Category: Northwest Senior News

by Robert H Lustig, MD, MSL

Synopsis of Report #1

Lustig’s central thesis is that corporations and governments are purposely conflating (mixing up two opposite concepts) pleasure and happiness. This is being done for their gain and at the expense of the person that is left confused by the conflating of these two distinctly different but related concepts.

Pleasure: Enjoyment or satisfaction derived from what is to one’s liking; gratification. While pleasure has a multitube of synonyms, it has a specific, well understood “reward pathway” in our brain.

Happiness: The quality of being happy or contentment. I’ll skip over the philosophy of Aristotle that he cites to further explain happiness. Contentment says that I’m satisfied; it’s not necessary to seek more.

 

Chapter 1: The Garden of Earthly Delights

Chapter 1 to a large extent reiterates the concepts that Lustig proposes in his introduction. Let’s see what we can gleam, however, from this chapter.

Lustig poses the question, why are so many people miserable? He also points out that many rich people are unhappy. Additionally, he points out that some people claim that the argument between pleasure and happiness is a “straw man.” He asserts that it does matter and that the differences between these two otherwise positive emotions forms the narrative arc of this book.

He explains that pleasure is the “reward pathway” and happiness is the “contentment” pathway. Lustig also concedes that the definition of happiness has changed over time.

He spends page 19-20 discussing how various religious traditions have dealt with the concepts of pleasure and happiness. He says that the definitions of these words are a moving target.

Because people want to learn how to be happier, numerous pop psychology books have appeared in recent decades, ostensibly leading people on the way to the happiness that they seek. However, most of these books confuse pleasure with happiness.

Until you can distinguish the difference between these two emotions, you can’t recognize either one as unique and you can’t understand, let alone fix, the problem for yourself and for your family.

One Origin of the Confusion

Lustig says that if you “google” happiness you will find definitions such as pleasure, joy, bliss, contentedness, etc. He points out to the reader that this is a classic example of conflating pleasure and happiness. I’ll skip past his references to Aristotle. He shows how academics such as those at Stanford University have conflated pleasure and happiness. He quotes from the Stanford Encyclopedia of Philosophy:

 Happiness: Hedonism (maximization of pleasure) …

Lustig is not happy about Stanford’s conflating his two key concepts that drive his book. He spends the reminder of page 24 discussing some philosophical nuances of pleasure and happiness.

Lustig concludes chapter one:

And as corporations have profited big from increased consumption of virtually everything with a price tag promising happiness, we have lost big-time. America has devolved from the aspirational, achievement oriented “city on a hill” we once were, into the addicted and depressed society that we’ve now become. Because we abdicated happiness for pleasure. Because pleasure got cheap.

My comments: All through school I struggled with abstract concepts, and I’m struggling again. I’m fully sympathetic with anyone who thinks the following as he/she reads this summary: “I’m not sure that I understand all of this. Let’s see if this helps.

As a pre-adolescent emerging into adolescence, I loved drinking soda pop. It was sweet, fizzy, and tasted good. Back in those days soda pop was marketed in returnable bottles with deposits. I marveled with a friend when we bought a bottle of Royal Crown Cola. Why? The Royal Crown came in a 16-ounce bottle instead of the standard 12-ounce bottle. Coke was still being sold in 8-ounce bottles.

That extra 4 ounces of pop delivered more pleasure that lasted longer as I drank it down. As it fed my sugar addiction, it certainly didn’t add to my long-term happiness. In fact, because the massive sugar fix that I was imbibing contributed to weight gain, which contributed to me becoming more depressed.

Fast forward from the 1950s to today. Pop is still marketed and sold in 12-ounce cans. However, the 20-ounce plastic bottle has now become the new norm. That 20-ounce bottle has 67% more bad stuff compared to the old, 12-ounce can. And don’t think you’re getting off the hook if you consume “diet.” It’s all bad.

If the 20 ounce “new” serving size wasn’t big enough, the liquid candy purveyors are now marketing 24 ounce and 1-liter single serving sizes. However, the sales in recent years has been lagging for these super-sized servings, so the liquid candy folks have originated a clever new marketing gambit.

The liquid-candy-in-a-can folks are now marketing a 7.5-ounce can that sells for more than 12-ounce cans! This is something like $0.50 per can versus the $0.31 for a 12 ounce can. Or put another way, the liquid candy drinker now pays more for his/her smaller sized fix compared to a larger size.

A couple of years ago I attended an insurance meeting in Denver, and as a treat for the attendees, the sponsoring agency bussed us to a Colorado Rockies baseball game at Coors Stadium. The last major league baseball game I attended was around 50 years ago at Dodger Stadium in Los Angeles. Was I in for a rude shock.

