THE "UNDER ONE-TRILLION DOLLARS" HEALTHCARE DECEPTION:

AT WHAT REAL COST WAS THE NEW HEALTHCARE BILL RAMMED THROUGH CONGRESS?

For whatever reason ascribable to the mystical realm of Obamanomics, keeping the GAO (Government Accounting Office) projection of the cost of the Healthcare Bill to less than one-trillion dollars was key to passage of the bill. So what was omitted from the Bill, perhaps to be legislated and paid for in later legislation?

For one thing the Bill included no permanent nor temporary fix to adjust the Medicare-participating-physician reimbursement rates from the scheduled 21% decrease. This, in addition to other cuts in Medicare reimbursements to Medicare Providers, is causing physicians, clinics, and hospitals around the country to refuse new Medicare patients and even to cease caring for existing Medicare patients. It should be remembered that in a stunning 'tour de force' in July of 2008 the Democratic Party thumbed it's nose at President George Bush by calling on Senator Kennedy to rise from his death bed (soon to be dead of brain cancer) to come to Washington, DC to cast the key veto-defying vote for the legislation that eliminated the PFFS Advantage Plan and restored -- temporarily -- the 21% fix in physician reimbursements. That 21% physician reimbursement fix, so 'important' in 2008, was deliberately and cynically omitted from the recently passed Healthcare Bill and is before Congress now as a separate funding initiative mixed in with other funding initiatives such as jobs initiatives. And the PFFS Advantage Plan is still scheduled for termination 01/01/2011 (note: see prior post this Blog).

As if this obvious sin of legislative omission was not enough, the oppressive Medicare cuts to Medicare Advantage Plans may sooner or later challenge the affordability of the voluntary inclusion in these Plans of the profoundly important MOOP (Maximum Out Of Pocket) protection that distinguishes these Plans from Traditional Medicare, as Traditional Medicare does not include MOOP protection. For those Medicare Beneficiaries living on fixed incomes including those, who may be comfortable, but, who cannot afford a Medicare Supplement Plan, the Medicare Advantage Plan currently provides financial protection from loss of house and home due to medically caused financial crises. Now there is a cloud over this value added Benefit to those on Medicare, who choose the Medicare Advantage Plan as their Medicare choice. The irony here is that the new Healthcare Bill requires non-Medicare insurance for non-Medicare health plans to provide MOOP protection. (If you are among those fortunate enough to now have health coverage through work or private insurance, you may look forward to some dazzling health insurance premium increases to cover such universal initiatives as MOOP protection. Incidentally, this Blog is favors such benefits as MOOP protection, elimination of waiting periods, and amelioration of policy cancellations; that said, this Blog is disgusted with the hypocritical, demonizing, demagogic, and divisive politics that characterize not only the national healthcare debate, but, national politics in general.)

These above are only two of the profound ways that the new Healthcare Bill targets our senior citizens, causing seniors a deprivation of Providers and a loss of financial protections, among others. If the current Bill is stuck to, these real cuts to Medicare will remain permanent. If these and other problems in the Healthcare Bill are dealt with to shore up such sinful omissions, then there is no way the Healthcare Bill will sustain itself at the "less than one-trillion dollar" ceiling.

WHY WERE "POS" (POINT OF SERVICE) PLANS MISNOMERED AS "PFFS" PLANS, AND DID THIS FAULTY NOMENCLATURE CONTRIBUTE TO CONGRESSIONAL LEGISLATION TO ...

... TERMINATE THIS TYPE OF PLAN FROM THE PORTFOLIO OF MEDICARE ADVANTAGE PLANS?

Presumably, it is either CMS or the legislation creating Medicare Advantage Plans or both, which can be held accountable for the misnomering of what should have been called a POS (Point Of Service) Plan as a PFFS (Private Fee For Service) Plan. What cannot be denied is that the Congress, since 2006, has undermined the Medicare Advantage Plan industry, and that in the summer of 2008 struck a severe blow against the industry by scheduling the termination of PFFS plans effective at the close of 2010.

