Tricare Prime vs Tricare Standard

I just heard a report on talk radio that the government wants to get rid of Tricare Prime. My husband has Tricare Prime. I've written about this before. Our co-pay for meds just went up 60% for generic and 75% for non-generic. Plus, all of our doctors are now charging between $12-25 just to write a prescription (if we don't have an office visit).

So I decided to do a side by side comparison of Standard and Prime. When my husband was getting ready to retire from the military, 11 years ago after serving 20 years, we compared the two programs and decided Prime was best for us. At the time, there was a yearly fee for Prime, and then you paid a co-pay for each visit. Standard didn't have the yearly, and you paid 20% of what Tricare allowed. Providers who agreed to take Tricare insurance, accepted whatever the government allowed and wrote everything else off. We have a special needs son, who possibly would need another heart surgery. Prime was the best choice for us, even under those conditions.

Those conditions have now changed. With Standard, you not only pay the 20% (25% if you're retired) of what is billed, but you have to pay whatever wasn't "allowed." In other words, if the doctor bills you $200 for an office visit, but the government only allows $100, you pay $25 (for your 25%) plus $100 that wasn't allowed. With Prime, it doesn't matter what the doctor bills, you pay $12 for an office visit. With Standard, there is no yearly fee, but you don't have a primary care physician. You can go to anyone on the "list." With Prime, everything (including referals) have to go through your primary care physian. So, in order to see a specialist, you have to first go to your primary and get permission. With Prime, you pay a yearly fee. I came in (and for the past 11 years have paid) $460 a year. I don't mind that going up a bit. Nothing else costs the same as 11 years ago. It just went up 13% to $520. I put away each paycheck spread out over a year so that I can pay that when it comes up every June. I JUST found out it was going up. My premium is due in 4 months and I have to make up that extra money.

Also, with Prime, I only pay $25 for out-patient surgery and $30 for emergency room treatment. With Standard, I would pay 25% of what is billed for the ER plus 25% of any doctor's bills. Have you ever been to the ER? You see a doctor, a technician, if you get x-rays, you have an x-ray tech. I'd wager to say you see at least 4 people. So I'd pay 25% of 4 different doctors/technicians, plus 25% of the actual er bill. NOW, I will also pay what is above what they "allow." I've seen what the government reimburses at. They pay 12% of what is billed for an MRI. Let's use $100 so it's easier to figure out. So, the ER will charge me $100 for an MRI. The government will pay them $12. I pay $3, so they actually only pay $9. That leaves $88 that I'm responsible for. Plus the copay of $3 that I already paid, I'm now paying $$91 for that MRI while the government paid $9. This is worse even than Medicaid. At least with Medicaid the hospital has to accept whatever the government pays.

I have stage 4 Breast Cancer. I can't even wrap my mind around how much I would be forced to pay if I had to switch to Tricare Standard. I might as well just die. But I suppose that's what they want in the first place. If you're healthy, it won't cost you anything. And if you're not healthy, the government has no use for you.

News on Me

I've kept everyone who reads this blog caught up on my status, so I'll continue to do that. I will have the opportunity to see how Obamacare has effected the medical field. My remission is over and the cancer is back.

I had a PET scan in mid-December and got the results on Jan. 3rd. They weren't good. I had my breast cancer come back last year (starting my chemo treatments in January, 2011). It had come back in the lining around my left lung and on the T5 vertebrae of my spine. After 4 and a half months of chemo, it was announced that I was in remission. I had 2 clear PET scans during the following 7 months, but this last one lit up. There is evidence of active metastasis in the lining of the left lung again as well as T5. Also involved are 3 lymph nodes, one in my left armpit, one in or near the little hollow at your throat and one on the right side of my neck, down low where the muscle (forget the name, trapezoid?) is.