During every inning break we were bombarded with a plethora of advertising, especially for soda pop, on the brightly lit, monster outdoor screens. I vividly remember one of the scenes of the HAPPY young adults romping around and having fun while guzzling down their liquid candy. Their heads were tipped back with their pop bottles tipped upside down at a 60-degree angle. The close-up shots showed the imbibers’ throats flexing as they swallowed their caffeinated candy. I don’t think it’s a stretch to suggest that the scenes had sexual overtones.

I can’t think of a better example of Lustig’s narrative of the conflating of pleasure and happiness. He also repeatedly hammers at the theme that the corporations’ conflating of pleasure and happiness is done at the expense of the consumer, or more accurately, the unwitting victim. That could be you!

Warren Buffet’s Berkshire Hathaway collects around $500 million dollars per year in dividends from the Coca Cola stock that he purchased around 30 years ago.  On December 1, 2012 the value of one Class A share of Berkshire Hathaway’s stock (BRK-A) was around $152,000. BRK-A hit $325,000 plus on January 22, 2018. That’s a doubling of wealth in a little over five years!

Every consumer that purchases Coke products (or any other liquid candy brand for that matter) has contributed to that explosion in wealth. It’s a they win, and you lose proposition. Meanwhile we hear on the news that America’s middle class in shrinking. We hear reports of the startling high percentage of seniors that are living at or below the poverty line. An exhaustive study of the causes of this occurrence is way beyond the scope of this chapter summary.

However, here is what Lustig is trying to get across to his readers. Drinking that liquid candy offers temporary pleasure, but let’s look at what happens for all too many people. That after effects include but are not limited to the following:

1. Weight gain and obesity
2. Please remember that the “diet” form of liquid candy introduces toxic substances such as aspartame or sucralose (Splenda) into your body. The evidence is clear that “diet” increases your appetite and is totally counter-productive as far as losing weight goes.
3. Type 2 diabetes
4. Heart disease
5. Stroke
6. Cancer
7. Increased dental costs due to the phosphoric acid in colas eating away the enamel on your teeth. I have received many calls from people needing thousands of dollars with of crowns, implants or other expensive dental work.
8. Financial ruin. The money spent on soda pop might as well be money flushed down the toilet. Worse yet, for those whose health has been damaged by the consumption of pop, there are increased medical costs that somebody is paying for. I have heard many people anguishing over the copays for their insulins (especially when packaged in pens) such as Lantus, Humalog and Novolog. Additionally, major pharmaceutical companies have developed expensive new diabetic drugs such as Januvia, Victoza, Onglyza, Byetta, and Trajenta. The costs for some of these are so high that some people simply cannot afford them.
9. Depression caused by a combination of the above occurrences.

I think Dr. Lustig would whole-heartedly agree that the drinking of soda pop may give temporary pleasure, but not only does it not lead to long-term happiness, but it contributes to depression when the negative results begin to occur. Please remember that too much pleasure leads to addiction and not enough happiness leads to depression.

Continuing:

Chapter 2: Looking for Love in all the Wrong Places

I thought Chapter 1 was a little on the technical side, but Chapter 2 is even worse. Lustig delves into the physiology of how the reward pathways work in our brains. For details, please read pages 26-32. He summarizes his commentary by stating:

These three pathways generate virtually all human emotion, and in particular, those of reward and contentment.

Because of how dopamine works on the reward pathways, virtually any stimulus that generates reward can lead to addiction. These addictions can include drug addiction, but they can also include behavior such as gambling or internet use. Sugar along with high fructose corn syrup sweetened foods or beverages are also highly addictive.

Happiness depends on serotonin, but the brain’s interpretation of these signals isn’t as simple as the pleasure signal.

Lustig explains that when the THC in marijuana binds to our CBI receptors it heightens mood and alleviates anxiety, which is partially why people become so giddy when they smoke pot…in those who toke, anxiety is thrown to the wind, leaving plenty of room for pleasure.

He discusses the drug Rimonabant which suppresses pleasure receptors. This drug was supposed to help people curb their eating as they received less pleasure from eating. The only problem was that when a person loses motivation for reward, he/she also lost motivation for life. Some suicides were the end result.

No pleasure means no happiness. Pleasure is the straw that stirs the drink. Happiness is the drink. Anxiety melts the ice cubes. We all need reward, because reward keep anxiety at bay . . . for a short time.

Lustig discusses the reward-contentment paradigm in relationships. Infatuation is the spark that may start a relationship, but for the long-term run, here is what he says:

Studies of married people show that the contentment derived from the commitment of an interpersonal union generates added individual benefit; people within such unions tend to live longer and develop fewer diseases then those who never married or those that are previously divorced.

