HEALTH CARE ISSUES

About three months ago I was asked by a student taking a gerontology class to write my perspective on health care issues facing senior citizens. What I thought would be a short essay turned into a rather lengthy one. I was so fired up by it that, on April 4, 2008, I sent copies of it to my congressman, senator and to the three people who were running to be nominated as their parties’ candidate for president. I placed a cover letter on it asking them to review and act on it. None of them responded to it.

Until now I have hesitated to put it on my blog. Two things have happened today that have provoked me to do so. One is an email from AARP encouraging us to send links to our blog if they contain postings about our lives and issues we address on our blog. The second was an article in the paper about the huge number of people unable to afford health care.

Part of my essay addresses the need for universal health care for all families and individuals. Those of you who are facing the challenges of divorce and loss I am certain will identify with many of the issues commented upon in this essay. It is rather long, but I believe it is worth the effort of reading it.

In my next blog I will be posting three poems, two deal, in a humorous way with medical conditions, and medications. The other is a satire on politicians. (Could be either party.


HEALTH CARE ISSUES
As we age many changes take place in our lives which affects the whole “mobile” of our existence. As physical strength and its medical ills increase there is an increased need for competent medical and hospital care. Many of us are introduced to a multitude of medications. Most do not plan for these contingencies even though it is clearly a part of our cycle of life.
The Psalmist stated it very clearly this way: Psalm 90:10 (NKJV) “The days of our lives are seventy years; And if by reason of strength they are eighty years, Yet their boast is only labor and sorrow; For it is soon cut off, and we fly away.”

Many of us have been independent into our 70s when we find ourselves becoming more and more dependent on others. With some of us it presents itself in the form of no longer having the physical strength to maintain our homes. With others there is a decrease in mental competence. As our health declines we require increased medical attention. Those who gradually lose their ability to make medical and personal decisions, require intervention by family members, friends, social agencies and medical care providers. With the Psalmist we are prone to find ourselves faced with labors almost too hard to be borne; depression or sorrow may become our lot. For many this results in the need for mental health services, thus increasing health care costs. It makes some yearn for the time we will “fly away.”

If we, our families and Nation do not address what I consider FOUR major health care issues we will be faced with the almost overwhelming burden of the aging process. In a sense the golden years will be turned into fool's gold. And with that said, let us go on to look at the four C’s related to health care needs: Coordination, Cost, Complexity and Comprehensive Universal Health Care.
COORDINATION: There is a critical need for social and health care agencies to expend more effort with families in preplanning with aging parents. As a couple who have had to do planning with a grandmother and an aunt, who were showing symptoms of Alzheimer's disease we know how difficult this can be. Having had 30 years experience in social work and eight years in the pastoral care ministry I had knowledge of various aspects of planning with families, which most families do not have. Still the task that confronted us was almost unbearable. 2

Making such plans is very stressful and requires counseling from social workers, healthcare professionals, legal and financial advisors. A long-term care plan needs to be developed which includes life end planning. The final chapter of a book I wrote outlines how my wife and I made our life care and life end plan. I also developed, “My End Of Life Planning Guide” to help others as they address life end issues. It does not include placement planning. Free copies of the guide are available at my blog site: http://divorce-and-remarriage.blogspot.com/

COST AND COMPLEXITY: We hear many politicians and others talk about the need to contain health-care costs. These very same politicians when passing the infamous Medicare part D prescription plan yielded to pharmaceutical and health insurance groups, placing their interests ahead of the elderly and disabled. This bill which was sponsored by these special interest groups, purposely excluded Medicare from negotiating prices with pharmaceutical companies and thus permitting them to continue charging inordinate amounts for their medicines. Congress passed and the president signed this bill knowing it advantaged health insurance and pharmaceutical companies to the disadvantage of the elderly. Interestingly, the bill was pushed through Congress during the middle of the night. Some of the main promoters of this bill, including at least one congressman, later accepted high paying positions with Pharmaceutical companies.

These men who promoted the bill and then accepted payoff positions remind me of Christ’s words: (John 3:19-20 NKJV) "And this is the condemnation, that the light has come into the world, and men loved darkness rather than light, because their deeds were evil. For everyone practicing evil hates the light and does not come to the light, lest his deeds should be exposed.”
One of the major expressed concerns of the elderly is how they can meet their medical costs. From my new experience with Medicare Part D let me give you an example. Medicare describes 4 tiers of prescription medications. My plan also outlines 4 tiers: 1. Preferred Generic ($4 co pay 1 mo.); Preferred Brand ($25 co pay 1mo); Non Preferred Brand ($54- 1 mo); and Specialty (25% per mo). In addition, they have what is called 3 stages: Stage One is up to $2510 during which time you pay the co-pays shown above: Stage 2 – (Donut Hole) Between $2510 and $4,050 during which you pay the full amount; and Stage 3 – Catastrophic coverage you pay “the greater of $2.25 for generic and $5.60 for all other drugs or 5% coinsurance”. Do you begin to see the complexity and personal cost in this kind of system? 3

For some elderly this tier and stage structure is incomprehensible. For others of us it is frustrating and stressful. In a sense, the “tier” system brings “tears” to our hearts and eyes. Each month we see funds from the sale of our home being eaten away.
Let me go on. I am on over twenty prescribed medications. Three of which are not covered. One of these taken as needed costs $157.90 for a 90 day supply. Several of the covered medications fall in the Specialty tier (or should I say “tears”).

