Medicare change?

Strengthen the Independent Payment Advisory Board (IPAB)

The IPAB is a group of 15 health experts (generally appointed by the president and approved by the Senate) who are required to recommend ways to hold down Medicare spending growth if that growth exceeds a certain limit.  The IPAB has the authority to reduce payments to some Medicare providers (e.g. hospitals, doctors), but it cannot raise beneficiary premiums or reduce their benefits.  Some proposals would change the law to give the IPAB more authority so it could also reduce benefits, while other proposals would further limit the amount of Medicare spending on doctors, hospitals and other health care providers.  Some would eliminate the IPAB altogether.

Pro:  The IPAB is a promising way to limit the growth of Medicare spending without rationing care or cutting access to care by the elderly and disabled.  It should be retained and strengthened so it can improve incentives for doctors, hospitals and other providers to deliver higher-quality care at reasonable cost.  Some members of Congress want to kill the IPAB even before it goes to work because of a mistaken belief that it usurps Congressional authority.  It does not.  Congress remains free to reverse any recommendations that the IPAB makes.  It could even kill the IPAB with new legislation.  But the creation of the IPAB expresses a Congressional commitment to an important goal — slowing the growth of health care spending.  (Henry J. Aaron, Brookings Institution)

Con:  The IPAB was created in the new health law to cap total Medicare spending so it grows only a little more each year than the economy grows.  To accomplish this, the 15 unelected board members will be able to cut payments each year to your physicians, hospitals or Medicare plan provider by however much it takes to stay under the spending cap.  If Congress cannot agree on its own package of cuts, the board’s cuts will go into place automatically and nobody — not the courts or even Congress itself — can stop them.  This board should not be strengthened.  It should be dismantled.  (Stuart Butler, Heritage Foundation)

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Raise Medicare Premiums???

Most Medicare beneficiaries pay a monthly premium for doctor visits (Part B) and prescription drug coverage (Part D).  The premiums people pay for parts B and D covers about 25% of what Medicare spends on these services.  Individuals with annual incomes of more than $85,000 and couples with annual income above $170,000 pay higher premiums, which cover more than 25% of Medicare spending.  Some proposals would increase premiums for everyone in Medicare to cover a larger portion of the program’s costs.  Under one proposal, the standard Medicare premiums would go up from 25 to 35% of program costs.  If that proposal were to go into effect this year, the current $99.90 monthly premium for Medicare Part B paid by a typical beneficiary would cost 40% more, or an additional $40 per month.  Part D premiums, which vary widely by plan and region, would increase similarly.

Pro:  Increasing the basic premiums for Medicare Part B and D makes sense.  It would help Medicare’s finances and can be done while protecting lower-income seniors.  Parts B and D are voluntary “add-ons” to the Medicare coverage seniors receive for hospital services (also known as Part A), which Americans pay for through the payroll tax.  A retired couple with, say, $120,000 of annual income from investments is certainly better able to pay a higher proportion of B and D costs than their $50,000-a-year working-age neighbor can pay in taxes, so it would make sense to raise premiums for many older people with incomes below the level where Medicare currently charges higher premiums.  (Stuart Butler, Heritage Foundation)

Con:  Some upper income Medicare beneficiaries can afford — and already pay — more than the normal premium.  But for too many seniors, even current premiums are burdensome.  Across-the-board premium increases would hit elderly and disabled single persons with incomes barely above $15,000 and couples with incomes above $23,000 who can ill afford higher charges.  Raising premiums across-the-board is a terrible idea.  (Henry J. Aaron, Brookings Institution)

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Lords, love, and the curse…

Just finished an excellent romance novel with a fascinating plot and fully fleshed out characters.   A Scottish witch, a noble Lord, and a duke’s daughter are all intertwined in this tale of The Chattan Curse.  LYON’S BRIDE by Cathy Maxwell.

The story begins in 1632 Scotland.  Then it jumps to 1814 London.  They call him Lord Lyon, proud, determined — and cursed.  He is in need of a bride, but if he falls in love, he dies.  His fervent hope is that by marrying — and having a son — without love, perhaps he can break the curse’s chains forever.  Enter beautiful Thea Martin — a duke’s headstrong, errant daughter and society’s most brilliant matchmaker.  Years ago, she and Lyon were inseparable, until he disappeared from her life without a word.  Now she is charged with finding Lyon’s bride — a woman he cannot love for a man Thea could love too well.

Cathy Maxwell spends hours in front of her computer pondering the question, “Why do people fall in love?”  It remains for her the great mystery of life and the secret to happiness.

Paperback…372 pages.  Published in 2012

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Reduce Medicare Coverage?

Increase Supplemental Plan Costs and Reduce Coverage

Even with Medicare coverage, seniors are often left with significant health care costs, so many people purchase supplemental private insurance coverage (such as Medigap plans) to reduce their out-of-pocket expenses.  One proposal would charge more for certain types of supplemental plans, such as those that cover all costs so seniors incur no out-of-pocket expenses themselves.  Other proposals would limit what Medigap supplemental insurance plans will cover.  For instance, they could prevent Medigap from covering the first $500 of a Medicare beneficiary’s out-of-pocket costs, and only cover 50% of the remaining charges.  Some proposals may also include a cap to limit overall out-of-pocket expenses.

