COVID-19 vaccines thrust them into the spotlight and suddenly everyone, it seemed, had an opinion on how the FDA should operate. The FDA’s time-tested accelerated approval process came under scrutiny and rumors of political influence were rampant. Sadly, this ill-advised mistrust caused some people to turn their back on these lifesaving vaccines . . . vaccines that some estimate saved almost 20 million lives worldwide. With all this controversy some have begun to doubt that the FDA was still the gold standard for the safe and effective approval of medicines. I thought that it would be important to review where the FDA stands today in this very important role.

The FDA, as an organization, is tasked with using unbiased scientific facts to ensure the efficacy and safety of the medicines it approves. Its historical record has proven that the FDA has done an outstanding job. The unbiased requirement has sometimes been tested and the FDA has yielded to outside influences in the past, but this outside influence was not authored by politicians but by the patients themselves.

For example, in 1988, hundreds of AIDS activists surrounded the FDA Parklawn headquarters building to protest what they perceived as a slow and inefficient drug approval process that was preventing patients from receiving possibly effective medicines and costing patients their lives. These protests, organized by the AIDS Coalition to Unleash Power (ACTUP), publicized patients’ concerns to improve access to emergent therapies and pushed the FDA to develop a new accelerated approval process to accompany the new treatment regulations for Investigational New Drugs which was implemented in 1987. This change enabled these desperately ill patients access to these promising new therapies. This accelerated approval process has been used ever since when the circumstances dictate and was used effectively to quickly approve the lifesaving COVID-19 vaccines.

There was another extremely important outcome from these patient protests. In 1987, the huge cultural impact of the AIDS crisis was evident as the AIDS quilt was first assembled on the National Mall in Washington, D.C. In the coming years AIDS Walks were organized across the nation. This was a clear signal of how important the patient was to the FDA’s policy making process. The new Office of AIDS and Special Health Issues was developed to build a relationship with the patient communities, and the FDA made it a requirement to include at least one patient representative on every advisory committee. The advisory committees were also more open and transparent and allowed public comment, an opportunity that I have taken advantage of and testified numerous times.

Over the years, this refocus on the patient has made the FDA more effective and should have diminished the fears people had on the effectiveness of the accelerated approval process for the COVID-19 vaccines, but the din of misinformation and conspiracy theories fogged our vision and led to the lingering distrust that still prevails in some people’s minds. I think it is important to use our 20/20 hindsight to look back at our experience with the COVID-19 vaccine approval process and the resulting effectiveness and safety.

Historically, a typical vaccine takes five to ten years to develop and manufacture. The Pfizer/BioNTech mRNA vaccine was developed and was being administered in less than a year. Prior to this vaccine, the quickest vaccine development was the mumps vaccine, developed in 4 years. Some of the concern as to the safety of the new vaccine was certainly the result of this four-fold reduction in development time. It might not have been as clearly communicated as it should have been that the accelerated approval process and the emergency authorization rules were not altered. The same criteria and adherence to scientific fact that was used in the past was employed. This same methodology was brought to bear when the ensuing variants were discovered, and the vaccines were modified to address these new strains. There is one thing that I think people overlooked as they tried to evaluate the accelerated approval process. The process of developing an effective and safe vaccine wasn’t just the goal of the FDA. A huge company like Pfizer wasn’t about to ruin its business reputation by producing an unsafe vaccine in the spotlight of the pandemic. I suspect their criteria for success might have been more stringent than that of the FDA.

So . . . what was the outcome? The results of the 5.5 billion people worldwide that got the COVID-19 vaccine reveal an extremely safe and effective vaccine. Some have indicated that the COVID-19 vaccine is safer than some of the other vaccines that have been around for decades. Any ill effects on specific categories of people have been miniscule. For me, the results speak for themselves, the accelerated approval process was effective, safe, and timely. Suffering was reduced and lives were saved.

Are there things that can be done to improve the process? Absolutely! I do believe that there were instances of political influence that have crept into the FDA. For Americans to trust the FDA they need to see an impenetrable wall between Congress and the FDA. The voice of the patient needs to be not only heard but recognized. I’ve seen instances where the FDA leaders and advisory committees have only given lip service to the patients and their advocates. They listened to the AIDS patients and it made them better. They need to continue listening.

In reviewing the facts of the pandemic, my 20/20 hindsight has shown me that the FDA is still the gold standard for ensuring our medicine is safe and effective. The FDA needs to do everything within their power to resist any pressure from outside entities, may they be political or in the private sector. The lawmakers need to resist the temptation to alter the goals of the FDA or to influence them in any manner. We need an independent, scientific driven FDA if we expect them to maintain their standing as the gold standard.

Best, Thair

Lawmakers introduce legislation for a variety of reasons, which already indicates there’s a problem. One would think that the only reason legislation should be introduced is for the betterment of the citizenry, but sadly, that’s not always the case. Take the latest piece of legislation, the SMART Price Act, that is being introduced by U.S. Senators Amy Klobuchar (D-MN) and Peter Welch (D-VT). This proposed legislation would amend the drug fixing language in the Inflation Reduction Act (IRA). These two Senators worked hard to get the price fixing language into the IRA. I’ve talked a lot about this language that serves to block innovation and allows the government to insert itself into the extremely successful drug discovery process and dictate prices of new, life changing medicines. We discussed the IRA last month, at our latest Facebook Live event. Our special guest, former U.S. House Speaker Newt Gingrich, wondered why, when we are at the dawn of huge breakthroughs and new discoveries, our lawmakers are choosing to sign into law policies that will chill investors and limit breakthroughs. He voiced his opinion that this is the time we ought to be removing roadblocks to research and finding ways to increase resources for innovation, not discouraging it. Notwithstanding the impact of this price fixing approach, Washington passed this partisan bill, and the gears are turning in Washington to implement it.

So . . . a logical question may be, why do these two Senators and the other Democrats who have joined them think it is necessary to amend this new law? Which brings me back to the beginning of this blog—this bill has nothing to do with the betterment of our citizenry and everything to do with optics, getting re-elected and setting the stage for more restrictive laws and government intervention. The SMART Price Act (Strengthening Medicare and Reducing Taxpayer Act) expands the number and kinds of drugs that the government has the power to price fix. The bill has little chance of moving forward, but it does show the long-term goals of these Senators and the current Administration. In a recent blog I wrote about the insidious way a camel can worm his way into the warmth of his owner’s tent, with the first step being to insert his nose underneath the tent wall but with the final goal being to be completely inside. It seems that these two Senators looked at the price fixing language in the IRA, not as a final solution, but as the first step to slowly insert the government into every aspect of Medicare’s prescription drug program. The ink is barely dry on this bill before they want to increase the government’s power over our prescription drugs.

The SMART Price Act is very small as compared to the 274-page IRA, yet it would have an enormous impact on innovation and access to new medicines. The new legislation is a little over three pages long but dramatically changes the impact of the IRA. Here are four ways it increases the power of the government over our prescription drugs:

• It eliminates the long-standing law that prohibits the government from total control of the Part D program while also allowing the creation of a government created national formulary. I for one don’t want the government telling me what drugs I will and won’t have access to.
• It doubles the number of drugs subject to price controls in 2026 from 10 to 20 and increases the number from 15 – 20 to 40 drugs in 2027. There is no reasoning for the increases, no evaluation of the impact, no benefits itemized, just a promise to save patients money.
• It moves up the eligibility for Medicare Part B drugs to fall under price controls to 2027. These are the drugs that are often injected at the doctor’s office or hospital for diseases like cancer. Again, no justification for this change was offered.
• It reduces the exclusivity from price controls down to three years for many drugs. This virtually eliminates the benefits of competition from generics and biosimilars.

My logical mind looks at this legislation and I would hypothesize that, since its only reasoning for adoption is that the increase in the number of drugs and the decrease in the exclusion period would be to save money, we should double the numbers again, or better yet, to save even more money, why not put all our medicines under government dictated price controls? I think that’s exactly where these Senators are leading us.

I look at this legislation and all I see is a bid to increase the government’s role in our healthcare and nothing for the long-term betterment of Medicare beneficiaries. How quick we forget that this debate over whether a new prescription drug program should be government controlled or it should be a public/private partnership was conducted at the end of 2003 and the choice of a public/private partnership was adopted, a choice that cost 40% less than projected and has an almost 90% approval ratings by those who use it. We made the choice 20 years ago and it was a good one.

While this legislation has a small chance of passing, it will make the next watered down proposed legislation seem more palatable. Grandstanding, optics to get re-elected and power positioning do little to solve the problems in our country. It’s important that we pay attention to these insidious moves to insert the government into our healthcare. We’ll do our best to keep you alerted to these serious threats.

Best, Thair  

Six days ago, Seniors Speak Out held a Facebook Live event with special guest Newt Gingrich. We once again had the opportunity to talk with the former Speaker of the House to discuss the various legislative changes that directly impact seniors’ lives, such as their access to treatments and medicines. Our discussion also highlighted the importance of seniors making their voices heard about how Washington’s actions impact their healthcare. You can click here to see the entire half hour event.

I started the event by welcoming everyone reminding everyone that Seniors Speak Out was created by the Healthcare Leadership Council’s Medicare Today as a resource for older Americans, caregivers, and advocates to encourage seniors to advocate for themselves and ensure seniors are educated on healthcare issues and access needs.

I pointed out that the Inflation Reduction Act (IRA) will have a huge impact on seniors’ access to certain medications and treatments given that the new law includes government price controls which has already begun to discourage R&D investments in new treatments. In fact, recently, several major drugmakers announced they are suspending drug development programs out of concerns that IRA implementation will make it impossible to receive a return on investment.

I further discussed how Seniors Speak Out prioritizes senior advocacy and our goal is to provide resources to help seniors understand the healthcare policies that affect their lives and one of the best resources I know is former Speaker Newt Gingrich.

Speaker Gingrich began by reminding us of how much our lives have changed since we put in place a system that encouraged the development of new innovative prescription drugs. He reminded us that these discoveries laid the groundwork for many life improving and life saving medicines and even produced the development of cures. He then wondered why, at this important juncture of new discoveries, our government would decide to enact policies that would restrict innovation. He pointed out that already, 24 drug manufacturers suspended or were going to suspend research on some drug research due to the IRA. He referenced a University of Chicago study that said these cuts to innovation would result in 18 trillion dollars in losses due to the cost of these unimpeded diseases. He conjectured that we should be implementing policies that accelerated innovation.

Speaker Gingrich referenced a book he authored in 2003 titled, “Saving Lives and Saving Money,” and he commented that the order of the title put saving lives in front of saving money because it is a critical moral issue, and he was worried that the current policies deal with the money at the expense of lives.

After these comments I pointed out that, despite the efforts of advocacy groups and seniors across the nation, our government passed the IRA, and it is now even more important for us to speak out to influence the implementation of the law to protect our access and innovation. I then asked Speaker Gingrich if he had any thoughts on how seniors can voice their opinions most effectively?

He quickly stated how important a constituent’s opinion is to lawmakers and he urged everyone to contact their member of Congress and their two Senators to make their feelings heard. He postulated that the reason they only allowed a short 30-day period for comment on the implementation of the drug provisions of the law is because they don’t want to hear from us. He said that these aren’t the people who are dealing with diseases. That’s why those of us who are impacted by these policies need to make our voices heard.

I then took some time to kind of “get into the weeds” on how the price setting portion of the IRA will hurt innovation. One way is that the price exclusivity for new drugs will be only seven years, reducing the time to recover R&D costs which, including drugs that never get approved, can be one to two billion dollars. I then asked Speaker Gingrich if he thought Washington could come up with a way to more soundly encourage innovation?

He responded saying that the first part will be the hearings that are conducted where the drug manufacturers can document exactly what these policies will do and how they will limit access. The second part will be finding ways to accelerate research, with a good first step being to enable tax credits, with a second step being to speed up the approval process. He commented how the drug approval process has gotten bogged down in regulations over the years and that there had to be a way to lower the time and cost of getting a drug approved without jeopardizing safety.

I interjected that if the hearings gave us an opportunity to see exactly where the research would be curtailed due to the IRA that we might then see how it would personally affect us. Speaker Gingrich noted that if the drugs that were discovered and developed decades ago weren’t available now that many people’s lives would have been impacted and much suffering would still be experienced. He stated that the cost in money and suffering would be enormous. He said that investors could invest in many areas and making it riskier to invest in healthcare is not what we should be doing. I then said that we often don’t account for the long-term savings that come from a new drug. Speaker Gingrich followed up with the statement that many of us who are retired can enjoy an active retirement because of these life-altering drugs and it would be a sad situation if we would deprive the next generation of new discoveries because of the policies we enact. He pointed out again that the study that predicted that the new policies in the IRA would cost our society 18 trillion dollars which is far more than what encouraging innovation would cost.

I then asked him how important was the input of his constituents during the time he was Speaker? He replied that many of his ideas came from groups in his home district. He was adamant that we should never underestimate the power we have as a constituent.

I brought the event to a close by encouraging seniors to contact their elected officials’ offices, submitting public comments on federal matters, voting, or volunteering in political events. We can all speak out on these things that affect our lives. You can find an easy way to contact your lawmaker by going to our web site at seniorsspeakout.org.

I hope you will join us again when we have our next Facebook Live event.

Best, Thair

Federal lawmakers are coming back from their spring break with a lot of items on their agenda which, from my point of view, is a dangerous situation. I’ve often thought it was a positive thing when, long ago, Congress had to go home in the summer to take care of their farms. But that fact of the matter is, there is a lot of things that Washington will be focusing on and some of them will have an impact on our healthcare.

If you’ve followed my recent blogs, you know that I’ve always been critical of Congress or the President usurping powers to either circumnavigate signed laws or to implement legislation to their own liking. It’s the reason I dislike the increase in Presidential executive orders and using so called “test projects” to implement nationwide programs. As I wrote in my last blog, the implementation of the Inflation Reduction Act (IRA) is falling into this category and it worries me and a lot of members of Congress a lot. It is something former Speaker Newt Gingrich and I will discuss in our Facebook Live event tomorrow (details below).

While there are some positive things in the IRA, one of them being the yearly $2,000 cap on our out-of-pocket drug costs starting in 2025, there are some negative things that are destined to have a long-term effect on the availability of new medicines. The price fixing portion that will stifle innovation is one of the most serious parts of the IRA. I talked last week about the comments Senator Manchin (D-WV) made complaining about the way the administration was implementing the IRA. There are others that are also mad about how President Biden is bending, or sometimes ignoring, the guidance and rules in this and other legislation.

Last September four Senators wrote a letter to the Administrator of the Centers for Medicare & Medicaid Services (CMS) asking how the government agency that is responsible for ensuring older Americans have access to life altering and life saving medicines can arbitrarily reduce access to an FDA approved Alzheimer’s drug. I talked back then about the bad precedent this overreach set and some members of the Senate agreed. It is a civilian agency exercising powers that they have no right to use. As predicted, there is now another situation where the misuse of power threatens to restrict the access to important cures.

A recent letter sent to the Secretary of the Department of Health and Human Services (HHS) and the Administrator of CMS signed by 18 U.S. Senators talked about the Administration again seeking to override an important part of the FDA’s responsibility, the Accelerated Approval Program. This important FDA tool allows for specific medicines to receive special accelerated focus to quickly get life saving and life changing medicines to patients. HIV/AIDS and cancer treatments have gotten to patients faster due to this program. Our COVID-19 vaccines benefitted from this program and saved millions of lives. We’ve trusted the FDA to keep our medicines safe and they remain the worldwide gold standard for keeping our medicine safe, yet the Administration wants to lower payments and restrict access to medicines that have been approved through this proven program, once again overstepping their powers and overriding an efficient FDA.

When we talk about IRA implementation there are more and more instances of the implementation deviating from the legislation. One of these worrisome areas is the actual funding for the implementation. While many in Washington would like to reduce the size of government (and many of us outside Washington desire the same), the IRA authorizes the spending of 3 billion dollars for the implementation of IRA. That money is unaudited and unregulated and is a huge amount of money. Two House committee chairs and a Senate committee ranking member recognized accountability concerns and sent a letter to the HHS Secretary and the CMS Administrator asking them for some accounting of this huge amount of money. Their statements in the first part of the letter succinctly relays their feelings:

“Americans deserve fiscally responsible and accountable leadership, not bureaucratic bloat. Unfortunately, the so-called Inflation Reduction Act (IRA, Pub. L. 117-169) enacted last year has doubled down on the recent trend of federal expansion and excessive expenditures.”

This accurately spells out why the ever-growing government is a real threat to our healthcare independence.

As detailed above, many members of Congress are dissatisfied with the way the administration is using any method it can to further its own agenda. It’s a clear case of our government dictating more and more of how we receive our healthcare. My topics of my blogs over the years have always leaned toward less government and specifically less government control. The Administration, in the implementation of IRA and in other Administration initiatives, has shown that they will usurp whatever power they require to enact their agenda and expand government control of our healthcare.

Tomorrow, former Speaker Newt Gingrich and I will talk about some of these subjects. I’m looking forward to Speaker Gingrich’s perspective on IRA implementation and especially on the parts of the legislation that will impact us the most. I invite you to join me for our Facebook Live event, tomorrow, April 18 at 2:30 PM ET. We will discuss the importance of seniors advocating for healthcare policies that will impact their lives. We plan to use this conversation as a time to review Congress’ recent legislative activity, such as IRA, and how this would affect seniors’ access to innovative treatments and medicines. You can find the event details by clicking here. Mark yourself as “going” on the event page if you plan on tuning in to our live event.

I hope you take the time to tune in.

Best, Thair

One of the basic tenets of our constitution is the checks and balances that limit the power of each of the branches of our government. I see red flags when legislation or rules or guidance are proposed that seek to bypass these checks and balances or when the implementation of a signed law does not adhere to the law’s provisions.

This happened a little over 13 years ago when the Affordable Care Act (ACA), often called Obamacare, was being debated. The ACA established an Independent Payment Advisory Board – an unelected, administration appointed board, to make healthcare cost and payment decisions without any judicial oversight or control. It was this lack of adherence to the basic checks and balances that caused me to fight against that part of the ACA and advocate for it to be fixed. I’m thankful that this board was never formed and was ultimately eliminated.

I’m beginning to see this lack of adherence to the statutes and protocol in the implementation of the Inflation Reduction Act (IRA) and I’m not the only one who’s concerned. Senator Joe Manchin (D-WV), in an opinion piece in the Wall Street Journal, said that he was concerned President Biden wasn’t implementing the IRA as the bill instructed. In reference to the IRA Senator Manchin said;

“Yet instead of implementing the law as intended, unelected ideologues, bureaucrats and appointees seem determined to violate and subvert the law to advance a partisan agenda that ignores both energy and fiscal security. Specifically, they are ignoring the law’s intent to support and expand fossil energy and are redefining “domestic energy” to increase clean-energy spending to potentially deficit-breaking levels.”

I tend to pay attention when a Democrat calls out his party’s administration for not following legislation that was legally signed into law.

I also see the administration ignoring the accepted protocol for the release of rules and guidance as the IRA is implemented. The agency responsible for the healthcare portions of the IRA is the Centers for Medicare & Medicaid Services (CMS). Either through bill language or by direction of the administration, CMS was instructed to use administrative guidance to implement the negotiation provisions. Using administrative guidance means that they can bypass the notice-and-comment requirement of the Administrative Procedure Act or Medicare statute. This process does not require comment periods for public input which means that some significant areas of the guidance are being issued as final and immediately effective. But, CMS states that it is “voluntarily soliciting comment on certain topics” in the guidance. This seems to be the reverse of the bait-and-switch technique, they switch the rules and then try to bait you into forgetting about it by offering a chance to comment on certain topics in a short amount of time.

This approach was used when CMS released the Medicare Drug Price Negotiation Program: Initial Memorandum a few weeks ago on March 15^th. This 91-page document revealed details and rules that could have a huge impact on the amount of money that will be invested in the future toward discovering medicines that could improve or extend our lives. Yet we are given only 30 days to analyze this complex document and then we can only comment on certain parts of the memorandum. Page two of the memorandum states, “In the revised guidance, CMS may make changes to any policies, including policies on which CMS has not expressly solicited comment, based on the agency’s further consideration of the relevant issues.” CMS is not obligated to seek input from stakeholders, like me and you, and they can make changes to any policy based on their “further consideration of the relevant issues”. This is a perfect example of the government giving seniors a chance to speak out – except when it’s not convenient.

I know that many organizations are working to comment on this possibly life changing document. It is a complicated document and is lacking in detail in some areas and contradictory in others. I will try to keep you abreast of these comments.

There is a way you can be heard, a way you can speak out. You can write your Senators and member of the House of Representatives to tell them that the CMS is misusing its power when it dictates on what policies we can comment on and ignoring the notice-and-comment requirement of the Administrative Procedure Act. You can do this by clicking here which will take you to our Seniors Speak Out – contact your lawmaker web page.

You can also make an appointment to speak face-to-face with your lawmakers. It is a great way to get to know them and for them to get to know you. I can guarantee it will be a rewarding experience.

Also, I invite you to join me for our Facebook Live event on April 18 at 2:30 PM ET. Former Speaker of the U.S. House of Representatives Newt Gingrich will sit down with me to discuss the importance of seniors advocating for healthcare policies that will impact their lives. We plan to use this conversation as a time to review Congress’ recent legislative activity, such as the Inflation Reduction Act, and how this would affect seniors’ access to innovative treatments and medicines. You can find the event details by clicking here. Mark yourself as “going” on the event page if you plan on tuning in to our live event.

I hope you decide to speak out, no matter how inconvenient our government may make it. It’s an important way we can make democracy work.

Best, Thair

It’s the end of March. The spring equinox, the “official” indicator of spring, has passed yet there’s still some, me included, who beg to differ with the calendar. I moved from Virginia four years ago where I lived for a total of 28 years. My kids grew up there and we enjoyed the early springs, and the April cherry blossoms. This year spring came early in Virginia after a very warm winter and the cherry blossoms bloomed in March. That was NOT the case in the west.

The west, especially the southwest, has been plagued by a multi-year drought. The dams in my home state of Utah were almost empty, which is a real problem because they supply most of the water for this high desert state. The governor of Utah got into a little trouble for mixing religion and politics by urging Utahns last fall to pray for rain. Whether it was prayer or a quirk of El Niña this was a record year for snow and rain in Utah and most of the west. Some of the ski resorts, in this greatest snow on earth state, have over 700 inches of snow. This has certainly been a tale of two different cities/states between the east and the west. While the timing of the transition from winter to spring may be different depending on where we live, we will still have the same problems to deal with if we are burdened with allergies, which is the subject of my blog today. As we transition into the season of allergies, there are things we should pay attention to that can help us avoid some of the impact of allergies.

Allergies impact many of us. They are one of the most common medical conditions. It is estimated that over 100 million Americans are affected by different types of allergies. Hay fever, the most common allergy, affects 26% of adults and 19% of children. Many allergy symptoms are seasonal. When I was young I developed mild allergy symptoms that occurred every other August. Now that seems to me to be an extremely specific plant blooming allergy. Each of us is either affected by allergies or we know someone close to us who is.

If you live in the east, you might not have been ready for the early onset of allergies that came from the early spring. Spring is when many allergies start and will continue through summer and early fall. There isn’t a cure for allergies, but they can be controlled through a good allergy treatment plan based on your medical history, the results of allergy tests, and symptom severity. Many people with asthma are also affected by allergies. Allergies can be a trigger for an asthma attack. Allergic reactions and asthma attacks are caused when your body senses that the pollen or allergens that enter your body are harmful, and releases antibodies to combat the allergens. Too much of these antibodies cause inflammation and swelling. Older people may be especially affected by allergies especially if they are also asthma sufferers.

The good news is there are some things we can do to lesson the impact of allergies on our life. Below are some everyday steps, recommended by the Asthma and Allergy Foundation of America, that will reduce our exposure to the most common allergen, pollen.

• Check pollen counts or forecasts daily and plan outdoor activities on low pollen days.
• Keep windows closed during pollen season or peak pollen times.
• Use central air conditioning or air cleaners with a CERTIFIED asthma & allergy friendly® filter and/or HEPA filtration.
• Remove your shoes before entering your home.
• Limit close contact with pets that spend a lot of time outdoors. Wipe furry animals off when they come inside or bathe them weekly (if appropriate).
• Dry laundry in a clothes dryer or on an indoor rack, not on an outdoor line.
• Wear a mask outside to block much of the pollen in the air from getting into your nose, mouth, and lungs.
• Wear sunglasses to limit the amount of pollen that gets into your eyes.
• Cover your hair with a hat or other hair covering when outdoors so pollen doesn’t collect in your hair.
• Change and wash clothes after outdoor activities.
• Shower before bed to keep pollen out of your bedding.
• Wash bedding in hot, soapy water once a week.
• Clean your blinds or curtains regularly.
• Vacuum your carpets, rugs, and fabric furniture once a week. (A CERTIFIED asthma & allergy friendly® vacuum will trap pollen, dust mites, and pet dander and stop it from spreading in the air while vacuuming.)

As you can see these are all ways to limit your contact with pollen. Some people already remove their shoes when they come indoors but I think they were trying to eliminate dirt rather than pollen. Many of us have pets but I never considered that they could also transport pollen.

There are over-the-counter medicines that can greatly decrease the impact of allergies. Consult your doctor as to which would be best for you. Even over-the-counter medicines can interact with prescription medicines. You might consider taking these medicines a couple of weeks before the allergy season starts, depending on what your healthcare provider recommends.

If you do not get complete relief from medicines that treat allergy symptoms, talk with your allergy doctor about immunotherapy. Immunotherapy is a long-term treatment that can help prevent allergic reactions or make them less severe. It can change the body’s immune response to allergens.

Allergies can have a huge impact on our quality of life but there are things we can do to lessen their impact. Being able to go outside without being stuffed up is nothing to sneeze at.

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

In past years I’ve talked about things we can do to make us more heart healthy. While there are some things we can’t change, like age, gender or genetics, there are many things we can do improve our heart health. In most cases, heart disease is preventable when people adopt a healthy lifestyle, which includes not smoking, maintaining a healthy weight, controlling blood sugar and cholesterol, treating high blood pressure, getting at least 150 minutes of moderate-intensity physical activity a week and getting regular checkups. There isn’t anything in that list that should surprise us or is something we don’t understand. I can guarantee that there are multiple places on the internet, at the library, or at your doctor’s office that can explain in more detail how to accomplish each one of the healthy lifestyle recommendations. It is a fact that an ounce of prevention is worth avoiding a heart attack and I encourage each of you to take the steps necessary to improve your heart health. There is, however, another aspect of your heart health that will be my focus for this blog.

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

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

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

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

The major warning signs for women include:

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

Play With Your Grandkids – A 2016 study found that half of the grandparents who occasionally participated in their grandchildren’s lives were alive five years post-study compared to individuals who had no involvement. Playing with your grandkids is not a hard ask.

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

Merry Christmas and Happy New Year, Thair

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

If you’re wondering what the blog title is referring to then my efforts these last few months have been in vain, at least as they pertain to you. For everyone else, who knew right off what I was talking about, that’s great. Knowing about Medicare’s open enrollment period, that started on October 15^th and ended last week on December 7^th, is the first step in this yearly exercise, but knowing without doing anything else is maybe worse than not knowing at all. Abu Bakr, an early Islamic leader, said, “Without knowledge action is useless and knowledge without action is futile”. This yearly enrollment period is a chance to assemble the knowledge of our healthcare, combine that with our financial situation and take the action to make an informed decision about our healthcare insurance for the upcoming year. I hope everyone took the time to take this important action and for the purposes of this blog I’m going to assume that everyone took the steps necessary to review their supplemental or Medicare Advantage plans, including their Prescription Drug Plans (PDP), to ensure that they still fit their healthcare and financial goals.