Lustig points out that romance novels run on infatuation (reward) while love (contentment) is boring. Infatuation leads to alteration in the brain chemistry that resembles drug addiction, almost assuredly due to dopamine.

He concludes Chapter 2 by mentioning how the neurotransmitters dopamine and serotonin physiologically work in our brains. He explains that these two pathways influence each other.

When taken to the extreme, these two pathways can take you to the highest mountain or the lowest valley—addiction, depression, and just plain misery. The science in Part 2 and 3 says so.

End

Note from Lance: This is a reprint of an article by Dr. Sears with my comments after.

by Al Sears, MD

You’ve probably heard the expression that something important is “worth its weight in salt” and that a person who’s decent and good is the “salt of the earth.”

These expressions have their origin in the fact that up until about only a hundred years ago or so, salt was one of the most valuable and sought-after commodities in the world.

Today, it’s one of the most vilified. In fact, the American Heart Association (AHA) recently made a shocking announcement in the journal, Hypertension. They claimed that one in 10 Americans dies from eating too much salt.¹

I’m sure you’ve heard the dire warnings about salt from your own doctor, the media, the FDA and just about everyone else. It makes great attention-grabbing headlines. But these recommendations are not just misleading; they’re downright dangerous.

Current FDA and AHA guidelines recommend that to lower blood pressure and reduce your risk of heart disease, you should consume no more than 1,500 mg of salt per day.

Their hypothesis goes like this… You eat salt and get thirsty, so you drink more water. The excess salt causes your body to retain that water. And retaining excess water increases your blood volume, which leads to higher blood pressure… and therefore to heart disease and stroke.

It seems to make sense in theory. But there’s a big problem. The facts don’t back it up. Repeated studies have failed to show a causal link between salt intake and high blood pressure. In fact, a lot of research even points in the opposite direction.²

Most doctors will never tell you that multiple peer-reviewed studies published over the last 10 years reveal that when your daily sodium intake drops below 3,500 mg, your body reacts with a rapid rise in the hormones renin, angiotensin and aldosterone.³

This can lead to insulin resistance and trigger chronic diseases, like diabetes, metabolic syndrome and heart disease — precisely what salt restriction is supposed to prevent.^4,5

Let me explain…  In a 2016 Harvard study — involving 130,000 people across 49 countries — researchers put healthy people on a low-salt diet. Within just 7 days, these previously healthy participants developed insulin resistance! In fact, the researchers found that low salt intake raised their risk of heart attack, stroke and death, compared with an average salt intake.⁶

I’m all for better labeling and your right to choose how much salt you consume. But if you were to slash your salt consumption by 30% or more, as the FDA and AHA recommend, the chances are we’d be struck by a major health crisis.

Decades of pushing a low-salt diet may even be partly responsible for the epidemic in insulin-resistance and diabetes faced by millions of Americans today.

Salt craving is normal. It’s a biological need, just like your thirst for water. The truth is, you can’t live without salt.

Salt carries nutrients across cell membranes and into your cells. Your heart, kidneys, liver and other organs need it to function. It helps regulate fluid balance and muscle contraction. You can’t digest food without it. And humans are salty people. We cry and sweat salt. Even our blood is salty.

Studies show that when people are allowed to use as much salt as they like, they tend to settle at about a teaspoon-and-a-half a day — around 3,500 mg of sodium. This is true all over the world, across all cultures, climates and social backgrounds.⁷

The real question you should be asking is not, should you eat salt or not — but what kind of salt should you eat? Because not all salt is created equal…

Don’t Buy Into the Big Salt Lie

Here’s what I tell my patients who are worried about their salt intake: Toss the processed table salt. The salt you find on supermarket shelves is refined table salt. And table salt is not even anywhere close to the kind of salt Mother Nature intended. Table salt is superheated and bleached until it’s devoid of nutrients and minerals.

Stop eating fake foods. Americans get almost 80% of their salt intake from processed foods. And these fake foods are loaded with sodium — even if they aren’t traditionally “salty” foods. It acts as a food preserver and works by removing water from the food so bacteria can’t survive.

Salt has been used to preserve food for thousands of years. But the salt Big Agra uses is loaded with chemicals and can be listed in the ingredients under names like sodium ascorbate and sodium lactate.

Choose natural salt alternatives. Here are two of my favorites:

Sea Salt: Natural sea salt is unrefined. It contains sodium chloride like ordinary salt, but also has 50 other minerals, with all the co-factors and trace elements nature intended real salt to have. Sadly, most sea salt around the world has been contaminated by plastics pollution. But it’s still better for you than processed table salt.

Himalayan Crystal Salt: Himalayan salt is mined from ancient salt beds in the Himalayas. Since these salt beds are ancient and dried, they don’t have a risk of contamination. They also contain many trace minerals. For example, 500 mg of Himalayan salt has 250 mcg of iodine. Its pinkness comes from its rich iron content.

