God Bless Us… Every One

 

"Many can't go there; and many would rather die." "If they would rather die," said Scrooge, "they had better do it, and decrease the surplus population."

A Christmas Carol, Charles Dickens 

 

“This boy is Ignorance. This girl is Want. Beware them both, and all of their degree, but most of all beware this boy, for on his brow I see that written which is Doom, unless the writing be erased. Deny it!"

A Christmas Carol, Charles Dickens

 

Thousands of seniors of meager means in our pastoral commonwealth of Monroe County, Michigan, expect very little from the rest of us for the coming Holiday Season. Their expectations are usually neither disappointed, nor exceeded. This year must be different.

Many elderly citizens receive a small monthly Social Security stipend, health insurance coverage in the form of Medicare, hot meals from Meals on Wheels, limited access to affordable foods at the county food bank, and restricted personal mobility via a subsidized, county-wide bus transit system. Some receive additional health insurance assistance from Medicaid.

These combined services help provide a veritable lifeline, often proving the difference between just scraping by… and living alone in abject poverty. All of these recipients are wildly grateful for these blessings that they receive. They seldom complain… God willing and knock on wood.

House Speaker, Paul Ryan, and Senate Majority Leader, Mitch McConnell boasts a less charitable view of such matters. They are currently working together on a plan that would effectively end Social Security and Medicare as we know it, to create budget savings that would free up more fiscal shimmying room in the annual dance to peg a Federal Debt Ceiling. They hope to start the process shortly after Christmas of this year, and finish things up before Thanksgiving of next year.

The scheme will utilize a cleverly crafted U.S. House Omnibus Appropriations Bill that would; convert Social Security into a tax deferred annuity investment product in which to park spare retirement cash, and convert Medicare into a block-granted insurance voucher system that would offer fixed value coupons to apply toward the purchase of individual health insurance from the open and competitive insurance marketplace. No spare retirement cash? Cannot afford insurance at current market prices even with the coupon? Tough luck.

The clever element of this legislative dodge arises from the fact that U.S. House Appropriations Bills are filibuster-proof in the U.S. Senate. They allow only a straight yea-or-nay vote by the Senate… and cannot be stalled by a filibuster on the basis of legislative merits. Such bills are unstoppable. If the votes are there in the Senate when the bill arrives, the bill will pass unchallenged… with a whimper. All of this plus a pound of flesh… carved directly from the hearts of the very old, and the very poor.

All that stands between The House Speaker, The Majority Leader, and draconian success… are the needed votes of their lawmaker peers. Those pesky votes, democracy be damned.

Federal lawmakers are a cautious lot when it comes to voting for things that outrage the voters who hire them. Bad votes, votes that anger voters… are the leading cause of career death among the short-termed members of the U.S. House of Representatives. For example, hands off my Medicare… or you’re FIRED! As few as one thousand voter e-mails from a home district in protest of a bad political stance can vex a lawmaker… more than a spike of holly driven through a cold and unfeeling heart.

To salve the ill ease and heartache caused by frequent comments from the voters, lawmakers have cleverly made it more difficult to make contact. They no longer accept or open handwritten mail, blaming fear of anthrax infection. They do not publish accessible e-mail addresses, but rather instead require the use of hard to find online comment forms attached to their lawmaker web-pages. They also often require inclusion of a ZIP Code Plus Four, (ZIP + 4), in the body of the comment form… to add just one more little irritation to the process.

Federal legislators need to be hunted down online before they can be addressed. The following handy links will allow you to easily locate your own three federal lawmakers, and to find your
own ZIP + 4.

ZIP Code Tool: https://tools.usps.com/go/ZipLookupAction!input.action 

Find a U.S. Representative: http://www.house.gov/representatives/find/ 

Find a U.S. Senator: http://www.senate.gov/senators/contact/

Elderly voters are often less tech savvy and less digital than most other citizens. They often do not own computers or smart-phones, and many have limited internet and wi-fi access. This makes contacting lawmakers for the purpose of defending the best interests of seniors difficult.

Our charity spends much of its time taking our own laptops and wi-fi hotlinks directly into the homes of seniors in Monroe County, Michigan… to give these citizens an opportunity to make their voices heard. We also make the above contact links available in a point-and click format, to other seniors throughout our Congressional District who do own digital devices… via social media, via e-mail, and via verbal instructions during direct telephone canvassing, to facilitate the opportunity for citizens to voice concerns directly to their legislators.

