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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 Axios.com, if you’ve been vaccinated for COVID-19, you have less than a 0.1% of testing positive for COVID-19 and all of its variants. If you know someone who hasn’t been vaccinated, listen to them, listen to why they haven’t chosen to be vaccinated. Tell them how liberated you felt when you got vaccinated.

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

Best, Thair



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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.

Best,
Thair



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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: 

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

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



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Our Medicare Prescription Drug Benefit – It Works

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Best, Thair

Medicare Today Town Hall

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

Guest Speakers

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

Thair Phillips 
Former President and CEO of RetireSafe

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

Register Here

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

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

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



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Alzheimer’s and the Summer Solstice

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

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

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

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


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

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


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

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

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

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


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

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

Best, Thair