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Health care

Memento Mori…and all that stuff

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So, as expected, the CardioDoc prescribed a blood pressure med. When I pointed out to him that if a drug has a bizarre side effect, I will get it (and no, it doesn’t matter whether I know what the side effects are or not), he came up with something so mild one can even eat grapefruit with it. Besides a little diarrhea, a little belly pain, a little syncope, and kidney failure, it’s fairly benign.

Lovely.

You have to die of something, and between you and me, dropping dead of a heart attack, which occurred to my great-grandmother and my great-aunt when they were in their mid-90s, looks a helluva lot better than dying of cancer while bat-brained doctors stand around hooting that you’re a mental case, as occurred to my mother in her early 60s. It also looks a great deal better than dying of kidney failure, which is a) a possible outcome of high blood pressure and b) a possible outcome of blood-pressure drugs. If one could be sure of the heart attack, possibly one would have a clearer view of the best course of action.

Whenever I’m in a doctor’s office or, God forfend, an ER, my blood pressure obligingly goes into the 150s. Here at home, a battery-operated blood pressure monitor registers in the high 110s and low 120s. But CardioDoc blew those figures off this afternoon — he said home BP monitors are unreliable and don’t measure a real figure: you have to take three readings five minutes apart (consuming FIFTEEN MINUTES of generally miserable time), and then average them to get anything resembling accuracy.

Well. Since every time I repeat a BP reading here at the Funny Farm, it’s invariably lower than the first effort, that would push my readings significantly lower. The guy refused to even look at the record I had. Sooo…. I’m thinking maybe I need to get a second opinion about this before I start gulping prescription drugs.

I don’t know. If the guy is right, I need to get on this stuff ASAP. If he’s wrong, it could do more harm than good; at best, it’s unnecessary.

Tomorrow I’m driving out of town. You’re not supposed to drive after taking the stuff until you see what it will do to you, since it can make you pass out. So the soonest I can start gulping this chemical down will be next Thursday…after I finish the dawn junket to Scottsdale.

Two things I like about this guy are that he seems to be right about the heart palpitations, which are extremely uncomfortable and scary, and that he is manifestly correct about the fact that I’m some 20 pounds overweight. How can one do without reassurances that you’re NOT old and you’re NOT fat?

Yes. Young Dr. Kildare has denied not only  that I’m old (give me a break, kid!) but that I’m fat. When I remarked in passing that I need to go on a diet, he looked at the 158-pound weight I’d logged that morning and allowed as to how I was within the “normal” range for my gender, age, and height. Right. And I look like I’m three months pregnant because…why?

CardioDoc suggested that I might be able to shuck the BP drug if I would get off my fanny and exercise (now there’s a radical idea) and if I would lose 22 pounds. These are things I’ve known for a long time but been too indolent to act on.

He also believes that the uncomfortable chest sensations are a manifestation of a genetic tendency to anxiety, which he describes as something different from stress, per se. It amounts to a pathological over-response to pretty much routine stressors. And I do have to say, I get these “heart palpitations” or whatever they are when a series of stressful events or situations occurs over a long period of time, especially when these happenings kick into “it never stops” mode. Even when on the surface things seem fairly quiet, what goes on day by day can add up, in the same way small savings here and there can add up to big savings, or small expenses here and there can add up to big bills.

Consider, for example, the day-by-day sources of stress I’ve recorded in the blood-pressure and Holter monitor logs since this annoying medical venture began:

4/10

• About 3:30 or 4:45, client called. Long angst-filled talk about her co-editor & the project.

• Racing out the door, late for choir, find notice in mail from IRS billing me for $10,000 in 2011 taxes and accusing me of fraud. Fly out the door to rehearsal. Sing for 2 hours.

• Accountant didn’t get message. Client from Hell persists. Student submits late paper in format I can’t open.

4/11

• Get up after awaking at 4 a.m.

• Return extremely difficult edited essay to anthology editors, with involved cover note. Start calculating billable hours. Not washed, made up or dressed! Now running late for 7:15 meeting.

• Late; fly out the door. Make u-turn, fly back to house, RUN to take out overfilled recycling bin, run back to car, race to Scottsdale thru rush-hour traffic.

• Finish chairing business group meeting; have light breakfast w/ coffee. Haggle with nuisance client. Discuss client’s work and general business issues with designer.

• Correspond with book packager, client. Correspond with accountant. Try to find password for p/w-protected financial statements from manager. E-mail binging nonstop. Client’s co-editor nagging for a bill.