When the insurance company under whom I was previously insured decided not to offer a contract to my former employer it became necessary for it to change insurance carriers whose coverage would not meet my needs. This forced me to change insurance carriers, moving me into the infamous Medicare part D plans.

Thinking the new carrier would handle my prescriptions using the same filling cycle of my previous carrier I requested that they obtain my standing prescriptions from my old carrier. These prescriptions had been filled in late November and December. I did not expect the new carrier to start filling them for 60 to 90 days. Instead they immediately started to fill them. When the first batch arrived I immediately phoned and asked them to hold all future deliveries until I requested them. The initial 10 prescriptions received cost me $1446.49 for a 90 day supply of each. The highest price prescription, which was a specialty drug, cost me $726.93. It is shown in the stage two category, which means I am already in the “donut hole” where I pay the full price for my drugs until I reach $4,050. If I had not stopped the shipment of my additional medications I would have flown through the donut hole within two months.

This week I had to order a ninety day supply of two medications that I was running out of. Plavix which I take once a day cost me $374.30 ($4.16 per pill). Patanol an allergy drop for my eyes, which I take one drop in each eye twice a day cost me $414.11 ($1.15 a drop). I am delaying shipping on that one for a few days so it will go on my next credit card billing. The reason I order a ninety day supply is that I get it at a 2.5 month (75 days) rate instead of a full 3 months (90days) rate.

At this rate with one or two more refills I will be through the donut hole in less than four months. It seems like rather than getting a bite of the donut it gets to bite you!
Hopefully, through the above illustrations, you can see why negotiation of prices on medications is essential. It also raises the question of why these same 4 medications sell at much lower prices in foreign countries.

Pharmaceutical companies say high prices here are to recoup research and development expenses. Their argument is weakened by the fact that they sell the same medications in foreign countries, with price controls, for a much lower price. When profits get out of control are price controls the answer? It worked in World War II. Perhaps we should declare war on spiraling health care costs!

From what I said above I believe you can see how complex, confusing, and costly this program is to individual seniors. Yes, you can see why as seniors we have grave concerns with the cost and complexity of our Medicare programs. On a fixed income and seeing funds disappear from the sale of our house caused mostly by health care and inflation, is a staggering concern to us. Other seniors we know must make choices between paying bills and filling prescriptions.
Another concern related to costs and complexity is the loss of your primary care or specialist when you change your health care plan. Some of these plans will only cover you if you go to one of their contract doctors. On numerous occasions confused elderly patients have signed up for plans that do not contract with their present doctors and have had to go through the difficult task of finding and establishing a rapport with an unknown Doctor.

My wife who volunteers at our local hospital is often approached by seniors who are looking for a doctor. Many of the doctors in our area are no longer accepting patients or are not contracted with some of the health care plans in our area. Other seniors express grave concern as to how they will meet their health care needs.

While I am primarily addressing the concerns of senior citizens related to our health care I believe we need to extend our concerns to the population in general. We often hear that the health care system needs a major overhaul. From my perspective we need a COMPREHENSIVE UNIVERSAL HEALTH CARE PLAN for people of all ages. I have heard that we are the only industrialized nation without a universal health care plan.

While being aware of problems with universal health care in other countries I believe we could develop a model for our plan by taking the best that is found in programs in Canada, England, France, and Cuba. Certainly, from the knowledge we can gain from their years of experience with universal health care, and models from these countries, we could develop a sound system here. One of the things which needs to be considered very seriously is reducing costs by eliminating greed driven health insurance companies from the equation and 5 negotiating lower prescription rates with pharmaceutical companies. Perhaps setting price controls would be a feasible alternative?

In summary, I believe the major concerns of senior citizens regarding health care which need to be addressed are:

1. Coordination of health care and long-term planning with the elderly and their families. A global approach to this through a coalition of family care providers, in-home support services: in-home health care; hospice; Independent living facilities: residential care facilities; nursing homes; social service agencies; rehabilitation hospitals; hospitals and other health related systems. Years ago, when I managed residential care licensing and in home support services in a large county, I developed a similar plan for coordination of in home support services and residential care. A more comprehensive plan could be developed to include all of the above services.

Another aspect of Coordination is the lack of available doctors to meet the needs of elderly, who are covered but are unable to find physicians who are accepting new patients. Many face the challenge of getting to their medical appointments due to the lack of adequate transportation.

