Vol 3 Issue Two
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September 2009
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Ahh, the Good Old Days . . .
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Were They Happier Back Then?
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PLEASE VISIT MASON LAW
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I WANT TO KNOW
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| If you have an idea or comment that will help me make this a better newsletter please send it to me. Just click! |
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Greetings!
 After a summer hiatus, we're back.
This is the Health Care Reform issue, I guess. Doctor Beth Hodges weighed in with her view of health care reform efforts. I had no idea she would be doing that at the same time I took a deep breath and decided to weigh in.
Unlike what we have seen on TV, my Georgia law partner Kristin Cerbone and I are living proof that reasonable people can disagree on the health care issue. We do. I guess we need to be reasonable, because our law practice depends upon it. I'm kidding, Kristi. She may disagree with me, but she is still a nice person and a good lawyer.
Speaking of Kristin, check out her article on dementia and wandering (a real problem) below.
Also back, is Social Security guy Warren Coble with an outline of "Medicare 101". By the way, Warren has been asked by the North Carolina Bar Association to present an overview of Social Security "nuts-n-bolts" ideas at the annual Elder Law Symposium in February. Way to go, Warren!
While on the health care issue, I thought we'd add a little humor. I hope you'll find a chuckle or two immediately to the left of these comments. I have a few more I'll run next month.
If you have other viewpoints on the health care issue, please do share them. As I have often reminded our readers, I'm happy to lend space to a reasoned (and civil) opinion!
Email me if you have any questions.
Bob Mason
Certified Elder Law Attorney
Certified by the
National Elder Law Foundation, recognized by the American Bar Association as
the certifying entity for specialization in Elder Law.
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A
Physician's Perspective of Healthcare Reform
Beth Hodges, MD
 Many
of my patients have been asking me questions about the proposed healthcare
reform legislation, so I thought that would be a good topic for this month's
article.
First,
let's get some basic information out of the way. Yes, I believe that healthcare in America needs
some reform. No, I do not believe in
throwing the baby out with the bathwater.
There are many things about healthcare in America that are wonderful. Let's list some of them:
- Universality
of treatment. No one in this country
truly has to go without healthcare. The
reality is that even if you can't pay for it, your local emergency room will
see you and treat your illness. (Even if
you have been there and stiffed them for the bill 100 times before.) Okay, maybe you can't get your Joan Rivers
deluxe liposuction and face lift from that capitalist pig plastic surgeon down
the street, but dialysis, a heart/lung transplant, even gender changing surgery
in San Francisco-paid.
- Speed
of treatment. You can be treated in a
matter of hours at your local emergency room, faster at a private office or
urgent care. Just try that in Canada, where
the wait to get an initial appointment with a general practitioner is 18
months.
- The
best technology in the world. Capitalism
breeds innovation, and modern medicine is all about innovation. If we lose the potential for making profits,
guess what will happen to medical research?
We might never find the cure for anything again.
- The
best medications in the world. Many of
the medications we use in a casual commonplace manner cannot even be obtained
in Canada or the UK. The UK has recently banned the use of
hormone inhibitors in late stage breast cancer-not because they don't work or
have dangerous side effects, but because they only prolong a woman's life for a
few years. The UK feels they
are NOT WORTH THE COST. What if that
were your mother? Another tiny detail
about medications in Canada:
80% of the medications handed out in Canada
are manufactured in Libya
and Iran and China. Hmmm.
How safe would that make you feel, especially after what China has done
to our toys and our drywall!
Yes, healthcare in America needs
some changes. Here are a few things that
would make it more affordable:
- Tort reform.
If trial lawyers (John Edwards) could not amass huge fortunes by
manipulating (rightly or wrongly) the heartstrings of a jury, they would lose
interest and take their toys and subpoenas somewhere else. Then doctors could stop practicing defensive
medicine, which would save tons of money, malpractice premiums would drop,
doctors would be more willing to see the difficult patients, and many fewer
trees would lose their lives to paper mills.
- Tax credits for
the purchase of health insurance by individuals, making it more financially
feasible for self-employed or part time employees to purchase insurance for
themselves and their families.
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Expansion of
programs like NC Healthchoice, a cheaper subsidized version of health insurance
for middle to lower income families to insure their children.
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Tax benefits to
private insurance companies to offer reduced premiums and nullify the concept
of "pre-existing condition."
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There are many
other excellent ideas for reduction of healthcare expenditures out there. I have listed but a few. Senator Richard Burr is working hard to
organize sensible legislation, as are many others. Their voices cannot be heard over the
shrieking of Harry Reid and Nancy Pelosi, but they are working on it. My best advice is to continue to pay
attention, fellow citizens, to this extremely important debate and let your own
opinion be heard by your elected representatives. Make sure they know you are watching. Remember, they work for us.
Beth Hodges, MD is a principal in Hodges Family Practice, with offices in Asheboro and Ramseur, North Carolina.
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My
Take On Health Care Reform
Bob Mason
I have
been watching the health care screaming match all summer . . . along with
everyone else. What might set me a bit apart, however, is that I am an attorney
with over 20 years experience seeking solutions to peoples' problems in a
number of strange and involved areas of the law. Things like employee benefits
and ERISA, estate taxes, Medicaid and Medicare reimbursement and, later,
beneficiary planning. My point: I am not afraid of technicality and complexity.
