Opuscula Presidential Presumptions

INCUMBENT PRESIDENT DONALD TRUMP presents his Middle east “peace plan” that forget to ask what the PEOPLE in the plan want.

Presidential contender Mike Bloomberg is going to “Get it done,” even if the people to whom “it” will be done don’t want it.

TRUMP, TO THE DEMOCRATS’ lingering embarrassment, offered what the media termed the “Plan of the Century.” A plan to shuffle Israeli towns to create an artificial “country” to be called “Palestine.”

Admittedly Trump did not consult the PLO leadership.

He tried, but Abu Mazen rejected contact; even refusing a phone call from Trump.

The leftist media, of course, only reported that Trump never talked to Abu Mazen. A half-truth is as bad as a lie.

Trump and his representatives also never talked to the people in the communities that would be most effected by his proposal.

 

Because we say so

The plan calls for several Arab-dominated communities in Israel to be transferred by Trump fiat to the PLO.

The problem is that the Israeli Arab citizens of those communities WANT to remain Israeli citizens.

Several polls have indicated the majority of these communities’ citizens want to keep their Israeli citizenship.

But “polls” always are of questionable value.

What needs to be done is to hold a plebiscite to determine the will of the majority of the residents in those communities. The election could be monitored by representatives from Israel and from the PLO, or from the U.S. and Russia, both of which are experienced at influencing elections.

Trump also did not ask the Israelis in the Sinai if they want to have Hamas terrorists living next to them. (He obviously did not speak with Hamas leaders since, like Abu Mazen, they only talk to Iran’s “Supreme Leader,” Ayatollah Ali Khamenei.) There is no indication that Trump consulted with the Egyptians before expanding Hamas rule over more land along the Egyptian border.

Egypt, in order to deter Hamas’ air attacks, cleared a wide swath of land on which Hamas balloons, kites, and other items can land sans damage to property or crops.

 

Pipe dream

Part of the plan is to “demilitarize” the future “Palestine” and, as part of “Palestine,” Gaza.

Who will guarantee that “Palestine” will be demilitarized?

Who will guarantee “Palestine’s” defense from its neighbors?

There is talk of an airport in Gaza. There IS an airport in Gaza: Arafat International.

It was ruined in retaliation for attacks on Israel and to reduce war materiels from entering Gaza by air.

What guarantee will Israel have that “demilitarized” Gaza won’t be the same, albeit on a smaller scale, as was a demilitarized nazi Germany. Does anyone REMEMBER nazi Germany?

 

Healthcare at what cost?

Bloomberg is going to give us healthcare a la Obama (who is endorsing him).

“Medicare for all.” (Amusing that Obama won’t endorse his own vice president.)

OK; will everyone then pay what Medicare beneficiaries pay into Medicare every month? What about co-pays?

This scrivener’s Spouse works and pays into Medicare. She also is a Medicare recipient and pays her monthly fee. For her, Medicare is double jeopardy.

I never understood: I paid into Medicare from Day 1. Now, as a recipient, I STILL pay into Medicare?

If a Medicare-like plan is put into place, will people be obliged to see their personal physician on a regular schedule for “preventive medicine”?

Regular, candid, visits with primary care physicians and nurses DO reduce emergency room visits and reduce hospital stays. The military has known this for decades.

No one knows what the Trump health care plan would be like since the Democrats blocked it at every turn. Is Bloomberg’s plan Obamacare on steroids or is it closer to what Trump tried to implement?

 

More jobs, higher pay

Bloomberg promises to create jobs (as Trump has done) and to raise pay. Great.

Does anyone consider what a raise in pay sans increased responsibility causes?

Raised pay means higher prices (higher cost of living for everyone).

Raised pay means fewer jobs as employers cut costs (that, bottom line, increase owner/share holder profits).

My first few jobs paid minimum wage — then $1/hour — but I could buy gasoline for anywhere from 17 cents/gallon (gas “wars”) to 50 cents/gallon. Milk and bread were much less than a dollar and cigarettes went for 50 cents/pack from a machine. Newspapers from a rack were a dime weekdays and 25 cents on Sundays.

But higher pay is a good election promise. In the end it is meaningless, as it drives up the cost-of-living, but it SOUNDS good.

 

Making America safer

Reasonable gun control needs to be implemented.

Is it “reasonable” for a privately-owned rifle to have a 30-round magazine? Why would a hunter need THIRTY ROUNDS to kill one animal? Even a lousy shooter should be able to bring down the target with two or three rounds.

True, there never is a LEO (Law Enforcement Officer, cop) when you need one. My First Born, a LEO, frequently reminds me of that fact.

So let’s say a person buys a firearm for home defense. Is that person expecting a fire fight, something out of a war movie? A 10-round magazine for a rifle or pistol should be enough. If not, buy another 10-round magazine.

(My revolver holds seven rounds but for safety, I only load 6 rounds. If I can’t hit my target with 6 rounds, I’ll throw the gun at my attacker.)

I see no reason for noise suppressors/silencers. Maybe in the world of James Bond they are sexy, but in the real world where most of us live, there is no justification.

 

Get serious about background checks

Background checks? Absolutely; serious checks using on local and national databases. The state did a cursory check when I bought my first side arm. When I applied for a concealed carry license, the check was much more stringent.

No more instant delivery for guns bought at a gun show. Gun show purchases must be the same as gun store purchases.

Still, until gun laws are enforced, what’s the use?

Most criminals who committed crimes with guns did not buy their weapons at the local gun store.

It is not xenophobic to believe a lot of crime is committed by illegal immigrants. If a person is illegal, he or she may have a hard time finding a liberal scofflaw to hire them, and then cheat them on their wages. The alternative: crime.

Meanwhile, why are the scofflaws — the illegals’ employers — allowed to go free with, worst case, a “slap on the wrist”? Punish them with the inconvenience of jail time, 30 days minimum. Then led the Feds add money penalties for lack of I-9 forms.

 

Silence kills

Many of the recent spate of school shootings have been at the hands of students. Many of these shooters’ plans were obvious long before the murders. Social media were ignored. Classroom behavior was ignored. Psychological warnings (e.g., tormenting weaker kids, animal cruelty) were dismissed. When there WAS information, it often was not shared. The FBI is notorious for failing to share information with locals.

Making America safer is not just about gun control; that is only a small part of the effort.

What cannot be legislated in the feeling of entitlement many criminals possess. Why else would someone kill another for a pair of sneakers or car hubcaps. Why else would young people with semi-automatic rifles randomly shoot at houses in their own neighborhoods?

People hit the streets and call for their neighbors to “see something, say something,” to work with LEOs to get the killers off the streets, but in the end, rarely does anyone say anything, especially to the LEOs.

Is there anything any president can do to instill respect for others?

Parents, for whatever reasons, have abrogated responsibility for their child’s behavior.

