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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Will Drug Companies Give Rebates or Discounts to Medicare?

Here is another idea for tweaking Medicare.  Under current law, drug manufacturers are required to give rebates or discounts to the Medicaid program for prescription drugs purchased by Medicaid beneficiaries.  However, Medicare Part D — the optional prescription drug coverage — does not require similar manufacturer rebates or discounts.  This proposal would require manufacturers to provide Medicare with the same rebates or discounts as those Medicaid receives for drugs purchased by certain low-income Part D enrollees.

Pro:  Before 2006, drug companies provided discounts on drugs prescribed for all Medicaid beneficiaries.  In 2006, legislation moved many of these beneficiaries to Medicare and ended the required discounts.  As a result, the price of drugs for Medicare enrollees is higher than that under Medicaid and other government programs.  Drug companies manged fine before 2006 and they can do it again.  Restoring the discounts will save the Medicare program $112 billion over the next decade.  This is a simple and effective way to save money for Medicare and help lower the federal budget deficit.  (Henry J. Aaron, Brookings Institution)

Con:  Some people think requiring drug companies to reduce the prices they charge Medicare for low-income seniors with Part D drug coverage would reduce Part D costs and be a good idea.  It’s not a good idea.  Prices would just go up for other Americans, and there would be less research on cures for diseases such as Alzheimer’s.  This is not to say nothing is needed.  Like other parts of Medicare, the revenue from Part D premiums covers only a small part of the actual cost.  So today’s and tomorrow’s taxpayers will have to write bigger and bigger checks to the IRS if no action is taken.  (Stuart Butler, Heritage Foundation)

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Will Medicare become a Premium Support Plan?

Today is Grandparents Day.  Medicare is very important to most Grandparents, now and in the future.

Here is another way Medicare may change.

Change Medicare to a Premium Support Plan (This is essentially the Romney Ryan plan)

Under this proposal, newly eligible Medicare beneficiaries would receive their health coverage through private insurance plans, not traditional Medicare.  Beneficiaries would choose among competing plans and the federal government would contribute a fixed amount to pay the premiums for the private insurance plan.  If the private insurance premiums prove to be higher than the federal contribution, seniors would be required to pay the difference.  If the government’s annual contribution does not increase by the same amount as the annual cost increase in premiums, beneficiaries would pay the difference, which could get larger over time.

Pro:  It makes sense to put Medicare on a long-term budget that reduces the burden on our children and grandchildren while making health care affordable for seniors.  The best way to do that is through the idea called “premium support.”  This means older people would receive their own share of the Medicare budget to use toward a health insurance plan or with doctors.  One way or another older people will have to pay more for Medicare benefits.  Premium support is the best way for Medicare to stay within a budget because it would give older people more control and choice over how that budget is actually spent.  — (Stuart Butler, Heritage Foundation)

Con:  Now is not the time for premium support.  All current proposals carry a threat that the vouchers will not keep pace with rising health care costs,  threatening the elderly and disabled with increased health care costs they cannot afford.  Not until and unless we find out how to effectively enroll and pay subsidies to the working age Americans in the health insurance exchange that are called for by the health reform legislation, will it be time to consider whether to take on the much harder job of shifting elderly and disabled Medicare beneficiaries into such new and untested organizations.  (Henry J. Aaron, Brookings Institution)

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Looking ahead with Medicare

Now that both the conventions are history and you now have to make a choice for Nov 6, I thought we would take a look at another possible medicare change…

Raise Medicare Premiums for Higher-Income Beneficiaries

Most Medicare beneficiaries pay a separate monthly premium for doctor visits (Part B) and prescription drug coverage (Part D) in Medicare.  The premiums people pay for parts B and D cover about 25% of what Medicare spends on these services.  Individuals with annual incomes of more than $85,000 and couples with annual incomes above $170,000 pay higher premiums, up to 3 times the standard premium depending on income level.  Under several proposals, these higher income beneficiaries would be required to pay as much as 15% more than they currently pay.

Pro:  The best way to generate more premium revenue to help pay for Medicare parts B and D is to raise premiums for higher income seniors.  That would improve Medicare’s finances by bringing in more premium revenue, but without imposing burdens on modest income seniors.  When Medicare was created in 1965, the vision was that the health benefits beneficiaries received should be adequate for all and should also be roughly the same for rich and poor alike.  But even if that made sense at the time, the costs of Medicare are rising at a rapid clip, and we just cannot afford that vision any more.  That’s why we’ve already accepted the principle that better-off beneficiaries should pay for their parts B and D benefits.  (Stuart Butler, Heritage Foundation)

Con:  On the surface, it may seem reasonable to charge Medicare beneficiaries with higher incomes more for the same parts B and D coverage.  However, in reality, many of these proposals will push costs on to more middle-class beneficiaries, particularly if the income level at which individuals are subject to the higher premium continues to be frozen, or even reduced.  In addition, higher-income beneficiaries already pay more money into the Medicare program before retirement, and they also pay more in premiums for Medicare parts B and D — they should not have to pay even more for the same coverage as other beneficiaries.

Also, some higher income beneficiaries may decide it is more advantageous to drop out of parts B and D if they are able to buy less expensive private coverage or simply self-pay for the physician visits and medications.  If enough higher income beneficiaries drop out of parts B and D, the premiums for Medicare parts B and D will need to increase for beneficiaries who remain in the program, making Medicare participation more expensive for almost everyone.  (Avalere Health)

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First Tea Party!

Mary Jane couldn’t wait to invite her three “bestest” friends to come to a fancy tea party at her house.  Her grandmother had given her a sweet little tea set that was decorated with colorful ducks, and Mary Jane was eager to show it off.  All of her friends said, “Yes, oh yes, I’ll come!”  It would be the perfect occasion for them to dress up in their very nicest frocks.  (Of course, each friend planned on bringing along her favorite doll.)  The girls knew there would be plenty of tasty things to eat and that they would find lots of things to giggle about.  When the day of the party arrived no one was disappointed; everyone had a really good time.  After the last cup had been poured, all the guests agreed that the afternoon had been, well, ducky.

The delightful child’s tea set here has a Nippon mark backstamp.  Nippon porcelain was manufactured in Japan from 1891-1921 (Nippon being the Japanese word for Japan).  This particular duck pattern was produced between 1911 and 1921.

How about some cupcakes to go with the tea?  Easy as 1,2,3.  Cupcakes date back at least to the 18th century, when they were known as number cakes, or 1,2,3,4 cakes.  The names come from the proportions of the ingredients in the recipe:  1 cup of butter, 2 cups of sugar, 3 cups of flour, and 4 eggs.  Older cookbooks refer to baking cakes in small cups, which may have been earthenware teacups.  The smaller cakes became popular as they took less time to bake in a hearth oven and were less likely to burn  than a larger cake.

Tea and cake anyone?

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