Gathering your health records can sometimes be difficult but there are some added benefits to getting all that information up-to-date and in one place. For instance, I’ve found it’s sometimes difficult to obtain the results of tests or procedures. It’s often easier to get the written results of a doctor’s visit rather than the detailed results of tests and prognosis. I’m a big believer in the fact that future health problems can be better analyzed if there is a base line to compare them with. For instance, a little over a year ago, during a physical, I had an EKG that was not normal. I went through a battery of tests, including an Echocardiogram (ultrasound) and a nuclear cardiac stress test (anything with the word “nuclear” in it should be taken seriously). Luckily the results proved that my heart was just fine, the EKG must have been in error. I worked very hard, and it took some time to get electronic copies of the results of these tests. My reasoning for getting them was I figured that if I had any future heart problems the cardiologist would benefit from seeing what had changed from my earlier tests. My point here is, there are benefits in gathering your records together that go beyond open enrollment.

Another benefit has to do with gathering your prescription drug information. It seems that more than once over the course of a year you are asked detailed information about what prescription drugs you take. Having the detailed type and quantity of drugs you take can help with responding to these requests. It can also be important to have a history of drugs you have taken and even a note of why it was prescribed and its effectiveness. I’ve known more than one person who had recurring urinary tract infections that through tracking the history and effectiveness of medications came to know which antibiotics worked and which didn’t. This person could supply the doctor with this history, and it helped speed up recovery immensely.

Hopefully gathering this information gave you a clear picture of where you stood with your healthcare such that you could compare other healthcare plans and prescription plans and come to the best decision for you. I heard from some people that they first looked at their existing plan to make sure that it still fit their needs and to establish a base line from which they could compare other plans. I wish I had relayed this great approach to you before the enrollment period ended, I’ll try to remember to pass it along next year. It seemed that my plan added some benefits for next year and it cemented for me that I would stay with my existing plan.

On that note, it is interesting that in choosing traditional Medicare prescription drug plans from 2008 to 2020, only 10 to 13% of Medicare enrollees changed their plans each year. For Medicare Advantage drug plans, 6 – 12% changed. To me this either means that everyone went through a thorough review of their plan and was satisfied with their current plan (like I was) or not many people took the time to review their prescription drug needs. I’m going to stay optimistic and go with the first assumption.

Now that you have made this important decision there is still a little more work to be done. If you haven’t already, you will be receiving the information on the plan you have chosen for 2023. Take some time to go over the information. While you should already know about deductibles, co-pays and coinsurance and your current PDP’s formulary there may be some added benefits that you didn’t know about or even some hidden restrictions that might apply to you. My plan added a Spending Account Card that I’m going to find out more about. It wasn’t a variable to renew with my current plan, but it sounds like an easier way to take advantage of my over-the-counter allowance and maybe save me some money on some out-of-pocket costs for some benefits. The insurance companies are less busy now that open enrollment is over, and it might not take so long to talk with someone who can answer your questions and explain some of these benefits.

I hope that the work you did gave you peace of mind about the decision you made. If you take the time to update your healthcare information throughout the year it won’t take so much work in preparing for the next enrollment period. Having choices in our healthcare is one of the benefits of living in this country, but it is only through action that we can take advantage of this great benefit.

Best, Thair

It became evident to me one and a half years ago that those Americans who were 65 or older were the wisest among all of us. We were the age group that was listening to the scientists and getting the lifesaving COVID-19 vaccinations that had just been approved. In all honesty, from my point of view, it really didn’t take a whole lot of smarts for older Americans to get vaccinated. We were the ones who were experiencing the brunt of the deaths in the first year of the COVID-19 pandemic. Just as a reminder, of the 1,072,281 Americans who have died of COVID-19, 804,394 were 65 or older. To put that in perspective, our age group accounted for 75.2% of the COVI-19 deaths while only making up 16.5% of the total population. Almost everyone lost an older friend, grandparent or parent to COVID-19. Who can forget the pictures of the gurneys carrying the dead out of assisted living facilities? It was a terrible time. The new vaccines saved the lives of countless seniors.

We all have been looking forward to a “normal” holiday season. I’ve traveled by air, eaten in restaurants and attended the Broadway musical The Music Man and, in short, acted normal. Well, as the line in that beloved musical so eloquently states, “we’ve got trouble with a capital T . . . right here in River City”.

We are now facing a new threat, the emergence of what many are calling a “tridemic” or “tripledemic” which is a threat of three different infections created by simultaneous surges of COVID-19, the flu, and respiratory syncytial virus (RSV). We expected a rise in COVID-19 infections in the fall and winter, but we also are seeing an early rise in flu cases and now with RSV affecting younger people, we are seeing our hospitals again begin to fill up. It is important to note that RSV isn’t a new infection, and it is also prevalent in older people. What do we do?

This tridemic is not a reason to revert back to sheltering at home, but it is a reason to get your COVID-19booster and your flu shot. Now, I just praised older Americans for their wise choice of getting vaccinated to fight the COVID-19 pandemic. We were, by far, the most vaccinated age group and it saved many of our lives, but it seems that now we have lost our focus. The number of seniors getting the latest booster is down and we have also been slow in getting our flu shot. As a result, deaths in our age group from these infections are rising. We need to, excuse the expression, wise up!

While there as been much discussion about the latest booster and who really needs to get it but there is one thing that has remained constant, Americans 65 and older need to get the latest booster. Our age group is the most vulnerable and it has been shown that this booster saves lives of those who are more vulnerable. Experts have all agreed that for our age group the booster will lower the severity of COVID if we catch it and it will save lives. The same goes for flu, catching the flu puts a strain on our entire system and exacerbates any other health problems we have. RSV is especially serious for those who have any type of respiratory problems. An early diagnosis of RSV enables the application of various solutions that can ease the impact. Your doctor can quickly diagnosis if you have RSV rather than just a cold.

My plea is – get your COVID-19 booster and your flu shot. You can get them together if you’d like. I got my booster in early October and then my flu shot early in November. I thought it was better to get the benefits of the highest immunity of the flu shot closer to the flu “season”. Remember, the vaccinations won’t cost you anything and are easy to get. I walked into a local pharmacy, got my vaccination without an appointment and was out in 10 minutes. There is no reason for wise people not to get these shots. One other thing to consider, if you are vaccinated there is a much lower chance of you infecting your loved ones as you visit them this holiday season and there will be a much lower chance of you missing out on these family events because of COVID-19 or the flu.

Now is the time to turn off all the white noise that is circulating concerning the latest booster and even flu shots. The vaccines for COVID-19 have proven to be safe and effective, they have shown to greatly reduce the diseases’ severity if you catch the virus. The flu vaccine has been around for years and has shown to greatly reduce the chances of getting the flu. Even before the pandemic, only a little over half of our age group got their flu shot. We should be working to raise these numbers rather than continuing this alarming trend of even less of us getting our flu shot.

A wise old man once told me, “Get your shots, numbskull”, and I concur.

Best, Thair

Thanksgiving is over and we now look toward Christmas (although there’ve been Christmas decorations for sale since before Halloween). Remember when it was against the rules to start selling Christmas items until after Thanksgiving? Isn’t that where we got black Friday? Now, some Black Friday sales started weeks ago, which has greatly reduced the size of the lines forming outside stores Thanksgiving night. I remember my boss at my college job telling me he was going to give his kids money at Christmas so they could take advantage of the after Christmas sales! Kids nowadays would have no context to understand the concept of after Christmas sales. Even the much more recent Cyber Monday has faded into irrelevance, the number of packages that show up at my door day after day surely proves that every day is cyber day. Times, they are a “changin”.

There’s a lot of different dynamics at play this year and I think this year will exhibit some new wrinkles and some return to normalcy.  We have high inflation that has shrunk the amount of disposable income available for many of us, yet this is probably the first almost normal Christmas we’ve had for two years, and we want to make it a memorable one. This may be evident in the big reversal in the size of America’s credit card debt. When the pandemic hit the amount of credit card debt held by Americans dropped significantly, probably due to the checks we received in the mail from the government and the fact that we couldn’t go anywhere to spend it. Now the credit card debt is shooting back up as we try to pay for the higher priced basic goods and services we need while we also try to ensure our families have a great “normal” Christmas. It’s a precarious balance that is fraught with worry and is an indication of our greater goal of trying to restore the overall balance in our lives. We are searching for a way to restore some basic faith in our institutions and some hope for the future. I think our votes a few weeks ago revealed our growing weariness with extremes and the negative feelings it seems to foster. We are tired of being impacted by things we can’t control –  it has made us feel helpless.

One of the ways the extremes have affected us is the way we discuss major issues with our friends and relatives. Unfortunately, it seems that lately we have taken our lead from the way politicians are acting these days, who often disrespect their fellow members of Congress, by disrespecting those close to us just because of a political stance. On social media and in our own personal relationships we see the ending of friendships over political issues. One of the few sanctuaries against the outside world is our friends and loved ones. We shouldn’t threaten this comforting retreat over politics. With that in mind I want to share some great advice for how to discuss differences with our friends and relatives during these holiday get-togethers.

I do have to say that I thought I was an expert on discussing differences with loved ones. I’ve grown moderate in my conservative thinking over the years, but I have two brothers who are more extreme in their solutions and a son who leans toward more progressive solutions. Having said that, I found great value in the advice found in this article from Lifehacker.

They list three ways we can have more civil discussions and defuse any disagreements.

• Be Respectful – As logical as this sounds it seems it has become harder and harder to actually do. Lifehacker points out that it is entirely possible to disagree with someone without being a jerk about it. I’ve found that it is not only the decibel of your statement but also the attitude that indicates whether you are going to be a jerk or not.
• Agree to Disagree – As soon as it is determined that there may be a large distance between you and your friend’s stance on an issue or its solution, someone needs to state that it is ok to agree to disagree. If nothing else, it lets both parties agree on something. While this statement often results in a stoppage of discussion on this issue, it leaves room for each person to clarify why they feel the way they do.
• Move on When It’s Time – I’ve found when phrases like, “you must be crazy to believe that” or “you’ve been brainwashed” raise their ugly heads, it’s time to move on. Change the subject or suddenly feel the need for a bathroom break. No good can come from continuing on.

I hope these points give you some ideas on how to enjoy the holidays and avoid some of the negative aspects that tend to creep in.

Now, I wouldn’t be doing my job if I didn’t urge you to get vaccinated. I know there has been much said lately about the most recent boosters but here is something that I think is important and I hope you take it to heart. If your health makes you vulnerable in any way, get vaccinated. This virus seems to prey on the less healthy among us, so don’t let your guard down this late in the game.  

We’ve all been through a lot over the last couple of years and I for one have been enjoying the relative normalcy of the last few months. I hope these holidays bring a renewal of faith, hope and charity for all of us.

Best, Thair

Last Thursday, November 17^th, Seniors Speak Out held a Facebook Live event with Debbie Witchey, Healthcare Leadership Council’s EVP, and me, Seniors Speak Out Spokesperson. The live event covered two subjects, information concerning Medicare open enrollment and the preliminary results of our post-election healthcare check-in survey. The live event can be found by clicking here.

Debbie introduced the program by explaining that Seniors Speak Out is part of Medicare Today a coalition run by the Healthcare Leadership Council. She explained that Seniors Speak Out is a conduit for educating seniors on issues that affect their healthcare and ways that they can advocate for changes that they feel are important and against changes that they feel would be detrimental. She then turned the time over to me.

I opened by reminding everyone that it’s open enrollment season, which started on October 15^th and ends on December 7^th, and is a time that we can review our insurance plans. These plans include traditional Medicare and Medicare Advantage (MA) which is a program where we contract with a private insurance company to administer our Medicare benefits. There is also Medicare supplemental or gap insurance which is offered by private health insurance companies separate from Medicare. I pointed out that reviewing Medicare Part D, the Medicare prescription drug program, is especially important given that it might be the Medicare program that is costing you the most. I also pointed out that, in choosing an insurance plan, your personal health requirements and financial position are the things that will point you to the best plan for you. I have found that when I moved, I found it advantageous to move from traditional (or fee for service) Medicare with supplemental insurance plan to Medicare Advantage. Changes in my situation made a Medicare Advantage plan a better fit for me. I went on to point out that a great resource that can help you make the best decision is the State Health Insurance Assistance Program (SHIP) – each state has this program. Go to the CMS website to find the contact information for your state.

Debbie pointed out that she saved a couple of hundred dollars a month by switching her insurance in the health insurance exchange, so it is very important to go through this review. Debbie’s first question was, who is eligible for Medicare?

I pointed out that everyone 65 or older, younger people with disabilities, and people with End Stage Renal Disease are eligible for Medicare. Debbie then asked what was the difference between Medicare Supplemental (or Medigap) and Medicare Advantage?

I explained that Medicare Supplemental insurance helps pay for out-of-pocket costs that were incurred under traditional Medicare whereas Medicare Advantage is a program where your Medicare benefits are administered by a private insurance company. I pointed out that the private insurance company is motivated to keep you healthy and thus often offers expanded benefits, like free exercise club memberships, some dental, eye and hearing benefits and other preventative care benefits. There are plus and minuses with each program and, again, find out which fits you best.

Debbie then asked what things are important in picking a Part D plan? I answered by detailing some important questions to ask yourself. First, does the Part D plan cover the prescription drugs you take and second, what is the cost? Those are the two most important questions. You also need to assess your own health and what indications you might have of coming health problems. Debbie interjected that your own preference for visiting a pharmacist rather than using a mail order system might be part of your decision.

Debbie then asked about possible penalties for not signing up for Medicare or trying to change plans outside of the enrollment period.  I stated that there are some situations that allow you to enroll after 65 or change plans. For example, if you had private insurance that was stopped, you have the chance to enroll in Medicare without penalty. I encouraged people who would like to make a change to not hesitate to ask if there is an option to change without penalty. Insulin users especially might find some exceptions for them.

Debbie then asked about any changes that have been made to Medicare. I detailed the increase in our cost-of-living adjustment for Social Security and the smaller Part B premium and the slightly lower average premium for Part D changes that will increase our Social Security payments. Also, there was a $35 cap put on the monthly cost for insulin, a great benefit for those who have seen their insulin costs go up and up lately. I cautioned that they haven’t had time to update the Part D plan finder for all the plans so be alert to that as you are comparing plans and disregard any insulin charge that is greater than $35 a month. Evaluate that plan using the $35 per month charge. The plan, by law, can only charge a maximum of $35. Because of this problem they have given insulin users the chance to change plans one other time during the year. I also pointed out that Congress must deal with a scheduled cut to Medicare’s payments to doctors of 4.5%. They deal with this every year, and this year especially, it could really hurt doctors who are faced with this high inflation rate which is affecting their overall costs. I encouraged all of us to talk with our members of Congress to encourage them to eliminate this harmful payment cut. Some good news is the fact that all our vaccines will be covered with no cost to us. Debbie pointed out that hospitals are also under the threat of payment cuts and we should work to make sure they don’t suffer these cuts.

We then pivoted to the post-election survey that we just completed, and I discussed the preliminary results. I first pointed out that there will be almost 100 new members of the House going to Washington in January. It is important that they know where we stand on our healthcare. In the survey seniors overwhelmingly shared with us that their biggest concerns are their out-of-pocket costs for care. When asked what actions to improve healthcare they would like to see, respondents voted for less government involvement in their healthcare decision-making and lower out-of-pocket copays and

deductibles for prescription drugs. High costs for prescription drugs were clearly weighing on seniors’ minds when they voted that their biggest concerns heading into a new congress is that their out-of-pocket costs will increase. Respondents also cited concerns with more government price controls on prescription drugs.

The bright side of this all is that when asked what’s working best for their healthcare currently, seniors cited the choices of health plans through Medicare Advantage and Medicare Part D as well as the quality of care from their area doctors and hospitals. I reiterated that the new Inflation Reduction Act did have an upside where in two years there will be a $2,000 cap on our out-of-pocket cost for prescriptions. In our survey respondents also indicated that they didn’t want to stifle innovation, and wanted to continue to have hope that new discoveries will help all of us live longer.

Debbie closed our event by reminding everyone that there is still a lot that will be happening in Congress this year, and we should still be vigilant in staying current on the issues that will affect our healthcare. You can find more information at our web site, seniorspeakout.org.

We, at Seniors Speak Out, will continue to keep you informed on the important issues that affect you and will be conduit for magnifying your voice to those who represent you in Congress.

Best, Thair

Contrary to the pollsters’ and pundits’ best prognostications the American voter has managed to once again surprise everyone and prove that they are still the best at telling all the politicians what is really most important to them.

There were many ebbs and flows in the issues leading up to election day. The Supreme Court’s decision on abortion suddenly jumped into the headlines and caused a real ripple in the standard thinking that the President’s party always lose seats in Congress in an off-year (non-presidential and non-midterm) election. It seemed instantly that the momentum swung toward the Democrats’ favor and this feeling was bolstered by the constant headlines of the January 6^th Committee’s ongoing investigations and the legal problems of former President Donald Trump which threatened his hold and influence on the Republican party. The Democrats also seemed to focus on what they perceived as a threat to democracy poised by the election deniers and the upheaval it caused during the last election leading up to the January 6^th attack on the Capitol.

As the election grew closer, the pollsters began to see a change. They detected a return to the basic beliefs that the President’s party would lose Congressional seats and the catch phrase, “it’s the economy, stupid” coined during the Clinton campaign would come to bear as Republicans put the blame of the high inflation on the Democrats. It just seemed logical that these two historical truths would rule the day and talk of a Republican red tsunami began to emerge.

So, there we were, the often wooed, repeatedly polled, American voter trying to decide how we really felt and how our votes could reflect those feelings. As the votes rolled in there were clues that arose that indicated this election was not one that would follow history. Different regions told different stories. New York State looked like the issue of the economy and the Republicans would prevail, while just south, in Pennsylvania, abortion and the threat on democracy would prevail. Overall, it was clear that the gains that the Republicans hoped for were not to come to fruition. Because of the favorable pre-election predictions of a Republican wave, the results have been categorized, especially by Democrats, as a victory for the Democrats but the final results will, most likely, weaken Biden’s ability to advance his agenda.

Here’s where we stand. As I finish writing this blog on the weekend, the Republicans are inching toward gaining control of the House while the Democrats will remain in control of the Senate. What I do know is that the majorities in both chambers will be so small that any new legislative initiatives will be very difficult to pass.

Before I talk about the post-election environment, I want to offer my own opinion of this election. I think the pollsters missed the basic fears that Americans have been feeling over the last three years and especially in the last year. We went through a life changing pandemic that was nothing like any of us had ever experienced and, just as we were emerging out of the shadow of COVID we were confronted by, what many called, an insurrection on January 6^th. This threat on some of the basic tenets of our country was followed by Putin’s invasion of Ukraine, which devolved into some talking of the use of nuclear weapons. If this wasn’t enough, we began to face inflation that immediately reduced the value of the dollar, which especially affects older Americans. I think, and this is just my opinion, that Americans wanted to find a safe harbor, and that meant avoiding extremes and reducing the affect our government could have on our everyday lives. I feel the ballot boxes reflected this flight to safety. I think this is what the pollsters missed.

OK, so what does the future hold for our healthcare? While there won’t be an easy path for legislation there will be the implementation of the Inflation Reduction Act which will have a big impact on how this law will affect each one of us. I keep saying that the devil is always in the details and this is especially true of this vaguely written law. There could also be some angels in the details which we can also recognize and work toward. It is also true that it has become a habit over the last decade or so that the current President, when it is difficult to promote his agenda through legislation, uses Executive Orders, experimental programs that emerge from the Center for Medicare and Medicaid Innovation and are implemented nationwide and regulations that emerge from HHS and other civilian agencies as ways to enact his agenda without the approval of Congress. We need to be vigilant to quickly react to these unchecked attacks on our healthcare.

The elections were certainly interesting and I for one was happy to see that the American voter can still surprise the experts and have a big impact on those who represent us in Washington. As Seniors Speak Out looks forward to next year, we decided it is important to find out how you feel about your healthcare and what you would like the new politicians to focus on going forward. We have a post-election survey that we would like you to take to tell us how you feel. Please click here to take the survey. We are also doing a Facebook Live event this Thursday at 6:00 PM ET where we will talk about Medicare open enrollment along with the early results of our survey. Take the survey and then see the results by registering for the Facebook Live event.

It’s going to be an interesting time going forward. Everyone at Seniors Speak Out will work to keep you up-to-date on what’s happening with your healthcare and ways you can have an impact on what happens in Washington.

Best, Thair

It’s my opinion that my home state of Utah is the epicenter of Halloween celebrations. People here go crazy over Halloween. This year I’ve personally seen complete houses turned into graveyards, or yards with a ghoulish pirate theme. I’ve seen pictures of costume parties with people dressed in costumes that would put movie special affect professionals to shame. I think there are more houses decorated for Halloween than there are for Christmas. It is truly a holiday that is enjoyed by everyone regardless of political affiliation. It seems there are some things that rise above the chasm of differences that inflict our country and has the power to bring us together.

In Utah, for the first time in many years, there is a close race for a Senate seat. The incumbent, Mike Lee, has found himself in a real battle with the independent challenger Evan McMullin. The ads and campaign rhetoric have revealed a real animosity between followers of both Senate hopefuls. Yet, among all this divisiveness, there are neighboring houses, one with signs showing their allegiance to Mike Lee, the other with signs in support of Evan McMullin, that teamed up for a two-house common themed Halloween decoration that was spectacular. They obviously found a way to put their political differences aside and do something together that they both obviously enjoyed and agreed on.

There are some things that we do agree on that might help us see that Congress can actually work together. Over 71% of Americans agree that we should quit throwing off our circadian rhythms and stop changing our clocks twice a year. Over the years, in my public policy career, I’ve searched for a way to stop this crazy twice-yearly madness. The Senate passed a bill by a unanimous voice vote that would stop this unpopular tradition and the House is set to take it up. It looks like it really is possible to set aside our differences to pass some commonsense legislation that will benefit us all. I can only hope the House and the President jump on board this popular, bipartisan legislation.

I bring this up because we are just over a week away from voting in the midterm elections. While the ads and rhetoric tend to rise to an almost unbearable decibel level,  the fact remains that the most important thing we can do is . . . VOTE. While I like to think that my blog and your advocacy voice are powerful, the real power is in your vote. It’s truly the most powerful way that seniors can speak out.

Ok, I’ll climb off my stump and get to another important thing about Halloween, the chance to get together with your family and enjoy the day, and night. Tonight is the first Halloween for two years that many of us feel like we can get out and enjoy it with our kids, and for most of us, our grandkids. I know from the amount of candy my friends are buying they are expecting a great turnout. The schoolteachers must be expecting a huge celebration given that many of the schools have a teacher workday with no school for students on the day after Halloween. The teachers aren’t dumb and they know they don’t want to try and teach a bunch of sugared-up kids who haven’t had a good night’s sleep, so maybe that’s why they gave them a day to recover. The fact of the matter is we love to be with our grandkids when they get dressed up for Halloween. It seems to me that Christmas is the only other holiday that rivals the excitement we see in our grandkids’ eyes. It’s also true that it’s really great that we get to go home, and we don’t have to face the tired kids the next day.

Halloween has come to signal the start of the holiday season. It seems to be the first step toward Thanksgiving, Christmas, and New Year’s. It is a hectic time and filled with much food, which often brings on that holiday weight gain. I thought now is a good time to offer some great advice I found from SilverSneakers about how to avoid holiday weight gain.

1. Prioritize Sleep for Stronger Willpower – Aim to get seven to eight hours of sleep every night, because it will help you make better food choices
2. Create a Daily Eating Plan – Planning always helps keep me focused.
3. Pre-Game with Vegetables and Tea – The extra fiber and tea will keep you from arriving hungry.
4. Eat and Enjoy – Go ahead and enjoy those once-a-year holiday treats but eat slowly and savor it.” Simple trick: Always move away from the food. Instead of standing over the chips and dip while talking to your friend, put a handful of chips and a tablespoon of dip on your plate and find a spot to continue your conversation. Bonus: It’ll be easier to catch up with your friend if you don’t have to keep moving out of the way for others.
5. Keep Liquid Calories in Check – It’s certainly possible to have fun without alcohol, but if you do choose to drink, remember that alcohol has calories too. Steer clear of cocktails with many ingredients that can really pack a lot of calories. Instead, choose a five-ounce glass of wine or a 12-ounce bottle of light beer, which counts as one serving of alcohol.

One other thing to remember as we start this holiday season, the holidays aren’t always the happiest time for some of us. Holidays can bring loneliness and depression. Take some time to think about someone who would benefit from a visit or an invitation to a party.

I hope your Halloween is safe and brings you and your family smiles and laughter.

Best, Thair

Last week on October 10^th the world celebrated World Mental Health Day which gave everybody an opportunity to re-kindle our efforts to protect and improve mental health. The number of people with a mental health disorder was growing even before the COVID-19 pandemic with an estimated one in eight people affected with some form of mental health disorder. The pandemic exacerbated the problem with some estimating the rise in both anxiety and depressive disorders at more than 25% during the pandemic’s first year. This, coupled with people sequestering themselves which disrupted many of their mental health services, worsened the treatment gap for mental health. These statistics magnify the importance of taking the time to consider how we can make a difference in the understanding and treatment of mental illness.

I think many people my age have had their perspective of mental illness change over the years. When I was young people never talked about their friends or relatives who had mental health disorders. It was not uncommon for people to reject a mental health diagnosis of themselves or a loved one. Often there was a lack of insurance coverage for many mental health disorders.

Things slowly began to change with some of the stigma of mental health disorders yielding to more education and understanding. But for many of us, mental illness was something that happened to other people, so we didn’t pay much attention. I can tell you from experience that it suddenly comes into focus when a loved one begins to suffer.

One of the amazing statistics that came out of the pandemic was the fact that those 65 and older was the age group least affected by increased anxiety and depression. Here we were, the age group that had the most deaths from COVID-19, seemingly not affected by the strain of this worldwide illness. This might be due to the fact that our life experiences had taught us that we could do tough things and also that we knew the importance that a family played in helping us through anxious times. We are certainly not through the woods yet with inflation, the threat of a recession and the war in Ukraine, adding to our anxiety.

So, what can we do to help? First, we can advocate for a broader range of effective mental health services. There has been an understandable reluctance to cover mental health disorders in the past due to the difficulty in diagnosing a specific disorder and the problems with prescribing an effective treatment. Mental health treatments are often long term and can prove to be costly. More and more effective medicines and treatments are being discovered and can be brought to bear. The loss of productivity for the patient and the time and money spent by those who care for the patient are certainly reason enough to justify the cost. We need to advocate for finding a balance in supporting the coverage of mental illnesses. One immediate way is supporting the continuation of Medicare’s payments for telehealth. It has been shown that mental health services via telehealth, meaning all non in-person treatments like video conferencing, phone, on-line forums, and texts of phone apps, have been effective in treating anxiety and depression. We’ve all become more comfortable in these last two years with zooming and webinars. This opens the doors to less costly approaches to mental health treatments and would be a big step in finding the balance between cost and effectiveness.

