Viewing entries by
Laudra Eber

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Reflection on Hawaii Health Care and Medicare

Its almost the end of another year, hard to believe I have been retired somewhere between 5 and 7 years. That first year I was semi-retired and came into the office at Restaurant Row a couple of days a week. So much has happened in the intervening years: Patient Protection Act aka Obama Care is the law of the land. Employers in Hawaii didn’t get the shock that mainland employers did because the Hawaii Prepaid Health Care Act meant that employers were used to providing health insurance for their employees. With two laws covering health care, Hawaii employees get the most generous benefits. If PPA has a more generous benefit (ie drug coverage, coverage to age 26) then that applies in Hawaii. If the Prepaid has the more generous benefit (ie lower deductibles, invitro, lower maximum out of pocket) that’s what applies in Hawaii. Health care is still extremely expensive.

It will help a good deal if Medicare were able to negotiate drug prices (as does Kaiser and large insurance companies). The reason they don’t at present is because in order the get Medicare Part D through Congress, the administration had to agree that Medicare would not negotiate for lower drug costs. Big Pharma was afraid that if Medicare could negotiate their profits would go down, never mind that US taxpayers already subsidize the drug companies by allowing deductions for research and advertising from their taxes and that other countries pay less for drugs manufactured in the US than Medicare and US companies do. Drug companies have multiple lobbyists for every member of Congress because they like it that way. There is an ad on TV right now with a woman who says that if the law passes that allows negotiation, she won’t be able to get the drug she needs because her doctor won’t decide on her drug, the insurance company will. That ad is deceitful. I have been on Medicare since 2005. With my prescriptions, there are three drugs costing over $5,000 a month and an infusion costing $28,000. My prescriptions were never turned down under my prescription coverage plans. Thank goodness for Medicare and thank goodness for me. Lucky we live Hawaii.

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October and Hawaii's Quarantine

Here it is October and I have been quarantined since March.  Like you, I am bored. But I can get outside, I can watch TV, read, listen to music, use social media and email my friends.  Some of our neighbors are not as fortunate because although they may have all of the above they also have young children at home missing out on valuable schooling.  Some of our acquaintances also have terrible financial worries; without a paycheck how do you pay for groceries, rent and mortgages not to mention car payments, water and electricity?

Small businesses are folding and with them all the jobs they have been providing.  In Hawaii, this is particularly dire because our healthcare system, for those under 65, is directly tied to employment. There are 8,000,000 individuals in the United States that have been diagnosed with Covid19.   The disease itself and the side effects such as shortness of breath, heart damage, chest pain, cough, headache, joint pain, scar tissue on the lungs are all pre-existing conditions.  Hawaii is the only state that has outlawed exclusions for pre-existing conditions for group plans. 

Please remember your fellow citizens when you vote.

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Koa furniture in Clinics - Who pays for that cost?

When I was a child, we had a family Doctor, Malcolm J. Tear. He delivered both me and my brother and also took care of my mom and dad. We would go to his office, sit on a folding chair (without music or magazines) and wait for Dr. Tear to come out and tell us he was ready for us. When Dr. Tear retired, we started with Dr. Craig. Dr. Craig shared an office complex with our dentist. He diagnosed my mother’s colon cancer and diabetes and delivered my first-born son. No more folding chairs but no receptionist, the nurse would come out when it was your turn.

I’m not suggesting we should go back to folding chairs and a lack of specialists, but I do think we need to look at some of the other factors that are pushing up the cost of health care. We have already talked at length about prescription drugs and the advantage the drug companies are taking on the United States that allows them to deduct their research and their advertising. Drug representatives often earn more than the physicians they sell their wares to. I have mentioned the outrageous salaries of hospital administrators and hospital executives often numbering in many millions of dollars a year (each, not in total).

The cost of MRIs, CAT scans and other durable medical equipment have diagnosed and therefore, saved lives. Specialists are better for many maladies and if you have a heart attack, you’ll be wanting to see a cardiologist. I support advanced technology and providing the best physicians in every specialty, so our healthcare is the best in the world.

I believe that overdoing it in décor is a symbol of “we can do anything because we have the money and we are going to get more.” It is not just the Koa furniture but the philosophy that says a hospital needs a decorator and furniture most of us could not afford for our own homes. There is a woman’s clinic here in Honolulu that mainly does mammograms. The lobby is three times the size it needs to be and there are two receptionists with what looks like, Koa desks. The double glass entry doors are etched with a Hawaiian theme and the comfortable chairs are upholstered with Hawaiian prints. There is a wide selection of reading material. It made me uncomfortable and I changed clinics. The mammogram still hurts and I’d rather not be subsidizing over indulgence in decoration.

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Medicare For All: What It Really Means & Thoughts on Alternatives

It is December.  Hard to believe that we will be voting in less than a year.  So here are some thoughts. I am not in favor of Medicare for All, at least not in the way several political candidates have proposed it. Medicare, as I know it, has copays, deductibles, maximums, and premiums based on income.  In many cases, it also requires a Supplement to cover the deductibles, copays, and amounts above the maximums. I have it and I love it.

