Advantage ours Things to consider In a Medicare plan

 

Over the years I have had two Medicare Advantage plans.

For several years I had a plan from AvMed. When AvMed failed to renew its contract with my long-time, and excellent, Primary Care Physician (PCP), I signed up with Humana.

Humana had some economic benefits and its Providers' Directory listed both my vascular surgeon and my long-time ophthalmologist.

CAPITATION

Humana has a program called "capitation" that basically restricts its PCPs - and there were 108 in the plan I had - to referrals to specific specialists; even if a specialist is on Humana's Providers' List, the PCP may not be able to refer a patient to that specialist.

Human warns prospective clients in its Provider Directory, under the heading Getting Care from Specialists that: "Each PCP may have certain network specialists they use for referrals. This means that the specialists you can use may depend on which person you choose to be your PCP.

If there are specific specialists you want to use, find out whether your PCP refers patients to these specialists. You can change your PCP at any time if you want to see a network specialist that your current PCP does not refer to."

The problem is, how to find out which PCP can/may refer to which specialist. Humana Customer Service can't or won't tell the client; is the client supposed to contact and query each of the 108 PCPs?

I contacted seven other Medicare Advantage providers and only one had a similar "capitation" arrangement.
Aetna: Any PCP may refer to any specialist (both within the same plan)

AvMed: Any PCP may refer to any specialist (both within the same plan)

BCBS: Any PCP may refer to any specialist (both within the same plan)

CarePlus: Any PCP may refer to any specialist (both within the same plan)

Coventry: Any PCP may refer to any specialist (both within the same plan)

HealthSun: Depends; if the PCP is part of an independent practice association (IPA) group, then any PCP may refer to any specialist within the same plan; otherwise similar to Humana, PCPs have limited options. However, HealthSun will provide a list of IPA PCPs upon request.

United Healthcare: Any PCP may refer to any specialist (both within the same plan)

IN-PATIENT COSTS

Humana and at least one other Advantage plan (Preferred Care Partners) offer $0 co-pays for hospital stays from Day 1 through discharge. Other plans charge from more than $100 to slightly les than $300 for Days 1 through 5. AvMed charges $0 for days 1 through 5, $80/day for Days 6 through 20 ($1,200), then $0 to discharge.

When I initially signed up with AvMed I asked about this and was told that typical hospital stays were 5 days or less. Two surgeries later, one "major," I have to admit the sales guy was 100% correct. (When the hospital over-charged, AvMed resolved the issue in our - AvMed's and mine - favor.)

It's a good idea to check costs for Skilled Nursing Facilities (SNF) as well; some plans charge for the initial days, other do not.

MEDICATIONS

It pays to check a potential plan's "Formulary" - list of prescription medications - before signing on the dotted line.

For two reasons:

One, to assure the medications are on the list and

Two, to see what LEVEL the plan lists for the medication. The "level" determines the cost to the patient and, in some cases, the amount of medication that may be dispensed at one time (e.g., 30 days or 90 days).

AvMed, for example, fails to list one of my medications, a Level 3 on Humana's list. It does offer an identical generic version, If I order the medication via AvMed's mail order pharmacy, my cost is $0 for 90 days. Mail order usually is slightly less expensive for the patient. (Some local pharmacies may offer some common medications, e.g., Metformin, gratis. It's convenient for the patient and a way for the local pharmacy to get the patient inside the store.)

Before signing on the bottom line, check with the prescribing physician to see if there are alternatives to your current medications and then check to see if the alternatives are listed by the plan's formulary.

Some plans include a small ()$5, $10) monthly allowance for Over-The-Counter (OTC) medications.

ADDITIONAL SERVICES

Most plans offer dental coverage; my experience is that this coverage usually is wanting; of little value.

Most plans also offer hearing services that cover exams and hearing aids. The plans I have reviewed seem generally the same.