In the health insurance industry there are three now traditional models: POS, PPO, and HMO. For reasons that remain mysterious to this writer, CMS [presumably] chose not to use the standard health insurance terminology and misnomered the POS type plan as a PFFS plan. As Bill Shakespeare said (that famous thespian, author of poetry and plays, who died in 1616 AD - not the tennis player), "What's in a name? A rose by any other name would smell as sweet!" Thus spoke Juliet of "Romeo and Juliet" - and we know exactly what happened soon after these words were spoken!

There's much in a name, as evidenced by the role in the current healthcare debate that is displayed by criticism of the PFFS (Private Fee For Service) model of payment to medical providers as responsible for a great deal of the outlandish cost of medical care. Whether or not this is a true does not matter to this article, except to the extent that there may be negative spill-over and a poisoning of attitudes towards Medicare PFFS plans based solely and inappropriately on the faulty nomenclature. In point of fact our entire American system of health care payments is based on the PFFS reimbursement system and all Health Insurance Plans including all Medicare Advantage Plans are in one way or another paid according to the PFFS medical reimbursement mode.

Are you confused? Remember, the PFFS reimbursement model to health providers is NOT synonymous with the misnomered "PFFS Medicare Advantage Plan". One has to wonder, how such a blunder of nomenclature could occur and be institutionalized by CMS [or was it Congress?], the regulatory body responsible for that industry. Then again, CMS is the same body that is responsible for a seemingly harmless, but, profoundly faulty TV advertisement by the Government, misinforming the Medicare Beneficiary that Medicare Prescription Drug Plans could be reviewed and even switched during "Open Enrollment"; in point of fact, while this is true during the AEP (Annual Enrollment Period occurring November 15 - December 31), this is not true during the OEP (Open Enrollment Period occurring January 1 - March 31). So, having misinformed the public, will CMS (Centers for Medicare and Medicaid Services) [why not "CMMS'?] grant an SEP (Special Enrollment Period) to last the entire OEP this 2010 to allow Medicare Prescription Drug Plans to be switched per it's own word, however mistakenly advertised?

Anyhooooooo... returning to the subject of this article.... It should be clear that a Point Of Service Plan should be called a Point of Service Plan, not a PFFS plan. Properly labeled in the first place, perhaps they would not be facing extinction at the end of 2010. Perhaps as well there is a clue here as to how such a Plan can be given new life as a "POS - Network Plan". [This will be the focus of my next article.]

SENATE COMPROMISE GOES TOO FAR IN IT'S STATUTORY REGULATION THAT MEDICARE PHYSICIANS MAY NOT REFER MEDICARE BENEFICIARIES TO MEDICAL FACILITIES...

... IN WHICH THE PHYSICIANS THEMSELVES HAVE FINANCIAL INTERESTS.

Such a regulation can only interfere with and limit care options available to Medicare Beneficiaries, and does so based on a paranoid, pernicious, cynical perspective that physicians are entirely self-interested, don't care about their patients, deliberately abuse their patients financially, may abuse their patients mentally and physically, and deliberately abuse the Medicare System.

If anything, it is the Medicare System that abuses physicians; it's pro-rated pay rates to physicians are excessively low. It must be remembered that physicians participate voluntarily in the Medicare Program. Reimbursement rates are so low that without question the majority of physicians participate, because they care and only because they care! There are always a few fraudsters, whose practices make national headlines and disgrace the medical profession. This is true in every profession -- even in politics....

The Senate should drop this pernicious statutory regulation before the Tuesday morning vote. The Supreme Court should draft a voluntary advisement to the Senate today to this effect, stating that inevitably such a statute will find it's way before the Supreme Court, where it will inevitably be found unconstitutional.

THE OPERA AIN'T OVER 'TIL THE FAT LADY SINGS....

