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.