A dinner table discussion for seniors—an “organ recital” and talk of falling.

In this episode, Gary tells listeners about a dinner with friends that started with the usual "ills and pills" discussion and closed with the premise that Dirty Harry (Clint Eastwood) might have some good advice for seniors dealing with slowly diminishing capabilities. A fun evening with some interesting insights.

Sam Toperoff died this year, and that makes me really sad.

I never met Sam, but as all good writers do with their readers, he created a connection. I felt I knew him as a friend after reading his essay In The Land of the Very Old. There are no geographical coordinates for this strange place. It’s a state of mind Sam conjured up about aging. In this sweet piece of writing, he describes his journey from living in the “old country” to his new home in the “land of the very old.”

Last March, I posted a podcast episode recommending Sam’s essay to Camp Codger listeners. While preparing the podcast, I reached out to Sam, asking his permission to use a photo he took at his home in the French Alps, where he lived with his wife, daughter, and grandson. Sam never replied, but I assumed he would be okay with it since the episode was about Sam and his essay.

A few weeks ago, I became curious about what Sam was up to and discovered the sad news…Sam was no longer with us. It matters to me because I’m approaching “the land of the very old,” and he was a guide. I’m not at the border yet, but I can see it in the distance. Thanks to Sam’s depiction, the “land of the very old” seems like a good place. Not perfect, of course, but, as he says using a bittersweet chocolate simile for the “land of the very old,“ “the bitter is really not so terribly bitter, the sweet, when it comes, is surely a good deal sweeter than it has ever been.”

With his first essay about his new life in the “land of the very old,” Sam made a connection with thousands of readers. The response by his new friends, hundreds of who responded with emails, caused him to write a follow-up essay. In the Land of the Very Old, Part 2, which was published after his death, Sam continues his story about residing in this strange new place. And he must have been planning on keeping the conversation open since he even suggested he was getting a visa to the “land of the very, very old” as he was approaching his 91st birthday.

I was moved by Sam Toperoff’s passing because he was an inspiration. Not headline-news inspiration about a random old person doing some impossible feat for an 80-year-old. No, Sam inspired me because he continued to keep doing what he loved and did so well. At 90, he was still creating and writing, even as he was aware of the creeping limitations that make everything just a bit harder as we grow older. I continue to do this podcast at 76 because Sam is showing me the way.

Thanks, Sam. We never met, but I’ll miss you. I was looking forward to your take on your life in the Land of the Very, Very Old. I know it would have been a good read and a pretty good place to be.

Thanks for listening. I encourage you to read Sam’s essays. They’re long but worth the time. The links are below.

In the Land of the Very Old In the Land of the Very Old, Part 2

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Gary returns with an episode about receiving an insane EOB (Explanation of Benefits) from United HealthCare.

Today, it’s a rant, but I promise to make it a short tirade. The trigger? My latest EOB statement from my healthcare insurance company. To be honest, I seldom download and open these statements. I’m a big fan of Medicare and have a really good Advantage plan thanks to my late wife’s retirement program. Until this year, I have had the good fortune of being relatively healthy—no major illnesses or chronic medical issues. I typically incur few medical expenses, and it never costs me more than a small copayment for any procedure. My healthcare insurance company? UnitedHealthCare. Yes, the purported Darth Vader of the healthcare insurance evil empire.

On to my rant. So, I opened this new statement and was blown away by the year-to-date numbers it presented. The top line was enormous. My providers—the labs, imaging facilities, clinics, and doctors who delivered services—billed UnitedHealthcare over $256,000 from January to October. I know I was diagnosed and treated for prostate cancer, which isn’t cheap, but a quarter of a million dollars? I might add that I did not spend one night in a hospital or have an operation in a surgical facility. Now, the relevant numbers were the actual payments to the providers and my share of the costs. UnitedHealthCare paid a bit under $33,00, 13% of the billed amount. My out-of-pocket share was an incredibly small $521.

This begs the question about what kind of screwed-up system, knowingly and with a straight face, bills anywhere from five to eighty times the negotiated cost of a medical procedure? Every provider knew precisely what they would get paid by my Medicare insurance company before they submitted the claims. These are pre-authorized payments, yet they still billed these egregious amounts. Why did a urologist bill over $23,000 for a 15-minute, in-office procedure, knowing they would get paid $279?

As I noted, I have the good fortune to have a decent Medicare Advantage plan that pays for almost everything. My concern is for the poor patient who sees an enormous unpaid balance and wonders if they will be required to cover it. Sure, there’s a note in the EOB saying you should not be billed for the balance, followed by another notation that the patient may need to pay a copayment, coinsurance, or deductible. So, am I on the hook or not? No wonder there is so much anxiety today around medical treatment and its costs.

In my humble opinion, the medical-industrial complex of healthcare providers and insurance companies maintains this evil pricing charade to take advantage of the disadvantaged. These obscenely inflated prices are the starting point for unfortunate patients who may be underinsured or even uninsured. How many families have lost homes or gone bankrupt based on their inability to pay these fantastical prices?

Explaining the complexities of the healthcare payment system is way above my pay grade. Still, these thoroughly confusing payment practices can partially explain the anti-healthcare sentiment rampant in our country. And we haven’t even touched on the burden of self-advocacy placed on patients dealing with complex medical issues. Or the simple frustration of just trying to ask their healthcare provider a simple question. Leave a MyChart message? No response. Call the office? Listen to a long phone tree before being sent to voicemail. Leave a voicemail message? Ignored. As you can probably tell, I’ve dealt with a few challenges over the last nine months.

My tirade was triggered by a stunning Explanation of Benefits statement from UnitedHealthCa...