DEALING WITH THE REALITIES OF HEALTH CARE TODAY

 REAL WORLD STORIES - We all have read, or watched reports on television, about the latest horror stories about the economy and the ham-handed attempts by our president and his minions to “fix” it.  The troubles spread like tentacles throughout our society, including the availability and cost of health care.  Well, here is a personal, real-life story to give you some perspective.

LOTS OF DOCTORS - At our advanced years my dear wife and I have nearly a dozen doctors between us.  We share some and have individual personal specialists, too.  We joke that if we didn’t have doctor appointments we’d have no social life at all.  In recent years several of them have retired, passing us on like a couple geriatric batons to the next health care provider.  A sign of the times is the fact that it’s getting tougher and tougher for our health care professionals to continue to provide excellent service without some kind of changes.

CONCIERGE SERVICE - A year ago my long-time cardiologist announced that he was converting his practice to a “concierge” model that would require those of us wishing to remain as his patients to fork over some cash annually so he will look after our heart and circulatory issues.  Some of us chose to remain with him, but his practice diminished by more than 80%!  No longer is he seeing 25 patients a day to “make his nut”.  Now he can, and does, spend much more time with each of his remaining patients and, under the new system, assures us he’s available almost any time by phone or text.  Yes, he still bills our insurance - Medicare and a supplemental insurance policy in my case - but I still have to pay him a few thousand dollars a year for the pleasure of his company.  He’s a great guy, but I worry that, as he sees fewer and fewer patients and performs intricate procedures less frequently, his once finely-honed skills will diminish and he will farm-out those procedures he once did regularly. I am seriously contemplating my future as his patient. 

MY INTERNIST WILL JOIN THE RANKS - Last week I received a notice from my internist that he, too, is making some changes.  He’s been my primary care physician since he bought the practice five years ago from my previous internist, who had been my guy for 35 years.  His practice is part of a larger, well-established group that has been run efficiently for decades.  Because Medicare insurance coverages have been reduced, including no reimbursement for telemedicine consultations, he has found it necessary to join others within his group and find another way to cover his costs.  He thinks a “hybrid concierge" model will work for him.  I will have three choices.  The first will be to pay $500 a year for something he describes as an “Administrative” fee - basically business as usual, but it will cover the cost of an annual physical exam and related lab tests.  Presently my insurance doesn’t cover the total cost the exam, so I pay a couple hundred dollars out of pocket. This option seems to be fairly reasonable.  The second will be a “Concierge” fee - less than my cardiologist’s fee, but not insignificant - which entitles me to all of the above PLUS “almost guaranteed” access to him 24/7/365 - except when he’s doing family stuff.  I joked with my wife that if I chose that option I’m going to be making calls to his cell phone at 3 am, just to test the service!  My third choice is to not select either option and no longer be his patient. I will have to find another physician to provide me with primary health care.

DON’T GET EXCITED - Actually, I’m not surprised about this change.  I’ve spoken with both the above doctors at length about how things are changing in the health care arena.  I get it.  The government is tightening the purse strings, so many health care professionals are re-examining their business models.

AND THERE’S MORE - The above news came on the heels of an announcement by our Long Term Care Insurance provider, to whom we have been paying premiums for two decades, that, beginning next month, they will phase in a 40% premium increase over the next 3 years.  We have been given options to continue with our coverage as is and pay the premium increase or exercise one of several options to change our coverage and/or duration of the coverage at reduced premium levels or to just stop paying premiums and have a very reduced benefit equal to the premiums we’ve paid - not a good option.  Based on our analysis, that would cover us at the current daily rates for about nine months.  This is forcing us to think very hard about one of the great “what ifs” in the world of us geezers - “What if we require long term health care?”  And, compounding the complication of our decisions, we found buried in the text of the multiple pages of this announcement, a paragraph telling us that the rating company, A. M. Best, thinks the company might not be able to fulfill it’s benefit payment obligations downstream.  Yikes!

COULD BE COMING TO YOUR NEIGHBORHOOD, TOO - It’s our understanding, based on conversations with other folks who advise us on personal health and financial issues, that this is very likely the wave of the future and, if it hasn’t hit you yet, it may be coming to your neighborhood soon.  Nobody really knows the long-term impact of the draconian moves by our current President and his minions on the availability and cost of health care.  We DO know that the recent announcements of drastic staff cuts at the Veteran’s Administration will dramatically negatively impact my fellow veterans - men and women who served our country when asked and need our care the most.