Pro:  Current Medigap plans are complicated.  They cover some routine costs most Medicare beneficiaries could pay themselves, and they raise the cost of Medicare itself by increasing the use of Medicare-covered services while only paying part of the cost of this service use.  Taxpayers pay the rest.  Medigap plans should be changed to improve the coverage for serious illnesses and cover fewer small expenses.  That change would lower Medigap premiums and Medicare costs, and improve the insurance protection Medicare beneficiaries need.  (Henry J. Aaron, Brookings Institution)

Con:  It would be unwise to increase the premium amounts for Medicare supplemental insurance, such as Medigap, or to decrease the amount of coverage available to enrollees under these policies.  There is no evidence that these reforms would deter the use of unnecessary health care services.  Rather, these Medigap proposals would simply raise costs for Medicare beneficiaries and have an unfair effect on lower-income Medicare enrollees and those in poor health.  (Avalere Health)

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Love and Scandal

Just finished reading two very different romance novels:  Toni Blake’s WILLOW SPRINGS and Karen Ranney’s A SCANDALOUS SCOT.

WILLOW SPRINGS by Toni Blake takes place in Destiny, Ohio in the present day.  The main character, Amy Bright, is the best matchmaker in town, but she’s desperately shy when it comes to her own love life — and helpless when it comes to Logan Whitaker, with whom she’s head-over-heels in love.  So Amy decides to become Logan’s secret admirer, sending him sensual love letters steamy enough to unseal their own envelopes.  After a tragedy on the job, firefighter Logan is battling demons.  Thank goodness Amy is there for him.  But when a woman from Logan’s past resurfaces right as the anonymous letters send Logan’s pulse hammering, suddenly he doesn’t know what he needs.  One smoking-hot kiss could change everything, but will it ruin a one-of-a-kind friendship, or show Logan and Amy that they’ve already found everything they need, right there in Destiny?

A SCANDALOUS SCOT by Karen Ranney is set in 1860 Scotland.  After four long years, Morgan MacCraig has finally returned to the Highlands of his birth with his honor in shreds.  After a scandal, all he wants now is solace — yet peace is impossible to find with the castle’s outspoken new maid trying his patience, challenging his manhood, and winning his love, body and soul.  Jean MacDonald wants to leave her past behind and start anew, but Ballindair Castle, a Scottish estate rumored to be haunted, hasn’t been the safe haven she envisioned.  Ballindair’s ancestral ghosts aren’t as fascinating as Morgan, the most magnificent man she’s ever seen.  Though their passion triggers a fresh scandal that could force them to wed, Jean must first share the secrets of her own past — secrets that could force them apart, or be the beginning of a love and redemption unlike anything they’ve ever known.

Of the two books, A SCANDALOUS SCOT was my favorite.  Historical romances seem more…romantic, and this one is very well written.  It seems that all her books have their setting in Scotland, although she lives in Texas.  The character development and the descriptions of the estate and the highlands are excellent.

WILLOW SPRINGS by Toni Blake in paperback.  373 pages.  Published in 2012

A SCANDALOUS SCOT by Karen Ranney is in paperback.  349 pages.  Published in 2012.

Do you have a favorite romance writer?

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Up and Up and Down…

Today was my weight watchers meeting.  In the last 3 weeks I had gained a pound two weeks in a row and today I had lost a pound.  Kind of like going two steps back and one step forward.  I feel good that I have lost 17 pounds since I started in April.

During the meeting one woman of a certain age has been coming to weight watchers for the last 8 years and has lost 56 pounds!  That’s about a half a pound a week, but at least she is losing and not gaining, so I have to give her credit.

This week’s “lesson” is about habits:  good, bad, and ugly.  First step is to think of a habit you would like to change.  Then identify the cue for that habit.  What are you getting out of this habit?  Then insert a new routine.

“I will rehab my habit of munching while watching tv in the evening.  When I watch tv in the evening, I will try chewing gum while watching my favorite show because it provides me with the entertainment without the added points (calories).

Do you have a habit that is interfering with your weight loss or weight maintenance?  How are you going to set up your three steps to success?

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Increase Medicare Payroll Tax Rate?

The primary source of funding for Medicare hospital services (part A) comes from the payroll tax.  Workers and their employers contribute 1.45% of earnings for a total contribution of 2.9%.  Medicare also offers coverage for physician services (part B) and prescription drugs (part D), but these services are not funded by the payroll tax.  It’s estimated that beginning in 2024 Medicare will not have enough money to pay for all the expected hospital expenses.  Increasing the payroll tax rate by o.5% to 3.9% (or to 1.95% each for workers and employers) would raise additional revenue for Medicare’s inpatient hospital expenses.  For an individual earning about $50,000 a year in wages, this increase would amount to an extra $250 in Medicare payroll taxes per year.