• Trim tree suckers and cut back dead (man-eating!) agaves.

5/22

• Insomnia; meet with difficult client; undergo stress test; worry about health; drive thru awful traffic.

5/23

• Insomnia; take on new client’s challenging project on tight deadline; worry about health.

5/24

• Meet with client starting at 8:30 a.m.; it’s after 12:30 before he leaves. Edit Chinese scholars’ work on 5-day deadline.

5/25

• Just once I’d like to be able to sleep for 6 or 7 hours straight. SO tired!

5/26

• Wrestle with annoying ditzy job; pressure from author to accelerate deadline; many errors in Au’s References; Word as usual puts up a fight.

• Work  like a horse to finish Chinese researchers’ paper. Word crashes. MacBook crashes; looks like its drive is fried but it finally reboots. Terror!

• Carbonize my dinner on the grill; have to throw out expensive cut of lamb that I couldn’t afford in the first place & sure as hell can’t afford to toss in the garbage.

5/27

• Spend day shopping w/ KJG at Arrowhead, which should be fun. Feel terrible most of the time: weary, lightheaded, marginally headachey, tense sensation in chest.

• Return from dog walk to find front door open. No one there. Unsettling, after prior garage invasion episode

5/28

• Land another new client! Yet another Chinese scholar, likely to be difficult and low-paid. Chinese faculty’s salaries make ours look like manna from heaven.

• Getting an ear infection — hurts.

• Drive from pillar to post; hustle a business owner to donate to next fall’s choir fund-raiser.

• Get told I need blood pressure meds.

• Make my way through rush-hour traffic to pick up Rx at Costco; luckily, I decide to go by surface roads, because a crash closes the offramp that leads from the freeway to said Costco.

• Lose my American Express card. Find it while on interminable hold with AMEX customer disservice robot.

• Dog is sick. Throws up. Tomorrow I have to carry her in the car to Yarnell, spend the whole day there, carry her back down to SDXB’s house, then drive her home. Hope she doesn’t throw up in the car, on La Maya’s floor, or on SDXB’s floors. What on earth could be wrong with her? She’s been under the weather for days and not only is not getting better, she seems to be getting worse.

Gaaaahhhhhhhh! Is there any question why my heart pounds like a gazelle’s on the veldt?  This is not a hereditary disorder. This is fuckin’ normal! Whose heart would not pound when every goddamn day plays out like that?

So as I was saying, one of CardioDoc’s appealing traits is his advice that the way to deal with all this is to indulge in a spate of wildly vigorous, totally exhausting exercise. I’ve tried this several times and it works.

Today when I came home from picking up the prescription, I fell in the pool and swam a dozen laps as fast as I could go without stopping. It worked. I feel pretty good right now.

And it’s almost 10:30 and I’ve gotta go to bed. Hope to get more than four hours’ sleep tonight.

“Harmless” OTC Drugs: When Will I Ever Learn?

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Suffering again from heart palpitations, a few weeks ago I visit Young Dr. Kildare, who sends me to a cardiologist. He diagnoses “stress” but recommends a stress test. The blood pressure, BTW, is hovering in the lower stratosphere.

The stress test gets put off for two or three weeks while I struggle with the accursed insurance companies, trying to get a better rate from one of the rapacious private Medigap carriers. While going through underwriting, I cannot have any diagnostic tests pending, even “routine” ones. Finally I get accepted for a new plan with a new insurer.

So at last, on Wednesday I stumble into the cardiologist’s office for the stress test. That seems to have gone OK — it was pretty easy and even kind of fun — but afterward the technician keeps taking my blood pressure. Over and over and over. Even though it slowly drops a little, it is very high.

She tells me to go buy a blood pressure monitor (yup! I needed a gratuitous $50 expenditure just as the AC bills start to peak!) and track my blood pressure between then and next Tuesday, when I’m supposed to go back to the cardiologist.

The heart palpitations, which are very uncomfortable and (despite assurances that they’re probably harmless) quite scary, continue. The blood pressure scores are mind-boggling: 147/93 ; 154/86…holy SHIT!

Yesterday morning I awaken at 2:10 and take another reading. In the past, my blood pressure readings have been lowest just after awakening. Not at this particular awaking, though: 145/80.

“Normal,” for those of you who are as yet uninitiated, is <120/<80.

