Sunday, August 29, 2010



Not everyone is lucky like me to have a friend like Donna. At least, I hope I'm considered her friend. Don't want to get too presumptuous.

I've known Donna and her Husband Wayne since the early 70s where I've handled their insurance on their farm, Wayne's Dairy in Waianae. Both were what I considered to be good, decent, human beings who worked hard every day, as one would expect to do when running a dairy. It is only when something happens that the normal person would consider to be a tragedy that ordinary people like the Costas begin doing extraordinary things.

Donna Costa, my hero
Over the years, the dairy industry has gone through a slow decline, mostly because of Hawaii's high property and business taxes, the Jones Act and excess regulations. Today, Hawaii has only one or two dairies left, from about a hundred 40 years ago. In the 1980s, the industry was devastated by the Heptachlor lawsuits, where the dairies were buying feed from the pineapple industry. The feed was tainted with heptachlor, which also tainted the milk.

I once thought I was helping them when they were milking. Donna began screaming at me to stop when she noticed that I was trying to milk their bull. Wayne, being a kinder, gentler person who wouldn't think of telling someone what to do, would've likely let me continue.

In May, 1994, an event happened that changed their lives. Their grandson, Cody, who was two at the time, was watching T.V. at a friend's house with a 5 year old boy who had Down syndrome. As far as they know, the boy set fire to Cody's blanket with a lighter. Cody thought he had done something bad so he hid under the burning blanket.

Cody's prognosis was dim, given only 5% chance of survival by Kapiolani Hospital. He was burned over 80% of his body. When he lived past 48 hours, the Shriners got involved and sent Cody to Galveston for specialized treatment. He was in constant pain, writhing and making mewing sounds from his scorched vocal cords. The doctors were all covered from head to toe so as to not pass on any bacteria as they daily debrided the burnt tissues. Donna wondered how a human being could withstand such intense pain and trauma without losing one's mind and spirit. But, survive he did, and eventually thrived.

Donna and Wayne gained custody over Cody in 1998 and had him involved in soccer, swimming and scouting. Donna first volunteered at the elementary school Cody attended and later became a substitute teacher so she was always close by. She stood by with a lump in her throat as other children referred to Cody as a "monster" and adults using Cody's condition as an example of "what happens when you play with matches".

Cody has had over 50 surgical operations over the years and will be getting another one in September on his eyelids.

Cody was enrolled in Island Pacific Academy in middle school and just graduated as part of their first graduating class of 2010. He was even voted by his classmates as the prom King at their Senior Prom. Cody will be attending OTIS College of Arts in Los Angeles to pursue his art. For the first time, Donna won't be close by as he attends school and goes through his daily life on his own.

Oh, I forgot to mention that Cody is considered legally blind with marginal vision. His sight deteriorated over the years because he has no eyelids or lashes to protect his eyes. The purpose of the operation in September is to try to reconstruct the eyelids. Oh, and he doesn't have hands. His right hand was amputated above the wrist and the fingers and thumb were amputated on the left hand. He just returned from S.F. where they reconstructed his upper lip since he doesn't have one. Yet, he has been able to achieve what every child needs to achieve scholastically. All with courage that I wish I had.

Cody refuses to consider himself handicapped and thus refuses to learn how to be a blind person. And he has refused the use of prosthetics.

Cody as Island Pacific 2010 Senior Prom King

I tip my hat to Donna and Wayne for guiding this fine young man. His classmates at Island Pacific Academy and the faculty were super in supporting this young man and turned him into the fine adult that he has become. And, of course, Cody for the courage and the toughness he needed to come this far. He refuses to lose at anything.

Donna didn't want me to do a feature on her. She believes that she was blessed to be given the opportunity to be a part of Cody's life and is even today, amazed at his resiliency. I am grateful that she was able to share his story with me. And with us.

He is destined to achieve greatness as a contributing member of our society. I guarantee it.

