Do Enhanced Medicare Programs Make Sense?

Dr. E, guest blogger

Medicare advantage I have an elderly relative in a nursing home.  She has Medicare, of course, and secondary health insurance provided by the state she lives in, a state with excellent health care coverage.

I recently got a phonecall from a social worker at the nursing home.  She told me that they had a few openings for residents to join, at no cost, an Enhanced Medicare Program available to nursing home residents and wondered if I'd like to sign my relative up.  "What are the pros and cons?" I asked.

The social worker seemed stunned.  Since she presents the option as a gift your relative has been chosen to receive, she is used to most people saying "thank you" and signing right up.    She was hard pressed to answer my question as well as others I asked.  She finally gave me the local and national information phone numbers for the Enhanced Medicare Program she was promoting.

What I learned from making those calls is that Enhanced Medicare Programs for nursing home residents are run by several different private insurance companies, who have persuaded the Federal government, with questionable and self-serving studies, that these programs reduce patient hospitalizations and thus reduce Medicare costs.  From what I've learned and seen, however, nothing could be further from the truth.  That insurance lobby in Washington must be way more powerful than we've been told!

 I was told that the way these enhanced plans work for nursing home residents is that Medicare pays a significant monthly fee to these companies.  In return, the only added benefit for my relative is that an outside nurse practitioner would visit my relative just once a month.  We do not know how long the nurse's visit is or what the qualifications of the nurse practitioner are.  And, I wondered, do the nursing homes get a fee for every resident they sign up?  The social worker seemed more like a saleswoman for the program than an informed patient advocate. 

But here is the main question:  since licensed nursing homes have nurses round the clock and aides who see residents 24/7, and since these nursing homes also have doctors who make periodic visits and are available for phone consultations 24/7, and since Medicare and secondary insurance pay for everything else, how can this brief, just once a month visit, which costs Medicare a great deal of money, end up saving Medicare anything?  

I did my part to reduce questionable Medicare costs incurred by insurance companies in this country: I declined enrollment in the plan for my relative. 

The bottom line is that there's no substitute for your being totally involved with your relative's health and care in a nursing home.  Call the relative daily, if possible; stay in  constant communication with the nursing home staff/doctors; and and make unannounced visits as often as possible.

I'm Dr. E., Ph.D.   For more information, click on the following resources: 

Medicare Meets Mephistopheles

Healthcare Fraud:Auditing and Detection Guide 

Medicare and Medicaid Fraud and Abuse,2009 ed. 

The Political Life of Medicare  

Reforming Medicare:Options,Tradeoffs and Opportunities

My Opinion of the Proposed Health Care Reform

Health care I, and many other doctors I know, breathed a sigh of relief when Speaker Pelosi announced that the Health Care bill passed in the Senate would not be approved by the House.  At least for now, the Health Care bill seems dead, in spite of  President Obama's remarks to the contrary after the recent election of a Republican Senator in Massachusetts.

As an immigrant physician who chose America based on the knowledge and perceptions I acquired while visiting the United States, I shivered at the thought that an enormous bureaucracy would make decisions that should be made between a doctor and a patient.  In addition, having some experience with state bureaucracy in a former communist country of my origin, I know how stifling and inefficient such a bureaucracy can be.

It was not uncommon for people to circumvent the bureaucracy by offering bribes in return for quality medical care, while physicians were forced to accept these bribes in order to support their families because the state paid them so poorly.

In my opinion, when bureaucrats run the system, individual talent and initiative suffer.  Everything is reduced to its lowest common denominator and all share equally in poor care.  Yet somehow highly positioned bureaucrats, politicians and the privileged always find ways to exploit the system while the average person is left with no recourse but to accept the state's largess.

I'm Dr. Blokar.  For more information, click on the following resources:

The Healing of America:A Global Quest for Better, Cheaper, and Fairer Health Care

Health Care Will Not Reform Itself:A User's Guide to Refocusing and Reforming American Health Care 

Cured! The Insider's Handbook for Health Care Reform 

The Truth About Health Care:Why Reform Is Not Working in America 

A Second Opinion:Rescuing America's Health Care  

Casey Johnson and Juvenile Diabetes

Casey johnson dies Casey Johnson, heir to the Johnson & Johnson fortune, died recently at the age of 30.  Now, snippets of her life that we are hearing about and seeing reveal that like many other children of the rich and famous, her life was a shipwreck.  Someone should do a study on why people who have so much going for them, so much of what all the rest of us want, either get into trouble and end up having to throw it all away, or die young without ever really enjoying what they had.