SENATORS JOSEPH LIEBERMAN (CT) AND OLYMPIA SNOW (ME) TOOK THE "HEAT" for Senator Harry Reid (NV), the Senate Majority Leader, with respect to scuttling the extension of the Medicare Buy-In to age 55. This may be a wise decision in the moment. Senator Lieberman stated that while he favored the idea of the Medicare Buy-In in principle, the current Medicare system is not set up to handle such a large influx of new Beneficiaries, especially when cutbacks in Medicare Budget expansion are written into the current Healthcare Reform Bill. There is indeed merit in this statement.

The opinion already expressed in this Blog is that the extension of Medicare to age 55 would be an excellent thing. For this to be done rightly, several things would have to be assured: (1a) the Medicare Budget would have to be increased significantly, (1b) the Medicare Part-B Premiums collected would have to be put in a "lock box" so that those funds remain available strictly to Medicare and are not used elsewhere in the Federal Budget, and (1c) funds already "stolen" from Medicare and Social Security for use by the Federal Government for other purposes would have to be returned; (2) Medicare Providers (physicians, hospitals, etc.) would have to experience a significant increase in remuneration from Medicare to compensate for the already low reimbursement rate and to compensate for the loss of income that would inevitably result from many Baby Boomers relinquishing high-premium private insurance in favor of Medicare.

At 1am this morning the Senate Democrats succeeded in obtaining 60 votes (58 Democrats and 2 Independents) to end debate on the Healthcaare Reform Compromise Plan (in which Medicare extension to age 55 is excluded). There are good and bad things in the Bill, it will be voted up or down Tuesday morning at 7am (will the Fat Lady appear?), and then assuming the Bill passes, it yet must go back to the House for confirmation. The House has many Fat Lady's and no shortage of Rats and Snakes....

Highlighting the good things in the Bill are: (1) mandatory national participation in either private or semi-private or public insurance programs, which will reduce the catastrophic costs of medical care born by the government by those refusing to obtain insurance, who yet take advantage of Federal Law requiring hospitals to treat everyone; (2) elimination of coverage exclusions such as pre-existing conditions and waiting periods [it remains a mystery that the private sector hasn't already done this long ago by offering Riders to provide such coverage]; (3) federally compensating the private sector and/or extending Medicaid so that poorer Americans may afford insurance.

JUST AN IDEA.... WHAT MIGHT MEDICARE AND GUANTANAMO HAVE IN COMMON?

TODAY THE NEW YORK TIMES REPORTED...

THAT: THE SENATE IS SCUTTLING THE IDEA OF EXTENDING MEDICARE COVERAGE TO AGE 55;

THAT: A PRISON FACILITY IN THE STATE OF ILLINOIS IS UNDER CONSIDERATION FOR THE RELOCATION OF WAR PRISONERS FROM GUANTANAMO TO THE AMERICAN MAINLAND.

JUST AN IDEA.... AFTER THE TRANSFER OF THE WAR PRISONERS FROM GITMO TO THE AMERICAN HOMELAND, WHY NOT TRANSPORT OUR CONGRESS FROM THE AMERICAN HOMELAND TO GITMO?

HAPPY HOLIDAY HEALTHCARE ADDENDUM

SCRATCH THE MEDICARE EXTENSION TO AGE 55?

The New York Times reported today that Senator Harry Reid of Nevada, Democratic Senate Majority Leader, has announced the scuttling of the idea to extend Medicare coverage to some Americans aged 55-64. May there be a special place in hell for those, who are scuttling this good idea!

So far Congress has written off $60-billion in bail-out money to prop up banking and investment and insurance firms, as well as automobile manufacturers. Result? The cost of automobiles has doubled, so those most needing automobiles cannot afford to buy them, whether new or used; so, the automobile industry is again flat.... And, we have no positive healthcare reform!

That $60-billion alone could have significantly financed healthcare reform. May we remember as well that the crisis in Medicare and Social Security funding began years ago with the inappropriate use of Social Security funds by Congress for purposes other than Social Security?