Medicare for All has no copays, no deductibles, no premiums, no maximums and covers medical inpatient and outpatient, drugs with no copay, dental, and vision.  See the problem? Have any trouble getting in to see a doctor recently; or even getting a doctor to accept you as a patient? Imagine what it will be like when everyone knows they can go to see a physician or dentist and it won’t cost them anything. There is already a problem with people using the emergency room because it is more convenient than waiting two weeks for an appointment or going during the day when the evening is more to their liking.  If the cost of such a program doesn’t scare you (and I have heard the rich will pay for it) then the lack of resources should and the millions of people involved in the health insurance industry that will be looking for jobs should.

But just knocking a problem and not offering any solutions is counterproductive.  So here is what I am in favor of:

  • Outlawing advertising of drugs except for medical professionals.  The drug companies say they spend more on R&D than advertising but it is not true.  Those billions of advertising dollars could be used to look for cures.   Congress outlawed alcohol advertisements they can do it with drugs.

  • Universal Coverage:  Medicare, expanded Affordable Care Act (ACA) or some other vehicle.   These plans should have no annual maximums; deductibles and premiums should be based on income.  Insurance companies could sell supplements to those that wanted them as they do now for Medicare.

  • Dental:  Free cleanings and fillings done at clinics staffed by senior dental students or by your favorite dentist for a fee.  We actually had this system in Hawaii for a while.  If you want veneers or some of the other things that make you look beautiful, like whitening, then I’m with you.  I want them too but we should pay for them from our own pocket.

Next issue:   what I think of  Koa furniture in the waiting room.


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Laudra's Lessons - Medicare for All

It’s fall already and by this time next year we will all (I hope) be thinking about who we will vote for in November.  I’m not going to go into President Trump’s policies and promises as we will have 5 years worth of those, counting the time he was campaigning.  I do urge you to consider what the opposition is proposing because there is a good deal to choose from. Unfortunately, Hawaii being a relatively small State, our impact is limited.

At least two candidates are proposing “Medicare for All.”  Medicare by itself is not enough. Seniors that have Medicare already either have employer coverage that supplements their Medicare or they buy a 

Supplement or Medicare Advantage Plan.  Medicare for All would be extremely expensive but our health system is already extremely expensive and it doesn’t serve everyone.  Medicare for All would cut down on the costs for claims administration and other bureaucratic paperwork and could cut the cost of drugs.  There is a bill in Congress right now that would do that but chances of passage are slim.

On the negative side, many medical professionals are leaving Hawaii and they cite low reimbursement rates.  Reimbursement rates even for insurance companies are set by Medicare. The insurance companies look at what Medicare is paying and set their reimbursement rates as a percentage or ratio of what Medicare pays; generally, a few percentage points higher.  That means that medical professionals would be making less money than they are now. And every year Congress would be able to cut the reimbursement level. 

We don’t get to vote on whether to have Medicare for All or the Patient Protection Act but the candidate that is elected will decide.  President Trump has said he has a plan but we have not seen any specifics. If John McCain had not had the courage to vote against the bill to cancel the PPA  three quarters of the country would have been without any medical coverage at all because there was no plan to replace it and it would have taken time for the insurance companies to get any new plans through State Insurance Departments.  

Think about it, and vote.


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FMLA Basics

The following is written by Laudra Eber

FEDERAL & MEDICAL LEAVE ACT

Passed by Congress to cover all employers in the US and Territories, FMLA applies to all eligible employees of covered employers and provides twelve weeks of unpaid leave with job protection and continuation of health insurance under the same terms as though they had not taken leave. The twelve weeks is extended to 26 weeks if the leave is taken to care for a related service member.


Eligible employee:   a salaried or hourly individual employed for 12 month with 1250 hours of service.

Covered employer:  a company with 50 or more employees within a 75 mile radius.

Twelve weeks: may be intermittent

Employees are entitled to 12 weeks in a 12 month period for the following:

  1. The birth of a child or care of a newborn within one year of birth.

  2. Placement of child for adoption or foster care within one year of placement.

  3. Care of spouse, child, or parent with serious health condition.

  4. Serious health condition of the employee.

  5. A qualifying emergency of an active duty military service member who is the

spouse, son, daughter or parent of employee.

The employer or the employee may require that FMLA be run concurrently with accrued paid leave

(vacation, sick leave) or in the case of the employee, with TDI.

Words of caution and how to avoid a lawsuit.

  • Dads as well as moms can take 12 weeks to care for a newborn or bond with a newly adopted or fostered baby.

  • Do not tell employee that you “cannot afford” for them to take time off.

  • When bonuses or pay increases are automatically given, ie COLA, an employee on FMLA is entitled to the same increase.

  • It is a good idea, though not required, that you insist that individuals taking FMLA make two phone calls, one to their immediate supervisor and one to (pick one) Human Resources, a third party administrator, a preselected manager.  Failure to do so negates FMLA.  This has already been upheld in several court cases.

  • Another option being used, and legal, is to have the employee submit requests in writing for all absences.   Not practical for someone who wakes up in the morning with the flu but for vacation, scheduled medical appointments and FMLA, easily done.