Medicare: Choosing The Right Plan

Medicare: Choosing The Right Plan

Medicare is one of the most transformative laws in U.S. history

Medicare: Choosing The Right Plan

by D. S. Mitchell

AARP Contribution

I am convinced one of the best publications for a senior citizen is AARP magazine. This little newspaper is a gem. A year ago Dena Burns wrote an article on how to be a smart consumer when it comes to Medicare benefits. I thought her observations were worth passing on.

Important Calendar Events

I can’ t stress this enough. When it comes to signing up for Medicare, time matters. So, sign up on time to avoid hassles and higher monthly premiums. The initial enrollment time is called the IEP, unless you have health insurance through your job or your spouse’s. The IEP spans 7 months; the month a beneficiary turns 65 and the 3 months before and after that birthday.  Missing the IEP can cost you, for the rest of your life. Here’s how it works for parts A, B, and D.

  • Part A: This is the hospitalization portion of the program and covers hospital stays and short term nursing facilities. If you miss your deadline you will have no coverage until you enroll.
  • Part B: This portion of the program covers doctor services, outpatient and preventive care along with some covered medical supplies. If you miss your enrollment deadline your premium will increase by 10 percent for every 12 months you are overdue in signing up. As an example, if you sign up 2 years late you will pay an estimated $6,500 more in monthly premiums over the next 20 years. 
  • Part D: Part D helps pay for prescription medications. In this case, if you miss your IEP your monthly premium will increase by 1% each month you remain unenrolled. In 2019 the average monthly premium was $31.83.  As an example, if you delay for 24 months to enroll, you will pay an additional $8.00 per month for your coverage for life. (* I personally have a  story regarding Part D.  I was hit with the additional 1% when I filed nearly 2 years late for Part D. In my case it was my employers fault and when I appealed the decision and it’s penalty I won the appeal because my employer had failed to provide the information to me, although they had provided all the enrollment information on Parts A and B.*)  So, remember, in some cases you can appeal the ruling and win, but it is easier to do it right to start with.
  • Once you are enrolled it is important to make a note each year that between October 15 and December 7 you can legally switch coverage for the upcoming year.

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Health Care Goblins We Ignore

Health Care Goblins We Ignore

By D. S. Mitchell

Grassroots Platform

Over the last couple of days Calamity has focused on Medicare-For-All. But there is more to the story of  health care in America. Www.CalamityPolitics.com gives me a grassroots platform to discuss health care. But, it does not give me the right to manipulate facts or lie about the issues. With that said, I am sharing opinions developed through my years of ground level experience in health care, otherwise known as trench warfare.

Street Level Experience

I am a baccalaureate prepared RN, and have worked nearly four decades in major hospitals in Oregon, Washington, California and Nevada. On the battlefield I have formed many opinions about the scope of care we give our patients and how to deliver better client results.   I’m not only experienced, but I am passionate about health care and how to improve it.  Mine is a pragmatic common sense small world approach to these issues. I am not a policy maker.  I do not have a doctorate in nursing or public policy. It is important to leave policy creation to the experts. My comments and opinions come from a community view.

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Lies About Medicare For All

Lies About Medicare For All

By D. S. Mitchell

 

Drop The Labels

Honest health care policy experts know that the solution to fix the American health care system is staring us in the face, and it is single-payer. Whether dubbed “Medicare-for-All” or an “expansion of Medicaid” through ObamaCare. The solution is easy when labels like “socialism” “liberalism” “progressivism” are ignored. Trump and his DOJ is in court at this very moment trying to invalidate the ACA (ObamaCare). It seems that the more resistance Republicans arouse over destroying ObamaCare the voices for Medicare-for-All grows louder.

Health Care As A Right

The evidence is clear, Americans believe that every person has a right to health care, irrespective of their ability to pay. We as a people, believe that we have an obligation to take care of each other. In fact, there is more momentum for the adoption of a single-payer health care system than at any time in our history.

Scuttle Safety Net

Despite its enormous popularity and unparalleled record of success Republicans are neck-deep in their war against the nation’s health care safety net, whether it is Medicare, Medicaid or the ACA.  New Republican proposals have emerged since the 2016 election that would slash benefits for the elderly and leave older Americans at the mercy of the “for profit” insurance industry.