In the previous post to which this post is an addendum I exclaimed, "DO THE MATH!" So, here is a good idea -- extension of Medicare to age 55 -- being scrapped and thus compounding a bad idea (cutting Medicare by 25%)....

"Let them eat cake...."

HAPPY HOLIDAY HEALTHCARE?

Much is being kicked around in the media and on Capitol Hill with respect to "healthcare reform". Mostly, it is our stomachs that are being kicked around, like footballs! By the way have you ever noticed that there is only a one-letter difference between the words "Capitol" and "Capital"? I find myself wondering, whether or not the 'de facto' Capital of the country is Las Vegas, home of Senator Harry Reid....

As it stands Congress has passed it's version of "healthcare reform" and the Senate is working on it's own version, which at the moment APPEARS to include (a) elimination of the typical one-year waiting period for coverage, (b) extension of Medicare to some Americans to age fifty-five, and (c) a 25% chop to Medicare. DO THE MATH! It's going to take some serious magic to make this work positively for healthcare delivery. I am reminded of the infamous words of Marie Antoinette, when France was starving under Louis XVI, lacking even bread: "Let them eat cake!"

Let's hope there is no "reform" prior to these holidays; such a gift the nation does not need. There are sound ideas and ways to finance them; springtime is soon enough for a first sprouting of truly good ideas!

pretty words, ugly words: Obama on Healthcare... but, where's the math?

Much of what could be said in this post was already said in the preceding post of December 2008. In fact it was Obama's speech in December 2008 that motivated my December posting, just as it was Obama's newest speechmaking on the subject of healthcare, reported all over the news this Tuesday, that motivated me to this current posting. What is uncanny is that it may has well have been the same speech, as it is the very same wrong ideas that President Obama puts forth as meaningful fact. Would someone righteous, whose mouth has access to his ears, please, speak to him and alert him to Medicare reality, before he adds even more insult to congressional injury, hell bent towards destroying the Medicare Advantage Plan?

Let's start with a little mathematics:

(Case 1) Suppose Medicare Advantage Plans provide approximately the same coverage as Traditional Medicare at approximately the same cost; then, why not allow the Beneficiary the choice? After all, there would be no net financial loss or gain.

(Case 2) Suppose Medicare Advantage Plans provide approximately the same coverage as Traditional Medicare at a somewhat higher cost, say 10-20% (this is generally said to be true); then, is that savings of 10-20%, allegedly to be recouped by eliminating Advantage Plans, even close to being enough money's to provide universal healthcare? Clearly not! And it must be pointed out that, if the Advantage Plans were more proactively and more cooperatively marketed by the private and public sectors together and in harmony, then economies of scale would likely bring the Medicare Advantage Plan to an economical comparison to Traditional Medicare. (This of course pre-supposes that present accounting is nor overly skewed in one direction or the other to reflect bias pro or con the Advantage Plan.)

(Case 3) Suppose current accounting ignores the profound benefit of MOOP coverage to the Advantage Plan Beneficiary, that has no equal counterpart in the Traditional Medicare coverage? It is true that at additional cost the Traditional Medicare Beneficiary can purchase a Medicare Supplement Policy from private industry -- if he or she can afford the premium payments and not lapse the coverage. But, just comparing Medicare Advantage Plan Beneficiary to Traditional Medicare Beneficiary absent the Med-Sup Policy, the Traditional Medicare Beneficiary is at far greater risk to lose home and bank account as a result of catastrophic medical expense. Given the spate of foreclosures in the past decade, there must be a significant percentage of those overall statistics, that belong to Medicare Beneficiaries suffering medically caused financial crises -- unnecessary, had they only been advised to enroll in a Medicare Advantage Plan. Now, extend that idea across the nation, keeping in mind that universal health care coverage could include MOOP coverage for everyone, protecting homes and bank accounts everywhere!