Saving Social Security and Medicare for the sake of needy seniors nationwide, is a simple numbers game. For the sake of a few minutes of personal time multiplied many people over, and of several million intimidating e-mails to federal lawmakers… efforts to deprive our most vulnerable citizens of vital financial and insurance services can be sidetracked.

Take a moment to contact your own three federal legislators, (two Senators and one Representative), to warn them: Keep your hands off of our Social Security and Medicare… or you’re fired! Invite a few friends to follow suit. Grassroots efforts like this can exponentially generate an unbroken chain of millions of lawmaker contacts. Help to stuff some stockings in Congress with comments in favor of Social Security and Medicare this Christmas. Do this for your elderly neighbors… and do this for your soon to be elderly self. Everyone is in this together, so God bless us… every one.

Maybe you would like to do even more using your own social media and e-mail accounts? We can offer some helpful tips. Like us on Facebook at “ACS Clinical Pharmacy & Sociably Secure-NGO.” Contact us for help at abcfreeseminars@gmail.com or telephone us at 734-241-5580. Why not do good… for goodness sake?

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One Thing Leads to Another

“Why don't they do what you say?
Say what you mean… oh, babe
One thing leads to another.”

The Fixx “One Thing Leads To Another”

“All in good time, my little pretty. All in good time.”

 The Wicked Witch of the West

It is vitally important that all people aged sixty five years or older develop the healthy habit of keeping current with recommended adult immunizations.  None more so important than those immunizations that protect against flu related pneumonia.  Life or death important.

Influenza related pneumococcal disease, (pneumonia, septicemia, meningitis, and diarrhea), causes ten percent of all early deaths in seniors over the age of sixty five.  As the emerging problem-trend of antibiotic resistance by common pathogenic bacteria grows, so too will the number of lives claimed by these deadly diseases.  Likewise, as our overall population trends toward a preponderance of baby boomers over the age of sixty five… the risk of pneumococcal disease in seniors will increase.  Winter is coming.

An exemplary senior turns sixty five, gets an influenza vaccine every subsequent year, gets the first of two recommended pneumococcal vaccines, gets the second of the two pneumococcal vaccines a year later… and the prevention of a slow and miserable demise in a local hospital might well be the prize.  Eight out of ten seniors who fail to mimic this sage course of action risk a far-too-soon shuffle off this mortal coil.  In each of these instances… one thing leads to another.

The herd of seniors who are newly turned sixty five years of age, plus those who are older, properly immunizes against influenza and pneumonia only at a rate of about twenty percent.  A large portion of those who do immunize, are only partially immunized against pneumonia:  receiving only one of the two pneumonia vaccines, receiving the two pneumonia vaccines in the less than optimal order, or failing to receive recommended pneumonia booster doses after turning sixty five.

For a numeric perspective, consider my home state of Michigan… where millions of unimmunized seniors live at risk of early death from influenza related pneumococcal disease.  Thousands of them die in hospitals yearly.  Just fathom the nationwide preventable cost in lives and in treasure.

It is important to note that the influenza vaccines, and both pneumococcal vaccines, are offered cost-free under coverage through Medicare Part B via CMS coding and billing protocols.  Treatment of pneumococcal disease places a huge cost burden on Medicare.  The cost is largely preventable… a fact not lost on CMS.

Medicare charges no co-pays for vaccines that protect against influenza, pneumococcus, and hepatitis; to eliminate any financial barriers against immunizing.  Most other adult vaccines are similarly covered by Medicare Part D prescription coverage, but co-pays often apply.

Immunizing at-risk seniors against influenza related pneumococcal disease is a worthwhile mission of mercy.  Some simple practice rules apply:

• All persons sixty five years of age and older should be vaccinated against influenza and against pneumococcus regardless of prior immunization status.  Booster protection in seniors is the rule of the day.
• All persons aged sixty-five years or older should annually immunize against influenza, and should receive one pneumococcal conjugate vaccine (PCV-13) and one pneumococcal polysaccharide vaccine (PPSV-23).
• Superior protection against pneumococcal disease is afforded to seniors who receive both pneumococcal vaccines.  A large percentage of immunized seniors currently only receive the pneumococcal polysaccharide vaccine (PPSV-23).  These seniors are considered only partially immunized until the pneumococcal conjugate vaccine (PCV-13) is administered.
• Influenza vaccine and one of the two pneumococcal vaccines can be administered concurrently during the same immunizing visit, with one vaccine administered in each arm.
• All persons immunized against pneumococcus prior to the age of sixty five should additionally receive booster doses of both pneumococcal vaccines after turning sixty five.  Five years of spacing between the original doses and the booster doses of the pneumococcal immunizations is adequate.  Seniors who do not receive booster doses are considered only partially immunized.
• Optimal pneumococcal protection is offered to seniors by administering pneumococcal conjugate vaccine (PCV-13) first, followed one year later by pneumococcal polysaccharide vaccine (PPSV-23).  This order of administration is clinically important.
• The two pneumococcal vaccines must be spaced one year apart to provide optimal protection.  To promote this practice, Medicare Part B will only pay for pneumococcal vaccines that are spaced one year apart.

Pneumococcal disease causes up to ten percent of all deaths in unimmunized seniors sixty five years of age and older.  Ten percent of all unimmunized seniors admitted to hospitals for pneumococcal disease later die from the disease.  Ten percent of all hospital emergency room admissions for seniors are the direct result of influenza related pneumococcal disease.  Fifteen percent of all seniors admitted to hospitals for pneumococcal disease are later readmitted to those hospitals as very costly “Medicare readmissions in under thirty days.”

Immunizers who dedicate their time and efforts to protecting unimmunized seniors against influenza related pneumococcal disease have an opportunity to offer important humanitarian relief to millions of local people.  The good in need of being done is readily measurable… in both dollars and in lives.  How satisfying might be the good works of directly saving fellow human beings; family, beloved, friends, and neighbors?

An at-risk senior turns sixty five, is gently persuaded to get an influenza vaccine every subsequent year, to get the first of two recommended pneumococcal vaccines, and to get the second of the two pneumococcal vaccines a year later… and a single life is saved.  Then another life is saved, and another and another… like millions of dominoes toppling in a row.  Only a gentle nudge to the first piece in row is lacking.  And one thing leads to another.

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A Matter of Trust

“I've lived long enough to have learned
The closer you get to the fire the more you get burned
But that won't happen to us
Because it's always been a matter of trust.”

Billy Joel, A Matter of Trust

“Whoever is careless with the truth in small matters

 cannot be trusted with important matters.”

Albert Einstein

I recently asked my Garmin for directions to a prospective client’s farm in rural Monroe County, Michigan.  I asked for the shortest route… gravel roads acceptable.  Garmin took me at my word and sent me up a decent unpaved road about three miles short of my destination.  Halfway to the house I was stopped short by a missing bridge that was currently under repair, and I had to backtrack and reroute.

I expect my Garmin to shoot straight with me… to tell me what I need to know when I need to know it, and to get me where I need to go.  My Garmin is a valued advisor and things usually work out okay.  If I run across the occasional missing bridge or washed out road, if Garmin fails to provide me with vital tidbits of information… I am comfortable allowing that Garmin simply didn’t know any better, and would never purposely do me wrong.  It’s a matter of trust.

I expect at least the same level of service and reliability from the advisors at my local Social Security Administration Office when I ask questions about benefiting from; Social Security Disability Insurance, Social Security Retirement Income, or Medicare.  I hope for the shortest and quickest route to the answers to my simple questions and to relief from my problems, gravel roads acceptable, no missing bridges.  Again, a matter of trust.

My charity advises folks about Social Security and about Medicare rights and benefits.  I occasionally send a client to the Social Security Administration office to seek answers to important questions or to apply for benefits.  They too often return to me after a visit frustrated, confused, and missing important information.  Allowing that a trained advisor at the Social Security Administration office might offer incomplete answers to simple questions simply because he or she didn’t know any better… would be a generous assumption.

Consider a few examples from my current client list.

• A fifty nine year old man who was badly injured in a car accident was enrolled in Social Security Disability Insurance, and allowed to early-enroll in Medicare.  He was not advised that he was eligible to enroll in a supplemental Medicare Advantage plan that would cap his annual out-of-pocket Medicare expenses at sixty eight hundred dollars.  After several surgeries at the local hospital to correct his injuries, he accrued thirty three thousand dollars in unpaid Medicare co-insurances and co-pays.  He makes monthly payments out of his limited income toward his Medicare debt.  He is now enrolled in Medicare Advantage.