Saturday, August 21, 2010



Most of our kupunas are on Medicare, a program designed and implemented in 1965 under the "Great Society" and was to serve the elderly once they reach age 65. The program is difficult to understand, but, since many of you couldn't pass the entrance exam to get into Farrington, and thus, were deprived of the fine education that I was privileged to get, I will help you.

The program has evolved over the years and has two basic parts and two other optional parts. Part A is hospital insurance and will cover the expenses when a person is an inpatient in a hospital, nursing home, or a hospice facility. Thus, (for those of you who went to Punahou or Iolani) MEDICARE DOES NOT PAY FOR CUSTODIAL CARE!

Everyone who is eligible for Medicare has this coverage and there is no premium required to be covered.  To become eligible for Medicare, one must enroll in the initial enrollment period (3 months before and 3 months after reaching age 65), be disabled, or have kidney failure.

Part B pays for the costs of doctors' visits and outpatient care. There is a premium charge for this and in 2010, the amount is $96.46 each month and could go up to $400+, depending on a person's income. This is called "means testing" and is likely where our entitlement programs are heading because frankly, the government over-promised and will have to turn programs from "earned benefits" to welfare, or wealth transfers.

Medicare is also financed through payroll taxes, deductibles and co-pays. Those who do not sign up for it during the initial enrollment period at age 65 pay a higher premium (premium surcharge) for not signing up in a timely manner.

In 2010, the government passed a massive healthcare law with the hope of covering 48 million "poor" uninsured people. To keep the cost of the program below $1 trillion (which they felt was politically acceptable), they plan to cut Medicare by $500 billion. We don't yet know where and how much these cuts are going to be and how they're going to be applied.

Many practitioners are beginning to opt out of accepting Medicare patients because the limits on payments on services are already too low and further cuts will cause them to lose too much to remain in business. This will create more "gaps" in coverage which we'll discuss in Part C and Part D.

Part C is the part that allows Medicare participants to receive their coverage through private insurance plans and private arrangements. This was introduced into law in 1997 and reintroduced in 2003 as "Medicare Advantage". These private insurance companies contract with, and are approved by the Centers for Medicare and Medicaid Services.

Under this arrangement, the Medicare Advantage program is paid by the government a fixed amount each month to provide services to the Medicare beneficiary, rather than pay on each service or procedure provided. Most Medicare Advantage plans offer additional services and the premiums charged is based upon how extensive the additional services are, the deductibles and the co-pays. Those involved in providing Medicare Advantage plans are preferred provider organizations, health maintenance organizations, medical savings accounts, private fee-for-service plans and special needs plans.

Part D was added in 2006 and provides for prescription drug coverage. It is sometimes included in Medicare Advantage (Part C) plans but beneficiaries can purchase drug-only coverage under Part D.

These are concepts difficult to understand because beneficiaries must always be aware of the yearly deductibles, the cost-sharing up to a predetermined limit ($2,830 in 2010) and then the coverage gap or "donut hole" where Medicare pays nothing until the patient reaches a catastrophic limit ($4,550 in 2010). After that limit, the plan pays for all of the prescription drug costs for the rest of the year, except for a nominal co-payment of a few dollars.

There are many gaps in Medicare coverage and thus the need to consider additional Medigap plans. Part A has a deductible, then pays 100% for the first 60 days, then there is a co-pay from 61 to 90 days and a higher co-pay from 91 to 150 days of hospitalization. This lifetime 150 days, once exhausted leaves the beneficiary responsible for all hospital costs thereafter. There are differing amounts and differing rules for nursing care, hospice care and home health care.

In Part B, the gaps are found in the annual deductibles, the 20% co-pay and the amounts above the "approved"charges. To further confuse us, there are 11 different standardized Medigap plans that insurers can offer after June 11, 2010. Insurers can't mix and match Medigap benefits and have to stick to these 11 standardized plans.

We still don't know what changes will occur when the Health Care Reform law goes into full speed. Most people suspect that the government will further enslave us as they did with Social Security, Medicaid and Medicare. Insurers have already increased their premiums in anticipating covering adult children of their current policyholders. Younger people subsidize older people and healthy people subsidize unhealthy ones.