Schools have failed.

LEOs look the other way at minor crimes.

Courts either will not, or cannot sentence juveniles for their crimes.

I’m entitled to that gold chain you stupidly are flashing; give it to me or ...

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PLAGIARISM is the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.

Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.

Web sites (URLs) beginning https://tinyurl.com/ are generated by the free Tiny URL utility and reduce lengthy URLs to manageable size.

 

Comment Presidential Presumptions

Opuscula Pay me now * And * Pay me later

MEDICARE WAS SIGNED INTO LAW on July 30, 1965 by President Lyndon Baines Johnson in Independence MO.¹

I HAVE BEEN WORKING AND PAYING INTO Social Security since 1957, and Medicare since its inception.

Each month, Social Security deducts an ever-increasing amount from my stipend for Medicare.

Why?

Didn’t I pay into Medicare enough from 1965 until I signed up for Medicare in 2008?

Is the government such a bad steward of my money that at almost 77 years old I STILL must pay into Medicare?

Social Security and Medicare were supposed to be inviolate; untouchable.

It is — “sort of.”

Medicare and Social Security funds were put up as collateral by U.S. governments to cover loans from China.

In other words, China owns the Social Security and Medicare I paid into for decades.

The government will tell me the funds are still here and that the money is safe.

I fear I have no faith in the government; not with Democrats in control and not with Republicans in control.

Since the politicians in the House, the Senate, and the White House have special plans for things Medicare supposedly covers and their own retirement plan separate from Social Security, why should “our” elected representatives care about these two funds.

Sometimes I feel like Diogenes of Sinope, looking for a politician who cares.

 

Diogenes looking for honest man (https://tinyurl.com/tkvlw5c)

 

I know not all politicians are self-centered, but given how hard they campaign to stay in office — and complain about the cost of living in the capital, be it D.C. or Montpelier (VT) — there must be some benefit to the job beside “prestige” and a desire to perform a public service. Color me a skeptic.

I won’t say that each year my monthly Medicare contribution has increased, but it seems to have gone up every year recently.

(I have a Medicare Advantage plan, a money-maker or the insurance companies but one that provides better benefits that “original Medicare.” I live in an area heavily populated by “geezers” and, because of competition, I get more benefits than someone who lives in the tulies or boonies — six of one, half dozen of the other. People who live one county south get more benefits; people who live one county north get less. It's all about competition for the shrinking dollar.)

I understand having to pay tax on my Social Security benefit. It was “pre-tax” income. I don’t LIKE pay tax on my Social Security stipend, but I understand why.

As I understand it, Social Security never was intended to replace retirement savings, and the Social Security number was never supposed to be a national ID to be shared with just about everyone.

When I joined the Air Force in 1960, I got a unique Air Force ID number (that I can recite to this day); sometime later, the military decided to make ever soldier, sailor, and airman’s ID the person’s Social Security number. Some states, e.g., Virginia, used a person’s Social Security number as the person’s driver’s license unless the person complained. So much for making identity theft easy.

I’m glad I HAVE Medicare, but in my heart I resent having to continue paying into a fund to which I have been contributing since its inception.

Pay me now AND pay me later.

Somehow that doesn’t seem fair.

Sources

1. Medicare law: https://tinyurl.com/y3mq74x7

PLAGIARISM is the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.

Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.

Web sites (URLs) beginning https://tinyurl.com/ are generated by the free Tiny URL utility and reduce lengthy URLs to manageable size.

 

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Opuscula Selecting A Medicare Provider

IT’S THAT TIME AGAIN, time for geezers (like me) to review Medicare options.

The top four are

1. Plain ol’ Medicare
2. Medicare with a drug plan
3. Medicare Advantage plan, and
4. Medicare Supplement (Medi-Gap) plan.

THE PLACE TO START IS medicare.gov. Medicare puts out a booklet titled “Medicare & You” that includes a wealth of information about Medicare AND plans available to people in different parts of the country. The booklet is free from the Centers for Medicare and Medicaid Services, a/k/a CMS. (What happened to the second “M” is beyond me.) The booklet is available on line or may be requested from

U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore MD 21244-1850

MAKE A LIST, CHECK IT TWICE

No matter if you are a Medicare innocent or an old hand, there is some information you want at the ready.

Do you have a family physician, a “Primary Care Physician”?
If you do, write down the doctor’s name.

Do you have any specialists on whom you depend?

Write down the specialists’ names.

Do you take an prescription medications?

Write down the names of the drugs and their potency.

WHAT PLAN TYPE?

After looking at “Medicare & You” (ibid.) decide what plan option suits your needs. Medicare Part B will cost you at least $135/month no matter the plan option.

Yes, you paid into Medicare all your working life or at least from 1958, and no, it doesn’t seem reasonable that you have to keep paying, but ...

A Medicare Supplement (Medi-Gap) plan will cost you the monthly fee PLUS an additional fee.

If you want to see ANY practitioner, usually sans a referral, the Supplement plan may be right for you. However, don’t be talked into a Supplement plan because you like to travel. Medicare and most Medicare Advantage plans cover you wherever you go in the U.S. Most Advantage plans provide coverage outside the U.S. as well, albeit there will be paperwork on your return to the U.S.

Once you decide on the plan (Medicare, Medicare with Rx, Medicare Advantage, or Medicare Supplement) see what plans are available for your ZIP code.

There are two basic “variations on a theme” with Advantage plans.

There are plans for people with limited incomes; these are identified as “SNP” plans.

There are HMO and PPO plans. HMOs generally are “plain vanilla” and require subscribers to see a limited number of doctors while PPO plans offer a greater number of physicians – at a cost.

My preference is Medicare Advantage HMO.

WHICH PLAN SUITS BEST?

Each Advantage plan has three (3) main documents. All of the documents are online or may be ordered from the company offering the plan.

Evidence of Coverage
Forget about “summaries” or “plan overviews.” They are useless. The controlling document is the EVIDENCE OF COVERAGE, the EoC. The EOC is the agreement between the plan provider and CMS. Once approved by CMS, it is “cast into concrete” for the calendar year. Get a copy of this document (digital or paper) and guard it well.

Providers’ List

The PROVIDERS’ LIST identifies all the physicians, hospitals, urgent care clinics, pharmacies, and, often, optometrists and opticians, and dental providers. This list is “subject to change” during the year.

Formulary

The FORMULARY lists all the prescription drugs the plan will provide and the tier level for each drug. Most advantage plans have four or five “tiers”; each tier has an associated price. The PRICE for each tier is listed in the EoC. The drug list is “subject to change” during the year.

ITEM BY ITEM

Most plans’ EoCs conform to an alphabetized list.

Many of the service’s fees (co-pays) are determined by Medicare. Common immunizations are $0 co-pay because Medicare requires it. Mammograms, PAP smears, prostate tests are sans co-pay.

