New Medicare Cards and New Scams

The following is a reprint of a letter of the Editor from Ron Iverson, President of the National Association of Medicare Supplement and Medicare Advantage Producers.

Background: As dictated by 2015 legislation, the Social Security Administration (SSA) will begin the roll-out of new Medicare cards without the use of social Security numbers. Sadly, the scamsters are always looking to take advantage of a new script.

Letter of the Editor by Ron Iverson

There is great news for Medicare enrollees, and a bit of caution regarding scammers.  The good news is that Medicare will be sending out new Medicare cards to each recipient.  The cards will arrive sometime between April 1st of this year and will be completed by April 1st of next year.

The new cards will not have the enrollee’s Social Security number on them, as they do now.  This is a major accomplishment for Medicare and is being done to help put a stop to identity theft via Social Security identification numbers.  This problem has been rampant nationally and is very serious business for Medicare enrollees who have had their cards compromised by internet bandits.

The new cards will have an 11-digit number that will have no relation to your Social Security number. So that is good news.  I understand that Montana will be in the second wave of states being sent the new cards, and that delivery is scheduled to begin May 1st.

But, along with the good news, bad news sometimes seems to follow.  The bad news is that Medicare scammers have already jumped into the game.  There is more than one technique involved, but these are the two most used.

First, scammers are calling Medicare recipients, sometimes identifying themselves as Medicare or “government” officials and telling them that the new cards are coming out, but that they will have to send $30-50 to get the new cards.  That is bogus—there is no charge for the new cards—and CMS/Medicare does not call people—it only uses the US Postal Service to communicate.

The second technique is for the scammer to say that they have a Medicare Advantage Prescription Drug Plan available, but then request personal Medicare information so that the new plan can be utilized.  This is also bogus.  Whatever you do, do not fall for this.  Medicare information is personal, and the scammers simply use it for other nefarious activities.

So, we don’t know when or how the scammers will spring into operation in your area, but if you receive one of these calls, just hang up and report the activity with a call to 1-800-Medicare (800-633-4227).  And…above all, do not feel pressured to respond to any of these calls—the scammers are well-trained in intimidation and persistency.  Don’t fall for it.

My Comments: Thank you Ron for your timely letter and information about the new Medicare card rollout. Let’s review some common techniques used by scammers and how to avoid becoming a victim.

  1. Governmental agencies such as the SSA, IRS, and CMS always communicate with you via U.S. Mail. They do not phone you nor do they email you. You can automatically assume that any purported “governmental” communication from these sources are either scam or phishing schemes. Hang up to any such phone calls and do NOT open any suspicious emails. Hit the “delete” key.
  2. In a similar vein, your credit card company, cable company, or tel-com company will never ask you to provide your user and passwords to them so they can ”update” their information. Delete such suspicious emails.
  3. Passwords: Use complex passwords with 12 or 16 characters. Use a mix of upper case, lower case, numbers and symbols. I highly recommend using a password manager such as Last Pass, KeePass, or 1Password. For more information, please click here.
  4. Use second factor authentication for critical accounts.
  5. Be careful about what you post on social media.
  6. Ron Iverson sent an email to our members warning us about a new phony email touting “TrumpMedicare.” Keep your delete key in good working order

End

Gary Taubes ‘The Case Against Sugar’, a YouTube video Part 4

transcribed by Liz Reedy

To view Gary Taubes’ 1 hour and 22-minute YouTube video, please click here.

Part 3 continues beginning at 38:43

What if Roald Dahl and Michael Pollan are right that the taste of sugar on the tongue can be a kind of intoxication? Doesn’t it suggest that the possibility that sugar itself is an intoxicant, a drug? Imagine a drug that can do this to us, that can infuse us with energy and can do so when taken by mouth. It doesn’t have to be injected, smoked or snorted for us to experience its sublime and soothing effects.

Imagine that it mixes well with virtually every food and particularly liquids. Imagine that when given to infants it provokes a feeling of pleasure so profound and intense that its pursuit becomes a driving force throughout their lives.

By the way, when I put together this thought experiment that I’m about to read, I never thought I’d ever be able to use it in a book. I thought that if I put this in my first chapter it gives away my hand so profoundly that no one will ever think I was balanced or unbiased. And then I sent it to a colleague of mine who is one of the best scientists I know. He said, “If you don’t use this then you’re crazy.”

