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Beware the Camel’s Nose

There’s and old expression, “don’t let the camel’s nose into the tent,” It is in reference to an old tale about an Arab master who let his camel stick his nose under his tent flap to get warm and pretty soon found that the camel had slowly moved completely into the tent and pushed him out. The moral is, don’t let something start that is wrong, no matter how small or innocuous, because it will soon grow large, much to your detriment. I heard this term used in Washington when I began working in public policy in 1996. It was a way for a partisan party or administration to start the process of passing an untenable change to public policy by passing a small seemingly harmless bill and then slowly building on this approach until it only takes a small step to pass the final ultimate legislative goal. I argued 12 years ago that letting an unelected, judicially exempt government panel decide how to ration healthcare in Medicare was dangerous. It was letting the camel’s nose into the tent that would ultimately result in government-controlled healthcare. I think we are seeing this tactic used again.

Lately, our government has begun sticking its nose into our healthcare in ways that scare me. There has been legislation proposed and, in some cases, signed into law, that inserts the government into our healthcare in unprecedented ways. Here are three examples of what I’m talking about.

The recently passed Inflation Reduction Act (IRA) contains some very dangerous precedents. It allows the government’s health agency, Centers for Medicare & Medicaid Services (CMS), to set the price of selected prescription drugs. This is certainly a step toward government control of our healthcare. The law gives CMS no flexibility on which drugs to select, because there is a very stringent method that leaves no agency discretion on which drugs are selected, while expressly denying any judicial review of their actions . . . does this sound familiar? The legislation grants CMS a huge budget increase to add government workers to support the new oversight. This certainly doesn’t sound like a reduction in government control. The nose has found its way into the tent.

There has been a lot of talk about the new Alzheimer’s drug Aduhelm. It was approved by the FDA for broad use and then the Department of Health and Human Services (HHS) restricted the use to only those participating in a trial, which greatly reduced access to the drug. This seemingly innocuous move to save money was a precedent setting move by a government agency, overriding the approval of the FDA, the world’s gold standard in ensuring the safety and efficacy of prescription drugs, to arbitrarily ration your and my access to this approved drug. The Biden administration had the audacity to claim credit for the expected reduction in next year’s Part B premium price, a reduction that was paid for by their denying our access to an FDA approved Alzheimer’s drug. This government rationing was on just one drug but is clearly the first move into the tent.

My last example is a waiver request Oregon submitted to HHS. This request would allow Oregon to deny Medicaid patients access to selected drugs that were approved under the FDA’s accelerated-approval program. By law, states must allow access to all FDA approved drugs, but this precedent setting waiver would change that requirement. In their request Oregon stated that “it will only exclude accelerated-approval drugs with limited or inadequate evidence of clinical efficacy, as determined by state review.” So, the state of Oregon, with all its legions of medical experts, would “wisely” determine if Oregon citizens would have access to an FDA approved drug. This means that, if this waiver was in affect two years ago, Oregon could have denied access to the COVID-19 vaccines, since they were approved under the accelerated approval program. It seems that this waiver request represented not just a nose into the tent but half the body. I’m a champion of states’ rights, but this seems to be a clear over stepping of powers and would be a dangerous precedent. I expect this part of the waiver to be withdrawn, since I would hope that HHS would not approve of this exclusion, but the mere fact that it was included in the waiver request in the first place scares me.

These examples should be red flags to all of us. Is this the camel we want sharing our tent? Do we want more government involvement in our healthcare? While the Oregon accelerated-approval part of the waiver will likely be withdrawn, it will lessen the shock the next time something like this is proposed. Soon, this approach won’t shock us, and we won’t think it’s so bad when they propose that they limit access to a small portion of accelerated-approved drugs, maybe like in the IRA, where it is 10 drugs for the first year and then adding 15 more and then . . .

It is impossible not to see that the government, both at the state and federal level, is moving toward more involvement and more control of our healthcare. We need more competition in all facets of our healthcare not more government oversight and regulations. I’ll continue to stay up-to-date and strive to inform you on the things that impact your healthcare. I hope you realize that you can have an impact if you take the time to stay informed and active as an advocate. Together we can make a difference.

Best, Thair

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Vaccines – The Choice is Yours

Before COVID-19 most of us didn’t know much about how vaccines worked. There were movies I saw in grade school, sponsored by Bell Telephone, that taught us about the world around us (I think you have to be over 70 to remember those movies). I remember they explained vaccines as a bunch of fake soldiers coming into your body, which caused your body to quickly build up real soldiers to blunt the attack. When your body found out the enemy soldiers were fake and didn’t need to be attacked, your body was left with this inventory of real soldiers that could beat back any real enemy soldiers that might attack later. It really wasn’t a bad way to explain vaccines to young people, but I suspect, because of COVID-19, we all know much more about how vaccines work and even how the new mRNA vaccines work. But, even with all this new information, many are still leery of many vaccines and, because of the freedoms we enjoy in this country, everyone has the right to make their choice.

The goal of my blog this week isn’t to try to convince you that vaccines are good or bad. By now, most of us have taken a stand on the vaccine issue and we’ve heard more than we’d like about each side. My goal in this blog is to talk about the choices each of us have and the decisions we need to make as fall and winter approaches. I will disclose that I’m a believer in vaccines, as you probably know from my earlier blogs, but I’ll try to pass on unfiltered information that I’ve gathered about where vaccines fit in as we look forward to the next few months.

For those of you who have decided that vaccines aren’t something you want for yourself, you should be taking extra precautions as fall approaches. Many scientists expect both COVID-19 and flu infections to increase as winter approaches. At the height of the pandemic, when we were all isolating and wearing masks, the number of flu cases dropped dramatically from their historical average. That will not be the case this year. This especially applies to older people, those who suffer from lung problems, have serious health issues and especially for those who are immunocompromised. The pandemic taught us how to avoid getting exposed and it is important that you take those precautions to protect yourself and your loved ones.

I also recognize that there may be those who have been vaccinated in the past for the flu, pneumonia, etc. but were hesitant about the new COVID-19 vaccines and decided against those vaccines. My hope is that you continue to stay up to date on the traditional vaccines that are available. There is a great web page that asks a few questions and then gives you a recommendation on what vaccines you need. I’ve given out this link before but here it is again  — link. I answered the questions and found out that I needed a dose of tetanus, diphtheria, and pertussis vaccine (Tdap). I thought that was only needed when you are young or stepped on a rusty nail . . . not so, we need the dose every 10 years. The vaccines recommended at this site are all the traditional, time-tested vaccines.