At this writing, private insurers are offloading their insureds with pre-existing conditions to a new plan similar to the government plan called Government Employees Health Association. Businesses are not hiring people because they're afraid of the rising health insurance premiums. This new class of insureds with pre-existing conditions will be subjected to a monthly premium, but also a huge $2,500 deductible before one penny is paid in benefits. It operates like a Medical Savings Account.

I don't have a possible solution because I don't know how the healthcare plans and coverages will evolve. We are at the mercy of our government. All that I've presented above will likely change in the next few years. Or weeks.

Meanwhile, our kupunas will be facing denial of treatment and procedures based not on what the doctor and patient chooses, but what some bureaucrat in Washington decides is best. The kupunas can no longer work to earn an income to make up for any cutbacks that the government imposes. They are out of options.

We need to step up our volunteer efforts. If you know someone who is a caregiver, volunteer to give them 4 hours of respite every week. Or, offer to do errands for them. Lanakila, Hospices, nursing homes and adult day-care centers are always looking for help. Volunteers help them to keep their costs down.

Sunday, August 15, 2010



Contrary to popular belief, it is a misconception that fraud is a field of study at Farrington High School. In fact, fraud regularly is perpetrated by ordinary people like us. Before you get mad, let me explain some things.

There are two types of fraud. A "hard" or a "soft" fraud. A hard fraud is when someone submits a claim knowing that a loss did not take place. A soft fraud is one where there is a legitimate claim, but a person adds or pads the amounts of the loss suffered.

When a person falsifies the information on health insurance applications, he has committed fraud. If a person smokes cigarettes and knows there is a higher rate for smokers, and he emphatically states that he does not smoke just to qualify for the lower rate, he has committed fraud. When a person submits claims for services or treatment that's not provided, that is fraud. When a doctor tries to "help" his patient by padding the claim so that the patient's "deductible" is covered, that is fraud.

When a medical provider bills for services not provided (called "phantom" treatments), bill for more expensive services than were provided (called "upcoding"), perform a single procedure but bill it as a series of separate procedures (called "unbundling"), provide treatment or services not medically necessary (overtreatment), pay kickbacks and finders' fees to attorneys and others, bill for equipment for patients like wheelchairs that were never provided and diverting drugs, these are fraudulent acts.

Insurance companies and agents also sometimes commit fraud too. Agents can misrepresent coverage to get the sale, they may issue policies that are fakes and/or may divert premiums for their own personal use.

People in the legal profession could also be a part of fraudulent schemes. They sometimes steer legitimate, as well as dishonest patients to dishonest medical providers in exchange for a fee. They even use their legal practice to threaten and often sue for disability and medical claims to get large settlements. Some even shakedown medical providers unless a fee is paid. That's why medical malpractice insurance premiums are so high.

There are also people called "cappers" or "runners" who introduce patients to dishonest practitioners or dishonest lawyers in exchange for a referral fee. They troll nursing homes and even low income neighborhoods to look for people to come in for unnecessary tests and procedures.

Medicare fraud offers large payoffs so it's a lucrative activity to engage in. Further, even criminals who are convicted of violent crimes can easily obtain Medicare supplier licenses. Medicare fraud is estimated to be about $60 billion a year. Americans spent $2.24 trillion on healthcare in 2007. The FBI believes that fraudulent billings to health care programs to be up to 10% of that.

To be fair, many medical practitioners regularly order extra diagnostic procedures to avoid lawsuits. Nevertheless, this practice increases the cost for insurance coverage and for medical services rendered. The ideal situation is if the patient and the practitioner can decide together as to what services should be done and the patient pays the co-pay and signs off on the decision.

If you have a provider who offers to change the paperwork so that you don't have to pay a deductible or co-payment, then you are likely participating in health care fraud. I've even encountered people who tell me that their doctor is so good that he/she is able to eliminate the deductible for them.