Overconsumption of this drug has long-term side effects but there are none in the short-term. There is no staggering or dizziness, no slurring of speech, no passing out or drifting away, no heart palpitations or respiratory distress.

When it is given to children, its effects may be only more extreme variations of the apparently natural emotional roller coaster of childhood. From the initial intoxication to the tantrums and whining that may or may not be withdrawal a few hours later. More than anything, our imaginary drug makes children happy, at least during the period in which they’re consuming it.

It calms their distress, eases their pain, focuses their attention and then leaves them excited and full of joy until the dose wears off. The only downside is that children will come to expect another dose, and perhaps demand it on a regular basis.

I should have said this book was also informed by the fact that I am a parent of two pre-adolescent boys. Michael Pollan said to me at lunch one day that moderating your children’s sugar intake is one of the primary responsibilities of adulthood. I borrow from Michael there as well, but I don’t quote him.

How long would it be before parents took to using our imaginary drug to calm their children when necessary, to alleviate pain, to prevent outbursts of unhappiness, or to distract their attention? And, once the drug became identified with pleasure, how long before it would be used to celebrate birthdays, a soccer game, good grades in school?

How long before it would become a way to communicate love and celebrate happiness? How long before no gathering of family and friends was complete without it, before major holidays and celebrations were defined in part, by the use of this drug to ensure pleasure? How long would it be before the underprivileged of the world would happily spend what little money they had on this drug rather than on nutritious meals for their families?

 

How long would it be before this drug, as the anthropologist, Sidney W. Mintz said about sugar, demonstrated, “A near invulnerability to moral attack.” How long before writing a book such as this one was perceived as a nutritional equivalent to stealing Christmas?

I wanted to call this book Stealing Christmas: The Case Against Sugar and just lay it out there. I understand the Grinch-like aspect of what I’m doing; I’m not blind to it. It’s another way of saying that I’m not an idiot. But my editor preferred otherwise. When I would tell people the title of my book, a surprising number of them didn’t get the Grinch reference. Maybe Dr. Seuss hasn’t permeated our lives quite as much as I thought.

What is it about the experience of consuming sugar and sweets, particularly during childhood that invokes so readily the comparison to a drug? I have children, still relatively young, and I believe raising them would be a far easier job if sugar and sweets were not an option, if managing their sugar consumption, as Michael Pollan said (but I’m not quoting here), did not seem to be a constant theme in our parental responsibilities.

Even those who vigorously defend the place of sugar and sweets in modern diets, “An innocent moment of pleasure, a balm on the distress of life,” as the British journalist Tim Richardson has written, acknowledge that this dose does not include allowing children to eat as many sweets as they want at any time and that, “Most parents would want to ration their children’s sweets.”

Well, why is it necessary? Children collect many things: Pokémon cards, Star Wars paraphernalia, Dora the Explorer backpacks, and many foods taste good to them. What is it about sweets that makes them so uniquely in need of rationing? Which is another way of asking whether the comparison to drugs and abuse is a valid one.

This is of more than academic interest because the response of entire populations to sugar has been effectively identical to that of children. Once populations are exposed, they consume as much sugar as they can easily procure, although there may be natural limits in that culture about current attitudes about food.

The primary barrier to more consumption, up to the point where populations become obese, diabetic and perhaps even beyond, has tended to be availability and price. This includes in one study, sugar-intolerant Canadian Inuit who lacked the enzyme necessary to digest the fructose component of sugar, and yet continued to consume sugary beverages and candy despite “the abdominal distress that it brought them.”

As the price of a pound of sugar has dropped over the centuries, from the equivalent of 360 eggs in the 13th century to 2 eggs in the early decades of this one, the amount of sugar consumed has steadily, inexorably climbed.

In 1934, while sales of candy continued to increase during the Great Depression, the New York Times commented, “The depression proved that people wanted candy and that as long as they had any money at all they would buy it.”

During those brief periods of time during which sugar production surpassed our ability to consume it, the sugar industry and the purveyors of sugar-rich products have worked diligently to increase demand and at least until recently have succeeded.

The critical question which scientists debate, is what journalist and historian Charles C. Mann has eloquently put it, is whether sugar is actually an addictive substance or do people just act like it is. The question is not easy to answer. Certainly, people and populations have acted as though sugar is addictive, but science provides no definitive evidence.