For those of us who have decided that taking advantage of all the vaccines available is right for us, we are faced with many choices about when we should be vaccinated. I’ve read multiple sources that state that the traditional fall flu vaccine, pneumonia and COVID-19 can all be administered at the same time. The most common combination is getting the second COVID-19 booster and flu shot at the same time. Note, if for some reason you are a vaccine believer but have not been vaccinated for COVID-19 do it now, don’t wait. The same goes for those who have received the initial COVID-19 shots and booster but haven’t received the second booster — go ahead and get it now.

Here’s my experience, which seems to be a very common scenario, and the choices I made as to timing. I had the initial two Pfizer shots and the subsequent booster. In January of this year both my wife and I got COVID-19. I felt poorly for about 36 hours. My wife had the shivers and then felt fatigued for around three days. We felt the vaccines did their job by greatly reducing the affect of the virus. Now that the booster has been authorized, we plan on getting it this week. We also decided to wait until late October or early November to get our flu shot so that it would be the strongest during the traditional times that the flu is most prevalent. Again, there is no problem with getting both shots at the same time, even in the same arm at different shot sites. I think some officials have pressed combining the two shots because the uptake on the second booster has been slow and they hoped that those who were in the habit of getting their yearly flu shot would go ahead and get the second booster at the same time since they were already at the doctor’s office. I’m a big fan of not trying to second guess human nature or “tricking” people into certain behaviors. I’d rather have everyone get unfiltered information and leave how people use that information to them. Whether you get them at the same time or not is up to you.

The important point I want to make is the fact that there are lifesaving vaccines available. It is our choice as what is best for each of us. Don’t let a busy life, a lack of transportation or procrastination be the reason we don’t act on our choice.

Best, Thair

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Our Yearly Survey Results

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

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Do You Know Your Cholesterol Score?

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

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Making Medicare Advantage Even More Advantageous

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

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Vaccines, a Lifesaving Miracle

According to an Imperial College of London study, the COVID-19 vaccines saved almost 20 million lives around the world in the first year. I can’t comprehend the deaths of 20 million people. Each one of those 20 million have people who loved them and people they loved. They each had people who depended on them. They each had a purpose on earth that would have been cut short if it weren’t for the vaccines. We were so lucky to have those lifesaving vaccines.

While these new vaccines were developed in an unprecedented short period of time, we have had other vaccines that have been around for a long time that we seem to be taking for granted. Remember the days when vaccinations were for newborns and kids getting ready for school. Measles, diphtheria, smallpox, and polio have largely become diseases of the past because of vaccines but they were primarily for children. I want to focus on important vaccines that protect adults.

Pneumonia, the disease that in the past was a killer of the elderly, can be controlled and prevented by a vaccine. Shingles, a painful disease, can be controlled with a vaccine. Older adults are encouraged to get the tetanus, diphtheria, and pertussis vaccine booster to renew their resistance to those maladies. Another killer of older people is the flu. The estimate for deaths caused by the flu for the 2017/2018 season was 61,000. Each year we can get a vaccine that greatly reduces the impact of the flu, yet less than 50% of us get that lifesaving shot. This goes against what happened during the pandemic.

94% of the adults between the ages of 65 and 74 were fully vaccinated against COVID-19 during the pandemic. What changed, why did 94% of us choose to get the COVID-19 shot but, historically, 50% of us chose not to get vaccinated against the flu? It doesn’t seem to make sense. It is true that we reduced our visits to the doctor as we sequestered ourselves and our mask wearing during the pandemic reduced the spread of the flu, but what is going to happen this fall? We’re mostly not wearing masks so we are more vulnerable. Will we come to our senses or will we return to that embarrassing condition where half of us don’t get vaccinated?

Here’s an idea, since it looks like we will get another booster approved in the next few weeks that will protect us against the COVID-19 variants, why don’t you just ask your healthcare provider to give you the flu shot also? And if you want to get real crazy, why don’t you review your vaccination history with your doctor and catch up on all your vaccinations? So, how do you know what vaccines you need . . . glad you asked.

Here is a link to a website that asks you questions and generates what vaccinations you need. I went through the process, and it has given me a great start on what vaccinations I need but it also brought up more questions. What vaccinations have I already had? I’ve changed my primary physician three times in the last three years, once when I moved and a second time when I found a doctor that better met my needs. Where are my immunization records? What about when I got my flu shot last year at a pharmacy? Did they pass my immunization record to my primary doctor? I don’t recall if they even asked the name of my doctor. This brings me to something else we need to do to keep us on track – keep our own record of all of our immunizations. I bet you have been like me and carried you COVID-19 immunization record with you over the last two years. Mine is kind of worn around the edges from being in my wallet. I even took a picture of my record in case I lost my wallet. We need to use this same dedication in keeping track of all of our immunizations. It may be the only place where a complete and accurate record of all your immunizations exists. Think back, when was the last time your doctor asked you to go over all your immunizations? As of five years ago some doctors’ computer systems didn’t have a place for tracking adult immunizations. It’s a valuable thing to have.

If you’re like me, you can’t remember all of your past vaccinations. Here is another web site with some hints on how to find past health records and also a place to download a form that you can use to track you immunizations. Whatever you do, begin now to track your shots. If you get poked, write it down. It will be so fun the next time you cut yourself or step on a nail and the doctor asks when you last had a tetanus shot and you can tell her/him the exact date.

It’s National Immunization Awareness month. Let’s build on the momentum of being the best COVID-19 immunized age group and become the best immunized age group for all of our recommended immunizations, along with having the best record of our immunization history. It’s a lifesaving goal.

Best, Thair

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Inflation Reduction Act – How and When It Will Affect You

The Senate and the House passed the Inflation Reduction Act (IRA) and President Biden signed it into law six days ago. As I’ve said before (in this blog) it has some good things and some bad things. It was passed on a purely partisan vote, with the 50 Democrat Senators voting yes and the 50 Republican Senators voting no, and Vice President Harris voting yes to break the tie. It was a party line vote in the House with 220 Democrats voting yes and 207 Republicans voting no. Once again, our government chose to pass a purely partisan piece of legislation that will have a huge impact on seniors in this nation. I’ve written previously about the evils of partisan governing here. It’s not good when a small majority can pass such important legislation.

