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Health care

Best Guide to the Medicare Maze

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If you or someone you’re close to is about to walk into the labyrinth that is Medicare, take a look at the December issue of Consumer Reports, now on the newstands. This month CR is running the best, clearest guide to Medicare I’ve seen to date.

Medicare’s rules are astonishingly complicated and booby-trapped with land mines. The government and a vast slew of vendors send you hundreds and hundreds of pages of information and sales pitches. As well-intentioned as most government writers are, the copy they pour out is verbose, involved, sometimes contradictory, and often impossible to figure out.

CR has boiled the entire mess down into two pages of do’s and don’ts. Their article explains why you should get signed up for Medicare before you turn 65, how Medicare Part B works and what will happen to you if you fail to sign  up in a timely way, how to avoid being screwed out of Medigap coverage—and why you really need it—and what the advantages and disadvantages are of Medicare and Medigap.

It’s crystal clear, easy to understand, and mercifully brief. This thing should be offprinted and sent to everyone who’s coming eligible for Medicare.

Hmh. I’d forgotten how much I enjoyed Consumer Reports before I let the subscription lapse. Now that I’m feeling flush again (sort of…), maybe I’ll re-up. It’s a useful resource for the frugalist and the wily consumer. If you’d like to subscribe, you can click here to subscribe online at the same rate the magazine is offering on its blow-in cards. Come to think of it, those of us who are running monetized PF blogs ought to be able to write off the cost as a business expense.

🙂

Back to the Future…

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{sigh} We have seen the future, and it is…the Dark Ages. The Party of No has wrested control of the U.S. House of Representatives from the Party of the Half-Baked. No hope for relief from the metastasizing mean-mindedness and outright viciousness that have invaded our body politic is to be found, anywhere.

Here in Arizona, voters have approved a measure that exempts citizens and businesses from the national healthcare plan. The comically moronic Governor Jan Brewer (she of “uhhhhhh………..tee hee!……..uhhhhhmmmmmm”) was re-elected, of course, and the craven pol who presided as superintendent of public instruction while Arizona’s school system sank to the bottom of the national rankings is now, God help us, the state attorney general.

Now I’ll have to say, I wasn’t pleased with Obama’s healthcare plan. Without a national option, it’s just another iteration of what we already had: it threw us into the lion’s den with a pride of hungry insurance companies. We needed an option to make something like Medicare available to everyone who wished to accept it. Medicare is expensive — even after the state’s insurers raised their rates, my employee plan cost an eighth of what I’m paying to be fully covered under Medicare. However, for what I’m paying, coverage is better. If I fall ill and have to go doctors frequently, my overall costs will be much lower. Requiring everyone to sign up for full coverage with private insurers while blocking insurers from shafting people who really need care simply guaranteed that everybody’s costs would go up, coverage would be no better than what we have, and the well-heeled insurance industry would be joined by every other well-heeled industry in mounting a no-holds-barred campaign against the Obama administration.

Accepting compromise on healthcare was stupid. If the Democrats couldn’t swing a national healthcare option, then they should have dropped their plan until they could.

As for the Afghanistan mess: We were in Afghanistan long before Obama came along. Matter of fact, it seems to me we entered the war in the Middle East because a certain pack of lies emanated from a previous administration. Afghanistan was where the perp was hiding, but instead of going after him, we took it upon ourselves to depose a dictator who was formerly our ally, not because he was much of a threat but because, said our then-President, “This is the guy who tried to kill my dad.”

So…now we have in office some folks who think it’s acceptable to stomp on the head of a woman who disagrees with their doctrine.

Time to get out our brown shirts and iron them. And if you still believe you’re in the middle class, say good-bye to all that.

Gotta love those insurance companies…

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Wellcare, the outfit I selected (among dozens) to handle my Medicare Part D insurance—that’s prescription drug coverage—just sent me a package to plow through: TWO HUNDRED AND TWENTY-FIVE PAGES of dense, incomprehensible copy to try to figure out!