Until recently, nutritionists studying sugar did so from the natural perspective as viewing sugar as a nutrient, a carbohydrate and nothing more. They occasionally argued about whether or not it might play a role in diabetes or heart disease, but not about whether it triggered a response in the brain or body that made us want to consume it in excess. That was not their area of interest.

The few neurologists and psychologists interested in probing the sweet tooth phenomenon or why we might need to ration our sugar consumption so as not to eat it to excess, did so typically from the perspective of how these sugars compared to other drugs of abuse, in which the mechanism of addiction is now relatively well understood.

Lately, this comparison has received more attention as the public health community has looked to ration our sugar consumption as a population and has thus considered the possibility that one way to regulate these sugars, as with cigarettes, is to establish that they are indeed addictive. These sugars are very likely unique in that they are both a nutrient and a psychoactive substance with some addictive characteristics.

Historians have often considered that the sugar-as-a-drug metaphor to be an apt one. “That sugars, particularly highly refined sucrose, produce peculiar physiological effects is well known,” wrote the late Sidney Mintz, whose 1985 book, Sweetness and Power, is one of two seminal English-language histories of sugar, on which other and more recent writers on this subject, myself included, heavily rely.

But these effects are neither as visible nor as long-lasting as those of alcohol or caffeinated beverages, “The first use of which can trigger rapid changes of respiration, heartbeat, skin color, and so on.” Mintz has argued that a primary reason that through the centuries sugar has escaped religious-based criticism for the kind pronounced on tea, coffee, rum, and even chocolate is that whatever conspicuous behavioral changes may occur when infants consume sugar, it did not cause the kind of “flushing, staggering, dizziness, euphoria, changes in the pitch of the voice, slurring of speech, visibly intensified physical activity or any of the other cues associated with the ingestion” of these other drugs.

As this book will argue, sugar appears to be a substance that causes pleasure with a price that is difficult to discern immediately and paid in full in the years or decades later. With no visible, directly noticeable consequence as Mintz says, questions of “long term nutritive or medical consequences went unasked and unanswered.” Most of us today will never know if we suffer even subtle withdrawal symptoms from sugar because we never go long enough without sugar to find out.

Mintz and other sugar historians consider the drug comparison to be so fitting in part because sugar is one of the handful of “drug foods,” to use Mintz’s term, that came out of the tropics, and on which European empires were built from the 16th century onward, the others being tea, coffee, chocolate, rum and tobacco.

Its history is intimately linked to that of these other drugs. Rum is, of course, distilled from sugar cane, whereas tea, coffee and chocolate were not consumed with sweeteners in their regions of origin.

Actually, when the conquistadors discovered the Aztecs eating chocolate in Mexico, in their march and fully confident of their devastation of the people, the Aztecs were mixing it with chili peppers. The conquistadors tried it and said it “tasted awful and they wouldn’t feed it to their pigs.” So, they shipped it back to Europe anyway, and they started mixing it with sugar. Within about 50 years, hot chocolate had become the morning and afternoon drink for the Spanish aristocrats.

In the 17th century, once sugar was added as a sweetener, and prices allowed it, the consumption of these substances in Europe exploded. Sugar was used to sweeten liquors and wine in Europe as early as the 14th century. Even cannabis preparations in India and opium-based wines and syrups included sugar as a major ingredient.

Kola nuts, containing both caffeine and traces of a milder stimulant called theobromine, became a produce of universal consumption in the late 19th century, first as a cocoa-infused wine in France, and then as the original mixture of cocaine and caffeine of Coca-Cola, with sugar added to mask the bitterness of the other two substances. [For more information about kola nuts, please click here and here.]

Stop 49:31 and to be continued

The Hacking of the American Mind—Report #2

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

Too Much Salt?

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 Hacking of the American Mind—Report #1

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

Gary Taubes ‘The Case Against Sugar’, a YouTube video Part 3

transcribed by Liz Reedy

To view Gary Taubes’ 1 hour and 22-minute YouTube video, please click here.

Please click here for our Part 1 transcription.

Please click here for our Part 2 transcription.

Part 3 continues beginning at 28:03

Think about it this way. If I was giving a talk on wealth, I might get a pretty good audience. And afterward in the Q&A, someone would ask me, “Why are Bill Gates and Jeff Bezos so rich?” And I would say, “Because they make more money than they spend.” You guys would leave, right?