The other
thing that sets me apart as an attorney is that I am trained to be a skeptic,
to go look for myself when confronted with an assertion. Which is why HR3200,
in all of its 1.75 Megabyte, 1,017 page glory sits on my computer where I can
check the often wild assertions made by crazies on both sides of the debate -
er - argument. Some anti-reform statements are simply wrong . . . I've checked.
Some pro-reform statements are equally wrong. I'll come back to HR3200 and why
I do not support it in a moment.
I believe
the US
has one of the best health care systems in the world. I do know what I am
talking about. Before I went to law school I recruited physicians and other
health care professionals for Hospital Corporation of America, working out of the USA, the UK,
Canada
and various European countries. The "recruitees' destination: Saudi Arabia.
It was no accident the Saudis wanted/preferred American health care
professionals. They are the best money can buy.
Ah,
money. The US
health care system is expensive, in addition to being very good. The expense is
not in over paid doctors. As I told folks at a speaking engagement a few weeks
ago, I will not begrudge one penny to some very bright person who does well in
college, does well for another 4 years in med school, and absolutely "busts a
gut" for another span of years in near-slavery conditions at some major medical
center learning the trade/art of medicine. After all, I want my doctor happy .
. . very happy.
The
expense comes in a variety of other areas too numerous to list here. Some are
"fixable" and others, I suspect, are not.
The
problems we are all having with the health care issue seem to involve something
much more basic than the US
health care system. First, Congress and the President backed into the health-care-debate-mess
without looking at underlying assumptions. There is little common ground
concerning these assumptions, so there will be little progress and much
yelling.
Is good
health care a universal right? Before you say "of course" think through it. Is
it better for some to have the very best at the expense of others who have the
basics, or is it better to insure everyone has "adequate"?
What
should the role of government be? When should government move from being a
referee/rule setter to being a player? Are there times when government should
be on the sidelines with the other game officials and others when it should be
out on the field playing? When are those times?
In the
end, I believe progress will come only when cooler heads on both sides can agree
on a set of incremental goals based on shared assumptions and principles. As it
stands, we're talking over each other's heads and will continue to do so until
one side or the other rams a "solution" down upon the other side, which, of
course, will lead to more resentment and anger.
So, why
do I not support anything I have seen thus far? Complexity. I thought of this
the other day while I was waiting on the telephone for a very long time to
reach an official with a certain federal agency only to learn when I finally
caught up with the official that he hadn't the faintest idea of what he was
talking about . . . and it was a topic he was supposed to have a very good idea
of what to talk about.
Take a
rifle approach to a few problems and fix them. Leave the shotgun for later if
ever.
As I
wrote above, I work in an area that demands a grasp of complex topics and
arcane rules. So I'm not ashamed to admit to my friends and clients why I am
against HR3200 and other proposed legislation: I don't understand it. I suspect I am not alone. Have you heard anyone give a coherent explanation?
Some House Republican office came up with a
flowchart of how HR3200 would work (it checks out . . . I looked!). I have
reproduced it here. Complexity. More parts to break.
You may comments to Bob by clicking HERE.
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Dementia and Wandering
Kristin Cerbone
 Recent
news from Atlanta, Augusta
and Savannah
alert us again to the all-too-common problem of people with dementia
wandering. In the Atlanta
area, an 82-year old man was reported missing and later found on July 3 alive
and safe in Huntsville, Alabama. He had been last seen earlier that same day
leaving his house by car. In Augusta,
an 85-year old woman walked out of her personal care home on July 2. After a four day search, she was found dead
in the woods; she apparently had walked several miles wearing heavy clothes. A 77-year old man living near Savannah has been missing
since Sunday June 21st. All
three of these Georgia
residents had Alzheimer's disease.
As these
recent events show, wandering can be dangerous and life threatening. Over 60 percent of those with dementia will
wander at some point. People with
dementia who wander often have a purpose or goal in mind. They may be searching for something that is
lost or trying to fulfill a former job responsibility. At least seven states, including Georgia and North Carolina, have a Silver Alert system
that alerts the public and law enforcement to be on the look out for missing
adults with cognitive impairments. In Georgia, this
system is known as Mattie's Call and it was activated in all three of the above
incidents.
In order to further protect someone from
wandering and getting lost inform your neighbors and local emergency responders
of the person's condition and keep a list of their names and telephone
numbers. Keep your home safe and secure
by installing deadbolt or slide-bolt locks on exterior doors and limiting
access to potentially dangerous areas.
Never lock the person with dementia in a home without supervision. Be aware that the person may not only wander
by foot but also by car or by other modes of transportation. Also enroll the person in MedicAlert + Safe
Return. MedicAlert® + Alzheimer's
Association Safe Return® is a 24-hour nationwide emergency response service for
individuals with Alzheimer's or a related dementia who wander or have a medical
emergency. They provide 24-hour,
nationwide assistance, no matter when or where the person is reported
missing. To enroll call 1-888-572-8566. Contact your local Alzheimer's Association
office for more information about preventing a person with dementia from
wandering.