The booklet you’re supposed to start with, which explains annual changes to the plan, is twelve pages long. Apparently every single year you have to study all this garbage, try to decide if you can live with the changes they’ve come up with, and, if you can’t, try to find another insurance company whose terms you can live with, if any such thing exists.

This year they’re raising the prescription drug coverage from $19.70 to $23.80, or $285.60 a year.

That doesn’t sound like much, except for the fact that you don’t get much for your $285.60 a year. The yearly deductible is $310, so in fact before this thing starts to pay for prescriptions, you pay $595.60 out of pocket. Then it only covers $2,840 until you reach the “doughnut hole.” When your prescriptions have racked up a $2,840 bill (easy to do if you have cancer, diabetes, MS, Parkinson’s, or any of the numerous other ailments of old age), then you’re screwed. You then have to cough up $4,550 for your meds, at which point you reach what Congress in its wisdom has decided is the “Catastrophic Coverage” stage. Then you pay $2.50 for the drugs the company approves, $6.30 for brand-name drugs (many drugs do not come in generic form, you know), or 5 percent of the total cost. Again: Five percent of cancer drugs could add up to one whopping bill.

So really, you’re paying almost $600 for what amounts to only $2,840 worth of coverage. For the cost, it’s very chintzy.

All these plans are about the same: they’re required to provide approximately the same coverage with about the same terms. So, buying a more expensive plan won’t help you, except insofar as some plans apparently are a little more or a little less generous about what types and brands of drugs they’ll cover.

To figure out whether anyone else is offering a comparable drug plan for a lesser price, I’ll have to get a ten- or fifteen-page list from the state SHIP department, plow through that, negotiate telephone punch-a-button mazes to order up information from several insurance companies, and then plow through thirty- to forty-page piles of paper from each of those. Like I have time to do that, and like I could understand what any of that verbiage means, anyway.

Medicare Part D coverage is highly restrictive. To keep you from understanding exactly how restrictive it is, insurance companies have set up a complicated four-tier system involving generic, “preferred generic,” “preferred brand,” and “nonpreferred brand” drugs. It is so baroque as to be incomprehensible. According to the booklet my company sent, some drugs, apparently chosen arbritrarily, can cost you nothing if you order them from WellCare’s pharmacy. Once you start ponying up cash or daring to do business with the nearest drugstore, though, the least you will pay is $36. Yes: per prescription.

Some generics and “preferred brand” drugs can cost you $123 per prescription! Then you get to the Tier 3 “generic and nonpreferred brand drugs,” where you’ll pay $282 per prescription!

Think of that: $282 for a bottle of pills.

To further confuse matters, they move drugs from tier to tier. This year, we’re told, “Some drugs will be in a lower cost-sharing tier; others will be in a higher cost-sharing tier.” So, if you have a chronic disease, chances are you’ll have to change drugs once a year as the companies jack up the cost by moving them up a tier or two.

Evidently they’re supposed to give you some sort of discount on drugs once you tumble into the doughnut hole, but that’s not evident in the 12 pages of daunting gobbledygook in the summary booklet. It says here that the new healthcare legislation, which our Republican friends are campaigning to get rid of, “continues to close the coverage gap, or ‘doughnut hole,’ by reducing the percentage of cost-sharing for beneficiaries in the gap. Effective January 1, 2011, drug manufacturers will provide a 50 percent discount on brand-name drugs and the government will provide a 7 percent discount on generic drugs for those who fall into the coverage gap (Sec. 1101, HR 4872). This is in addition to a $250 rebate, effective in 2010, for beneficiaries who reach the coverage gap.”

All very nice, but it doesn’t change the fact that the doughnut hole amounts to $4,550 and that if you get seriously ill, which all of us will unless we drop dead of a heart attack or are killed instantly in a car wreck, you’re going to be out the cost of your premiums plus the cost of your deductible plus the vast out-of-pocket costs of the doughnut hole. For my modestly priced plan, that would amount to $5,146, not counting the costs of copays ranging from $12 to $235 per prescription.