If I was giving a talk on climate change, that would probably get a pretty full house. And at the end somebody would ask, “Well Gary, why is the atmosphere heating up?” And I would reply, “Because it’s taking in more energy than it expends.” And if I looked at you like it was a serious answer you would think I was joking.

But in obesity research, if somebody asks why some people get fat and others don’t, the answer is that they take in more calories than they expend. And it’s almost incomprehensively naïve. It has become conventional wisdom. You show me a paper on obesity, and I’ll show you where that belief system is interwoven into that research or that paper.

My geneticist friend at Cambridge University, the BBC host, is not studying the genetics of why people get fat; he’s studying the genetics of why he thinks people eat too much or exercise too little. Part of this goal is to get people to get rid of that energy/balance idea. And the stakes are enormous. I am trying to do a fundamental thing with this book.

Claude Benard, the great French physiologist, said in 1865, “Science is about explaining what we observe.” Fundamentally that’s what you’re always doing in science, whether what you observe is a supernova or a gamma ray burst or something else in the night sky. It could be how a frog behaves or how swallows mate or anything you can name.

Why we get heart disease, why we have obesity, it’s about explaining what we observe. The observation today that is so frightening is these obesity and diabetic epidemics are worldwide. It happens in every population in the world in which they transition to a Western diet from whatever they were eating baseline.

It doesn’t matter if they were Inuits living on caribou and seal meat, or Maasain Africans living on the meat and milk and urine from the cattle they herd, or the agrarian population in the Himalayas, or Native Americans or any population that started eating western diets. They experience these tremendous increases in obesity and diabetes.

In October, the director general of the World Health Organization, Margaret Chan, gave a key note address to the annual meeting of the National Academy of Sciences. She said that these epidemics of obesity and diabetes represent a slow-motion disaster world-wide.

They are overwhelming health-care systems. The estimated cost of obesity and diabetes in direct health-care costs in the U.S. is a billion dollars a day. If you look at indirect societal costs and you believe these estimates, it’s a trillion dollars a year.

Margaret Chan said the chances of the public health organizations like the W.H.O. to reign in these epidemics in order to prevent a “bad situation” from getting much worse is effectively zero. Think about that. The director general of the World Health Organization is talking about these slow-motion disaster epidemics, and not only acknowledging that organizations like hers have completely failed to curb them, but predicting complete failure in the future.

One of the things I would do if I were a journalist or in newspapers, I would imagine if this was HIV. In 1985 we understood that the HIV virus causes AIDS. But imagine after coming to that conclusion, thirty years later, AIDS prevalence and AIDS incidents had continued to go up and mortality from this disease had continued to go up.

We would have a task force, committees, think tanks and a team of researchers. We would be spending billions, if not trillions of dollars, trying to understand what we don’t understand about this disease. But in obesity and diabetes we’ve had this same phenomenon.

In the 1890s, on the Eastern coast the estimate was that one out of every three thousand patients in the hospital suffered from diabetes. Today, if you go to a VA hospital, one out of four patients suffers from diabetes. One out of every eleven Americans in or out of hospitals has diabetes today. There’s been this tremendous explosion, and we have to understand what’s causing it.

You cannot stop an epidemic unless you understand the cause. You have to know what to remove, what to get out of the population, whether it’s the HIV virus, or you recommend safe sex and contraceptives and you design drugs that go after the virus. If it’s a lung cancer epidemic you have to know that smoking is causing it, right? So you can tell people to stop smoking.

In this country with obesity and diabetes we have the director general of the W.H.O basically shrugging her shoulders and saying, “Yes, we’ve seen 900% increases of diabetes in the United States in 50 years. And it’s going to go up. But we don’t know what to do about it.” Well, how about you examine your assumptions.

What I’m trying to do in this book is ask the question, “Are we wrong about what the cause is?” If this was a legal case and we have a similar crime being committed in a very similar way in every country in the world, who is the prime suspect? Who should we be targeting? Why should we be targeting? And the answer is sugar.

So, with that long introduction I’m going to do a little bit of reading, and I’m going to hope for the best. I have to borrow a book. The first chapter of this book discusses obesity and diabetes epidemics and why I’m focusing on sugar and why I think it’s the prime suspect. As I say in this book, if this were a legal case this book would be the prosecution’s strategy.