So, before we get into the new law, I’m going to rant a little. Maybe some math will highlight the reason for my displeasure. The vote was 50 for and 50 against the bill in the Senate so, from the Senate perspective 50% of us had Senators that were against the IRA. There were 13 more House members (all Democrats) that voted for the IRA than voted against it. The average size of a House district is 761,000 so the difference in citizens represented by the 13 yes votes was 9,893,000. With the population of the United States at 329.5 million the ratio of those 9,893,000 yes votes to no votes of citizens represented was 3%. That 3% made the difference and they were all in districts of Democrats. A bill of this magnitude should not pass on such a slim majority. Somehow, our country needs to figure out how to work together to develop laws that are bipartisan.

Ok, let’s talk about this new law. I’m only going to talk about the healthcare portions of the law and only those that affect older Americans. I’ll go year by year since many of the changes won’t go into effect for a few years. I’ll try to keep it short and to the point.


  • The price of some drugs may not increase as fast since the manufacturer must pay a rebate if they raise prices above inflation. I wonder how much a benefit this will be if inflation stays high.
  • Out-of-pocket costs for insulin is capped at $35 a month.
  • Reduces the cost for adult vaccines.


  • If you reached the catastrophic phase of your Medicare Part D coverage, which means you spent $7,050 on drugs, that’s all you’ll have to pay. Eliminates the 5% coinsurance that you used to pay.
  • Expands the eligibility for the Part D low-income subsidy.
  • Starting in 2024 and continuing through 2030 Part D premium growth is capped at a maximum of 6% per year.


  • Part D 0ut-of-pocket costs are capped at $2,000 per year.
  • The payment of drug costs can be smoothed out over the entire year.


  • Government price controls will be implemented on 10 selected drugs. This may affect what you pay depending on the drugs you take.


  • Government price controls will be implemented for 15 more drugs, for a total of 25.
  • The Trump Administration’s drug rebate rule, which had been delayed until 2027, will be further delayed until 2032.


  • Government price controls will be implemented for 15 more drugs, for a total of 40.


  • Government price controls will be implemented for 20 more drugs, for a total of 60.

The amount of savings generated by government price controls for any one individual will depend on a lot of variables. The Kaiser Family Foundation, a non-partisan information source on healthcare, said the following about possible savings.

“The number of Medicare beneficiaries who will see lower out-of-pocket drug costs in any given year under this provision will depend on how many beneficiaries use drugs whose prices increase more slowly than would otherwise occur and the magnitude of price reductions relative to baseline prices.”

These are the pocketbook impacts of this new law for seniors. What hasn’t been discussed much since this bill was signed into law is the other impacts of this new legislation, like the constraint to the development of new drugs. This will be especially felt by the small bio firms which produce many of the new scientific break throughs. This law doesn’t do anything to add more transparency and efficiency to the drug supply line. There were many improvements that could have been done that would have saved money and improved access that were not considered.

As with all big changes to our healthcare system, the real impact will depend on how the law is implemented and how the providers, drug manufacturers and insurance companies react to the changes. There is much more to understand about this bill, and we must still stay involved as it is implemented. The devil is in the details and the details will reveal the real impact these big changes will have on each of us. We’ll stay involved through the process and we hope that you will stay involved also.

Best, Thair

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A Balancing Act That’s Important to Your Health

I read an article recently that made me jump out of my chair . . . no it wasn’t a notice that I won the Master’s lottery and would be going to Augusta to watch the golf tournament next year. It was an article about a recent study that said if you can balance on one leg for 10 seconds it’s an indicator of your overall health. So, before you jump up, here’s a picture of how you stand to take this simple test. I tried it immediately, both with and without shoes, it didn’t seem to make a difference. I did find that I did better if I stood on my dominant foot. I’m right footed, but you are allowed to use either leg. You can take three tries to successfully complete the test. The thing that really grabbed my attention was the statement that, “The inability to stand on one leg for 10 seconds might indicate an increase in the risk of death within the next decade.” Now that seems like an ominous prediction for a simple test but the study (click here to read about the study in more detail) seemed thorough and legitimate. The fact does remain that as we age, our flexibility and balance diminish. Balance begins to be more difficult beginning in our 50s and can quickly go downhill. According to the World Health Organization problems with balance increase the risk of falling, which is troubling as falls are the second leading cause of unintentional injury deaths worldwide. More than 37 million falls are severe enough to require medical attention each year.

Now I’m a few years past 50, OK, I’m a few years past 70, but I have never had a balance check at any of my physicals. I’ve pressed my hands and legs against the opposing pressure from the doctor and the doctor has tested the strength of my grip, both important tests of physical health, but no one has tested my balance. The authors of this balance study recommend that this balance test be included when the doctor evaluates the overall health of a patient over 50.

I will reveal that I passed the test but found it harder than I thought it would be. I guess this goes along with the realization that I don’t get up off the ground as easily as I used to and my wife’s insistence that I don’t go up more than three rungs on ladders. I’ve also lost distance on my drives when I golf. My son says that it’s because my core strength isn’t as strong as it used to be. In doing some further research I found that core strength is directly related to balance, the stronger the core, the better the balance. For me, taking a little more time to get up off the floor, or not climbing too high on a ladder are not big problems, but when I lose distance when driving a golf ball – now you have my attention. If strengthening my core muscles will increase my driver distance and, as an added bonus, keep me from falling, then sign me up. My next question is how do you do it?

A little more research and advice from my son pointed me toward doing “planks.” I didn’t do those in high school gym class but evidently, they are the way to strengthen your core muscles. A plank is a simple, but effective core exercise that helps you build stability and strength throughout your entire body. The plank is achievable in a number of different ways, but the main position of the plank exercise is with your body perpendicular to the ground, stomach facing down, elevating your torso off the ground with either your elbows or hands. This will position you as if you were stuck in an extended push-up pose without actually moving your body weight up or down. This may sound much nicer and more forgiving than a set of push-ups, but the plank can become a strenuous exercise very quickly as you continue to hold that position. You can go online and find a multitude of different types of planks. An excellent article I found talked about how the plank helps build core strength, the benefits of doing them and some variations that can further build strength. You can find that article here.