WHAT’S NEXT? - Well, we will have some very serious decisions to make regarding our health care future, both near and long term.  I don’t really want to change doctors, so I will likely select one of my primary care physician’s options and stick with him,  He’s a youngish guy who very likely will outlive me.  As far as my cardiologist is concerned, we’ve been around the horn for a full cycle as a ‘concierge patient” and I’m seriously wrestling with the whole “value received for payment made” issue. Perhaps I will just rely on my primary care physician and head to the nearest ER if I have a heart issue.  I'm paid-up for the rest of this year, so that decision can wait awhile. The Long Term Care issue is a bigger dilemma.  Without a crystal ball we just don’t know what the future holds for us, health-wise.  Our respective family histories tell us we’ve already outlived our parents and we are, knock on wood, in relatively good health.  So, do we roll the dice and reduce the coverage or duration for a reduced premium or stick with our coverage to the tune of thousands of dollars in premiums per year? At our ages we now see friends and family members dealing with these kind of issues frequently.  As I said, it is a dilemma - one we must address soon.

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GREAT TIMING - How's this for a coincidence?  Twenty minutes after I posted this entry we received mail notification that our Supplemental Health Care Insurance premiums will increase 15% in June!  The beat goes on, and on, and on...

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OUR ADVICE TO YOU? - That’s easy - live every single day as if it was going to be your last!  Try to stay healthy!  Enjoy your lives!  Be kind!  Make someone smile every single day!  If you want to do something, DO IT!  If you want to travel to some exotic place, find a way to do it!  Many of you have done that, or are doing it!  Good for you!  Running out of friends?  Make some new ones!  Join a club!  Visit a Senior Center!  Take up a sport - pickleball is addictive and very social!  Write your memoir!  But… plan for the next steps.  As the clock ticks, and the calendar pages flip, there are fewer easy choices, so make the necessary tough choices now.  If you have not done so, write a will or create a trust and a durable power of attorney for your health care.  Make your wishes crystal clear.  And, my friends, tell those you care about exactly how you feel about them.  

Tell them you love them. 

I'M WILLING TO CONCEDE IF.....

(photo courtesy of NBC News)

FOR THE RECORD

President Donald J. Trump has been in office for the second time for 46 days as I write this, although sometimes it has seemed like 46 years.  

A REFRESHER

Most of you who read the things I post and share on my Facebook page  and here on my blog know how I feel about Trump.  A refresher - I think he’s an ignorant, arrogant, self-absorbed, vindictive sociopath with no real affection for our country, as demonstrated recently by his willingness to spit in the eye of ALL our allies and cozy-up to leaders of countries who have been our greatest enemies - Vladimir Putin in particular.  

A CHRONIC BUSINESS FAILURE

He touts his success as a businessman as a qualification for the job of the leader of the free world, when his history demonstrates failure after failure after failure in his businesses. 

A PATHETICALLY SLOW LEARNER

Despite already having held his office for 4 years, he still fails to understand that government is not, and cannot be run as, a business.  Government’s sole purpose is to provide safety and services to the citizens of this country.  It is not, and cannot, be a “profit making” enterprise - a completely alien concept to Trump. 

HE SURROUNDED HIMSELF WITH LOYALISTS, NOT SEASONED PROS

In his attempt to “remake” government Trump has surrounded himself with loyal sycophants - some of whom have little, if any, qualifications for high ranking positions in government.  They “think smaller” than is required when acting on behalf of the President of the United States of America.  Many of them “shoot from the hip”, attempting to emulate and impress their boss.

A BULLY, NOT A STATESMAN

He demonstrates absolutely no aptitude for statesmanship, choosing, instead to berate and bully those with whom he must deal. 

WHEELER DEALER

That word, “DEAL”, is the cornerstone of his existence.  To him EVERYTHING in his life is a “deal” - every breath he takes is part of a “NEGOTIATION.”  And, in his life, many of those deals have failed badly!

THE GAZA SOLUTION - BONEHEADEDNESS PERSONIFIED

His “Gaza Solution” - to dislocate nearly 3 million residents of that area, scrape it down to dirt and rebuild it as the “Riviera of the Middle East” - is beyond hair-brained, conjured up with no apparent actual thought to where all those people will go and what kind of societal turmoil it will create for them and the entire middle east. 