What we have here is one real good reason why I don’t want to go to the doctor for my bellyache. Don’t know what I’d be getting into…and if it’s anything that requires a lot of drugs, well…

After a month and a half of general misery, I’m pretty sure that whatever is ailing me is probably serious. If it weren’t, it would have passed by now. But with Social Security confiscating an entire month’s benefit—$1,275 gross, $975 net—after my having struggled through a whole summer without enough income to cover my expenses, I’m flat broke. I simply do not have money to pay for doctors and drugs.

What this partnership with despotic private insurance companies actually insures is that seniors will delay going to doctors as long as they can. That actually pushes up costs, because by the time you get to the doctor whatever is ailing you will have reached an advanced stage, which will cost more to treat.

Some puppies are pleased that we lazy, greedy old bustards who oughta get a job won’t see a cost of living increase from Social Security in 2011, for the second year in a row. WellCare’s premium is the smallest part of my Medicare bill. If it’s gone up $4, you can be sure the much more expensive Medigap policy will go up even more. I’m already ponying up $90 a month (God only knows what it’ll be in 2011) to another private plan to cover the many lacunae in the government plans (Part A and Part B), and Part B itself, costs $111 a month for rather skimpy coverage.

With Part D, you have the option of taking a chance that you won’t get sick and won’t need a lot of drugs before you croak over. There’s no law that says you have to buy Part D coverage. (If you think the game doesn’t play out in favor of the table at Vegas, then by all means take this bet!)  But if you don’t get it at the first opportunity when it’s offered to you, then the cost goes way, way up: effectively, you’re punished for not buying insurance from private corporations until you think you’re actually likely to need it.

Nor is there any law that says you have to buy Part B. But you’d be a fool if you didn’t, unless you’re already so poor as to qualify for Medicaid. Part A is roughly the equivalent of major medical. It doesn’t cover much.

So far it appears the Medigap coverage works pretty well, though I haven’t used it except for the useless follow-up care for the torn rotor cuff, which I can’t afford to have repaired because I can’t afford to take a semester off my part-time job. So to date, I’ve paid $90 a month for air. Presumably next year the cost of air will even higher.

For $111 a month plus all the Medicare taxes I’ve paid and still pay on every dime I scrape together, Medicare should cover everything—without forcing beneficiaries to open their wallets wide to the rapacious insurance industry.

How to Choose the Perfect Office Chair

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This is a guest post by my friend Kenneth F. Muhich, D.C., of the Stetson Chiropractic Clinic

Is any one office chair perfect for everyone? Experts in ergonomics will tell you “no.”  The perfect office chair for you depends on many factors, such as your height, weight, posture, areas of pain, and what your chair will be used for.  How many hours per day will you be in it? And does your work entail computer, phone, or paper work?  As you can see there are many variables.

As a doctor of chiropractic my main concern is the patient’s posture.  Recent research has shown a direct relationship between many health problems and a forward neck posture.  With more and more people spending more and more time on computers, cell phones, and other electronic devices, health problems are beginning to pop up.  Some of these health conditions include disc herniations, loss of concentration, reduced immune function, and cardiovascular, respiratory and gastrointestinal problems.

Human bodies were not designed to sit in chairs for hours at a time, yet this is what our modern age has brought us five to seven days a week for six or eight or more hours per day.  Welcome to the wonderful world of health problems and premature aging.

So, since you’re spending most of your waking hours sitting in front of a desk, it’s in your interest to find the best office chair for your body. An ergonomic chair gives you the most adjustable options for your body. But these chairs have so many options to select! If you are looking for the best office chair for yourself, what are the guidelines you should use?

What is Ergonomic?

The term “ergonomics” comes from two Greek words: ergo, meaning work and nomos, meaning natural laws. Ergonomics works with your body’s makeup so the chair fits your body’s posture.

A correct office chair for you should be adjustable in many  ways to fit your body.

• The chair should rotate 360 degrees.
• The depth of the seat should be adjustable.
• The chair height should be adjustable.
• The chair seat should tilt front and back.
• An adjustment to tighten or loosen chair seat tension should be available.
• The chair’s back should tilt front and back.
• Arm height should be adjustable up and down.
• The distance between the arms should be adjustable in and out.
• The arm pivot front and back should be adjustable.
• A lumbar air pump should be available.