As mentioned above, the exercise can become very strenuous and may not be the best way to exercise our core muscles as we grow older. Luckily there are other ways to build these muscles that will fit all levels of mobility. Remember, the goal here is to improve your core muscles and therefore your balance. It doesn’t matter where on the range of muscle strength we start, it only matters that we do something that makes our core muscles stronger.

I found a place that offers some great non-plank core muscle exercises for older adults. It’s on the SilverSneakers web site. Click here for these non-plank exercises. These are great exercises that help you improve no matter where you start on the strength spectrum.

One of the great things about all these exercises is that they don’t require special equipment or a membership to a gym. They just require some time and effort. It will be time well spent. Whether you passed the 10 second test or not, it’s worth doing the exercises just to improve your balance. How many times have you heard that an older person fell and broke their hip and died a short time later. It happened just like that with my mother in-law. Maintaining your balance is a great way to keep yourself healthy and it might even help your golf game.

Best, Thair

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The Good the Bad and the Ugly

While the blog title is a good one for a great spaghetti western it’s not so good when it applies to pending legislation that will have a long-range effect on our lives. I’m talking about the Inflation Reduction Act that survived Saturday night and early Sunday’s gauntlet of voting on amendments to the bill, affectionally known as the vote-a-rama, and was passed by a partisan 50 to 51 vote with the Vice President breaking the tie. It will now go to the House where they will most assuredly pass it, probably on Friday. So, how did we get to this point on this ominous piece of legislation?

Since the massive Build Back Better bill failed to gain traction, the Democrats have worked feverishly to try to find a narrow bill that they could pass before the midterm elections. This meant they needed to broker a deal with two moderate Democrats, Senators Joe Manchin III (W.Va.) and Kyrsten Sinema (Ariz.), who were the ones that held up the passage of the larger bill. When Senator Manchin abruptly changed his stand opposing legislation that would impact inflation and raise taxes, and Senator Sinema got her changes to the bill, the door was open for a pared-down bill that they named the Inflation Reduction Act, an obvious nod to Senator Manchin. The only way to pass this bill was through a process called reconciliation. I discussed this process and my disdain for using legislative maneuvers like it to pass such important legislation in a recent blog. Suffice it to say that this bill, if it passes, and it probably will, will be a purely partisan law. In essence, a bill that affects 100% of us will only have the support of 50% of those who represent us. It took the vote of the Vice President to break the tie. This bill certainly contains some good, some bad and some ugly parts.

The good –I think that capping the out-of-pocket costs for prescription drugs at $2,000 a year is definitely good for seniors. I’ve been advocating for this change for more than a decade. It gives older Americans some sense of security knowing they won’t be bankrupted by drug costs, and it gives younger people a definite ceiling on out-of-pocket costs as they plan their retirement.

The bad – This bill allows the government to fix the price of some of the highest priced drugs. I’ve talked ad nauseum about the problems of allowing the government to insert itself into our healthcare when it’s not needed. Drug prices have not risen faster than inflation for years and they have risen slower than the other parts of healthcare. There are parts of our prescription drug system that need to be changed. Having the government set the prices for important drugs is not the answer. Many have talked about the negative effect this change will have on innovation and the discovery of new life improving and lifesaving drugs. It is difficult for many of us to understand how this will dampen the willingness of investors to risk their money on new research. Maybe this example will help.

The movie industry and prescription drug business have a lot in common. For starters, the drug industry calls a very successful drug a blockbuster, the term was taken from the same moniker enjoyed by a very financially successful movie. Thousands of movies are made each year with very few of them breaking even or making a profit. Small independent movie makers have an idea and develop a script and work to find money to make the movie. Likewise, there are many small biotech firms that have a scientific idea about a new drug and work to find the money to continue their research. Both of these businesses rely on investors who are willing to wait years, some over a decade, for a return on their investment, with the understanding that about 9 out of 10 will be failures. They are still willing to invest because of the chance for the financial windfall of a blockbuster, whether it be a movie or a drug. If the government gets the power to limit the price of the expensive blockbuster drugs, it will be like the government limiting the number of movie tickets that can be sold for a successful movie. In both of these scenarios the number of new movies and the number of new drugs will both be limited because the reduced reward will not be worth the risk. Investors will take their money elsewhere. This same scenario plays out for big movie producers and big drug manufacturers – they won’t be willing to purchase these smaller companies if the big payoff is not available.

There is one other consequence of this price fixing legislation. In the late 1980s and 1990s many prominent scientists left companies in other countries, especially Europe, and came to America where the environment for pharmaceutical innovation was much better. If that environment worsens, that migration is sure to reverse itself and we will lose those great scientists. Having new discoveries in our country proved to be very valuable during the pandemic. I would hate to lose that advantage to other countries.

The ugly – I’ve already talked about the ugliness of the process used to pass this bill here and in an earlier blog. The reason this bill was forced through had everything to do with politics and the upcoming midterm elections and very little to do with the long-term health and the wellbeing of older Americans. I wish it didn’t have to be this way.

I’m sure there will be more to say as this law is passed by the House at the end of the week and as it is implemented. We will continue the fight to lessen the impact of this bill and we will continue the fight for better healthcare for you and me.

Best, Thair

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Survey Says . . .!

Most of us have watched or have heard about Family Feud. They ask members of a family how they would answer certain questions and then compare those answers to how a group of 100 people answered those same questions. Sometimes the family member matches many of the same answers the survey group came up with; often they don’t, which leads to some very entertaining situations. I think the producers of the show realize that a family of four people may have some quirks and unusual experiences that leads to entertaining answers. In fact, I think they’re counting on it.

It seems to me that Washington, in its feverish haste to look like they are doing something for older Americans, has forgotten to find out how their older constituents feel about Medicare’s prescription drug Part D program. They are letting political quirks and their own small view of the issue cause them to come up with answers that are a far cry from what their older constituents want. It may make for entertaining campaigning, but it doesn’t really solve the problems.