But there ARE differences among plans.

I usually create a spread sheet starting with my critical requirements. For me, those are three things: my specialist, my hospital, and the tier level of my most expensive medication.

After that, I simply go down the list.

Some plans will have extra services, and some plans are more generous that others. For example, one plan gives the first five inpatient days as $0 co-pay; another gives all Medicare days (90) as $0 co-pay, and another EoC promises $0 co-pay for unlimited inpatient days. (It turns out that most acute hospital stays are five days or less.)

Given my personal priorities – specialist and hospital – I quickly reduce the field.

ACCESS TO SPECIALISTS

Many, in fact almost all, Advantage plans have a great number of specialists on their Providers’ List. HOWEVER most plans allow the PCPs to refer to a “sub-list” that may, or may not, include a specialist you want to see.

To find out is a particular PCP can send you to the specific specialist you have to ask the PCP’s office administrator. (Most PCPs haven’t a clue.) If you are willing to accept an alternate, well and good; but if you are committed to one practitioner, you will need to select a different PCP.

REFERRALS ARE A GOOD THING
Referrals can be a pain in the posterior, but they actually are a good thing. The PCP should be the center of your health care and should know who you’ve seen and the results of the visit. A good PCP will aggressively follow up with the specialist to make certain the PCP gets a complete report.

Do NOT, however, depend on the PCP to be up to date with medications. If you take multiple pharmaceuticals and over-the-counter (OTC) drugs, talk to your pharmacist. The pharmacist is more likely to be aware of any contra-indications than the PCP. (However, make the PCP aware of ALL prescription and OTC drugs you take.)

YOU AND THE PCP

Your PCP should be your adviser; he or she should be your medical consultant, just as you (may) have a financial or mechanical consultant. Consultants recommend, they are not paid to dictate. It’s your health, after all.

If you have a PCP that insists on something with which you have an issue, change PCPs. Medicare Advantage plans allow subscribers to change PCPs once-a-month. You are “stuck” with the plan for the calendar year, just as the plan is “stuck” with you. The only “out” is to move out of the plan’s coverage area.

PLAGIARISM is the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.

Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.

BCPLANNER: Comments on Medicare

Opuscula Medicare plans: Beware the plan Is not “capitated”

CAPITATION: of, relating to, participating in, or being a health-care system in which a medical provider is given a set fee per patient (as by an HMO) regardless of treatment required1

WHAT THAT MEANS TO the person considering a Medicare Advantage plan is that the plan may have 10,000 providers – physicians, hospitals, etc. – but an individual Primary Care Physician (PCP) may have a highly abbreviated list of only a few hundred specialists and a handful of hospitals from the plan’s Provider List.

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Double-checking a Medicare plan: Read Don’t trust Medicare info on the Internet (http://tinyurl.com/y8yzl4eh)

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HOW TO SELECT A PLAN
There are three plan documents to review before any decision is made. In order of review:

First: Provider’s List
Second: Formulary (drug list)
Third: Evidence of Coverage (EOC)

If the potential plan subscriber lacks any preferences re doctors and hospitals, it makes no difference which plan is selected.
On the other hand, if the potential subscriber has a preference for a particular PCP or specialist, or even a hospital, then the first thing to do is check the plan’s Providers’ List.
PROVIDERS’ LIST.
If all, or at least most, of the desired providers are listed, contact the plan and ask “Are the PCPs capitated.”
Very likely the prospective subscriber will have to explain to the sales person – sales folks always are the initial contact – about capitation. The easiest way is to ask: “Can the PCP refer to ALL providers listed on the Provider’s List? If the answer is “Sure, they can refer to all on the list,” you might want to get that in writing. About 50 percent of the plans reviewed this week are capitated. Of the non-capitated plans, only two claimed they had the required providers. One of the two did not, despite its web site's listings.

There is no need to list plans here since what is available in one area may not be available in another.

Once the plans have been winnowed out, the next step is to check the plan’s Formulary.
FORMULARY
A formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.²
Are the pharmaceuticals – prescription drugs – needed on the list?
If they are, check the TIER LEVEL.
Tier levels determine the drug’s copay; the higher the tier, the more expensive the copay.
Be aware that not all plans are equal. One plan lists a specific drug as a Tier 2 for which there is zero copay. Another plan for the same geographic area lists the same generic drug as Tier 3 and demands a $100 copay for the same 90 day supply. (As it happens, a neighborhood pharmacy sells the same drug in the same quantity for less than $50.)
What is the copay for each tier? For that information the potential subscriber needs to locate the plan’s Evidence of Coverage.
EVIDENCE OF COVERAGE.
The Evidence of Coverage, a/k/a EOC, is the most important document the plan produces. The EOC tells everyone what benefits it will provide and what copays the subscriber must pay. The Formulary is “subject to change” as is the Providers’ List. Not so the EOC.
Most EOCs follow a fixed-by-Medicare alphabetical presentation.
That’s convenient when comparing plans. (LibreOffice Calc’s spreadsheet is great for this, and it’s free.)
Copays vary by plan. The ONLY document in which copays are “cast into concrete” is the EOC. Summaries are nice, but they lack the authority of the EOC.
GET THE DOCUMENTS
All the critical documents should be available online at the plan’s site. New documents usually are available in mid-October of each year. Medicare enrollment for people already with Medicare is between Oct. 15 and Dec. 7 (Pearl Harbor Day). For people joining Medicare at other times, check with Medicare.³
Plan documents normally are available online in PDF format. (Most browsers can display PDF, but in some cases the free Adobe Reader may be needed.) The documents also can be mailed on request.

The selected plan will send a printed copy of its EOC, Providers’ List, and, usually, its Formulary.

OTHER OPTIONS
There are two other options to a Medicare Advantage plan.

1. Original Medicare.
2. Medicare Supplement plans.

Original Medicare usually has higher copays and sometimes fewer benefits. The main advantage of Original Medicare is that it’s good everyplace Medicare is accepted: doctors offices, hospitals, etc. No concerns about “Will my plan cover this doctor or this hospital.”
Medicare Supplement plans are similar to Original Medicare in that the plans are accepted everyplace Original Medicare is accepted.
Supplement plans are provided by insurance carriers, many of which also offer Medicare Advantage plans.
The drawback to Supplement plans is they cost more than an equivalent Advantage plan; the user is paying for the freedom to go to almost any practitioner or facility.
THE PLACE TO START
Beware of commercial sites that offer to find the “right” program. They often don’t include ALL available plans.
The absolute BEST place to start looking for a Medicare Advantage or Supplement plan is the Medicare site, http:\\www.medicare.gov Accept no substitutes.

