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Medicare’s Annual Wellness Visits
Many seniors covered by Medicare are puzzled when their visit to their primary physician is limited to his or her going over their blood and urine laboratory studies and inquiring as to any questions or concerns the patient might have … but without examining the patient in any manner whatsoever. (A medical assistant might have preceded the visit by taking the patient’s blood pressure.)
This might leave the patient dissatisfied with the physician, but this is all that Medicare’s Annual Wellness Visit provides for!
A more detailed visit, or referral to a specialist, would have to be ‘problem directed’ or involve various levels of ‘decision making’ if the primary physician found them necessary. And Medicare provides for different payments to physicians for such ‘problem directed visits’ that is greater than the payment for ‘Annual Wellness Visits.’ A review of summaries sent to those on Medicare might be revealing as to what Medicare was billed for by physicians for specific visits.
I had changed my primary care physician after two years of at least quarterly visits during which he never came near me with a stethoscope or made any pretense of examining me (except for on my very first visit).
His office did perform studies such as EKGs and various Ultrasound tests, (perhaps justifiable as ‘problem directed’?) which he told me were normal for me, but there really were as no further examinations by him. His favorite comment was ‘You have no reason to panic, until you see me panicking.’
Ultimately, I switched primary care physicians when he decided to have two levels of patients, those just on Medicare and those willing to pay an additional annual fee to become his ‘concierge’ Medicare patients. That was the last straw.
I had asked him what would be the difference between his treatment of patients in these two classes. In reply, he then pointed out, as an example, that if he saw the need for referral of a ‘concierge’ patient to a specialist, he would make arrangements for an appointment with one, speak to the specialist, and forward all the patients’s records records to the specialist. ‘Non-concierge’ patients, on the other hand, would just be provided with the names and phone numbers of several specialists and be told to contact them. Needless to say, I have not seen nor spoken to that primary physician since that conversation.
Here’s a piece published in numerous newspapers (I saw it in the Palm Beach Post) which touches on this problem.
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Dr. Keith Roach is on the staff at New York City's Cornell Presbyterian Medical Center. |
His periodic comments are carried in many newspapers under the title of ‘To Your Good Health.’ To read it, just CLICK HERE or copy and paste https://www.oregonlive.com/advice/2025/05/dear-doctor-whats-the-difference-between-a-regular-checkup-and-an-annual-wellness-visit.html on the browser line, up on top, of your computer.
I suspect that some medical practices manage to include a more extensive examination in an ‘Annual Wellness Visit’ than what is described in the first paragraph above. This might include the physician listening to one’s heart and lung sounds via their stethoscope or manually palpating certain organs.
It is conceivable that a primary physician might see justification for billing an ‘Annual Wellness Visit’ as a ‘problem directed’ visit based on a patient’s medical history, or on abnormalities in laboratory findings, for example, which over the years might even have remained unchanged and not involved problems or been otherwise connected to any symptoms. These still, however, might be considered by a conscientious physician to be a ‘problem,’ opening the way for a more comprehensive ‘problem directed’ examination. I suppose if such practices exist, it is a ‘judgement call’ on the part of the physician as to what he or she might be looking for.
JL
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Our Liz Truss Moment
Paul Krugman’s May 21 posting on his Substack site included these comments on the international bond market:
‘In other words, until now markets have believed that the U.S. has the resources to deal with its deficit whenever it musters the political will. And bond buyers have been willing to assume that we are a serious country that will eventually get its fiscal house in order.
But markets’ patience with American dysfunction isn’t unlimited.
Consider how quickly things went wrong for the UK. In 2022 Liz Truss, Britain’s Prime Minister, announced a “mini-budget” that involved cutting taxes and blowing up the budget deficit. Markets freaked out: long-term interest rates soared and the pound plunged. The tabloid The Daily Star famously set up a webcam showing a photo of Truss next to a head of iceberg lettuce wearing a wig, and asked which would last longer.
The lettuce won, because Britain’s parliamentary system allowed it to get rid of a disastrous leader. We, unfortunately, can’t.
So are we facing a Liz Truss moment in America? Long-term interest rates are close to their highest level in many years’
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In our Constitutionly-based system, we are stuck with Donald Trump until 2028, elected by a misinformed and misled voting public in 2024, seduced by lies and appeals to barely hidden bigotry.
In a parliamentary system, he might right now be on his way out, just as the UK’s Parliament dumped Liz Truss during the fiscal crisis she brought on, more quickly that it took for the head of lettuce mentioned above to wilt.
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In the UK in 2022, their Prime Minister quit before the head of lettuce wilted. But that can't happen here. If you wish, blame it on the Founding Fathers who devised our Constitution. |
We can remove him from the presidency during his four-year term of office only via impeachment or the 25th Amendment’s disabilty provisions! I believe It is worth a try.
I suspect many Republicans agree but are afraid to open their mouths. Jackspotpourri went into this more deeply in its April 17 posting, easily accessed through the Archive off to the right.