Every year since 2007 the Healthcare Leadership Council has conducted a survey of older Americans to ascertain how they feel about Part D. The satisfaction in 2007 was at 86%. That is unheard of when referencing a new broad government program. Now, 15 years later, our latest survey shows that seniors in our nation are still very satisfied with Medicare Part D. The nationwide survey of 1000 seniors found that 88 percent of senior enrollees are still satisfied with their Part D coverage and 86 percent agree that their plan is a great value. That’s not bad for a government program that has come in almost 40% under the budget estimates calculated at the program inception. I challenge anyone to identify a government program that has come in 40% under budget with an almost 90% satisfaction rating. A satisfaction rating that’s not from those who run the program, not from the providers or insurance companies, not from the politicians in Washington, but from those who are directly served by the program. One of the basic questions I need to ask is, “why do we need to fix a program that is under budget and wildly successful?” My father always said, “if it ain’t broke don’t fix it.”

While these satisfaction numbers continue to be excellent, year after year, there is another part of this survey that is extremely important given the current Part D changes that are being proposed. These proposed changes would allow the government to set the prices of an ever-expanding number of drugs. It would enforce prohibitive fines against price increases that go over the Consumer Price Index (CPI), which is a measure of inflation. Just as an aside, given the current rate of inflation the drug manufacturers would be allowed to raise their prices three times above what the average price increase has been in the last three years. Again, Congress wants to insert themselves into a successful program that will most assuredly cause unintended consequences, to say nothing of the intended consequences that will limit choice and access and have very little to do with saving out-of-pocket costs for seniors. Given these proposed changes I think it is extremely important to hear what those that will be impacted by these changes have to say.

Here’s what the survey said:

  • Two-in-three Part D enrollees said prescription drug plans should negotiate prices directly with the biopharmaceutical manufacturers instead of letting government set prices and determining which drugs will be covered under Part D formularies.
  • 83 percent of seniors are concerned that federal involvement in pricing could reduce choice and options for prescription drugs for seniors and individuals with disabilities in the Medicare program.
  • 82 percent of seniors are concerned government price setting policies would limit access to newer prescription medicines.
  • 81 percent said it is important to them to have a variety of plans from which to compare and choose.

It should be evident to even the most casual observer that the people who are impacted by the proposed changes aren’t convinced that they are in their best interest. Political expediency and leverage are not reasons to make these types of basic changes to a very successful program.

I do want to point to one positive part of the proposed changes. While fixing prices would not lower out-of-pocket costs, capping the yearly drug out-of-pocket costs to $2,000 will most certainly give a great relief to those who were suffering the most from high prices and the impact of high deductibles or co-insurance. There’s no middleman or arbitrary selection process or other regulations to be gamed, it’s a simple benefit that is applied to those who have been impacted the most. It takes away the worry of wondering what would happen if you suddenly needed some lifesaving expensive medicines. It takes a huge variable out of retirement planning. I have advocated for this change for over 10 years.

We all listen intently when Steve Harvey says, “survey says!!!” Why don’t those who represent us in Washington take a moment to listen intently to what their older constituents say? We have many government programs that don’t work. It doesn’t seem logical to try to fix one that is working just fine.

Click here if you want to tell your Representative or your Senators how you feel about these proposed changes. Your voice is powerful when you choose to speak out.

Best, Thair

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Drug Price Controls Deserves the Full Constitutional Process

The odyssey of how the President tries to rescue some portion of the Build Back Better act continues. Now that he can’t get the votes for the scaled down version that was proposed a few weeks ago he is extracting one part of that scaled down version that he hopes can get the votes to pass. Unfortunately, that part is the drug price control proposal. This approach has been discussed a lot. . . how it would impact innovation, how it would reduce competition and impact access. You’ve heard me echo many of those feelings. As it is with any issue that has the ability to affect millions of lives, there’s been deafening rhetoric from both sides. It shouldn’t take long, if you go back and read some of my earlier blogs, to ascertain where I stand on government price controls on prescription drugs and why. I would like to step back a little from all the specific pros and cons of this proposed legislation and talk about the evolution of how our government works and how this evolution impacts each of us.

I think that the process of how we pass important legislation has evolved (or in my opinion devolved) to a point where those officials who we elect to represent us have less and less control over the final regulations that will ultimately have a huge affect on our lives. I offer some examples.

I was very involved in the issues and the impact of the Affordable Care Act (often called Obamacare). This law was passed in the short two-year window when the Democrats controlled both the House and the Senate. The House passed their version of the bill and sent it to the Senate for action. There were Senators, both Democrats and Republicans, who had concerns with some parts of the bill – the power of the Independent Payment Advisory Board (IPAB) and the lack of any tort reform, for instance. The Senate did make changes to the bill and some Senators still had misgivings because the changes they wanted, like the two highlighted above, were not included. These Senators were assured that those changes could be added when the House and Senate went to conference to resolve differences. But, in the interim, Sen. Ted Kennedy, a Democrat, died and was replaced by a Republican. Concerns arose that a new bill could not be passed out of the Senate. The House speaker and the President convinced the House members to vote to pass the Senate’s version of the bill without a conference. This action assured that it would be a very partisan law and that for over a decade the Republicans would work to try to repeal the law rather than working to improve it.

The Republicans were no better. An amendment to alter the powers of IPAB, a sore spot for many on both sides of the aisle, was voted out of subcommittee with votes from both parties with the assurance that this clean bill would pass both the House and the Senate. The Republicans, rather than accepting the clean bill, added amendments that lost the votes of the Democrats. They passed up the chance to improve the bill for purely partisan political reasons.

President Trump used the power of executive orders and regulations to pass significant changes to our healthcare system. One of these was rebates at the pharmacy counter. Some people thought that was a good idea, others thought it wasn’t. Either way it didn’t matter because as soon as President Biden took over, he rescinded the order.

The process of reconciliation was instituted to make it easier for Congress to pass legislation that dealt with finances and budgets. It isn’t subject to the filibuster and only needs a simple majority in the Senate rather than 60 votes. It is used often when one party controls Congress and the White House but doesn’t have a 60-vote majority in the Senate. The Build Back Better bill was submitted under the rules of reconciliation as are all of the latest trimmed down proposals.

In the last few weeks, as it was evident that Senator Manchin couldn’t agree with the climate change and tax portions of the bill, the Senate decided on a smaller version containing the drug price controls. This proposed legislation would also be submitted under the rules of reconciliation. President Biden then indicated that he, like those before him have done, would use executive orders and other regulations to accomplish those parts of the initial legislation that had been removed.