Some specialists in ergonomics frown on chairs with arm rests, because they may make it hard for you to get close enough to the computer. This is another matter that depends on the user’s size, body characteristics, and preferences. Each workstation problem can be solved by working with a specialist in ergonomics.

Putting Your New Chair to Work

Once you have chosen your chair and it feels great, you must integrate it into your workstation.  Although many believe that the chair you’ve chosen is the most important device in your workstation, there are other factors to consider.

The overall workstation, including chair, desk, computer, and desktop tools, can be the most modern and up-to-date in the industry, but if you abuse it, you will have health problems. With your ergonomic chair, some of these problems are easy to solve.  For example, when you sit at your workstation your computer should be in front of you.  The top of the screen should be no further than 24 inches from view, controllable by chair positioning.  Don’t forget to use a glar- reducing screen, which helps with eye strain.  Arms and hands on your board should be relaxed and just below the level of your heart. Knees should be either level with or slightly higher than your hips.  All of these can be made correct with your new ergonomic chair.

The height of your work surface should be between 24 and 32 inches. This is a variable based upon the individual’s height. Raise or lower chair or work surface to find the most comfortable position.

Now Get Up!

You have your chair and work surface perfect, right?  Now consider one other thing.

Sitting at your workstation for hours without moving causes stasis, which for individuals may mean vascular problems, muscle tightness, headaches, fatigue, and numbing of the work brain. The solution is to get a kitchen timer or something similar and set it for 30 or 45 minutes. When the alarm goes off, simply get up, walk around your workstation, and take a few deep breaths. This will do wonders for you and your job.

A proper office chair can mean the difference between a comfortable place to work that is safe, healthy, and productive or drudgery blighted with repetitive strain injuries and postural health problems.

Go find yourself an ergonomic chair and enjoy your job and a healthy life.

Images:
Aeron Chair. Public domain.
Computer Workstation Variables. Integrated Safety Management,
Berkeley Lab. Public Domain.

Health care, Woo-Woo, and the Spread of Superstition

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Did you read where whooping cough has been declared epidemic in California? It’s an entirely preventable disease that kills little children. There’s an easy way to keep your kids from getting miserably sick or even dying from this disease: vaccinate them.

Sadly, Americans have for some years been resisting calls to immunize their kids against diseases that were once common scourges. Somehow folks have absorbed the idea that immunization is dangerous to kids, and that magically nothing bad will happen to children if they are not vaccinated. Despite solid scientific evidence to the contrary, some parents persist in imagining that childhood vaccines cause autism. Despite the indisputable fact that because of vaccination we no longer need to fear smallpox and polio, or typhus, tetanus, typhoid, cholera, diphtheria—horrible diseases that devastated populations—people have allowed unfounded theories to frighten them to the point of putting their children at serious risk.

Vaccines do not kill children. Whooping cough kills children. While it is true that the older version of whooping cough vaccine had some side effects, occasionally severe ones, the “acellular” type now in use does not bear much risk; in either event, the disease itself has always posed a greater threat to children than has vaccination.

Vaccines do not cause autism. No one knows for certain what causes autism, but it pretty clearly has something to do with genetics; removing thimerosal, the vaccine preservative alleged to have caused a purported rise in cases, has done nothing to reduce the rate of autism diagnoses. One thing you can be sure of, though: viral and bacterial diseases do cause death, long-term physical harm, and mental disability.

Why have Americans become so superstitious? Where do people get ideas so misguided that they are led to put their children at risk, in a country where universal education is required? Shouldn’t an educated populace be wiser and more aware of the facts?

Snake-oil-poster

One reason is that we are being blitzed with propaganda for so-called “alternative medicine,” an approach that, more often than not, amounts to snake oil. A friend of mine, hearing of the continuing pain from my three-month-old shoulder injury, gave me a large bottle of pills that, while legally required to be called a “nutritional supplement,” were sold to her as an anti-inflammatory. She remarked, in handing the stuff over to me, that although her friends had assured her it’s highly effective, it hadn’t done anything for her.