It is an utter illusion to think that gutting the Medicare Advantage Plan will do anything to improve national health care or to reduce the overall expense of health care, if at all; and the effect of gutting the Medicare Advantage Plan is likely to have the opposite effect by destroying the working model that actually could provide the nation with a universal health care Plan that integrates the private and public sectors, achieves great economies of scale, and separates ordinary medical care finance from the workplace, potentially unsticking the economy from the enslavement of employer and employee to health care insurance bondage. After all, isn't it true that most people work at jobs they hate, living "someone else's life", sick of their jobs, and sick from their jobs -- all in order to be able to count on having healthcare coverage from their job? "My job makes me sick; but, I need the health care coverage...."

president-elect barak obama disparages medicare advantage plans and the insurance companies contracted by the government to manage these plans ...

During his press conference on health care this morning a severely mis-informed President-elect Barak Obama took issue with the Medicare Advantage Plan Program and the insurance industry, blaming both for high expense and little if any improvement on health care delivery for Medicare Beneficiaries. This is unfortunate, because there is much that can be adapted from the Medicare Advantage Plan Program towards solving some of the medical and economic problems that face our country.

Economics and healthcare do hold hands with each other, and there is one Benefit now available to all Medicare Beneficiaries, who choose Medicare Advantage Plans, that was previously available only to those Medicare Beneficiaries, who could afford to purchase a Medicare Supplement Plan, or who had earned a similar type Retirement Plan. In earlier postings to this Blog attention has been drawn to the "OOP" -- Out of Pocket Maximum.

OOP -- Out of Pocket Maximum: The Unsung Hero and Untold Story of the Medicare Advantage Plan Program:

The singular, profound, most outstanding Benefit available (in most counties at no additional monthly premium cost) to all Medicare Beneficiaries, who choose an Advantage Plan, is OOP coverage.

A Medicare Beneficiary today, who cannot afford the secondary coverage of a Medicare Supplement, who does not carry secondary insurance in the form of a Retirement Health Plan [modeled after the Medicare Supplement model], and who does not choose the optional Medicare Advantage Plan, will find that TRADITIONAL MEDICARE DOES NOT INCLUDE "OOP" COVERAGE.

Since OOP coverage sets an annual limit of financial obligation as to the amount of medical expenses (exclusive of premiums or Part D Drug expenses) a Medicare Beneficiary must pay in a calendar year (typically $1000 to $4000, depending on the Plan) and THE INSURANCE FIRM PICKS UP THE FINANCIAL OBLIGATION TO THE BENEFICIARY THAT EXCEEDS THE OUT OF POCKET MAXIMUM, this means that a profound protection exists to the bank accounts and homes of millions of Medicare Beneficiaries previously unprotected from the potential shock of extraordinary medical expense.

At a time in history of historical foreclosures on homes and bankruptcies, many of which can be associated with one or more extraordinary medical expense -- with or without insurance coverage -- the OOP benefit can protect Medicare Beneficiaries, the most vulnerable segment of our citizenry, from financial ruin and devastation.

There are other important, though less profound benefits provided by Medicare Advantage Plans. For example, some Plans designed for low-income Beneficiaries include a set number of planned non-emergency transportations to and from a Medical Provider. To the poverty stricken Beneficiary with a broken leg needing to see Medical Provider in the dead of winter or in a location not easily accessible by public transportation, such a benefit can mean the difference between accessing or not accessing timely healthcare. Other Plans may include Hearing benefits or Dental Benefits or Vision Benefits otherwise not affordable to the Medicare Beneficiary.

But, the OOP benefit stands out as the unsung, untold heroic benefit of Medicare Advantage Plans.

Now, as an American with or without health insurance in today's economy, ask yourself:

"Suppose I could obtain a health insurance policy for myself and my family that included OOP protection, so that I am not faced with the possibility of financial ruination due to any extraordinary medical event in any given calendar year...?"