• A sixty three year old Registered Nurse spent her entire professional career caring for patients in Skilled Nursing Facilities.  After forty one years of service, she developed physical disabilities related to her work.  She underwent surgery that resulted in two total hip replacements and vertebral fusions in her lower back.  She has trouble walking without a cane and is unable to lift even the lightest of weight.  She was discharged from her job, and was unable to find other employment.  She was too young to apply for Medicare, so she asked the Social Security Administration for help applying for Social Security Disability Insurance.  She was told that her professional degree, combined with the fact that she has substantial personal financial assets, made it unlikely that she would qualify for help, and was advised not to apply.  She took the advice.  I met her when she turned sixty five, and helped her to enroll in a Medicare program.                           

 

• A sixty one year old businesswoman with severe osteoarthritis gradually lost full function of both hips severe enough to require hip replacements, and developed lower back damage.  She was fired from her job and was left without the medical insurance needed to seek proper surgical care.  She was too young to apply for Medicare.  She learned to drag herself around with the aid of two wooden canes.  She earned money collecting intermittent sales commissions on industrial equipment as an independent operator for a vendor who would not hire her as a sales employee.  When she asked to apply for Social Security Disability Insurance, she was told to come back when she was making less money.  She earned only ten thousand to thirteen thousand dollars in sales commissions per year at the time, but she took the advice and did not apply for help.  I met her also when she turned sixty five and helped her enroll in Medicare.  She will soon seek surgical help.

These are only three tragic examples out of more than a dozen similar clients who were given bad advice or incomplete advice after seeking help from a local office of the Social Security Administration.  I wish that these examples were rare or unusual, but they are not.  If only.

I currently advise new clients to seek advice from the Social Security Administration with a grain of salt.  I advise them that it is not unusual for answers or advice to be withheld from them in those instances when the information might cost the federal government money in the form of benefits.  I advise them that “no” sometimes means “maybe” or even “yes”.  I warn them to watch for missing bridges and for dips in the road.

It is never fair to paint any whole group of service professionals with a single brush.  It is likely that many, perhaps even most, advisors for the Social Security Administration do a terrific job for all of their clients; but it is important to realize that some advisors fall way short… with tragic consequences.

People expect trained counselors for the Social Security Administration to shoot straight with them… to tell them what they need to know when they need to know it, and to get them where they need to go.  People look to them as valued advisors who are employed to assure that things work out fairly for their clients… and who would never purposely do them wrong.  It’s a matter of trust.  Simple, decent, public trust.

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The In Crowd

“I'm in with the in crowd
I go where the in crowd goes
I'm in with the in crowd
and I know what the in crowd knows.”
Dobie Gray, The ‘In’ Crowd

“What is missing, I think, is this notion of the common good.”
Susan George

Annual influenza vaccine formulations are generally less effective in two types of patients: those who are very young, and those who are very old. The why-of-it… is neither clearly understood nor has it ever been fully explained. This is not to suggest that the vaccines are ineffective in these folks… rather, only that they are less effective.

Maybe babies and geriatrics have less than optimal immune competency that lends itself to less than desired immunologic response? Maybe the vaccines bear less responsibility for the failure, than do the vaccinated themselves? Maybe the ghosts of diminished flu vaccine utility past are (unlike the ghost of poor Jacob Marley)… more of gravy than the grave. Who can say?

A busy-bee anti-vaccine faction has lately seized upon the notion of this lesser effectiveness, (but NOT ineffectiveness), of flu vaccines in kids and in seniors. It is suggested that in times of ever scarcer public healthcare dollars, money spent on promoting and providing flu shots for large pockets of citizens who respond to them poorly, might be better spent other ways. It is suggested that current efforts to promote flu vaccines for the very young and the very old is a misguided exercise… that pours tax dollars down a morbid rat hole.

This argument implies that a heretofore great job has been done by the public health effort to vaccinate most babies and most old folks… and that the effort has resulted in a costly treatment failure. Perhaps flu vaccinations are wasted on the very young, the very old, the very rural, and the very poor? Hmm. Perhaps not.

Truth be told, a shabby job is currently being done of immunizing Americans against the flu. In my rural home area of Monroe County, Michigan patients aged sixty five years and older annually immunize against the flu at rates of less than twenty percent. Young children annually immunize against the flu at rates of less than sixty percent. Teens annually immunize against the flu at rates of less than thirty percent. Americans of all ages combined annually immunize against the flu at rates of well less than fifty percent.