I had trouble writing it. I don’t like writing. One of the reasons I’m such a good reporter, if I am a good reporter, is because reporting is a way to procrastinate on writing. As long as you keep doing the research you don’t have to write…until you run out of money as I said earlier, and then you have to write.

I finally wrote the first chapter, and then I wrote the second chapter, Drug or Food, which I’m going to read from. And I finally had the sense of profound relief that this is a good chapter, that I’m on my way, that I’m going to be able to get this book done. So, I have four thousand words written discussing whether sugar is a drug or a food, and is it addictive?

Then I read a book called 1493, [1493: Uncovering the New World Columbus Created] written by a friend of mine, Charles Mann. It’s about the history of what’s called the Columbus exchange, which is about the spread of foods and plants around the world after Columbus discovered America. Charles (Cam) is such a beautiful writer that I can’t even read his writing, as it depresses me so much.

But I realized he had a chapter on the history of sugar and knew I should read it. He’s a great reporter and a great writer. I read it and in this chapter, he has a single line made up of seventeen words. He says, “Scientists today debate amongst themselves whether sugar is an addictive substance, and people just act like it is.”

And I think, “Great. I’ve just written four thousand words about this, and here Cam wrapped it up in seventeen.” I could throw away my first chapter and then I’m back to the state of frozen writer’s block that I was in, or I could keep the first chapter and quote Cam, which is what I decided to do. So, you can find Cam’s quote in here.

It begins with two other quotes, two epigraphs. The first is from Roald Dahl, from his memoir, Boy: Tales of Childhood, which was written in 1984. Dahl said, “The sweet shop in Llandaff [UK] from 1923 was the very center of our lives. Thus, it was what a bar is to a drunk or a church is to a bishop. Without it, there would have been little to live for. Sweets were our life-blood.”

The second quote is from Michael Pollan’s, Botany of Desire in 2001, one of the great books Michael wrote before Omnivore Dilemma. He said, “Imagine a moment when the sensation of honey or sugar on the tongue was an astonishment, a kind of intoxication. The closest I’ve ever come to recovering such a sense of sweetness was secondhand, though it left a powerful impression on me even so. I’m thinking of my son’s first experience of sugar, the icing on the cake at his first birthday.”

“I have only the testimony of Isaac’s face to go by, that and his fierceness to repeat the experience. It was plain that his first encounter with sugar had intoxicated him. It was, in fact, an ecstasy in the literal sense of that word. That is, he was beside himself with the pleasure of it. No longer here with me in space and time in quite the same way he had been just a moment before. Between bites, Isaac gazed up at me in amazement (he was on my lap as I delivered the ambrosial forkfuls to his gaping mouth), as if to exclaim ‘Your world contains this? From this day forward, I shall dedicate my life to it.’”

By the way, you should argue the wisdom of starting a book with quotes from two authors who can write better than you can. Your readers are likely to put your book down and say, “I’m going to go get Botany of Desire.”

What if Roald Dahl and Michael Pollan are right that the taste of sugar on the tongue can be a kind of intoxication? Doesn’t it suggest that the possibility that sugar itself is an intoxicant, a drug? Imagine a drug that can do this to us, that can infuse us with energy and can do so when taken by mouth. It doesn’t have to be injected, smoked or snorted for us to experience its sublime and soothing effect.  END at 39:08

Medicare Updates and News

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

Always Call Your Agent First

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

The Closing of the Coverage Gap

Note: This is a reprint of an article we originally published in October 2015.

One of the provisions of the 2010 Affordable Care Act (ACA) is to close the coverage gap in Part D Prescription Plans (PDPs). By 2020, PDP members (that’s you) will only pay 25% of the cost of both generics and name brand drugs while in the coverage gap.  The key questions are what is the schedule for this reduction and how will that affect the premiums for the PDPs?

Name Brand Drugs

Starting in 2011, pharmaceutical companies were required to give members a 50% discount off the retail cost of brand name drugs when the member entered the coverage gap.  The member paid the other 50%. In 2013 and 2014 the PDP paid 2.5% of the cost of brand name drugs reducing the members’ share to 47.5%.  The manufacturers still contribute with their 50% discount.  In 2015 and 2016 the PDP now pays 5% of the cost of brands while the member is in the coverage gap.  The member’s share is reduced to 45%. (See chart #1 below)

The manufacturers’ discount remains at 50% as represented by the light blue.  The dark blue represents the declining amount that the member pays.  The medium blue represents the increasing share that the PDP pays.  Thus, from 2017 to 2020 the PDP pays 5% more every year. Unless the plan receives an increased subsidy from Medicare, it has no other alternative then to raise the premium for the plan in order to raise more revenue to pay for their increasing share of the costs while a member is in the coverage gap.