This is where the Medicare Advantage Plan could be a model for all health insurances!

president elect barak obama appoints tom daschle and jeanne landrew

President-elect Obama chose this morning's press conference to announce his appointment of former senator Tom Daschle to the Cabinet post of Secretary of Health and Human Services. Obama also announced his simultaneous appointment of Tom Daschle as Director of the White House Office of Health Reform. Daschle's co-author on health reform, Jeaane Landrew, will be Daschle's Deputy Director.

post introductory post: all Medicare accepting Providers should also accept all Medicare Advantage Plans

Within a week or two of my introductory post Congress passed the ill-conceived legislation that attacks the PFFS type Medicare Advantage Plan. In my opinion this had more to do with politics and little to do with care for the elderly, for doctors, or for the health of the Medicare Program. In my opinion this was nothing but cynical politics in which under the aegis of rolling back a scheduled ten-percent cut to Medicare physicians, the PFFS type Plan was placed on death row. The physicians could have had that ten-percent cut rolled back, as it was in previous years, without Congress also tolling the death knell for the PFFS plans. If there was anything truly significant about the vote, it was the drama of Senator Edward Kennedy appearing on Capitol Hill, relatively fresh from the surgery to remove his brain tumor, to pass the filibuster-breaking vote. The cynical politics becomes clear, when one sees that this is the first legislation that the Democratic legislature could slip past a Presidential veto. It was all about using propaganda and the wallets of physicians to break the presidential power of veto.

There is a technical matter that goes to the heart of the actual health care delivery via Medicare Advantage plans that has been either forgotten or ignored and ought to be righted by Congressional legislation, if it cannot be righted by a CMS Administrative regulation or by a Presidential edict. This technical matter is the "deeming" process by which health care Providers choose on a voluntary basis to accept or reject participation in any particular Medical Advantage Plan. This matter of deeming is most acute, when it comes to the PFFS type plan. Why? On the one hand the power of the PFFS plan is that it gives the Beneficiary the option to choose any health care Provider -- in theory. The "catch" is that while the Beneficiary may receive services from any Provider that he or she may choose, it is contingent upon the Provider deciding to accept the Terms and Conditions of the particular PFFS Plan (with the exception of emergency care, which is always guaranteed by all PFFS plans). Technically, this contingency exists each and every time the same Beneficiary seeks care, even from the same Provider. (Technically, this contingency exists as well with other type plans such as HMO's and PPO's, although this contingency right is mitigated by the contractual obligations of such network plans.) In reality once a Provider has cared for a Beneficiary and has accepted the PFFS Plan of that Beneficiary, the Provider is likely to accept other Beneficiaries using the same Plan and there is little reason for any Beneficiary to be concerned that the Provider will care for them once, but, not on a regular basis.

That said, there have been some instances in which some Providers have had trouble with some Insurers leading to non-acceptance of some PFFS plans by some Providers. And this is where the technical matter of "deeming" has missed in it's application and where PFFS plans have unfairly been targeted. Remember, there is no permanent contract between Provider and PFFS Insurer. such that however extensive the acceptance of PFFS insurance, each and every instance of insurance is unique, ad hoc, and as such there is a systemic insecurity about the PFFS insurance that ought not exist. It is far too easy for a Provider to decide even whimsically to no longer accept a PFFS Plan. In that sense Congress was right to address the issue, although Congress may not have found the optimal solution in that beginning in 2011 all PFFS plans must be converted into some type of network plan. This is not necessarily a bad idea. Yet, that in itself will not mitigate the expense issues Congress has raised about PFFS plans and about Medicare Advantage Plans altogether. If anything a network plan is more expensive to the insurer and therefore to Medicare, as it is Medicare that foots the expense. Yet, Advantage Plans across the board face deep cuts in funding, thus we see increasing Premiums.

