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The Elderlaw Forum Radio Broadcast

RECORDED: NOVEMBER 14, 2012

“MONEY, MEDICARE AND THE BATTLE OF LIFE”
MYERS COMMENTARY/ZACHARY VOLK, FINANCIAL ADVISOR

It was Ralph Waldo Emerson who told us that “To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.” Last week I had an opportunity to attend a hearing in Sioux Falls—it lasted from 9 a.m. until 5:20 p.m.—during which Dr, Annette Bosworth, who was a guest on this program last week continues to resist the South Dakota Medical Board’s and the healthcare establishment’s efforts to make her into something else because—when affiliated with one of the systems—she spent too much time with patients and confronted hospital staff when she felt patient care was being compromised.

When a healthcare system views a physician to not be “fully accountable” to its standard of care and behavior, it has the capacity to inflict harm and to defame. But Dr. Bosworth—who now practices independently outside of corporate medicine—is found in another Emerson quote: “Our greatest glory is not in never failing, but in rising up every time we fall.” Dr. Bosworth will continue to rise up as she moves forward with her “patient-centered home care center” and her professional encounter with some of her peers. I wish her well.

Commentaries from two physicians in this week’s Kevin.MD newsletter is reminiscent of Dr. Bosworth and her insistence of being herself and defying efforts by others to make herself into something else.

The first comes from Edwin Leap, an M.D., who in the journal “Physician,” wrote an essay entitled: “In the battle of life, a joy that only the ferocious can comprehend,” he said he recently treated two young men, both injured in the same football game, and on the way out, one passed the other in the hall, injuries treated and dressed. “See you next game!” they said. They laughed and looked forward to the struggle.”

He wrote that he and his wife tried to raise their kids that way. “The lesson we hope to instill is simply this: “Get on with it. Get back in the game of life. Get a bad test score? Try harder. Feel afraid to sand in front of people? Give it a shot anyway. Fell off the bike. Get back on. Life is like that.”

“The thing is, life is a battle, whether you like that bellicose image or not. In our brief sweep of years we will struggle to protect our families, practice our faith and ensure the future of the Republic. Sometimes illness will win. Friendships may falter. Education may not be enough. Careers may wax and wane. Our beliefs will be challenged. Things won’t do our way. Nations will fall.

“To which we must say, “press on.” We have to move past excuses and pain, past the fear of uncertainty and risk. The doctor contends “We have become timid and fearful. We act as if failure must be rescued, that all risk must be mitigated by the herd, that greatness is the same as arrogance, or progress the same as regress. We turn things upside down by blaming everyone else for our inadequacies and expecting legislators or executives or courts to sooth our hurt feelings by mandating equality of all outcomes, by stretching a net across the chasm of public life so that we can only fall so far and only climb so high.”

Dr. Leap wraps up his essay by quoting Lucinda Matlock, a pioneer woman, who in describing her joys and sorrows with no regrets condemns her descendants: “Degenerate sons and daughters, life is too strong for you. It takes life to love life.”

Well, on that note, I have referenced Ivan Illich who observed in his 1975 book, “Medical Nemesis: The Expropriation of Health,” that ours is a generation unwilling to suffer its reality and that the medical establishment has become a major threat to health. He conducted a devastating analysis into “iatrogenesis” (doctor-made and now health system-made illness, which is ranked as the third leading cause of death in the U.S.) examining what medicine really does as opposed to the myth that has been built around it. In its review, Medical Nemesis poses some basic questions not only about the medical profession but about the direction of modern society and its dependence upon a maintenance system that is categorically robbing us of power, money, dignity—even life itself. On the death side, iatrogenesis shortens the life of some 250,000 to more than 500,000 persons, depending upon whose statistics you wish to believe.

And remember, when you cannot measure what is important, you measure what you can measure.

Well, based upon conversations with my fellow seniors, while acknowledging that “death” is a disease that is unlikely to be cured, the vast majority wish to delay that event as long as possible, reaffirming that Fifth Affliction of Hinduism: “Fear of death” and “clinging to life.”

Overwhelmingly, seniors look to Medicare and the access it provides to the medical establishment as a way of clinging to life. Last week I attended an AARP community meeting that sought to obtain citizen opinion on proposals to strengthen Medicare and to maintain Social Security. Attendees confirmed that both political parties—Democrats and Republicans—understood that seniors vote and have grown fond of their Medicare coverage—and therefore both sides promised they would keep Medicare strong, and perhaps even strengthen it.