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Sources
1. http://tinyurl.com/y7pmhbp8
2. http://tinyurl.com/yavjkaeb
3. http://tinyurl.com/ybof3f5a

PLAGIARISM is the act of appropriating the literary composition of another, or parts or passages of his writings, or the ideas or language of the same, and passing them off as the product of one’s own mind.
Truth is an absolute defense to defamation. Defamation is a false statement of fact. If the statement was accurate, then by definition it wasn’t defamatory.

Comments on Medicare plans

Opuscula Patient welfare Vs. AvMed profit

THIS IS ALL ABOUT what I perceive as a way for AvMed to increase its profits at the expense of its subscribers – its raison d’être.

For 2017, AvMed raised the “tier” – the level that determines the subscriber’s copay for a specific prescription – for one of my medications from Tier 2 – copay $7 – to Tier 4 – copay $75. The drug, Fenofibrate, has been on the market for several years and replaced, for me, Omega 3 which, like Finofibrate, AvMed jumped from Tier 2 to Tier 4 for 2016.

Sharon Robison, Manager, AvMed Medicare Member Engagement Center - no address included in her communication – informed me by mail that I could avoid a $75 copay for Fenofibrate by having my Primary Care Physician (PCP) prescribe Gemfibrozil instead. Gemfibrozal is Tier 2; the copay is $7.

I checked with my pharmacy and found out the full retail price for Fenofibrate is LESS THAN the AvMed copay – and that’s sans coupons, discounts, or drug discount cards. We are in the final throes of the 2016 presidential election disaster – no matter who wins, America loses – and my level of skepticism on all things is high; my suspicion is that AvMed is using Fenofibrate as a money maker – over and above what it gets from the government.

My pharmacist told me that Fenofibrate was developed several years ago to supplement Gemfibrozal because the later often was contra-indicated for people taking statins – which I do. Ms. Robison’s missive failed to apprise me of that little fact.

According to the National Institutes of Health (NIH),

Compared with gemfibrozil, fenofibrate produced significantly greater reductions in total cholesterol, LDL, and triglycerides and significantly greater increases in HDL. These changes were evident in patients receiving and not receiving concomitant statin therapy.

Between my pharmacist and the NIH, there appears no medical advantage for the patient to switch from fenofibrate to gemfibrozil; indeed this would be a step back.

It is interesting that of the several companies in the area that offer Medicare Advantage plans, one plan, HealthSun, rates Fenofibrate as a Tier 1; i.e., $0 copay. Others listed it as Tier 2 or Tier 3; only AvMed listed it in the $75 copay tier. AvMed’s copay was the same if the drug is purchased from a local pharmacy or via AvMed’s mail order partner.

The Center for Medicare and Medicaid Services generally sets guidelines for Medicare programs (which explains why most Advantage plans look pretty much alike). It apparently allows program owners, e.g., AvMed, Humana, and United Healthcare, flexibility with charges, most noticeably in re hospital stays and, to my chagrin, pharmacy copays.

There was a time when access to “my” specialists was critical, but that time has passed. I now can, albeit reluctantly, deal with PCP capitation.

Medicare programs are highly competitive. I can’t understand why AvMed would shoot itself in the wallet by what appears to be price gouging. I don’t sit in the AvMed board room so I’m not privy to management’s decision making processes, but if appearances count for anything . . .

Opuscula AvMed copay Greater than Pharmacy’s price

I AM A MEDICARE ADVANTAGE subscriber. Most of my Medicare years have been with AvMed – I had Humana for a year and quickly returned to AvMed – but my loyalty is starting to waiver.

Last year AvMed raised the “tier level” – this determines the copay - for one of my medications from Tier 2 to Tier 4. On request, it provided my Primary Care Physician (PCP) with a lesser-cost Tier 2 alternative: fenofribrate. (My PCP claims he never got the message; I complained and AvMed sent the information directly to me. For this and several other reasons I have a new PCP.)

Generic fenofribrate was a Tier 2 drug; the copay was $7 for a 30-day supply (30 tablets). For the 2017 calendar year, AvMed moved the drug to Tier 4 with a $75 copay. That’s a painful increase: from $84/year to $900/year copay.

WHY the two-tier jump is beyond my ken and, thanks to a crashed hard drive, my email contacts with AvMed “disappeared.” (To its credit, AvMed customer service is pretty good.)

Perhaps the jump is the work of the current incumbent at 1600 Pennsylvania Avenue and his “law-by-sneakiness” Patient Protection and Affordable Care Act (PPACA); he has mucked about with the healthcare system to the detriment of many.

I don’t know if fenofribrate is a Tier 4 drug for all 2017 Medicare advantage plans – I suspect it may be; if it is, AvMed’s $75 copay is competitive with other plans’ Tier 4 copays:

BlueMedicare HMO MyTime Plus (HMO) - H1026-061-0 - $65
Optimum Platinum Plan (HMO) - H5594-002-0 - $69
Simply More (HMO) - H5471-051-0 - $75
CareOne (HMO) - H1019-001-0 - $85
Harmony Maximum (HMO) - H4627-006-0 - $85
Humana Gold Plus H1036-065C (HMO) - H1036-065-0 - $85
Optimum Gold Rewards Plan (HMO) - H5594-001-0 - $85
Preferred Choice Broward (HMO) - H1045-005-0 - $85
Medica HealthCare Plans MedicareMax (HMO) - H5420-003-1 - $89
Humana Gold Plus H1036-237 (HMO) - H1036-237-0 - $97
Coventry Summit Ideal (HMO) - H1609-018-0 - $100

The exception was HealthSun HealthAdvantage Plan (HMO) - H5431-012-0 - $30.

The information above is from https://q1medicare.com/PartD-SearchMA-Medicare-2017PlanFinder.php#results

For kicks, I checked GoodRx.com for Fenofribrate in my area. The site returned RETAIL (full) prices of

Walgreens - $76
CVS and Target/CVS - $77
Kmart - $82

Of those, with free discounts or coupons, the price for a 30-day supply of fenofribrate dropped to

Walmart - <$22 (d)
CVS@Target - $32 (c)
Walgreens - <$33 (c)
CVS - $43 (c)
Kmart - <$50 (c)
Publix <$60 (d)

In the above, c = with coupon; d = discount.

There also is a discount card available at My DiscountRx Card.pdf, but I have no idea the amount of discount using that card at my regular (Publix) pharmacy.

The question remains: If Medicare is supposed to help limited income seniors, WHY IS THE COPAY HIGHER THAN THE LOCAL DISCOUNT OPTIONS?

It will be a little inconvenient to fill the fenofribrate script since my new PCP will have to give me three scripts for the medicine – coupons and discounts are “subject to change” and what is “best price” at one pharmacy one month may not be the following month. As it is today, I insist that all scripts (prescriptions) be given to me to take to the pharmacy of my choice; I lack confidence in medical practice front offices. Currently, all scripts are for 90-day supplies; it is more convenient.

