Pablo Neruda was a Chilean poet and diplomat who died under questionable circumstances during the Pinochet coup of Salvador Allende in 1973. He began writing poems at the age of 10 and has been called the greatest poet of the 20th century in any language.
 
Below is a poem that someone sent me attributed to Neruda that speaks to all generations. It's worth a read even though the Pablo Neruda Foundation says he never wrote it. More likely the poem was written by the Brazilian poet Martha Medeiros, which underscores one of the key issues that our country faces as a new administration takes the stage tomorrow: separating fact from fiction. 
 
You start dying slowly
You start dying slowly if you do not travel, if you do not read, If you do not listen to the sounds of life, If you do not appreciate yourself.
You start dying slowly When you kill your self-esteem; When you do not let others help you.
You start dying slowly If you become a slave of your habits, Walking everyday on the same paths… If you do not change your routine, If you do not wear different colors Or you do not speak to those you don’t know.
You start dying slowly If you avoid to feel passion And their turbulent emotions; Those which make your eyes glisten And your heart beat fast.
You start dying slowly If you do not change your life when you are not satisfied with your job, or with your love, If you do not risk what is safe for the uncertain, If you do not go after a dream, If you do not allow yourself, At least once in your lifetime, To run away from sensible advice.

And it came to pass…Last week I signed up for Medicare in anticipation of my 65th birthday in a few months. It was an alphabet soup of choices that yielded a monthly savings of about $300 from my present plan, but did not include coverage for four of my biggest cost concerns heading toward retirement: dental, eye, hearing, and long-term care.
 
That got me thinking about coverage in other countries. Enter The Commonwealth Fund, which has been publishing surveys comparing health care in industrialized countries since 1998. A report they released at the end of 2014 in tribute to Medicare’s 50th anniversary focused on health care coverage for people age 65 and older.
 
There were 11 participating countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, US) representing a variety of health care approaches, including single-payer national systems and subsidized private insurance coverage. And their structures involved many different benefits, thresholds and exemptions.

Regardless, what each country shared aside from doing a better job for their seniors than the United States at a lower cost was that their systems covered all ages. Also, their seniors were less likely to arrive at age 65 trying to catch up after years without adequate medical care, and deductibles and cost-sharing requirements still left many Americans scrambling to afford drugs and doctors which also cost more.

Additionally, all 11 countries shared some problems: fragmented, uncoordinated care; gaps in hospital discharge plans; conflicting information from doctors, and a considerable proportion of older adults serving as caregivers to elderly or disabled people.

Survey Highlights (from NY Times article)

• The US leads in the proportion of people over age 65 who have two or more chronic diseases (68 percent), and who take four or more prescription drugs (53 percent).
• 19 percent of Americans say that cost was a barrier that prevented them from seeing a doctor, undergoing a recommended test or treatment or filling a prescription. The next highest nation was New Zealand at 10 percent.
• 21 percent of Americans had out-of-pocket medical expenses that topped $2,000, and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.
• 57 percent of Americans get same-day or next-day appointments when they are sick compared with more than 80 percent in France, Germany and New Zealand.
• Americans are near the top in emergency room use. They also rarely wait more than a month to see a specialist, possibly because there are more specialists.
• Americans are more likely to say their doctors spend enough time with them and encourage questions compared to other countries.
• The US ranks highest in having health care professionals who talk about healthy eating and exercise.
• Americans are more likely to say they are receiving good guidance in managing their chronic illnesses than compared with other countries.
• The US does better than almost everyone on advance care planning, and ranks second in having written plans describing end-of-life wishes.

Learn more:
https://newoldage.blogs.nytimes.com/2014/12/12/u-s-health-care-lags-worldwide-for-those-over-65/
http://seniorplanet.org/the-5-best-countries-to-grow-old-in
https://en.wikipedia.org/wiki/Universal_health_coverage_by_country

We ring in the year 2017 wrought with the threat of sweeping changes that could undermine the very fabric of American society. The hard fought Affordable Care Act will most likely be one of the first targets of the newly led Republican Congress. However, don’t be surprised if its replacement is simply a rebranded version of the one under attack, trading some of the negatives, like the tax penalty for not signing up, to something that sounds more positive, such as the Freedom of Choice Tax Exempt Rider.

Also at play is the well-studied phenomenon known as loss aversion where it feels worse to lose something than never to have had it in the first place. Thus, the more people who are insured (20 million+), the more likely they will object when this benefit stands to be lost. Further, the transformation of American health care that has occurred over the last eight years has a momentum that could prove impossible to stop, especially in its shift from individual fee-based services to one based on care coordination and performance.

4 Things To Know About Medicare and the Affordable Care Act (www.medicare.gov)
Medicare now covers certain preventive services, like mammograms or colonoscopies, without charging you for the Part B coinsurance or deductible. Also, you can get a free yearly wellness visit.

If you’re in the donut hole, you'll receive a 60% discount when buying Part D-covered brand-name prescription drugs. The discount is applied automatically at your pharmacy. The donut hole will be closed completely by 2020.

With new initiatives to support care coordination, your doctor may get additional resources to make sure that your treatments are consistent.

The life of the Medicare Trust fund will be extended to at least 2029—a 12-year extension due to reductions in waste, fraud and abuse, and Medicare costs, which will provide you with future savings on your premiums and coinsurance.

Learn more:
http://www.nytimes.com/2017/01/02/us/politics/obama-health-care-affordable-care-act.html
https://www.statnews.com/2017/01/03/behavioral-science-offers-insights-as-repeal-and-replace-looms-for-obamacare
https://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html
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