I hope you see the common theme in these illustrations. The normal process for our government to pass and enact laws that impact our lives has been altered. The party in power now has the tools and the precedent to circumvent the checks and balances prescribed in the constitution and single handedly implement healthcare changes with none of the compromise that has historically been the hall mark of passing legislation.

The price controls proposed in this slimmed down bill will have to be reviewed by the Senate parliamentarian to see if it fits the rules of reconciliation. This decision is subject to debate and even legal intervention. Presidential executive orders and directed changes in regulations is not the way basic parts of our healthcare should be changed. Is this how we want changes to our healthcare implemented, using a process that has no mention in the U.S. Constitution and can be canceled with a stroke of the pen when the other party inhabits the White House? Do we want to implement laws that affect almost all of us in a very basic way with a short cut process that is intended primarily for financial and budgetary actions? When legislation is a one-party creation, we miss the compromise and balance of a bipartisan approach. We also almost always lose the willingness of the excluded party to participate in later amendments to improve the law after it is enacted. We deserve the full checks and balances afforded in the Constitution to come into play, especially when the legislation may eliminate the discovery of medicine that may save my life or the lives of my family.

Both sides of this drug pricing legislation emphasize the impact this legislation will have on our lives. Don’t we deserve the full constitutional prescribed process and debate for something so important? Tell those who represent you in Congress that you think this important piece of legislation deserves the debate and process guaranteed in the Constitution.

Best, Thair

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An Ounce (or so) of Vaccine Prevention is Worth a Pound of Cure

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

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Government Prescription Drug Price Setting – Still a Bad Idea

I’m back after our 4th of July break. I hope everyone had a safe and enjoyable holiday. My plan was to have a light, feel good blog on enjoying a summer without the stringent COVID restrictions, but it wasn’t to be. The threat of the government setting the prices on prescription drugs has reared its ugly head again.

As the Senate’s Democrats frantically search for some way to rescue some of the Build Back Better bill that failed on the launching pad, they have released language concerning the control of drug prices that reportedly all Senate Democrats support.

I’ve pontificated ad nauseam about the problems with proposals for the government to control drug prices. I’ve talked about the impact their solutions would have on innovation and how the insertion of government controls would limit access. There are two other aspects of their proposed solution that I haven’t discussed too much that I think need to be highlighted.

First, this proposal is another attempt at finding a politically convenient solution to a complicated problem. H. L. Mencken said, “For every complex problem there is an answer that is clear, simple, and wrong,” and it absolutely applies in this case. The problem is not just proposing a “simple” answer to a complex problem but with politicians turning away from even understanding the complexities of the problem and only searching for a solution that polls well with constituents. That’s why they favor inserting the popular term “negotiations” into the solution’s description when the true process will give the government the ability to arbitrarily impose a non-negotiable take-it-or-leave-it drug price.

The current prescription drug pricing and supply chain is convoluted and costly. It is fraught with perverted incentives and controls that do nothing to lower the out-of-pocket costs for the patient and can even raise the list price of the drug. Seeking to dictate the cost of drugs after they have gone through this inefficient and flawed process is like continuing to manufacture a car with very uncomfortable front seats and then giving everyone who buys the car padded seat cushions for the back seats . . . it doesn’t fix the basic manufacturing problem and the proposed fix shows a lack of understanding of the current problem.

The drug manufacturers continually offer to sit down and talk about drug prices. To my knowledge it hasn’t happened. We need to somehow decide to get to the root of the problem and fix the process rather than continue to propose band aid solutions that further complicate the situation.

The second part of this issue that I feel needs to be discussed is the motivation behind proposing this price fixing proposal. The indications are that the bill will not only contain the drug price control scheme but will also contain programs and costs dealing with climate change, energy production and taxes, and the Democrats are counting on the “projected” savings from drug price-setting to pay for these other programs. To quote the non-partisan Kaiser Family Foundation,

“At the very least, advancing the drug bill would make some other Democratic goals easier to achieve, since it would save the federal government a lot of money, which could then be applied to other programs.”

That’s what bothers me – a lot! Why do our elected politicians think it’s ok to use the hard-earned money we sent to the government to pay for other programs. We were told our money was put into a trust fund that was to be used to pay for our healthcare when we got old. They didn’t say that they were going to use the money to finance other programs, like climate change, energy production, lower taxes or any other current or future whim Washington may come up with. It seems to me this type of action removes any trust we had in the fund and the government that over sees it.

There were some good changes that were implemented in Obamacare. One of the problems I had back when it was being debated was using cuts and savings in Medicare to pay for some of those changes. It wasn’t right then and it’s not right now. If there are savings that can be realized, without reducing healthcare choices and access, then those savings ought to be used to lower the patient’s out-of-pocket costs or shore up Medicare’s financials. We hear continually about when Medicare will run out of money, yet we are willing to use projected Medicare savings for other programs. Even if the proposed changes to Medicare would generate savings without reducing access, benefits, and innovation to find new cures (and you know that I don’t think that’s possible), the savings should be used to the benefit of the Medicare beneficiaries, not other programs. Medicare shouldn’t be used as Washington’s uncontrolled ATM.

Washington needs to understand what’s causing the problem and get all the stakeholders together and decide how to fix the problem rather than continuing to come up with politically expedient band aid solutions. They also need to quit using Medicare to finance this month’s popular issue. We need to tell our leaders in Washington we deserve accessible, quality, innovative healthcare.

Best, Thair

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Summertime and the Living is Easy

George Gershwin had a way with words and there are no words more recognizable than the title of this blog . . . at least to those of us who are over 60 or someone who has listened to one of the more than 25,000 recordings that have been made of that song. But the real question remains, is the living really easier in the summer?

For those who have weathered a long winter of shoveling snow or driving on slick streets, summertime is a welcome relief. For all of us it’s a time to enjoy the warm weather and the promise of a vacation, especially given many of us have been robbed of our vacations over the last two years. It’s a time to come out from the shadow of the pandemic and begin to again live our lives unencumbered by a virus.

So, what do we do this summer to make the living easy? One thing you might think about is trying some new recipes. As we found ourselves eating at home more often due to the pandemic, we may have found that we got tired of the same old things. Some of us may have tried out the new cooking appliance, the air fryer. I’ve found it’s a great way to fry food without the mess of hot oil and it’s much healthier. If any of the eight air fryer meals below look interesting, you can get the recipes by clicking here.          