To Your Good Health,

Al Sears, MD

Lance’s Comments: The website for the brand Himalayan Crystal Salt contains some excellent information as to the why’s of this type of natural salt. They list “Five Factors that differentiate the different types of salt:

1. The amount of trace minerals in each salt.
2. The ratio of those minerals.
3. The particle size and structure of those minerals.
4. The level of contamination with additives, chemicals or pollution.
5. The research on that specific salt showing its health benefits.

They next list a useful spread sheet that shows why their brand of salt is superior compared to others.

There is another brand of unrefined salt called Real Salt. It is mined from an underground salt deposit in central Utah. Their website does not get into the detailed specifics as does the one for Himalayan Crystal Salt.

Another entry in the healthy salt lineup is Celtic Sea Salt. Again, this salt is mined from ancient sea beds. End

 

References

1. “Sodium and Salt.” American Heart Association.
2. Brownstein D. “Salt Your Way to Health.” A Grain of Salt Winter. 2006 issue.
3. Graudal NA., Hubeck-Graudal T., et al. “Effects of Low-Sodium Diet Vs. High-Sodium Diet on Blood Pressure, Renin, Aldosterone, Catecholamines, Cholesterol and Triglyceride [Cochrane Review].” Am J Hypertens. 2012 Jan.
4. Alderman MH., Madhavan S., et al. “Association of the Renin-Sodium Profile With the Risk of Myocardial Infarction in Patients With Hypertension.” N. Engl. J. Med. 1991.
5. Ruivo GF., Leandro SM., et al. “Insulin Resistance Due to Chronic Salt Restriction is Corrected by α and β Blockade and by l-arginine.” Physiology and Behavior. 2006.
6. Mente A., et al. “Associations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension: a pooled analysis of data from four studies.” Lancet. 2016 Jul 30.
7. Alderman MH. “Dietary salt and cardiovascular disease.” Hillel Cohen. Published: 10 Dec 2011.

The Introduction

My Beginning Comments: I became familiar with Dr. Robert Lustig from his Youtube video titled, Sugar, The Bitter Truth. In the video, Lustig discussed the myriad of health problems that have resulted from the introduction in the 1970s of High Fructose Corn Syrup (HFCS) in Western diets. Among these ill-effects are an explosion of type two diabetes and obesity. An acquaintance referred me to his newest book, The Hacking of the American Mind. For future reference I’ll shorten the title to Hacking.

I looked at Lustig’s Youtube video titled The Hacking of the American Mind with Dr. Robert Lustig and decided that Hacking has merit for anyone wanting to better understand how we got to where we are as far as the American diet goes. Lustig poses an interesting question, “Have our minds been hacked by corporate and governmental interests?” He suggests that they have.

Lustig deals with philosophical, political, economic, and theological elements as he discusses one of the central themes of his book. This is the conflating, or mixing up of the concepts of pleasure and happiness.

In college I was never thrilled when I had to deal with abstract subjects; it just wasn’t my cup of tea. So, here I go; I’m dealing with more abstract topics. I feel like I’m struggling with my college classes all over again.

I’m totally sympathetic with those of you who aren’t too thrilled about having to deal with abstract topics and concepts. With that in mind, I promise that I will do my best to explain Lustig’s concepts in a simple and understandable way.

Lustig uses an English word that was new to me, and that is conflate or conflating. Merriam-Webster defines “conflate” as to bring together, fuse. A second definition is to confuse. Google defines conflate as follows: combine (two or more texts, ideas, etc.) into one. Specifically, Lustig demonstrates how corporations have conflated the concepts of pleasure and happiness for their profitable gain.

If you would like to delve into more detail than I can realistically present in these reviews and digests, I encourage you to acquire your own copy of The Hacking of the American Mind: The Science Behind the Corporate Takeover of Our Bodies and Brains.

 

Lustig’s Introduction

Lustig begins by explaining that childhood is a time when the balloon of happiness soars high above the mundane. He says that he became a pediatrician in part, to relive and help channel the wonder and delight involved in growth.

He sadly explains that four decades later something has happened as he now sees children taking adult prescriptions such as metformin for type 2 diabetes and benazepril for hypertension. Lustig says that the balloon of happiness has been deflated and now children have the pleasures of Capri Sun, Netflix, and Snapchat.

Lustig poses these questions: What if those pleasures, ostensibly developed and marketed in the name of increasing your happiness, actually did the opposite? What if they actually made you unhappy? What if they changed your brain so that happiness was sapped from you? What if today’s kids are actually canaries in the coal mine?