There is too much at stake. Not getting our fiscal house in order can destroy our nation’s economy and everything that depends upon it.
The ability to borrow money on the international bond market at a reasonable rate is essential to any nation whose economy produces an annual deficit ... and you live in one.
JL
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Another Reason to Read a Daily Newspaper
Here’s a letter published in Friday’s Palm Beach Post (I have deleted the writer’s name). The criticism of our two Senators and the Congressman from the Northern part of Palm Beach County is well deserved.
‘Proposed Medicaid cuts will hurt Floridians - The United States is the only industrial nation that does not have universal healthcare for its residents. Of the 10 wealthiest nations in the world, we are the only one not to provide universal healthcare.
We have the most expensive medications. Our veterans and the elderly must wait weeks for medical care not performed in hospitals. And yet, Republicans in Congress are hellbent on cutting Medicaid and veteran hospitals.
Their budget plan will cut healthcare for 7 million to 17 million people.
Medicaid is the lifeblood for rural communities like Belle Glade and Pahokee. Millions of elderly and disabled Americans depend on the nursing homes financed through Medicaid. Cutting it will result in millions of people infecting others, closing facilities, and raising health insurance premiums. It is unconscionable that Sen. Ashley Moody now sanctions taking healthcare from the working poor, as does Sen. Rick Scott, the richest man in Congress because of the 'golden parachute' he received as CEO of Columbia/HCA after the company committed the largest Medicare and Medicaid fraud in U.S. history at the time.
The most reprehensible though is Rep Brian Mast, an Army veteran who lost both his legs while serving in Afghanistan, declaring, 'I am committed to working with members of Congress on both sides of the aisle to cut spending and responsibly shrink the size of our federal bureaucracy.' Cuts that would deny military veterans the services and resources he has enjoyed.’
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The legislators mentioned in the letter hold office only because of the grossly misinformed and misled voters who in 2024 cast their ballots for Scott, Mast, and for the Governor who appointed Moody when ‘Little Marco’ Rubio, ignoring the insults Donald Trump had thrown at him over the years, was sufficiently spineless to accept the job as his Secretary of State, necessitating his resignation from the Senate.
Blame for these legislators rests, if only partially, on those voters who do not read a local, daily newspaper and haven’t a clue as to who the Republicans budget-cutters they put into office really serve … and friends, it isn’t those same voters!
Bargain rate subscriptions to local newspapers like the Palm Beach Post, the South Florida Sun-Sentinel, and even the Miami Herald are available at their websites, and all provide a decent amount of national and international news as well as the more local news you won’t find in the New York Times.
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Incidentally, my letter to the Palm Beach Post, mentioned in the May 21 posting of Jackspotpourri, was printed in that newspaper’s May 24 edition.
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About Opinion Pieces: When you read an ‘opinion’ piece in any newspaper, it is important to identify from where the writer is coming. Journalists, although they may have strong opinions, are engaged in reporting and writing ethically about things as they see them. This also applies to writers from the academic world who don’t hesitate to voice their opinion. This warrants your giving more credence to what comes from the pens of these sources, even when you disagree with it, than opinions of writers who are full-time employees of organizations dedicated to certain goals and however much expertise they might possess, are little more than mouthpieces for their employers’ views.
JL
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Flooded Out? - Blame FEMA!
Check out Heather Cox Richardson’s May 23 posting (https://substack.com/@hrichardson) to see how massively misinformed Trump’s supporters in flood-ravaged western North Carolina are, and the real harm they are doing to themselves by swallowing Republican lies, convincing them that FEMA (the Federal Emergency Management Agency), part of the Department of Homeland Security, is the cause of their problems and would best be done away with.
This is no longer a political problem; protecting and saving human lives are at stake, but since when have Republicans really cared about that?
JL
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A Book Worth Reading, or Re-Reading
Arthur M. Schlesinger, Jr.’s monumental ‘The Age of Jackson,’ winner of the Pulitzer Prize for History back in 1945, eighty years ago, expounds ageless ideas. Rather than go into the details of the book, here are two quotes that should let you know what it is about. First is a dedication at the very start that quotes Nineteenth Century historian and politician, George Bancroft:
“The feud between the capitalist and the laborer, the house of Have and the house of Want, is as old as social union, and can never be entirely quieted; but he who will act with moderation, prefer fact to theory, and remember that every thing in this world is relative and not absolute, will see that the violence of the contest may be stilled.”
Each of the book’s 37 chapters is prefaced by a brief paragraph hinting at what that chapter will be about in much greater detail. Here is the author’s such paragraph introducing the book’s final chapter:
“XXXVII – Traditions of Democracy: The tradition of Jefferson and Jackson might recede, but it could never disappear. It was bound to endure in America so long as liberal capitalistic society endured, for it was the creation of the internal necessities of such a society. American democracy has come to accept the struggle among competing groups for the control of the state as a positive virtue – indeed, as the only foundation for liberty. The business community has been ordinarily the most powerful of these groups, and liberalism in America has been ordinarily the movement on the part of the other sections of society to restrain the power of the business community. This was the tradition of Jefferson and Jackson, and it has been the basic meaning of American liberalism.”