I wonder, given the RETAIL cost of finofribrate (ibid.) how much AvMed is about to make when my copay is about the same as the full price of the drug at local pharmacies. Unless, of course, AvMed knows that the wholesale cost of finofribrate is about to drastically jump – rather like stock market insider trading. (But that fails to explain why the HealthSun HealthAdvantage Plan only has a $30 copay for Tier 4 drugs.)

There is more to Advantage plans that “just” medications. There are related plans (e.g., dental, vision, hearing) and hospital/ER/urgent care copays to consider as well as being able to see ANY provider on the plan’s provider list (e.g., Humana’s capitated lists that limit PCP referrals). As with auto and home/renter insurance, it pays to compare plans. What may be good for me may not be good for others. There are options not only within Advantage plans, but there is “straight” Medicare and extra cost Medicare Supplement plans

Fortunately I have a little time to select a plan for 2017. Interestingly, the deadline is December 7, a date most plan participants will remember as Pearl Harbor Day, that “infamous” day in 1941. (Sixty years later, on 9-11-2001 we were attacked again.)

Opuscula Ripping off Medicare

 

MY MEDICARE INSURANCE company, AvMed just sent me a notice that it paid a doctor $343.00 on a bill of $350.00.

My co-pay was zero.

So why am I complaining?

I WAS IN THE hospital overnight for a "fem-pop bypass" to bypass an aneurysm.

I was admitted Wednesday morning and discharged Thursday evening.

The surgeon chatted with me before the operation (he's cut on me before) and he had me as a "show-n-tell" for some floor nurses and one of his partners the next day.

Today, AvMed informs me it paid another physician $343.00.

I never saw the physician.

Neither my wife nor son, who were with me, saw any physicians other than the surgeon. The Spouse supposes that this doctor's nurse came by to say "Hello," but I don't recall any nurses or nurses' aids that were not identified on the huge white board on the wall.

Again, my co-pay for this invisible doctor's visit was $0 - nada, effis, nothing.

BUT I THINK MEDICARE - FUNDED BY MY TAX DOLLARS - IS GETTING RIPPED OFF; the doctors who bill for visits not made are thieves.

Maybe this phantom physician has to make his payments on a prestigious car; my surgeon drives a leased Jaguar - we chat about cars and other topics between surgeries.

I may not have a co-pay, but in the end, I am - and all tax-payers are - paying for services not rendered. That, plain and simple, is theft.

Maybe $343.00 is a pittance to AvMed, too little in the grand scheme of things to investigate. But consider: if you add up phantom physician visits at one a day times 256 days (52 5-day work weeks) time $350 (the fee billed) the Grand Total is a healthy $91,000 (91 thousand). Granted that's probably peanuts for a lot of doctors and they do have debt - college and medical school aren't inexpensive, even the off-shore schools can be pricy.

Mind, that $91,000 total is for ONE visit to ONE patient for ONE day. Any invisible doctor should be able bill for 8 to 16 "visits" per day. Think about it: $350 times 12 "visits" per day and our phantom physician has billed Medicare or some other insurance company $4,200 - and the doctor may not have set foot in the hospital.

Even if the doctor sends a nurse in his or her stead, the doctor still is raking it in; nurses, as important as they are, don't get the dollars doctors do.

It's fraud, Medicare fraud, and while Medicare,gov preaches "report fraud," I suspect when fraud is reported, the individual fraud - e.g., $350 - is just to picayunish for the government to consider. The Medicare budget for 2014 was $511 billion.

Opuscula Selecting the right Medicare plan for you

 

First things first: FINDING PLANS IN YOUR AREA.

The best source of approved Medicare plans in your geographic area is the Medicare.gov web site: https://www.medicare.gov/

Now, ASKING THE IMPORTANT QUESTIONS

Q1: Do you have a specific physician - primary care or specialists - that you feel you must have?

If YES, then compare only those plans that include that physician.

The easiest way to find out is to call the plan's toll-free number and ask: "Is Dr. (insert name) on the providers' list?"

Lesson learned the hard way Ask if the primary care physician (PCP) is capitated. That means while a doctor you want to see may be on the plan's Provider List (more on that later), the PCP may be limited to only a few of the practitioners on the list; if the doctor you want is not on the particular PCP's list, you cannot be referred to that doctor; referrals are allowed only to those practitioners on the PCP's personal list.

Q2. Do you have any specific medications that have no substitutes?

Check with a PHARMACIST - not a doctor or nurse - about alternatives for the medication you are taking. Pharmacists usually know better than doctors, nurses, pharmacy reps, and your Great Aunt Tillie when it comes to medicines.

If YES, check with the plans you like to assure the plan's FORMULARY (drug list) includes the drug(s) you are taking. Also check the drug's LEVEL (typically 1 through 4; each level being more expensive) and what your co-pay will be for a 30-day and 90-day supply.

The easiest way to find out is to call the plan's toll-free number and ask: "Is drug (insert name) on the formulary?"

Q3. What are hospital in-patient costs? Some plans have $0 co-pays for the first "n" days with $100 or greater co-pays for the next "n" number of days; other plans charge (relatively) high co-pays of $250 or more for the "n" initial days then $0 for the remaining days.

Since I've been on Medicare I have been hospitalized three (3) times (for surgeries). My maximum time-in-hospital was 5 days. My plan has the first five days free (no co-pay); my co-pay bill for all three surgeries combined was $0.00.

The easiest way to find out is to call the plan's toll-free number and ask: "What are the in-patient co-pays?"

SOME providers provide easy access to this information from their Web site. Others force prospective clients to call a toll-free number and hope the information received is accurate. Get hard copy documentation to be safe and sure.

Keep in mind that you and the plan are "stuck" with each other for the full plan year. You normally can change PCPs every month, but you normally cannot change to a different plan.

THE DOCUMENTS

There are three (3) documents you want to see, preferably BEFORE you make a decision:

1. EVIDENCE OF COVERAGE: The evidence of Coverage follows Medicare's list of benefits and adds the plan provider's additional benefits. This is the "bible" of the plan; it is approved by Medicare and cannot be modified during the plan year. It is subject to change ONLY for the coming plan year. (If you sign up for a 2016 plan, it won't be subject to change until 2017.)

2. PROVIDERS' LIST: This is a list of physicians, hospitals, clinics, therapists, etc. that have contracts with the plan. This list IS "subject to change," but for the most part whoever/whatever is on the list when it initially was published remains on the list through the plan year.

3. FORMULARY: This lists all the prescription medications the plan covers. Like the PROVIDERS' LIST, it is "subject to change," but change rarely occurs in mid-year.

NOTE There are several plan types in two plan categories.

The categories are Advantage plans and Supplement plans. Many excellent Advantage plans cost no more than what the Medicare recipient pays already. Medicare Supplement plans typically charge an additional fee. Supplement plans often have no restrictions on providers or locations and may be a better option for travelers. (Some Advantage plans have "worldwide" coverage, but there are conditions.)