COSTLY ARROGANT IGNORANCE ON DISPLAY

Without really understanding the monumental negative impact of his actions, he has unleashed the unelected, un-confirmed Elon Musk and his minions on the government like a pack of rabid pit bulls, where they are attempting to dismantle many of the essential functions of our government without apparent concern for the damage they are doing.  By firing tens of thousands of government employees across the spectrum they will create chaos when essential services are abandoned.  Veterans will be forced to stand in much longer lines to receive necessary services.  National Parks will be shuttered due to lack of staff to manage them.  Social Security payments may be delayed or abandoned altogether.  Income tax filings may be delayed because of dramatic staff cuts.  The beat goes on and on and on, with no real end in sight.  

HAIR-BRAINED IDEAS

He spontaneously combusts with hair-brained ideas, like levying onerous tariffs on goods imported from some of our most important trading partners, apparently not caring that it is the American consumer who will be paying the bill.  And, the reciprocal response will kick us consumers in the teeth - twice!  Yep, that $45,000 Canadian-built Toyota RAV4 may end up costing you $55,000!  If you live in a few of the northeast states who import their electricity from Canada your next bill will be a whopper!

HIS “GOLD CARD” PATH TO CITIZENSHIP

While probably not illegal, his scheme to permit wealthy wannabe immigrants to purchase a path to citizenship by simply forking over 5 million bucks for his “Gold Card”, along with some amorphous promises to ‘build businesses and create jobs”, makes me uncomfortable while less wealthy immigrants may end up imprisoned at Guantanamo Bay.  

ADIOS, USAID

He attempted to cease payment to organizations contracted to provide goods and services on our behalf around the world.  Those actions will, in fact, bankrupt many American businesses, including large numbers of farmers for whom the United States Government is their only customer.  

MORE BULLYING

He mistreats and harangues leaders of other countries as they pay homage to him.   Yeah, he’s the most powerful man in the world, but he doesn’t have to treat people like they’re his servants! 

WITH FRIENDS LIKE HIM…

He has abandoned the people of Ukraine in their most dire time of need because their president, Mr. Zelenskyy, failed to pay "proper respect" to Trump in their recent Oval Office engagement. He accused Mr. Zelenskyy of flirting with “World War III”, when, in fact, it is Trump’s behavior that is steering us toward that brink. 

THE PARALLELS ARE UNDENIABLE

He, much like Hitler in the late 1930s, overtly expressed in no uncertain terms an interest in taking Canada, Greenland and the Panama Canal by whatever means necessary because “we need them”. 

AND MORE...

These are just of the few more "memorable" gaffes Trump has perpetrated since being inaugurated in January.  You may remember many more, but you get my drift. 

MARK YOUR CALENDARS - I WILL CONCEDE IF…

But, despite all the anger and distrust I feel for Trump, I am willing to concede that I’ve been wrong about him if, by one year from today, he has actually accomplished the things he seems to be trying to attempt to do, although very much like a bull in a china shop, without destroying our country.  

*If he has stemmed the flow of illegal immigrants and drugs across our borders without going to war with our neighbors to the south and north.

*If he has rebuilt our economy and, by doing so, driven prices on essential goods and services down as he promised.

 *If he has managed to orchestrate a peaceful conclusion to the Ukraine/Russa war without forcing Ukraine to give up even more land to Putin. 

*If he has helped orchestrate peace in the Middle East without uprooting entire populations.

*If he has mended fences with our NATO allies and helped them become stronger both economically and militarily.

*If he has managed to keep China from taking Taiwan without us becoming involved in a Pacific War again.

*If he will begin acting Presidential and stop acting like a dictator in a 3rd World country.  Just follow the darn script on the teleprompter, for goodness sake!

*If he will focus his ICE agents on seeking out the real criminals among the illegal alien population and stop terrorizing hard-working citizens in our minority communities.

A YEAR IS ENOUGH

Based on his blitzkrieg through our government since taking office less than 2 months ago, a year is plenty of time for him to accomplish his promised goals without destroying our country.  I will not promise to agree with his self-assessment that he’s the “greatest American President”.  He recently conceded that "maybe" George Washington was our greatest President.

ONE FINAL THING, MY FRIENDS…

Some of you reading this are actually my friends, not just “Facebook Friends”.   Some of you are both.   I value every one of you, even if you disagree with me.  Unlike Trump, I accept the fact that others may have a different view of things than I do - such is life.  And, I respect your right to express that disagreement without fear of retribution.  Of course, I feel you should always agree with me. (That’s a joke)  What I do NOT want to happen is for us to stop being friends.  If what I write bothers you so much that it angers you,  then please, by all means, stop reading it.  As I’m permitted to do in this Representative Republic, I will continue to express my views, for whatever they are worth.  For me, they are not worth losing a good friend.  So, off we go, with fingers tightly crossed for the future of our wonderful country.  