Between these two quotes are about 577 pages of American History which are just as pertinent today as they were in the third, fourth, fifth, and sixth decades of the Nineteenth Century. Although electronic media did not exist in those years, the proliferation of political opinion, mostly in newspapers and other journals, probably exceeded what is available today on TV and the internet! And what transpired in Congress and in government agencies was meticulously documented. Schlesinger makes great use of these sources.
Not incidentally, the rise of a class of industrial and shop workers in America during this period, having secured voting rights despite their possessing neither property nor wealth, heralded the contributions of labor to the nation’s economy and was catered to by mostly insincere politicians and Parties who were not at all eager to bring about changes in whom the government favored.
Ideas connecting human labor with the creation of wealth were already prevalent in the United States, even before Karl Marx wrote about them in Germany in the 1850s, as were efforts by the business and banking communities to oppose them during ‘The Age of Jackson.’
It was an environment of a growing nation struggling internally to deal with physical expansion and the continued existence of slavery under the guise of preserving the rights of States. This ultimately led to the Civil War.
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(I want to point out that Arthur Schlesinger has been faulted for not writing about Jackson’s support of slavery [he ‘owned’ many] and his mistreatment of Native Americans, dark issues which might have had something to do with his ability to remain popular with the common laboring man and farmers who sometimes saw these attitudes to be to their advantage. In addition, Jackson had their support because of his successful efforts to end the private banking system which favored the wealthy, businesses, and the newly emerging corporations of that era.
Although he was succeeded in 1836 by his Vice-President, Martin Van Buren, Jackson’s popularity did not suvive the unification of his opponents into what became the Whig Party, which soundly trounced Van Buren in the 1840 elections. The two presidents elected by the Whigs (William Henry Harrison in 1840 and Zachary Taylor in 1848) both died soon after being elected and were succeed by their vice-presidents (John Tyler and Millard Fillmore); the Whigs were never really able to replace the conservative Democratic Party that survived ‘The Age of Jackson’ and did not stand in the way of the Civil War.)
JL
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Housekeeping on Jackspotpourri
Your comments on this ‘blog’ would be appreciated. My Email address is jacklippman18@gmail.com.
Sources of Information on Jackspotpourri: The sources of information used by Jackspotpourri include a delivered daily ‘paper’ newspaper (currently the Palm Beach Post, a Gannett publication) and what appears in my daily email.
Be aware that when I open that email, I take these steps:
1. I quickly scan the sources of the dozen or two emails I still get each day at my old email address to see from where they are being sent. Without reading 99% of them, I usually immediately delete them.
2. I then go to the email arriving at jacklippman18@gmail.com. Gmail enables ‘Promotion’ emails to be so designated and separated out. I believe their criteria are whether or not they end up asking for donations or if they are no more than advertisements. I ignore most of these emails without reading them, deleting them. A very few, perhaps one or two a day, get moved over to the two or three dozen other emails which I will actually open.
3. Then I read my email.
Besides email, my other source of information is the Google search engine where I can look up any subject I want.
Lately, these search results have been headed by a very generalized summary clearly labeled as being developed by AI (Artificial Intelligence). I do not use such summaries in preparing Jackspotpourri.
Following such ‘AI’ search results, there follows the results of my initially having accessed Google (or any other search engine) for information. Contrary to the AI-generated summaries, the sources of these results are clearly indicated.
I feel that It comes down to who YOU want to be in the driver’s seat in seeking information, yourself or something else (AI), the structure of which somewhere along the way had to have been created by others, with whose identity I am neither familiar nor comfortable.
(In doing searches on Google, I have found that these AI summaries can sometimes … but not always … be avoided by saying so in your search. For example, instead of searching for ‘FDR’s New Deal,’ I might search for ‘FDR’s New Deal – No AI.’ This is a work in progress.)
Forwarding Postings: Please forward this posting to anyone you think might benefit from reading it (Friends, relatives, enemies, etc.) If you want to send someone the blog, you can just tell them to check it out by visiting https://jackspotpourri.blogspot.com or you can provide a link to that address in your email to them.
There’s another, perhaps easier, method of forwarding it though! Google Blogspot, the platform on which Jackspotpourri is prepared, makes that possible. If you click on the tiny envelope with the arrow at the bottom of every posting, you will have the opportunity to list up to ten email addresses to which that blog posting will be forwarded, along with a brief comment from you. Each will receive a link to click on that will directly connect them to the blog. Either way will work, sending them the link to https://jackspotpourri.blogspot.com, or clicking on the envelope at the bottom of this posting.
Email Alerts: If you are NOT receiving emails from me alerting you each time there is a new posting on Jackspotpourri, just send me your email address and we’ll see that you do. And if you are forwarding a posting to someone, you might suggest that they do the same, so they will be similarly alerted. You can pass those email addresses to me by email at jacklippman18@gmail.com.
JL
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