Voucher Plans

When Paul Ryan was Speaker of the House he was extremely vocal in his attacks against both Medicaid and Medicare. He supported a voucher program that would transfer more costs on to seniors and leave them at the mercy of the private insurance industry.  Just because Ryan is gone, doesn’t mean that the Republicans have jettisoned that philosophy. The actions to undermine Medicare and Medicaid are ongoing and must be stopped.  It is not just about protecting our existing Medicare system, it is about ensuring that every citizen has access to excellent health care as a right. In such a system it definitely works best when “everybody is in, and nobody is out.”

An American Tragedy

It is believed one hundred Americans die everyday from the lack of health insurance. That is over 30,000 unnecessary deaths each year and that number is expected to grow steadily over the next decade. This is an American tragedy.

Republican Tax Scam

The Republican tax scam was hard on American health care. Millions remain uncovered and millions more are losing coverage due to increased cost for insurance brought on by the elimination of the ACA insurance “mandate”. The insurance mandate was a device used by the ACA plan to expand the pool of healthy people in the system to keep prices down.

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What You Don’t Know About U.S. Health Care

“I think the health care market is functioning perfectly.  The problem is that the market is producing profits, not health.”  Unknown

Understanding U.S. Health Care                         

By D. S. Mitchell

Around The World

Things you don’t know about U.S. health care starts with understanding how other world governments look at health care. Government leaders in other developed countries have defined two basic tenets: 1.) health care is a right AND as such, is different than typical free market arenas.  2.) when the ‘invisible hand’ of Adam Smith’s free market philosophy controls a nation’s health care system the result is higher costs and sicker citizens.

In 2011, Jason Adkins commented in a Catholic Spirit article, “slavish adherence to ideology in politics can and does inflict harm to the very people public officials claim to serve.”

Failure Of Competition

One basic element rarely discussed is failure of competition.  The hospital industry is highly concentrated in areas with higher populations while under serving the rural populations of the U.S.; often leaving rural hospitals subject to failure.  As with hospitals, “health care services don’t really compete with one another as equal goods,” The Health Care Congressional Committee (2011).

Each Individual

My doctor’s care is different from the care provided by my neighbor’s physician.  The neighbor’s medications are different from mine.  My response to care is different from my cousin.  These variables make sure that no case can ever be the same.  Thus, in health care; there is no such thing as “equal goods”.

Don’t Expect Better Results

An unknown source made this insightful comment, “I think the health care market is functioning perfectly.  The problem is that the market is producing profits, NOT health.”  Hmmm.  Patients most likely would call this failure.  However, for all facets of the health care industry, profits are spectacularly high, so it can be claimed that the market is a success and doing what it is intended to do, make money. To expect better health care results would be unrealistic in this environment.

An Obvious Dilemma

A very obvious dilemma exposes itself.  Two separate and divergent end desires.  The free market wants profit.  The citizenry wants good, inexpensive health care.   The ideology of profit and successful health care delivery do not coincide.  Since the primary goal of the free market is profit, “Any diversion from this goal is inefficient and against the interests of the holders of capital,” Mark Sokr concluded in congressional testimony in 2011.

Selling Health, One Tablet At A Time

It is not just hospitals. The advertising gurus have taken Big Pharma to the masses. Through near constant media indoctrination the public has been brain washed into believing that there is a prescription (solution) for everything. Isn’t modern medicine wonderful? Unfortunately, the picture is false. Yes, modern medicine is great, and we can do truly amazing things. Unimagined a century ago. But the goals of Big Pharma are not the same as the consumer. Big Pharma wants to sell you a product, over and over, day after day, year after year. You want to heal. So you can stop taking medication. Those goals are not compatible.

Defining Factors

Non-Modifiable:  unchangeable circumstances, such as age, gender, race, genetics.

Modifiable:  changeable circumstances, such as life style choices. Things that can change.  Most particularly, cigarette smoking, poor diet, inactivity, alcohol abuse (or overuse), and chronic stress.  The link between lifestyle choices and chronic illness are undeniable.   Knowing that unhealthy behaviors leads to chronic disease, does not lead people to making better choices, but that needs to change.

You, Your Family, Your Community

“I’m going to die from something,” is the most common response people make when confronted with their poor life style behaviors.  That response is an easy, quick go to, not a thought out desired destination. That “I’m going to die from something” answer gives no regard to the overall effects of that attitude on yourself,  your family, your community or your country.