Another way we can improve the treatment of mental health disorders is by supporting those who are the caregivers for the patients. Employers need to broaden their support of time off for those who care for those with mental illness. The government can also help. For at least 20 years, that I know of, there has been a movement to offer tax relief for those who are caregivers for sick loved ones. It’s always been a battle over how to regulate the benefit but in these days of constant contact and communication there has to be a way for those who give care to rightly claim and be compensated at some level for their service. It has been shown that this uncompensated care saves money in the long run by keeping patients out of costly institutions and expensive long term care situations. A tax break would, in a small way, ease the burden of those unselfish caregivers.

Mental illness is difficult to diagnose and sometimes to understand. Lately I’ve seen a commercial of a young man crossing a street and suddenly confronting a second person who is another him. They fight and wrestle with each other, while people around them go on about their business, with the second person suddenly disappearing and the original guy left by himself, unnoticed and alone. It helped me understand how difficult it is to wrestle with yourself and your mental illness while very few people even notice or understand what you’re going through. We all need to recognize and seek to better understand how debilitating mental illness is and strive to support programs that help treat this growing mental health epidemic.

Best, Thair  

Last week we held a Facebook Live event that reviewed our yearly Medicare Part D prescription program satisfaction survey. Almost from the beginning of the implementation of Part D, the Healthcare Leadership Council, through its Medicare Today coalition, has conducted a yearly satisfaction survey to determine how Medicare’s Part D program is doing. The results of this yearly survey continue to be very positive, in fact the satisfaction level went up in this year’s survey. You can see a summary of the results of the survey here.

Morning Consult, an award-winning Decision Intelligence company, conducted our satisfaction survey. In our Facebook Live event, Matt Monday from Morning Consult and I reviewed the results and discussed the possible impacts of the recent changes to Medicare Part D. I’ll offer a short recap below, but you can click here if you’d like to see the entire event.

I started the review by pointing out that the Inflation Reduction Act, often called IRA, contains policies that seniors said they opposed if it interfered with their Part D plans. I did mention that IRA did contain a good change which limited the yearly out-of-pocket costs that seniors pay for prescription drugs but, unfortunately, it did implement government-controlled price controls which would slow biopharmaceutical innovation. I voiced that this is an example of how lawmakers often ignore seniors’ input on healthcare issues.

I went on to say that the survey showed that seniors remained highly satisfied with their Part D plans, which is not surprising given their access to safe affordable drugs for even the most serious healthcare issues. The survey showed that seniors were happy with the choice and flexibility of their plans. I highlighted the fact that Part D has overperformed from the beginning, coming in 40% below projected costs while premiums remained stable.

I did mention that the new legislation put a six percent cap on yearly premiums causing me to think lawmakers feared the new IRA policies would increase Part D premiums, forcing them to put in some protections so it wouldn’t scare seniors too much.

I then got off my soap box and welcomed Matt Monday to go over the survey in more detail.

Matt started by telling us that the survey was conducted at the end of June and they questioned over 1,000 seniors who have Part D insurance. The survey focused on their satisfaction with their Part D insurance, the perceptions they have around their coverage and the potential impacts of government price setting of prescription drugs. Matt pointed out that many of these survey questions are tracked over many years, making the resulting trends very compelling.

There were four main findings:

1. 88% of seniors were satisfied with their Part D coverage which continues the year over year trend.
2. Two out of three seniors felt a peace of mind that they were covered and nine out of ten felt their coverage was convenient to use.
3. 90% agree that they have access to affordable prescription drugs and that their costs would be higher without Part D.
4. Four out of five seniors said that government price setting would impact access to medicines and reduce choice and options.

At this point I took the opportunity to ask a few questions.

My first question was whether there were any increases or decreases in the satisfaction rates this year from prior years? Matt pointed out that often, when a program has high satisfaction rates, the rate begins to fall. This just hasn’t happened with Part D over the years. Satisfaction rates have stayed consistently high. I pointed out that the many choices in Part D plans have enabled seniors to choose a plan that fits them, which adds to their overall satisfaction.

I then asked Matt if seniors thought their plans were affordable or do they find it difficult to afford their coverage? He replied that nine out of ten seniors find their plans convenient and affordable. I mentioned that, with over 8% inflation, the premium price for Part D is projected to go down next year, which begs the question, why do politicians feel the need to fix something that’s not broken.

I next asked Matt if the survey gave any insight into why the satisfaction level has stayed so consistent? He replied that they didn’t specifically ask that question but there were some metrics they could look at. He said that seniors value that their doctors have options and choices and have access to the drugs they need. They don’t have to jump through hoops or have fail first requirements to satisfy. These all lead to maintaining a high satisfaction level. I pointed out that the VA formulary has about half the number of drugs on their formulary as Part D showing how broad the Part D coverage is.

Next, I asked Matt what most concerned seniors about government interference in Part D? He replied that he thought it had to do with access and their fear that the government would interfere with the doctor patient relationship. It also worried me that this new law would restrict innovation such that I might not have access to a drug that would have helped me because it wasn’t discovered due to the new law.

This led to the next question concerning how worried were seniors about the possible reduction in innovation? Matt replied that seniors were not only concerned about their access to medicines they have now but also equally concerned with the medicines they may not have in the future. 82% are concerned about access to newer prescription drugs and seven in ten were worried that government price setting would lead to less research and development. I pointed out that we are on the verge of many new discoveries, and it concerned me that the new law would hinder this research.

I then asked if there were any other options the government had concerning drug prices? Matt said they used a 1 to 10 scale to see how acceptable other drug pricing options were. These questions centered around,

• keeping out-of-pocket costs low
• increasing transparency
• maintaining predictability

Keeping out-of-pocket costs low – Putting a cap on out-of-pocket costs scored 8.3, a very high score.

Increasing transparency – Garnered a score of 9.02, the highest of any option.

Maintaining predictability – The ability to spread their costs over the year so their costs were predictable scored 7.38, also a high score.

I talked a little about the new IRA legislation and the many implementation details that haven’t been defined, which means that we need to be vigilant in our understanding and advocacy. The devil is in the details and we can have a voice in eliminating the devil that hurts our access and affordability. Matt pointed out that the increased predictability will be extremely important given the impact high inflation is having on fixed income seniors.

I then thanked Matt and Morning Consult for their work and closed the event.

This yearly survey is very important in tracking how seniors feel about Medicare Part D. It is another way for Seniors to Speak out.

Best, Thair

This month is National Cholesterol Education Month which hopefully will turn our attention to learning how we can take some preventative steps toward lowering our risk of heart disease. We’ve heard a lot lately about vaccines . . . OK, maybe I was an author of a portion of the many informational diatribes on how important vaccines are. Probably the main point that I stressed was the fact that vaccines were a way to prevent illness. That same reasoning applies to your cholesterol score, it can give you an early warning to a possible heart disease risk and allow you to take some preventative measures to lower that risk.

A high cholesterol score is bad, doctors would like you to have a score of 200 or below but “normal ranges” are less important than your overall cardiovascular health. Your doctor will take into account your personal health and history and advise you if any steps need to be taken. Remember, over 102 million Americans have total cholesterol levels above healthy levels and 35 million have dangerous levels that put them at high risk for heart disease. It is worth taking the time to have your doctor test your cholesterol levels.

In the spirit of education, here is some information on cholesterol from the Medical West web site:

“Cholesterol is a waxy, fat-like substance made in the liver and found in certain foods, such as from animals, like dairy products, eggs, and meat. The body needs some cholesterol in order to function properly. However, too much cholesterol can increase a person’s risk of developing heart disease. There are several factors that contribute to high cholesterol — some are controllable while others are not. Some of the non-controllable factors include age (men above age 45 and women above age 55), gender (women are at higher risk after menopause), and a family history of high cholesterol. Controllable factors include eating a high fat diet, being overweight, and not getting enough exercise.”

Click here for a great 3-minute video that explains even more about cholesterol.

The next question we should ask is, who needs to get their cholesterol checked and how often?

• Most healthy adults should have their cholesterol checked every 4 to 6 years.
• Some people, such as people who have heart disease or diabetes or who have a family history of high cholesterol, need to get their cholesterol checked more often.
• Children and adolescents should have their cholesterol checked at least once between ages 9 and 11 and again between ages 17 and 21.
• Talk to your healthcare team about your health history and how often you need to have your cholesterol checked.

There’s a lot of rumors and myths out there about high cholesterol. Here are some of the more prevalent myths:

• Myth: I would be able to feel it if I had high cholesterol.
  • Fact: High cholesterol usually has no signs or symptoms.
• Myth: Eating foods high in cholesterol won’t make my cholesterol levels go up.
  • Fact: We know that foods with a lot of cholesterol usually also have a lot of saturated fat which can make cholesterol numbers higher.
• Myth: I can’t do anything to change my cholesterol levels.
  • Fact: Exercise, lifestyle changes and medicine can all work to lower your cholesterol score.
• Myth: All cholesterol is bad for you.
  • Fact: Some types of cholesterol are essential for good health. LDL (low-density lipoprotein), sometimes called “bad” cholesterol, makes up most of your body’s cholesterol. High levels of LDL cholesterol raise your risk for heart disease and stroke. HDL (high-density lipoprotein), or “good” cholesterol, carries cholesterol back to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.

We’ve seen some great strides in the discovery of medicines that can help lower our cholesterol score. A CDC website identifies five medicines that will help us lower our score. You can click here to find out more about these great medicines.

We’ve hopefully imparted some knowledge in the spirit of the National Cholesterol Education Month. For fun, click here to take a quiz that will test your smarts on cholesterol.

As with all my blogs there is always an action required. If you haven’t had your cholesterol checked in the last 5 years call you doctor and get it done. It’s one of those preventative things we can do that can truly change, or even save, our lives.

I want to remind you that we will have a Seniors Speak Out Facebook Live event with Matt Monday from Morning Consult and me this Thursday, September 15, at 2:00 PM ET where we will discuss how seniors feel about their Medicare Part D plans. Click on this link for more information. This discussion will focus on the yearly survey that the Healthcare Leadership Council has been taking since the inception of Medicare’s Part D Prescription Medicine program. This yearly survey helps me keep a finger on the pulse of the important people in this program . . . you, the program’s beneficiary. It should be an especially interesting discussion given the changes to Part D that have just been signed into law. Click here to find out more and how to join what looks to be a spirited discussion.

Best, Thair

In an effort to get input on how to improve Medicare’s Part C, better known as Medicare Advantage (MA), the Centers for Medicare and Medicaid Services (CMS) has issued a Request for Information, (RFI) to get input from stake holders on improvements to this important part of Medicare. MA is the fastest growing option for those who are 65 and older, offering an option for a private insurance company to provide your healthcare.

The Healthcare Leadership Council (HLC) is the sponsor for Seniors Speak Out and is in a unique position to offer insightful and balanced suggestions on how to improve MA. This unique position comes from the fact that HLC is a coalition of chief executives from all disciplines within American healthcare. Members of HLC – hospitals, academic health centers, health plans, pharmaceutical companies, medical device manufacturers, laboratories, biotech firms, health product distributors, post-acute care providers, home care providers, and information technology companies – advocate for measures to increase the quality and efficiency of healthcare through a patient-centered approach. This broad membership ensures this balanced approach to the suggestions for improving MA.

While the suggestions offered by HLC covered many aspects of MA, I want to highlight a few that I feel are very important improvements to MA.

Telehealth – While it is difficult to think there was anything good that came out of the pandemic, there was at least one silver lining. The use of telehealth was slowly growing prior to the pandemic and then we were suddenly thrust into the directed isolation of this deadly virus, which was especially dangerous for older people. The very people who historically require more healthcare services were advised to limit their exposure to other people, especially doctor’s offices and hospitals. These healthcare providers were suddenly asked to find alternative ways to treat their patients. Another silver lining of COVID-19 was the crash course seniors went through to learn how to use Zoom and other virtual platforms, since it was often the only way they could see the faces of their loved ones. It shortened the learning curve on using this new technology and enabled doctors to both talk and see their patients, a definite plus in the evaluation of their patient’s condition. Using emergency powers, the administration enabled Medicare to pay for these remote services by waiving certain payment restrictions. It is important now that those payment restrictions be extended and permanent payment options be studied and instituted. For example, studies have shown that Virtual care during the pandemic reduced patients’ risk of overdose and boosted the use of medication-assisted treatment for opioid use disorder, the CDC, CMS, and the National Institute on Drug Abuse found in a new study out in JAMA Psychiatry. Researchers examined data from more than 175,000 Medicare beneficiaries between September 2018 and February 2021. They found that during the pandemic, receiving opioid-use treatment via telehealth was linked to better retention for medication-assisted treatment and a lower risk of medically treated overdose compared to people who didn’t receive opioid use services via telehealth. This specific example shows that telehealth can be very effective. The best practices gleaned from the COVID-19 experience should allow us to reap the savings and efficiencies of providing remote healthcare.

Broadband Access – The pandemic emphasized the need for broadband access and accelerated the upgrading of internet access. Access to a high-speed internet connection has reduced the barriers for those who live in rural areas, reduced the problem of transportation, and even increased the equitable application of healthcare. As states imposed stay-at-home orders, consumers required alternative sources to remain connected with healthcare professionals so they could continue to receive important care – this was particularly critical for people with chronic conditions, who required access to consistent, continuous care to manage their overall health. Additionally, many home digital health products offered today work most effectively with a sufficient and sustained connection. As the Infrastructure Investment and Jobs Act included provisions to advance digital connectivity, CMS should continue to partner with agencies such as the National Telecommunications and Information Administration and the Federal Communication Commission to better target communities in need and work to reduce existing health disparities. CMS needs to pursue options that increase Medicare beneficiaries’ connection to, and use of, digital tools, such as supporting cellular devices programs and incorporating digital literacy.

Data Interoperability – The ability for different computer systems to communicate with each other is extremely important when it comes to healthcare. There are many initiatives, like the Trusted Exchange Framework and Common Exchange, that support a common baseline for quickly sharing information among stakeholders while ensuring that healthcare information receives robust privacy and security protections. We all fill out many forms during our visit to different healthcare providers, many times entering the same information over and over. Some of this duplicity is due to the inability of different information systems to share a common standard which would ensure the quick and accurate sharing of information. I have personally advocated for years for the establishment of a standard and secure way to share information. It is imperative that we consider the needs of healthcare stakeholders to ensure a smooth and successful transition to an efficient secure standard.

The improvements detailed above are a few of the improvements mentioned in the HLC letter but I feel they are key in turning the silver linings that came from the COVID-19 pandemic into permanent improvements in the MA program. It’s an opportunity for improvement that we can’t let slip away.

Best, Thair

As we have gone through the COVID pandemic I think we’ve all learned a lot more about the workings of the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). We found out about accelerated approvals and the FDA advisory committee meetings, especially when they dealt with the controversy involved with the Alzheimer’s drug Aduhelm. The FDA uses advisory committees to give them scientific and third-party input on drug approvals. They also give stake holders the opportunity to participate in public written, and in person, testimony. I have testified multiple times at these advisory committee meetings as I advocated for older Americans.

The CDC also has an advisory committee for immunization decisions. The CDC describes this group as follows:

“The Advisory Committee on Immunization Practices (ACIP) comprises medical and public health experts who develop recommendations on the use of vaccines in the civilian population of the United States. The recommendations stand as public health guidance for safe use of vaccines and related biological products”.

As you know I have often written about the importance of keeping up to date on our vaccinations . . . more and more of our preventative medication and treatments for illnesses come to us through immunizations. I’ve written often about the impact that the pandemic had on causing some of us to postpone these important preventative measures. I continue to stay involved in the CDC’s recommendations for immunizations and was selected recently to give a three-minute public testimony at the ACIP meeting held on June 23rd. While the subject of the meeting dealt with what guidance the CDC should recommend for COVID boosters, my comments were tailored to urge the CDC to expand their focus to include renewed recommendations on other preventative vaccinations. Below is my testimony.

Thank you for having me, I’m Thair Phillips of Seniors Speak Out.

I want to start by thanking this committee for your continued diligence toward ensuring vaccines are available for Americans throughout our lifespan. As many of us are parents, grandparents, aunts and uncles, we were particularly grateful for the recent approval of the COVID vaccines for the youngest children.

As you know, older Americans can benefit greatly from vaccines as we are more likely to be managing chronic conditions and a weakening immune system. As we learned early on in the pandemic, COVID-19 posed a greater threat to older Americans than any other age group. In fact, grim statistics recently released by the Associated Press showed that 3 out of 4 COVID deaths were older Americans which further illustrated this very real threat.

Despite entering into year three of this pandemic, our generation has not lost our resolve in fighting back against this virus and has embraced the vaccine more than any other age group with 95 percent of Americans over 65 having received at least one dose.

With that in mind, it is particularly important to those of us who serve older Americans to continue our work to keep their vaccination rates high, and for the COVID vaccine—added booster doses if necessary.

Now that we as a country are able to vaccinate to prevent or mitigate COVID from the very young to the very old, we should remain steadfast in our efforts to keep COVID boosters at the front of older Americans’ minds.

To that end, the work of ACIP will be critically important in the months to come, so that groups like ours can help encourage our fellow Americans to remain up to date on boosters, as well as being vaccinated for other respiratory illnesses like the flu and pneumonia.

As you know, vaccination rates pre-pandemic were not ideal. The pandemic squashed those routine vaccination numbers even further. COVID vaccinations were somewhat of a bright spot, with older Americans lining up. Let’s build on that. Let’s continue to work together to benefit this important community and ensure that they are informed and most importantly protected against COVID-19 and other preventable diseases.

Thank you.

I am encouraged by the movement to include our yearly flu shot with the next COVID booster if that becomes available. Anything that reduces the number of trips we make to the pharmacy, doctor or other healthcare provider will increase the number of people who take advantage of the vaccines that are available to us.

There has been a silver lining to the pandemic that we need to build on. The scientific push that produced our COVID vaccine in record time was based on a new form of cell level signaling that could be the pathway to breakthroughs in other disease areas. We could find vaccines that help prevent, treat and even cure diseases based on this new science. We need to encourage and embrace this expansion in the use of vaccines.

I’ve found it interesting that we are quick to accept a new pill, ointment or liquid that is discovered but some of us have been hesitant about a new vaccine. Older Americans need to continue to lead on being vaccinated, not only against COVID but for the other preventative vaccines that are now or will come available. As we get older our bodies may become a little less able to fight off illnesses, but we can continue to be resolute in our march toward doing everything we can to keep ourselves healthy.

I hope the CDC recognizes the importance of building on our willingness to take preventative measures by expanding and clarifying their immunization recommendations.

Best, Thair

Tomorrow is the official start of summer but, more importantly, it is the longest day of the year for those of us in the northern hemisphere. It’s the day with the most light and it has a very special meaning for those who have been impacted by Alzheimer’s.

This month is Alzheimer’s & Brain Awareness Month and June 21^st, the summer solstice, is a special day for those who advocate and support the fight against Alzheimer’s; it is labeled “The Day With the Most Light Is the Day We Fight”. This day was chosen to refine the focus on the fight against Alzheimer’s to a specific day.

Usually, I include some statistics about the disease that I’m writing about in my blog. I do that to highlight and educate you about the impact that disease has on our lives. Unfortunately, I really don’t have to do that with Alzheimer’s or other types of dementia, because almost without exception Alzheimer’s or dementia has affected each one of us in some way. Let me tell you about how it has affected me.

I spent over eight years in the Air Force with most of my time as part of a crew in a B-52. Downstairs in a B-52 is where the bombardier and the navigator sit, no windows just radar sets and low light/infrared screens to keep us entertained. That’s where I spent my time. I flew a large part of my 2,000 hours in the B-52 with a man who became a lifelong friend. He was one of six Air Force friends and their wives who have continued to get together every two years for 46 years. He died a little over two years ago from Louie Body Dementia. Louie Body Dementia is an aggressive form of dementia, but it is just one of many different types of this terrible disease. I will use the term Alzheimer’s in this blog since it is the most common type of dementia, but I will use it to also include all of the types of dementia. As is the case with Alzheimer’s you lose the loved one you knew long before their death. It was so hard as I visited, vacationed, and cared for my friend after he was diagnosed because I saw the man I knew and loved slowly disappear. We had to continually say that it was Louie talking and acting rather than the man we knew before. It was especially hard on his wife and family. I suspect that many of you have your own experiences that you could talk about.

As I’ve advocated over the years for more Alzheimer’s research, I’ve often pointed out that Alzheimer’s costs us 300 billion dollars each year with the cost rising each year. This always seemed like such a strong argument for expanded research. After my experience with my Air Force friend the money part, while it remains very important, dimmed somewhat in relationship to the impact on the lives of those who care for those who suffer from Alzheimer’s. The mental, financial, and physical impact of this disease on those around the patient is huge. I don’t think there is any better way for us to spend our time and resources than searching for a cure.

Discoveries of new treatments for Alzheimer’s have been rare, almost non-existent. There have been many promising medicines that have been tested and failed, some of the failures coming at the very end of the clinical trials. It has been heartbreaking to those impacted by Alzheimer’s to have hope and then be disappointed. Just last year a drug was approved that offered some hope. The cost was substantial and, even though the cost was ultimately cut in half, CMS decided that it would only be available to people who participated in clinical trials. While there are many people and organizations on both sides of the question of who should get access to this medicine, the fact of the matter is the hope of a treatment for Alzheimer’s was again dimmed. Just recently a promising drug, named crenezumab, failed in a trial that had been going for 10 years. Once again, the hope for an Alzheimer’s treatment has been dashed, to say nothing of the cost of a 10-year trial. It’s time we take action.

We’ve had government programs that used the “moon shot” moniker to focus commitment and funding. We’ve shown that we can develop vaccines at breakneck speeds when our backs are against the wall. These are all important efforts. I think it’s time we recognize the impact on not only those who suffer from Alzheimer’s but also to the loved ones and care givers by marshaling are personal and government resources to conquer this disease.

As noted above, this is the month and today is the day that we focus on advocating for more research and helping those affected by Alzheimer’s. You can find out what activities are going on in your community during “The Day With the Most Light Is the Day We Fight” project by clicking this link. Get involved, do it for that someone in your life who has been affected by Alzheimer’s.

Best, Thair

This week is Men’s Health Week and, at the risk of going against our push for inclusion, I’m going to eliminate approximately half of our population in this week’s blog and focus on men, and, specifically, older men.

There’s a good reason for this focus. Because of poor health habits, lack of health insurance, failure to seek medical attention, and dangerous occupations, men live sicker and die younger than women. Men die at higher rates for 9 of the top 10 causes of death. This includes deaths from cancer, diabetes, suicide, and accidents, and diseases of the heart, kidney, and liver. Men account for over 90% of workplace fatalities, are far less likely than women to have health insurance and are half as likely to see a doctor for preventive care. When men get sick it affects those around them, the loss of their income to the family often has serious consequences. I’ve talked with many older widowed women at seminars and health fairs about the impact on her life when her husband died. Often there is a loss of retirement income to say nothing about the loneliness that ensues. According to the Census Bureau there are 105 males born for every 100 females, but by age 34 there are more women than men. According to the United States Census Bureau (2000), the ratio of men to women in the early retirement years (age group 65-69) reduces to 85 men per 100 women. According to the Administration on Aging (2001), more than half of the elderly widows now living in poverty were not poor before the death of their husbands. Poor health and the early death of men impacts their families and loved ones. The good news is that the cause for this disparity is not unchangeable.

In my generation, and historically, men have been the primary bread winner, while women were focused on the family, which included the health of the family. This begins to explain some of the health disparity between men and women. I’ve worked with the Men’s Health Network for many years, participating on panels and working with them on common issues. They are a national non-profit organization whose mission is to reach men and their families with health awareness messages where they live, work, pray, and play. They’ve done many health fairs with professional sports teams, businesses, and religious organizations where they did screenings and offered health information for men. They found that the way to get men to attend these health fairs was to go through their wives. It was the wife who convinced her husband to attend the fair, do the screenings and get the helpful health information. Men, and I speak from experience here, are very good at ignoring their own bodies’ health signals, not scheduling or postponing checkups, and generally not taking care of themselves.

The pandemic continued to show this disparity. Over 65,000 more men than women have died from COVID-19. Now I’m a big fan of individual responsibility and taking care of your own health falls under that heading, but men are absolutely influenced by loved ones, family and friends who are important in supporting them to take action toward better health. Darrell Sabbs, a community health advocate in southwest Georgia, emphasized that, “Today we see men come in with more advanced diseases simply because they lost trust in, and access to, healthcare during the pandemic. What we are doing now is celebrating a return to normal where hopefully men and their families will take on a deeper concern for their health.” He also noted, “Trusted voices had to be found, and they were found in our communities and churches.”

I was intrigued by Mr. Sabbs saying that men lost trust in, and access to, healthcare during the pandemic. What we didn’t need was another reason for men to ignore their health but I’m afraid that some of the vaccine hesitancy during the pandemic was uncharacteristically fueled by men and a growing distrust in government agencies. I’m sure this, along with the other noted reasons, was the basis for disparity between men’s and women’s deaths in the pandemic.

 So, here comes the action portion of my blog. What can we do? One thing we can do is observe Wear BLUE Day. Wear BLUE Day is observed on the Friday of National Men’s Health Week, which is this Friday and just happens to be the Friday before Father’s Day. It is a great time to raise awareness and educate everyone about encouraging men to seek regular checkups, to get educated on testicular and prostate cancer along with other health issues that affect men (cardiovascular disease, skin cancer, lung cancer, diabetes, gout, and more.) Hopefully, wearing a blue ribbon will trigger conversations about men’s health.

There is something else you can do, if you have a friend, husband, or a family member who hasn’t taken the steps to keep himself healthy, find a voice that he trusts to discuss the steps to a healthier life. If that trusted voice is yours, fine, if it’s a close friend, a relative or a church leader, get them to have a serious talk with the man in question. Encourage the trusted voice to emphasize how important your man’s health is to those around him. To remind him about the joy he will have when he is able to actively participate in, and be present at, important events with his children, grandchildren, and even great grandchildren. A trusted voice can make a huge difference in a man’s life.

Men’s Health Week is an ideal time to focus on improving the health of those men in our lives who are so important to us.

Best, Thair

Last Wednesday, we held a Facebook live event in recognition of National Cancer Survivor Month and invited a special guest, Pam Traxel, Senior Vice President of Alliance Development and Philanthropy at the American Cancer Society Cancer Action Network (ACSCAN), to talk about cancer prevention, screening, treatment, the importance of clinical trial diversity, and the need to protect cancer treatment research and development. You can click here to watch the entire half hour event.

I started the event with a few remarks about the impact cancer has on each of our lives. I pointed out that there are an estimated 16.9 million cancer survivors alive today, but, in 2022 in the U.S., there will be an estimated 1.92 million new cancer cases and 609,360 cancer deaths. These statistics highlight the importance of screening and other methods for early detection and prevention.

As is my habit I took a few moments at the beginning of the event to talk about some important issues that are threatening our healthcare, starting with a proposal that has once again been put forth to allow the government to set the price of prescription drugs. As we progress toward personalized healthcare, the reduction of options available to doctors is not the path we should be taking. Thrusting the government into this process would reduce the number of options available. I emphasized that no patient should face even the possibility of having fewer treatments or therapies available when undergoing cancer treatment.

I also pointed out that Senator Bernie Sanders may introduce an amendment in an unrelated piece of legislation to allow drugs to be imported from Canada. This is an unsafe and unworkable solution that will do very little to reduce the price of drugs for you and me. With that I turned the time over to Pam Traxel.

Pam began by pointing out that Cancer Action Network is the public policy arm of the American Cancer Society and that working to shape public policy concerning cancer patients has made a difference. She went on to point out that they advocate for the entire cancer continuum from screening and early detection to treatment and survivorship across all types of cancer.