He spends some time discussing the ancient philosophical differences between pleasure and happiness. As Lustig reflects back over a four-decade time span, he makes this telling comment:

These past forty years have witnessed the twin epidemic of the negative extremes of both of these emotions: addiction (from too much pleasure) and depression (from not enough happiness).

He asks more rhetorical questions:

Did this uptick in addiction and depression occur naturally? Separately? In a vacuum? Or under what form of outside pressure? What if all of Western society has been hacked, to profit a few at the expense of the many? And what if you didn’t even know you’d been hacked?

Lustig then proceeds to define what he means by “hack.” Initially “hack” meant a prank. Then Silicon Valley types stole the word to denote clever solutions to difficult problems. That was “white hat” hacking. “Black hat” hacking is breaking into computers and infecting them with viruses and stealing data.

Lustig emphatically points out that he is not a conspiracy theorist by saying I’m not going to stick my neck so far out as to say that there has been a conspiracy between different industries and the government to purposely inflict malice on the public. However, he states that there has been a plot by some industries to obfuscate the link between their products and disease, and to willfully confuse the concepts of pleasure and happiness with the sole motive being profit.

My comments: All one has to do is to look at the food and beverage industry’s peddling high profit snacks and beverages that promote type 2 diabetes, obesity, and hypertension.

Continuing: Lustig refers to “sugar” as the other white powder [the first being cocaine]. He references his earlier book, Fat Chance where he posed these two rhetorical questions. Why are we all so fat and sick? And in just thirty years? He points out that there is a wealth of information on the role of nutrition on outcomes related to behavioral health. He says that this information is virtually unknown to most doctors and patients. He continues by saying that industries and governments have pushed their reward-generating substances onto their unsuspecting populations which has caused further unhappiness. Lustig concludes this section by stating that some of the basic tenets [beliefs] of modern medicine are rubbish.

Lustig next defines pleasure and happiness and how they are different.

Pleasure: Enjoyment or satisfaction derived from what is to one’s liking; gratification. While pleasure has a multitude of synonyms, it has a specific, well understood “reward pathway” in our brain.

Happiness: The quality of being happy or contentment. I’ll skip over the philosophy of Aristotle that he cites to further explain happiness. Contentment says that I’m satisfied; it’s not necessary to seek more.

My comments: To help myself better understand the difference between the emotions of pleasure and happiness, I have recounted these memories. I knew a young woman who was somewhat overweight. One evening she binged on chocolates and had immense pleasure as she was scarfing them down. The next day she was bummed and depressed about what she had done. What gave her fleeting pleasures devolved into unhappiness and depression. I, too, well understand this as sadly, in my previous life of being a sugar addict, I have experienced the same emotions.

Fast forward to today. When offered addictive sweets and treats, I do everything possible to politely pass on the offerings. I willfully forgo indulging in the goodies as I derive much more happiness that I have mastery over a temporary pleasure. I cannot agree enough with Lustig when he states that too much pleasure leads to addiction, and not enough happiness leads to depression. It’s so true!

Continuing: Lustig states that scientists know that pleasure (reward) is the emotional state where your brain says, this feels good—I want more. Contentment says I’m okay, I don’t need any more.

My Comments: Here is what is swirling in my mind as I sit here and press keys on my keyboard. If I’m contented with my station in life, my house, my car, my clothes, and my wholesome food diet, I don’t feel the need to be out there spending money to buy stuff to make me happy.

Continuing: Lustig uses pages 9-10 to further discuss the connection between reward and pleasure. He points out that pleasure and happiness are not mutually exclusive [meaning they can both exist at the same time]. The example he cites is having dinner at a fine restaurant where it’s a shared experience with family and friends.  You can simultaneously have the pleasure of eating fine food and happiness derived from your social gathering.

He continues with this revealing comment about reward:

Reward when unchecked can lead us into misery, like addiction. Too much substance use (food, drugs, nicotine, alcohol) or compulsive behavior (gambling, shopping, surfing the internet, sex) will overload the reward pathway, and lead not to just depression, destitution and disease, but not uncommonly death as well.

He points out that pleasure is usually driven by taking something such as taking a drug (legal or illegal), taking in sugary foods, and going to casinos to get the thrill of rolling the dice and winning the big one.

Happiness or contentment is derived from giving. This can include spending time with your grandchild or giving to a charity.

Lustig’s final point about reward is this:

Reward is driven by dopamine and contentment by serotonin. Each is a neurotransmitter—a biochemical manufactured in the brain that derives feelings and emotions—but the two couldn’t be more different. Although dopamine and serotonin drive separate brain processes, it is where they overlap and how they influence each other that generates the action in this story.

This concludes his discussion of reward. He continues with a caution saying that the science about dopamine and serotonin is largely based on animal studies. He says that human studies are correlational at best. Correlational means that two things are related, but that doesn’t mean that one thing proves another. He offers more details on page 12 concerning some of the problems with human studies.