                                              

GRIEF, ANGER AND FRUSTRATION

A REMEMBRANCE - A year ago I wrote HERE about the passing of a friend - a man I'd known since the first day of kindergarten.  It was a melancholy remembrance, posted to mark a major change in my life - a time when more and more friends and acquaintances depart their earthly ties.

ONCE MORE - Early this morning I wrote on my Facebook page about the passing of a very dear friend and neighbor, Barry Mason, yesterday evening.  My wife and I spent a few hours at his home comforting his long-time companion and helping her deal with the necessary details involved with this kind of a situation.

THE POTOMAC PLANE CRASH - Meanwhile, most of the country was glued to their televisions, watching the coverage of the crash between a commercial airliner and a military helicopter over the Potomac River adjacent to Reagan International Airport in Washington, D.C., looking for explanations and grieving the 67 souls lost in that tragic accident.  None were yet forthcoming.

IDIOT-IN-CHIEF - I awoke a little late this morning - I didn't actually hit the sack until around 3 a.m. as I contemplated the passing of my neighbor.  I immediately called his companion to be sure she was doing OK, then checked communications from friends and found several expressing outrage at the comments being made by President Donald Trump about the air accident.  When I finally dragged myself out of bed, cleaned up a little and, through bleary eyes, I watched replays of  news reports of the accident, including Trump's comments.  I was stunned by the thoughtless, heartless, ignorant speculation he was spewing to the world on the issue.  He had already decided the accident was due to misguided DEI hires and was blaming the Biden administration - before a single fact about the crash had been authenticated!  All the while,  loved ones of the crash victims are looking for the truth, not speculation by the President, yet, that's what they, and we, are getting.

SAME AS THE FIRE INFORMATION - This kind of uninformed, speculative, bloviations were exactly the kind of bilge he puked out at the press event after touring the Palisades Fire site last week.  He chided state and local officials for not "turning on the spigot" to route more water from the Pacific Northwest to quash the fires - which, according to actual knowledgable experts, would not have helped with 100+ mph winds fanning the fires.  He consistently fails to grasp his depth of ignorance on important issues (I guess that's kind of redundant, huh?)

GRIEVING MORE THAN THE LOSS OF FRIENDS - Today, running on fumes, I continue to grieve the loss of my dear neighbor and friend.  Today I also grieve for our nation that has elected an ignorant,  callous, thoughtless bully as the President of the United States.  I grieve because, based on his public utterances and actions after only a few days in office, he shows us the path he is planning on taking this country over the next 1,451 days - and I'm terrified!

DESTROYING THE ECONOMY, ALIENATING ALLIES AND PROVOKING ENEMIES - Every day we see him perform acts and making statements that seem aimed at destroying the very foundation of this country - the Constitution!  Time after time he attempts to toss aside portions of that document designed to provide protection for us all from abuse of power and - dictatorship!

APPOINTING INEXPERIENCED SYCOPHANTS AND BOOTLICKERS - We've seen him nominate some candidates for senior advisory positions who bring almost no relevant experience to the job - just blind loyalty to the man himself.  This reeks of behavior of a certain World War II dictator who began exactly the same way - and I am terrified.

HIS BEHAVIOR SHOWS US JUST WHO HE IS - Trump has demonstrated that he is a mean-spirited, vindictive, ignorant human being throughout his life and with recent actions.  During his first tour as President he surrounded himself with old hands in government - men and women of great character who actually understood the jobs and tried to do them to the best of their abilities.  Trump fired many of them when they pushed back on his inane proposals.  Since taking over two weeks ago he has cancelled protections provided to a few of them - protections necessary because of their actions and views expressed in their service to this country made them subject of death threats by foreign governments and others.  Without careful contemplation of the impact of his actions he issued a few dozen Executive Orders, many of which gut existing programs and place tariffs on goods from countries that will certainly impact American consumers in a very negative way.  He bellows brainless screeds, then is forced to have his staff backpedal when legal challenges are put forth.  He is a blustering, brainless buffoon who poses a real threat to our form of government and way of life.

FINGERS CROSSED - So, sleep-deprived as I am this afternoon, I will do my best to contemplate a bright future for our country as real, honest-to-goodness fine human beings like my neighbor pass on.  As a friend recently reminded me, Tocqueville told us that we will get the government we deserve.  Will we ever learn?