Percentage rates of immunization against the flu in each of the above groups plummet further… as the poverty level of the group increases. The poor and the poorly insured immunize poorly against influenza. Even poor seniors who qualify for free flu shots under current Medicare coverage immunize in paradoxically sparse numbers.

Rural counties tend to immunize against influenza at much lower rates than is normal in more urban counties.  However, even urban counties immunize against the flu at herd rates of less than fifty percent.
There are several sound reasons to immunize against the flu:

Personal protection: a flu shot can protect most recipients from catching the flu varieties represented in the influenza vaccine formulation.

Communal protection: if a large enough percentage of a population is immunized against influenza, the spread of the disease can be hindered… offering protection from the disease to the non-immunized portion of the population. This protection phenomenon is called herd immunity. A herd vaccination rate of over eighty percent is usually needed to create widespread herd immunity.

Health system protection: immunization against influenza and pneumonia can drastically reduce costly emergency room visits for the treatment of flu related complications: pneumonia, meningitis, septicemia, and debilitating diarrhea. Budget busting Medicare readmissions in under thirty days for patients covered by Medicare can likewise be curtailed. Deaths from flu complications can be greatly reduced.

The combined savings to the commonwealth from these three protections are both significant and well documented. Flu shots save big money for individuals, for businesses, and for local health systems. Deliberately reducing immunization rates against the flu for young children and for seniors would only cut these savings, and would negatively impact herd immunity. That makes little sense. It costs less to care for a healthy herd of people.

Less is not always more in the healthcare spending game. The money saved by cutting back on efforts to immunize large numbers of Americans would be mere pocket change compared to the money saved as the result of a more successful effort to push the nation’s annual rate of immunization against influenza up over the eighty percent mark.

Combining the resources of the federal government, state governments, public health system, local health systems, and licensed and certified immunizers in a program that promoted the creation of an immunized in crowd that represented over eighty percent of the American herd… would yield an impressive return on investment, and a substantial savings of healthcare dollars.

The notion that the best way to save money is to never spend money, sings a siren’s call in the ears of those currently cinching the strings of the health spending purse. The ship of state has lately favored parsimoniously piloting us onto the reef over clear sailing… when doling out needed public healthcare dollars.

However, infrastructure must eventually be served… be it for the climate, crumbling cities, the highways, the electrical grid, clean tap water, or the healthcare system. Pay a little now, or pay a lot later.

Given the choice between saving big money by preventing costly diseases and reducing human morbidity and mortality with the aggressive application of affordable and proven medical treatments like influenza and pneumonia vaccines… versus saving small change by amputating healthcare costs with the blunt instruments of budgetary surgery? I’m in with the in crowd… every time.

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Held Harmless

“Large amounts don't grow on trees.
You've got to pick-a-pocket or two, boys.”

You’ve Got to Pick-a-Pocket or Two, Oliver!

“It was so cold in Washington that I saw a politician with his hands in his own pockets”

Fred Allen, Johnny Carson

“The difference between a politician and a pickpocket is that a pickpocket doesn’t always get indignant… when you tell him to keep his hands to himself.”

Joseph Sobran

Federal law offers a little known temporary protection for current Medicare enrollees, against legislative increases in Medicare costs:  premiums, co-insurances, and co-payments.  Seniors who are currently receiving a Social Security benefit cannot be immediately required to pay increased Medicare costs unless, (or until), they receive a concurrent raise in Social Security benefits.

This protection feature is called hold harmless… and a person so protected from cost increases is said to be held harmless.  Protection applies only to Medicare enrollees who are receiving a Social Security check at the time that the cost increases are approved and enacted.

Raises in Social Security benefits usually come in the form of federal cost of living adjustments, (COLA).  Folks who are held harmless from Medicare cost increases are only spared cost changes until such time that they receive the next raise from Social Security.  The cost protection is only as good as that next COLA pay raise.

 

Medicare enrollees NOT held harmless from cost increases include the following:

• Eligible for Social Security but not currently receiving a Social Security check.
• Not eligible to ever receive a Social Security benefit.
• Newly enrolled in Medicare during the year in which cost increases take effect, with no established history of Medicare expenses.
• Earning an income high enough to exceed a federal threshold for expense protection.

 Seniors who turn sixty five years old now, or within the next five years; and who are eligible for Medicare enrollment… cannot immediately apply for a full Social Security benefit.  They face modern program enrollment guidelines that delay full program eligibility until participation ages of sixty six, sixty seven, or sixty eight.  These Medicare enrollees would not be held harmless for any expense increases that happen before they were allowed to draw a first Social Security check.