Vision plans for optometrists and opticians are OK if your area lacks a "2 pair for $69 with a free eye exam" outlet. The plans cover the optometrist's fee and the cost of one pair of glasses or contacts. If you want "designer" frames or frames not made in China, expect to pay more at all opticians.

While podiatrists are covered, acupuncture and "alternative medicine" are not.

A number of plans offer patient transportation to and from specific locations; sometimes the number of trips is limited. If you lack transportation to a doctor's office or hospital, this may be a benefit to consider.

ANNUAL CHECK-UP

Unless you are employed by a plan provider - e.g., AvMed, Humana - it pays to annually review your current Medicare Advantage plan with other plans. It helps to put everything on a spreadsheet to compare plans item-by-item, side-by-side. In the Benefits column, add your PCP and specialists and your medications so you'll remember to include them. Conveniently, all Advantage plans follow the same presentation format (different from 2014), Select one and list the benefits as they are presented to create the Benefits column.

You do the same thing with your health - you see your PCP at least once a year.

You probably do the same thing with your car and homeowner's insurance.

Plan benefits are "subject to change." (Case in point, AvMed dropped one of my medications from its 2015 drug list.)

NOTHING'S PERFECT

There will be surprises. The purpose of this rant is to help eliminate some of these surprises by knowing the questions to ask. If I never had Humana, I would never have known to ask about "capitation" or how to find out which PCPs referred to which specialists (I still don't have the answer to that). Capitation may not be an issue for you, but it's worthwhile to ask "Can any PCP refer me to any specialist listed on this plan's provider's list?" If the answer is "No," your next question is "How do I know which PCP refers to which specialists?"

You can change PCPs during the calendar year, but unless a plan is cancelled - and Medicare makes this difficult for the insurers - you are "stuck" with your plan until December 31. (You may do your homework and sign up for a new plan from October to Pearl Harbor Day for the coming year.)

MEDICARE IS A GREAT THING

Medicare is, in my opinion, a great - albeit not perfect - thing and if the politicians will stop chipping away at it, well worth the price.

Opuscula CDC or governors Who can you trust?

 

From the Philadelphia Inquirer's philly.com we learn that the CDC offers new Ebola guidelines, less strict than NJ.

I have a lot of respect for the Centers for Disease Control and Prevention (CDC), but given its "behind the curve" position regarding Ebola and how to contain it, I am giving this round to the governors of New Jersey, and

• California
• Florida
• Illinois
• Maine

Because I am from a generation that was routinely quarantined for the litany of highly contagious and dangerous childhood maladies - MMR and chickenpox, the later dangerous to pregnant women and the fetus they carry - I don't consider isolating a person who might be a disease carrier for a short incubation period.

I also note that the occupant of 1600 Pennsylvania Avenue has made a political issue of quarantine and, as the CDC is a government agency , I am not surprised that the CDC has released its "less strict than NJ" ruling.

MEANWHILE, the health care worker who threatened to sue New Jersey - or perhaps just Gov. Chris Christie - has thumbed her nose at her own state's governor, Paul LePage, by ignoring the state's quarantine order and leaving the house to go bicycling with her boyfriend. The Reuters' article noted that President Barack Obama, who has criticized state mandatory quarantine policies for returning medical workers, was scheduled to arrive in Maine later on Thursday to campaign for Democratic candidates, including Mike Michaud, who is trying to unseat LePage in Tuesday's midterm elections.

Despite the CDC and president's opinions, the US military continues to order a 21-day quarantine for all personnel returning from Ebola-infected areas. The Commander in Chief has not countermanded that order.

According to the governors, it is a matter of public health and as their state's CEO, they are obliged to protect the health and welfare of the state's populace. Given that some of the governors are Democrats and some Republicans, the decision is not one that follows party lines.