As all Medicare Advantage Plans are Medicare Approved and are ultimately administered by CMS (Center for Medicare and Medicaid Services), it should be required that all Medicare accepting Providers also accept all Medicare Advantage Plans. The "deeming" option should be available on an ad hoc basis to non-Medicare Providers as a way to expand the pool of physicians serving the Medicare population. Medicare Advantage Plans pay the same or more to Providers as simple Medicare. By law Medicare Advantage Plans provide equal or greater coverage and benefits to Beneficiaries of Medicare than does simple Medicare. It makes no sense that Medicare Advantage Plans are not required of acceptance by Providers on an equal basis to simple Medicare. It makes no sense that Medicare Advantage Plans are stigmatized and are not promoted proactively by CMS. CMS should actively educate the Medicare population about Medicare Advantage Plans. And the profound importance of the "OOP" Benefit (Out Of Pocket Maximum Co-payment) that is written into Medicare Advantage Plans, but, not into simple Medicare, is a Benefit that ought to be publicized on the order of an old town crier, "Eleven o'clock and all is well!" After all in these hard economic times, when so many are facing their "Eleventh Hour" and are losing their homes and their bank accounts, the financial protection of the OOP Benefit of the Medicare Advantage Plans is a financial salvation to millions!

introductory post

For a little more than a year now I have been breaking into a new career as an agent of life, accident, and health insurances in NYS (New York State). The specialty area I have entered pertains primarily to Medicare related health insurances, most particularly: Advantage Plans, Prescription Drug Plans, and Supplement Plans.

In the short time I have engaged in this new career I have already experienced many ups and downs, as the career change in itself is quite dramatic and at times even traumatic due to the responsibilities of operating an independent business. Freedom is neither free nor easy nor devoid of regulation, ethics, and accountability. In my middle age I have transistioned from the predictable but less than subsistence income and mentality of being an hourly laborer, faced with one glass ceiling after another, to being CEO, CFO, CIO, VP-Marketing, VP-Sales, VP-PR, VP-IT, Outside Sales Representative, Customer Service Clerk, Bookkeeper, and whatever other duties and the indefinite, unguaranteed income that go along with being owner of one's own business. In other words I have transitioned from being Gopher to Boss, from Step'n-Fetch-It to Bone Thrower, from Slave to Master -- only now, as a one-man business, I am all of those roles and everything in between.

Eventually one may be more than a one-man business. In the meantime there is quite a learning curve. One is constantly educating oneself, licensing, re-licensing, certifying for this, certifying for that, recertifying -- and somehow time must be found for actually doing business! No certification, no right to sell; no sales, no income.... Such daily matters as personal illness, holidays, personal time, weekends, seasonalilty of marketing, commissions, commission lag time, operating expenses including insurances, equipment, transportation -- all of these take on new and deeper meaning. For better and for worse one knows largely that one is the measure of one's own success or failure -- however one defines success and failure.

Some define success strictly by sales volume. Others define success by personal freedom. Still others define success by helping as many clients as possible. For me all three are equal ingredients. One can be too "free" and do nothing; once can "sell" quickly and carelessly to too many too soon and risk one's integrity by doing harm rather than good for clients and for the firms one represents; one can "help" so disproportionately to one's level of responsibility that one can involve oneself to an inappropriate degree in the life of a client and one can deprive oneself of time for education, sales, and personal time. The challenge is learning to achieve a proper balance and to manage one's time efficiently and in good health.

Most clients are initially complete strangers, although in some cases friends or family may sooner or later choose to become clients. It is often easier to be objective with the complete stranger than with a familiar individual. In either case one must be professional. Sooner or later, some strangers become familiar; it is also true that sooner or later, familiars may become strangers. It is all about relationships and boundaries.