So I’m sitting at the dining room table contemplating this state of affairs when it occurs to me that I’d squirted my nose with generic Afrin, because it was kind of stuffy when I woke up at 2:00 a.m. Come to think of it…I’d been squirting every evening, in a sleepy haze, right before I went to bed. Bad. Normally I would use the stuff no more than two or three nights in a row, but in a frenzy to get more than four or five hours of sleep a night, I’d been snorting decongestant up my schnozz every night for…longer than I could remember. At least ten days or two weeks; probably longer than that.

Years ago, when SDXB was living with me, he had a terrible cold and couldn’t breathe through his nose. I suggested he try a squirt of Afrin nose spray to clear his head, He said he couldn’t use decongestants because they drive up one’s blood pressure — he’s had chronic high blood pressure forever.

Well… There in the wee hours I came to remember that exchange, out of the blue. It dawned on me that, when asked what drugs I was on by the cardiologist and later by his tech, I’d totally blown off the nose squirt — my mind didn’t register it as a drug, and besides, I’ve been using it late at night or the episodes of insomnia, when I’m half asleep and barely conscious.

Interesting.

So I go online and look up the drug — generically it’s called oxymetazoline hydrochloride — and damned if it doesn’t say “causes high blood pressure and heart palpitations.”

Holy shit, indeed.

Also learned that for a lush like me (I have two drinks a day, which the US gummint describes as “heavy drinking” for a woman), knocking off the booze all at once will drive up the blood pressure. You’re supposed to taper off over a period of weeks. I haven’t had a drink in several days.

Well, “weeks” isn’t very practical, because the focus is just NOT THERE to limit the amount of booze in ever-diminishing amounts over that long a period. It’s either lap it up or don’t taste it at all. I figure I could have one five-ounce glass of wine yesterday and half of that today and then kick the habit.

So I knock off the nose squirt. Along about 5:30, I fix myself an amazing dinner and serve it up with 1 glass of white wine. Take the dog for a stroll and jog four of the six blocks (in my achy dotage I’m no longer capable of running).

Come back. Sit down for half an hour. Take the blood pressure: 120/76.

Well damn. That’s the first time it’s been anywhere near the normal range since these antics started. Skip the nose squirt on retiring.

This morning: 111/80. And the heart palpitations are almost gone.

I hadn’t made the connection between the crazy-making heart palpitations and the nose squirt. And I never would have, if SDXB hadn’t made that remark all those years ago.

Take-away message: Just because you don’t swallow it doesn’t mean it isn’t a drug. And just because something can be bought off the shelf in a grocery store or pharmacy doesn’t mean it’s harmless. Always look up every nostrum before taking it! Prescription or over-the-counter, you should know what’s in any medicament you swallow, rub on your skin, drop in your eyes, inhale into your chest, or blow up your nose, and know what its potential side effects are…before you ingest it.

Medicare Supplement: QUALIFIED!

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Thank goodness! The agent I stumbled across while trying to navigate the Medigap labyrinth after Mutual of Omaha decided to up its Medicare supplement premium by $433 a year called to say Government Personnel Mutual’s underwriters have approved me for a Plan G policy.

That will be a difference of almost $700 off the two grand that Mutual of Omaha proposed to jab me with.

A few months ago, I’d heard from another insurance salesperson that Mutual of Omaha (which is part of United of Omaha) is notorious for luring new Medicare recipients into a Medicare supplement policy by offering the lowest prices around, but then after a year or two, they jack up the prices through the ceiling. The current episode suggests she was right.

What’s going on there is that when you first get on Medicare, you have a window of a few months in which to decide whether to buy a Medigap policy; in that first “open enrollment” period, carriers may not subject you to underwriting, and they can’t except pre-existing conditions or anything they imagine might be a pre-existing condition. But after that introductory period, any change, even to a different Medigap policy offered by the same company, has to go through underwriting.

Because most Americans in their 60s have been “diagnosed” and something like 90 percent of those 65 and over are on some sort of medication, after you’re enrolled in that first Medigap plan you have about a snowball’s chance of getting approved for a new policy. Thus, once you’ve signed up for a Mutual of Omaha policy, in about 90 percent of cases it’s a gotcha. In a big way. They can raise their prices and there’s not a damn thing you can do, short of going bare or switching to an HMO.

To accomplish the $700 difference, I had to switch to Plan G with Government Personnel Mutual. It’s the same as my old Plan F policy, except that Plan G hits you with a $142 deductible, whereas Plan F has no deductible. Obviously, Plan F is preferable; however, I can afford $142 out of pocket, and the difference in premiums is so great that it’s worth it.

