DONNA COSTA... YET ANOTHER PERSON TO ADMIRE

DONNA COSTA.... A TRULY EXCEPTIONAL HUMAN BEING


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.

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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.

UNDERSTANDING MEDICARE

MEDICARE INSURANCE... ONLY LAWYERS CAN UNDERSTAND THIS


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.