The Work Begins

Let me explain two medical conditions that affect my treatments: I hate shots and the resulting numbness; I have an extreme gag reflex. In preparation for the work, Dra. Cubero asked if she could receive recent x-rays from my US dental team. No reason to incur the expense if things were available; and they were.

With the first procedure, replacing a rather large cracked filling, I was given a shot after some modest
numbing substance was applied. Never felt the shot. Dra. Cubero took out the old filling and replaced it. The filling replacement cost $50

Next she took impressions for the bigger job: the repair of a broken molar.  She used a half plate for top and bottom impressions, taking each independently.

No gagging occurred. I could not believe it, another plus. 

The initial intent was to do an in-lay procedure; the cost would be about $300-$400, considerable less than a crown in the US at an approximate cost of $1500.

The Big Job

It turns out that after further review of x-rays and mold impressions the in-lay would likely be unsatisfactory for an extended period. A crown was a more suitable solution.  At this point I was wondering if I was getting the bait & switch strategy. However, it seems that the crown was generally the same cost.  Also the same discussion regarding gold vs. porcelain, gold was less but more durable.

Now, however, a time factor has come into the picture, I would be leaving Costa Rica in 3 weeks. Not long enough to complete the work and have time for follow-up procedures. My return schedule was also unclear.  In the end, it was decided that Dra. Cubero would file the tooth a bit and add some material to protect the tooth, with the expectation it would last 6-9 months, followed by a periodontal check.

The next appointment is yet to be decided, but total cost for the above services was $60.  I will be submitting the two charges for $110 to my dental insurance carrier to see what, if any, reimbursement I will get. Even if they deny everything, I’m still ahead, and I feel very positive about my encounter with the Costa Rican dental system.

Consequently, I may utilize Dra. Cubero’s services for regularly.

In the past I have written articles and comments regarding the cost of health care in the US and whether we should support the Obama PPACA legislation. I’ve also discussed the potential of getting some services done outside the US for significant cost savings.

I’ve further pointed out that if Medicare allowed payment for such services, the country would save a tremendous amount on its health care costs.

“Put Your Money Where Your Mouth Is”

Most have heard the statement above, or maybe it was:  Put up or shut up.  Well, I decided the time had come for me to take the step and put my money and my mouth together.  I live currently near Jaco Beach in Costa Rica and have been here for a few weeks, coming with a chipped a molar and an old filling that was cracked. I do have regular checkups, some periodontal work and I have dental insurance.

I expect that for the filling and the tooth repair with a crown the cost would be around $1600 in the US. With deductable and my co-pay, it would cost me close to $900 even with my insurance.

Selecting a Dentist in Costa Rica

On a previous trip to Costa Rica, I spoke with a US colleague, who was having all his fillings replaced by a local dentist. I called him when I arrived to see how things went. He was very pleased and would not hesitate to recommend the doctor.  Unfortunately, the local dentist was not in Jaco.

So, I was forced to find an alternative. If possible, it would help show that the system has a range of good providers, just like the US.  So I began to ask around, as to who is good and who should be avoided. I was surprised at the amount of choice I had in Jaco, a town of probably 15,000 people.  One of the options was a practice that included three females “Dentistas”, all trained at local universities.

My First Visit

The Doctor I met with on my first visit to the Premier Dental Care Center was Dra. Selena Cubero, a dental surgeon, who is on the national board of dentists.  It should be pointed out to US readers, in Costa Rica the dental doctors and the medical doctors are all together in the practice of medicine, not separate like in the United States. In this instance her practice is associated with CIMA Hospital, one of three private hospitals certified in Costa Rica by JCAHO, the same organization that certifies US hospitals.

My first visit was exploratory: meet the doctors, learn the services, how they operated and who is their clientele, English language skills, etc.   I believe it is very important in health care that mistakes or misunderstandings don’t occur as a result of language skills.

Dr. Cubero took a fair amount of time giving me answers to all my questions, gave me a short tour of the facilities and then examined my teeth. We then talked about what she thought that needed to be done. I didn’t give her any details of the specifics, as I wanted to see how her review would line up with my dentist of many years, a second opinion of sorts.  She hit all the key points including a question of getting periodontal work.  I was impressed. A half hour later I left without charge, but with another appointment.

Is anyone looking out for your welfare?  We know the folks in Washington and Lansing seem to have trouble making good decisions. A recent story regarding the AARP has caught my attention and makes me wonder if we have another institution that has their own agenda and not necessarily the interests of its membership in mind.

With the big fight last year about the federal budget, we saw that one of the options discussed were cutbacks in Medicare & Social Security.  You may recall the head of AARP saying he might be able to support the idea.  Well after the dust settled, he was gone. So you might think it is a dead issue. Now it seems that AARP has a new initiative which involves a lot of meetings and options for its members to express their opinion on the matter.  Sounds like a good plan. However, it strikes me as a lot of smoke & mirrors to cover moving in a direction they probably already have established.

What is the real plan?

You have to be pretty naive to think the membership of AARP is interested in how to reduce their benefits. They want what they have, if not more, and they want it safeguarded. A national campaign of “listening” is not needed to establish the position of the AARP membership.  The leadership needs to present a menu of options for securing the benefits of SS & Medicare and then ask people which choices they like best.  Here is an example . . . (I’m sure the experts at AARP  and the Congress ought to be able to do as well) -

Options to Consider for Medicare

1. Change Medicare benefit coverages to lower cost solutions, but with higher coverage allowance.  Establish the formula so that total outlay is less than the current plan.  A 10% saving would be a big deal for everyone.
   