After running through an interminable punch-a-button noise-maker at Mutual of Omaha, I finally reached a person who seemed in a position to put an application for a Plan G policy through that outfit’s underwriting. She sent me not one, not two, but three duplicate applications. These are multipage, intrusive questionnaires, and so I felt no call to fill it in and drive it to the post office three times. I sent one. Haven’t heard a single word back from them.

Government Personnel Mutual has a better A.M. Best rating than Mutual of Omaha and far fewer consumer complaints floating around the Internet. And, apparently, it has no reputation for gouging its customers.

So. That’s a relief. And it’ll even give me a few extra dollars in my pocket next year.

Medigap Runaround, 2013

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So I get a notice from Mutual of Omaha that they’re jacking up the premium for my Medicare supplement insurance (known as “Medigap” because it fills the considerable gaps in Medicare Parts A and B coverage) by $433.58, an amount that happens to be exactly $433.58 more than I can afford.

In the mind-numbingly complicated maze that is the private Medicare supplemental insurance landscape, I have Plan F, a mid-priced scheme that effectively covers everything that Parts A and B do not cover. The last time I talked with Mutual of Omaha, their CSR suggested I switch to Plan G, which covers everything except a $147.50 Part B deductible. Part G premiums are so much lower than Plan F’s now that even paying the deductible out of pocket you still come out ahead.

Ooohkayyyy….

Meanwhile, I’ve compiled a list of a dozen companies that do business in Arizona and are charging less than Mutual of Omaha for Plan F.

Monday, I begin the endless round of calling with Mutual of Omaha itself, trying to get underwritten for Part G.

I speak with one Ernest. He says Plan G will cost $116.28, well under what I’ve been paying for Plan F. I ask about the underwriting. He transfers me to another agent, one Nicole. She says she’s a licensed agent in Arizona. But she also won’t talk with me. She tells me to call an 800 number and utter these words: “I have a Plan F and want to change to Plan G, and I want underwriting.”

I dial the 800 number and, interestingly, reach another Nicole. I say, “I have a Plan F and want to change to Plan G, and I want underwriting.” She is confused. Do I want the Underwriting Department? I say I was told to call her number, and I start to complain about the runaround.

She transfers me to one Carol. I explain what I want. Carol is in life insurance. She transfers me — to a phone tree.

Eventually, I reach one Cheryl. She says you have to fill out a whole new application for a whole new policy. She says they’ll send it to me.

Now I call Universal Fidelity. Kayla answers and says she can give me a quote. She says their Plan F is $133.85 — about what I’m paying now — and Plan G is $112.99. She explains that you have to trigger the Medicare deductible before Plan G will cover anything. This implies that there could be circumstances that Plan G will not cover, since not all issues covered by Medicare A & B are doctors’ visits. She says an agent will call me — some guy from American Health Underwriters in Ft. Worth.

I call Everence, where I reach one Jason. He says Everence is a fraternal benefit organization for fundamentalist Christians. Episcopalians do not count as Christians in their book.

Next I call American Family (the ever-annoyingly advertised AFLAC). Here I get an incredible electronic runaround and finally give up without ever reaching a human.

Moving on, at United Healthcare I reach one Don, who tells me that their Plan F costs $180 a month and their plan G, $160. He tries to corral me into an AARP HMO. I tell him to get lost.

Now I dial Heartland, where a person named Tracy transfers me to a male person with a name pronounced “Teal.” He’s with Equitable Life. He says their Plan F costs $149 and Plan G costs $140. There’s a $20 application fee, he notes. He says he will send an application and gives me a direct phone number at which to reach him.

Next I call Forethought. It’s after hours now on the East Coast, and their offices are closed.

I wonder if Government Personnel Mutual will cover state employees or the children of Merchant Marine officers. In the course of searching for an answer to this question on their website, I’m shunted to a webpage of something called Medicare Marketplace. I dial the 866 number and reach one Larry Peters, who presents himself an insurance agent & broker in Omaha. He says that Government Personnel actually started out serving only federal employees and members of the military, but it now covers civilians, too. Its plan G is only $110.70; if I want a Plan F, the next-best deal he can get for me is with American Continental at $141.94.

However, he says, it’s late at his office and the computer system is about to shut down. Could we talk the following day? We exchange phone numbers and agree to try to get in touch about mid-morning Arizona time.