The doctor said that since chemo didn't keep it away very long, we won't go that route again. He's planning radiation treatments and a monthly shot that blocks the hormone receptors (mine is HER2 Positive, meaning it's affected by hormones). I'll continue the herceptin and zometa. Herceptin is also a hormone blocker and zometa will help keep my bones healthy. Apparently the form of bone metastasis I have causes too much inferior bone to be made, so zometa inhibits calcium. It's better than not making enough bone and causing holes.

The hardest thing this time around is that I have pain this time. I didn't have bone pain last time.

I don't know how the health system is affecting my treatment just yet. I do know that I'm 48 and nearing that arbitrary age Cass Sustein determines to be of no more use to society. My doctor got clearance for a shot, but I don't know if it was the first one he asked about. I was told they don't normally carry it, and I have to wonder why he would ask for a shot they don't normally carry. I wonder if he was told, we won't authorize that one, but we will this one? I'll have to ask when I get it. I don't recall the name he told me or the name of the one approved.

I have my radiation consult on Monday, and get my first shot on Tuesday. I skip a week, and then get the shot, herceptin and zometa the next week.

I'll keep everyone posted.

Lori Ann Smith

Is our Constitutional Republic Being Replaced by a Guided Democracy?

I know I can't be the only one to see it. Our media, including Fox News, is doing everything in their power to "guide" us to the candidate they want elected. That would be Mitt Romney. I've see the ads. You know the ones, where Mitt Romney says he's pro-choice, he won't get in the way of a woman's decision about abortion. Then he turns around and suddenly he's pro-life. The footage where he says some guns need to be banned, then turns around and says he's pro 2nd Amendment. Then there's RomneyCare, that everyone knows was a blueprint for Obamacare. He can say it works on a state level, but is unconstitutional on a national level all he wants. He is Obama Light. He is NOT a conservative.

I haven't made up my mind yet who to vote for. They all have good and bad points. I haven't even eliminated Ron Paul. I know a lot of people that like Michelle Bachmann. Why has the media eliminated those 2? Why did Cain get driven out of the race?

If you do a little research on Obama, that's how he won his Illinois Senate seat. He eliminated the competition. Why has no major media outlet attacked Romney? FoxNews brought it up a little, but they let Romney wiggle out of it and let him get by with his excuses.

Have you ever researched the term Guided Democracy online? While I don't entirely trust Wikipedia, here's the definition from them of Guided Democracy:

"Guided democracy, also called managed democracy, is a term for a democratic government with increased autocracy. Governments are legitimated by elections that, while free and fair, are used by the government to continue their same policies and goals. Or, in other words, the government has learned to control elections so that the people can exercise all their rights without truly changing public policy. While following basic democratic principles there can be minor deviations towards authoritarianism. Under managed democracy, the electorate is prevented from having a significant impact on policies adopted by the state through the continuous employment of public relations techniques." [Reference numbers removed.]

And for those of you who are a little fuzzy on the definition of autocracy:

"An autocracy is a form of government in which one person is the supreme power within the state. It is derived from the Greek αὐτοκρατία: αὐτός ("self") and κρατείν ("rule"), and may be translated as "one who rules by himself". It is distinct from oligarchy ("rule by the few") and democracy ("rule by the people"). Like "despot", "tyrant", "strongman" and "dictator", "autocrat" is a loaded word with a negative value judgment." [Reference number removed.]

This is the form of government that Indonesia has, a guided democracy. Basically put, you are free to vote, but we'll decide on who you vote for. This is controlled in our country by eliminating the conservatives, whether Democrat (yes, I believe there are a few of those left) or Republican. It is also the premise behind President Obama wanting more power, and trying to eliminate our checks and balances.