Lustig concludes his introduction by briefly outlining what he will cover in each part of his book.

Part 1: He discusses the differences between reward and contentment.

Part 2: He will elaborate on the biology of reward and science of dopamine.

Part 3: He discusses the biology of contentment and the science of serotonin. Anyone taking an anti-depressant may find this chapter to be very informative.

Part 4: Lustig will show how the perpetration of this “plot” [the conflating of pleasure and happiness for profit] has brought us to this place from a personal, cultural, and economic standpoint. He makes this sobering statement:

In the last half century, America and most of the Western world have become more and more unhappy, sicker, and broke as well.

Part 5: He will offer solutions as to how you can defend yourself against the “peddlers of pleasure.”

To be Continued

by Ron Iverson, President of the National Association of Medicare Supplement and Medicare Advantage Producers. Inc. and Lance D. Reedy

New Medicare Numbers

Background from Lance: I’m sure that everyone is aware that the Social Security Administration (SSA) has used your Social Security numbers for your Medicare numbers [Health Insurance Claim Number or HICN] since the beginning of Medicare. For most people that have worked at least ten years and paid into the SS system, their Medicare number is their SS# followed by the letter “A”.

In some cases, for those that have not paid into the SS system for ten years, their Medicare number is typically their husband’s SS# following by the letter “B”. The letter “T” has been used for those on Medicare but not yet drawing SS. There are various “D” codes for typically a widow who is drawing off her deceased husband’s SS. The Railroad Retirement Board uses letter(s) in front of one’s SS#.

The problem, of course, is that we are sadly in the age of identity and medical theft. If your wallet or pocketbook containing your Medicare card is lost or stolen, now your or your spouse’s SS# is floating around ready to be co-opted by an identity thief.

People have griped at the SSA for years about this problem, but the wheels of government bureaucracies turn slowly. Finally, Congress passed the “Doc Fix” legislation in 2015. One of its amendments was to direct the SSA to begin issuing new, non-Social Security, Medicare numbers beginning in 2018.

From Ron Iverson: CMS [Centers for Medicare and Medicaid Services] recently released a bulletin answering questions about the rollout of the new non-Social Security Medicare numbers. The first wave [of new Medicare numbers] from April to June will be sent to Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia.

I have provided the following links to CMS’ website to answer questions you may have about this new rollout.

Number 1: Medicare Card Messaging Guidelines

This link answers general questions and provides instructions about the new Medicare card that you will be receiving in the coming year.

Number 2: New Medicare Cards and Why They are Important

This link provides more details about the new Medicare Beneficiary Identifier (MBI). Yes, you have a new acronym to keep straight. The new MBI replaces the SS# based Health Insurance Claim Number (HICN) that is on your existing Medicare cards.

Number 3: New Medicare Card Mailing Strategy

Oregon will be in Wave #2. Idaho, Montana, Wyoming, and Washington will be in Wave #6

 

Speech, Physical, and Occupational Therapy Limits

from Ron Iverson

One of our members, Paula Smith, sent me an article from AARP dated January 24th, which indicates some rather unsettling news regarding the Part B benefit of speech, physical, and occupational therapies. We all have been aware that there are limitations on those benefits, but you may not have known that, according to the article, “Congress has previously passed an automatic exception that allows Medicare to pay for care beyond the caps when the treatments are deemed medically necessary.”

Paula was rightfully concerned because her accountant had forwarded the article to her, and she contacted her Congressman who knew nothing about it.  She also was told that people should be contacting their legislators to keep this benefit going.  So, what is the change in the benefit?

Well, the change is pretty serious, because the automatic exception expired December 31st. According to the article, “which then means that the caps of $2,010 for physical and speech language therapy and the $2,010 cap for occupational therapy are being enforced.  When the exceptions were in place, Medicare beneficiaries paid only the 20 percent coinsurance* that Part B requires.”  (The $2,010 figures are for 2018.)  *Some or all of this amount would be picked up by your Medicare supplement plan.

“Without the exceptions, Medicare beneficiaries must pay the entire therapy bill once they exceed the threshold.“ According to AARP, some beneficiaries with high-cost conditions could reach the annual cap in the coming weeks.  According to a recent analysis commissioned by the American Occupational Therapy Association, nearly 6 million Medicare beneficiaries accessed outpatient therapy services in 2015.  Of those, nearly 1 million cases required care that exceeded the combined cap on physical and speech therapy, while nearly 250,000 surpassed the occupational therapy threshold.”