The following is a brief listing of just some of the important Medicare cost increases that were approved to take effect in 2016:

Medicare Part B Monthly Premium:               $104.90   (2015)          $121.80   (2016)

Medicare Part B Annual Deductible              $147.00   (2015)          $166.00   (2016)

Medicare Part A Hospital Deductible            $1216.00 (2015)          $1288.00 (2016)

Additionally, daily room rates for a hospital admission and for a convalescent stay in a skilled care facility have also been increased.  The Medicare Part A Hospital Deductible applies to EACH medically unique hospital admission, and can be assessed as many times during a year as there are hospital admissions.

More bad news, anyone?  Starting in 2020 Medicare supplement insurance products like Medicare Advantage and Medigap will no longer be allowed to cover payment of the $166.00 Medicare Part B annual deductible.  Supplement policies are currently allowed to cover that cost.  All new Medicare enrollees without exception will be forced by federal law to yearly shoulder the financial burden.  This requirement will NOT be enforced retroactively; as persons enrolled in Medicare supplements before 2020 will forever be held harmless.

Another popular proposal to shift more Medicare expense burden back onto elderly enrollees… would require that a six month elimination period be attached to each Medicare supplement insurance policy.  An elimination period would delay payment of supplemental insurance benefits for the first one hundred and eighty days of the supplemental insurance contract.  Enrollees would be required to pay policy premiums during the first six months of the policy, while being denied payment of any insurance benefits.

A six month elimination period for Medicare supplement insurance policies is already allowed by federal law.  Elimination periods for Medicare supplements are currently on the federal books.  However, although their use is now permitted… it is not yet encouraged or required by Medicare.

If Medicare cost increases in such troubled financial times seem a bit unfair and insensitive to the circumstances of most Medicare enrollees, that’s only because such is exactly the case.  The added expenses will weigh particularly heavily upon the poorest of seniors.

Simply put, members of the U.S. Congress have recently approved steep increases in Medicare premiums, co-insurances and co-payments that go into effect this year… because they believe that seniors do not already pay their fair share of Medicare expenses.  The changes were silently snuck through in a last minute omnibus budget bargain passed during the holiday season late last year… with little media fanfare, and absent public scrutiny.

Congress does not generally believe that Medicare enrollees have enough skin in the game, that seniors are suffering a fair share of the country’s financial pain. Whether or not that fiscal philosophy hits the mark… Congress deserves feedback from all seniors about the cost increases.  Voter reaction is always important… but it is doubly important in a federal election year.

Little consideration was given by legislators last December… for the ability of ALL elderly enrollees to absorb new Medicare costs.  Ability to pay was not taken into account.  Even the poorest and least capable of seniors must now pay the piper.  You’ve got to pick a pocket or two, boys.

If congressmen are not held accountable for paying down Medicare’s tab by picking the purses of the elderly, both the financially capable and the poor alike… it’s only this current crop of U.S. Congress members who are truly held harmless in such hurtful bargains.

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Thanks for the Memory

“Did your ever stop to think… and forget to start again?”  A.A.Milne

immunomodulation. [im″u-no-mod″u-la´shun]. adjustment of the immune response to a desired level, as in immunopotentiation, immunosuppression; acquired immunodeficiency syndrome; immune system amnesia.

Interest has lately been revisited concerning a clever viral self-preservation and survival technique called immune system amnesia.  Some viral pathogens have the selfish ability to modify the human immune system in such a fashion that it forgets how to recognize and battle previously familiar infectious threats… while concurrently forgetting to remember and target the newly offending virus.  These viruses cleverly create temporary acquired immune deficiency syndromes for the purpose of protecting their own infectious hides.

Such immune system amnesias can be either short lived, or long lasting.  They present the added disease burden of crippling a host’s ability to remember and to battle harmful germs such as those responsible for often fatal bacterial infections like; pneumonias, septicemias, meningitis, and diarrhea.  Frequently, it’s not the primary viral infection that wreaks the greatest havoc; but is instead a secondary bacterial infection that drives home the fatal dagger thrust.

One viral example, the Human Immunodeficiency Virus (HIV), is an apex predator pathogen responsible for the development of AIDS (Acquired Immunodeficiency Syndrome)… an extreme immune system amnesia.  AIDS victims are put at severe risk of infection when their immune systems forget how to recognize and to combat the simplest of disease causing germs.