Herman Cain scared the bejesus out of the establishment politicians. Rick Perry does, too. They are both unconventional, swear they'll change things, and that's what scares the establishment. Just like the insider trading not being called insider trading when Congress does it. I read an article on The Blaze that said the two major members of congress that DON'T do insider trading are Michelle Bachmann and Ron Paul. I have to admit that I personally didn't care much for Ron Paul, until I heard that. I know it takes courage to not go along with the crowd. I've been a teenager that didn't go along with the crowd, but it wasn't easy. We have a congress full of grown men acting like teenagers affected by peer pressure. "There's no law against it, and besides, everyone is doing it." I have to say the same thing my mom told me: If everyone was jumping off the Mississippi bridge, would you do it?" And yes, I've used that analogy before and someone asked me which bridge on the Mississippi. I grew up in Cape Girardeau, Missouri. We only had one bridge across the Mississippi. We didn't call it the Bill Emerson Memorial Bridge. We called it the Mississippi River Bridge.

But, it's early and I haven't had a full cup of coffee yet, so I digress. Just because CONGRESS hasn't made a law saying it's illegal for CONGRESS to trade on information they are the only ones in possession of, doesn't make it morally right. Of course there's no law against it. Congress is the one who makes the laws. If they made it illegal, as it is for the rest of us peons, how would they come into Congress with a modest amount of money and leave millionaires or billionaires?

The establishment doesn't WANT anything to change. They want the same policies in effect. That's why they're pushing Romney. Romney has a record of saying what he thinks the public wants to hear. He made the decision to be a little more liberal as Governor of a liberal state. Now he's running for President, and sees the reaction of the country to liberals, so he's hiding behind conservative rhetoric.

I have two theories. 1. The establishment wants to run someone who won't change things, or at least not by much, so they're guiding us to who they think that will be. 2. They truly don't believe any of the candidates have a chance to win against Obama, and know he can only legally serve one more term, so they want to run someone they don't really care gets tarnished by the run. They'll put their chips behind a true conservative in 2016.

I don't really believe the second one, as much as the first one. I would like to see a list of the Tea Party candidates (those supported by the Tea Party in 2010) and what their finances looked like before they got into Congress, as opposed to now. How many of them have been corrupted by the power they attained? Why hasn't anything ever changed? Have you seen President Obama's approval rating? I believe it's at something like 39%? I know it was lower than President Carter's at the same time in his term. With approval ratings like that, how could he possibly get re-elected? Hasn't just about everyone been saying, "Anyone but Obama?" So why is the media concentrating on a moderate so that, in their words, he has a chance to beat Obama? Why does the media, including Fox, say that we need someone who is capable of beating Obama? I've heard of Alinsky's Rules for Radicals. I've also heard of Hitler's tactics of tell a lie often enough and people will believe it. The media is going out of the way to tell us that only a moderate can beat Obama. Is that why over 50% (I think it was something like 60%) of the country identifies themselves as agreeing with Tea Party values? Even Democrats are moving more conservative.


I don't have a solution on how to change our path away from becoming a Guided Democracy except through education. If you like this blog and agree with it, please share it with as many as you can. Just keep my name with it.

Lori Ann Smith
Fighting for Freedom with my last breath

November 5th

I've been wondering about the fact that people all across this nation attach some significance to the 5th of November. The far left have chosen that date to try and collapse our banking institutions. It's only 8:20 AM where I am, and banks don't open until around 9:00, so I don't know if they will succeed or not.

So I did an Internet search for significant events that happened on November 5th to try and see if there are any patterns. This is what I found:

Act of November 5th: The Act of 5th November of 1916 was a declaration of Emperors Wilhelm II of Germany and Franz Joseph of Austria. This act promised the creation of the Kingdom of Poland, envisioned by its authors as a puppet state allied to and controlled by the Central Powers. The origin of that document was the dire need to draft new recruits from German-occupied Poland for the war with Russia.

(So, basically this date was significant for fascists who needed more conscripts to fight a war against the evil capitalists.)

The Observance of 5th November Act 1605: The Observance of 5th November Act 1605 (3 Ja. I, c. 1)[1] also known as the "Thanksgiving Act" was an Act of the Parliament of England passed in 1606 in the aftermath of the Gunpowder Plot.