Casey Johnson, though, had something else besides wealth and privilege.  As a very young girl she was diagnosed with juvenile diabetes, an incurable disease that takes constant management.  Imagine her having to go through daily finger prickings in order to monitor her blood sugar level.  And imagine having to think about everything you eat in order to keep your blood sugar numbers at an acceptable level.  And think about having to restrict physical activity because overexertion can reduce one's blood sugar numbers to dangerously low levels.  And, of course, there are the daily injections of insulin to control symptoms.

Some of those symptoms, like fainting or becoming incoherent, can result in emergency trips to the hospital, often being witnessed by peers which can be embarrassing.  The growing up process unfolds in a field full of potential land mines.  Puberty is a particularly disruptive and challenging time for kids with diabetes.  The struggle between childhood and emerging adulthood, when the young person wants to assert him/herself, break away from family and shift one's loyalty to one's peers, can be particularly difficult because the chronic illness requires ongoing adult supervision.  In addition, being different and sick can be embarrassing.  Many young diabetics rebel against their illness by challenging it with careless abandon, resulting in more hospitalizations and more embarrassment. 

No doubt, Casey Johnson's diabetes, as well as her wealth and name, shaped her personality.  And there is some sad irony, and maybe subliminal anger in Casey, that the company that gave her such wealth by creating medications to treat so many illnesses never created one that could cure her diabetes. 

But at age 30, when asked what her biggest regret was, Casey Johnson did not say "having diabetes."  She said it was not doing the reality television show with her friend  Paris Hilton. 

I'm Dr. Blokar.  For more information, click on the following resources:

Type 1 Diabetes for Dummies

The Everything Parent's Guide to Children with Juvenile Diabetes

Type 1 Diabetes:A Guide for Children, Adolescents,Young Adults--and Their Caregivers, Third Edition 

Taking Diabetes to School 

487 Really Cool Tips for Kids with Diabetes  

Avoiding Mistakes with Prescription Medications

Prescription pills We have all heard of mistakes made with prescription medications, even in hospitals.  Some prescriptions sound and are spelled so similarly that it is easy to see how mistakes happen.  But even though drugs may have similar spellings and sound alike, they are often used for very different purposes which makes these mistakes dangerous, sometimes even fatal.

A friend ordered a six-month supply of her antidepressant from a Canadian pharmacy, where she saved money.  About a month later she realized that something was not right.  She felt anxious, "blue," and easily frustrated with a short fuse.  When she looked again at the supply she had received from Canada, she discovered that she was not taking her antidepresssant at all but a medicine used for stomach/digestive problems. At a glance, the medicine started with the same first three letters as her antidepressant and contained the same 20 mgs dosage, but it was a very different medication used for very different illnesses.  While in this case there was no immediate or long term danger, the consequences of prescription mix-ups can be fatal.

There are many sources of medications abroad that are less expensive (but not regulated or under the supervision of a known and trusted pharmacist), and the potential  for  mistakes is enormous.  But even at your own neighborhood pharmacy, you must take responsibility for being informed about what  medications you take, in what dosages, and what they are for. 

Human error is always possible everywhere. For your own protection, always check that no mistake has been made on your order. 

I'm Dr. Blokar.  For more information, click on the following resources:

Medication Use:A Systems Approach to Reducing Errors

Medication Errors 

Medication Errors Guidebook 

Medication Errors:Lessons for Education and Healthcare  

Can a House Be Too Insulated?

Radon Recently President Obama encouraged people to insulate their homes under the "Cash for Caulkers" program.  He said making your home more energy efficient by insulating is "sexy."  But is it healthful? There are some who believe that old homes are much healthier because they are not well-insulated and are built with natural materials which are porous, so they allow air to enter and leave freely.  

It is estimated that one out of every 15 homes has too high a level of radon gas (a naturally occurring gas without taste or smell) especially in confined, low lying areas.  Radon, which comes into a home from the surrounding ground and rock, may be responsible every year for 20,000 deaths from lung cancer, and children may be more sensitive and vulnerable to the damaging effects of radon.   Radon easily penetrates many common building materials and most insulation, and while low ventilation does not cause radon gas, it does enable a greater concentration of radon gas once it's in the home.   Increasing the amount of fresh air that gets into a home can dilute radon and other contaminants. 

If it is true that some people get sick from breathing the air in airplanes, it may be because they are in such close contact with others and without fresh air and good ventilation, and some argue that's what a too well-insulated house may be like.  But, do your research, become well-informed and then decide whether going in and out of your home and the opening and closing of doors lets in enough fresh air to make it "sexy" for you to insulate your home and save energy and money.

I'm Dr. Blokar.  For more information, click on the following resources:

Harmonious Environment:Beautify,Detoxify and Energize Your Life,Your Home and Your Planet

Building Today's Green Home:Practical,Cost-Effective and Ec0-Responsible Home Building 

Green From the Ground Up:Sustainable,Healthy,and Energy-Efficient Home Construction 

Home Enlightenment:Create a Nurturing,Healthy and Toxin-Free Home 

Health and the Modern Home 

The Healthy Home:An Attic-To-Basement Guide to Toxic-Free Living 

The Mom's Guide to Growing Your Family Green:Saving the Earth Begins at Home  

What Causes The Holiday Blues and Can They Be Avoided?