A recent article in the journal, Science, takes a retrospective look at another example of immune system amnesia imposed by the virus that causes measles in humans:  “Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality” Michael J. Mina, Jessica E. Metcalf, Rik L. de Swart, A. D. M. E. Osterhaus, Bryan T. Grenfell; Science, May 2015:

The measles virus appears to have the ability to cause a long acting immune system amnesia that leaves infected individuals vulnerable to life-threatening secondary bacterial infections:  pneumonia, septicemia, meningitis, and diarrhea.  This particular acquired immune deficiency syndrome can last for up to several years.

Aggressive programs to vaccinate against measles pack the one-two punch of:  eradicating the number of active measles cases, AND eradicating a large number of cases of secondary bacterial pneumonia, septicemia, meningitis, and diarrhea. Trivialization of the risks of measles infection that leads to avoidance of measles vaccination… fails to consider and appreciate the hidden risks of mortal peril from secondary bacterial infections.

Subsequently, an aggressive and successful vaccination program against a virulent viral pathogen that causes immune system amnesia might offer a threefold benefit:

• Individual immunity for each vaccine recipient.
• Herd immunity for each non-vaccinated member in a predominantly vaccinated group, (with a herd vaccination rate of 80% or more).
• Protection against immune system amnesias that permit dangerous secondary bacterial infections.

 Successful antibiotic therapy is critically dependent upon competent immune system response.  Secondary bacterial infections that result from viral immune system amnesias can be less susceptible to antibiotic treatment due to a lack of strong immune response.  Treatment failures can contribute to the burgeoning problem of antibiotic resistance.

Drugs and biologics that suppress the immune system are commonly used to benefit organ transplant recipients, and to aid sufferers of auto-immune conditions including Rheumatoid Arthritis.  Antibiotic therapy can similarly be compromised in these patients. The famous co-founder of The Eagles, Glen Frey, recently succumbed to secondary bacterial pneumonia and diarrhea… while being treated for Rheumatoid Arthritis with a common biological immune suppressant.  Antibiotic treatment failed.

Vaccination against viruses known to additionally impair the immune system would be critical for the patient crowd treated with these agents... to help avoid problematic secondary infections, antibiotic therapy failures, and development of antibiotic resistance.  Vaccination against influenza and against pneumonia would also seem wise.

Retrospective reviews of the virulent influenza pandemics of the past are currently underway to evaluate their potential for having caused viral immune system amnesias.  Influenzas that kill are notorious for causing serious secondary bacterial pneumonia, meningitis, septicemia, and diarrhea… which are often the actual causes of death.  Might viral immune system suppression have played some mortal role?

 

Annual vaccination against influenza viruses would gain a whole new cachet were it established that flu viruses can cause problematic immune system amnesias.  However, while that jury is still out… the case in favor of an annual flu shot, and of both types of pneumonia vaccine, while awaiting the verdict seems pretty solid.

The notion that vaccination programs offer yet another health benefit in the form of protection against immune system amnesia and direct prevention of serious secondary infections is relatively new.  In addition to voicing gratitude for being spared the misery of suffering from a viral infection like the measles, rubella, mumps or the flu; we can now add from the bottom of our immune systems… “Thanks for the memory.”

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Tips for Wily Medicare Veterans

“True wisdom is knowing what you don't know”  Confucius

"It ain't what you don't know that gets you in trouble.  It's what you know for sure...

that just ain't so."  Mark Twain

My little non-profit organization, ACS Clinical Pharmacy & Sociably Secure-NGO, produces a free educational program entitled, "The ABC's of Medicare Enrollment".  These programs are presented as a public service, nine months out of each year, at different public library locations throughout Monroe County, Michigan.

As a regular speaker and educator on the topic of Medicare rights and benefits... I am often asked for helpful hints and money saving insights involving all things Medicare.  I have gathered a few along the way that I call "Tips for Wily Medicare Veterans"... and am delighted to share them below:

*Tip for Wily Medicare Veterans:  the federal Medicare Program hires certified Medicare Educators to teach Medicare concepts at the county level.  One requirement of the job is that they  NOT be licensed insurance agents.  Because federal Medicare Educators have only limited knowledge about commercial Medicare insurance product… the advice that they offer about purchasing private insurance products can be uneducated, incomplete, flawed, and costly for you.  Talk to both a Medicare Educator and an Insurance Agent to get a balanced view of commercial Medicare insurance products before you buy.

