Too Good to be True; Lessons in Gratitude

The end of summer is upon us. In little more than a week, Labor Day will roll around and for those of us who are slaves to fashion, we will put away our summer whites and move into the fall taupe season. Of course, there are other events occurring that have resulted in big changes!

For reasons unknown, Democrats in Congress have decided to take advantage of this end-of-summer energy and pass remarkably important legislation that will have an impact on the lives of many aging adults for years to come. The legislation itself is dense and complex, but the outcome is pretty straightforward.

The Inflation Reduction Act

American’s who are using Medicare as their health insurance will see a cap in their out-of-pocket costs for medicines starting in 2024 and finding full benefit by 2025. The implementation of these benefits will take a couple of years because the rules and regulations that govern how prescriptions are paid for are so convoluted that it will take that amount of time to untangle and then re-write them to achieve the goal of saving money. But it will be worth the wait!

Another, more behind-the-scenes benefit that will have long-lasting impact, is handing the power to negotiate with pharmaceutical companies back to the Secretary of HHS rather than leaving it solely to the pharma folk to inform the Centers for Medicare and Medicaid (CMS) what they would have to pay for the latest product being brought to market. This may not seem like much, but now the government will be able to say to pharma, “Your price is too high! Bring it down.” and pharma will have to come to the table a negotiate. Before, there was no discussion!

The enforcement piece of this is drug manufacturers that fail to comply with negotiation requirements are subject to civil penalties and excise taxes. While this benefit is quite limited (only 10 drugs will be negotiated the first year), assuming this works as is intended, the astronomical fees charged for a mere change in molecule will now be on the table for discussion. That’s a first!

Infrastructure Jobs and Investment Act

While the focus of this bill was on getting roads and bridges made safe again, one seemingly minor part of this Act has to do with establishing requirements and incentives related to increasing energy efficiency in homes, commercial buildings, manufacturing facilities, public schools, nonprofit buildings, and federal buildings.

This is particularly important for aging Americans as many of the places we reside are energy inefficient. For property owners who are on limited incomes, where the home may be the sole asset, there is little incentive to upgrade to higher energy efficiencies. Yet, without making these upgrades, we put ourselves at risk. These risks include health issues related to extreme weather (too hot; to cold), water quality (lead pipes), and exposure to toxins in building materials (asbestos). This bill will make money available to address these issues.

When it comes to facilities, these incentives will become vital in upgrading and providing safe environments for those of us who will need some form of assisted living or skilled nursing. Not all of us will be able to age-in-place, and communities will be able to apply for funding to expand both where and how services are provided and insure energy efficiency. No more nursing homes without proper heating and air conditioning.

More Change on the Horizon

As impactful as these new laws are, still more needs to be done. The student loan forgiveness plan is controversial. It could have an enormous impact on who may choose to become a psychologist, geriatrician, nurse practitioner, or healthcare provider. Costs for completion of degrees in these areas are astronomical. A common complaint of newly-minted physicians is how much their loan debt contributes to over-all stress.

How would health care be improved if folks who are called to be of service in these different areas knew that their education would either be subsidized or supported through loan-repayment-work-agreements (e.g., the Northern Exposure model – two years of service in a needed area in exchange for loan forgiveness)?

Unprecedented Times Call for Unprecedented Actions

It will take time for many of us to see the benefits of these bills. The gap between what is done in the halls of Congress and how it plays out on the streets of your neighborhood is enormous. Yes, there will be misappropriation of funds and mistakes. And, there will be folks who make good use of the opportunities afforded them and actually improve lives. Of course, there will be reinforcement of the status quo. That just seems to be human nature.

Still, these bills mark a shift in “business as usual”. There exists a possibility that roads will actually be repaired and bridges made safe. That railroads will carry freight across the country without contributing to carbon emissions by switching to hydrogen fuels. There is a good likelihood that local communities will see EV stations on every block alongside gas stations.

I Hope I Live Long Enough to See

One of the realities of being older is that I won’t see some of these wonderful things come to be. But I really do hope I live long enough to see medicines come down in price and be made available not through advertising on TV, but through conversations with trained healthcare providers who want to use cutting-edge discoveries to improve the quality of my life.

I really do hope I live long enough to ride a bullet train between San Francisco and Los Angeles in three hours. I hope I live long enough to take advantage of incentives that will make my home energy efficient, safe from fires, and no longer dependent on electricity. I hope I live long enough to experience a sense of predictability and security that is elusive at the moment.

Invitations of the Fall

This time of year invites us to start things anew, to return to familiar places with new pencils and writing tablets. To reconnect with friends and classmates and begin a new year of learning; to think ahead to what needs to be done before the coming winter and to enjoy the last lingering twilight of a summer now fading.

I am no longer a slave to fashion. I dare to wear white after Labor Day and I do it with impunity!  I also have hopes that the bills passed during these last weeks of summer will create a ground swell of renewal in communities across the country. There is so much that needs to be done.

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