PRESIDENT TRUMP ON THE CALIFORNIA FIRES

Last Friday President Trump marked "disaster Friday" by first visiting the North Carolina site of the carnage caused by Hurricane Helene, then flew directly to the Los Angeles area where he helicoptered over the Palisades Fire site, ignoring the larger and more destructive Eaton Fire site.  Following that flight he and his wife participated in a "round table" discussion with federal, state and local officials.  This was widely covered by local and national media.  I observed the entire session and wrote about it on my Facebook page.  The following is the text of what I wrote.

VIEWING TRUMP AND FOUR-LETTER WORDS...

Around 5 p.m. Friday afternoon I began watching television coverage of President Trump on his tour of the Palisades Fire site and the subsequent "round table" (even though the table was not "round" but in a "U" shape).

GRATEFUL... BUT

First, I'm very grateful to the President for taking the time to visit the sites of the Hurricane Helene disaster in North Carolina and then flying across the country to view our catastrophic site - or one of them.  I thought it was interesting that, for some reason, he chose to not fly 10 minutes away over to the Eaton Fire site - where more homes and businesses were destroyed - to give him a more complete perspective on the carnage caused two weeks ago.  The cynic in me thought he chose the Palisades site (including Malibu) because it was the location of much wealthier residents.  The Eaton Fire destroyed the homes of many more middle class families - and most of them were black.  Just a thought

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WATCHING AND LISTENING

During the press event a wide array of local, state and national politicians were present, along with many senior public safety leaders and a few "regular" people.  During the lead-in to the event he met many firefighters and was presented with a firefighter helmet with "47" emblazoned on it.  He lugged it around proudly (mentioning that firefighters must be in good shape because the helmet was very heavy) and displayed it on the table in front of him during the chat he held with those present.

PAINFUL, PAINFUL, PAINFUL!

As I watched him express concern for the devastation he'd just flown over, and the angst expressed to him by "several people" who lost their homes, I became very frustrated and disappointed as he devolved into a teenager in a 78 year-old man's body - his normal modus operandi when he's flying solo without a teleprompter.  I don't for one second doubt his sincere concern, but I just can't abide his juvenile presentation when he couldn't help but expose his inner-bully. 

 

INFANTILE, ILL-INFORMED

I found myself yelling many, many four-letter words at the TV screen as he presented "facts" that were falsehoods.  Somewhere in the recent past one of his salivating sycophants must have told him that "all they need to do to fight those kind of fires is just turn on the tap from the Pacific Northwest and Canada so they'd have plenty of water", because that's the bilge he spewed many times during the event.  Several news organizations "fact checked" him following this event, demonstrating the untruth of many of his pronouncements.

IT WAS ALL ABOUT HIM..

Throughout the event it was clear that he thought the whole thing was about him, and what a wonderful President he was (his words) for visiting and "helping".  Time after time he made that point - observing that "a previous President" wouldn't have done this.  I found myself yelling "WTF" and other epithets at the screen.

"CONDITIONING" THE HELP

Earlier in the day he had told the world that for California to receive federal aid in recovering from the fires it would have to meet certain conditions, including voter ID and cleaning the forests!

 

PERMITS

During one screed - several times, actually - he demanded that the permitting process be basically abandoned so people - apparently those wealthy folks who lost homes with whom he had just spoken - could "clean up their lots" and get started re-building "tomorrow"!  He showed no signs of actual knowledge about the process of remediation of those disaster sites.  He apparently was willing to let the property owners dive right into the toxic residue of the fires with a shovel and wheelbarrow, ignoring the danger involved.  State and local leaders had already laid the groundwork for streamlining the permitting process. 

ADIOS, FEMA

One of the more interesting pronouncements he made was to imply pretty clearly that he was going to shut down the Federal Emergency Management Agency - FEMA.  Apparently he heard horror stories in North Carolina earlier in the day about the "poor performance" of FEMA personnel at that disaster site.  So, he was considering shutting the whole thing down and just turn the keys to the recovery bank over to one person - maybe his pal, Rick Grenell, who was sitting beside him.  Yikes!

"LOOK AT ME!  I'M STUPID!"

 Again, our President is more than willing - yes even enthusiastic - to demonstrate his ignorance on important issues, and then compound the issue by jabbering juvenile stream-of-consciousness gibberish attempting to make his point. He does this time after time and it's terrifying to contemplate what kind of exchanges he must have with more mature, well-educated, intelligent heads of state.

THANKS, MR. PRESIDENT

So, I want to thank President Trump for coming out to see the devastation and helping folks understand the scope of the damage.  Now, please, Mr. President, just get out of the way, send us the money, let the professionals do their jobs and STFU!