Her first point was how important screening and early detection are and noted the important role that health coverage plays in getting screened.  ACSCAN is working to encourage Congress to extend and make permanent the subsidies in the American Rescue Plan for health coverage in the exchanges. They are also working to encourage states that have not chosen to expand Medicaid to do so, given that those states that have chosen to expand have seen a huge increase in cancer screening participation. The final area she focused on was encouraging Congress to implement a yearly cap on out-of-pocket Medicare prescription drug costs.

Pam also discussed the importance of states ensuring access to bio marker testing. She emphasized how important it is that our elected officials hear from us and where we stand on these important issues.

I then asked Pam a few questions, the first one concerned how seniors can prevent cancer and detect it early. Pam pointed out that living a healthy lifestyle is important and taking advantage of different screenings will help detect cancer early. She gave out a great link to information that will give us healthy lifestyle hints and the screenings available depending on our age. She emphasized that the best way to survive cancer is to detect it early. She knows that the pandemic has caused many of us to delay our screenings, and I admitted I was one that had delayed some screenings. She implored us to talk with the doctor about where we stood on our screenings and what do we need to do to get current.

In response to a question on the biggest advances she has seen in cancer research and treatment innovation, Pam noted the ability to target cancer more closely and for medicines to go directly to the cancer cells and kill them is very encouraging. Through the use of bio markers and unimpaired access to new medicines we have a much better chance to survive cancer. She also said that there are many new developments in ways to detect cancer early that is lifesaving.

Pam pointed out that ACSCAN is pushing for the passage of the Diverse Trials Act, a bipartisan, bicameral piece of legislation. This bill would help people who are participating in clinical trials with their ancillary costs, removing some of the barriers that exist for clinical trial participation. Pam also pointed out that in cancer clinical trials half of the participants receive the normal cancer treatment and half receive the new drug, as opposed to other trials where half get a placebo and half get the new drug. This removes another barrier to trial participation.

I then asked about the impact of screenings and early detection. Pam discussed the fact that early screening and detection along with a significant increase in the number of drugs and therapies available has made a huge difference in cancer survivability in the last decade. She pointed out how important innovation is in the fight against cancer. New drugs mean new options which means more lives saved. This led to my final question of what would happen if we limited innovation and produced fewer drugs to fight cancer. Her answer was simple – cancer will kill you if there is no intervention, and the tools that are used to fight cancer are prescription drugs. If we have fewer drugs, we have fewer tools to fight cancer and save lives.

To sum up our conversation, there are three main points:

• Early detection through screenings and healthy living will have a huge impact on surviving cancer
• Government intervention in our healthcare will obstruct innovation with little reduction in out-of-pocket costs for the patient
• Your voice in speaking out to your elected officials can and will make a difference

I hope you enjoyed this Facebook live event; you can see the entire video here. We look forward to your participation at our next Facebook live event.

Best, Thair

There are two threats to prescription drug accessibility and innovation that are once again threatening your health. These are not new threats, but they continue to be thrust forward as politically popular “solutions” to help reduce drug prices. These two threats are government “negotiation” and foreign importation. Inserting the government into the drug pricing equation through so called negotiations was mentioned in the President’s State of the Union speech. Importing drugs from foreign countries is not a new approach but it has recently been raised as a possible amendment to be added to proposed legislation. Before I discuss these two approaches in more detail, I’d like to remind you of some important facts concerning drug prices.

In 2021, the list price of drugs, the price that many of the patient’s out-of-pocket costs are based on, rose less than the Consumer Price Index (CPI) which measures inflation. There are many parts of our healthcare system that rose more than the CPI, but not the list price of drugs. Even more relevant is the fact that the net price of drugs, the amount the drug manufacturer actually receives, dropped by 1.2% in 2021. That’s right, the net price dropped! This is the 4^th year that the net price has dropped. If the drug companies were trying to raise prices so they would get paid more each year, they have failed miserably. In these days of 8% inflation, it seems crazy to increase government regulations on an industry where their net prices have dropped. Given this backdrop I’d like to discuss these two drug pricing proposals.  

The proposed insertion of the government into the Medicare prescription drug program, Part D, would involve repealing the non-interference clause in Part D and allow the government to get involved in setting the price of selected drugs. The government would calculate what they considered a fair price to be for a particular drug and present that to the manufacturer. If a manufacturer was not willing to accept the price the government calculated, they would be charged anywhere from 65% to 95% of their gross sales to continue to sell the drug in the U.S. No drug manufacturer could continue to sell their product if they had to pay 65% of their gross sales to the government. This is not a negotiation but a take it or leave it ultimatum which reduces the so-called negotiations to simply price fixing. History has shown that government price fixing never works.

Foreign importation of prescription drugs has thrust itself into the limelight because of a proposal put forth by Senator Bernie Sanders to include this sweeping change to Medicare Part D into the FDA user fee “must pass” legislation. I’ve talked about this “solution” to drug prices in previous blogs, explaining how it bypasses the safety net we now enjoy without any proof that the patient will see any savings while counting on Canada to implement a program that they have already said they can’t support. Because of the variation in foreign government laws and control of healthcare prices the price of prescription drugs can vary between different countries. While you or someone you know may have gone across either our southern or northern boarders to purchase medicine at a lower price, this is not what this proposal is about. This importation proposal is at a much higher-level involving suppliers and transporters and large volumes. Some states have passed laws allowing importation but none of them have yet been implemented. The non-partisan Congressional Budget Office, our government’s accountants, have studied this approach and said, “Even if this practice was made legal, however, unique aspects of the prescription drug market would limit the additional volume of prescription drugs reaching the United States. On the basis of its evaluation of recent proposals, the Congressional Budget Office (CBO) has concluded that the reduction in drug spending from importation would be small”. There have also been legal challenges asserting that the government can’t legally implement this proposal. In spite of the facts that the safety we now enjoy through FDA-approved drugs would be compromised, that Canada has said they won’t support importation, that any savings would be small, and that this idea may not even be lawful, Senator Sanders has chosen to ignore these facts and has proposed implementing this change in some must-pass legislation. Which brings me to what I think could be the worst part of this whole situation.

Adding this huge change to Medicare Part D as an amendment to User Fee legislation bypasses the discussion and debate that this huge change deserves. It’s an attempt to sneak this change into an unrelated piece of legislation which eliminates the chance for members of Congress to review the facts, for hearings to take place, and for stake holders to offer their input. It even bypasses the judicial branch from reviewing its legality. It’s not the way we should be doing the people’s business. This big of a change to our Medicare prescription drug program should be out in the open, analyzed and debated. I’m tired of politically expedient proposals that do nothing to make our healthcare better but will look good in some election ads and speeches. These proposed changes will affect real people for a long time, Congress should take the time to hear from the people these changes affect.

On that note I encourage you to write or call your members of Congress and tell them you want real solutions, not changes that need to be snuck in as an amendment to unrelated, must-pass legislation.

I also urge you to tune in on June 1 to our Facebook Live event where I will talk with Pam Traxel who leads the advocacy arm of the American Cancer Society. I’m sure some of the above issues will be discussed. You can tune in for the event by clicking here on Wednesday.

Best, Thair

This Wednesday, May 25^th, is National Senior Health and Fitness Day, one of two days a year that focuses on seniors’ health and fitness. As the title might suggest it probably will take more than two days a year to get some of us off our duffs and doing something that has some semblance of exercise. For most of my life someone has been telling me to exercise and they always have good reasons, it’ll make your lungs/heart stronger, raise your endorphins (I’m still not sure what those are and why I need to raise them), and you’ll sleep better. I’m probably like most people and have, periodically, developed some routine of exercising, but at no point did it become part of my everyday life. The question is, why should I start now? Glad you asked.

Here’s my take on this question. I’ve noticed a definite decline in my ability to perform some physical things. I don’t play basketball anymore, I don’t run unless it’s a real emergency, and getting down is easy, getting back up, not so much. It doesn’t seem right that just when I have more time on my hands my ability to do some of the things that make me happy has decreased. There’s the crux of the problem and the source of the answer. Prolonging your ability to do things that you enjoy and feeling healthy enough that you want to go out and do them may be the motivator that you need to get off the couch. I guess that’s why they named the day National Senior Health and Fitness Day, you need to be both healthy enough and fit enough to enjoy the activities that give you joy.

Here’s my challenge, this Wednesday, sit down and write down the things that you used to do that health and fitness are keeping you from doing. There are going to be some things that just aren’t going to be possible. I’m never going to go back to playing basketball, but hiking may be something that I don’t do anymore because of my knees or hips or aerobic weakness. This is the time to talk with your doctor. I’ve found that I’ve got in my head that the only time I go to the doctor is when I’m sick. You have every right to make an appointment with the doctor and ask the simple question, I want to go hiking but this (whatever is keeping you from hiking) makes it so I can’t, what can I do?

For instance, I love to golf but periodically my legs started hurting. It seemed like it was a strange hurt, not like it was in the muscle. I went to the doctor, and she says it might be a nerve problem. She suggested I schedule an MRI to look at my lower back and upper legs. If there is something that can be done to alleviate this problem I’m motivated to do it, even if it’s exercising. The point here is don’t be bashful about being proactive in the preservation of the things that make you happy.

It’s almost a given that exercising and eating healthy are going to be in any doctor’s advice for restoring or prolonging your ability to something physical. Which brings us back to this Wednesday’s National Senior Health and Fitness Day. It’s a great time to take stock, as I recommended earlier, and make a change. Look at the resources available. There are often activities on this day, walks and runs and screenings that you can take advantage of. Here are seven senior health and fitness day ideas that you can do:

1. Go to the Park – 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 – Whether at a local community center or private gym, look for a structured workout session.

3. Walk to Health – Organizations near you may be organizing walking events.

4. Work in the Garden – Gardening is a leisurely hobby promoting both health and fitness

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 of 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.

There is one other source of fitness help that you might find helpful. My insurance offers SilverSneakers as a benefit. It is the nation’s leading community fitness program for Medicare-eligible Americans. I recently joined their email program and I get periodic, about once every four days, emails giving me health information, recipes, exercise tips, etc. They also offer free video exercises classes, online classes and even a free app for your smartphone. You can click here to find out what they offer and check if you’re eligible.

I hope that this Wednesday’s National Senior Health and Fitness Day motivates you to get off the couch and do something that helps you get healthy and fit so you can enjoy the things that make you happy.

Best, Thair

The one thing that I don’t have to tell anyone is that summer is coming. We’ve been careful over the winter to not get caught in the new COVID-19 variant trap and limited our travels. We just barely have been free to remove our masks on airplanes and in the airport, although, depending on our health status and age some of us have chosen to continue the practice. We are all looking forward to going on a vacation, getting away, feeling the warmth of the sun on our face . . . and just as I say that I know you are all saying, “here he goes again, given the blog title, he is going to ruin our fun with dire warnings and a list of dos and don’ts”. Well, there still might be some dos and don’ts but we can still be free to have some fun in the sun if we just follow a few simple steps.

First, a little background. Skin cancer is the most common type of cancer diagnosed each year, but there are ways for us to significantly lower our chance of getting skin cancer and, if it’s found early, it often can be treated and eliminated completely. Here are some interesting and sobering facts:

• One out of five of those over 70 will develop skin cancer.
• An estimated 3.6 million people will be diagnosed with basal cell carcinoma (BCC), the most common and least serious type of skin cancer.
• Having five or more sunburns doubles your chances of getting skin cancer, but just one blistering sunburn in childhood or adolescence more than doubles a person’s chances of developing melanoma (a more serious form of skin cancer) later in life.
• People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent.
• When detected early, the 5-year survival rate for melanoma is 99 percent.

When I read these facts I came to the following conclusions – a lot of people are going to get skin cancer. Things that we did when we were younger affect our risk of getting skin cancer. Since the name of this blog is “Seniors Speak Out,” and we can’t do anything about the stupid decisions we made when we were younger, I’m going to talk about the things that older people should do to limit their chances of getting skin cancer or having a bad outcome if you do get it.

Different people may have a higher or lower risk of getting skin cancer depending on your own background and physical characteristics. I recommend you take this skin cancer risk quiz to see what your own personal risk is. It’s a good first step to take.

Here’s the list of dos and don’ts you’ve all been waiting for, I trimmed it to the ones that fit the older crowd.

• Seek the shade, especially between 10 AM and 4 PM.
• Don’t get sunburned.
• Avoid tanning, and never use UV tanning beds.
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
• Use a broad-spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad-spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming or excessive sweating.
• Examine your skin head-to-toe every month.
• See a dermatologist at least once a year for a professional skin exam.

These are things that we’ve all probably heard before but maybe have periodically neglected to follow. This month is a good time to start following the guidance above. I would like to talk a little more about the final two items on the list.

As I get older, I’ve found myself looking at myself in the mirror less and less. The sagging and wrinkles just aren’t that exciting to look at. Examining myself from head to toe once a month just doesn’t seem like much fun, but you can see the wisdom in doing that type of examination. I’ve given this guidance some thought and have come up with a personal solution that I’m going to try. As I’ve grown older, I’ve found the accuracy of my memory has declined. According to my wife (and she is right on this point) my memory hasn’t declined, I still remember things just fine, I just remember them wrong. Given that fact I saw a problem with trying to remember from month to month if something on my skin has changed. I decided I’m going to take some baseline pictures that I could use to compare to my monthly exam. This way any changes would be apparent and not based on my flawed memory. It’s just something I thought I’d do; you’re welcome to use your own methods. The important thing is that you do the monthly exam. Remember, early detection makes a huge difference in achieving a positive outcome.

The last item, seeing your dermatologist, is another point that I want to stress. Sometimes skin cancer doesn’t present itself as something you can see. Your dermatologist is the key to detecting things that need further evaluation. Many of us postponed appointments like this due to COVID-19. If it’s been over a year since you saw a dermatologist, schedule an appointment.

I always look at these blogs as hoping they cause some of you to make a change. It’s huge if you just do one thing that helps you stay healthier. My change is I’m going to finally follow the suggestion of my sons and my wife and start putting sunscreen on when I golf, and I’m going full out and using SPF 30. I hope you also decide to make a change that will help protect your skin.

Best, Thair

I thought this week would be a good time to get back to basics on Medicare’s prescription drug program. I realize that any “back to basic” blog has the potential to be boring but stay with me on this. I think that almost everyone will find out something about their prescription drug coverage that they didn’t know.

I do realize that some of you may not have your prescription drugs covered under Medicare; you may be covered under a commercial prescription drug program as part of your employer’s employee or retired insurance benefit. If this is the case in your situation it still might be worth your while to read on. Some of this information is relevant to commercial insurance. I also will be talking mostly about the standard Medicare Part D plan for standard Prescription Drug Plans (PDP). Having said that, much of the information and nomenclature will also apply to Medicare Advantage (MA) Part D benefits.

There are important words and phrases that you need to understand as you deal with your prescription drug costs.

• Deductible – Most of us have dealt with deductibles over the years with our commercial plans. Many types of insurance have a certain amount you pay before your insurance starts to help with paying costs. Under PDP’s the yearly deductible in 2021 was $445; after that you had to pay Coinsurance.
• Coinsurance – This is where you pay a percentage of the drug cost. In Part D you pay 25% of the drug cost until you reach the TrOOP limit.
• TrOOP – The True Out Of Pocket cost. When you’ve paid $6,550 you reach the catastrophic coverage period in your Part D prescription drug plan; at this point, the beneficiary pays $3.70 for a generic or preferred drug and $9.20 for other drugs, or 5% coinsurance, whichever is greater.

While the amounts and rules of the phrases above may not be the same in a Medicare Advantage prescription drug program, the general meaning and importance do apply. There are two other words that are important as you review your drug coverage each year.

• Formulary – The formulary is the list of drugs that are covered and available in a specific drug plan.
• Tier – Drugs in a plan’s formulary can be placed in different tiers. These tiers are important because your out-of-pocket costs may be different depending on which tier your drug is in.

You can see why the formulary and tier are important considerations as you choose your Part D plan in a PDP or a MA drug plan.

The Medicare Part B benefit is another program where you may receive prescription drugs. Part D drugs are usually obtained at the drug store while Part B drugs are administered or obtained at a doctor’s office or as an outpatient at a hospital. The Part B drugs are often injectable, which frequently requires a doctor’s office visit. An example of this type of drug is treatment for cancer. These Part B drugs are often expensive and it’s one of the primary places where the government would like to control prices. Part D and Part B are two Medicare benefits where we are required to pay monthly premiums.

The Part D premiums have stayed very stable over the last ten years, with the average premium being $38 per month in 2012, going to a high of $41 per month a few years later and returning to $38 in 2022. These premiums are an average of the premiums paid by seniors for different types of Part D coverage administered by private health plans in different states. Most states had over 20 different prescription drug insurance plans to choose from. That type of premium stability is unbelievable, especially in these days of inflation. I credit most of the stability to competition with maybe a touch of plan design and cost shifting thrown in.

The Part B premiums are more expensive and reflect what the government spent on funding this benefit. They were $148 per month in 2021 but went up to $170 per month in 2022. This was the largest increase ever. Some of the increase was because of increased utilization and the government’s reduction of the calculated premium last year due to COVID-19. The premium, according to the government, was also affected by “the uncertainty” regarding the potential use of the Alzheimer’s drug Aduhelm by people with Medicare. The secretary of Health and Human Services has requested that Medicare reassess the premium cost. There’s a chance we might get a refund!

One of the things some people don’t realize is that the Part D and Part B premium costs will go up depending on your income. This is due to IRMAA (not your aunt Irma but the Income-Related Monthly Adjustment Amount.) For Part D there’s a monthly premium add-on of $12.30 if your joint income is above $176,000 per year. The monthly premium add-on continues to go up until it equals $77.10 a month for a joint income over $750,000. For Part B the monthly premium add-on is $68.00 if your joint income is above $183,000 a year. It continues to go up until it equals $408.20 a month for joint income above $750,000. Some may ask (me included) why our income should determine the amount we pay when we all paid into the program our whole life an amount that was based on our income. That’s not an issue to explore today but perhaps in a future blog, just a minor rant today I had to get out of my system

The CMS website is a great place to find a lot more detail about your prescription drug benefits. You will be able to dig as deep as you like to find out a lot more about this great benefit.

One thing to know, there is a lot to consider as you make your initial choice of a prescription drug program or as you do your yearly review. The lack of standardization, especially among the tiered plans, means that it is virtually impossible to compare plans and Part D cost-sharing without the use of CMS’s online Plan Finder tool. While the Plan Finder is relatively easy to use, Medicare beneficiaries who lack confidence in their computer skills should ask family, friends, their local pharmacy, or their area State Health Insurance Assistance Program (SHIP) agency to help them compare plans on the Plan Finder. There are resources out there to help you.

I hope you found out something new about Medicare Part D. It’s a great benefit that continues to be a life enhancing and lifesaving program.

Best, Thair

This month is Arthritis Awareness Month with Aware being the operative word. The number of people affected by arthritis in America is shocking. Over 50 million adults and 300,000 children suffer from arthritis, and it is the leading cause of disability in our country. The one thing I know is that most of us either have firsthand experience with the disease or at least know someone who is affected by it. The mere fact that over 50 million of us have it means that there are a lot less than six degrees of separation from us and an arthritis sufferer (my apologies to Kevin Bacon). So . . . why should we be aware?

The first thing we should be aware of is that there are over 100 different types of arthritis, and the diagnosis and treatment may be different depending on the disease type. There are some common symptoms that we can look for to help us decide if we need to see a doctor. We’ll get into those in a minute. We do know that there are benefits in catching arthritis early. There are medicines and actions we can take to slow the onset of the disease and, in some cases, put it in remission. I think it’s important at this point to talk a little bit about remission. Many people who have arthritis define remission as the absence of pain or symptoms. Doctors, on the other hand, may not classify the disease the same way. They may see the continued presence of the disease and its continuing detrimental impacts on your body even with the absence of pain and not declare the disease as in remission. There are two things that this difference of opinion brings up. First, when I talk with people who suffer from arthritis, they say that if the pain was eliminated, they would call it remission because they feel that pain is the most debilitating part of arthritis. Second, we need to also listen to the doctor when they talk about not being done with arthritis just because the symptoms have stopped. Their advice and treatments are important, and we need to continue with the medicine or treatment that they prescribe. It’s always hard to stay vigilant against an unseen and non-painful enemy but it’s important to not let our guard down.

Ok, so now that we are aware of this disease that affects a lot of us, how do we recognize it and what do we do? As you might imagine the Arthritis Foundation has some great guidance on these two questions.

1. Pain – Pain from arthritis can be constant or it may come and go. It may occur when at rest or while moving. Pain may be in one part of the body or in many different parts.

2. Swelling – Some types of arthritis cause the skin over the affected joint to become red and swollen, feeling warm to the touch. Swelling that lasts for three days or longer or occurs more than three times a month should prompt a visit to the doctor.

3. Stiffness – This is a classic arthritis symptom, especially when waking up in the morning or after sitting at a desk or riding in a car for a long time. Morning stiffness that lasts longer than an hour is good reason to suspect arthritis.

4. Difficulty moving a joint – It shouldn’t be that hard or painful to get up from your favorite chair.

What do you do if you experience some of these symptoms?

Your experience with these symptoms will help your doctor pin down the type and extent of arthritis. Before visiting the doctor, keep track of your symptoms for a few weeks, noting what is swollen and stiff, when, for how long and what helps ease the symptoms. Be sure to note other types of symptoms, even if they seem unrelated, such as fatigue or rash. If you have a fever along with these symptoms, you may need to seek immediate medical care.

If the doctor suspects arthritis, they will perform physical tests to check the range of motion in your joints, asking you to move the joint back and forth. The doctor may also check passive range of motion by moving the joint for you. Any pain during a range of motion test is a possible symptom of arthritis. Your doctor will ask you about your medical history and may order lab tests as needed.

Most people start with their primary care physician, but it’s possible to be referred to doctors who focus in treating arthritis and related conditions. Getting an accurate diagnosis is an important step to getting timely medical care for your condition.

It seems like I always have some story to tell about my own experience. I started having pain in my left index finger and a bump in my palm that hurt. I thought it was arthritis since it mirrored some of my wife’s symptoms who is suffering with arthritis in her fingers, but she urged me not to ignore my seemingly accurate self-diagnosis and see the doctor. Strange as it might seem, my diagnosis was wrong. It turned out to be trigger finger syndrome and I was able to take some ibuprofen and do some exercises and rest, and it went away. The point of this story is, look at the symptoms, track them and gather information as indicated above and see your doctor; they are the ones who can make the correct diagnosis and either treat you or get you to a specialist.

This a great month to become aware of the symptoms of arthritis and, if needed, do something about them. I hope May finds you in good health and good spirits.

Best, Thair

After a two-week break Congress is coming back in session at a time that historically has been an active period for passing legislation. This time, however, there might not be much activity. As you probably know the Build Back Better (BBB) Act failed to gain traction at the end of last year. The House passed the BBB Act, but it died in the Senate due to the reluctance of Senator Manchin to pass legislation that cost over two trillion dollars on programs that he didn’t think were needed. Parts of the Build Back Better Act passed by the House would have made changes to Medicare. It would have added some level of eye, hearing and dental benefits, initiated government price controls on many prescription drugs, and would have set a cap on the yearly out-of-pocket costs in the Medicare prescription drug (Part D) benefit. I’ve commented in a recent blog on how destructive government price controls would be. In that same blog I stated that a yearly out-of-pocket cap on costs for Part D would be a great change. While adding benefits seems like a positive change the costs and the details for the added benefits would need to be carefully scrutinized.

I’ll go out on a limb (a pretty secure limb) and say that the BBB Act as passed by the House is dead. I’ll go out on a little less secure (but still pretty secure) limb and say that pulling out some of the parts of the BBB Act that affect Medicare and passing them in some other smaller bill is not going to happen in the next few months. Given that assessment I would like to talk about some overall long term healthcare changes that Washington should be considering.

We need to somehow wean ourselves away from a fee for service healthcare system. It magnifies the wrong incentives by focusing on volume rather than outcomes. This doesn’t mean we should cut back on tests and procedures that give us the advantage of early detection of health problems; it means we should pay attention to best practices and gather the data that will allow us to develop insights into the true value of individual tests. This same perverse incentive to order added tests is also driven by the lack of tort reform for our healthcare providers. When the fear of being sued drives our providers to order excessive tests and procedures it not only raises the overall healthcare and individual patient costs but often exposes the patient to added discomfort and danger. These types of changes have enjoyed bipartisan and bicameral support in the past and should be revisited.

We need to consider pricing drugs by the value they impart. We have been experimenting and, in some cases, implementing results-based pricing contracts that are based on the overall effectiveness of a medicine or procedure. There are ways to make informed estimates of the true overall value of a medicine. A medicine that saves lives, restores the ability of the patient to be self-sufficient or allows a patient not to be institutionalized all have a huge impact on healthcare and societal costs. We need to pursue these types of value-based solutions.

The value and effectiveness of preventative programs have been widely recognized but paying for these types of programs have been difficult to implement given the current short-term focus on cost. This bias was evident in my experience at the American Society on Aging conference I attended two weeks ago. There was real resistance to the idea of expanding Medicare Advantage (MA) programs that have the benefit of offering wellness programs to help us stay healthy rather than treat us after we get sick. MA plans are an example of the type of incentives we need to adopt in America’s healthcare system. The MA program saves money in the long run by keeping us healthy and out of the doctor’s office and out of the hospital. This allows the cost of a medicine or procedure to be offset by the savings generated by the avoidance of a stay in the hospital. Our siloed Medicare system (divided into Parts A,B, C, and D) prevents this type of accounting. For example, when Medicare Part D was first implemented hospital admittance by seniors fell. There was no way then or now for the savings generated by these lower hospital admissions to be credited to Part D. This lack of accounting is even less accurate in estimating the social affect of a patient who, through the efficiency of a provider or a new medicine, is able to return to work, support themselves and pay taxes rather than consume government funds. We need to find out how to develop systems that look to the long term and take a broader look at keeping seniors healthy.

These are some pretty lofty goals and may seem unreachable. I often find myself looking only at the next piece of legislation or the next executive order or the next regulatory change and fail to step back and look at the direction we should be headed to really fix America’s healthcare system. I think the suggestions detailed above should be touchstones to which we compare each proposed change, asking the question, does this get us closer to the above descriptions or take us further away? We can’t get closer to these long-term solutions if our next piece of legislation or executive order or regulation takes us further away.

As always, I’ll keep my eye on any healthcare legislation that pops up and keep you informed, but rest assured that I won’t just be interested in the short-term savings or impacts, I’ll also be looking at the long-term implications of each proposal.

Best, Thair

Every year the American Society on Aging (ASA) has held a conference that brings together a specific group of healthcare providers for older Americans. The attendees are primarily providers of home care, assisted living facilities, long term care, etc. Many nonprofits and providers of services covered under the Older Americans Act also attend. It is a huge conference, one that I have attended many times in the past. It is held each year in New Orleans, and this was its first non-virtual, in person conference held since the start of the pandemic. I took the opportunity to attend this year to stay updated on what the future holds for older Americans.

This conference offers workshops and training that are valuable to those in this sector of healthcare. They offer different tracks of classes and panels that represent different facets of healthcare. One of these tracks focuses on public policy and legislation and regulations that will affect the attendee’s organizations. As you might guess this is the conference track that I chose to attend. ASA is a large and powerful organization, and, since most of their funding comes from Medicare, Medicaid or other government funded programs, they are very interested in proposed changes to these programs. As I listened to the presentations, I found some general themes that concerned me as I considered the long-term impact on our healthcare.