This product costs around $100 for a bottle of 800 pills. One is supposed to take six tablets a day—that’s considered a “maintenance” dose.

When I looked up the product on the Web, not one skeptical word about it appeared in page after page of Google results. High on the lists of results were blissful songs of praise to the stuff. We learn, to our mounting joy, that the product is a cure-all. Not only does it ease your aches and pains, it reduces the occurrence of injury among athletes; lowers blood pressure; lowers cholesterol; prevents strokes and heart attacks; treats pancreatic cancer, breast cancer, multiple sclerosis, and hepatitis; eases the pain of rheumatoid arthritis; supports your joints (whatever that means); and aids digestion.

A miracle.

The research supporting these claims? Minimal to none. The buzz about the stuff is emanating from purveyors of vitamins and dietary supplements, the product’s manufacturer and distributors, naturopaths, and various other “holistic” practitioners.
Try to find solid clinical studies of this product, and you come up blank. Some “research” is quoted here and there, but when you examine the sources, you quickly see it’s bogus. The NIH and FDA have done nothing, as far as I can tell, to look into the product, whose sales in Germany are second only to aspirin. Adding tags like .edu to a Google search does nothing to bring up anything resembling actual science.

Adding “scam” and “snake oil” to the product’s brand name will bring up a few reports showing that the stuff does nothing for MS—but even with that search string, the results are full of sales pitches and ecstatic testimonials.

That notwithstanding, when the pain flared up a few days ago, I tried the pills. True to standard snake-oil claims, the product was said to cause few or no side effects, although its manufacturer notes it can cause an upset stomach and diarrhea.

Well, yes. It made me good and sick to my stomach but did nothing for the pain.

Lordie. We need to get out of Woo-Woo Land, both politically and intellectually. Part of the reason so many people subscribe to Woo-Woo is that our healthcare system is so poor. In quality of healthcare, the U.S. ranks at the bottom among developed nations. If you can’t get access to a doctor, you can’t get enough of her time to get diagnosed and treated effectively, or you can’t afford the treatment, you naturally seek alternatives. Unfortunately, many or most of these alternatives are unproven, ineffective, and sometimes downright unsafe.

Equally unfortunate, the products are aggressively marketed by profit-seeking entities (imagine the worth of a product that can sell like aspirin!) and touted by practitioners who may  sincerely, if naively, buy into the hype. They’re making a great deal of money from alternative products and treatments. And when you try to look into the facts, you’re run around in circles—probably because there are no facts, only unsubstantiated claims and anecdotal stories, all of them coming from folks who have already bought into the propaganda.

The fact that people don’t recognize when they’re looking at “research” whose sources have an ax to grind speaks to another cause of the widespread taste for credulity: the lack of real, solid science education in our school systems. People don’t understand what the scientific method is and why it is a more valid way of seeking verifiable facts than are anecdote and unsubstantiated theory because they don’t learn science in the public schools. To the contrary, the forces of superstition work against the teaching of real science—textbook publishing is dominated by parties who think science is a faith-based system of beliefs, no different in that respect from their own religion, which they believe should take precedence in educating everyone’s children.

The predictable result of weak science education is…well, exactly what we have. Ignorance leading to epidemics of preventable diseases that kill children, and a population of gullible consumers prone to wasting their money on highly profitable, untested nostrums.

Update: Shoulder fiasco

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Okay, so on Friday I get hailed in to the Mayo for an MRI. Dutifully show up at 12:30, as requested, bearing an author’s review copy of a novel I’m supposed to be copyediting (don’t ask how copyedits happen at the ARC stage; just be thankful this one is very clean).

Almost two hours later they call me in for the test. I’ve spent this entire time, undressed, in a small waiting room with a damnable television nattering away, rerunning the local morning show, over and over and over and over, telling us all about the weather and the traffic conditions and the six-hour-old news. Focusing on my work over the yammering voice of the woman DJ or whatever the hell she’s supposed to be is passing difficult.

This gives me lots of time to get tensed up.