Pro:  The Affordable Care Act health reform legislation includes important measures that promise to slow the growth of spending under Medicare hospital insurance (part A).  However, even with these cost-control measures, Medicare hospital insurance faces a small long-term deficit.  That gap can, and should, be closed by a modest increase in payroll taxes.  In addition, some changes in benefits are in order to improve protections against extended or repeated hospitalizations.  There is no reason to perpetuate the myth that Medicare hospital insurance is in crisis.  It isn’t.  Vigorous enforcement of the health care law together with this modest tax increase will secure hospital insurance for current and future Medicare beneficiaries.  (Henry J. Aaron, Brookings Institution)

Con:  Addressing Medicare’s long-term financial problems by raising payroll taxes on working Americans is not the answer.  Doing so will make the situation worse for the economy and for our children and grandchildren, and it will erode the political will to undertake needed reforms.  We need to make sure that programs like Medicare don’t take such a large share of the economy of the future that there is not enough for other critical goals like education, rebuilding our roads and bridges, and defending America.  We’ve got to get the future costs of Medicare down, not tax Americans more.  (Stuart Butler, Heritage Foundation)

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Increase Medicare Home, Nursing and Lab Services???

Medicare does not charge a copay for patients whose doctors prescribe home health care for the first 20 days in a skilled nursing facility.  Several proposals would require a copay for home health care, including one that would require a payment of $100 for home health episodes with 5 or more home health visits and add copays for the 1st 20 days of care in a skilled nursing facility (nursing home).  Medicare does not currently require a copay for laboratory services (such as blood and diagnostic tests).  A number of proposals would require beneficiaries to pay 20% of the cost of laboratory services

Pro:  Imposing a copayment for home health, skilled nursing facility and laboratory services will discourage unnecessary use of these services.  Shifting more of the cost for these services to Medicare beneficiaries will also reduce Medicare costs and help to improve the long-term stability of the program.  Most Medicare supplemental insurance plans would cover at least a portion of the cost-sharing, which would lessen the financial burden of these proposals on the majority of beneficiaries who have supplemental coverage.  (Avalere Health)

Con:  Many Medicare beneficiaries — particularly those who are low-income and do not qualify for any additional assistance — will have trouble affording new copayments for home health, skilled nursing facility and laboratory services.  These individuals may end up not receiving needed care or services.  Even Medicare beneficiaries with supplemental policies could face higher out-of-pocket costs, as premiums would likely rise to offset the higher copays.  State governments would also pay more, as Medicaid would be responsible for the copayments of low-income Medicare beneficiaries who receive assistance from Medicaid.  (Avalere Health)

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NY Times Bestseller…Laura Lippman

Just finished reading this mystery novel THE LAST PLACE by Laura Lippman, a Tess Monaghan novel.

“Lippman pushed the edges of the traditional private eye novel… THE LAST PLACE is the first place readers should turn for a superior story.”  Ft. Lauderdale Sun-Sentinel

“Intricately plotted…increasing creepiness…Laura Lippman just keeps getting better and better.”  Houston Chronicle

In hot legal water — and court-ordered therapy — private investigator Tess Monaghan accepts an assignment with a local nonprofit organization to review police documents for inconsistencies and investigative blunders surround five unsolved Baltimore homicides.  The cases seem unconnected except for the suspicion that each brutal death was the result of domestic violence.

But curiosity is soon pulling Tess off the paper trail and into dangerously unfamiliar territory, as she joins forces with a police officer obsessed with bringing a murderer down.  Scant leads and intuitions are pointing the disgraced p.i. toward the most remote corners of Maryland, where a psychopath can hide as easily in the fabric of a tiny fishing community as in the alleys and shadows of Charm City.  And a single, shocking common thread seems to be tying all the loose ends together into one bloody knot:  Tess Monaghan herself.

Lippmann is a great story-teller.  Every book I have read of hers is so totally different.

Available in paperback.  494 pages.  Published June 2012.


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Winter Garden

Just finished a romance book you may like.

WINTER GARDEN by Adele Ashworth.

Julia Quinn says  it is “Exquisitely written and brimming with emotion.”

Lisa Kleypas says “Adelle Ashworth is a thrilling discovery.”

In this Avon romance set in southern England in 1849,  a celebrated beauty, Madeleine DuMais’s cleverness is her greatest asset — one she puts to good use as a spy for the British.  Assigned to help break up a smuggling ring in the south of England, she arrives at the quaint resort town of Winter Garden and meets her partner in subterfuge:  Thomas Blackwood.

Unlike any man she has ever met, Blackwood’s quiet confidence and mysterious intensity send shivers of pleasure coursing through her.  And, despite the danger, as duty gives way to desire, Madeleine aches for Thomas’s gentle touch on her body…on her heart…on her soul.  For surrender holds it own sweet reward…

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