Everyone was extremely disappointed in the failure of the Build Back Better (BBB) Act that was to be President Biden’s signature piece of legislation. I certainly understood their disappointment. There were many pieces of that legislation that would have increased government funding for their organizations. There wasn’t much concern with the trillions of dollars that the government had already spent on COVID-19 related expenditures and how much the BBB Act would add to this huge debt. This huge debt was the main concern for those Senators and Representatives who chose not to support BBB. There were certainly weaknesses in our healthcare that were exposed by COVID-19 that need to be fixed. Issues like increasing the use of telehealth, ways to serve those in rural areas, and one of the most discussed issues at the conference, how to develop equity in our healthcare services. There weren’t many discussions, however, on how to get these solutions implemented.    

The opening keynote speaker, Raymond Jetson, an inspirational speaker who has pioneered programs that use local assets to improve the lives of older people in different communities, made an interesting observation about some nonprofits and institutions that were created to serve seniors. He said that sometimes the people running the organization became more enamored with the container, the organization itself, rather than the people within the container . . . older Americans, the people the organization was created to serve. I think that this description details much of what has caused problems within Medicare and Medicaid, and government organizations in general. They get wrapped up in self-preservation and layers of regulations rather than focusing on the people they should be serving and their changing needs. Often, a government institution’s reaction to problems is the addition of more regulations and more oversight, which was part of the problem in the first place. An example of this situation was revealed in two panels I attended later in the conference.

The first panel centered around what advocates need to know about what’s happening in Washington, D.C. After bemoaning the failure of the BBB Act one of the panelists ventured off into a discussion about the administration’s failure to rein in Medicare Advantage (MA) programs. He pointed out that last year the government had paid $15 billion in extra payments to the insurance companies that had taken on the total responsibilities for treating the seniors who had opted for a MA program which offers many more benefits than basic Medicare. He even said that the administration was encouraging the privatization of Medicare and it seemed everyone in the room agreed with this inaccurate description. Later in the panel discussion, as a solution to stop the privatization of Medicare, a panelist opined that rather than Medicare for all we should push a single payer system to the state level and have Medicaid for all, to which there seemed to be widespread agreement. It seemed the room’s solution to any problems with Medicare was an increase in government control.

The next day there was a panel discussion of what the first year of President Biden had accomplished as it relates to seniors. The same panelist who disparaged the increase of seniors that have opted for Medicare Advantage again discussed his displeasure with this alarming trend. I couldn’t hold back any longer . . . I pointed out to the panel that the cost in the BBB Act for adding benefits like those offered by MA were going to cost about $40 billion a year and that was mostly just for the dental benefit. I asked if that didn’t seem like a pretty good deal, the $15 billion payment mentioned yesterday instead of $40 billion for less benefits in the BBB Act. There was a sudden diversion into a discussion of other higher estimates for MA payments. I then asked what they thought was the reason for the percentage of seniors joining MA plans going from 30% just a few years ago to almost 50% now. They said that one reason was the intense marketing (Joe Namath’s name was bantered about). I asked if they thought this large number of seniors would pick a plan that wasn’t best for them because of a Joe Namath commercial? Much discussion ensued. It always gets my dander up when people insinuate that seniors aren’t capable of making informed decisions about their healthcare.

There were many devoted people at this conference who were interested in learning how to better care for the seniors in our country. There was, however, a disturbing trend on the public policy side that revealed many who were more interested in building up the container than doing the things that would benefit the people the container serves, older Americans.

It was great to, once again, see and talk with people face to face. I listened and learned (except when I was moved to speak out) and I feel like I have a better reading of the pulse of healthcare policy going forward. I will continue to speak out about issues that affect the health of America’s seniors.

Best, Thair  

Thank goodness, the avalanche of ads and emails and stuffed mailboxes with pleas to sign up with their Medicare plan is a distant memory. Whatever plan you chose is what you are experiencing right now and it’s important to take a moment to reflect on how you feel about the choice you made.

In our recent survey we asked you if you felt your Medicare prescription drug plan made drugs more affordable and accessible. Almost half, 49.3% said no. This is a long way from the almost 90% that, year after year, have said they were satisfied with their plan. What changed?  I’m convinced that it’s the barrage of rhetoric that is blasting out of Washington that is convincing people that their once valued prescription drug plan is somehow now not working. We need to step back and decide for ourselves what’s best for us.

I think now is a good time to evaluate where you stand with both your prescription drug plan and your Medicare supplemental plan, if you have one, or Medicare Advantage if you have chosen that option. Are the services recommended by your doctor available when you need them? Do you and your doctor have the ability to initially choose the prescription medicine that fits your specific condition and then to change as your needs dictate? How are your co-pays and co-insurance? Has your out-of-pocket expenses increased? It is sometimes difficult to make comparisons year over year when your health may have changed. If your health required more doctor visits, more tests or even some time spent in the hospital, your out-of-pocket expenses are obviously going to change. The real question is whether the plan you have is the best for your particular situation and, maybe just as important, will the changes proposed by the current administration improve accessibility and affordability?

Now is a good time to take some time and write down what works for you and what doesn’t with your insurance. Some of that introspection is an honest evolution of where your current health is headed. Are there inherited family vulnerabilities that should be taken into account? My wife’s grandmother, mother, and aunts, on average, lived to be over 100 years old. My father died when he was 66. Maybe there are some things I need to consider going forward. Family longevity is only one thing to consider. Science has given us tools that can look at our DNA and uncover threats to our health that should influence our plans for staying healthy as well as the insurance plan we choose. We should not only look at how our plan works for us when we get sick but also how it helps us stay healthy. For instance, when I lived in Virginia, I joined a gym that included a pool where I could swim laps. I paid for the membership, and it helped me stay healthy. When I moved out West, I found that my new Medicare Advantage plan included the benefit of a free membership to a local swimming pool. My insurance carrier reminds me (some people call it bugging them, but I choose reminding me) about things I should be doing to stay healthy. At my last physical my doctor said it was time to get another colonoscopy. A colonoscopy is not one of the fun things I’ve done in my life, but it is definitely for my own good. Well, because of a myriad of not really good reasons, I haven’t scheduled the procedure. This last month I’ve been getting emails from my Medicare Advantage provider reminding that it I should be getting a colonoscopy. I’ve set a deadline that I’ll get it done by the end of May. Remember, the reminder is from an organization that is going to pay for this procedure. They do that because it’s to both of our benefits to discover possible colon problems early.

So, here’s the bottom line, statistically less than 40% of seniors even review their insurance coverage during the open enrollment period and 10% or less change their coverage. Does that mean that 90% have had no change in our circumstances over the last year and we’re happy with our current coverage? It would seem logical that one of these four things will probably happen during this year:

1. Our health status changed.
2. Our current plan changed in some manner.
3. Competing plans that changed benefits might be of interest to us.
4. There were new plans offered in our area.

There are some things we can do now to be ready for the next open season:

1. Keep a diary of things you like and dislike about your current plan, both your prescription drug plan and supplemental or Medicare Advantage plan, as applicable.
2. Track how much you spend on your healthcare – be sure to include what you spend on preventative care.
3. Find out and document family health history. It will not only help you choose a plan but is something you need to bring up with your doctor.
4. Evaluate your own health and your health trajectory.

Hopefully, doing these things will give you the information you need to make an informed decision about your insurance. No one else is responsible for your health. If we don’t take the time to select the right plan for ourselves then insurance companies won’t be incentivized to compete for our services. We need to keep the competition alive so the government doesn’t seize the opportunity to regulate and dictate our healthcare.

Best, Thair

Every month I’ve focused on at least one healthcare-based day/week/month. It was usually linked to a disease, like National Cancer Prevention month or Bone and Joint week. These yearly observances are important because they help us pay attention to information that may help us either avoid a disease, better manage our health when we have the disease, or give us hints on how we can be better caregivers to a loved one that has the disease. I’ve always learned something as I did research for this blog, and I’ve changed some of my habits because of the things I’ve learned. Well . . . this week we take a broader look at how our health can be impacted when we celebrate National Public Health Week.

This observance is a project of the American Public Health Association (APHA) and the theme this year is “Public Health is Where You Are”. Much of the APHA’s efforts center on access and they realize that where you live affects your community’s health. There are ways that we can make our communities healthier, stronger and safer. One way is to realize there may be barriers that keep some people in our communities from accessing the care they need as they face different health challenges. The National Public Health Week has identified daily themes for the week, they are:

Racism: A Public Health Crisis (Monday)

Public Health Workforce: Essential to our Future (Tuesday)

Community: Collaboration and Resilience (Wednesday)

World Health Day: Health is a Human Right (Thursday)

Accessibility: Closing the Health Equity Gap (Friday)

Climate Change: Taking Action for Equity (Saturday)

Mental Wellness: Redefining the Meaning of Health (Sunday)

Clicking on the title can help you find out more about each one of the themes. Reading through the different themes helped me understand how important each of these themes affect our communities and how are our own health can be affected.

As you might know from my earlier blogs, I always try to find some way that each of us can make a difference. Most of us get our healthcare close to where we live, in our communities. We may have faced one or more of the barriers mentioned above as we work to access our own healthcare providers. I’d like to talk about three ways you can personally become involved in helping your friends and family and improve the healthcare access in your community.

Transportation – I would guess that all of us have encountered problems with getting to the doctor or some other healthcare providers for a scheduled appointment or know of someone who couldn’t get to the pharmacist to pick up a prescription. There are many local organizations that are looking for volunteers to help with anything from rides to the doctor to being a visitor to people who are homebound. Get involved, find a way you can help remove the transportation barrier in your community.

Access to available programs – There are many federal, state, and local programs available to help seniors gain access to needed healthcare services.  A resource that you can use and share with your family and neighbors is found by clicking here. This is the U.S. Administration on Aging web site, and it will help connect you to the state and local services that are available to older Americans in your communities.

Older Americans Act – The Older Americans Act (OAA) funds critical services that keep our nation’s seniors healthy and independent—services like meals, job training, senior centers, health promotion, benefits enrollment, caregiver support, transportation, and more. It’s reauthorization is being debated right now in Congress and must be renewed before it expires. There are proposals that would cut some of the funding for this important program that has been helping seniors since 1965. I would urge you to contact your Washington representatives and tell them you want to make sure the Older Americans Act gets funded without cuts to these life supporting programs.

Our community is where we receive our healthcare. We all need to recognize that many of us have barriers that inhibit our ability to obtain needed care. We need to become involved in helping those in our community overcome those barriers and obtain access to the life changing and lifesaving miracles of medicines and care that are available.

Best, Thair

Last Thursday, March 24^th, we held the first Facebook Live coffee chat. It was the culmination of our March emphasis on one specific drug pricing proposal . . . the government proposal to set drug prices. My blogs this month have been centered around this proposal and we released a survey on the subject, giving you the opportunity to speak out and give us your input on what is important to you. We had a very important guest at our coffee chat, former Speaker of the House Newt Gingrich. We discussed this drug pricing approach and the results of our survey. I will offer a brief summary of the event below but you can see the entire Facebook live event by clicking here.

I opened the chat explaining this proposed “solution” which has been around for some time but was given added emphasis when President Biden referenced it in his State of the Union address earlier in the month. I pointed out that the only way to accomplish this price fixing was to limit the formulary, the number of prescription drugs available in Medicare. This approach would also limit the discovery of new drugs for the treatment of serious diseases like cancer, Alzheimer’s, and diabetes. I went on to explain that just as medicine is moving rapidly toward personalized treatments the government’s approach of price controls would pull us back to the one size fits all era of cookie cutter medicine, leading to treatment, abandonment, and worse health outcomes.

I then introduced Speaker Gingrich. He was Speaker of the House from 1995 to 1998 and has stayed involved with public policy in a variety of ways since that time.

Speaker Gingrich started out by reminding us of all the amazing discoveries that have been made in Medicine in the last 5 to 10 years. People he knows personally are still alive today because of those discoveries. He compared government controls to a snapshot that freezes drug discovery in time as opposed to a motion picture, changing every day. He said, “What I don’t want to see happen is the heavy hand of government bureaucracy come in, set artificially determined rules, cut off all of these new innovations, all of these new breakthroughs.” He described Great Britain where they have a government committee that determines which prescription drugs will be available to the citizens. He pointed out that people from other countries still come to United States when they have a serious health problem. He said, “I don’t want us to adopt a policy that leads us to mediocrity, and that deprives senior citizens of the kind of breakthroughs that are going to improve the quality of their life, enable them to live independently, enable them to remain healthy for 10 or 15, or 20 years longer, because of all the new science that’s coming down the road.”

At this point Speaker Gingrich said something that summed up the whole concept of government price controls, he said, “So it’s very important, when somebody tells you that they’re going to involve price controls, remember, they’re telling you they’re going to have health controls, because that price control is going to affect your health.” As this blogs title says, price controls equal health controls. This approach will let the government control your health.

I then asked Speaker Gingrich if he thought price control legislation would be enacted this year.

He said he didn’t think it would be passed this year. He was in Florida at a Republican retreat and said, “I know from talking to Ways and Means Committee members here, they’re deeply opposed to depriving the American people of the opportunity to have the best medicine in the world, and to have the best pharmaceutical industry in the world, which is capable worldwide, of offering better solutions and better health.” He reminded us to continue to be vigilant and tell those who govern us that we don’t want this government interference.

I then pointed out that some would tell us that seniors are OK with having a reduced number of drug discoveries and asked him if he thought that was accurate? He noted the difference between answering that in general and answering it from a personal perspective, about not having a lifesaving drug available for a loved one or for one’s self. He said, “So I don’t believe any survey, which suggests that people think it’s all right, to deprive them of a choice of the medicine that may make their life better, or that may actually save their life.”

I then asked him whether he had seen benefits since Medicare’s prescription drug program, Part D, was implemented. Speaker Gingrich replied that he was an ardent advocate of Part D and through his speeches and writings has said that providing healthcare was a moral issue and then a monetary issue. He reminded us that when Medicare was first implemented the number of prescription drugs available was very small and not considered important. He was proud when Part D was created and had seen the positive impact it had on older Americans. He recalled how Part D costs came in well below that government’s estimate of what it would cost. He also said, “Drugs are not a major driving force in the cost of healthcare. In fact, if anything, the price of drugs has risen in recent years slower than the price of the rest of healthcare.”

I then asked the question whether he thought it was a good idea to purchase drugs from another country? His answer was to point out that the FDA does not have a way of monitoring these drugs and there would be no guarantee as to the safety of these foreign drugs.

In my final question I asked Speaker Gingrich why he believes people in other countries sometimes pay less for their prescription medicines. He pointed out that a country, he used France as an example, would set a price they would pay for a particular drug and if the manufacturer wouldn’t pay it then they would revoke their patent and let a French company manufacturer it. He also pointed out that he has advocated for years that we should treat it as a trade issue and force other countries to share in the cost of drug innovation. He also stated that he thought there was some streamlining of the FDA that would lower the cost of innovation.

I then transitioned to a review of our Seniors Speak Out survey. Last week’s blog dealt with the survey in more detail and you’re welcome to click here to read that more detailed explanation.

Here are a few highlights:

• Nearly 40% of respondents said they want our lawmakers to prioritize lowering healthcare costs, with 37% wanting lower drug costs, 16.5 percent of respondents wanting more access to federal healthcare programs like Medicare, Medicaid, and the VA to innovate drugs and treatments. Lastly, only 8% want to ensure that we have vaccines and treatments for future pandemics, like COVID-19, which I feel shows that seniors believes that the pandemic is over, and they’re not as concerned with being prepared for future ones. It was interesting that seniors recognized that overall healthcare costs was their top concern with drug costs being a close second.

• 91% of respondents said they were concerned government cost controls would limit the number of medicines available to them. When seniors understand the results of proposed changes to their healthcare their true attitude is revealed.

• 84% were concerned that price controls would devastate biopharmaceutical innovation and make it more difficult for patients to access advanced treatments for serious diseases.

• The top two changes respondents indicated they would like to see are increased transparency in the current drug pricing supply chain and putting a cap on the yearly out-of-pocket prescription drug costs for Medicare beneficiaries.

In closing, Speaker Gingrich and I reiterated the importance of telling those who govern us that government-imposed price controls are not the answer. Tell them you understand that government price controls equal government health control and that’s not what you want.

It was a pleasure to participate in this important discussion and I look forward to continuing with more of these types of events.

Best, Thair

Interesting Preliminary Drug Pricing Survey Results

We have the preliminary results from our Seniors Speak Out survey and the results are proving to be very interesting. Our survey focused on the recent drug pricing proposals that have been put forth by different politicians, mostly recently by President Biden in his State of the Union address. We thought it would be important for you to let your voice be heard. Our questions avoided some of the rhetoric that has accompanied the drug price discussion, identifying in the questions some of the consequences of the different proposals. The results were very interesting.

It is important to note that these are preliminary results – the final results will be in later this week. You still have a chance to participate in the survey before it closes. Click here to take the survey. You might want to take the survey before you continue reading this blog, so you won’t be “swayed” by the preliminary results. You should also know that I will be discussing the drug pricing topic with former Speaker of the House Newt Gingrich on Thursday, March 24^th at 1:00 PM ET. You can tune into the event once it is live by clicking here. If you’re able to attend, mark yourself as “interested” in attending.

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

Answers:

• 16.7% – More access through federal healthcare programs (Medicare, Medicaid, VA) to innovative drugs and treatments.
• 7.5% – Ensuring we have vaccines and treatments for future pandemics like COVID-19.
• 37.5% – Lowering drug costs.
• 38.3% – Lowering all healthcare costs

Analysis:
The first thing that caught my attention was the fact that we seem to be done with the pandemic; it was deemed least important. The top two choices, not surprisingly, dealt with cost. What was surprising was the number one choice, lowering all healthcare costs. With all the media and rhetoric focused on drug costs you still recognized that other aspects of our healthcare have had price increases and we should concentrate on all aspects of our healthcare costs.

Question two.
Government price controls could limit the number of drugs and treatments available to patients, taking away choice and flexibility in treatment plans. Does this concern you?

Answers:

• 91% – Yes
• 9% – No

Analysis:
Government price controls only work when access and choice are rationed. A good example of this limited accessibility is the government formulary for the Veterans Administration drug program, which has about half as many prescription drugs available as Medicare Part D.

Question three.
Government price controls could devastate biopharmaceutical innovation and make it more difficult for patients to access advanced treatments for serious conditions like Alzheimer’s, heart disease, and diabetes. Is this concerning to you?

Answers:

• 83.6% – Yes
• 16.4% – No

Analysis:
While we don’t know exactly how much innovation will be affected by government price controls, the Congressional Budget Office has indicated there would be some reduction in the number of new drug discoveries, with the small and limber biotechnology firms being impacted the most. You overwhelmingly thought that this negative impact on innovation was a bad idea.

Question four.
Below is a list of drug pricing policy proposals. Which proposal would you rank as your number one choice for proposals for lawmakers to pass:

Answers:

• 10.4% -Allow drugs to be imported from other countries despite safety concerns
• 35.8% – Caps on out-of-pocket drugs costs in Medicare Part D.
• 13.4% – Allowing the government to set the price of drugs (some call it “government negotiation”).
• 40.3% – Transparency within the drug pricing system.

Analysis:
I am so encouraged by your recognition that drug importation and government price fixing are not viable, long-term solutions to lowering your cost of prescription drugs. You also recognize that having a cap on our drug costs would give us the peace of mind that we won’t be bankrupted by the cost of our prescription drugs. Your number one selection reveals your understanding that any long-term solution needs pricing transparency, enabling the patients to share in the savings.

Question five.
Do you feel like your Medicare Advantage or Medicare Part D prescription drug plan makes prescription drugs more affordable and accessible?

Answers:

• 50.7% – Yes
• 49.3% – No

Analysis:
I’m somewhat confused by these results. Over the last 15 years, surveys on the satisfaction of Medicare Part D have been at or near a 90% satisfaction rate. I would like to find out why only half of you thought Part D made your drugs more affordable and accessible. This might be a subject for a future blog.

I appreciate your willingness to take the survey and tell us how you feel about these proposed drug price solutions. I am looking forward to talking with Speaker Gingrich this Thursday about these issues.

Again, you can take the survey by clicking here. You can join Speaker Gingrich and me on Thursday, March 24^th at 1:00 PM ET. You can tune into the event once it is live by clicking here.

Best, Thair

(Take our survey and join our discussion with Newt Gingrich – see below)

Each month, one or more of my blogs would focus on a specific health issue or disease that was highlighted that month, like the American Heart Month that was the subject of my February 7^th blog. March has five health observances (You can click “Link” to find more about each observance).

• National Colorectal Cancer Awareness Month – Link
• National Kidney Month – Link
• National Nutrition Month® – Link  
• National Women and Girls HIV/AIDS Awareness Day – Link  
• World Tuberculosis Day – Link  

A part of each one of these observances encourages us to take advantage of the new medical discoveries available to us today. There are tests and procedures to help make early diagnosis. There are procedures that can alleviate or eliminate the problem. There are medicines that can lengthen or save our lives. In every instance some sort of innovation or discovery has made that medical problem less deadly or has improved the quality of life for those who are suffering. Even getting the most out of the food we eat has benefited from innovation. People with digestive problems and food absorption problems have more medical options that can help alleviate their problems.

The benefit of these innovations was revealed a little over 15 years ago when Medicare’s prescription drug program, Part D, was implemented. That year the number of elderly patients admitted to the hospital fell. The only plausible reason was the new accessibility to prescription drugs made possible by Medicare Part D. We often forget the broad impact that these new drugs have, not only on our quality of life, but also on the overall cost of our healthcare.

One of the problems with Medicare accounting is each of the parts is its own silo. Each of the Medicare Parts (Part A – provides inpatient/hospital coverage, Part B – provides outpatient/medical coverage, Part C – an alternate way to receive Medicare benefits, and, Part D – provides prescription drug coverage) has a closed accounting system, and is not financially connected to the other parts. None of the hospital admittance savings that were made possible by the implementation of Part D were credited to Part D. The true cost and savings of Part D were not recognized. This lack of broad recognition of the value of a new medical discovery, especially in prescription drugs, has hindered the move to a more equitable way to price these new innovations and discoveries.

The President, in his State of the Union address, once again brought up his desire to lower the cost of prescription drugs. To me this statement always begs the question, what is the true cost and who pays that cost? If we truly account for the broad savings of less hospital visits, the reduction in caregivers’ time, the economic impact of less lost days of work and less doctor visits, we might find that the cost of the drug is much less when the overall savings to our economy is recognized.

What will these proposed changes do to the prescription drug costs that we pay? The government’s nonpartisan accounting agency, the Congressional Budget Office (CBO), has said that some of the price cutting solutions proposed to lower drug costs would have negligible effect on the Medicare patient’s out-of-pocket costs. That doesn’t sound very reassuring to me that my costs are going to go down.

What worries me the most about these changes to Part D is the affect it will have on innovation. Politicians are quick to say that the “rich” drug companies will do just fine, that innovation will continue. The CBO has done some preliminary work and has concluded that there will be a reduction in the number of new medicines discovered if the proposed Part D changes are implemented. I think that any reduction is worrisome. If the drug that saves the life of my grandchild is not discovered because of these changes, I’m against the changes. We are at the cusp of life changing and life saving discoveries. The new COVID-19 vaccines are evidence of the impact of innovation. With all the progress in understanding the ways different cancers work, we now can dare to imagine a time when cancer is conquered. We are understanding how to repair DNA. Now is not the time to change the mechanism that has brought us to this dawn of discovery.

As our national leaders ponder these questions, we thought it was important to hear from you. We have created a survey that asks you how you feel about these issues. We encourage you take the survey and tell us how you feel. Click here to take the survey.

You also have the chance to tune into a Facebook live discussion concerning the survey results and the drug pricing question with former Speaker of the House, the Honorable Newt Gingrich and me. It will be held at 1:00 PM ET on Thursday, March 24^th. You can tune into the event once it is live with the below link. If you’re able to attend, mark yourself as “interested” in attending.

https://fb.me/e/1x0psWUNA

I hope you take the time to take the survey and then to join us as we discuss this important issue.

Best, Thair

President Biden declared in last week’s State of the Union speech that he was going to lower prescription drug prices. It has become a mantra echoed over the years by Democrats and Republicans alike. It is important to note that each of the approaches that have been proposed for lowering drug prices involves inserting the government into the Part D Prescription drug program. If you haven’t already deduced from my earlier blogs, you need to know that I’m an ardent fan of keeping the government out of our lives and especially out of our healthcare. Having said that, I also recognize that the free market has its limitations when it comes to healthcare. For instance, if I didn’t like the heart transplant I got last week I can’t just go to a different doctor or hospital for this week’s heart transplant. Some aspects of the free market don’t work when it comes to healthcare. There are places where government oversight is needed to set guardrails and to ensure the safety and accessibility of our healthcare. The very inception of Medicare Part D is a great example of this balance of the free market and government oversight.

If you turned 65 less than 15 years ago you may not realize that Part D was not always a part of Medicare. When Medicare was first implemented, the number of prescription drugs available was very small compared to those available today. It wasn’t considered necessary in 1965. By 2003, it was evident that prescription drugs were an important part of our healthcare and it needed to become part of our Medicare benefit. The debate over how this new benefit would be administered ranged from those who wanted to have a government run program, they even estimated what a government-controlled Part D approach would cost, to those who wanted the government to issue vouchers to beneficiaries that could be used to purchase prescription drug coverage from commercial insurers. It quickly became evident that neither of these approaches had the votes to pass so the search for a compromise approach began.

The side that wanted more government control of the process worried that there wouldn’t be enough insurers offering plans, especially in rural areas. Their solution was to create more regulations that would force levels of insurer participation and to propose a fallback approach that, if no plans were offered in a particular area, a government-based Medicare plan would be offered.

The side that wanted less government intervention pushed for the ability for private insurers to contract with Medicare to offer prescription drug plans in specific areas and compete with other commercial plans for customers. To ensure free competition, an explicit non-interference cause was to be included in the law, prohibiting the government from influencing or directing drug prices, letting the competition drive the premium prices.

After much discussion, the Part D program we have now was narrowly passed at 3:30 am. It took over 2 years to prepare for the benefit roll out, with Part D being fully implemented in 2006. The resulting law was a public/private partnership that included the non-interference clause and the provision to offer a Medicare sponsored plan if no commercial insurance plan was offered in an area. This is what has happened over the last 15 plus years.

• Montana, a very rural state, has 23 Part D plans to choose from; it was never necessary to implement the Medicare based plans.
• Premiums have grown slower than the consumer price index.
• Part D costs are 40% less than what was estimated for a government-controlled solution.

The point I want to make is that, in this particular area of healthcare, keeping the non-interference clause in the law worked.

There have been many drug price solutions proposed:

• Drug negotiations – This would allow the government to essentially set drug prices.
• Drug importation – Allow states to import drugs from foreign countries, primarily through Canada.
• Limit drug prices – Base drug prices on those of a select group of foreign countries.
• Limit existing drug price increases – Using the Consumer Price Index (an inflation indicator) the government will limit the amount certain drug prices could be increased.
• Change the prescription drug rebate process – Push rebate savings to the patient at the pharmacy counter.
• Change Part D to operate like the VA drug program functions – It would mimic the government-run VA drug program which has about half of Part D’s formulary and sets price discounts.

Every one of the proposed “fixes” to drug prices involved government intervention with none of these solutions having any history of working. We have 15 years of history of proof that non-interference works. The Part D program has an almost 90% favorable rating among its users. We don’t know need to revert to an untested government-controlled prescription drug program.