*Tip for Wily Medicare Veterans:  make sure that the Medicare Advantage plan that you choose does business with the local hospital and the local medical community as part of its closed care network!

*Tip for Wily Medicare Veterans:  beware of Medicare Advantage policies that offer special lowered annual out of pocket limits by cost-shifting a large portion of the cost onto the annual cost of premiums.  For example:  a plan might reduce an annual out-of-pocket limit from $6700 down to $4500, a difference of $2200.  That $2200 is then added back on to the annual premium amount… resulting in ZERO net savings for the client.  Although this procedure might spread costs out over a longer period of time, making paying for them easier… the change rarely saves you any costs.  These plans should never be sold as cost saving plans, or less expensive plans.

*Tip for Wily Medicare Veterans:  buy your Medicare Supplement from an insurance agent who brokers for many different insurance companies that sell the plans.  Although the coverage for each plan (F Plan, N Plan, G Plan, etc.) from each company must be identical under federal law… prices from company to company will vary widely.  An insurance broker will offer a variety of prices from which to choose from an assortment of competing companies.

*Tip for Wily Medicare Veterans:  beware of Medicare Supplement policies that offer special lowered premiums for the first two policy years.  Premiums may skyrocket after the second year… and the enrollee would be required to health qualify to switch to a more affordable plan!  It is possible to be trapped in the more expensive plan by your own bad health.  Beware of this common bait and switch practice! 

*Tip for Wily Medicare Veterans:  the most important difference between the two Medicare supplement insurance products (Advantage and Medigap) is the out-of-pocket-cost to you.  How much must you pay, on top of insurance supplement premiums and Medicare Part B premiums… before coverage fully kicks in?

• Medicare Advantage Plans are high cost plans of $4500 to $6500 per year out-of-pocket.
• High Deductible Medigap Supplements are medium cost plans of up to $2100 per year out-of-pocket
•  Low Deductible Medigap Supplements are low cost plans that run as low as zero dollars per year out-of-pocket
•  Pick the supplement product with the lowest sum of annual premiums plus annual out-of-pocket costs!  Simple arithmetic.

*Tip for Wily Medicare Veterans:  because all Medigap Supplement Plans MUST BY LAW admit even the sickest enrollees into a plan during the initial seven month enrollment period; older plans tend to cover sicker, and riskier enrollee pools.  Older plans are often sicker plans that have higher premiums due to an accumulation of multiple past premium increases.  Be sure to shop with an independent insurance agent who brokers for several companies that offer several younger and healthier Medigap Supplement Plans… which should have lower premiums.  A good broker can offer two or three prices for the exact same Medigap plan, (F Plan, G Plan , N plan, etc.).

Know your rights under federal law before meeting with an insurance agent to discuss Medicare insurance supplement products:

Before You Meet With and Insurance Agent:

• The agent must make an appointment to meet with you in person.
• The agent must document the Medicare insurance products you wish to discuss.
• The agent cannot come to your home to discuss Medicare insurance products without your permission in advance.

During an Appointment an Insurance Agent MAY:

o       Give you printed insurance materials.

o       Tell you how to get Medicare plan information.

o       Talk about only the Medicare insurance products that you previously agreed to discuss.

o       Make a separate appointment to discuss any additional Medicare insurance products that you want to learn about.

o       Provide insurance enrollment forms, and collect completed forms.

o       Leave business cards for you to share with family and friends.

During an Appointment an Insurance Agent MAY NOT:

o       Discuss Medicare insurance products that you have not previously agreed to talk about.

o       Sell you any other insurance products not related to the discussion of Medicare insurance products; like life insurance.

o       Offer you cash inducements, or offer you items of value worth more than fifteen dollars.

o       Ask you for credit card or banking information, unless the information is used to pay for a purchased Medicare insurance product.

o       Use high pressure sales tactics like; “If you fail to act now, you might go without needed insurance protection.”

o       Ask for the names, addresses and telephone numbers of your friends and loved ones for the purpose of selling them insurance.

o       Pressure you to sign an enrollment form for a Medicare insurance product.

Insurance Agents who violate these good practices should be reported to Medicare by dialing toll-free:  1-800-MEDICARE

What you don't know about Medicare CAN hurt you... and WILL cost you money.  Learning the basics about Medicare rights and benefits only makes good sense.  How can you spot a Wily Medicare Veteran?  That's easy... they speak fluent Medicare.

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