The two sub-options are "with drugs" and "sans drugs." There also are "drugs only" (Part D) plans.

What plan is best suited to each individual is determined only by that individual.

Opuscula Visualize Bottom line

 

Medicare Advantage programs - and they all seem similar in this respect - allow customers roughly US$115/year toward corrective lenses, with frames, or contact lenses.

The lenses are "plain vanilla," no polycarbonate, no line-less bifocals, no tints, no, no, no.

Installed in a pair of Chinese frames.

One pair. $115.

Compare this to non-Advantage plan glasses.

In my area, there are at least two chains offering two pair for $69.

Same plain vanilla lenses.

Same made-in-China frames (albeit with a wider selection that I saw at two Advantage-approved vendors).

And a "free" eye exam in thrown in.

Even Sears has a two-for-$75 offer on tv. (Whatever happened to Roebuck?)

I'm curious.

If I can get TWO - count'em, 2 - pair of plain vanilla lenses in made-in-China frames for $69, why do Medicare Advantage providers charge $115 for a pair of glasses AND pay more for an eye exam?

Medicare claims to be on the outlook for fraud.

Medicare claims to be on the outlook for cost savings.

I pay slightly more than $100/month for Medicare. That money is then paid to the Advantage plans.

IN ADDITION to my monthly payment, Medicare pays ADDITIONAL MONEY to the Advantage plan based on several variables, including the Medicare (geezer) population served by the Advantage plan.

Like newspapers that make their money on advertising with rates based on circulation, Advantage plans make their money by head count, not on an individual's monthly payment to Medicare.

Consider the competition for customers in geezer-heavy geographic areas, both in terms of advertising and in rates. In South Florida, the competition is fierce and the rates available to customers ranges from zero additional dollars to whatever the market will bear; elsewhere - in rural Maryland, for example - rates start with an added cost to the covered geezer of from about $50/month to whatever the market will bear.

Why, then, don't the Advantage providers contract with the "discount" companies? There are several that are nationwide, or nearly nationwide. It seems that the Advantage providers could negotiate a discounted price - say $50 in lieu of $69 - and still make their profits, albeit with only a slightly reduced margin. Medicare, likewise, could reduce its payments to the Advantage providers.

This also could apply to Obamacare.

Advantage-contracted optometrists and opticians may take umbrage at the idea that a discount optometrist and optician may be eligible for Advantage dollars. Most discount opticians accept prescriptions from any optometrist, so Advantage-contracted optometrists would face the loss only of their related optician business. (On a personal note, I found an optometrist with whom I think I can have a good, long-term relationship.)

The "bottom line" question is: If a "discount" optician (chain or independent) can offer eye exams and TWO PAIR of glasses, albeit "plan vanilla," for $69, why is Medicare allowing Advantage providers to pay a non-competitive price for simple lenses in Chinese frames?

 

LOW COST OPTICIAN CHAINS

America's Best

Eye Lab

Sears' Optical - offer may be time-limited

Visionworks - offers vary by location

Opuscula Humana Promises, just promises

Ahh, Humana. Can you possibly make my life more frustrating?

It states, clearly in my Member Benefit Package, Page 34, that

Mandatory Supplemental Benefit includes: - $115 annual eyeware^cq benefit for eyeglasses or contact lenses and fittings from the network optical provider OR - One pair of eyeglasses at no cost annually, including ultraviolet protection coating.

Moving back in the same document I find one and a half pages of "Vision Providers." Among these providers is the optician I want to use.

The optician works with the ophthalmologist I initially wanted to use. My then-Primary Care Physician (PCP) told me I had a choice: go to the ophthalmologist with whom he had a "capitated" agreement or find a new PCP. I found a new PCP.

I've been told that "capitated agreements" return more money to the referring practitioner and the patient be damned. Capitated, as defined by Merriam-Webster online is found at the end of this entry.

My initial Humana PCP insisted that Humana demanded that I see an optometrist before I could see an ophthalmologist.

I checked on line and found a Humana-approved optometrist (with whom I was pleased). The OD told me to see an ophthalmologist to determine if a cataract was ready for surgery. If it was not, come back to order new lenses.

It is my personal "Standard Operating Procedure" (SOP) not to have a prescription filled by the same practice that wrote the prescription; helps keep everyone honest. However, in this instance - since Humana was willing to pay $115 toward the package, I decided to return to the practice's optician.

It turns out that the practice's intranet was "down" and the optician was unable to access my prescription. She refused to look at a printout I received when the eye exam was completed, and she refused - despite twice being told about a work-around - to do anything sans the intranet.

No one bothered to try to find out WHY the intranet was down; no one called technical support; everyone was content to wait until the intranet finally came alive. I left before it did, if it did at all that day.

Having made an unnecessarily long trip (gas prices in Florida now average $3.64; about a dime above the national average) three times, I thought to use a Humana-listed provider closer to the manse.

I checked Humana's online provider's list. Sure enough, my preferred provider was listed, top of the list based on the search parameters I entered.

I went down to my nearby optician's office and talked to the Woman In Charge, hereafter The WIC.

I gave The WIC my Humana ID card and she tried - for several minutes - to find that I was covered. (Remember, the provider is on Humana's paper and online lists.)

Nothing, nada, effis. I'm the man who never was.

I went home and re-checked the Humana provider lists.

Then I called Humana Customer Service.

Pay attention, HIPAA

After playing 20 questions with Humana's voice response system I finally got a Customer Service Representative (CSR) to talk to me. First I have to answer - again - questions I already answered early in the call. (I shouldn't complain; it was Humana's dime.)

I explained the situation to the CSR and told him I found my preferred provider on Humana's lists.

Yes, they are on the lists, he agreed, only they are not on any list associated with my coverage.

Sudden thought: I wonder if the CSR was looking at a list associated with my initial Humana PCP. I'll try again tomorrow.

NOW, THE HIPAA CONNECTION. While waiting to the CSR to research the issue I could clearly hear other CSRs' conversations with Humana clients, conversation that, per HIPAA, I should not hear. I mentioned this to the CSR and asked if Humana really did record client calls. He assured me it did and I repeated the information about hearing other clients' calls. (I followed up with an email to Humana that might be read by a low-level clerk before end of year when I will have a new Advantage provider.

In the end, I think I'm going to go to one of the several "two pair for $69" opticians; it will cost me closer to $115 (which Humana budgeted but …) but at least I'll be able to read house numbers again.

I would rather that Humana not promise something it has no intent to deliver. I'll chalk this up to "Lessons Learned."

