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.

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.

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.

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.

Travel Smart

One of the great things about summer is the coveted family vacation.  This season, be prepared in the case of an unexpected trip to the emergency room or urgent care while traveling away from home.  Here are some smart tips when planning your next vacation:

• Before you leave, look up a participating doctor, clinic or hospital in the area you will be traveling. All carriers have a link to their mainland network on their website where you can search for participating entities by name, city and zip code (see links below).

• Take a picture (front and back) of your insurance card. Even if you lose your wallet, you will know who to call in the case of an emergency.

• Fill up on any prescriptions before leaving on vacation.  Having an ample supply of your medication while away from home will come in handy in the event of a delayed return.

• Sign up for an online account or download an app. All carriers have online accounts (and some a phone app) for their members to use.  This helps with keeping track of your medical history, doctor’s visits, lab results and some even allow to fill prescriptions right from your phone. Having this information at the tip of your fingertips can be useful when traveling.

• Consider using your telemedicine benefit (if applicable) to connect with a doctor over the phone for minor conditions.

Please refer to your insurance carrier and details of you plan coverage to see what kind of resources and benefits are available to you. Happy traveling!

UHA

HMAA

KAISER

HMSA

HDS

Weekdays with Bernie 2019 Review

Joni, Lachelle and Jessica had the opportunity to participate in the Bernie Portal Weekdays with Bernie which was conducted over 3 days from March 25 to March 27 in Nashville, Tennessee.  As the days progressed, it was clear that Bernie Portal is not just a typical HR tool and it was evident they share our desire want to help HR departments eliminate redundancies in their everyday processes.  During one of the sessions, we were shown the staggering increase in healthcare administrative costs over the years which has resulted in more paperwork and time spent for everyone.  Our ability to provide Bernie Portal to our clients means these administrative tasks can be completed with accuracy and efficiency therein giving HR departments more time to focus on the real issues and initiatives their companies and employees need to be addressed.  The conference expanded our knowledge of the system’s capabilities and we learned how to best leverage these features to assist our clients to reduce their workloads and free up valuable time.  We look forward to utilizing our newfound knowledge to support our client’s HR teams and their employees.

To learn more about how we have teamed up with Bernie Portal to assist HR teams, please contact us at HRsupport@ebchawaii.com.