ON THE FLIP SIDE of the isolation coin is the question of who compensates the isolated person for their time in isolation? How about the organization that put them - allowed them to voluntarily go - into harm's way? The organization that funded the health worker's trip and provided some compensation - rents/mortgages and utilities must be paid even when the person is away doing volunteer work - should take responsibility to continue compensating their volunteer for an additional 21 days.

Meanwhile, admitting that living in a tent is hardly a suite in a four-star hotel or even a top-rated hospital, being waited on hand-and-foot does not seem particularly objectionable. No cooking. No cleaning, No making the bed. No shopping for groceries. Sounds like the military except that unlike the military, no one gets you up at 5 a.m. for calisthenics and then expects you to put in a full day at whatever duties are assigned. (Been there, done that.) More akin to being sent to your room as a kid.

I will concede that being separated from loved ones, even by only a canvass wall, is "bothersome," but 21 days is a lot less separation than the separation from loved ones for sailors on nuclear submarines.

The governor of Maine explained that the citizens of Fort Kent, where the health care worker resides, are concerned for their safety, never mind the CDC's words that - like HIV - Ebola is transmitted only via body fluids and that requires close contact.

Since the healthcare worker's boyfriend has been in close contact with her, he now should be subject to the same isolation requirement.

Admittedly she so far has shown no sign of infection, but one would think a healthcare worker who was so concerned for others' welfare that she traveled thousands of miles to volunteer her services would be as considerate of the folks who live in her town.

The CDC may be right, but what if it isn't?

Opuscula Stringing lights Before November

 

Today is October 29, 2014. It currently is 85^o F; the relative humidity (RH) is at a comfortable 54%, and there is a gentle, 4 mph, breeze.

The trick or treaters will be hitting the streets Friday; in our neighborhood there will be a lot of dark houses - observant Jews don't celebrate the pagan/Christian holiday.

My wife's natal anniversary is 3 days into November, Election Day is 5 days; hence, and Thanksgiving is just around the corner.

Today, as I rode out to add to the larder^* I drove past a truck bearing a sign that read: " Miami Christmas Lights". I might add that I was neither in Miami nor even Dade County.

It put me in mind of Ely Nevada.

Ely is a small town located between a copper mine in Ruth and a copper smelter in McGill; the county seat of White Pine County. There are other "population centers" in the county, but in some cases (e.g., Lund) cattle and oil rigs outnumber people.

Ely is located in a valley. The catch is, the valley FLOOR is at 6,000 feet.

Translation, it gets cold - very cold - in Ely well before Thanksgiving.

Unlike the local gated community that hired the Miami company to "light it up," in Ely the Jaycees strung the lights. Back then, the Jaycees were the movers and shakers in the county; Jaycees and "retired" Jaycees (labeled "Exhausted Roosters") were involved in almost every civic and political function.

Ely - Nevada in general, but Ely in particular - is a place that believed in tolerance. The town had all manner of people; different races, different colors, different religions. About the only people the folks of White Pine County would not tolerate were people from "across the state line" who came to Nevada to do things they would be ashamed to do in Utah; rather like conventioneers sans convention. Other "close to the border" towns had the same problem.

Nothing is perfect, not even Ely Nevada. But it was an experience, a generally good experience.

Still, that was Ely then and the Ely now may be far different.

I think the Ruth mine has been abandoned; if it was, the McGill smelter likewise must be abandoned. As I understand it, the State is the main employer; Nevada built a prison nearby.

 

^* LARDER, according to two on-line resources I checked, has nothing to do with "lard," pig fat shortening. My sources, should you care to read what I read are:
Wikipedia
Merriam- Websster.com

Dealing with Ebola Quarantine

 

What's the big flap over quarantining a person suspected of being infected with a highly contagious killer disease?

Is it the WORD "quarantine?"

According to http://www.merriam-webster.com,

quar•an•tine

1: the period of time during which a person or animal that has a disease or that might have a disease is kept away from others to prevent the disease from spreading

2: the situation of being kept away from others to prevent a disease from spreading

A health professional returning from an Ebola-infected area was incensed that New Jersey's government ordered her into a hospital's infection disease section for 72 hours; long enough for her to be tested.