Predictors

Predictors of chronic illness: smoking, processed foods, fast foods, starchy carbs, bread & pasta, sugar drinks, excess alcohol, overeating, excessive salt use, sugar, high fat diets, and lack of exercise.  These behaviors will lead to obesity.  Obesity increases risks, particularly of diabetes, cardiovascular disease and certain forms of cancer. We, as thinking creatures, are capable of health promoting decisions.

Smoking Dangers

Smoking is the leading preventable cause of chronic illness and death in the U.S.  One in five deaths is directly related to smoking.  Statistics show that 10 times as many Americans have died prematurely from cigarette smoking than have died in all American wars.  Smoking hardens arteries and causes the heart to work harder and causes emphysema and COPD.  Smoking causes 80% of all COPD deaths and 90% of lung cancer deaths.  Additionally, smoking is a major cause of throat, bladder cancer, voice box, liver, pancreas, stomach, kidney and colorectal cancers.

5 Lifestyle Killers

Lifestyle diseases kill more people than communicable diseases.

The top five killers are:
1.) Diabetes
2.) Cardiovascular disease (High Blood Pressure, Heart Attack, High Cholesterol)
3.) Stroke
4.) Chronic Obstructive Pulmonary Disease (COPD)
5.) and certain forms of cancer.

More than 70% of deaths in the United States are attributable to one of the 5 listed lifestyle diseases.  Even more alarming is that 75% of the U.S. Health Care dollar is spent on those same listed diseases.  Furthermore, the numbers do not reflect the personal and economic burden of chronic illness, lost work days, low productivity, disability, and poor quality of life.

Become Your Own Best Physician:

1.) Stop smoking 2.) Lose weight  3.) Switch to a plant-based diet 4.) Exercise at least 7 hours per week 5.) Reduce stress
6.) Practice good dental health 7.) Have fun, enjoy life

Conclusion

To slay the goblins in our health care closet it seems to me that we need to drop the ideology and look at the facts.

1.) Prevention must become the primary health care goal of this country.  Prevention is within our reach. Confronting life style disease can  cut the cost of health care by billions of dollars. 2.) Give up the idea that a pill will fix everything.  It is just well done marketing. This includes re-educating our Big Pharma brain-washed doctors.  Doctor’s need to direct their patients to a healthy lifestyle and stop handing out a pill for every complaint. Tough love, as the behavior mod guys say. 3.) Personal responsibility and self advocacy must become the center of each individual’s health care and ultimate well-being. I know we are all innately lazy and we all love our bad habits, but those bad habits are contributing to significantly shorter life spans and skyrocketing health care costs. 4.) Accept the proven fact that “free market” systems are by their very nature, inappropriate for health care and continuously fail both in delivery and results. 5.) A single payer system delivers the best and least expensive care.  As a massive consumer ‘the single payer system’ buying power can force down prices across the spectrum of health care.

About The Author

I am a retired RN. I worked nearly 40 years in hospitals in Oregon, Washington, California and Nevada as a travel nurse. Although I am retired, I am still passionate about health care. I am an advocate for universal health care. I never want to know of another patient denied health care services, because they lack insurance, or have poor coverage.  Because of my street level experience, I have strong opinions on the state of health care in America and how we can make it better. At the core of that vision is a society that encourages good health through good behaviors and a happier life style.

 

6 Lies About Single-Payer Health Care

SINGLE-PAYER HEALTH CARE LIES

By D. S. Mitchell

Drop The Labels

Honest health care policy experts know that the solution to fix the American health care system is staring us in the face, and it is single-payer. Whether dubbed “Medicare-for-All” or an “expansion of Medicaid” through ObamaCare. The solution is easy when labels like “socialism” “liberalism” “progressivism” are ignored. Trump and his DOJ is in court at this very moment trying to invalidate the ACA (ObamaCare). It seems that the more resistance Republicans arouse over destroying ObamaCare the voices for Medicare-for-All grows louder.

Health Care As A Right

The evidence is clear, Americans believe that every person has a right to health care, irrespective of their ability to pay. We as a people, believe that we have an obligation to take care of each other. In fact, there is more momentum for the adoption of a single-payer health care system than at any time in our history.

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TrumpCare 2: All In One Place

TrumpCare Two: All In One Place

D. S. Mitchell

First 100

I had intended to talk about Trump’s first 100 days, today. However, I decided it was more important to talk about the proposed Republican health plan, TrumpCareTwo.  The 17% of Americans that supported TrumpCareOne should be thrilled with Episode 2.