2. Make lower cost solutions and reimbursements easier to process for both patient and provider.  The provider could save on administration and be the advocate to the patient.
   
3. Make Medicare payments for services available in foreign countries.  Use a lower payment schedule, and easy reimbursement methods to certified service providers. It protects the patient and would take advantage of low cost operating systems, a double savings.

Options to Consider for Social Security

1. Employers who are convicted of hiring 'illegal immigrants’'' could be assessed a premium of 1% on the employers contribution to Social Security for 2 years for all legitimate employees.
   
2. Allow employees to contribute an extra 1% to their account above required amounts to be invested in government securities with a return of 75% of the going rate on such securities in the international market.  It then becomes a low cost option for the government and makes us less dependent on foreign investment. The employee increases their retirement benefits with deferred taxable interest, or non-taxable income.

Get your Thinking Cap on!

Just think, all of these options could be presented for consideration with no reduction to benefits. How about this for an AARP strategy?

To learn about AARP’s campaign and see the TV ad, visit www.aarp.org/protectseniors.

Nothing Changes - Unless You Do

A few years ago I was starting my first consulting company, one of my potential partners decided he would take some time to sail, before getting too involved. A 5 month excursion turned into a seven year lifestyle change. Eventually he decided maybe he needed to go back to work. He was very apprehensive about his ability to contribute. He had previously held a significant Human Resources position with a local leading company. We assured him he would be OK.

My associate’s main concern was the changes in regulations and how people managed in the new progressive environment.  After a few months of several clients and a variety of projects, an evening discussion over a glass of wine or two, covered various issues and solutions. My associate finally stated he was doing just fine in the consulting game.  A single observation seemed to sum up his thoughts: Nothing has changed. The same type of employees are the problems; managers make the same mistakes at the same point in their career progression, and the driving forces behind business decisions is pretty much the same. The regulations are a sideline.

What about results?

In many instances the results are the same, because processes are the same. Where the results are less forthcoming, it may be the result of a new type of competition, or the market is focused on a new need. One new element in the picture that seems to be impacting results is the use of technology in smaller niches of business operations. All sorts of people are using computers, smart phones, e-books and applications for unique situations. The compounding of these little changes is making a difference. It is slowly cutting back on the need for people with limited skills.

Those people who (I hate to use this phrase, but) “think outside the box” are shaping the world around us in a number of subtle ways. They are the people who are essential to the organization if it is to be sustained. They are the people who progressive organizations must attract and retain.

Every time business starts to ramp up, managers and owners begin to focus on critical resources and what they need. A light bulb goes on and someone says we can’t afford to lose Billie Bob, or Sara Slick.  So the first thing they do is throw some money at them and the price wars begin. New surveys are starting to show the re-occurring trend.  Then the cost of employees gets out of hand and everything evolves in much the same fashion as in the past. But like lemmings we line up doing the same things to retain the critical employees and keeping things in balance with the rest of the staff.

So my old associate seems to be right, time goes by, but nothing changes. It reinforces the old adage that insanity is doing the same thing over and over again, but expecting different results.  So let me propose a new strategy and process:

                1) Don’t wait until the crisis occurs, find out what your essential employees are thinking and                      react early.

                2) Create an environment that is more valuable than money to attract and hold employees.

 
POSITIVE OUTCOMES

We often see statements like ‘half of being successful is showing up’, or ‘get back on the horse if you fall off’, or ‘get up when you fall down’.  They center on perseverance being the key to success.  Even many of the Hollywood stars only begin to be viewed as successful after they have been around a long time. They just keep doing things that make them visible.

There is one item that I believe indirectly is a critical factor in success; a factor that is often seen but perhaps not recognized for its important contribution. That factor is a positive attitude.  If you don’t have it, ‘getting back up’, or ‘staying the course for the long haul’ is pretty difficult. A negative attitude by contrast achieves a failed outcome very rapidly. So, is there an underlying personality trait that supports a positive attitude? Something that is shaped over an extended period of time and therefore difficult for everyone to achieve? I don’t think so! It just takes a little effort to think of, and look for the positive outcome.

NEGATIVE IS EASY

The problem is we get bombarded constantly about the negative events of the day. Because that gets people’s attention. It sells newspapers and gets people watching television.  Even political campaigns seem to get better attention when the focus is negative. The number of good things in relation to bad things that are reported is pretty small.  Consequently, having a negative approach to life is pretty easy.  We report the number of people unemployed and even speculate on who no longer is looking for work so the number is higher. Why not focus on how many people are employed which is a concrete number usually in the 90% plus. Economists even recognize that consumer confidence has remarkable impact on the economy, so why not emphasize the good things that are happening? Even medical studies show that happy and positive people live longer.

NEGATIVE  LIFESTYLE

It makes no sense to focus on the negative results, but we do it constantly. Some people say it’s a way to identify opportunities to improve things. I’ve even heard it said that if I have low expectations, I’m not disappointed as often.  That seems like an awful waste of life to live with the expected black or gray cloud over your head. 

YOU REAP WHAT YOU SOW

I’m for random acts of kindness, smiling at people for no reason, believing the outcome tomorrow will be better if only in a small way. Self-fulfilling prophesies happen. The upbeat sales person is always more successful than the one that isn’t. People shy away from those who are down.  Change is tough, but if you look for the positive outcome you will find it, if only a little at a time.