On Tuesday I leave the house at 6:30 for a hike up the mountain and get back around 8:30. An hour or so later, I call him back. He says the application fee is $25. I agree to this and say I’m interested in Plan G. He asks the  underwriting questions and says he will send the form.

In the meantime, I’ve done a little research.

By Tuesday morning, I know that Universal Fidelity got a negative rating from A.M. Best in 2011 and again in March of 2012. Heartland has racked up a grade of F (for “flunk”) from the Better Business Bureau as well as 8 complaints at Ripoff Report. A. M. Best downgraded it in 2009.

Central States, which I  have not yet tried to reach but whose rates look pretty high, has an A. M. Best rating of A+; Manhattan, with slightly higher rates, has a rating of B+ and a long-term rating of bbb-; A. M. Best considers it to be “stable.” Government Personnel Mutual is rated A- (also in the “excellent” range) with a long-term rating of a- and a “stable” outlook; the Texas Department of Insurance’s excellent website shows no complaints against it.

Later on Tuesday, one Mike from Universal Fidelity calls. He says that company charges $129.85 for Plan F and $108  for Plan G. He’s a fast talker and he’s trying to maneuver me into committing to one or the other of these. In the course of conversation, he says the application fee is $45.

Since that’s clearly beyond the pale — the others are charging $20 to $25 for the privilege of asking humbly whether you may be allowed to purchase a policy to fill in the empty spaces around the capacious Medicare coverage — I ask him if that $45 is billed to me when he puts the application in the mail or only after I fill it in and submit it. He won’t give me a straight answer. I say, “You’re not answering my question. Am I billed $45 simply because you mail me a blank application, or am I billed $45 when you receive the completed application?” Disingenuously, he says I’m billed $45 when they send me a statement for the Part G coverage.

Annoyed, I say, “Look, you have competition. Why don’t you wait a couple of days before sending this application to me, until I can see what I can find out about Plan G from the several other companies that offer it in Arizona at affordable rates.” He flounders. I say, unequivocally, “Wait two days before you send this application. I will be in touch with you.”

This morning while I’m at a meeting, Mike calls back. He wants me to return his call. I’m involved with grading papers and writing a report about the meeting and so decide to delay that particular annoyance. While I’m still working, he calls again and leaves a message on my voicemail saying he had the prices for Arizona wrong, and that Plan F is actually $133.85 and Plan G, $112.79. They’ll divide the $45 application gouge between two months, making the first two months’ Plan G payments a bargain $135.29. Mighty white of ’em, eh?

Amazing picture, isn’t it? Over two days, I’ve called SIX insurance companies offering identical Medigap plans at six different rates and I’ve spoken to TWELVE different people and an impenetrable telephone tree. Of the twelve humans, nine could give me no information of any value, two tried to hustle me, and one may be hustling me but seems to represent a reasonably reputable company offering a plan at an almost affordable rate. Alleged plan G rates range from $112.99 to $160, for the same, identical, federally regulated coverage; “application fees” range from $20 to $45.

To start the underwriting process, I’ve had to give my Social Security number to a guy I met through an Internet page and who for all know could be Osama Bin Laden’s nephew, out to fund his organization’s enterprise with identity theft. And yes, I’ve asked around among friends and business acquaintances and been unable to find anyone living in Arizona who works as a broker for Medicare supplemental plans. The best I can say is that there is indeed a Larry Peters running an insurance agency in Omaha.

Ain’t private enterprise grand?

Why not  just have Medicare provide full coverage, instead of throwing elderly, frail, and often fuzzy-minded citizens into such a gawdawful briar patch?

What a flicking nightmare.

Apparently I’m going to have to go through this rat-race about once every year or two.

I did find an outfit that issues reports on Medicare Supplement and Part D (prescription drug) plans. The report on Part D will set you back $49. Their report on Medigap insurers is $99. So…that’s $150, just to try to get an allegedly unbiased comparison of these outfits.

Otherwise, there appears to be no help available to consumers for navigating this dangerous and expensive mess.

Hiking/Health Update

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North_Mtn_Shaw_Butte_Preserve
w00t! Made it to the top of the mountain for the FOURTH time this week!

When I described this hike on April 14, I imagined I was clambering up North Mountain. That’s because SDXB and I have perennially confused North Mountain with Shaw Butte all these years. In fact, the trail I pictured and described in that post goes up Shaw Butte, a slightly higher promontory with an interesting history.