You may email Kristin Cerbone by clicking HERE.
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MEDICARE
101
Warren Coble
An area
closely related to Social Security is Medicare.
Medicare is the Federal Health  Insurance program for:
*People
age 65 or older, or
*Under
age 65 and receiving disability benefits for 24 months, or
*Individuals
with a diagnosis of Lou Gehrig's disease, or
*Individuals
of any age with permanent kidney failure (End Stage Renal Disease, ESRD)
requiring dialysis or a kidney transplant.
This
month, we'll look at enrollment opportunities for individuals attaining age 65. In later months, we'll consider the different
parts of Medicare and how they work, along with Supplements, Part D
Prescription Drug Plans, and Advantage plans.
It is
important for everyone becoming eligible for Medicare to get accurate information about coverage
and delivery options. Attention to
certain issues will help you avoid serious and costly problems later. Individuals should begin to learn more about
Medicare several months prior to age 65, and determine Medicare's relation to
your own circumstances.
Special
rules apply to individuals actively
employed and covered by Employer Group Health Plans (EGHP).
If you
are retired, and covered by a
former employer plan, you should talk to your employer's benefits officer and
ask for information about company health insurance after age 65. Some former employers continue coverage for
age 65 retirees, other former employers drop retiree coverage at age 65. There is no requirement that employers
continue to offer coverage. Determine
the cost and benefits of the EGHP and if the EGHP will be primary or secondary
to Medicare. Once you understand the
costs and benefits of your retiree plan, you will need to decide if you should
keep your retiree coverage, or drop that coverage and purchase a Medicare
Supplement plan or Advantage plan.
If you
are not covered by an EGHP plan, you should learn about the various health
insurance options available and what Medicare will and will not cover. The Medicare & You Handbook, or Guide to
Health Insurance for People with Medicare will give you some idea of the health
care costs you may incur.
There are
3 potential Enrollment Periods:
*Initial
Enrollment Period
*General
Enrollment Period
*Special
Enrollment Period
Enrollment
is automatic for individuals already receiving Social Security benefits at age
65. You should receive your Medicare
card about 3 months before turning age 65.
Call Social Security or Medicare if you do not receive your card.
The initial
enrollment period (IEP) consists of a 7 month period, starting the three months
before age 65, the month of age 65, and 3 months after age 65. If you are not eligible for automatic
enrollment, contact Social Security to file an application for Medicare. The effective date of coverage is determined
by when you file your application. If
you file prior to the month you turn age 65, coverage will begin the first day
of the month you turn age 65. Filing
later can delay coverage you may need, meaning you could pay for expenses out
of your pocket.
During
the initial enrollment period, you will also have the opportunity to enroll in
a Medicare Prescription Drug Plan (PDP).
Failure to enroll for a PDP at the proper time can result in premium
increases and delays in coverage if you do not have equal or better coverage
already in place.
The
general enrollment period (GEP) occurs every year January 1 through March 31
and is for individuals who did not enroll during their IEP and do not qualify for a special enrollment period. Medicare eligibility will not begin until the
following July 1. The monthly Part B
premium is increased by a permanent 10% penalty for each year of delayed
enrollment.
A special
enrollment period (SEP) is available to individuals who are actively working at
age 65 or covered by a spouse who is actively working, covered by an Employer
Group Health Plan (EGHP), and the company has 20 or more employees. Depending on the employer coverage, you can
keep the employer plan and delay coverage until your employment terminates. If the company has less than 20 employees,
you should file for Medicare at age 65.
If your EGHP will be secondary to Medicare despite active employment,
you must enroll in Medicare
Part B during the IEP to avoid future penalties.
More
information is available on the Medicare website, WWW.MEDICARE.GOV or through the Seniors
Health Insurance Information Program in each state. In North
Carolina, the number is 1-800-443-9354. In Georgia, the number is 1-800-669-8387.
Next
month, we'll learn more about how Medicare actually works.
Social
Security expert Warren Coble welcomes your
questions regarding Medicare, Social
Security and Senior Life in general! Email
Warren by clicking
HERE.
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What Can MasonCerbone Do For You?
Robert A
You've
worked hard all your life for what you have.
You're concerned about being left destitute by long term care
costs. You'd like to leave something of
your hard work to your children. You're
tired of worrying about it all.
Maybe
we've just described a parent. If so, you're concerned about your mother's or
father's health care needs, you are busy and don't know where to start, your
prime concern is making sure your parent's assets are used in the best way
possible for their care.
We can
help you. Using state of the art mastery
of complex trust, tax, testamentary, Medicaid, and VA law we can save you
thousands, give you a sense of security and ease your troubled mind.
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The Usual Disclaimer: This newsletter is for general information only. Please do not rely on anything you read in this email as definitive legal advice applicable to you. All situations are different, including yours. Nothing you read in this newsletter is a suitable substitute for professional advice you may receive from your attorney, your accountant, or your tax advisor.
All contents copyrighted 2009 by MasonCerbone. Contents may be republished with written permission of MasonCerbone (which permission will usually be given!). |
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