While in the hospital the health care professional had 'round-the-clock care, meals, medications and - I'm guessing here - telephonic contact with the outside world. And she didn't even have to clean the bathroom or wash her dishes. Like being in a hotel with room service. On New Jersey's tab.

After three days in New Jersey - I lived there and it can seem an awfully long time - she was released to go to her home in, I think, Maine, where she will be quarantined at home - where she will have no visitors, no one to cook, clean, and wash dishes for her; hopefully someone stocked her cupboards and fridge before she arrived; otherwise groceries and other necessities will have to be left on the front stoop.

MEANWHILE, the CDC, playing catch-up with its recommendations, is telling people who might be carrying Ebola to check their temperatures twice-a-day.

Wonderful. Once the symptoms are present - high fever being one of several - the person is infectious; able to easily transmit the disease. Better, the person should be isolated- is "isolated more "PC" than quarantined?" - in a controlled (i.e., hospital) setting.

The U.S. military that is sending personnel into the Ebola danger zone plans to quarantine the returning people in Italy for 21 days, Ebola's incubation period. But if you are in Uncle Sugar's military, you do what you are told when you are told. I'm sure those about to be quarantined want to get back to their loved ones as much as the health care professional did, but I doubt there will be any loud complaints. To be fair, they will be in a group isolation just like boot camp (basic training); the Italian countryside just beyond their tether. Unlike the healthcare professional, the military men and women will have to do their own housekeeping (although I doubt any brass will visit to inspect the area).

As a child I was quarantined on more than one occasion: mumps, rubeola, and rubella - I don't think I escaped any childhood disease. It made life difficult being kept at home, and there was a large sign on the door that read

QUARANTINE

A police line's yellow Do Not Cross tape is far less effective in keeping people at bay that the sign with the large print word "QUARANTINE."

Call me old fashioned - or just plain "old," that's true, too - but quarantining people arriving from an area of infection seems a reasonable precaution; in Risk Management terms, risk mitigation.

Animals arriving from, or being sent overseas are quarantined.

Produce coming from overseas is sometimes quarantined and sometimes destroyed at the point of entry.

Quarantine is a legitimate method to control the spread of contagions.

I can't understand why anyone would complain at what most would consider a minor inconvenience - and with room service yet.

Experience writes Medicare Lessons Learned

 

Funny thing about the Medicare "Select your plan" deadline: it falls every year on December 7th - Pearl Harbor Day, the day that then-president Franklin Delano Roosevelt said would "live in infamy." Infamy apparently is a very short time; ask a 20-something "What is the significance of December 7?" and all you'll get is a blank look.

I have had a Medicare Advantage plan for a number of years.

For most of the years I had AvMed. AvMed cancelled my Primary Care Physician (PCP) so I cancelled AvMed. Seemed fair at the time.

I did my homework and compared Medicare Advantage $0 cost plans - that's not exactly true, $0 cost, but that's what is claimed - side by side. Set up a spreadsheet and listed the categories in Column 1 and the vendors in the columns to the right.

At the time, and even today, Humana seems to offer the best economics with $0 co-pay for hospital stays. (There is at least one other plan that makes that offer.) Humana also could save me a little on my pricy prescription.

One of the selection criteria is the presence of my specialists on the plan list. If one or more of my specialists are absent, the plan is removed from consideration. If a person has no specialist relationships, this is a non-issue. I have such relationships.

Another selection criteria is in-patient hospital costs.

Humana, and at least one other plan, offers $0 co-pay from Day 1 to the end of the hospital stay. Many plans have a first days (typically Day 1 through 5) co-pay of more than $100/day to a bit less than $300/day.