The joys are that one can do a great deal to help one's clients, if one "does one's homework, dots all the i's, crosses all the t's, etc." One of my greater joys was enrolling a client into a particular Medicare Advantage Plan such that he was able to save $500 monthly in healthcare expenses and afford to move from a dangerous living environment to a safer one. Another joy was in helping a client understand his medical billing better than he did and by so doing helping him to avoid a possible billing nightmare. Still another joy has been to educate certain low income clients as to additional benefits specifically created by law in order to help them keep their financial heads above water in these tough times. My most moving experience so far is the time that, in enrolling an elderly man into an Advantage Plan, it came out that a bureaucratic matter had left him unable to pay for his necessary prescription medications for heart disease and diabetes, including two forms of insulin, needles, and syringes; my positive intervention solved this problem for him within 48 hours and may have saved his life.

A word about Medicare Advantage Plans (Medicare Part C), Medicare Prescription Drug Plans (Medicare Part D), Medicare Supplement Insurance Plans, and "Medicare" (Medicare Part A with Parts B and D optional [customarily referred to as "Medicare", "Original Medicare", or "Traditional Medicare"]:

MEDICARE has gone through several major changes subsequent to it's initial creation. In it's origin there was only "Medicare Part A", providing hospitalization coverage at the cost of pre-paid premium to the government taken out as a tax during one's working years. Some decades later, voluntary "Part B" was added on retirement (or after 24-months in the event of eligibility by disability) at the cost of a monthly premium (today the Part B Premium amount in 2008 is $96.40/monthly for most beneficiaries). Medicare Parts A & B have deductibles, and/or co-payments and co-insurance obligations to the Beneficiary; but, no OOP Maximum (that is, there is no Out Of Pocket Maximum or "ceiling" limiting the possible medical liability a Beneficiary may accrue in a high usage or even medically catastrophic year).

Retiree Benefit Plans and Medicare Supplement Insurance Plans (commonly referred to as "MediGap Plans") were created by the insurance industry, and those, who could afford the respective premiums for the policies, could "supplement" their Medicare coverage and simultaneously protect their bank accounts and homes (OOP coverage) to a far greater degree than previously possible.

Today as a result of the Medicare Modernization Act of 2003, most Medicare Beneficiaries enrolled in Medicare Parts A & B can enroll in a Medicare Part C Plan (Advantage Plan) which by law has OOP protection built into the the policy of his or her choice, and in many cases there is a "zero-dollar" premium (Premium = $0.00 monthly)! Many Medicare Advantage Plans also include the Medicare Part-D Prescription Drug Coverage at no monthly premium as well. Then there are "stand-alone" (PFFS) Medicare Advantage Plans and "stand-alone" Prescription Drug Plans so that there is greater flexibility in choosing (for example) a PFFS Plan from one company and an RX Plan from the same or a different company.

Company Benefit Plans and Medicare Supplement Plans still flourish. There is no "one size fits all" plan in existence; there are many plans, enabling the independent insurance agent great flexibility in assisting the Medicare Beneficiary into the optimal policy for his or her needs and budget. As a result of the Medicare Modernization Act of 2003, more Medicare Beneficiaries have better coverage at costs more easily able to afford and budget.

This is not to say that medical costs or drug costs are universally inexpensive, nor to suggest that there are not improvements to be made in our healthcare system and how it is paid for. But it would be hugely wrong to fail to appreciate the good that has come to the Medicare Beneficiary in the latter half of this decade, and one hopes that the recent Congressional setback to the Medicare Advantage Plan system earlier this July month -- an Act of Congress done in the guise of affording to prevent a ten-percent Medicare paycut to physicians -- will not cripple the Medicare Advantage Plan system. One hopes the Act will not frighten Medicare Beneficiaries from choosing these Plans, will not harm the present enrollees, and will not undermine the positive cooperation between government and private industry that has shown the way for healthcare in America to evolve in a way that can be modelled after this type of cooperation and benefit all Americans.

In contemprorary America, health insurance is highly controversial and highly political. Congress is divided, whether or not to move towards greater privatization, towards universal healthcare, or to an "hybrid" system. This is especially true with respect to Medicare and Medicaid. The 2008 Presidential, Senatorial, and Congressional Elections may determine the direction of future healthcare for this country.