Rubio is the best choice

If Ronald Reagan were alive today, whom do you think he would support for president?

Reagan had famously said he would back the most conservative candidate who could win.

Currently, Donald Trump leads the pack among the Republicans. He is not a true conservative since he favors socialized medicine, thus putting him in the same league as Bernie Sanders. As Reagan used to say, with socialism, they start first with medical care and then go on to the rest of the economy. It would cost our nation $28 trillion to fund a single-payer system. Even if we confiscated the entire wealth of the hated one percent, it would not be enough, since we do not have 28,000 billionaires or 28,000,000 millionaires. So there will be an astronomical tax increase for the 52 percent of the population who constitute the tax-paying middle class, since 47 percent pay little or no taxes.

Trump has successfully tapped into the unbridled anger of those who are frustrated by the failed policies of President Obama. But is he electable? The recent Jan. 30, 2016 Gallup poll showed that Trump has the highest unfavorable rating of any candidate ever since Gallup began tracking the indicator in 1992. He has an unfavorable rating with 60 percent of Americans, versus 33 percent who view him favorably. This is not surprising, considering that Trump has systematically insulted prisoners of war, Mexicans, unattractive women, Muslims, and every single one of his Republican rivals (and hence their supporters). If Trump wins the Republican nomination, Democrats will dance with glee as they look forward to a 60 percent landslide.

In that same Gallup poll, Democrat Hillary Clinton has an unfavorable rating of 52 percent, with Republicans Jeb Bush at 45 percent, Ted Cruz at 37 percent and Marco Rubio at 33 percent. Not only is Marco Rubio the most electable, but he also has the charisma, youth, enthusiasm, charm and eloquence reminiscent of yesteryear’s John Kennedy. He will attract the conservatives, the young, the Hispanics, the minorities and the independents to forge a broad coalition that shares his vision for the future. In contrast, Ted Cruz is too much of an extremist for the independents, and the electorate is tired of the Bush and Clinton political dynasties.

West Maui Republicans will make their choice at the Presidential Caucus to be held on Tuesday, March 8, between 6 and 8 p.m. at the Lahaina Civic Center. Hopefully they will vote with their brains rather than with their emotions.

BEN AZMAN, Lahaina

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Maui agriculture at a crossroads

The letter “Support agriculture” by Michele Lincoln in the Feb. 4 Lahaina News was edited very well, and I feel she was correct in the statements made. I hope someone out there implements the facts written in that letter.

People with insight should share their thoughts today as we enter into dangerous crossroads. Hawaii has all the special elements for growing healthy food and medicine, especially on Maui.

Industrial hemp and medical marijuana will probably not be accepted to cultivate in Hawaii, even though it should be studied and voted on.

Food is the most important element, and water should be the priority to consider. Good living and prayer will bring rain to these islands. Water catchment and preservation are important to sustain enough water (rainfall) for our crops and drinking necessities.

Local food costs could be lower and can be made up in exports to Mainland stores. Mainlanders love food from Hawaii, and Mauians can save money, buying local.

There are so many ideas for exporting food; hydration is an inexpensive way for long shelf life using vegetables, fruit, fish and meat, to name a few.

If we don’t implement these ideas, “they” will turn Maui into Oahu. What is your choice: more cement, roads, expensive housing, Mainland invasion… or production of food and preservation of Maui land? We need a better voting system in Hawaii!

ENRIQUE GUZMAN, Lahaina

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How Medicare covers prescription drugs

Did you know that Medicare helps pay for prescription medications?

Even if you don’t take many prescriptions now, you should consider joining a Medicare drug plan. There are two ways to get Medicare prescription drug coverage.

Medicare standalone drug plans, also known as Part D plans, add drug coverage to Original Medicare, as well as to some Medicare Cost Plans and Medicare Private Fee-for-Service plans. You must have Medicare Part A or Part B to join a standalone Part D plan.

Medicare Advantage plans and other Medicare health plans often include prescription drugs. Medicare Advantage plans are managed care plans, similar to HMOs or PPOs. Many, but not all, Medicare Advantage plans offer prescription coverage. To join such a plan, you must have Medicare Part A and Part B.

You can sign up for either type of drug plan when you first become eligible for Medicare or during Medicare’s open enrollment season, which runs from Oct. 15 to Dec. 7 each year.

Beware: If your Medicare Advantage plan includes prescription benefits and you join a Part D plan, you’ll be dis-enrolled from your Medicare Advantage plan and returned to Original Medicare.

How much does a Medicare drug plan cost? It varies, depending on what plan you choose, which drugs it covers, which pharmacy you use, and whether you’re eligible for the Extra Help program (more on that later).

Most standalone, or Part D, plans charge a monthly premium, which you must pay in addition to your Part B premium. If you’re in a Medicare Advantage plan, the monthly premium for that plan may include an amount for drug coverage.

Most Medicare drug plans also have a yearly deductible, an amount you must pay before the plan begins paying for its share of your drugs. Once the deductible is met, you’ll also pay a co-payment or co-insurance amount at the pharmacy counter.

In addition, most Medicare drug plans have a coverage gap, also known as the “donut hole.” The gap begins after you and your drug plan together have spent a certain amount for your drugs. For more details on the gap, see the “Medicare & You” handbook, mailed to every Medicare beneficiary annually and also available online at www.medicare.gov/Pubs/pdf/10050.pdf.

Once you’re out of the gap, you get “catastrophic coverage,” which means you only have to pay a co-payment or co-insurance amount for your drugs for the rest of that calendar year.