Comments from Ron Iverson:  This is a serious matter, and one which very few Medicare Part B enrollees would know about until they go to their therapist and get the bad news.  I know of people who suffer a stroke, and the $2,010 limit does not begin to cover what can become a six-month, or longer, need for speech rehab, let alone physical therapy.  This situation is going to impact the providers, who now cannot use the exceptions, and risk placing themselves in a bad standing with CMS.  Good ol’ RACs [Recovery Audit Contractors] come into play here.  We, and Congress, have known for years that something must be done in relation to these limits on therapy.

Since Paula’s Congressman didn’t know about this problem, it’s likely that there are many others in the same situation. It’s time for CMS to take action and forward solutions to Congress for some type of revival of the “automatic exception” rule. I understand the fact that CMS is trying to save money and lower costs to the program, but this is not a way to do it.

Comments from Lance: For an even better understanding of this situation, please read this article on the American Physical Therapies Association’s website. Here is a key paragraph.

Wasn’t Congress ready to permanently end the hard cap? What happened?

It’s true: over the fall, a bipartisan, bicameral deal was reached that would have permanently eliminated the hard cap on therapy services. That deal was part of a larger piece of legislation that included other changes to Medicare, such as payments for ground ambulances and reauthorization of special needs plans. This package of so-called “Medicare extenders” was supposed to be adopted in early December. Unfortunately, the debate over the tax reform legislation dominated Congress in the final weeks of session, pushing nearly all other issues to 2018.

Let’s hope the Congress can fix this problem sooner than later.  End

By Lance D. Reedy

For several years I have pounded the table with this central message: If you have any questions, thoughts, ideas, or concerns about anything connected with your Medicare plans, please call your agent first. Doing so can save you much grief and acid indigestion.

Before I get into the details about this topic, I want to describe an incident that happened with one of my daughters. For this discussion, I’ll give her the fictitious name of Susan. In March of 2016 Sue was hit as a pedestrian in a crosswalk while walking to class at the University of Idaho in Moscow. She ended up with a cracked vertebra and a broken scapula. She was initially transported by ambulance to Gritman Medical Center in Moscow and then to St. Joseph Regional Medical Center in Lewiston.

Fortunately, the woman driving the Ram pickup that hit Sue had liability insurance in force. I told my wife and daughter that it was imperative that we quickly secure the services of a top-notch personal injury (PI) attorney. Through a referral, we met with Ted Harris (also fictitious), Attorney at Law in Moscow.

I might add here, that if you ever need the services of a PI attorney, make sure that he is a TRIAL lawyer. Insurance companies know that they can’t play foolery games with an experienced trial attorney. I’ll also comment that even though our PI attorney charged the typical 33 1/3% of the settlement, he was worth every penny!

All the phone calls, hassling with the insurance company, and dealing with bill collectors was lifted from us.  Not only was Mr. Harris worth his fees, he was able to put in a claim for under-insured motorists with our own insurance company as the offending party was under-insured. Sue ended up with a better settlement than she could possibly have imagined if we had done this on our own.

Additionally, Mr. Harris negotiated with the hospitals to re-price some of the billings. We were being billed the full-blown rate, and he used his influence to have those bills repriced to what the providers would have billed a health insurance company. That left a larger nest egg for Sue’s future physical therapy costs and who knows what else that might happen as a result of her accident.

About a year and nine months after the accident, attorney Harris had everything wrapped up and finalized, or so we thought. In December 2017 Sue received a letter from a local collection agency demanding payment of $850 for some past due medical bills. Her attorney said everything was wrapped up and finalized, and all bills had been paid out of the settlement. What happened?

I told my daughter that we’re not going to lose one second of sleep about this newest problem. I emailed Mr. Harris and attached a scanned copy of the collection letter. The $850 was for $675 of past due hospital bills and $175 in interest. I made NO phone calls to the hospital or collection agency. I just dropped the matter in Harris’ lap and said, “Please fix it.”

A week later he emailed me back that we could disregard the collection letter. When the hospital submitted their final bill to our attorney, they were legally, in fact, saying “Case closed, we have been paid in full.” Evidently, they had missed some bills for the final tally, or so they claimed, and since the bills were more than a year out, they turned it over to a local collection agency.

I will interject here that during my 18 years of being in the Medicare business, I have dealt with several billing mistakes. When there is some sort of a billing or claims issue, the chances are 90% or better that the billing office has made a mistake.

In Sue’s case, the hospital declared to our attorney that all bills were settled. It was legal finality; they agreed that that was it. Whether or not the billing office overlooked some charges is a moot point. They made a mistake by trying to charge Sue more after they had agreed that all charges had been settled.

In the end they agreed to “write off” the $650 and instructed the collection agency to drop that demand. Mr. Harris asked us if this was agreeable to us. “YES, of course!” I emailed back to him.