The Deficit Reduction Act of 2005 has two "false claims" provisions to provide for whistleblower activities. It allows for a person who has knowledge of fraud against the U.S. Government (Medicare/Medicaid) to file a lawsuit. If the action is successful, then the person gets a percentage of the recovery. The law also allows for states to an increased share of 10% of the amounts recovered if the state enacts a false claims law that is modeled after the federal version.

Our kupunas are vulnerable when there is so much widespread corruption in the healthcare system. When the government gets involved, they offer regulations, but do not enforce or even provide funds for the enforcement of the regulations. Many would also argue that our politicians are just as corrupt (or more so) as those in the healthcare industry as mentioned earlier.

We all have larceny in our hearts. If there's a chance that we'll get caught, our propensity for larceny will be low. Sort of like picking one's nose, I suppose.  If the amount to be gained increases, the propensity increases. We all sell our integrity at some point, but at differing prices. As an entitlement society, we have, over the past decades lost our moral character.

If the majority of the people decide to redefine what fraud is as each situation presents itself, then we have no rules as to what is right and wrong. For instance, when Roosevelt made those who are in the top 5% of income pay 98% in taxes, I assume that 95% of the population agreed that this was a good thing. So the 5% of the population who had their wages consficated has no voice in the matter because the majority decided that those who earned high incomes had no rights to their wages.

Or, we sometimes redefine it another way. If we were to commit a fraudulent act, and in doing so, we are able to provide for the survival of others (like children or aged parents), then that act is not fraud because we have done a good thing because are keeping our children alive with the money saved. You may even get a free swimming pool if your doctor can declare that the pool is necessary for your good health.

We complain about how high insurance premiums and medical costs are. Insurance companies will not lose money. If they do, they will no longer be in business. They pass on the costs of fraudulent activities to policyholders who pay premiums.

It is up to us. We need to resist the temptation to be a participant in fraudulent activities, and to speak up and let others know when fraud is being committed. Become a whistleblower. If not, all will be lost. When the patient is as corrupt as the doctors, lawyers, insurance companies and the politicians, then we end up with a healthcare system in complete chaos.

Sunday, August 8, 2010


KUPUNA HAS ALZHEIMER'S DISEASE... She doesn't know whether I visit or not

I received an email the other day. You know the kind where they forward a joke, or something. But no real communication. And, like most folks, I just delete these. For some reason, I read this one.

 True Love
It was a busy morning, about 8:30, when an elderly gentleman in his 80's arrived to have stitches removed from his thumb. He said he was in a hurry as he had an appointment at 9:00 am .

 I took his vital signs and had him take a seat, knowing it would be over an hour before someone would to able to see him. I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound. On exam, it was well healed, so I talked to one of the doctors, got the needed supplies to remove his sutures and redress his wound.

While taking care of his wound, I asked him if he had another doctor's appointment this morning, as he was in such a hurry.The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife. I inquired as to her health.

He told me that she had been there for a while and that she was a victim of Alzheimer's Disease. As we talked, I asked if she would be upset if he was a bit late. He replied that she no longer knew who he was, that she had not recognized him in five years now.

I was surprised, and asked him, 'And you still go every morning, even though she doesn't know who you are?'

He smiled as he patted my hand and said,

'She doesn't know me, but I still know who she is.'

I'm not a medical professional. Nor do I know whether the Kupuna with Alzheimer's disease knows when a child or loved one comes to visit. In fact, in my observations over the past 8 years that I've been volunteering at nursing homes, many can't tell the difference from one day to the next. Many begin crying a few minutes after a visitation from a family member, claiming that no one comes to visit.

And I do know why the majority of people don't visit a family member. The elderly with Alzheimer's disease becomes a different person. He/she is no longer a productive person and in fact needs care and handling like a baby. It's difficult to watch and to deal with someone who once had all the confidence in the world deteriorate so much.