Do we need to improve the Part D program? Yes! The business model and pricing mechanism is convoluted and inefficient. We need ways to reduce and/or cap the out-of-pocket prescription drug costs. There are solutions that can lower your prescription drug costs while continuing to encourage the discovery of life changing and life savings drugs. We need to all get together and work toward these solutions. Government setting the price of prescription drugs is not the solution.

This month Seniors Speak Out is focused on discussing drug prices. Our first step is to hear from you. We’d ask that you to click here and take a brief survey so you can tell us what your concerns are. You can then tune in on Facebook live, on March 24^th, where former Speaker of the U.S. House of Representatives Newt Gingrich and I will discuss the survey results and drug pricing. We’ll give details on how to tune in to the Facebook live discussion on my blogs later this month.

We look forward to hearing your thoughts.

Best, Thair

It’s no secret that many of us have neglected some of our healthy living habits as we concentrated on protecting ourselves from the COVID-19 virus. It’s time that we step back and return to those healthy habits and what better time than National Cancer Prevention Month.

While some of us may think that getting cancer is just an unlucky turn of events, the fact of the matter is there are many steps we can take that can prevent us from getting this life changing disease. The Prevent Cancer Foundation offers seven steps to prevent cancer. While some of these steps will also improve our overall health, there are some steps that are focused directly on cancer. Unfortunately, the pandemic has hindered some of these cancer preventive actions so now is the time to get back on track.

Seven Steps to Prevent Cancer

Don’t use tobacco – Kind of a no brainer but not an easy step for those of us who are currently using tobacco. If you do just a little googling (yes, it’s a verb in the dictionary but not in the dictionaries I grew up with) you can find out how many years you can add to your life if you give up tobacco. There is overwhelming proof that using tobacco can cause cancer. There are programs available under Medicare that offer counseling, prescription drugs and other tobacco cessation tools. As you get out from under the burden of the pandemic why not also escape the chains of tobacco.

Protect your skin from the sun – We grew up thinking that having a deep tan was great. There are still tanning salons everywhere. Yet, in colonial days having a tan lowered your standing in society since it meant you worked in the fields. In my time in Thailand during the Vietnam war I found that the Thai people found white skin and light complexion to be very favorable and wondered why we wanted to get tans. We now know how harmful the sun’s rays can be. We might have found ourselves outside more as we found that was one of the safest places during the pandemic, but it also exposed us to the sun’s rays. Getting outside is great, but we need to remember our sun block lotions and eye protection.

Eat a healthy diet – It’s no secret that food in the grocery store has more and different ingredients than it did in the 1950s. My son is a keto and a healthy food disciple. He reads food labels and avoids those with the harmful chemicals and additives that have been added to many of our common grocery items. He calls this eating clean. The link between some food additives and fertilizers and some forms of cancer has been established. Unfortunately, I found that it was easy to migrate toward fast food when the pandemic discouraged eating in restaurants. Drive through fast food is not usually found in the definition of a healthy diet. Eating basic, unprocessed clean food will benefit us in a lot of different ways.  

Maintain a healthy weight and be physically active – There is no doubt in my mind that the pandemic planted and nurtured a huge crop of couch potatoes. We stayed home, binge watched TV, ate and ate and didn’t move. We don’t have any excuses now – let’s get out and start swimming again, going to exercise classes and get back to our fighting weight. A healthy weight and good physical condition help our bodies avoid cancer and help us fight cancer if we get it.

Practice safer sex and avoid risky behaviors – While rumors of excessive STD cases in some Florida senior living communities have been shown to be exaggerated or even untrue, the fact that sexual activity in older adults is not uncommon does open the gates to some cancer risk if safe sex is not practiced.

Get immunized (HPV & hepatitis vaccines) – While the HPV vaccine is not recommended for those over 18 years old, the hepatitis vaccines may very well be recommended for those over 65. Depending on your health and health history and your travel destinations, hepatitis vaccinations may be an important consideration.

Know your family medical history and get regular cancer screenings – I have a good friend who has had preventative mastectomies and hysterectomy due to a gene mutation and a family history of cancer. The ability to identify or even know about this gene mutation wasn’t available until the 1990s, but now, through a cancer screening that revealed the gene mutation and a definite family history of breast cancer, my friend had these prophylactic procedures that dramatically lowered her risk of cancer. The secret here is to go to the doctor and get the screenings. We might have had an excuse during the pandemic to avoid going to the doctor for checkups and screenings. We don’t have that excuse any more. Science has given us so many more tools to help us avoid cancer, we need to use all of them.

Unfortunately, we all know someone close to us who has cancer or has had cancer. We probably know someone who has died of cancer. Above are seven steps that we can take to help prevent cancer from changing our lives. Not only can we do things to prevent cancer, but we can also urge those around us to take these preventative steps. Now is a good time to decide to be proactive in our fight against cancer.

Best, Thair

p.s.  Wanted to give everyone a heads up that you’ll have the opportunity to tell us how you feel about drug prices in a survey we will send out in the next few weeks. We will also have a Facebook live fireside discussion with Former U.S. House Speaker Newt Gingrich later next month on the survey results and drug pricing. Stay tuned for more details.

The threat of war in Ukraine has grabbed all of our attention. It’s too bad that the threat of war is the only thing that can divert our attention from the pandemic and our access to healthcare. Russia’s threat of an attack on Ukraine is certainly scary, it seems like we keep getting more things added to our list of stuff to worry about. I don’t know about you, but my worry list is just about maxed out. We just start to envision life after COVID-19 and then Russia gets crazy. My solution is to pivot back to healthcare and COVID-19, where there is finally some good news.

The Build Back Better legislation has stalled, and it looks like the bill will not move forward in its present form. There were some good things in that bill, particularly the yearly cap on the out-of-pocket costs for Medicare beneficiaries, but there were some onerous price fixing schemes that threatened both access and innovation. It seems that the only path forward is to break the Build Back Better bill into parts and try to wrangle the votes to pass the pieces, but Russia and inflation has seemed to ruin Washington’s appetite for taking on this new path at this time. The goal was to have some things passed by the March 1^st State of the Union but that is not going to happen. I do want to warn everyone that fixing the prices on prescription drugs and other attacks on Medicare Part D are still on the President’s “to do” list and I can guarantee that they will, at some point, be back in play. As my earlier blog discussed, all this focus on drug prices has somehow missed the fact that drug prices have risen slower than our year over year inflation and the net price that the drug manufacturers get has actually gone down each of the last four years. It seems strange that this issue still seems to garner a huge amount of attention. When all of this comes back in play, we’ll be here to keep you up to date.

I don’t have to tell you that COVID-19 seems to be fading. My own personal feeling, and I emphasize that it’s purely my own feeling, is that I’m done with COVID-19. I’ve been vaccinated, boosted, and then caught COVID-19 a little over two months ago. I had what seemed to be a two-day light cold and that was it. From my perspective, I’m going to do everything I can to return to my former normalcy.

From a national point of view COVID-19 is dropping as fast as its steep climb was. While there is still pressure on hospitals to treat those that are still ill, the path is clearly down. States and even other countries are dropping their restrictions – you can now travel to Australia, something you haven’t been able to do for almost two years. While there still could be surprises, it seems like more and more studies indicate that those that have been vaccinated and especially those that were vaccinated and had a breakthrough case of COVID-19 will be protected going forward, possibly for an extended time. The talk of another vaccination has diminished.

Having said all this, I do want to point out that there are still lives that can be saved as the pandemic wanes. We can still save thousands of older Americans’ lives. It is an absolute fact that age is the biggest determinate of whether you will die of COVID-19. We all quickly became aware at the beginning of the pandemic that the older population, especially those in assisted living circumstances, bore the brunt of the deaths. As the pandemic progressed and more and more younger people were infected, this fact kind of got lost. They need to be brought back front and center. According to the Atlantic, compared with someone in their 20s, a person over 65 is at least 65 times more likely to die of COVID-19; over 75, 140 times more likely to die; over 85, 340 times more likely to die. No other factors – not race, diabetes, cancer, or immunosuppression – have anywhere close to that risk. They increase the risk “only” between two to four times. While the older age group has the highest percentage of vaccinations, they are still bearing the brunt of the deaths. It is a fact that getting the third shot, the booster, has a huge impact on protecting us from COVID-19. Consider this, the vaccinated but unboosted elderly are still dying of COVID-19 at four times the rate of the unvaccinated adults under 49. A booster cuts that risk dramatically. There are those in this older age group who have indicated they are never going to get vaccinated. Those people have made up their minds. We need to concentrate on the vaccinated but unboosted. They are clearly open to vaccines and should be willing to get the booster. The booster is easily available and free. We all need to concentrate on getting this vulnerable but willing group to take this lifesaving step and get the booster. If you know anyone in this group, talk to them, tell them how much the booster will lower their risk. Getting the booster is guaranteed to save lives.

I hope your worry list has been lightened by the good news. We’re not out of the woods but we’re starting to see glimpses of the sunny meadows ahead.

Best, Thair

A few years ago, I attended a legislative briefing on Capitol Hill in Washington D.C. They were discussing dementia and Alzheimer’s when one of the panelists said “If you’ve seen one case of Alzheimer’s you’ve seen one case of Alzheimer’s.” That statement has stayed with me, it has continued to remind me that Alzheimer’s is a complicated and very individual disease. This complication is one of the main reasons that discoveries of medicines to cure or even slow down the progression of dementia or memory loss have been elusive. It has also made the care of dementia patients complicated.

While it is alleged that there are 6 degrees of separation between us and Kevin Bacon, I think that, for most of us, there is only one degree of separation between us and a relative or close friend who has some form of dementia. All of us have had conversations with someone who has dementia and realized the devastation of this cruel disease. I’m sure we have also had conversations with people who are the caregivers of dementia patients. It is those people and institutions that I want to focus on.

The challenge of caring for dementia and memory loss patients takes a skillful, patient, loving person with the support of doctors and facilities that offers individually focused and dignity centered care. This type of individual care requires resources that, unfortunately, are out of reach of some of the most vulnerable around us. It is crucial that we find a way to open up this level of care to everyone.  

The Healthcare Leadership Council (HLC), the supporting organization for Seniors Speak Out, is a non-profit organization that is a coalition of chief executives from all disciplines within American healthcare. In the description of their organization they state, “This coalition works together to jointly develop policies, plans, and programs to achieve their vision of a 21st century healthcare system that makes affordable high-quality care accessible to all Americans.” The last part of their description indicates how committed they are to ensure all Americans has access to the best care available.

To spotlight this commitment HLC created the Redefining American Healthcare Award, an award that aims to “draw attention to existing initiatives that effectively address and improve health inequities.” On February 3^rd, HLC gave the Redefining American Healthcare Award to the Center for Comprehensive Care and Research on Memory Disorders at the University of Chicago Medicine. Now that’s a pretty long name but the important part of the organization is the people. It is staffed by a committed team of highly trained neurologists, geriatricians, psychiatrists, neuropsychologists, social workers, and specialized nurses to ensure seamless, thorough care for dementia and memory loss patients. Evaluations are tailored to each patient, and the Center provides ongoing support and care throughout the course of the disease.

Dr. James Mastrianni and Tessa Garcia McEwen accepted the award saying, “We are honored to receive this recognition, as it reinforces our efforts to raise awareness and provide individualized and specialized care to the most vulnerable and marginalized populations, including those with the greatest barriers to healthcare, the younger-onset Alzheimer’s Disease population, and those with rare neurological conditions.”

Debbie Witchey, executive vice president and chief operating officer of the Healthcare Leadership Council, said, “This team has done a wonderful job of recognizing the unique needs of its patient population and addressing the bigger picture, which includes their home lives and caregivers.” I’ve spotlighted this award in the hopes that I can bring some focus as to where our time and resources should be applied as we consider the tsunami of dementia patients this country faces in the future.

There has been much discussion about a recently approved Alzheimer’s drug, talk about how accessible it will be and how good it will perform. What has been lost is the fact that we still face the huge responsibility of caring for the huge number of dementia patients that are diagnosed each year. Consider this, almost 6 million Americans have Alzheimer’s today and it is projected that by 2050 there will be almost 14 million patients suffering from Alzheimer’s. The cost of treating Alzheimer’s is breathtaking, it is estimated that by 2050 Alzheimer’s will cost $1.1 trillion a year. We need to focus on how we will take care of all these patients and do it so we don’t pass over the marginalized and most vulnerable. The Memory Center in Chicago is a shining example of how to efficiently treat those with dementia and memory loss while maintaining the individual focus needed to support both the patient and their caregivers.

We are expending a great deal of time and money on making sure we are ready for the next pandemic, if and when it happens. We should not ignore the fact that we already know the huge number of Alzheimer’s patients and we need to use places like the Memory Care Center as models to find efficient ways to get the care to all Americans.

Finally, a moonshot type research project to find a way to blunt or even cure Alzheimer’s would be a financially wise decision to say nothing of the human impact it would have on all of us. It is estimated if we just found a way to diagnose Alzheimer’s earlier, we could save 15% of the cost. In 2050 that would be $165 billion saved in one year. Whatever we do, we need to encourage our government to ensure that their regulations and decisions promote the research needed to find a cure or to at least slow the onslaught of Alzheimer’s.

Best, Thair

In my mind’s eye and ear, I can see and hear Sonny and Cher sing that hit song from 1967. Who could have imagined that Cher would still be pulling in huge audiences to her performances and that Sonny would go on to be a respected member of Congress and die fairly early in his life. Their song captured the feeling that no matter what happens, time keeps going on. One could take the song more literally and marvel at our heart that, without any conscious thought by any of us, just keeps beating, on and on and on.

February is American Heart Month, and it is a good reminder that, even though our heart continues to pump on its own without any direct guidance from us, we need to pay attention to our heart’s health. There is scientific proof that there are many things we can do that will help our heart beat longer and stronger.

The American Heart Association identifies seven key health factors and behaviors that increase risks for heart attacks and strokes. They call them “Life’s Simple 7” and can be used to measure and track progress toward improving cardiovascular health for all Americans. Life’s Simple 7 are: not-smoking, physical activity, healthy diet, body weight, and control of cholesterol, blood pressure, and blood sugar.

None of these Simple 7 should come as a surprise to any of us, each one of the seven will not only help our hearts but improve our health in other areas. What we do need to recognize is that the heart is at the center of all of our health; it delivers food and oxygen to all parts of our body, and it should be number one on our list of organs to take care of, but it is so reliable that we take it for granted. We might get a cold, so our lungs don’t work very well. We might get the stomach flu and not digest much food for a while. We could sprain our ankle or break something that requires us to do rehab and exercise to get back to normal. We might find ourselves getting winded going up one flight of stairs and realize that we need to get in better aerobic shape. But we often don’t get any prior warning of heart problems.

Case in point. During my annual physical two years ago, my EKG came back abnormal. I was scheduled for:

• A heart imaging test, which got my attention when they injected a radioactive substance that they took out of a lead container before putting it into my arm
• An echogram where they take pictures of your heart and the valves working (the technician took the time to show me the screen and pointed out the muscles working and the valves opening and closing)
• A stress test where I walked faster and faster on a steeper and steeper treadmill

I suspect many of you have gone though some or all of these tests. For me, I was given a clean bill of health with the cardiologist indicating that the EKG must have been in error because my heart was working just fine. The reason I tell you this was to relate how I felt from the time I got the bad EKG until I was told everything was all right.

For the first time in my life, I thought about the health of my heart, about what I had been doing as far as exercise, things I ate, my weight, etc. I thought about the descriptions of heart surgeries some of my friends have had. I thought about limitations that I might have if I had some sort of heart disease. It made me stop and think.

There are actions we can take. You can click here to find more details on the Simple 7 to help you understand more about where the risks are for heart disease. There is one risk that I want to highlight. High blood pressure.

High blood pressure is sometimes called the silent killer because it can really have a debilitating effect on your heart. It’s pretty easy to tell how important your blood pressure is. Whenever you go to the doctor, for whatever reason, the first thing they do is take your blood pressure. If your doctor thinks your blood pressure is too high, take notice! Get proactive. This link is to a page of questions you need to ask your doctor if she/he is worried about your blood pressure. I think we are often too passive about our own health. It’s our health, it’s not our doctor’s health or our wife’s or husband’s health – it’s our health. Your doctor’s answers to these questions will be specific to his/her understanding of your specific health condition. It’s the way you can get the personal guidance that fits you best. There are actions and medicines that can treat high blood pressure. The worst thing you can do is to do nothing.

I think the real purpose of American Heart Month is to get us to think about our heart before we have a bad EKG. They want us to do an honest evaluation of where we stand on the Simple 7. They want us to take action.

Sonny and Cher knew the beat would go on – it’s up to us to help that beat continue for a long, long time.

Best, Thair

As you may have heard, the Build Back Better Act (BBBA) is a non-starter. Senator Manchin from West Virginia just couldn’t find a way that he could support the bill and it has hung in limbo since his announcement of non-support in December. Since then, there has been much talk and conjecture and discussion, but it has become apparent that the BBBA, in its present form, is dead. A new approach surfaced last week, breaking up the proposed legislation into separate bills with the items that Senator Manchin supports and passing those pieces. The impetus behind this approach is to give President Biden something he can announce as an accomplishment during the March 1^st State of the Union address. There obviously will be some changes from the original BBBA but one thing that is almost certain to remain, unless there is some immediate action, is the drug price setting legislation that was in the original bill.

Over the last few years there has been pressure, from both political parties, to do something about drug prices. The common theme has been that the drug companies were the villains who went unfettered as they raised drug prices. The solution has always been for the government to insert itself into the equation and set prices at a “fair” level, with fair never being accurately defined. As we approach this important point where we are facing huge and non-reversable changes to Medicare Part D, I have some facts that should be considered.

The drug companies continue to voice their desire to be part of the solution. There are results based pricing and yearly caps that could be considered. There are a myriad of possible changes that the drug companies would like to discuss and consider. They want to be part of the solution.

Everyone needs to focus on the facts concerning drug prices. In 2021, the list price of drugs, the price that many of the patient’s out-of-pocket costs are based on, rose less than the Consumer Price Index (CPI). There are many parts of our healthcare system that rose more than the CPI, but not the list price of drugs.

The net price of drugs, the amount the drug manufacturer receives, dropped by 1.2% in 2021. That’s right, the net price dropped! This is the 4^th year that the net price has dropped. Let’s put this in perspective. If the drug manufacturer received $100 for their prescription drug in 2017, they received $97.50 in 2018, $95.60 in 2019, $93.70 in 2020 and $92.60 in 2021. If the drug companies were trying to raise prices so they would get paid more each year, they have failed miserably.

It seems to me that allowing our government to fix the price for drugs in an environment where the list price of drugs is increasing less than the CPI and the drug companies are getting almost 8% LESS than they were 4 years ago is a case of Washington trying to fix a problem that isn’t a problem anymore. We can’t let those who govern us do something that is not needed and will screw up and cripple the innovation that we depend on to improve our quality of life and even save our lives.

While it may be politically expedient to tout the taming of drug prices through price fixing it is the pinnacle of hubris to come up with a supposed solution that doesn’t really fix a problem. There are many things that can be done to save money, especially for the patient. Let’s attack the real problems that can be identified and fixed. Talking with all the stake holders is an important first step.

I ask all of you to contact your federal Representative and Senators and tell them you would like them to focus on the real problems that face our healthcare system. It’s important to make your feelings known. The time to Speak Out is now.

Best, Thair

We all seem to make goals at the start of the new year. It just seems to be the right time. All of these new year goals seem to deal with quitting, or at least reducing, the harmful things we do and starting, or increasing, the things that benefit our mental or physical self. I would speculate that the most common new year’s goal has to do with losing weight and I would also go out on a limb and say that it is the one goal that we fail at the quickest.

It’s no secret that Americans, compared to other countries, are overweight. American men rank as the 14^th most overweight in the world. The 13 countries where the men are more overweight than the U.S are all islands in the South Pacific. I’ve always conjectured that we are victims of our own hard work and prosperity. We strive to attain the American dream and when we are successful, we eat. We are always in a hurry, so we eat fast food. We reward ourselves with food. We do all those things that make us overweight, and we don’t even get to enjoy the paradise of a South Seas island. What’s the answer? . . . I’m so glad you asked.

This week is Healthy Weight Week. I’m sure it is strategically placed at the third week in January to help us as we struggle with our weight loss goals. I’m also pretty sure that you’ve tried to lose weight or get healthy before. I also think that we are facing an even bigger challenge than the usual holiday gain of 5 or 10 pounds. We’ve had 2 years of isolation due to the pandemic. One of the worst places we could go was to the gym. We couldn’t play many team sports. The swimming pools, one of the places that older Americans often frequented, was also off limits. Our 5 or 10 pounds may have turned into 10 or 20 pounds. If any of you fit this description, it’s time to take action.

The good news is that many insurance companies are recognizing the impact that being overweight has on your long-term health. Medicare itself is beginning to pay for weight loss programs and physician-guided programs. Medicare Advantage insurance plans (of which I’m a member) offers many programs, like SilverSneakers, that help you achieve and maintain a healthy weight. It just takes some research to find out about programs that fit you and are easily accessible.

Being a veteran, I try to stay updated on what is going on in the veteran community. I found a program that could be very helpful in attaining your healthy weight goals, even if you’re not a veteran. It’s called the Move! Weight Management Program. MOVE!’s core ideas—encouraging healthy eating behavior, increasing physical activity, and promoting even small weight losses—are easy to follow and based on the latest in nutrition science. This program takes you through a questionnaire and then offers information and programs based on your individual needs as reflected in the questionnaire. It even has an app that will guide you and help track your progress. It’s a really interesting program; it’s worth the time to look into the many aspects of Move! Go to this link to access the questionnaire. When you are done, you can print out the reports which give you access to information and programs that are tailored to the results of your questionnaire. You can also click here to get access to the Move! Coach app for your smart phone.

At the end of the day, it’s up to you. Change is tough, but the rewards are huge. Getting yourself to a healthy weight improves almost every aspect of your health. If not now, when? I’ve often felt that the healthcare system is so complicated and hard to navigate. It didn’t seem like I had any control over what the system was doing to me. Taking charge of getting to a healthy weight is something that you can control. It’s a change worth striving for.

Best, Thair

My eye doctor tells me to sit still and don’t blink and then “poof” a puff of air hits my eyeball. This has happened enough times that I’ve started kind of wincing in anticipation and sometimes the doctor has to repeat the test because, that’s right, I blinked. While it is just part of the many tests one goes through when you see your ophthalmologist, it is very important, especially for us older citizens.

A hint as to what this test does might come from the revelation that January is National Glaucoma Awareness Month. Obviously, this month of awareness revolves around the health of our eyes which sometimes get overlooked (pun intended). I’ve talked a lot in my blogs about how to stay healthy, whether it’s an awareness about a certain type of illness, or ways to eat healthy and to exercise, or actions we can take to prevent sickness, like getting vaccinated. While getting older often robs us of some of our physical and mental health we can do things to slow down this process and maintain our quality of life. When I sit back and think about my eyesight, I realize that losing my eyesight would have a huge impact on my quality of life. While my ability to see the golf ball has shrunk from 250 yards to 200 yards, I can still play and enjoy the game. It is also helpful that the distance I drive the golf ball has also shrunk. I do notice I must play closer attention when I’m driving the car at night. These small inconveniences would become huge if I had a big reduction in my ability to see.

Back to the eye test. I can’t remember how I found out, whether I asked the doctor or read about it, but the puff of air on the eye test is to measure the pressure inside your eyeball. This pressure, called intraocular pressure or IOP, has a direct correlation to the disease of glaucoma. The puff of air makes a very small indentation in your eyeball and by measuring the amount it indents and rebounds the test, called a Tonometry, can determine the pressure inside your eyeball. The higher the pressure the higher the risk of glaucoma. The higher eyeball pressure is caused by the lack of exit circulation of the liquids inside the eyeball. It’s like the drain is plugged so the pressure builds up. It is important to catch this increased pressure as soon as possible so that steps can be taken to stop the damage from progressing.

Glaucoma is one of the leading causes of blindness. There is no cure, but there are steps that can be taken to stop further loss of vision. Unfortunately, the onset of glaucoma can go unnoticed since it starts affecting the peripheral vision first. It is estimated that over 3 million Americans have glaucoma but only half of those know they have it. A fact that I found astounding is that blindness from glaucoma is 6 to 8 times more common in African Americans than Caucasians. This is a problem that needs to be addressed. The only way to detect glaucoma early is through testing. We need to ensure that our healthcare system reduces any access barriers that might exist so that everyone can easily get tested for glaucoma.

Another reg flag to be aware of is the propensity for glaucoma to run in your family. I’ve talked in an earlier blog about my early detection of a detached retina because both my brother and sister had experienced the problem and made me aware of the problem and symptoms. My mother had macular degeneration. Knowing what kind of problems run in our family gives us information on where we need to be vigilant. Glaucoma tends to be more prevalent in different families. If you have members of your family who have been diagnosed with glaucoma should be all the encouragement you need to get regular eye tests.

The Glaucoma Research Foundation identifies five tests that can be performed to detect glaucoma. You can click on the test names to find out more about each test. While it isn’t necessary to get all of the tests every time, they can all be used to refine a diagnosis. Regular glaucoma check-ups should include two routine eye tests: tonometry and ophthalmoscopy.

Examining…	Name of Test
The inner eye pressure	Tonometry
The shape and color of the optic nerve	Ophthalmoscopy (dilated eye exam)
The complete field of vision	Perimetry (visual field test)
The angle in the eye where the iris meets the cornea	Gonioscopy
Thickness of the cornea	Pachymetry

I realize that the COVID-19 pandemic may have made us hesitant to schedule preventive appointments with our healthcare providers. If you haven’t seen an ophthalmologist in the last year, I encourage you to schedule an appointment now. Before you go, find out if you have a history of glaucoma or other eye problems in your family and then talk to your doctor about it. The puff of air on your eye is nothing to blink at; it’s a great step toward keeping your eyes healthy.

Best, Thair

I look back on this whole pandemic and I see a succession of personal decision points that were based on information and guidance from many sources . . . sources that were evaluated and given weight dictated by our own individual experience, institutional trust, religious beliefs, and even political views. We faced questions at every step.

Initial discovery of COVID-19 – Did we need to wear a mask, social distance, wash our hands, clean the containers that were delivered to our door, was this whole thing a worldwide conspiracy?

Vaccine approval – Was the approval rushed, were there life-threatening side effects, was the government injecting us with small computer chips?

Post Vaccination – Was it OK to venture out, take plane flights, did we still need to wear masks, how should we treat those who weren’t vaccinated?

At each of these steps we each made our own personal decisions. For older Americans, those 65 and older, our decisions, more than any other age group, were often decisions of life and death. More seniors per capita died from COVID-19 initially but we have become the age group that has the highest percentage of fully vaccinated individuals. 88% of seniors are fully vaccinated and the death rate for us has plummeted. At each of these decision points I tried to offer my evaluation of the information and encouraged you to initially hunker down, then to get vaccinated, and the results indicate it was good advice.

As a side note, I was surprised that some of my friends and relatives, as well as business and religious acquaintances, evaluated the COVID-19 guidance and information much differently than I did and their actions, or lack of actions, reflected those differences. I had no idea that there could ever be this big of a difference in our reactions. It brought home to me that this country has multiple ideologies and multiple levels of trust in our government and institutions.  We need to first recognize that our country, and even our friends, have a broad spectrum of ideologies and trust. We need to talk about these differences and more importantly listen to each other. We should strive to find common ground from which we can work to build a better government and better institutions that deserve our restored trust. Now, back to the pandemic.