The Shaw Butte trail (about 2150 feet in elevation) can be accessed from several trailheads on the south and the north sides. From Central Avenue site, the round-trip hike is said to be about 5 miles (uh-huh…I’ll believe that when I see someone’s pedometer reading…I’d put it at about 3 or 3½ miles RT, but whatever…). You can get to it from the expensive-looking Seventh Street Visitor’s Center by following a trail that goes around and over the flood dam and intersects the upward-bound trail just above the dinky Central Avenue parking lot; I’d guess that trail is…ohhh…about a half-mile.

Yesterday, by peering off the side of the mountain, whence I had hiked from the Central Avenue parking lot on the north side of the hills, I figured out that a side trail probably led to the Visitor’s Center or someplace close to it.

So today I parked at the Visitor’s Center, which has a much more generous parking lot (I can park easily in the Central Avenue parking lot by taking advantage of my crip-space hanger, but…it’s a little embarrassing to park in a disabled space and then go bounding up the side of a mountain….) (I don’t use the crip space hanger unless a parking lot is practically empty, except when I’m in Tempe, where ASU commits a version of piracy in the public parking department) (and even in near-empty lots I rarely use it, because one of my eccentricities is a preference for parking on the far end of a lot by way of a) getting some exercise and b) parking my car in the shade).

(CHALLENGE: How many parenthetical asides can YOU cram into a single sentence?) 😀

Sh!t…where was I? I lost track…

Yeah, on the side of the mountain. Today’s trek was the fourth hike up the mountain since last Friday. I’d intended to do it tomorrow and make today’s exercise either a hike on the flat or a long bicycle ride, but one of my clients wanted to meet as dawn cracks tomorrow morning. It’s supposed to hit 90 degrees tomorrow, so I knew that by the time I shovel him out the door, it’ll be way too late for a journey up the side of a half-mile-high hill.

Saturday is the endlessly anticipated Oak Creek hike, the motivation for six weeks of physical therapy and all this mad conditioning-motivated hiking. The planned Friday conditioning hike obviated by the client’s demand, I decided to move it forward to today. That will make Friday into a day of relative rest (biking or canal-hiking planned for after the guy leaves tomorrow). This (a vigorous hike + a day of relative peace + vigorous hike + peace) is best, I’ve found, for building stamina.

So it was off to the Seventh Avenue Visitor’s Center as soon as I escaped from this morning’s wee-hours meeting of the Scottsdale Business Association.

It was late when I started, as in too goddamn hot to be climbing around: well after noon by the time I got back to the car. That notwithstanding, though, I reached the top with only four stops to gasp for breath. The first time up, honest to Gawd, I think I stopped to huff and puff about every twenty steps!

Useta be that when I would get out of shape, it would take three, count’em (3), trips up the mountain to reach the stage where I could hike all the way to the summit without stopping. Now that I’m old, however, I figure about six would be more like it. So far, I seem to be on target: this week I’ve made four trips up there. Hmm. Surely by next Friday, assuming I make three trips next week, I should reach the top without a pause.

Let’s pretend that the five-mile figure is correct (though I doubt it). I’ve been up the mountain four times this week: that’s 20 miles. And I’ve made two hikes on the flat of maybe a mile and a half apiece. Sooo…what do we have? Twenty-three miles? NOT FREAKING BAD, for an old bat pushing 70! (no, we do not mean 70 mph…)

IMHO, the distance up the side of Shaw Butte is more like three miles. So, if I could go up there three days a week and then walk the flat or the canal another three days a week (choir will obviate much outdoor activity now that the weather’s getting hot), that would give us…what?

3 three-mile uphill hikes = 9 miles/week
3 one-and-a-half flat hikes = 4.5 miles/ week
Total hill plus flat =13.5 miles/week

Well. That’s thirteen and a half more miles than the distance between the computer and the refrigerator.

I sure do feel a lot better. The cardiologist-doc was right in saying that a stint of sustained vigorous exercise brings a quick end to the anxiety attacks. Not only that, but the back pain is now almost 100% gone, with the exception of an occasional very mild twinge.

This is good. Very, very good.

Image: North Mountain and Shaw Butte Preserves. Jstuby at en.wikipedia. Creative Commons CC0 1.0 Universal Public Domain Dedication.

Private Fingers in the Medicare Pot

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A thousand curses upon the craven politicos who decided that private industry should get its sticky paws on anything related to Medicare. What a freaking mess! And it’s like this not because of the “government” the right wing so loves to hate but because of the programs that are run by private insurance companies.

No amount of federal regulation stops these SOBs from putting the screws on the customers.