We called our attorney

We hired a pro attorney, and by doing so, that lifted the legal burden from us. After all, my wife was almost full-time for four weeks caring for our daughter. We turned it all over to attorney Ted, and he guided us through the entire process. The last thing we wanted to do was to hassle with an insurance company, and we didn’t! Oh yes, there were email consultations during the process, but we were relieved from the legal hassles. The entire saga went remarkably well.

Joe Called His Agent First

To protect the individuals’ privacy in the following events, I have changed their names and city of residence. Those are fictitious, but the events are real. Joe Jensen lives in Pinetree, Montana. In the summer of 2014 he was in a serious auto accident, and very well could have died from his perilous injuries. But in his 80s, Joe is one tough ol’ dude. He is like The Cat Came Back, he Just Wouldn’t Go Away. Remember the old camp song?

Joe was on a Medicare advantage (MA) plan when this near fatal accident happened, and he stayed on Medicare advantage through the end of 2017. When his plan provider terminated his plan effective December 31, 2017, Joe elected to return to original Medicare and go with a Medicare supplement plan instead of signing up for another MA plan.

Please keep in mind that during Joe’s recovery, Medicare was never billed as he was on a Medicare advantage plan. In mid-January 2018 Joe went to his medical supply store in Pinetree to pick up some home-health medical supplies. When Joe presented his Medicare card and Medicare supplement card, he received some unsettling news.

The proprietor told Joe that Always Safe (fictitious) was his primary insurer and that Medicare was his secondary insurer. Highly puzzled, Joe called me FIRST.

Here’s what happened. Joe’s auto-insurance company, Always Safe, became the primary insurer for some of Joe’s accident claims. Joe’s MA plan was the secondary in some cases. MEDICARE WAS NEVER BILLED because he was on an MA plan. For the remainder of 2014 all the way to the end of 2017, Joe was on Medicare advantage. After his recovery from his injuries, his Medicare advantage plan was his PRIMARY insurer, and the thing with Always Safe was in the past and long forgotten.

Even though there was a lingering old record of Always Safe paying some bills from Joe’s accident, it was a non-issue. It never came up. However, starting January 1, 2018, Joe was now on original Medicare, and his Part B providers would now be billing original Medicare and his Medicare supplement plan as his secondary.

Once the proprietor at Pinetree (Mac) checked his Medicare data base on his computer to verify Joe’s Medicare status, this thing with Always Safe popped up now that Joe was on original Medicare for the first time in four years. Also, Mac likely misinterpreted what he was reading on his screen, which added more confusion to the issue. He said to Joe, “Always Safe is your primary and Medicare is your secondary insurer.”

In a state of bewilderment, Joe did the right thing and called me. I told him that we needed to initiate a three-way phone conversation with Medicare. With the privacy rules and regulations, I cannot take care of this on my own. Joe must be on the phone to give his permission to the Medicare representative for me to speak on his behalf.

The Medicare rep, Chris, after hearing the story, directed us to contact the Benefits Coordination Recovery Center (BCRC) at 855-798-2627. We thanked Chris, called BCRC the next day, and quickly and successfully resolved the problem.

If Joe had been on his own, he likely would have started making phone calls with his Medicare supplement plan. That would have been useless. In this case, since he contacted me first, I was able to work with him on a step by step process to correct the problem.

She Called Me Last

I have run into similar situations where people have spent stress-filled hours on the phone trying to resolve a similar situation. In one case, Joan went to her pharmacist for a recommendation for a Part D prescription plan (PDP) for her husband, Scott.

In January 2018 Scott went to his pharmacist to fill his prescriptions, but the pharmacist told him that the charge to his PDP provider wasn’t going through. The result was that Scott had to pay full price. Joan went to work on behalf of her husband in an attempt to resolve the problem. She spent hours on the phone with both Scott’s pharmacist and his PDP plan provider in an attempt to fix the problem. Getting nowhere, she called me.

I explained to her that this was a Medicare issue and that sometime in the past Scott must have had prescription coverage through a former employer. I explained to her that she needed to call Medicare to fix this problem. Joan called me back a day later to explain that she was successful. Unfortunately, before calling me, she spent many frustrating hours on the phone getting nowhere.

Conclusion

Some people have voiced to me that they didn’t want to “bother” us with what seemed to be a trivial issue. The insurance companies compensate us agents for your business. As part of that picture, you are entitled to customer service from your agent.

Our daughter Sue needed help after she was hit by a truck. Sue hired a professional attorney to handle her legal needs and to reach a fair settlement. She didn’t have to deal with legal complexities or hassling with an insurance company!

Joe called me first when he ran into a problem, and as a result, he didn’t have to stumble around trying to fix it on his own. The burden was lifted from him.

Once Joan finally called us, we were able to quickly direct her to the solution for her husband’s problem. End