Just when we felt like there was light at the end of the tunnel, we get the Omicron variant, and now we’re faced with another step that needs to be evaluated. This variant, while highly infectious, seems to be much less lethal for those who were fully vaccinated. Dr. Rahul Sharma, emergency physician in chief for New York-Presbyterian/Weill Cornell hospital said, “We are seeing an increase in the number of hospitalizations, but the severity of the disease looks different from previous waves. We’re not sending as many patients to the I.C.U., we’re not intubating as many patients, and actually, most of our patients that are coming to the emergency department that do test positive are actually being discharged.” The New York Times pointed out that doctors in high Omicron infected states like Florida, Texas and New York have said that, while Omicron is less severe, the lower proportion of severe cases is also happening because, compared with previous variants, Omicron is infecting more people who have some prior immunity, whether through prior infection or vaccination. The vast majority of Omicron patients in I.C.U.s are unvaccinated or have severely compromised immune systems.

So, where do booster shots fit into this new threat. As I pointed out, almost 90% of us are fully vaccinated and 60% of us are fully vaccinated AND have had a booster. So, what does this mean. For the 90% of us who are fully vaccinated, our protection against catching the Omicron variant of COVID-19 has dropped over the last 6 months to around 35%, and it’s important to note that being fully vaccinated has shown to still help limit the chance of hospitalization and death. For the 60% who are fully vaccinated and boosted, the protection against catching Omicron goes back up to almost 80% while also further reducing the chance for having a severe Omicron experience. Those are pretty impressive numbers.

With your permission, allow me to describe my personal experience with COVID-19.

I realize that when people write that phrase, they really haven’t asked anyone’s permission and thus they’re taking a big chance that the readers won’t want to read about a personal experience, and they’ll quit reading. My hope is that by staying with me just a little longer, you’ll be rewarded with one positive anecdotal case to refer to and possibly find some similarity in my experience to yours or to someone you know.

I got the first Pfizer shot in January 2021 and the second a month later in February. I got the booster shot, along with my flu shot, in October 2021. I hunkered down in the beginning months of the pandemic but slowly ventured out after being vaccinated. I don’t have any health issues that would increase my risk from COVID-19. I even took some plane trips for business reasons but remained cautious. When the Omicron variant hit, I decided to limit excursions, no sit-down restaurants, no large gatherings, no Sunday church. Late last Tuesday I began to feel like I had a cold, had a low-grade fever and some chills early Wednesday morning. I went to get tested and tested positive for COVID-19 using the ra[id test. My COVID-19 illness consisted of two days of cold- like systems and some fatigue, the third day was much better, allowing me to get back to doing projects with only a small cough. Within five days I had no symptoms. I don’t know where I caught the virus but here is what I do know. Whatever steps I took early on allowed me to not catch the virus before I was vaccinated and boosted. When I finally caught the virus, I experienced what can only be described as a light cold. I now feel like I have the protection of the vaccine, the booster shot, the flu shot, and the antibodies generated by the virus itself. I feel like I experienced exactly what the science projected I would experience. My experience last week seemed to prove, at least to me, that my advice during the pandemic was accurate.

Given my self-proclaimed history of successful advice, I feel safe in saying that the clear answer to the question asked in the heading to my blog is – the booster, in the parlance of the day, is WAY GOOD. It goes a long way towards keeping people out of the hospital and saves lives. My advice to the 10% of older Americans who haven’t got vaccinated – go get it done. My advice to the 30% who haven’t got the booster – go get it done. Encourage your loved ones to get boosted. The vaccination and follow-on booster represent a one, two punch that keeps you and me out of the hospital and keeps us alive.

Best, Thair

As is often the case this time of year, we spent the last few weeks looking back on 2021, a year like no other. Many of our dreams of a return to normalcy were stymied and December was especially worrisome with the Omicron variant infecting us with a flood of new COVID-19 cases. I want to do an about-face and look forward to 2022. A wise farmer once said that you can’t plow a straight line when you are looking back over your shoulder. So, let’s forget about 2021, and 2020 for that matter, and look forward to 2022.

Our focus at Seniors Speak Out has always been alerting older Americans to the impact Washington’s proposed changes will have on our healthcare. The Build Back Better bill has the potential to have a huge impact, both good and bad, on our country’s healthcare in 2022 and our immediate focus needs to be on this huge piece of legislation. But first, let me talk about a law that has already been signed and took effect on the first day of this new year.

This new law focused on something you might have heard of – surprise billing. Surprise billing describes some ancillary portions of our healthcare costs that have caused many patients to be billed for costly out-of-network costs that they often had no knowledge of or control over. Insurance companies keep healthcare costs down by building a network of providers that contract to supply services at a set price. These providers are categorized as being “in-network.” If a patient chooses to go to an “out-of-network” provider, they are often charged much more. Surprise billing came about when patients weren’t properly notified when they were going out-of-network or informed of the out-of-pocket costs that could result. Some examples of these situations are emergency care at a hospital ER or urgent care center; elective care at an in-network hospital but where attending doctors, often anesthesiologists, pathologists, radiologists and assistant surgeons, are out-of-network; and air ambulances. Many patients have been “surprised” when these substantial charges appeared on their bills.

The new federal law bans many types of out-of-network medical bills, switching the responsibility to the providers and insurance companies to resolve their payment disputes. This new law is designed to limit the number of unexpected charges from providers that are not in the patient’s insurance network. As is often the case when the government steps in to regulate healthcare the results are not always positive, and the devil is always in the details. The new law stipulates that if the providers and insurance companies can’t resolve their differences then they must go to an arbitrator who will use the median in-network rate as a guide for the final cost. Many providers, including the American Hospital Association and American Medical Association, are suing the government, saying in-network rates shouldn’t be the guiding factor for the arbiter. We will keep you apprised on the success of the implementation of this new law.

Now, what is going on with the administration’s Build Back Better bill. As you probably already know, Senator Manchin (D-WV) decided he could not vote for the bill in its present form and, with the razor slim majority in the Senate, losing one Democratic vote would doom the bill’s passage. The bill is huge, costing anywhere from $1.7 to over $3 trillion, depending on how you price it, and it impacts many aspects of our life. From a healthcare perspective it has the potential to change some basics parts of our care. It would give the government the power to set prices on an ever-increasing number of prescription medications. While drug prices are a concern to all of us, this is not the right solution. Government inserting itself into the middle of a complicated and often convoluted supply chain pricing mechanism has the potential to produce a cornucopia of unattended consequences, with the most concerning one being the reduction in the research required to discover new cures. A positive part of this bill is the introduction of a yearly cap on out-of-pocket drug costs. This simple and easily implemented change is a long overdue enhancement that will reduce the anxiety we’ve all had with the threat of bankruptcy due to an illness that requires very costly medication.

The ever-increasing cost of drugs is a problem that must be dealt with. Drug manufacturers have continually voiced their desire to be part of the solution. Our government should take them at their word and sit down and work in good faith toward an answer. There’s the potential for huge savings in simplifying the supply chain pricing mechanism. The utilization of value-based contracts offers the chance to move from arbitrary pricing to a fact based, results-oriented system. Inserting government price fixing into a flawed pricing system will only cause more chaos with minimal positive impacts on the patient.

As you can tell, 2022 will start with some important decisions to be made. The new surprise billing law has the potential to impact our out-of-pocket costs. The Build Back Better bill has the potential to have both positive and negative impacts on our lives. Coupled with our continuing battle with the COVID-19 pandemic and the recent emergence of the Omicron variant we have our work cut out for us in staying current on changes to our healthcare and how to stay healthy. Seniors Speak Out will continue to keep you updated on what’s going on and give you the chance to speak out on how you feel about each proposed change to your healthcare. Looking forward to see where the rocks and gullies in our field are is the only way we can plow a straight line.

Best, Thair

2021 is coming to an end and I thought it was a good time to look back at some things we would like to forget and some things that we should remember.

We would like to forget how mired we were in the depth of the pandemic at the start of the year. We were tired of staying home, of missing our children and grandchildren, of not going to church. We also had a shining bright light that broke through the COVID-19 fog, the approval of powerful vaccines. We were encouraged as we began to get vaccine approvals, first for the older population and those at risk and then to more and more of us until a large majority of us were eligible to get vaccinated. We had hopes of 70% of us getting at least one shot by July 4^th.  Our uptake of the life saving vaccines was a disappointment we would like to forget. It took us almost six months longer to finally achieve that goal with 73% of us now having received at least one shot but only 61% who are fully vaccinated. How many more lives could have been saved if we could somehow overcome our fears and doubts, followed the science and got vaccinated?

One thing I don’t want to forget is that feeling of freedom I received after I got my second Pfizer shot, knowing that in a short time I would feel comfortable to begin leaving the house. I could go shopping and later sit down in a restaurant and even return to church. I still needed to be cautious, but I saw the light at the end of the tunnel. I bet each one of us can remember when we began our trip back to the outside world.

Then, something we would like to forget, the discovery of the Delta mutation. While it didn’t return us back to the darkest of days, it did cause the number of infections to soar, especially among those who hadn’t been vaccinated. Then another bright light of discovery, a booster that again greatly reduced our chances of going to the hospital and even dying.

Now we are facing another mutation, the Omicron variant, a highly contagious version of COVID-19 but maybe not as likely to send us to the hospital or kill us. The data is slim, and we’ll have wait for the facts to come out, but once again we are faced with decisions. What risks should I take, do I need to wear a mask, social distance, stay away from inside crowds, etc. It seems like we are in cycle of ups and downs, things we would like to forget and bright spots that we would like to remember.

From my point of view, how we react to the pandemic is a very personal thing. I still have friends who refuse to get vaccinated. I know of people who don’t think wearing a mask helps prevent the spread of COVID-19. I have other friends who are washing their hands continually, wearing a mask everywhere and venture out very infrequently. What’s the right answer? My guiding light during this pandemic is the science, coupled with my knowledge of my own health and the health of those who I might come in contact with. The risks that I am comfortable with taking certainly may be different than other people’s comfort level. My approach is to identify what I feel are reliable sources of information and follow the suggestions of those sources. This pandemic is not going away anytime soon. My opinion is that the pandemic will slowly become endemic which means we will still have the virus around but either enough of us will have been vaccinated or have had the disease that it spreads slower or a mutation will have a greatly increased infection rate but will only result in flu-like symptoms without high level of hospitalizations or deaths. Maybe the Omicron variant will begin this transition. What I do know is that the booster shot has shown great promise in protecting us from the more severe symptoms of the Omicron variant. We should know in a few weeks where we stand with this new challenge.

The one thing that I think we need to remember is that somehow, someway, we need to remember the things we learned from this pandemic and figure out ways to be better prepared for the next virus that invades our world. We at Seniors Speak Out will strive to keep you informed about what Washington is doing and ways that we can impact the policies that affect our health and our wellbeing. My hope is that 2022 will be a year that we have less to forget and more to remember.

Happy holidays and happy new year!!! I’ll take a week off and talk to you again in 2022.

Best, Thair

While December 7^th will always be “a day which will live in infamy,” it was also the last day for making a change for next year’s Medicare coverage. While we may not miss the endless commercials/emails/letters that bombarded us, we hopefully did take the opportunity to review our plans and compare them to the other plans that were available in our areas. The sad news is that historically only 30% of us take the time to make this comparison. What is keeping 70% of us from taking the time to conduct this comparison? To me it just doesn’t make sense that many of us are so frugal and financially responsible in other parts of our lives but choose to ignore this chance to possibly save thousands of dollars and avail us of the opportunity to be healthier and happier. Does it seem too complicated? Is making changes in our lives disconcerting? All of this could be true, but those excuses shouldn’t get in the way of us taking the time for this important review and they really shouldn’t get in the way of us taking a broader look at our overall health. It’s a good time to decide to really take charge of our own health.

I reviewed my Medicare Advantage plan and decided to remain with my current provider. This is not unusual – only 8 to 10% of those registered in Medicare Advantage plans change. I guess this indicates a pretty high level of satisfaction. I did identify some areas of my plan that had changed, and I made notes on those areas for next year’s review. Part of my review focused on my plan’s hearing coverage.

Contrary to my assertion that everyone in the world has started to mumble, it has been medically proven that my ability to hear has declined. Given that fact I was interested in my plan’s hearing benefits. I was also interested in the proposed addition of some level of hearing coverage in the Build Back Better legislation that is being actively discussed. In digging deeper into that proposed legislation I found that if this section of the legislation passes as written, that benefit would not start until 2023. Since my hearing is not going to improve and I don’t want to miss anymore of the conversations that go on around me, in January I’m going to take advantage of the almost $1,000 hearing aid benefit that is part of my current Medicare Advantage plan. I bore you with this personal story to emphasize that knowing the benefits of your own Medicare plan and understanding the impact of proposed legislation on your healthcare can help you make informed decisions.

So, the window of open enrollment has closed, what now? I propose that we make a new year’s resolution. Starting in January 2022 I propose that we take inventory of our own health. What tests or preventive healthcare have I postponed because of COVID or other reasons? What vaccinations have I postponed? When was my last colonoscopy? When was the last breast exam of a loved one? A Medicare wellness exam is a good first step. I think another good 2022 resolution is to gather all of your health records into one, easily accessible place. I had a little scare earlier this year and had a series of heart related tests including a stress test. The tests gave me the good news that everything was just fine. I’m now going to work hard to get all of the results of those tests so that I have a baseline to compare future tests to as I get older. You have a right to have a copy of all of your test results and they can prove invaluable in the future.

Each of us made important decisions on how we would deal with the ongoing COVID pandemic. We need to broaden our perspective and take command of our total health – physical and mental. We here at Seniors Speak Out will keep you up to date on what healthcare changes Washington is proposing so you can include that in your decision of what’s best for you. 2022 will be a great year for each of us to take command of our health.

Best, Thair  

I know, we just started to feel like we could see a future that didn’t contain face masks and social distancing and then a new COVID variant raised its ugly head and now our focus is on how to control Omicron. It seems like worrying about getting a flu shot will fade into the background while we deal with this new problem. Well, I’m here to convince you that getting your flu shot should be really high on your immediate priority list.

The focus of my blogs at Seniors Speak Out has always been to advocate for improving the health of older Americans. I realize that if you followed every guide and suggestion for those 65 and older, you would be busy every waking hour and still not get everything done. What we need to be doing is evaluating each bit of guidance as it applies to our own health and situation and deciding which ones get priority. My job right now is to convince you to put getting your flu shot very high on that list.

Now, at the risk of dictating priorities, I will say that getting your COVID vaccination and booster shot should be at the top of the list. Getting the shot has proven worldwide to save lives, especially among older adults. If you haven’t already, go get your COVID shot now. It is also a fact that the flu shot has proven over decades to save lives. It is hard to gather accurate statistics on how many people get the flu, but the CDC’s broad range estimates are that between 2010 and 2020 the flu has annually resulted in 9 million – 41 million illnesses, 140,000 – 710,000 hospitalizations and 12,000 – 52,000 deaths. Yet, with all these facts, less than 50% of the adults in America get their flu shot. The fact is, many of the people these statistics represent are over 65. It seems that just like COVID, older people bear the brunt of this disease, and this has been happening for decades.

COVID has been taking our time and focus and it is a serious disease, but it shouldn’t stop us from doing the other things we need to do to keep us healthy. While this new variant is a concern right now there isn’t anything we can do besides getting vaccinated and taking prudent precautions. There is something we can do right now to help us avoid the dangers of catching the flu. . . get vaccinated.

One thing that might make you hesitate in getting your flu shot are all the rules concerning the COVID pandemic and the COVID vaccines and boosters. Here are some answers to questions that you might have concerning flu vaccinations and COVID.

Does getting a flu shot increase my chances of catching COVID?

No. There is no evidence that getting a flu vaccination raises your risk of getting sick from COVID-19 or any other coronavirus.

If I wear a mask and social distance do I still need the flu vaccine?

Yes. Wearing a mask and physical distancing can help protect you and others from respiratory viruses, like flu and the virus that causes COVID-19. However, the best way to reduce your risk of flu illness and its potentially serious complications is for everyone 6 months and older to get a flu vaccine each year

Can I get the COVID vaccine and a flu vaccine at the same time?

Yes, you can get a COVID-19 vaccine and a flu vaccine at the same time. This includes the COVID booster shot. Two months ago, I got my COVID booster shot in one arm and my flu shot in the other. It was quick and I had no side effects.

If I think I have COVID-19 should I get my flu shot?

No. Flu vaccination should be deferred for people with suspected or confirmed COVID-19, whether or not they have symptoms, until they have met the criteria to discontinue their isolation. Flu shots for these people should be postponed to avoid exposing healthcare personnel and other patients to the virus that causes COVID-19.

If you have any questions concerning the flu vaccination, don’t hesitate to contact your healthcare professional. Do whatever it takes to get yourself comfortable with getting your flu shot. While the data has been difficult to obtain due to COVID, the CDC estimates that last year the number of people who got the flu was the lowest on record, probably due to the wearing of masks and the reduction of human contact. They are quick to point out that they expect this year to be above average due to resumption of human interaction and the expected reluctance to get the flu vaccination. While many of us have been confused with how to combat COVID and its variants, there should be no confusion about getting your flu shot. If we were to reach CDC’s goal of 70% of people vaccinated, we would have a chance to have an even lower number get the flu this year.

Get vaccinated against COVID and get your flu shot, positive steps we can take now to stay healthy.

Best, Thair

There is one month left in the year and the President and Congress have a huge “to do” list of legislation and not much time to do it. Just in case you’re interested, here’s what’s on the “to do” list.

First up, the annual Defense bill. This bill is usually a bipartisan bill and was passed by the House but has languished in the Senate. It’s become partisan in nature but must be passed this year.

The current stop gap measure for funding the government runs out on December 3^rd. The only way to move forward on any other legislation is to pass the 2022 budget bill, which will never happen before the 3rd, so they will have to pass another stop gap continuing resolution. This again will probably turn into a finger pointing partisan exercise.

Raising the nation’s debt ceiling most likely must be done by December 15^th or America defaults on its debts. Surprise . . . this is another partisan exercise that will no doubt run right up against the deadline.

Finally, the President’s 2.2 trillion-dollar social spending bill is waiting everyone’s return from the Thanksgiving break. It can’t be done until the tasks detailed above are finished, yet the President and the Democrats are pulling out all the stops to get it done this year.

The real question is, how does this impact you? The legislation that will directly affect you is the social spending bill or reconciliation bill, its formal name is the Build Back Better Act (BBB). It is the center piece of President Biden’s social transformation agenda and, according to House Speaker Pelosi it, “will be the pillar of health and financial security in America.” The Congressional Budget Office (CBO) estimates that it will cost $2.2 trillion and deals with many aspects of our lives. My focus here will be the bill’s impact on your and my healthcare.

While none of this is carved in stone the bill that narrowly passed the House a little over a week ago changed some of the basic ways our healthcare is administered and paid for. That bill contained the following changes to our healthcare:

• Medicare expansion – Originally the Democrats wanted Medicare to begin covering eye, dental and hearing care. The final bill that passed the House only will cover hearing care.
• The increasing cost of insulin – These insulin cost increases have been the focus of Congress for over a year. This bill further limits the monthly cost of insulin services to $35.00.
• Prescription cost cap – Finally Washington has recognized the need to cap the yearly out-of-pocket prescription drug costs. The yearly cost would be capped at $2,000 with a mechanism to smooth the payment of those costs over the year. I have advocated for these changes for years.
• Allow the government to negotiate prescription drug costs – I’ve talked about this approach often in earlier blogs, pointing out that using the term negotiating is misleading. Normally when you enter into negotiations both sides have some leverage in the discussion with either side having the option to walk away. In these “negotiations” the government sets the price and if the drug manufacturer doesn’t agree, they are taxed at a rate of 65% of last year’s GROSS sales growing to 95% in 9 months. This huge tax makes it impossible for the drug manufacturers to say no. So, the fact remains that the government will not negotiate the price, they will set the price of selected drugs in Medicare Part B and Part D. You have no doubt heard a lot from both sides of this issue. My simple evaluation is that I very, very rarely find it advantageous for the government to get MORE involved in any aspect of our life, especially healthcare.

The Build Back Better Act will surely be changed in the Senate. The discussion on the other legislation that must be passed may turn even more partisan and bitter. This could have an impact on what changes in the BBB or if it even passes. The Democrats cannot afford to lose one Senate Democrat’s vote. Democrat Senators Manchin and Sinema have already voiced concerns with different parts of the bill. Pelosi’s vow that the bill will pass by Christmas seems very optimistic. We’ll keep you updated on the status of this legislation.

If you also think it’s wrong for the government to get more involved in our healthcare, call, email or write to your Senators. Even if your Senators have indicated they are against this part of the bill, get in touch with them and tell them you appreciate their stance.

Best, Thair

Last Wednesday we held an informational virtual town hall on the topic of Medicare open enrollment for Medicare insurance plans. We invited two experts to join me to discuss the dos and don’ts of this important enrollment period and to discuss how seniors feel about open enrollment and the different benefits that could be available in this year’s plans.

I started off by recognizing the amount of advertising and information that we get this time of year and reminded all of us that healthcare is complicated, but we shouldn’t let this deter us from doing the research needed to get us the best insurance plan that fits our individual needs.

The first panelist was Amy Gotwals who has 22 years of experience serving older Americans with 16 years spent at US Aging. She is Chief, Public Policy and External Affairs. She discussed some of the dos and don’t of finding the right insurance plan.

The second panelist was Dr. Justin Barclay who is a veteran of analytics and program evaluation and is Tivity Health’s Vice President of Analytics, Consumer Research, and Data Strategy. Dr. Barclay reviewed a Tivity Health survey that measured seniors’ attitudes about open enrollment and the benefits offered.

Amy began by pointing out the things that we can do during open enrollment which started on October 15^th and ends on December 7th.

CAN DO

• You can add, drop or change your Medicare Advantage and Part D coverage
• You can switch from Original Medicare to a Medicare Advantage (MA) plan, or switch to Original from MA
• Depending on your state, you may be able to buy a Medigap plan during this period

She then detailed the things that we should do.

SHOULD DO

• Consider your current needs (what’s changed since last year in your life and health?)
• Investigate your new options
• Even if you’re satisfied with your coverage, check to see if there is another plan offered in your area that offers health or drug coverage at a better price

A recent Kaiser Family Foundation report found that, for 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans—more than double the number available in 2017. Shopping may be worth it!

• When evaluating plans/options, consider:
  • Access to providers and pharmacies you want to use
  • Access to benefits and services you need
  • Total costs for insurance premiums, deductibles and cost-sharing amounts
• Check your eligibility for Medicare Savings Programs, which can help you with premiums and other costs.

Enrollment assistance is available in your community and 24 hours a day, 7 days a week at 1-800-MEDICARE to connect you to coverage that best fits your needs and budget.

She then gave us some ideas on where we can find the information we need to make this important decision.

FIND INFORMATION

• If you have Original Medicare, go to www.medicare.gov or read the 2022 Medicare & You handbook.
  • Sent to everyone enrolled in Medicare
  • Includes information about Medicare-covered services
  • Lists Medicare Advantage Plans and Part D plans in your area
  • If you did not receive a Medicare & You handbook, you can call 1-800-MEDICARE to request that your region’s copy be sent to you.
• If you have an MA plan or standalone Part D plan, look to your Annual Notice of Change and Evidence of Coverage documents, which list any changes for your plan in 2022. Pay special attention to the plan’s costs, benefits and coverage rules and the formulary (list of covered drugs).
• You can also contact a plan directly with questions; get everything in writing.
• Before joining a new plan, call your doctors to make certain they are in the provider network!

Amy then detailed some places we can get help with the decision process.

GET HELP

• www.medicare.gov or 1-800-MEDICARE
• For one-on-one help, find your local State Health Insurance Assistance Program (SHIP); SHIPs are federally funded to provide trusted, unbiased Medicare counseling. www.shiphelp.org or 877-839-2675 to find your local SHIP
• You can find SHIP contact info and other local aging resources via the Eldercare Locator, eldercare.acl.gov or 800-677-1116 (also federally funded, administered by USAging)

She then pointed out some things we should avoid/watch out for.

AVOID/WATCH OUT FOR

• During Open Enrollment, there is a higher risk of fraudulent activity.
• Medicare has rules for how plans can and cannot communicate with you (for example, a plan cannot call or email you if you did not ask them to do so or if you have no prior relationship with them).
• Beware of any pressure to join a particular plan, or scammers saying they are with Medicare, threaten to take your benefits, etc. 
• If you feel you may be experiencing fraud, abuse or errors, contact your Senior Medicare Patrol (SMP).
• SMP representatives can teach you how to spot and protect yourself from potential Medicare fraud.
• www.smpresource.org, 877-8082468 to contact your local SMP

Amy recognized that it is no small task to arrive at the right decision, but it is important to our health and can save us money. She wished us good luck and good health.

Dr. Barclay works at Tivity Health which offers health programs, like Silver Sneakers, for seniors. He discussed a Tivity Health survey that measured the attitudes of seniors toward open enrollment and the benefits offered by many Medicare Advantage plans. This survey only applies to Medicare Advantage plans.

He started out by pointing out that a majority of seniors (72%) do not plan on attending a Medicare Open Enrollment event this year. COVID-19 might have had some impact on these numbers, but it is still amazing that almost 3 out of 4 seniors aren’t going to take advantage of these great sources of information.

When asked how they would enroll, 37% of seniors had not made up their mind. I think it is important to note that 5% were going to enroll in person, 14% by phone, but 26% were going to register online. I think people continually underestimate the number and speed that older Americans are embracing technology.

Dr. Barclay then showed the results of how seniors rated the different benefits and decision criteria of plan selection.

The five main decision criteria, they are 20% higher than the rest, give a good indication of where are focus should be as we select our insurance plan. These are:

• Prescription drug coverage
• Premiums
• Benefit design (i.e., co-pays/deductibles)
• Network of health care providers
• My medical condition or preferences

The survey also revealed that 65% of seniors are unlikely to switch their insurance plan. I hope that this is due to their satisfaction with the plan and not the fact that they just don’t want to take the time to find a better plan.

For those that did decide to switch plans, 53% said the reason was lower co-pays and deductibles.

The survey then asked which benefits were included in their Medicare Advantage plan.

I was amazed at the different benefits that were available. While all of these benefits probably aren’t available on any one plan, it was amazing at the wide range of benefits, some of them not directly healthcare related. Dr. Barclay identified non-medical transportation services as one of these non-healthcare benefits.

The next question dealt with which benefits would they use the most if it was available in their insurance plan.

While eye and dental insurance were at the top of the list, hearing aid coverage was 7^th. It is interesting to note that the addition of dental, eye and hearing aid benefits have been discussed in the pending Build Back Better legislation but the version that was just passed by the House and sent to the Senate only included the addition of hearing coverage.

Dr Barclay then showed breakouts of the above questions by demographics. They used:

• Gender
• Income
• Ethnicity
• Community
• Region
• Gym goer or non-gym goer

You can find these slides here

We then had some time for questions. The first question asked was:

Question – I recently helped a family member who had an MA plan in one state move to a new state. Are there issues or concerns that are important to pay attention to when someone moves from one state to another?

Amy said that there are usually differences between states and that the SHIP people in the new state would be a great resource to understand those differences. I mentioned that I had moved to a different state a few years ago and found that there was a Medicare Advantage program in the new state that fit my requirements.

Question – Is Medicare.gov still the best plan comparison tool in your opinion?