We're also busy. We have lives to live and if they don't remember us anyway, why not visit once a week or even once a month, just to make sure the caregivers are making them comfortable? We have our work, our families and social events to attend. Visiting our kupunas eats up too much time.
At St. Francis West Hospice

I was at the hospice the other week and a lady had the staff wheel her mother out to the lobby where I was playing. Her mother had recently suffered a stroke but was somehow able to communicate with her daughter. I was asked to play something that Alfred Apaka had done so I went one step further and sang "To You, Sweetheart, Aloha" to her.

She knew Apaka back in the day and I could tell through the daughter that she was touched and happy hearing that song. When I got through with my hour and getting ready to leave, she again asked for that song and I complied.

On the way out, she wanted to talk to me and hold my hand. And I did. This happens a lot when I get through playing at nursing homes. So I have to make sure that I always have my hands cleaned with the solution that's provided so I don't pass any germs on to anyone. And all they want to do is to touch a human being. In many cases, they want to show their gratitude for bringing back memories through music.

Anyone can do this. While visiting, hold their hands. Just the human touch is enough. Some are scared and holding hands gives them reassurance that they're not alone. This gives them strength. And the assurance that when it's time to leave this earth, they will be appreciated for their contributions they made through life. It means a lot to them.

Sunday, August 1, 2010


EASIEST WAY TO ABUSE OUR KUPUNAS.... Just take away Medicare/Medicaid

What happens when the Government forces citizens into a medical reimbursement program and then decides to cut the reimbursements? My guess is that hospitals and doctors will begin to shut off access to care for Medicaid and Medicare patients. Hang on for a rough ride, folks.

Medicare is a medical insurance program that was promised to cover those who reached age 65. Part of the "Great Society" is what they called it. Medicaid is a welfare program where medical reimbursements are made for those who are on welfare and don't have insurance. Also part of the Great Society program under Social Security.

Beginning in August (at this writing), doctors will be forced to take a 21% cut in payments. The population specifically affected include seniors, the disabled and military patients on the Tricare program. Folks like me who made sure we served 20 years in order to qualify for medical benefits as military retirees believe that we kept up our part of the bargain by serving in the military. At great risk of life and limb, by the way. The government has decided to modify its promises by cutting payments. And they will have to do the same with Social Security, the recently passed universal health care and all other government programs because they no longer have any money.

Here I am at the Blaisdell Concert Hall, risking life and limb for my country

What will the elderly do? Many medical facilities will still take them in if they can pay cash. Others will not receive services if the person is on Medicare. In many places (costs vary with locations), Medicare only reimburses 50% of the actual cost of primary care. Cutting another 21% likely will further leave our elderly without care because providers will turn them away.

Congress is as confused as ever, but, they need to find ways to pay for the 48 million uninsured people that were promised coverage under the Health Care Reform passed earlier this year. So, they chose to cut Medicare.

Sort of like government bureaucrats deciding who will get care and who won't. Or, perhaps lawyers will be making such decisions. Or, an accountant. If a person is older and highly likely to pass away, then certain medications may be withheld. Or surgical procedures. Or treatment and rehabilitation services. The decisions used to be made by the practitioner and the patient. Not so anymore.

We need to become less dependent on our government and become involved with our respective communities. Churches previously served their communities by providing relief for neighbors whether it's a health issue or a financial issue, or, as in this case, both. Not so anymore. If you belong to a church, strongly urge the leaders in your church to create more community outreach programs. If you don't belong to a church, then  find some way in which you can help those who cannot help themselves.

If someone in our community needs help, we can help to raise money and/or voluntarily give up resources to assist those in need. Sort of like a barn raising, if you will. And as a side benefit, we may again have communities where neighbors get to know and work with each other.

We can do it. Like filling up a bucket one drop at a time. And leave our government out of it. They have no money of their own. They merely take from Peter to pay Paul, which makes Peter feel abused. When Peter is abused he doesn't work. Uh, oh! Doesn't sound very family-friendly. But you know what I mean.