Before I signed up with AvMed years ago I raised that issue with its sales person and was told that in most cases in-patient stays are 5 days or less - "no co-pay" days with AvMed. I think the sales guy probably was right; I have been an in-patient twice (open AAA repair and hernia repair) and paid $0 both times; the first time I was in the hospital 6 days (the discharge day doesn't count, so only 5 full in-patient days)). As it happened, the hospital billed me for two extra days and AvMed resolved that issue in my favor.

Still, having decided to "punish" AvMed for cancelling my PCP - a guy who I credit with saving my life - I compared other plans and settled on Humana.

WHAT I DID NOT KNOW ABOUT is a thing called "capitation".

Humana is about the only Advantage provider that utilizes capitation.

Translation: No matter if a practitioner is on a Humana plan's list of providers, you have access to that specialists only if the your PCP has that specialist on his or her personal referral list.

This came as an unpleasant surprise when I asked my first (of four) Humana PCPs for referrals to my specialists. The first told me to either use the specialist he used or to find a new PCP. He didn't explain that he choice of specialists was restricted by Humana. I never was sure if the restricted referral lists were the practitioner's choice or Humana's decision.

One PCP never addressed the issue; he simply made a referral to his (assigned?) specialist and ordered tests without consulting my specialist who wanted the tests.

My Humana plan lists 108 PCPs.

Bait and switch? False advertising?

To Be Fair On Page 4 of Humana's Provider Directory, under the heading Getting Care from Specialists it states: "Each PCP may have certain network specialists they use for referrals. This means that the specialists you can use may depend on which person you choose to be your PCP.

If there are specific specialists you want to use, find out whether your PCP refers patients to these specialists. You can change your PCP at any time if you want to see a network specialist that your current PCP does not refer to."

Not exactly "small print", but based on a survey of seven (7) Advantage providers one of only two that need the caveat.

I queried Humana's Customer Service on more than one occasion, asking it to identify PCPs who could/would refer me to the specialists I named. I was told to direct my issue to another Humana department.

The other Advantage provider who uses capitation said that it has PCPs that are not "capitated" and that the insurer will provide a list of non-capitated PCPs upon request.

A THIRD QUESTION to consider when selecting an Advantage plan: If the patient needs a service from a specialist who uses modern methods - e.g., laser-assisted cataract surgery - or special devices - e.g., multifocal intraocular lens (IOL) - will the plan pay the basic, Medicare-approved fee and allow the patient to pay any additional charges, assuming, of course, that the specialist agrees to the arrangement.

Humana allows the patient-paid extra costs; AvMed prohibits it. (If a specialist is willing to take the additional payments "under-the-table" will AvMed, if it discovers the transaction, penalize the patient and/or the practitioner?)

A QUICK FEW WORDS about so called "$0" Advantage plans.

The Medicare participant must continue to pay his/her Medicare fee, for most people, roughly $105/month. Additionally, Medicare Advantage providers - the AvMeds and Humanas, and many others, receive additional taxpayer dollars for each person they sign up. Now you know why there is so much competition for a geezer's signature on the dotted line. Certainly $0 additional out-of-pocket cost is a good thing, but it's not exactly true; still for a person watching "pennies," it is a consideration.

There are other concerns to consider, among them

• Dental coverage (typically of little true value)
  
• Drug costs and specific drugs' classification
  
• Geezer health club membership
  
• Hearing services coverage
  
• Skilled Nursing Care facilities (like hospital in-patient days needs to be checked)
  
• Transportation to/from and how often
  
• Vision services coverage

When I signed up for my Advantage plan I didn't know the questions to ask; hopefully the above will give you something to consider before signing on the bottom line.

The Curmudgeon writes Speak English!

 

This is not a tirade against people who come to a country and refuse to learn the local language albeit in my neck o' the woods it easily could be the tirade's topic.

This IS a tirade against native speakers - especially college-"educated" people in the media - who apparently flunked First Grade English.