From http://www.merriam-webster.com/dictionary/capitated cap•i•tat•ed adjective \ˈkap-ə-ˌtāt-əd\ (Medical Dictionary) Medical Definition of CAPITATED : of, relating to, participating in, or being a health-care system in which a medical provider is given a set fee per patient (as by an HMO) regardless of treatment required

Humana Advantage plan Customer DISservice

Why is it that more and more often, "customer service" is more akin to "customer disservice."

I'm a "geezer" - it beats the alternative - and I have Medicare via a Medicare Advantage plan. Financially, it's a really good deal so from a cost perspective I have no complaints.

I had AvMed for for several years and was less or more satisfied with it.

For the 2014 calendar year, AvMed

  (a) cancelled my Primary Care Physician (PCP) and
  (b) raised some of its copays albeit not egregiously.

Why AvMed cancelled my PCP's practice is between AvMed and the practice - although the practice's administration services might be the reason; the medical side was better than good - not so the admin side.

My choice then was

  (a) stay with AvMed and find a new PCP,
  (b) sign up with a different Medicare Advantage provider that had a contract with my PCP's practice, or
  (c) get a new provider and a new PCP.

There was a fourth possibility: sign up with a Medicare Supplement program; that would allow me to go to any practitioner who accepted Medicare, but that was an expensive option.

Bottom line: I checked a number of Advantage plans in my area and, after talking with several providers and checking on-line plan summaries of even more providers, I settled on Humana.

According to Humana's Web site, except for my PCP, it had all my doctors, in practitioners and facilities:

  General surgeon (Dr. Brett Cohen),

  Ophthalmologist (Dr. David Goldberger),

  Vascular surgeon (Dr. Jeffrey Hertz), and

  Hollywood Regional (nee Memorial) Hospital

Even better, the copays were less than AvMed.

So I became a Humana Medicare Advantage - perhaps DISadvantage is more accurate - client.

And then the fun began.

Both AvMed and Humana required referrals; Humana calls them "pre-authorizations." Not a problem.

I went to my new Humana PCP, who shall remain anonymous, and asked for a referral to my vascular surgeon for a one-year anniversary follow-up after an open AAA. It took Humana about a week to permit the referral. Not like the faster turn-around with AvMed, but this is Humana.

My PCP told me that he would not request a referral to my ophthalmologist until I had my eyes checked by an optometrist. That would be reasonable except my ophthalmologist is listed by Humana as a practitioner who does refractions. As a matter of fact, Eye Surgeons & Consultants, Dr. Goldberger's practice, is listed first on the page of people/organizations qualified by Humana to do refractions.

Humana recommends a couple of optical service providers. I took the one nearest me (still much father away than Eye Surgeons & Consultants). The OD who examined (and impressed me) said I needed to see an ophthalmologist about my developing cataracts - one of the reasons I wanted the appointment with Eye Surgeons & Consultants in the first place.

The OD sent his report to the PCP. I stopped by the PCP's office and gave the office staff two pages photocopied from Humana's provider book - unlike AvMed, Humana neither numbers its pages nor provides provider ID with the practitioner's name and address, making it hard to tell someone to "See Page nn" or "The practitioner ID is nnnnn" to aid in identification.

That evening the new PCP called - credit where it is due - and told me Humana gives him a list of practitioners to whom he can refer patients. Dr. Goldberger was not on this PCP's list; sorry, but I cannot be referred to my long-time ophthalmologist.

My options, the PCP told, me were two:

  1. Go to a ophthalmologist on the PCP's list

  2. Find a new PCP

The PCP explained that if I insisted on specific providers, I should either

  a. Contact the specialist and ask which Humana PCPs referred to the practice or

  b. Contact each potential PCP and ask them if they were able to refer to the selected specialists.

In 3 words: NOT MY JOB.

I accessed my Humana account and found "Contact Customer Service." It was a message form. Pretty standard.

I sent Humana my request on Sunday:

"Please tell me which PCPs can refer to the following specialists and facilities."

I know that Humana's customer service probably is closed on the weekend.

Today is Friday, a full week of "business days" and I have yet to hear from Humana's customer service. On Day 4 (Thursday) I snail-mailed a letter to Humana's customer service. Maybe that will generate a response.

Meanwhile, as Humana's approved OD pointed out, my cataracts are getting ripe and, unless an ophthalmologist decides it's time to operate, I need a new Rx for lenses. I can't do anything until Humana responds to my question.

My complaint is not only that Humana has so far failed to provide the information I need, it is more that Humana listed my specialists in its providers list and that greatly influenced my decision to buy the Humana plan. I don't understand why ANY PCP is restricted from referring to ANY practitioner listed in the providers list.

AvMed used to have someone monitoring the WWW for mention of the word "AvMed"; when a complaint or kudos hit the Web, AvMed knew it and acted on it. Hopefully Humana will do likewise.

It's customer service truly is customer DISservice and I am not a happy camper.

Humana, are you listening?

ERM-BC-COOP: AvMed letter raises Customer ire and BP

I have been an AvMed Medicare Advantage customer for several years. Over all, it has been a satisfactory relationship - at least for me.

But this year, 2013, AvMed's communications with its clients has left more than a little to be desired.

For example AvMed sent me two documents in one envelop.

The outer document told me my plan was cancelled.

The inner document solicited my continued patronage with a new plan.

It seems AvMed cancelled one plan and substituted another.

One letter stating "Your plan [Plan ID] has been replaced with [Plan ID]. The only differences between the plans are listed below: " would have sufficed AND avoided confusion.

Remember. This is a Medicare plan, and that means a plan for geezers who (a) know how to read and (b) usually don't make assumptions.

The previous two-letter package pales in comparison to the letter I received yesterday in which I was informed that "Your enrollment in has been cancelled. This means you don't have coverage from AvMed Medicare."

The only date in the missive was the date the letter was printed.

Since AvMed delisted by Primary Care Physician (PCP), I looked at plans that listed my PCP. None of the plans favorably compared to AvMed. But since I already was looking at other vendors' plans, I decided to look at plans that omit my PCP from their list of providers.

I found such a plan and, surprise, it was better economically for me. AvMed was good, but Humana had a more wallet-friendly plan.

By the way, there is no such thing as a "$0 premium" plan. Medicare charges a Part B premium of about $104/month (sometimes less, sometimes more, depending on income). An advertised "$0 premium" plan means there is no additional premium paid to the vendor. On top of the $104 (plus or minus) from Medicare, the U.S. government kicks in much more, which is why there are so many vendors vying for a geezer's business.

OK, I know that on December 31, 2013 AvMed and I will part company, but to get a letter that states that I "don't have coverage" - and given the wording it has to mean I don't have coverage as of the letter's date - causes panic; the blood pressure soars and my normally calm disposition is rattled.

I call AvMed's Customer (dis)Service number and a Sweet Young Thing answers. I give her my name, rank, and serial number and finally she allows me to tell her why I am calling. She pulls up my file and assures me that I am covered through 12/31/13.