A quick refresher course in the complexities:

Medicare consists of five programs. Medicare Part A covers hospitalization, hospice, and (in very  limited circumstances) some nursing home and home-health care. Medicare Part B covers doctors’ visits, some other types of health-care providers, outpatient care, durable medical equipment, home health care, and some preventive care. Each of these programs pays 80 percent and the patient pays 20 percent. Medicare Part C is a scheme roughly equivalent to HMOs and PPOs that strictly limit one’s choice in providers — something that can be very dangerous if you think you need a high-powered specialist and some insurance clerk says otherwise.

Obviously, 20 percent of the bill for catastrophic care or for a serious long-term disease such as cancer, MS, Parkinson’s, Alzheimer’s, or diabetes would quickly drain the savings of most elderly Americans. And since we all have to die of something, if you don’t go in an accident or by your own hand, chances are very high that the medical industry sooner or later will pauperize you. In the case of a married couple, this will mean that by the time one person dies, the other will be reduced to the most desperate kind of poverty, no matter how faithfully they have saved to support themselves in old age.

So, you’re pretty much forced to buy extra insurance, issued by private insurance companies, to fill in the gaps presented by traditional Medicare. This coverage is called “Medigap” or “Medicare supplemental insurance.”

You also are forced to buy one of the newer policies known as “Medicare Part D,” which supposedly covers prescription drugs but in fact covers almost nothing. A Republican scheme passed in 2003 and shepherded through Congress by a Louisiana representative who soon afterward retired into a $2 million-a-year-job with Big Pharma’s main lobbying group, Pharmaceutical Research and Manufacturers of America, Part D is one of the biggest rip-offs this country has ever seen. It seems to exist solely to clip the taxpayers and old people. George W. Bush’s Medicare administrator, Thomas Scully — now a lobbyist for the health care industry and general partner of an equity firm that invests in health care — threatened to fire Medicare’s chief actuary if he reported how much Part D actually costs the government. Medicare is forbidden to negotiate drug prices, a strategy that saves the Department of Veterans’ Affairs between 40% and 58% on its clients’ drugs. Between 2006 and 2013, this caused Medicare beneficiaries to spend an estimated $332 billion to $563 billion more than necessary.

My Part D carrier disallowed most of the generic drugs my doctors have ordered over the past 18  months and would not cover the full freight on the rest. To fill a prescription, you have to get prior approval before your doctor writes the prescription.

Once you’re in a Part D plan, you’re pretty well trapped in it, whether you like it or not. You’re allowed to disenroll or change carriers under very limited conditions, and — get this! — if your carrier stops covering a drug you need to take,  you can’t change to a carrier that will cover it!

That 85 percent of Part D patients claim to be satisfied with the scheme proves only that you can fool all of the people some of the time and some of the people all of the time.

If you are not permanently “on” some drug — as, for instance, I happen not to be — the monthly $20-plus premium pays for air. I would have been better off without Part D, because I could have purchased the antibiotic for the bronchitis, the steroid for the bronchitis, the double-strength omeprazole and sucralfate for the GERD kicked off by the steroid, and the muscle relaxant for the back pain cheaper had I been able to enroll in Costco’s cost-saving plan. But I’m not eligible for it or for Walgreen’s similar plan because, in cahoots with Big Pharma, by law these plans have been made off-limits for Part D customers.

However,  healthy Medicare beneficiaries decline to enroll in Part D at their peril. When (not “if”) you come down with some serious, expensive ailment, the cost of chemotherapy or meds for typical old-age hazards such as Parkinson’s could easily bankrupt you. And if you do not enroll when you become eligible at age 65 but delay until you’re more likely to need the coverage, you are gouged a penalty for late enrollment, in the form of permanently inflated monthly premiums.

Part C, which is an option, rips off the taxpayer with élan, to the enormous profit of the insurance companies that run the plans. Part C plans, which operate like HMOs, appear attractive to Medicare beneficiaries because they offer services like vision and dental care that are not covered by traditional Part A & B Medicare plus Medigap, and because at the outset they provided prescription drug coverage (the advent of Part D canceled that). The payment formulas overpay Part C plans by 12 percent or more compared to traditional Medicare. By 2006, these HMO plans had proved far more profitable to insurance companies than projected, at the expense of administrative costs that are far higher than traditional Medicare.