Satisfied%20guests  In Western countries, the suicide rate is highest during this holiday season.  The reasons for this are many and complex.  The expectation of the season, which has lost a good part of its spiritual and religious meanings, is to have a jolly good time, but good times do not necessarily follow a predetermined time frame; they come and go regardless of our expectations.  And all the merry making around us when we feel blue just makes us feel worse.

The holiday season practically forces us to take note of our achievements and failures, including last year's resolutions which mostly went unfulfilled, just like the resolutions of the year before that.  It is hard to face the fact that we were not able to live up to the promises we made to ourselves and to others.

This is also the season of voracious consumerism. No matter how much we buy, instead of feeling fulfilled we feel emptiness and a growing longing for more things.  We may even feel sadness that we can't afford what we want and jealousy of those who have and can afford more.

In addition, the pressure of gift giving can add to our holiday sadness.  Some of us feel we must give the perfect gift, sometimes within a strict budget.  And even if cost is not a factor, it is hard to come up with that special meaningful present for everyone who needs to be gifted.

Going home for the holidays is suppossed to be joyful, warm, fulfilling and serene.  In too many families, though, the modus operandi is anything but.  One tends to regress in emotionally charged situations, so many of us respond as we did as children when parents and relatives push certain buttons.   But you are an adult now, and this is your life, so take possession of it and be proud.

Learn not to apologize or feel ashamed for your failures.  And don't feel you have to perform spectacularly.  Your best approach is to dare to be yourself.   Be tolerant of others for they, too, have their own struggles.

The expectations we put on ourselves, our families and our close friends this season are so high and the pressure is so great that it ultimately proves to be too much to bear.  A cetain amount of letdown is unavoidable.  Family gatherings, however, are not the place for dramatic and forced resolutions of the family dynamics.  Individual and group therapy, if warranted, is a much better place for venting your regrets and casting the blame.  The ensuing results are beneficial and lasting.

I'm Dr. Blokar.  For more information, click on the following resources: 

The Family Gathering Survival Plan

Happy Holidays:How to Beat the Holiday Blues 

Holiday Blues Rediscovering the Art of Celebration 

No More Holiday Blues:Uplifting Advice for Recapturing the True Spirit of Christmas, Hanukkah, and the New Year  

The Symbolism of Hair

Bald_woman_free  At an event I recently attended, I met an actress who in her speech related how hard it was to pursue her dreams.  Although she had extraordinary talent and great looks, there were so many obstacles in her way, including auditions with inevitable rejections and more auditions with rejections, that it all became too taxing.  Exhausted and disheartened, she was going to abandon her extraordinary gift, her calling.  She found herself fantasizing about leaving it all, becoming a waitress and shaving her head, though she doesn't know what the shaving of her head was all about.

So what does fantasizing about shaving one's head mean?  Hair, after all, symbolizes power, potency and sexuality.  When in the Bible Samson's hair was cut, he lost his power.  When a newly ordained nun shaves her head, she is giving away her power as a woman in order to submit her life and her will to serving God.  In some Hassidic sects the young bride shaves her head on her wedding night, giving away her allure and personal power in order to submit to the marital union.

 Although the actress's fantasy provided needed relief from daily hardship and uncertain results, it was not without sorrow.  Shaving her head symbolized giving away her most extraordinary and powerful asset, her very special gift, in exchange for a seemingly easy and simple life.

Fortunately for her and for us, she persevered.  Today she is at the zenith of her professional life, enjoying her success fully with no regrets for living an exceptional life.

I'm Dr. Blokar.  For more information, click on the following resources:

Hair:Surviving the Fall

The Sabian Symbols & Astrological Analyses:The Original Symbols Fully Revealed  

The Roots of Desire:The Myth,Meaning,and Sexual Power of Red Hair 

Hair:Its Power and Meaning in Asian Cultures  

Women's Health Issues

50531595  For a long time women's health issues were inadequately addressed because of a lack of appreciation for the biological differences between men and women.  Women's heart disease, for instance, was not taken seriously because women rarely had heart problems in their 40's or 50's.  In those age groups, women are protected by the estrogen they produce, but after menopause, they lose their estrogen protection and become as susceptible to heart disease as men.  In fact, heart disease is the leading killer of women over 50.

Women's health care seems to be under attack again.  We have now been advised not to examine our breasts, hard to believe, and not to get routine mammograms until age 50.  These recommendations were made on the basis of statistics and cost effectiveness, with, in my opinion, cutting costs being the primary consideration.