So what, young lady is your name if I need to refer back . . .

She gives me her first name and, when pressed, the last initial of her last name.

Not satisfactory. I can anticipate the response if I call back and say that "Miss [CS person's first name and last initial] told me … " I'll likely hear either (a) "We don't have anyone by that name, or (b) "We have a number of people with that name and it's impossible to know which one spoke with you."

I demanded to speak to a supervisor and was told all of her supervisors were busy. (How many supervisors does one person need?) She said she'd send an email to a specific supervisor and that person would get back to me.

A day later the supervisor did call - and explained that AvMed has a 24-hour window to return calls, something the first person failed to mention.

By now I'm thinking like a Risk management practitioner.

How can I give callers a CS person's ID without compromising their privacy?

Bingo: Employee ID. John110 or Judy10.

AvMed, the supervisor tells me, instructs its CS people to give their telephone extension. That may work IF the called notes the day/date and time of the call; I'm reasonably certain the extension is shared during the call-in hours.

Since AvMed and I are quits on the last day of the year, I suppose I shouldn't let this bother me, but it does.

AvMed generally is a good company, but of late it has had a serious problem with communication. I sent letters to two company executives, noting that I do not want a response - I think I've had enough blood pressure-boosting letters to last for awhile.

ERM-BC-COOP: Politics as risk

When I would tell clients that they should – I prefer “must,” but consultants only can suggest – consider “politics” as a risk, for most of the clients I was thinking locally: town councils, planning and zoning boards, streets, public safety. I also was thinking about state-level politics, but “not so much.” With the exception of vendors to the Federal government, Washington was almost an after-thought.

How much impact could the Federal government have on a local, or even interstate, business?

It turns out quite a bit.

Forget about the Federal Aviation Administration (FAA) that can shut down airports and disrupt business travel), or Customs and Border Protection (CBP) that likewise interrupts business travel as well as import and export activities; these agencies must be considered risks for almost every organization that has any over-a-border interest.

Consider the Obama regime. It has shut down much of the government essentially over the Affordable Health Care Act, a.k.a Obamacare, including those agencies that generate revenue. It threatens to shut down most of the remaining services if an yet another hike of the Federal debt ceiling is refused. This follows a sequester of funds and services.

The President of the United States – POTUS – by fiat shut down the Internal Revenue Service (IRS) and the agencies that run Federal parks, monuments, etc.

In southeast Florida, that shut down means that the Everglades National Park and Biscayne National Park are closed. Translation: For tourists, no entry and for the government, no entry fees. For businesses that operated on or into the park, it means they are out of busyness; they cannot get to their business.

Three headlines in the Miami (FL) Herald tell the plight in South Florida communities:

Keys fishing guides protest closure of Everglades National Park A

ISLAMORADA -- Each day at noon, Capt. Matt Bellinger usually does his local radio fishing update from somewhere in the back country of the vast Everglades National Park, where he takes clients to fish for snook and tarpon or photograph birds and other wildlife.

He always ends his updates with his mantra: “Get on the water. And go fish!”

But on Wednesday, sunny with calm seas and a gentle breeze — a perfect day to be out on the water — Bellinger could not take clients to his beloved fishing grounds. Like all 401 national parks, the Everglades National Park was closed by the government shutdown.

Miami’s Biscayne National Park won’t be open to boaters during Columbus Day Weekend

Like the rest of its counterparts around the country, Biscayne National Park is closed because of the federal government shutdown — but not if you want to fish, boat through on your way somewhere else, or seek shelter in a storm.

But the thousands of powerboaters who normally gather in park waters over the upcoming Columbus Day weekend to anchor, raft, play music, dance and drink will not be welcome.

Diving and snorkeling also are prohibited.

Fishing guides want back in Everglades

ISLAMORADA, Fla. -- Frustrated by partial shutdown that has closed Everglades National Park and 400 other national parks across the country, fishing guides in the Florida Keys spearheaded a rally Wednesday hoping to convince federal officials to let them back into park waters.

Although Keys state and offshore waters remain open to anglers, fall is a prime season for visitors to fish in the park's shallow estuaries for prized gamefish, such as snook, tarpon, redfish and trout.

Guides who depend on that for income have lost money and are frustrated with Washington leadership's inability to pass a budget to fully reopen federal resources.

And that’s just the tip of the peninsula. I would provide a map of Federal parks in Florida but “Because of the federal government shutdown, all national parks are closed and National Park Service webpages are not operating. For more information, go to www.doi.gov.” And then we are told to “Experience Your America.”

An aside: the Interior Department’s Web site does provide Information on the Department's preparation of contingency plans for a possible government shutdown in October, 2013.

The DOI’s mandate includes:

• Departmental Contingency Plan
  
• Bureau of Indian Affairs
  
• Bureau of Indian Education
  
• Bureau of Land Management (BLM)
  
• Bureau of Ocean Energy Management
  
• Bureau of Safety and Environmental Enforcement
  
• Bureau of Reclamation
  
• Fish and Wildlife Service
  
• National Park Service
  
• Office of the Inspector General
  
• Office of Insular Affairs
  
• Office of the Secretary
  
• Office of the Solicitor
  
• Office of the Special Trustee
  
• Office of Surface Mining
  
• US Geological Survey

Back in the day when I was an honest newspaper reporter & editor in Nevada, I came to learn how much ranchers, farmers, timbermen, and others depended on access to Federal lands controlled by BLM or the Forest Service, the latter’s Web site announces “Due to the lapse in agency funding, the sale of all types of permits (i.e., recreation, firewood, forest products, mineral materials for example) are suspended, recreation.gov reservations are suspended, and all federally owned recreation sites are closed. All offices are closed. These services will be available once funding is restored.”

Much of the Forest Service’s mandate includes revenue producing activities.

Another aside: I wonder what this means to people who have built year-round homes on Federal lands; will they be able to access them? Will the roads be allowed to deteriorate to the point where nothing less than a tracked vehicle will be able to travel on them sans serious damage?

Looking into the future and assuming the Affordable Care Act, apparently the major bone of contention between Republicans and the President - is sustained, what will happen to those insured under the Act if something like this political flap happens again? For that matter, on a personal level, what will happen to seniors who contract with Medicare vendors paid from Social Security funds? (The vendors get substantially more than the Part B $102/month per insured.) If Social Security shuts its wallet – the threat if the debt ceiling is not raised – and will the vendors continue to pay for the senior’s care; will the vendors be able to pay for their client’s care?

While many businesses are not directly impacted by the current and promised threats, many will indirectly feel the impact. (Consider education, veterans - already penalized. The list goes on and on.)

Bottom line: When thinking about “government as a risk” (and it truly IS a risk) practitioners must look beyond local and state governments and consider the Federal government as well.

 

If I wrote it, you may quote it