Generics

As far as the PDP having to pay more for generics, the situation is very similar to what they will be required to do while their members are in the coverage gap.  The only difference is that there is no manufacturers’ discount. We can assume that the margins for generics are much thinner, so there is little or no room for discounts.

Starting in 2011, the plan paid 7% of the costs of generics when the member entered the gap.  The member’s cost was reduced from 100% in 2011 to 93% in 2012.  Every year until 2019 the PDP will pay an additional 7% and the member pays 7% less.  In 2020 the member receives another 12% discount, reducing his/her share to just 25% of the cost of the generic drug.  (See chart #2 below.)

The member’s share is represented by the dark blue, and the PDPs’ increasing share is represented by the medium blue.  The declining share of the costs for the member certainly is advantageous for him/her, however, the PDP is being required to shoulder more of the costs.

Similar to paying more for brand name drugs, the increasing percent of the coverage for generics for the PDPs will add to their costs.  This all puts pressure on premiums, pressure that pushes them higher.

Another factor that adds to premium increases is the increased costs for drugs. The PDP passes this cost along in higher copays or moving a drug from a “preferred” brand to a “non-preferred” brand.  This change approximately doubles the copay for the member.

There is another strategy that the PDP uses to mitigate its increased costs. The PDP can drop a more expensive brand, or generic, as long as it has two drugs covering each therapeutic category. For example, most of the cholesterol drugs have gone generic.  Many plans no longer cover Crestor, the only remaining name-brand statin drug, in their formulary.  Since they cover lovastatin, pravastatin, simvastatin, and atorvastatin (Lipitor), they have the therapeutic category of cholesterol drugs covered.  They do not have to cover the expensive brand, Crestor.  Editor’s Note: This article was originally published in October of 2015.  Since then, Crestor (Rosuvastatin) has gone generic.

In regards to premium increases, there is some good news. There is competition among the various insurance companies’ PDPs. We can assume that most of them would like to gain more market share.  The competition has caused the copays for many inexpensive generics to go down.  A couple of companies’ plans have either no copays or very small copays when the member orders his/her prescriptions through the companies’ mail order pharmacy.

Understanding the Estimated Annual Spend for PDPs

What is meant by the annual cost, annual spend, or estimated annual cost when we do a prescription drug plan (PDP) search on your behalf on Medicare.gov?

Put simply, the estimated annual spend is how much will you spend for your entire prescription drug plan package for the entire year (or remainder of the current year). This number includes the PDP plan premium, your copays and, if applicable, the deductible.

Example: After doing a search on Medicare.gov, the plan that shows up as the best buy for Sam Fuller (fictitious), using his preferred pharmacy has an annual cost of $444. The name of the plan is Good Health Rx (fictitious), and Sam’s annual spend will be $444.

The plan premium is $25 per month. $25 per month x 12 months = $300 for the year.

Let’s say Sam has all tier 1 and 2 generics with low copays. Good Health Rx also has no deductible for tier 1 and 2 generics.

Here’s the list of his prescriptions.

Name of Drug Dose Frequency Tier Copay
Atorvastatin 40 mg 30/month Tier 2 $4
Metformin 500mg 60/month Tier 1 $1
Lisinopril 20 mg 30/month Tier 1 $1
Amlodipine 5 mg 30/month Tier 2 $4
Citalopram 10mg 30/month Tier 1 $1
Meloxicam 15mg 30/month Tier 1 $1
Total monthly copays $12

 

Sam’s prescription copays are $12 per month. $12/month x 12 months = $144.

Plan premium = $300 for the year.

Drug copays = $144 for the year.

Sam’s annual cost = $444    ($300 + $144 = $444)

Note: If your plan effective date is mid-year, the annual spend refers to your estimated cost for the remaining portion of the year. Let’s say your Medicare A and B are effective July 1, 2018. You sign up for a PDP in May with a July 1 effective date. Using the above example, your annual cost will be half of the $444 annual or just $222. End