The Bill was drafted and introduced on 23 January 1605/06 by Edward Montagu. It called for a public, annual thanksgiving for the failure of the Plot.[2][3]

Forasmuch as almighty God hath in all ages showed his power and mercy in the miraculous and gracious deliverance of his church, and in the protection of religious kings and states, and that no nation of the earth hath been blessed with greater benefit than this kingdom now enjoyeth, having the same true and free profession of the gospel under our most gracious sovereign lord King James, the most great learned and religious king that ever reigned therein, enriched with a most helpful and plentiful progeny proceeding out of his royal loins promising continuance of this happiness and profession to all posterity: the which many malignant and devilish papists, Jesuits, and seminary priests much envying and fearing, conspired most horribly, when the king's most excellent majesty, the queen, the prince, and the lords spiritual and temporal, and commons, should have been assembled in the upper house of Parliament upon the fifth day of November in the year of our lord 1605 suddenly to have blown up the said house with gunpowder, an invention so inhuman, barbarous and cruel, as the like was never before heard of.[4]

(So, this would be important to people who want church and state to be united. I suppose that would include atheists, if you force people/government to believe in no God, or remove all references of God. It would also include Islam, which is a political/religious union.)

(See also: Gunpowder Plot: A conspiracy led by Robert Catesby to blow up the English Houses of Parliament is thwarted when Sir Thomas Knyvet, a justice of the peace, finds Guy Fawkes in a cellar below the House of Lords. - another anti-religion element.)

In the mid-1700s, the 5th of November was one of Boston’s most popular holidays. On that day, apprentices and young men paraded through town with giant effigies of the Devil, the Pope, and current political scapegoats, demanding coins from householders and passersby.

At nightfall, Boston’s North End and South End gangs met in the middle of town and brawled. The winners hauled away the other side’s paraphernalia and burned all the effigies in a festive bonfire. In 1764 the event became so violent that a young boy was killed, his head crushed by a wagon wheel.

In the decade that followed, the 5th of November processions became closely linked to the town’s protests against Parliamentary taxes. That political conflict led to the American Revolution. Ironically, the Revolutionary War ended up doing away with the 5th of November holiday in America.

(So, another one that demands tribute. I hope this movement in America doesn't take it to the streets, going house to house, demanding money. This sounds so much like the left. I'm going to protest taxes by making you pay me taxes.)

Apparently someone has been trying to make the 5th of November about shutting down banks since at least 2006 (see this site: http://wiki.urbandead.com/index.php/5th_of_November). I suppose it would be important to people who celebrate murder. From my understanding, they tried to blow up Parliament. I wonder if they'll take this to the next step and try to blow up Congress? It is, after all, the fault of Congress not the Banks. If Congress had left well enough alone, the banks that needed "bailing out" would have lost their shirts, been bought by someone else and life would have gone on.

I just wonder if these people have ever stopped to think about banks and credit unions? How do they think the banks keep their lights on and pay their bills? They don't hold every one's money in a safe location for free. They take that money and invest it in different ventures, hoping to make more off of it than they give in interest to their customers or for their services. They have to make enough money to pay their utilities, rent, and employees. If everyone decides to take their money out of the bank, it's not there. It's in investments. They keep a small amount in case a few people close out their accounts, but why do you think they give you a check? It gives them time to get the money.

This whole "Bank Transfer Day" is just another way to destroy our nation. Doesn't anyone remember the Great Depression? I don't normally like Wikipedia but here's a really good explanation of a run on a bank: https://secure.wikimedia.org/wikipedia/en/wiki/Bank_run

I guess only time will tell if they will do any damage to our financial system.

Congress, do you really want to get my attention?

I guess that could go for the Presidential candidates as well...do you really want to get my attention? I want to know why no one is talking about lowering the salaries for members of Congress?

I looked up some statistics. According to Ask.com:

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•From 1789 to 1855, members of Congress received only a per diem (daily payment) of $6.00 while in session, except for a period from December 1815 to March 1817, when they received $1,500 a year. Members began receiving an annual salary in 1855, when they were paid $3,000 per year.

The current salary (2011) for rank-and-file members of the House and Senate is $174,000 per year.