Amy said that the tool is a very important tool in the decision process and works well for most people. I said that at first it wasn’t very good but over the years they have worked hard to improve it and it’s now pretty efficient.

Question – Mail order delivery still seems to vex some seniors. They like the idea of the monthly pharmacy visit. Is there is a way to assist seniors to consider a 90-day supply via the mail?

Amy pointed out that while mail order delivery is very convenient, some seniors enjoy the interaction with the pharmacist. I pointed out that seniors have a great deal of respect for their pharmacist, and they see their pharmacist much more often than their doctor. I have advocated for years that pharmacists should be paid for this important service of giving advice and help to seniors.

The town hall gave out some very important information and I hope it gave you all some help as you make important healthcare decisions during this open enrollment period.

Best, Thair

While I appreciated Joe Namath’s skills as a great football quarterback, I’m not sure if he’s the best source of accurate information concerning the many Medicare choices available during this year’s Medicare open enrollment period. I’m also not a big fan of the deluge of mail I’ve received lately promising me a plethora of benefits at a low price. It’s difficult to separate the accurate information from the hype. I’m not going to beat around the bush here, if you have questions concerning the choices you have concerning Medicare, I think you will find it worth your while to click the Registration Link and register for our virtual town hall. It will be held this Wednesday, November 17^th at 2:00 PM ET. We hope to answer common questions and allow you to ask questions about Medicare and the options you have during open enrollment.

As you all probably already know, during our working years (which for some continues after we turned 65) we all paid into Medicare. When we turned 65 we all became eligible to register for basic Medicare and to start getting the benefit of the money we paid over the years. Most of us who use basic Medicare (known as fee for service), about 81%, have some sort of supplemental insurance, and over 40% have Medicare Advantage, which means this open enrollment period should be pretty important to most of us. It’s a chance to review both the changes in our current insurance plan and the changes in our health. I’m not going to get into a huge detailed discussion here about the details on how this review should be done, but I will talk about why it is important for each of us to do it.

There are a number of things that you should consider during open enrollment. There are new treatments that have been discovered that might benefit us, we should find out if our insurance plan covers those treatments. The opposite may also be true, important drugs or treatments that we currently use may be removed from your plan next year. Your plan’s deductibles, co-pays and co-insurance may change next year. Changes in your health may certainly impact the availability and cost of your healthcare for these new health conditions. New insurance plans may come available in your area or existing plans may cease to be available. Medicare Advantage plans particularly may become available as a choice in your area. All of these situations may affect both the cost and the availability of treatments for you next year. I hope you’ve started to consider some of these possibilities and maybe generated some questions. Our town hall is an excellent place to possibly answer some of those questions.

One important thing you should think about is the fact that medicine is becoming more and more personalized. The one size fits all approach to healthcare is not a valid healthcare approach. It’s certainly becoming more complicated and it is up to each of us to understand both the financial and health implications of the choices available.

All of the talk about the changes to Medicare that may come about shouldn’t delay our review. These changes are still being discussed and many of the proposed changes won’t be implemented for a few years. All the rhetoric should not fool you into putting off your review. The open enrollment period ends on December 7^th.

We have some excellent panel members for this Wednesday’s virtual town hall. I think it will be worth your time to dial in, the information will be straightforward and accurate and it will give you the chance to ask questions. Just click the Registration Link and get registered for this informative discussion.

Best, Thair

November 11^th is Veterans Day, a day that means different things to different people. For many it is a day to remember loved ones who served, for some it is a time to remember those we served with. I’m a veteran; I served as a B-52 bombardier and did a tour in the Vietnam theater in 1974-75. While I didn’t lose any friends during my tour, I lost friends in two different air training crashes that happened just 6 months apart. You grow close to fellow crew members and their families and it’s a deeply felt loss when they are taken from you. Each veteran who faces battle is changed in some way and often in ways that only those who have had similar experiences can understand. While I felt a loss in losing my friends, I’m convinced that it was different than the loss that was felt by a young Marine I knew and talked with 5 years ago.

This young man fought in the middle east and was part of some of the fiercest fighting in that theater. He lost good friends who were fighting with him. He was wounded and witnessed horrible things. He was honorably discharged because of his injuries, and he suffered severe post-traumatic stress disorder (PTSD) that manifested itself in depression and suicidal thoughts. He lost still more fellow Marines who committed suicide, and he struggled with thoughts of following in their footsteps. It is these veterans who deserve our respect, and even more they deserve healthcare for the physical and mental problems they face.

War exacts a mighty price from those who do battle. While we have identified some of the more common war-related maladies, like PTSD and substance use disorders (SUDs), the impact of war on each warrior can be different and complicated. The age, race and social integration of those who fought in the Vietnam and Persian Gulf were different than those who fought in the more recent Iraq and Afghanistan wars. The fact remains that these returning veterans come back with mental and health problems and they need the healthcare their country promised them.

For instance, one in three veterans are diagnosed with at least one mental health disorder. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Almost 50,000 veterans are homeless. These veterans need healthcare that recognizes their unique situation and needs.

For the 25 years that I’ve been involved with advocating for older Americans I’ve had the opportunity to talk with many veterans. Many of them see civilian doctors and they often say things like, “my doctor doesn’t understand me,” or “they send me to therapists or psychologists who don’t even know I’m a veteran.” I’ve moved quite a few times over my life and not once, has a doctor ever asked me if I was in the military. Recently I went to an audiologist, and she never asked me if I was a veteran. I know that your exposure to sound during your military service often has a big impact on your hearing. When I was in the Air Force, I was assigned to headquarters Strategic Air Command. My yearly physical included a hearing test. After the test the doctor, who had no knowledge of my prior assignment, said he could tell that I flew in B-52s because of the unique range of the minor hearing loss I suffered. He said that he often could tell which type of fighter aircraft a pilot had flown in. When I told my civilian audiologist this story, she said this level of specificity didn’t seem possible and never asked any follow-up questions concerning my military service and how that service might affect my hearing.

We need to do more to treat our veterans and the first step should be for doctors to recognize that to effectively treat a veteran they need to know that he/she is a veteran and also to understand how to best diagnose and treat veterans.

One side note, another theme I’ve heard is that this lack of understanding is far worse for female veterans. The number of women who serve in the military and the number who face combat has increased dramatically, yet the knowledge of how to treat their unique situation has remained stagnant. Our female veterans deserve healthcare that will effectively treat their particular physical and mental maladies.

So, what can we do? More and more veterans are treated by civilian doctors, especially since the new laws that have been passed. Given that fact, if you’re a veteran, tell every doctor you see about your military service. Don’t assume your family doctor will tell the specialist they refer you to that you’re a veteran . . . you tell them. If you’re caring for a veteran, make sure their doctors know. Also, don’t hesitate to talk with someone at the VA about your veteran benefits. There might be opportunities for expanded healthcare benefits of which you are not aware. Our country promised to take care of our veterans, and we need to speak out and tell those who govern us that we need to improve the healthcare for veterans.

It seems that every veteran who is recognized for their service and is called a hero quickly identifies their wounded and lost fellow warriors as the true heroes. Veterans are sometimes hesitant to call attention to themselves or even discuss the physical or mental battles they are fighting. We need to strive to help them – it’s one way we can truly thank them for their service.

Best, Thair  

November is National Alzheimer’s Disease Month, a time when we shift our focus to Alzheimer’s and other dementias, diseases that are one of the most debilitating and life changing diseases in America. Some facts. . . in America:

• Over 6 million people live with Alzheimer’s
• By 2050 this number is projected to more than double
• In 2021 the disease will cost $355 billion
• More than 11 million individuals provide unpaid care for people with Alzheimer’s
• In 2020 these caregivers provided care valued at almost $257 billion

These are staggering statistics, but they don’t effectively describe the physical and emotional impact on the patient or the caregiver. Almost all of us know of a loved one who has suffered from this disease. Many of us have been a caregiver for an Alzheimer’s victim. This disease robs them of the joy they hoped to enjoy as they grew older and puts a huge burden on those who give care.

I want to focus on the caregivers, but I first want to make the point that we need to find medicines that treat this disease. The Alzheimer’s Association states that they believe the first survivor of Alzheimer’s is living right now. That can only come true if we continue to do research to find these life changing medicines and procedures. The Association points out that no disease-modifying treatments exist, and for more than a decade there have been a series of initially promising but ultimately ineffective potential disease-modifying therapies. There recently was one medicine that gained FDA approval but time will tell its impact. Now is not the time to limit innovation. If Alzheimer’s continues unchecked our nation is projected to spend $1.1 TRILLION dollars in 2050, that’s $1.1 trillion in ONE year!

Caregivers are sometimes overlooked when we talk about the impact of Alzheimer’s. The fact is, nearly half of all those who provide care to older adults are caring for someone who suffers from Alzheimer’s or another dementia. Who are these Alzheimer’s caregivers?

• 30% are over 65
• Two-thirds are women and half of them are daughters
• Two-thirds live with the person they care for
• One-quarter care for their aging parent and also care for a child younger than 18
• They are twice as likely as other caregivers to have substantial financial, emotional, and physical difficulties

These caregivers need help as they bear this tremendous burden. Click here for access to tips for caring for those who suffer from Alzheimer’s. You will find help on caregiving during the COVID-19 pandemic, gaining access to help in your community, and dealing with a wandering sufferer.

If you are worried about a loved one who might be suffering some sort of dementia you can click here to find the 10 early signs and symptoms of Alzheimer’s. There is a difference between typical age-related changes and the signs and symptoms of Alzheimer’s.

For at least 20 years there has been proposed legislation that would lesson the burden on caregivers by giving them tax breaks or some sort of compensation for the care they provide. When family members or other supporters supply care, it keeps the Alzheimer patient out of institutions like hospitals, short- and long-term care facilities and other institutions. This care saves our healthcare system billions of dollars, but it takes a significant financial toll on the caregiver. We need to talk with those who represent us in Washington to find a way to compensate these caregivers. We would most likely find that we would save even more money if we gave caregivers some help.

It seems we’ve talked a lot about heroes this pass year as we’ve weathered the pandemic. We should also recognize those heroes who have been caring for those suffering from Alzheimer’s or dementia before the pandemic and will continue this loving service long after the pandemic is over. We owe them support now and a renewed effort to find a treatment or a cure for Alzheimer’s.

Our nation has proven that we can muster the resources and conviction to quickly find a vaccine for COVID-19. We need to develop this same “moon shot” determination to rid the world of this joy robbing and life taking disease.

Best, Thair

p.s. Don’t forget to join us on November 17^th at 2:00 pm ET for a virtual Town Hall talking about Medicare Advantage and Medicare Part D open enrollment. You can Register Here to sign up for this town hall that will answer questions about this important open enrollment period.

Open enrollment for Medicare Advantage health insurance and Medicare prescription drug plans started on October 15^th and goes to December 7^th. You no doubt have been receiving mail, phone calls and emails telling you it’s time to review your plan, or, if you’re just turning 65 to register for Medicare. If you’re like me, you’re pretty wary of all of these different companies offering free information and help with your review. You understand that in the end most of them want to sell you something. While this isn’t a bad thing in and of itself, their focus may not always be to offer you the best health services that match your individual situation at the lowest cost. I say this because I want to be up front with what my motivations are.

I’m paid by the Healthcare Leadership Council (HLC), a Washington based nonprofit made up of a coalition of chief executives from all disciplines within American healthcare. As the spokesperson for Seniors Speak Out, I try to advocate and educate for older Americans. The broad scope of the HLC membership dictates that I cannot, and I really don’t want to, recommend or advise on which Medicare Advantage insurance plan, Medicare Supplemental insurance plan or prescription drug plan is best. My only motivation in discussing open enrollment is to try and offer basic information that will lead you to accurately review your coverage and get the plan that fits you the best at the best price. One way I hope to accomplish that goal is through a virtual town hall on November 17th at 2PM ET that will offer answers to the most common questions that are asked during open enrollment and also give you a chance to ask any questions that you may have. You can register for the virtual town hall here.

In the meantime, I would like to offer some suggestions as you get ready to review your Medicare coverage.

• Take a moment to review your health and the direction it is going. When you’re older the one thing to count on is an increase in health problems. Discoveries in healthcare have enabled us to have healthier lives for longer than ever before, but time will catch up to all of us. Your evaluation of this year’s healthcare needs and your estimate of what next year will bring could have a big impact on which plan is right for you. Be as detailed as you can.
• Write down all of the prescription drugs you take, the name, the dosage, and the manufacturer. Write down any over the counter drugs, including vitamins and nutritional supplements you take. Keep this information up to date, not only for open enrollment but also for your doctor visits.
• Review your “2022 Medicare & You Handbook.” You can get a copy by logging into (or creating) your secure Medicare account.
• You can always get help at www.shiphelp.org, the State Health Insurance Assistance Programs. These are local trained assistants who can give you invaluable help.

Reviewing your health plans during this open enrollment period can potentially save you money.

I know that there have been many discussions about Medicare and proposed changes. Don’t let this rhetoric cause you to miss the chance to take charge of your Medicare and review your coverage and change plans if that’s what’s right for you. There’s been no legislative changes to Medicare so there is no reason to delay your coverage review.

Please don’t forget to look for signup information for our November 17^th town hall.

Best, Thair

When the air gets crisp, and the days get shorter we know it’s time to start looking toward the holidays and great times with our families. It’s also time to sharpen our focus on our health. First, let’s think about the approaching holidays.

Out west, for whatever reason, Halloween is a big deal. There are houses with elaborate decorations, huge haunted houses and corn mazes. I don’t know how it is where you live but it seems to get crazier every year. After Halloween the focus turns to Thanksgiving and big family dinners. We can’t always control the menu when we go to dinner at our family’s or friend’s house, but we can eat healthy this fall when we are cooking for ourselves. The National Institute on Aging, an institute and center under the National Institutes of Health (NIH), has a great web page that offers recipes for one day or for a week’s worth of healthy meals. I think it’s worth trying to see how you feel after eating healthy for a week. I know as my schedule gets hectic, I find myself eating a lot of fast food, both outside my home and inside. How many peanut butter and jelly sandwiches have you eaten when you didn’t think you had time to fix something nutritious. I know that if I’ve planned a week’s worth of meals, I’m more inclined to stick to the plan. Take a look at the web page – you might find yourself clicking on some of the links that talk about other healthy ideas, like lowering your blood pressure, menus to lose weight, and even a sample shopping list; it’s well worth your time.

I found another really good web page on Delish.com that is loaded with great recipes that are quick and easy. You need to be careful to choose the healthy ones, but it’s almost always better to cook at home with your ingredients than to go out to eat. This web page offers over 60 easy recipes.

If you want to go crazy here is a web page with over 2,000 fall recipes. Don’t say I didn’t give you many options. Everyone ought to be able to find something they like on one of these sites.

Now that your mouth is watering thinking about all that good fall food you’re going to be eating, let’s talk about how to stay healthy, both mentally and physically, this fall. There are some problems that come with the fall. The days get shorter, the cold sometimes keeps us from venturing out, some of us may not have family that is close. For some, the holidays can be gloomy. There are some things we can do. At Activeminds.org they offered 15 things you can do to make your autumn a safe and healthy time. Here they are:

1) Start taking a Vitamin D supplement. We get most of our Vitamin D from the sun, so our intake decreases when the weather is colder since we spend most of our time inside during the fall/winter seasons. If you find you are not getting outside much, a Vitamin D supplement can boost your mood and immune system!

2) Take some time to yourself. Autumn and winter are the Earth’s way of telling us to slow down. Start a journal or track your moods to get more in touch with how you’re feeling.

3) Get your flu shot and yearly check-up. Self-explanatory! No one likes sniffling and aching and sneezing and coughing getting in the way of life. Yuck.

4) Boost your immune system. You can do this by drinking plenty of water, washing your hands often to prevent sickness, and eating nutritious foods.

5) Get yourself ready for Daylight Saving Time. Go to bed earlier when you can, especially the week before the clocks change. Longer periods of darkness = longer periods of sleep!

6) Make some plans for the cold months. In the winter, we tend to hibernate if we don’t have things to keep us busy.

7) Moisturize your skin. Harsh temperatures can make your skin dry. Also, you still should be wearing sunscreen.

8) Buy in-season food. Beets, broccoli, cabbage, eggplant, kale, pumpkin, broths, roasted squash, roots, and sautéed dark leafy greens are all great choices.

9) Stay active! It can be easy to just sit around all the time, but it’s important to get in some movement throughout the day. Raking leaves or shoveling snow counts!

10) Wear layers and protect your body from the dropping temperature. Make sure you have gloves, a scarf, earmuffs, a winter coat, warm socks, and snow boots!

11) Do some “spring cleaning” in the fall. Clean out your closet, organize that back room, and rid yourself of things you don’t need.

12) Prepare your home for possible extreme weather conditions. Do you have a shovel and/or snow blower? Do your flashlights have batteries? Is your heat working okay?

13) Get some books to read and shows to watch. Who doesn’t want to sit by the fire on chilly winter nights and read a good book or binge-watch some Netflix?

14) Keep a schedule. The cold months can seem to drag on and push us into isolation. Stay on track by scheduling time in your day to do things you like to do.

15) Be kind to yourself. The holidays can cause weight gain, the shorter days can cause low mood, and the flu season can cause sickness. Listen to your body and give it what it needs, and don’t beat yourself up! Try reframing negative thoughts into positive ones.

These are all excellent points. They made me stop and think about how these months have affected me in the past and made me consider what I could do to have a happier, healthier fall.

One last thing, some of us are eligible now for COVID-19 booster shots, I was eligible and got my booster last week. Many more of us will probably be eligible in a few weeks. There’s been a lot of talk about people feeling guilty about getting boosters when poorer countries haven’t had very many vaccinated with the first shots. Many manufacturers and our government are working to get the vaccines to these poorer countries because it is important to get the whole world vaccinated, but the available vaccines that have already been distributed around the United States cannot be shipped overseas. We shouldn’t feel guilty about using these vaccines. It has been shown that our immunity drops after a few months, especially to the Delta variant. These COVID-19 booster shots will raise our immunity and continue to protect us. Go get your booster! Oh, and while you’re at it, get your flu shot also. I did, I got the COVID-19 booster in my right arm and the flu shot in the left. Made me feel like I was back in the Air Force.

Do everything you can to stay healthy and happy this fall – you deserve it.

Best, Thair

This week is Bone and Joint Week which is a chance to focus on the health of our bones and our joints and, which may come as a disappointment to some, has nothing to do with marijuana. Bone health has much to do with our whole body’s health and is especially important as we grow older.

How many times have we heard, “So and so fell and broke her hip and died a few days/weeks later?” It seems to be a common series of events and was made much more personal to me a few years ago. When my mother-in-law, Ada, was in her late 90s her healthcare nurse visited her and pled with her to use her cane or walker as she moved around. Ada had become somewhat unsteady, and her bone density was poor. Ada, who always had her own mind and was also very honest, told the nurse that she appreciated her advice but that she probably wouldn’t use either the cane or the walker. The nurse later took my wife aside and told her that Ada could fall, break her hip, and it would be the death of her. She told my wife to not blame herself or others who took care of Ada because people have their freedom and Ada was exercising hers. Ada had a huge 100^th birthday party and a few months later she fell, broke her hip, and died 3 days later, with her daughter at her side.

I tell this story to highlight a couple of things. First, in these days of battles over mandates and freedom of choice, it is difficult to know where to draw the line between preserving your rights while protecting those around us. My wife tried to help her mother but, in the end, it was her mother’s decision to venture out without her cane or walker. Second, it is amazing how impactful a broken bone can be on older people. The nurse, no doubt, had seen this scenario play out many times to allow her to make her prediction. It’s up to us to not become another participant in this common scenario.

As I did research, I was surprised that you didn’t have to be 100 to have weakened bones. In fact, as the chart below shows, you lose the most bone density between ages 35 and 60. Women are especially at risk for bone loss. This means you need to tell your children that they can impact their bone health before they get old, like us.

The good news is there are things we can do to help our bone health even when we are older. The first thing we can do is take this short survey that will help determine our risk level for osteoporosis. We also should talk to our doctors about our bone health. She/he may recommend that you have a bone density test to determine the status of your bones. The National Institutes of Health (NIH) recommends that all women over 65 should have this test.

There is an excellent link on the NIH website that references the Surgeon General’s report on bone health. The report covers all ages and, while it enables us to offer suggestions on bone health to our children and grandchildren, it has some great information on things we can do, even at our advanced age, to protect our bones.

My hope is that we pay attention to the information available and make some changes to our lifestyle to improve our bone health. There are some things we can do so that we don’t follow the scenario that the nurse predicted and ultimately came to fruition for Ada. We do have the power to not become part of the pattern.

Best, Thair

Drug prices have been a favorite discussion item of politicians for years, but never more than this year. There has been a myriad of solutions offered, from small tweaks to a complete replacement of Part D, Medicare’s prescription drug program. You’ve probably wondered if I was ever going to quit talking about these varied proposals but in order to speak out, we must understand the impact these proposals will have on each of us and when the votes on these proposals will take place. We need to take action before the votes are counted and there is a good chance that in the next few weeks, either the infrastructure bill or the big reconciliation bill will be discussed in committees or on the floor of the House and the Senate with votes to follow. Either one of these bills could, and probably will, have healthcare components and specifically drug pricing proposals. The time for action is now!

Let’s take a quick look at the most important changes to Part D that have been proposed, first the ones that historically have had some bipartisan support.

• Price transparency – Unmask some of the prices and costs in the drug business process to encourage competition.
• Balance copay costs – This change would let Medicare enrollees spread out their copays in monthly installments so they wouldn’t be faced with the entire yearly cost in the first few months.
• A cap on prescription drug out-of-pocket costs – This change would put a beneficiary cap on the yearly out-of-pocket cost for the Medicare prescription benefit, Part D.
• Telehealth – Expand payments and eligibility for telehealth services.

As you might imagine I think some of these proposed changes are needed, they increase competition, make it easier to pay copays, finally put a cap on yearly out-of-pocket costs, and add a cost-effective healthcare option. These are the type of changes where the government can help make a program efficient without ruining the competition inherent in the public/private partnership that is the basis of Medicare Part D.

 
Other proposals:

• Drug importation – Allow states to import drugs from foreign countries, primarily Canada.
• Drug negotiations – This would allow the government to essentially set drug prices.
• Limit drug prices – Base drug prices on those of a select group of foreign countries.
• Limit existing drug price increases – Using the Consumer Price Index (the CPI, an inflation indicator), the government will limit the amount certain drug prices could be increased.
• Expand Medicare eligibility – Possibly lower the eligibility age to 60.
• Expand Medicare benefits – Add dental, hearing and vision coverage.
• Change the prescription drug rebate process – Push rebate savings to the patient at the pharmacy counter.
• Change Part D to operate like the VA drug programs functions – This is a very recent approach that just came up. It would mimic the government-run VA drug program which has about half of Part D’s formulary and sets price discounts.

The bulk of these proposed changes reflect an approach where the government dictates prices and inserts itself into the very core of the whole process. This is where I want to step back and talk about the big picture.

Part D is successful because it lets the free market work within a framework of government oversight . . . the public/private partnership. You have declared yourself how well this partnership works in the recent Part D satisfaction survey we took. When government inserts itself into these complicated programs, politics is the focus and efficiency suffers. A case in point.

When America, and the whole world, needed a vaccine to combat COVID-19 they needed it fast, not in the historical years it takes to bring a drug to market, but in less than a year. The government opened the purse strings and offered to fund this impossible task. Pfizer turned down this offer; they turned it down because they knew that accepting government money would slow down the process. It’s no secret that they stood to make a sizable profit if they were successful, but there was no guarantee of success when they took on the challenge. Pfizer was able to move quickly and was the first to give the world a vaccine that has proven to be very effective. My point here is government in inherently inefficient.

We need to step back and look at each of the proposed changes to Part D and ask ourselves, do we want more government involvement? Is government price fixing the path we want to head down? Do we want our government to control access and the options available in our healthcare? These are the questions we need to ask.

Now is the time to act. Click here to find out how to contact your Senators and Representative. Take the opportunity to make your voice heard. Tell them that Part D works for you, and you don’t want more government intrusion into this successful program. Tell them there are ways to increase the efficiencies of the program without destroying the competition and private part of the partnership. Your voice matters and we need to act now. Take the time to speak out.

Best, Thair

This Wednesday, September 29^th, Is World Heart Day, a day created by the World Heart Federation to find ways to fight the CVD (cardiovascular disease) that kills 18.6 million people per year. The Federation says that 80% of premature deaths from heart disease and stroke could be prevented. It seems to me we could add a lot of time spent with our families if we could prevent 80% of premature deaths.

As we get older our bodies age differently, but the fact of the matter is, every body part becomes less efficient as we grow older. None of us escapes the deterioration of time. For example, I just returned from a week spent with my Air Force friends. We have been getting together every two years for over 40 years. As you might imagine when we first flew together, as B-52 crew members, we were in good physical condition. Over the years we all have developed different maladies that have caused us problems and made us slow down. Last week we met in Colorado and took one day to visit the Rocky Mountain National Park. We drove on the winding road higher and higher into the Rockies until we stopped at the visitor center that happened to be at 11,796 feet above sea level. As we walked around at that altitude, we all felt the effects of the thin air but some of us felt it more than others. I’m sure the condition of our heart had something to do with our fatigue and shortness of breath at that altitude. There is no doubt that myself and my fellow Air Force brothers could improve our heart health if we would follow the heart hints published by the Heart Federation.

The Federation identifies 4 areas where we could improve our heart health

• Diabetes – People living with diabetes are twice as likely to develop and die from cardiovascular disease.
• Physical Inactivity – Around 150 minutes of moderate physical activity per week reduces the risk of heart disease by 30% and the risk of diabetes by 27%.
• Cholesterol – Raised Cholesterol is estimated to cause 2.6 million deaths and is implicated in heart diseases and stroke.
• Tobacco – Globally, tobacco causes some 6 million deaths a year and poses a major risk for developing heart disease—it is also a highly preventable risk. Around 1.2 million deaths are due to exposure to second-hand smoke.

While we probably all know someone who has suffered some of the common heart problems, like clogged arteries or leaky valves. There are medicines and surgeries that can help with those problems. There are, however, rare heart problems that we may not know about and may be hard to diagnosis. Click here to read more about these rare heart diseases.

I think the leaflet that the Federation has developed gives us some concise information about improving our heart health and some excellent resources for educating those around us about heart health. I lost my brother to a sudden and instantly fatal heart attack. I’ve always wondered if there were some warning signs that I missed or some things he could have done to prevent his untimely death.

I recently went through a battery of cardiovascular tests, including a stress test, and it has given me a sense of relief that my heart is in good condition. If I pay attention to the guidance put forth by the World Heart Federation, I should be able to continue having good heart health. I urge all of you to take some time on World Heart Day to find out how you can improve your heart health.

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

Thanks, Thair

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

The answers are below.

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

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

Thair

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

Some bipartisan support:

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

Other issues:

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

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

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

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

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

Best, Thair

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

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

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

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

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

Here are some tips from the American Academy of Ophthalmology:

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

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

Best, Thair

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

1. Find an eye doctor you trust.

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

3. Add more movement to your day.

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

5. Step up your healthy eating game.

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

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

8. If you smoke, make a quit plan.

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

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

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

Best,
Thair

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

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

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

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

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

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

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

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

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

Best, Thair

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.

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.

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 16^th.

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 8^th, 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

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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 20^th . . . 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 20^th, 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

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 26^th, and another on October 27^th.

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

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

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

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

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.

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 complete