Many self examinations do lead to discoveries of irregularities which require many follow up procedures such as mammograms, sonograms, MRI's and biopsies.  In a great majority of cases, the irregularities are benign but require close follow up the next year, meaning more tests and doctor visits.  In short, there are more medical costs.

What I hear, then, is that it is better not to self exam because most of what we find is not cancerous.  But Carly Fiorina, formerly head of Hewlett-Packard in California,  is a 55-year-old woman who had a normal mammogram, only to to find a breast lump a few days later during a self exam. After mammograms, sonograms and biopsies, she learned that she, indeed, was harboring a viciously aggressive, malignant breast tumor.

If Carly Fiorina had followed the new guidelines, she would be dead, and hers is not the only case.

I'm Dr. Blokar.  For more information, click on the following resources:

Women's Health for Life

Contemporary Women's Health:Issues for Today and the Future 

Dr. Nieca Goldberg's Complete Guide to Women's Health 

Women's Health:Your Body,Your Hormones, Your Choices 

Womens' Bodies,Women's Wisdom:Creating Physical and Emotional Healing 

Women's Health:A Primary and Clinical Guide   

Do Katie Couric, Meredith Vieira and Natalie Morales Have to Be Blondes?

Dr.E (Ph.D.) Speaks Out: Guest Blogger


Just before Katie Couric left her position as cohost of "The Today Show," she let her short brunette hair grow longer and gradually get lighter.  She was a blonde when she started anchoring the CBS Evening News.

Then, soon after Meredith Vieira took over Katie Couric's spot on NBC's "The Today Show," I watched her hair color get lighter and lighter.  It ended up being a pretty color and a good bleach job, but her brunette hair was a pretty color without a bleach job.  Now, I'm talking about only hair color, not hair quality or hair styles.

Some time ago,  I watched another NBC "Today Show" anchor's hair getting lighter and lighter.  Natalie Morales, like Meredith Vieira and Katie Couric, had a beautiful brunette hair color. 

One day while having my gray hair colored, I was chatting with my colorist Kathy and mentioned how disturbing it was to see Natalie Morales gradually lightening her hair.  "I'm her colorist," Kathy replied.

Although I was embarrassed, I stood my ground.  I said I couldn't understand why someone as attractive as Natalie Morales, with such beautiful brunette tresses, would want to bleach her hair lighter and lighter.  Kathy  said something about the cameras and studio lighting "liking" blonde hair.

You know what I think, though?  I think it's the male bosses who like blondes!  And in the competitive business of tv news, these women know they have to compete with other blondes and they know how important it is for them to please the male bosses!

Funny thing is, those men and these women seem to have forgotten that Katie Couric was never more popular and never had higher ratings than when she was a brunette!

I'm Dr. E., Guest Blogger.

For more on this topic, click on the following:

News, Gender and Power

Seen and Heard:The Women of Television News 

Blonde Like Me:The Roots of the Blonde Myth in Our Culture 

Do Gentlemen Really Prefer Blondes?  

What Was David Letterman Thinking!

Talk show host, David Letterman, a high-profile person, after being threatened with blackmail admitted to having numerous sexual liaisons with women who work for him.  Whether he was legally married at the time we do not know, but he was certainly in a long-term relationship with the woman to whom he is now married and with whom he has a 6-year-old son.

One would think that men, especially successful ones, would be more diligent about controlling their libido, but men's appetite for exciting, new, extramarital sex will not abate.  When Bill Clinton was asked why he got involved with Monica Lewinsky, he stated simply, "Because I could."  His and Letterman's success and power, and that of men like them, attract ambitious women who can bask in the men's power, can be wined and dined, mentored and promoted.

Young, single women and powerful married men usually deserve one another.  Problems arise when one of them feels she/he didn't get what they bargained for, and the games involving body and greed may lead to a broken heart or wounded pride.

Then things can turn ugly -- going public, blackmail, extortion, or even violence.  And do not forget potential problems at home -- a vengeful spouse, depressed children, an expensive/acrimonious  divorce, and loss of job, property and finances.   Overall, a nasty disruption in life's routine -- from easy coasting along in the pleasant waters of privilege and indiscretions to catastrophe.

This may be the price one pays for playing with fire.  Was it worth it for Letterman and other men like him?  

I'm Dr. Blokar.  For more on this, click on the following resources:

Intimacy:An International Survey of the Sex Lives of People at Work

9-5 Sex, Lust,Lives Destroyed:What Happens When Sex Blossoms in the Workplace 

Dirty Little Secrets:Sex and the Workplace 

Sex and Business:Ethics of Sexuality in Business and the Workplace 

Sex at Work:Attraction,Harassment,Flirtation and Discrimination