In summary: Part A and Part B (“traditional” Medicare) pay exactly as advertised, with no hassle. Traditional Medicare is rather expensive: $104/month (almost five times what I paid for better coverage through my former employer); it only covers 80% of your costs; and it does not cover prescriptions or long-term care. To take in the slack, you have to buy additional coverage from private insurers that jack you around and charge you through the wazoo while collecting money from the government for the privilege.

Okay. Now for the rant of the day.

Saturday comes in the mail a notice from Mutual of Omaha, the outfit that carries my Medigap coverage, a notice that my premiums are going up “due to the rising cost of healthcare.” Yes. My Medigap insurance will increase by $400!

“Please be assured,” we’re told, “that you are not being singled out for this increase; the premiums for all customers with coverage like yours are being adjusted.”

There’s a story I’ve heard before: when I carried my own insurance for a time. If you make claims on a policy, your premiums go up forthwith. Companies get away with this, even though it is illegal to raise your rates or cancel your policy because you made a claim, by assigning customers to relatively small groups, so that if one or two people in that group should have a spate of illness, everyone in that small group gets their premiums increased. This allows the company to claim it’s being “fair” while dumping customers whose care is beginning to cost something.

This increase comes as President Obama caves to the Republicans by cutting cost-of-living adjustments for Social Security beneficiaries. Ducky.

So now I need to find a new Medigap carrier.

Finding reasonably priced Medigap coverage is an astonishing horror show.

There’s only one given: each of the fourteen plans (designated A through N) has to offer the same benefits, and insurance companies are not allowed to screw with those guidelines or to deny the services specified in each one.

Otherwise…it’s raw chaos.

Rules are different in every state. So different insurers make different plans available in different states, at different rates. Availability of plans and their costs vary by county. Companies charge what the traffic will bear, and so rates for identical policies can vary by as much as $150 to $200 a month. For example, in Maricopa County the lowest price for a Part F policy issued to someone in my age range is about $137; the highest is $338. And there’s no difference in coverage!

The only way to find the rates available to you is to access a long, incomprehensibly complicated document issued by your state’s insurance department. To find the cheapest plan available to Arizonans, you have to download a FORTY-EIGHT-PAGE BOOKLET. This PDF provides each company’s rates for each of the 14 plans in the various counties within the state. Some insurers offer some plans but not others. Some insurers offer certain plans in some counties and not in others. Prices in rural counties are usually lower than prices in Maricopa and Pima counties, where the cities of Phoenix and Tucson reside. But this is not consistent. Nor is it in any way helpful.

In Arizona, FIFTY-FOUR COMPANIES offer Medigap policies. Every one of them offers the same effing policies for different rates scattered over two pages of figures. To figure out which one is cheapest, you have to sift through 42 pages of figures listed 7 columns to the page.

Once you’ve parsed this out, then you have to find out

a) how the company is rated (is the damn thing about to go belly-up?); and
b) whether they’re even still offering the plan, because some of them quit after the booklet goes to press.

Then you have to track down a phone number for whatever outfit you select to provide this coverage. Then you have to make your way through the infuriating phone trees and jump through hoop after hoop after interminable hoop to find out what they really charge, which is different from what the Insurance Department booklet says.

Last night it took me four hours to identify the dozen companies that claim to offer premiums lower than the new gouge from Mutual of Omaha.

I’m now paying $128 a month. After the increase,  I’ll be paying $165 a month.

Here, on a preliminary basis, are the companies that charge no more than $165 a month but are likely to charge me, at 68, less than that:

2013 Medigap figures

Some of these providers are outfits that no one ever heard of. So, before you start calling insurance companies, you have to track down their ratings, to see if they’re stable enough to be around over the next year or two. To do this, you can go to one or more of various rating agencies, such as A.M. Best or Standard & Poor’s.

So we’re told. But in fact, to look up an insurance company at some these agencies, you have to be a member! At Standard & Poor’s, you can look them up and be damned — many searches return a “not found” message, and those that are rated have so many tentacles you can’t figure out which one you need to know about.

This means you have to call your insurance agent — if you have one — and ask him or her to look up ratings for a dozen candidates.

My insurance agent, who has been a godsend, does not deal with Medigap coverage…for obvious reasons! Another guy I know who does claim to address Medicare referred me to a woman who tried to high-pressure me into a Part C plan; when I told her I did not want a Medicare Advantage plan, she persisted, even to the point of trying to tell me things that are untrue and that federal law specifically prohibits agents from claiming.

So in addition to the mind-boggling complication, the whole process is a minefield of scam operators trying to take advantage of confused and frustrated senior citizens.

It is just a freaking nightmare.