By the time they finally get around to calling me in for the MRI, this fat lady is ready to go home. I’m hungry, irritated, and would like never, ever, ever to have to hear the inane chattering of some inane blonde talking head on the television again. Or, come to think of it, of anyone. What I would like is silence.

The MRI machine is one creepy-looking gadget, a huge donut-shaped affair reminiscent of a flying saucer stood on edge. It’s confined to a large room roped off with yellow “danger” tape, not very inviting. While it sits there waiting for you, it makes a weird otherworldly tweeting noise, like some sort of manic canary on meth.

The MRI techs pack me onto a kind of cot that can elevate the victpatient into the contraption. They tell me I can’t move—as in not budge and try not to breathe deeply—during the time the images are being taken, which will take about 20 minutes. I’m told this is a relatively brief exposure to the thing. Then they stuff cotton in my ears, which does nothing to dampen the sound of their voices, wrap my head with earphones through which some sort of treacly Muzak is pumped, cover my eyes with gauze, and tell me (only after I ask) that I can expect to be bombarded with a noise that sounds like a jackhammer.

holy. mackerel.

Well, I lasted about 30 seconds in there. They didn’t even get the thing turned on before I was asking to get out.

Creepy. Absolutely, indescribably creepy.

I didn’t feel afraid. I just felt so uncomfortable and so creeped out…sort of like having to pay an extended visit to a cockroach nest under the refrigerator…that I knew I was not going to be able to stand to stay in that thing for 20 minutes.

More to the point, a single cogent thought entered my mind: All these “stress attacks” I’ve been having—and there have been many, many more than the good Dr. Daley knows about—have never been satisfactorily diagnosed. There is some chance that those episodes could be minor cardiac events. If that is the case, then twenty minutes of uninterrupted, rather extreme stress could cause a heart attack.

Eff that, say I, only more explicitly.

Now they want me to consent to going back and letting them drug me with Valium or an intravenous sedative.

i. don’t. think. so.

The techs adjudged me “severely claustrophobic.” Not to be repetitious, but I don’t think so. Though it’s true that one reason I dislike flying in commercial jets is being jammed elbow-to-elbow with strangers (yech!); and it is true that I truly, truly hate the Flagstaff Ice Cave because it’s totally dark, totally devoid of light in there and you can’t find your way out without a flashlight or a lighter and we got in there one time without either of those and I was, yes, freaking scared; and no, I don’t like elevators, “severe” as in “disabling” is not the term I’d use.

Besides, I have a good reason to prefer stairs to elevators. I was once in an elevator that fell 11 stories before we could stop it. That’s 11 out of 13 possible stories…

Since then, if the climb is less than six floors, I’ll take the fire escape, thank you.

The inside of an MRI machine is not dark. It does not go up and down. It does not make you sit next to some odoriferous stranger with a screamy child. And it apparently poses little risk. It’s just creepy. Very creepy.

The fact of the matter is, the shoulder is on the mend. When I called the P.A. yesterday and reported that since the last time I saw him—quite recently—two days passed with almost no pain except for one out-of-the-ordinary position, and that I now can do the hold-your-hand-out-at-shoulder-height-and-pour-the-pop-out-of-a-soda-can maneuver with no pain at all, he remarked that it takes about three months “for the dust to settle.” It may be that given my age and the fact that I can’t take any over-the-counter anti-inflammatories, it simply has taken a long time to heal.

Yesterday after I got home from this entertaining experience, the kitchen sink clogged. To clean that out, I had to hold the plug down tight in the righthand sink and, with the injured left arm, pump a plumber’s helper vigorously in the lefthand sink. This caused exactly zero pain. It’s hard to imagine that if any very serious damage were lurking inside the shoulder, I could pull that stunt without repercussion.

At the moment it feels somewhat like a typhoid or cholera shot, only most of the time slightly less painful.

And frankly…some things are worse than chronic mild pain.

Images: MRI, shamelessly ripped off from a website now disappeared from my computer’s memory.
Elevators at 240 Sparks, Ottawa, Ontario, Canada. GNU Free Documentation License.