  • Breakfast
  • Hard “Boiled” Eggs
  • Roasted Tomatoes
  • Crispy Tofu
  • Roasted Fish
  • Snack Chips
  • Leftovers
  • Desserts

You also might have found some new ways to stay physically fit. Pickleball has caught on with the older crowd. The increasingly popular paddle sport, which has similarities to tennis and ping pong, has attracted 4.8 million U.S. players of all ages and fitness levels, according to the 2022 Sports & Fitness Industry Association (SFIA) report on pickleball. It doesn’t require an excess of running but keeps the participants moving and, most importantly, it gives us a reason to get out and get some exercise. I have friends who play almost every day, they all say it beats trying to force yourself to go to the gym and workout. Older adults are especially drawn to the fun sport: The SFIA report notes that among the 1.4 million “core” participants — defined as those who play at least eight times a year — 60 percent are 55 or older and more than 33.7 percent are 65 or older. Older people enjoy this sport because:

  • The court is small enough that you don’t need to move much to hit the ball, especially if you’re playing doubles.
  • The game encourages players to socialize.
  • There’s less of the frustration factor that accompanies sports like golf.
  • It’s designed to be carefree and fun.
  • It’s inexpensive.

The great thing about this sport is it’s readily accessible. You can input your zip code on the USA Pickleball Association website to find out where to play near you. 

Finally, it seems we’ve found a sport, besides golf, that older people can play, and it no doubt is better exercise than riding around in a golf cart. You’re hearing this from a guy who loves to play golf but is going to give pickleball a try this summer.

Volunteering is another activity that you might find very rewarding. Helping someone else gets us out of looking inward at our own problems and allows us to focus on others. There is nothing more satisfying than giving of your time and skills to help someone else. Below are five non-profits that accept and need volunteers. Just click on their name to find out more about their organization.

I hope you can find something new and exciting to challenge yourself this summer and you do it while also keeping yourself healthy and safe. I’ve written past blogs about taking care of your skin and your eyes and your joints as you venture outdoors this summer. Do a quick search of my blogs if you need some good guidance in these areas. One little hint, you might take some time to do a little training before you venture out on your vacation. I just spent a week walking around and touring Boston and I found out pretty quickly that I wasn’t as ready for that much walking as I thought.

Finally, while we’re looking forward to this summer it’s not too early to start looking at Medicare open enrollment coming up this year. I’ve been working hard these last few months to catch up on the preventative screenings and checkups that I put off because of COVID-19 (don’t you hate the preparation required for the colonoscopy). Keep track of any health changes that have occurred this year so you can make an informed decision as you review your insurance coverage. Especially keep track of any new prescription medication you may now be taking.

Above all, get out this summer and try something new, and also try to get that George Gershwin song out of your head. I haven’t succeeded yet.

Best, Thair

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What’s So Special About the Summer Solstice – the Longest Day

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 21st, 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

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Men’s Health Week – A Time to Focus on the Men In Our Lives

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

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Recap – Facebook Live Event with the American Cancer Society Cancer Action Network

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

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Two Threats to Our Medicare Prescription Drug Program

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 4th 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

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National Senior’s Health and Fitness Day. Do I Have to Get Off the Couch to Participate?

This Wednesday, May 25th, 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

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Skin Cancer Awareness Month

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

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Back to Basics – Medicare’s Prescription Drug Program

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

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Arthritis Awareness Month – A Chance to Become Aware

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

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What Will Congresses’ Next Step Be on Healthcare?

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

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Report From the American Society of Aging Conference

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  

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Medicare Check In and Check Up

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

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National Public Health Week

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

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Speaker Newt Gingrich, “price controls equal health controls”

Last Thursday, March 24th, 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

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Interesting Preliminary Drug Pricing Survey Results

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 24th 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? 


  • 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

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?


  • 91% – Yes
  • 9% – No

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?


  • 83.6% – Yes
  • 16.4% – No

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:


  • 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.

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?


  • 50.7% – Yes
  • 49.3% – No

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 24th at 1:00 PM ET. You can tune into the event once it is live by clicking here.

Best, Thair

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Innovation – A Life Improving and Life Saving Solution

(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 7th 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 24th. 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.

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

Best, Thair

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Prescription Drug Price Controls Won’t Make the State of our Union, Or Your Healthcare, Stronger

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 24th, 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

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It’s Time to Focus on Cancer Prevention

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.

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Some Good News on Healthcare and COVID-19

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 1st 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

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Dementia – The Coming Tsunami

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 3rd, 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

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And the Beat Goes On

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

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Drug Price Legislation – Are Drug Prices a Problem?

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 1st 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 4th 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

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Your New Year’s Goals – Which One Gets Broken the Quickest?

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 14th 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

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What Is That Puff of Air During My Eye Exam?

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 pressureTonometry
The shape and color of the optic nerveOphthalmoscopy (dilated eye exam)
The complete field of visionPerimetry (visual field test)
The angle in the eye where the iris meets the corneaGonioscopy
Thickness of the corneaPachymetry

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

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What Good Are Booster Shots?

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

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2022 – A Year for Change?

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

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2021 – A year to forget and to remember

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 4th.  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

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Open Enrollment – How Did It Go?

While December 7th 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  

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It’s Flu Season – Do I Need to Get Vaccinated?

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

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Washington – A Huge Year End To Do List

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 3rd. 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 15th 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

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Medicare Information Town Hall Recap

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 15th and ends on December 7th.


  • 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.


  • 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.


  • If you have Original Medicare, go to 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.


  • 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. or 877-839-2675 to find your local SHIP
  • You can find SHIP contact info and other local aging resources via the Eldercare Locator, or 800-677-1116 (also federally funded, administered by USAging)

She then pointed out some things we should 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.
  •, 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 7th. 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 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

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Open Enrollment – A lot of Information – Not Many Answers

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 17th 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 7th.

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

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Veterans Day – A Day to Fight for Improved Healthcare for Veterans

November 11th 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  

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Are You an Alzheimer’s Disease Caregiver?

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 17th 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.

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Open Enrollment – A Time for You to Take Control of Your Medicare Insurance

Open enrollment for Medicare Advantage health insurance and Medicare prescription drug plans started on October 15th and goes to December 7th. 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, 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 17th town hall.