However, not everyone will enter the coverage gap because their drug costs won’t be high enough. The gap is scheduled to be eliminated by 2020.

Keep in mind that not every Medicare drug plan covers every drug. You’ll need to check with the plan to make sure that the drugs you need are covered. Also, plans may have restrictions such as prior authorization, quantity limits, and step therapy, which requires that you try a lower-cost drug before the plan will cover a high-priced medication.

You or your prescriber has the right to appeal if you believe that such a rule should be waived.

I also want to mention the Extra Help program, which assists low-income folks in paying for their prescriptions. If you qualify, Extra Help can save you thousands of dollars annually on your drugs.

For more details, see the “Medicare & You” handbook.

DAVID SAYEN, Medicare’s Regional Administrator for Hawaii

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Residents misled on West Maui Hospital’s role

In answer to the letter in the Feb. 11 Lahaina News asking why I still write letters about the proposed West Maui Hospital (WMH) whenever there has been a meeting or notice about the hospital, it is because the public continues to be told that the WMH would be a “life-saving, full-service, first-responder hospital” – the first place where a critical patient on the West Side should be taken in the event of a serious accident or other life-threatening condition – and it can’t. While that is what the public wants, it is simply not true or realistic.

In the event of one of the major life-threatening conditions – heart attacks, strokes or serious accidents (i.e. trauma) – the best chance for survival depends on the patient getting promptly to a facility capable of giving very complicated treatment generally within the “golden hour.” For heart attacks, that means getting immediately to a cardiology team and cath lab (catheterization laboratory) that can open the blocked artery to the heart before the patient dies; for strokes, to a stroke team with imaging and complicated management of the block to the brain to prevent a disabling stroke; and for serious trauma, to different surgical specialists and teams to do complex procedures in high-end operating rooms that can stop internal bleeding that can result in death. None of this, plus the ready availability of the multiple physicians in each specialty necessary to provide 24/7 coverage, could be available on the West Side in a WMH, whereas it is available at Maui Memorial Medical Center.

The argument that is made by the promoters of the WMH that these patients should go first to the WMH for stabilization is simply not valid. Stabilization requires the most complicated part of the management – that which is only available in a true medical center such as MMMC, and it must be given promptly. Bypassing the small non-medical center hospital (that does not have the life-saving assets necessary) and going directly to a comprehensive medical center has been the accepted guideline for care for well over 40 years, not only nationally but internationally. This can be checked with the American Association of Surgery for Trauma, the American College of Cardiology, the American College of Surgeons, and any physician on Maui who does critical care medicine.

Going to a WMH as the first step for initial management would only delay the patient getting to MMMC in time – costing lives, not saving them. Not all hospitals are the same. Putting a sign “hospital” on a building one has erected does not make it equivalent to MMMC.

When I retired from the Army and began practicing in Central California, ambulances were taking serious accident cases to the “nearest” hospital, which often did not have surgeons, anesthesiologists, blood banks, etc., and patients died. We changed that to bringing the accident victim directly to a trauma hospital, such as MMMC is, so that we had a chance to save the patient. Even back in the 1960s in Vietnam, we bypassed the clearing stations and battalion aid stations and brought the casualties directly to us at our “MASH.”

The use of medevac helicopters for transport from the WMH to Oahu (as the letter writer suggested) is not an option. The time expended for mobilization of the helicopter, the flight, and getting to the hospital on Oahu would far exceed the time to transport the patient directly to MMMC by ambulance on our highway, which has wide shoulders that allow vehicles to make way for the ambulance. During the trip, the paramedics can do most of what can be done in a small emergency room.

The letter writer asked why I speak out on this. It is because we in medicine have a responsibility to the public to speak out when something serious regarding their health care is not on the level. Who else can let the public know? It would simply be wrong not to do so.

Although criticized, the only reason that I listed my experience in the previous letter was to provide credibility to what I was saying. I am retired from a regular office or hospital practice, have no conflict of interest, and as far as I know, I am the only physician with an extensive experience in managing immediate life-threatening conditions who lives on the West Side.

The promoters of the WMH are in real estate and property development; they have not included in their planning or foundation even one physician who has cared for life-threatening conditions. The two problems that result from the false expectations given to the public are that the public has donated a lot of money based on those, and in the event of a life-threatening condition, some may insist that they, their family or someone else be taken to WMH instead of directly to MMMC with dire consequences.

The letter writer mentioned that her husband barely arrived at MMMC in time to save his life. I do not know the circumstances, but if he had been delayed at a hospital on the West Side not capable of giving the treatment necessary, he might not have had his life saved. The letter mentioned some difficulty with the ER staff at MMMC, and also that I am against having a medical facility on the West Side. First, I am not against having a medical facility on the West Side at all, but it should be, and correctly portrayed to the public as, for the management of non-critical and non-life-threatening situations. This could be both a great convenience for those on the West Side for these lesser but urgent conditions and take some of the load off of the Emergency Department at MMMC, possibly obviating what the writer went through. Appropriate non-critical hospital care and long-term care (such as assisted living as the letter writer mentioned) could also be valuable.

I am glad that the letter was sent in, so that I could address the mis-information regarding the WMH that is still being put forward to the public. Even though the writer withheld her name and that of the other “WEs,” I am in the phone book, my contact information is readily available, and I would be most pleased to meet with the writer and any of the others over a cup of coffee or such so as to try and explain the situation more easily.

DR. GEORGE S. LAVENSON, Lahaina