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.