2. Complexity - a great deal needs to be done to simplify health care programs. One needs only read the handbooks, regulations and interpretations thereof to see a maze of requirements printed in small print which is very difficult to read let alone understand. Often when one calls for clarification of plan coverage, he is transferred from person to person and given varying answers to the same question. It is also “reassuring,” while waiting on the phone, to hear a pre-recorded voice telling you that the “information given to you by your service Representative may not be consistent with the terms of your policy!”

I believe as long as the legislatures write laws, legalists write regulations to interpret the law, and form fanatics create forms where every “I” must be dotted and “T” crossed, the complexity will only be compounded. There must be a shift to what the “Spirit” of the law is and less concentration on the letter of the law.

I am not optimistic that this simplification can be accomplished. Years ago, the state in which I worked decided to simplify application forms for Aid to Families with Dependent Children. The forms went from a total of 10 to 33. The guidelines for completing them were also greatly enlarged. All in the name of simplification! 6

From this senior’s perspective simplifiaction will be one of the major challenges of health care reform.

3. Cost - in this morning's paper I read that Social Security will run out of funds by 2041 and Medicare will be wiped out by 2019. One cannot help but wonder what the status of Social Security funds would be if Congress and the administration had not borrowed from them over the years.

Many of us seniors will not be around when these funds run out but we still have grave concerns with what Congress may do to fix the system. Beyond that we cannot help but wonder what will happen to our children and grandchildren who have paid in to the system.

Looking at the other side of the Cost Containment area concerns with health care costs is a major issue with seniors. Many of us see the erosion of our finances moving us toward personal financial crisis. Beyond the issue of Medicare and Medicare Part D co-pays and uncovered services we are faced with the future possibility of expensive in home or out of home assisted living services or the even higher nursing home care costs. Even those of us who have planned ahead with Long Term Care policies know that the care cost can be well above the policies’ limits and that money from sale of our homes or other assets can quickly disappear.

4. Comprehensive Universal Health Care - This is sorely needed for middle income, working poor, unemployed and the poor of all age groups. It would spread costs over the whole population and make health care services available to all persons in need of such services. It would also assure an equal level of care for all residents. Today, many have little or no coverage. Low and middle income families, when struck by enormous healthcare costs, can lose all that they have and end up in bankruptcy.

Those with little or no income have no way to pay. The cost of their medical care ends up costing not only the system, but, also, costs those of us with insurance more for our care, with increased premiums resulting. Why not level the playing field by universal health care? All should pay into the system based on the level of their income. This should include payments by registered illegal aliens, incorporating them into the system and legalizing them as residents moving toward citizenship.

As stated previously, the American system should be modeled after the best universal health care programs in other industrialized countries. 7

ADDITIONAL THOUGHTS: Keeping with my “C” outline I want to add one more observation dealing with inordinate GAS prices. The C here is CAR COSTS. While at first glance the cost of gas would not appear to be related to Health Care Cost and seniors’ concerns. In reality, it is. True most of our driving is local and we gas up once a month, but the inflationary prices in all areas food, clothing, heating, housing, transportation have all been affected by the greed of oil barons. To listen to their testimony before Congress is enough to make one gag.

Remember my “Mobile” illustration at the beginning of this essay? Imbalance in one area of our lives affects all areas. This is as true in our overall economy as it is in our personal lives. I see “Mobil” oil and their counter parts, as negatively influencing our “Mobile”. The energy companies receive not only windfall profits, but receive high energy expenditures from the government.

In GAO “Testimony Before the Subcommittee on Energy and Environment, Committee on Science and Technology, H.R” (Pg.3) on March 5, 2008 reported: “The federal government provides the energy industry and consumers with 20 tax expenditures affecting energy supply, totaling $6.3 billion in fiscal year 2007 and $4.9 billion in fiscal year 2008.2”
Why do we pay billions to oil and other energy companies to develop alternate fuel sources, when it is totally contrary to and in conflict with their goal of high profits from existing fossil fuels? Why not allocated all of those billions to scientists and others who have an interest in developing environmentally safe alternative energy resources?

Is it not odd, that our country will give billions to corporations and chooses not to provide smaller amounts for children’s healthcare? (Congress’s attempt to expand the SCHIP program from $5 billion a year to $12 Billion was vetoed.-Wikipedia)

Why does our government grant billions to bail out greed motivated banks and financial institutions, while doing very little to directly aid people losing their homes? Only $130 million in federal grants have been authorized for home owners nationwide facing home foreclosure. (Denver Business Journal 3-17-08) NOT ONLY IS OUR MEDICAL MOBILE out of BALANCE, BUT SO IS OUR ECONOMIC MOBILE SPINNING OUT OF CONTROL!
D
on E. Cunningham

Senior Citizen/Octogenarian/Author/Poet © 4/3/2008 2,981 words

I hope you have taken time to reflect on these issues and will help you to decide on what stance you will take in the area of health care.

Stand by for my next poetic posting!

Hugs, In Christ’s and My Love,
Don E. Cunningham, Author/Poet ©6/29/08 3,287