This is not a new phenomenon; as a reporter covering courts (vs. being a court reporter who transcribes what is said in a courtroom). I have seen many letters from collegians that are rife with misspellings and grammatical faux pas.

I get most of my news via the Internet and the tv.

Headline writers seem unable to comprehend that "over" is not synonymous with "more than" and, likewise, that "under" does not mean "less than."

Yes, I KNOW English is a "living language." It changes when people coin new words, and it changes when too many people misuse a word; e.g., "over" when they MEAN "more than."

Reporters, especially in the "electronic media," seem confused about the words "burglary" and "robbery."

While both are theft, "burglary" is theft from a property; an automobile, a building, any "thing."

"Robbery" is theft from a person.

A building is "burglarized"; a person is "robbed."

By the way, a person is "hanged by the neck until dead" while everything else is "hung"; the clothes are "hung" on the line to dry (assuming the Home Owners' Association allows clotheslines). Things, including people, may be "hanging" from something (rafters, branches).

People "lie" down to rest. You may "lay" down (put down) an object, e.g., a baby, a book; when you get up from your rest, you can say that you "laid" - or "lied" - down. Using "lay" in context of a human's activity is a euphemism for sexual intercourse.

Writing of SEX - now that I have regained your attention - the word is applied to humans and animals; "gender" is reserved for all other things, such as language that (not "which") fortunately English lacks. (I know of no language other than English that lacks gender association for nouns, verbs, et al. I confess I know about fewer languages than I have fingers on my hands.)

Consider. A person may be described as "sexy." Have you ever heard of anyone defined as "gendery?"

While I lack the vocabulary of the late Hubert Horatio Humphrey or the also late William Frank Buckley, I DO appreciate proper use of the few words I know and love. Politics aside, both men were a delight to hear.

There should be no excuse for misspelled words. Most word processors include fairly decent spell check, and if those fail, there are on-line (on line? online?) dictionaries to rescue the author, and if THOSE don't provide the correct spelling, try the Unabridged or, hie yourself off to a decent Thesaurus for an alternate word.

ERM-BC-COOP: Good intentions Pave road to court

You can lead a person to the gym,
But you can't force them to exercise

According to a Fox Rothschild Employment Discrimination Report titled Corporate “Wellness Program” Hits EEOC Radar As Violative Of The ADA, employers can offer health benefits but they cannot - in most cases - force employees to use them.
According to the article by Richard B. Cohen,

They may take the form of weight loss tips and weigh-in competitions, in-office fitness, exercise or yoga programs, “healthy choice” breakfast events to teach about cholesterol or diabetes or processed food, or things like subsidies to join health clubs.

These programs may seem selfless, and/or they may seem calculating – but in any event they serve an indisputably beneficial purpose and are win-win programs.

But – and this is a big but — they must be voluntary and must not violate the law.

It seems an employer wanted an employee to agree to certain tests to determine the employee's health. The employee refused, so the employer threatened the employee of loss of some company benefits, including its participation in the person's insurance costs.

The employer mandated testing was not, according to the article, job related; at least on the surface there was no connection between the employee's obvious health condition and the employee's job requirements.
Enter the Americans with Disabilities Act (ADA) that precludes from inquiring of employees about health or disability issues not related to the employee's job.

The "bottom line" for employers with good intentions is, according to the EEOC, ”Employers certainly may have voluntary wellness programs – there’s no dispute about that – and many see such programs as a positive development. But they have actually to be voluntary. They can’t compel participation in medical tests or questions that are not job-related and consistent with business necessity by cancelling coverage or imposing enormous penalties such as shifting 100 percent of the premium cost onto the back of the employee who chooses not to participate. Having to choose between complying with such medical exams and inquiries, on the one hand, or getting hit with cancellation or a penalty, on the other hand, is not voluntary and not a choice at all.”

Cohen's closing comment is that Employers who rightly start wellness programs would be prudent to dust off their employee manuals, revise them as necessary, keep training managers, and learn about the various anti-discrimination laws.