Best, Thair

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Fall is Here – It’s Time for Family and Staying Healthy

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 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 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

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Bone and Joint Week – A Chance to Improve Your Life

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 100th 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

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Drug Pricing – The Big Picture and a Call to Action!

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

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World Heart Day – Find Out How to Improve Your Heart Health

This Wednesday, September 29th, 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

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Town Hall Recap – 2021 Medicare Part D Satisfaction Survey

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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You Spoke! The 2021 Senior Satisfaction Survey

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

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

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

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

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

Thanks, Thair

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

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

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

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

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Turbulent Times Ahead

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

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

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

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

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

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

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

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

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

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

Best, Thair

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A pop quiz with a reward

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

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

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

The answers are below.

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

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

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

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

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

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

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

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

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

Best, Thair

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Summertime and the Living is Easy – – – Maybe

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

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

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

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

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

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

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

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

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

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

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


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Vaccines – A Different Focus

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

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

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

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

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

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

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

Best, Thair

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What’s the Focus?

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

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

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

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

Some bipartisan support:

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

Other issues:

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

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

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

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

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

Best, Thair

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The Eyes Have It

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

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

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

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

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

Here are some tips from the American Academy of Ophthalmology:

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

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

Best, Thair

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Medicare Part B – A Lifesaver

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

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

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

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

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

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

Best, Thair

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

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I Can See Clearly Now

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

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

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

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

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

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

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

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

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

1. Find an eye doctor you trust.

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

3. Add more movement to your day.

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

5. Step up your healthy eating game.

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

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

8. If you smoke, make a quit plan.

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

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

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


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Lowering Drug Prices – Two Different Approaches

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

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

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

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

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

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

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

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

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

Best, Thair

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Town Hall on Drug Pricing Legislation – A Recap

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We then had some final comments:

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

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

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Our Medicare Prescription Drug Benefit – It Works PART II

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

Medicare Today Town Hall

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

Guest Speakers

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

Thair Phillips 
Former President and CEO of RetireSafe

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

Register Here

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

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


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

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Our Medicare Prescription Drug Benefit – It Works

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

Medicare Today Town Hall

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

Guest Speakers

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

Thair Phillips 
Former President and CEO of RetireSafe

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

Register Here

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

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


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Alzheimer’s and the Summer Solstice

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

1. Go to the Park

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

2. Attend a Fitness Class

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

3. Walk to Health

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

4. Work in the Garden

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

5. Dance

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

6. Schedule A Health Screening

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

7. Volunteer

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

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

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

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

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

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

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

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

Best, Thair

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Osteoporosis Month – A Chance to Make a Difference

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

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

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

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

During your visit with your doctor, remember to report:

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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Drug Price Hearing

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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Medicare Quiz – The Answers May Surprise You

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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A Harmful Path on Drug Pricing

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

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

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

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

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

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

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

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

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

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

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Town Hall – Survey Results

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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Who Do We Trust?

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

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

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

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

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

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

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

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

Best, Thair

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National Minority Health Month

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

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

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

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

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

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

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

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

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

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

Best, Thair

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American Diabetes Alert Day

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

Here’s what we know:

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

When is normal coming?

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

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

What risks remain?

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

Best, Thair

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Springtime Medicare Refresher

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

Best, Thair

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H.R.3 – Legislation That Will Suppress Innovation

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

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

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

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

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

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

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

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

Stay safe and healthy, Thair

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Virtual Townhall on Vaccinations – Recap

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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Medicare – What Can We Expect Under the Biden Administration

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

Register Here

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

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

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

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

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

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

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

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

Best, Thair

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Why I Got Vaccinated

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

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

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

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

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

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

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

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

Best, Thair

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Looking back, Looking forward

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

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

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

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

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

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

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

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

Best, Thair

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Glaucoma – The Secret Sight-Stealing Disease

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

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

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

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

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

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

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

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

Best, Thair

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Who Do You Trust?

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

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

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

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

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

Best, Thair

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Speaking Out in 2021 is Critical

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

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

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

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

Best, Thair

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It Just Makes Me Mad!

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

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

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

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

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

Best, Thair

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20/20 Hindsight

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

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

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

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

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

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

Best, Thair

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How Did Your Medicare Open Season Go?

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

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

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

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

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

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

Stay Healthy, Thair

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COVID-19 Vaccine – It’s Use or Lose

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

1. The Vaccine was developed to quickly.

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

Best, Thair   

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Thanksgiving – A Tough Year to Give Thanks

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

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

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

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

  1. Some family members may have died young

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

  • Many families tend to get these diseases

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

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

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

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

Stay healthy, Thair

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Our Latest Virtual Townhall – A Recap

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

Best, Thair

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

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

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

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

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

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

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

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

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

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

Stay healthy, Thair

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Vote – But Be Safe

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

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

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

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

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

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

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

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

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

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

Best, Thair

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Bone and Joint Action Week

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

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

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

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

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

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

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

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

Stay healthy and safe, Thair

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Medicare Open Enrollment – Important Options to Consider

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

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

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

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

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

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

1.Contact your local SHIP office.

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

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

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

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

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

Don’t forget to register to vote!

Stay healthy, Thair

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A Questionable Way to Change Medicare

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

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

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

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

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

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

Get your flu shot and stay healthy, Thair

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The President Releases a Hurtful and Ill-timed Executive Order

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

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

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

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

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


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Upcoming Webinar/Tele Town Hall

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

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

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

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

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

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

Best, Thair

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This month is Healthy Aging Month

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

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

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

1. Do Not Act Your Age

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

2. Be Positive

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

3.  Ditch the Negativity

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

4. Walk Tall

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

5.  Stand Tall

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

6. How Are Your Pearly Whites?

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

7. Lonely?

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

8. Walk 10,000 Steps A Day

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

9. Get Those Annual Check-Ups

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

10. Find your inner artist.

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

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

Best, Thair

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A Birthday Check List

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

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

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

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

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

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

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

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

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

Be safe and register to vote, Thair

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Our Legislative Focus

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

International Pricing Index/Favored Nation Pricing

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

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

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


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

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

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

Changes to Medicare Part B

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

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

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

Part D Cap

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

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

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

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

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


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News Break!

NEWS Break!

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

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National Immunization Awareness Month

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

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

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

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

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

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

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

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


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Medicare Today – Tele Town Hall Overview

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

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

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

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

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

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

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

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