One of the features seniors seem to like is that Medicare will pay for an annual encounter with a clinic for what is described as “health screening.” But on this program it has been suggested there is considerable clinical and financial risk involved when presenting yourself to clinicians who although well-intended have a production-based bias to identify a condition that requires testing, therapy, surgery or drugs. Hospital executives and the medical establishment have been reluctant to acknowledge widespread studies demonstrating the harm of overtreatment and a generally accepted fact that about 30 percent of all treatment is unnecessary, improper, and even harmful; hence iatrogenic injury.

Now, this week we have from the Journal “Policy,” an essay entitled “Do annual physical do more harm than good” by Naomi Freundlich, who writes:

“It sounds like hereby, but recent evidence challenges the long-held belief that the annual physical is beneficial for healthy adults. Researchers at the Nordic Cochrane Center in Copenhagen wrote that although a regular check-up with multiple screening tests might seem to offer the advantage of catching problems like heart disease and cancer early, their review of studies involving some 180,000 adults actually found no benefit. People who had annual check-ups were no less likely to be admitted to the hospital, become disabled or miss work than those who did not have regular physicians. Even more surprising, they were no less likely to die from heart disease, cancer, or another illness.”

“In fact, subjecting healthy adults to this yearly battery of tests may do more harm than good. The authors write, “One possible harm from health checks is the diagnosis and treatment of conditions that were not destined to cause symptoms or death. Their diagnosis will, therefore, be superfluous and carry the risk of unnecessary treatment.

“The underlying message in this new analysis is that if we go looking for something slightly out of whack, we are likely to find it. That leads to further testing—some of which may be invasive—and possible diagnosis and treatment of disease that might never progress. Finally, wholesale testing for a range of conditions without determining a patient’s age, medical or family history, puts the patient at risk, raises the likelihood of over-treatment and even harm from unnecessary intervention.

While you are reflecting on such heresy, we will take a break, and when we return, Tamara Nash will give us this week’s adventures in aging, and upon our return, I will be visiting with an independent financial consultant who will offer advice on how to maintain a cash flow throughout those retirement years, whether or not a person undergoes annual physicals.

Tamara, what do you have for us this week on the Adventures of Aging?

Thank you Tamara.

Now, during this second half, I wish to introduce you to Zach Volk. Zach: Thank you being here. I understand you are in the financial consulting business and persons engage your services to plan for retirement. As a matter of introduction, what is your background and experience in helping seniors survive those retirement years when they are no longer employed?

A significant percentage of seniors lack the capacity to engage in investments or otherwise need the advice of a financial consultant. We are told that for nearly two-thirds of seniors, Social Security provides the majority of their cash income. And for more than one third (36 percent) it provides more than 90 percent of their income. And for about one-quarter of elderly Americans, Social Security is the sole source of income.

And they tell us that Social Security is well funded and able to pay full benefits through 2033 without any changes, and with relatively modest changes would place the program on sound financial footing for 75 years and beyond.

But even for low to middle income seniors, what advice can you offer?

What about that house? I have a report here from the National Consumer Law Center entitled “The Other Foreclosure Crises, Property Tax Lien Sales,” making the case for state and local reforms to help seniors and other homeowners save their homes from foreclosures related to tax lien sales. It tells us that a tax lien sale may be started over nonpayment of a single property tax or municipal bill (water, etc.). Although practices vary by state, the taxing authority typically auctions off the lien for the amount of the past-due bill.

Low income seniors and people with cognitive challenges, such as those with Alzherimer’s, dementia, or a mental disability are most at risk. Persons without a mortgage are at risk, because the mortgagor – the lender—escrows the property tax.

Example, Missoula, Montana, a woman who lived alone for a number of years, fell behind on her property taxes—the family home was purchased at a tax sale by a private investment group for the $5,822 tax debt. She was evicted and lost the remaining equity in her house, valued at $150,000.

Now, we talked about reverse mortgages—and this is a situation where a reverse mortgage would have likely saved her $144,000.

Who are your clients? Where should a person invest—with, say, $50,000 of savings? Risk free? Municipal bonds? Tax implications?