Opuscula It's not just Cubans, Haitians Taking to the boats

 

Americans, especially Floridians, are accustomed to seeing "boat people" arrive on the beaches, weary, malnourished, and dehydrated.

Some preferred to risk their lives rather than live in Cuba.

Others decided to chance the sea rather than live in the poverty of Haiti.

(Cubans, if they set foot on shore, get to stay; Haitians are returned.)

But Cubans and Haitians are not alone in taking to anything that floats. Palestinians, especially from Gaza, likewise are heading to sea to escape life at home.

The list of headlines grows longer:

• Al-Monitor: Escaping Gaza, hundreds of Palestinians drown
  The Gaza-based human rights organization Al-Damir (meaning "conscience” in Arabic) has since Sept. 17 been gathering reports and testimonies about the deaths of hundreds of Palestinian refugees off the island of Malta.
• YNet: Scores of Gazans die at sea in attempt to flee Gaza
  More and more Gazans are attempting to flee Gaza through Egypt into Europe – recent boat crash near Malta which saw over 500 people go missing or die highlights perils Palestinian face en route to new life in EU.
• The Guardian: Devil and the deep blue sea: how Mediterranean migrant disaster unfolded
  Desperate migrants from Gaza and Syria tell how they put themselves at the mercy of people smugglers – and hundreds died at sea
• HaAretz: Amnesty: 2,500 migrants have drowned in the Mediterranean this year
  Amnesty International calls on European countries to send boats to pick up migrants, including Palestinians from Gaza, rather than leave them to the mercy of smugglers.
• CNN: 'Laughing' traffickers ram boat full migrants and kill 500, survivors say
  Witnesses say as many as 500 migrants died in the Mediterranean Sea when human traffickers intentionally sunk their boat, the International Organization for Migration said Tuesday.
  The survivors -- both Palestinian men from Gaza who were rescued separately after days in the water clinging to flotation aids -- said they had packed into a boat in Egypt's port of Damietta in Egypt and left on September 6. They estimated at least 400 men and women, in addition to as many as 100 children, were on board.
• Jewish Press Palestinians and the “Death Boats” Scandal
  As the past few weeks have, shown, hundreds, if not thousands, of Palestinians would rather risk their lives at sea than live under Palestinian governments and leaders whose only goal is to enrich their bank accounts.
  They said that Hamas officials are providing the emigrants with forged visas and travel documents to enable them to enter Europe.
• Reuters: As many as 700 migrants feared drowned in Mediterranean
  More than 700 people fleeing Africa and the Middle East may have drowned in shipwrecks in the Mediterranean over the last week, bringing the death toll this year to almost 3,000, the International Organisation for Migration (IOM) said on Monday.

 

IT'S NOT JUST the "Jewish" or "Israeli" press that reports on the escapees; the world's press also has taken note of the attempted exodus from Muslim misrule not only in Gaza, but Africa as well.

People don't take to the boats when they have freedom. People don't take to the boats when they have a decent economy.

In the case of Gaza and the Palestinian Authority (PA), it's the economy; in Gaza its aggravated by despotic government that executes its opponents and uses its people as human shields.

Unlike the PA where the rulers are known to siphon off donated money into their own foreign bank accounts, in Gaza Hamas' also diverts donations to building tunnels and buying rockets in an attempt to fulfill its charter to wipe Israel off the face of the map and then, like ISIS - or whatever its nom du jour - to create a worldwide caliphate.

What I fail to understand is why the people escaping Gaza and Africa don't pick closer destinations that can be reached by land of a short boat ride, say across the Suez canal.

But then again, I also fail to understand why a person escaping from Cuba or Haiti would want to make the trip to Florida when Mexico is closer and shares a language with Cuba, or, for the Haitians, why not Jamaica or the Turks & Caicos.

Around the Mediterranean

Crossing the Suez - Destination options

Caribbean Sea