Rural Perspective

Rural isn’t just about cows and open spaces. There are many faces to rural health care. I live and write from the beautiful Oregon coast.  I live half way between Seaside, Or. to the south, and Astoria, Or. to the north. The small beach development that I inhabit has a heavy preponderance of seniors. Most people living in my little enclave are old, medically fragile with pre-existing conditions, and living at the poverty level, dependent on Medicare or Medicaid for government supported health care.  In this little community, people will be negatively effected by the Republican proposed health care changes.

Critical Access Hospitals

Health care in the rural areas of the country is very different from urban health care.  Within forty miles of my house there are two small hospitals.  In that sense I am very fortunate. I know that Columbia Memorial Hospital, in Astoria, Oregon, is a Critical Access Hospital.  CAH is a designation given to certain rural hospitals by the Centers for Medicare and Medicaid Services under a 1997 Budget Act. The CAH designation was in response to a tsunami of hospital closures, particularly in rural areas between 1980 and 1997.

Closures Still Happening

Closure of rural hospitals continues today. Maintaining hospitals in rural areas is vital for a large section of the American population. These CAH hospitals are dependent on ‘rural access’ benefits, and cannot be sustained without them. Dramatic changes to Medicaid and Medicare could potentially end up with nation wide hospital closures, most particularly again in rural communities, as occurred in the 1980’s and 1990’s.

Andy Slavit Breaks It Down

Andy Slavitt @ASlavin provided a complete review of TrumpCare 2.  Take a look at what this know nothing president and his henchmen put together in a couple of weeks. They held no hearings. There was no bipartisan advice. Here goes:

  • Eliminates access to care for 24 million people. One million more people lose coverage than if ACA was repealed and had no replacement.
  • 7 million employed Americans, and 1.2 million veterans will lose coverage. Many employers will be able to avoid providing lifetime cap protection.
  • Premiums expected to jump 15-20%, $2,400 average. Up to $13,000 increase for people over 50, and up to $10,000 more for rural residents
  • Deductibles would increase 60%
  • Medicaid cut by 25% and then capped.  Seniors, babies, children, low-income, people with disabilities, addiction treatment hurt. 3.6 million kids expected to lose coverage.
  • Medicare Trust Fund put into crisis.
  • Insurance companies permitted to underwrite and charge sick people–like $5,000 more for Autism, $17,000 for pregnancy, $140,000 for late stage cancer treatment.
  • Projected premiums in high risk pool? Estimated $25,700.
  • Eliminates pre-existing condition protections which could impact 100,000,000+.
  • Lifetime caps and limits would be allowed if your upon state request.
  • Because they intend to allow selling across state lines, all these waived rules would apply anywhere.
  • 1.2 trillion pulled from health care to pay for massive tax cuts to pharmaceutical companies, insurers, insurer CEO’s, tanning salons & medical device companies.
  • In the average congressional district 55,000 people would lose coverage and 300,000 people could lose pre-existing protections.

A Generational Impact

“Doctors, nurses, hospitals, seniors, patient groups–not one of them agrees with these dangerous changes to health care”, states Slavitt. The Republican strategy has been to rush, get it done with no public hearings, no updated Congressional Budget Office score, suspension of rules, no debate, secret drafting, all closed-door sessions. For a bill that would have generational impact. Thanks again, to Andy Slavitt for laying it all out for us. He told me to share.

Suzanne Bonamici Speaks Up

Suzanne Bonamici, Oregon 1st District Representative, said this in an email: “The latest version of Trumpcare has a lot in common with the first-except this time it’s worse. It would allow states to opt-out of providing essential health benefits –like maternal care, mental health treatment, prescription coverage, and emergency services-which would be harmful to millions of people across the country.  Once again we would go back to the days when people paid for insurance and then found out it didn’t cover them when they needed it. No one should have to choose between putting food on the table and paying for lifesaving medical procedures.”

The United Nations Is Concerned

Slavitt and Bonamici laid it out pretty clearly.  TrumpCareTwo is worse than TrumpCareOne. The state of health care in the United States is so alarming that the United Nations issued a statement.  The UN addressed an “urgent appeal” to the Trump Administration warning that repeal of ObamaCare (ACA) without adequate replacement could violate international law”.

My Opinion

All I can say is, it’s a sad day when the world community is more worried about the health care of the American citizens than their own government. Truly alarming.

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