Senate Leadership
Majority Party Leader - $193,400
Minority Party Leader - $193,400

House Leadership
Speaker of the House - $223,500
Majority Leader - $193,400
Minority Leader - $193,400

A cost-of-living-adjustment (COLA) increase takes effect annually unless Congress votes to not accept it.

Members of Congress receive retirement and health benefits under the same plans available to other federal employees. They become vested after five years of full participation.

Members elected since 1984 are covered by the Federal Employees' Retirement System (FERS). Those elected prior to 1984 were covered by the Civil Service Retirement System (CSRS). In 1984 all members were given the option of remaining with CSRS or switching to FERS.

(FERS is a retirement plan that provides benefits from three different sources: a Basic Benefit Plan, Social Security, and the Thrift Savings Plan (TSP). Two of the three parts of FERS (Social Security and the TSP) can go with you to your next job if you leave the Federal Government before retirement. The Basic Benefit and Social Security parts of FERS require you to pay your share each pay period. Your agency withholds the cost of the Basic Benefit and Social Security from your pay as payroll deductions. Your agency pays its part too. Then, after you retire, you receive annuity payments each month for the rest of your life.

The TSP part of FERS is an account that your agency automatically sets up for you. Each pay period your agency deposits into your account amount equal to 1% of the basic pay you earn for the pay period. You can also make your own contributions to your TSP account and your agency will also make a matching contribution. These contributions are tax-deferred. The Thrift Savings Plan is administered by the Federal Retirement Thrift Investment Board.)

(The Civil Service Retirement System (CSRS) is a defined benefit, contributory retirement system. Employees share in the expense of the annuities to which they become entitled. CSRS covered employees contribute 7, 7 1/2 or 8 percent of pay to CSRS and, while they generally pay no Social Security retirement, survivor and disability (OASDI) tax, they must pay the Medicare tax (currently 1.45 percent of pay). The employing agency matches the employee's CSRS contributions.

CSRS employees may increase their earned annuity by contributing up to 10 percent of the basic pay for their creditable service to a voluntary contribution account. Employees may also contribute a portion of pay to the Thrift Savings Plan (TSP). There is no Government contribution, but the employee contributions are tax-deferred. For more information about TSP, see the TSP website.)

Members of Congress are not eligible for a pension until they reach the age of 50, but only if they've completed 20 years of service. Members are eligible at any age after completing 25 years of service or after they reach the age of 62. Please also note that Members of Congress have to serve at least 5 years to even receive a pension.

The amount of a congressman's pension depends on the years of service and the average of the highest 3 years of his or her salary. By law, the starting amount of a Member's retirement annuity may not exceed 80% of his or her final salary.

According to the Congressional Research Service, 413 retired Members of Congress were receiving federal pensions based fully or in part on their congressional service as of Oct. 1, 2006. Of this number, 290 had retired under CSRS and were receiving an average annual pension of $60,972. A total of 123 Members had retired with service under both CSRS and FERS or with service under FERS only. Their average annual pension was $35,952 in 2006.

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I have to admit some of that surprised me, but it's still more than the average (I thought it was more retirement.)

In a nut shell, of those Congressmen already retired, the average retirement is $48,462.

It also says that they're not supposed to get more than 80% of their highest pay. Let's take the current crop of Congressmen. They START at $174,000 right now. Just 80% of that is $139,200 for retirement.

My husband is retired Navy, getting a pension of about $1380 a month (I'm not real sure because we have a life insurance policy taken out before we see it.) So let's look up what our Current service members are getting:

I'm not sure how to do tables yet (into a blog), but I'll give it my best shot:

E-1 <2 yrs experience ($17,611)
E-2 <2 yrs experience through 6 yrs experience ($19,739)
E-3 <2 yrs experience ($20,758) 4 through 6 years experience ($23,400)
E-4 <2 yrs experience ($22,993) 4 yrs experience ($26,770) 6 yrs experience ($27,911)
E-5 <2yrs experience ($25,081) 4 yrs experience ($29,380) 6 yrs experience ($31,442)
E-6 <2 yrs experience ($27,374) 4 yrs experience ($32,742) 6 yrs experience ($34,088)
O-1 <2 yrs experience ($33,408) 4 through 6 yrs yrs experience ($42,030)
O-2 <2 yrs experience ($38,488) 4 yrs experience ($52,189) 6 yrs experience ($53,262)
O-3 <2 yrs experience ($44,543) 4 yrs experience ($59,422) 6 yrs experience ($62,266)

As far as other compensations:

FOOD ALLOWANCE
The Basic Allowance for Subsistence (BAS) is used to pay for food for Enlisted Soldiers and Officers authorized to eat off base. Most Soldiers who qualify for BAS receive more than $200 per month.

HOUSING ALLOWANCE
The Basic Allowance for Housing (BAH) offsets the cost of housing when Soldiers live off base. BAH rates are based on location, rank and family status. BAH is the second-largest piece of compensation for most Soldiers.

CLOTHING ALLOWANCE
Enlisted Soldiers receive an annual allowance to replace uniforms and uniform decorations. For jobs that require civilian clothes, the military provides a civilian clothing allowance.

COST OF LIVING ALLOWANCE
Soldiers assigned to high-cost locations in the continental U.S. and overseas are paid a Cost of Living Allowance. This allowance offsets the higher costs of food, transportation, clothing and other non-housing items. Higher costs of housing are covered separately by the Basic Allowance for Housing (BAH).

MOVING & RELOCATION ALLOWANCE
The military pays for the transportation of household goods during a permanent change-of-station move. In addition, a Temporary Lodging Allowance covers the cost of temporary housing at the beginning and end of a move. To further offset moving costs, a Dislocation Allowance is also granted for permanent change-of-station moves.

FAMILY SEPARATION ALLOWANCE
Soldiers assigned or deployed to locations where the military will not move families receive a Family Separation Allowance of $250 per month to cover expenses incurred during a Soldier's separation from their family. Soldiers are also entitled to the allowance if their families are unable to accompany them overseas due to medical reasons.

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The military also gets 30 days a year of paid vacation, which rolls over a little. I think you can keep 60 days on the books, 120 if you're deployed.

As far as retirement for military, I found this:

Open to those who entered service on or after Sept. 8, 1980 but before Aug. 1, 1986. The retired pay rate is determined by the average pay rate during the three years when an individual’s pay was highest during his or her military career. That average is multiplied by 2.5 percent for each year in uniform to determine retirement pay. Thus, for 20 years of service, the High-3 formula offers retirement pay equal to 50 percent of average basic pay over the member’s three highest earning years in uniform; 75 percent of average basic pay over the three highest earning years for 30 years of service, and 100 percent of average basic pay over the three highest earning years for 40 years of service.

Those who entered military service after Aug. 1, 1986, can choose to receive retirement pay under the High-3 system or can choose the CSB/Redux option... For example, a service member under Redux with 20 years of service would multiply 20 by 2.5, then subtract ten (ten years short of 30 years of service), which yields 40. Thus, retired pay for a Redux member with 20 years of service would be 40 percent of average basic pay over their three highest earning years in uniform. Similarly, Redux members with 25 years of service would multiply 25 by 2.5, then subtract five (five years short of 30 years of service); their retired pay would be 57.5 percent of their average basic pay over their three highest earning years. Redux members with 30 years of service would simply multiply 30 by 2.5, which yields 75 percent of average basic pay over the three highest earning years in uniform. After 30 years of service, however, the formula for Redux members changes — they get a straight 2.5 percentage points for each year of service beyond 30. As such, retired pay for Redux members with 40 years of service would be 100 percent of their average basic pay over their three highest earning years in uniform.

My husband was in from 1981-2001. He gets about $16,680 a year from his retirement, which means he has to have another job, it's not really retirement. We live on it.

So, to sum it up: After 6 years, Congress supposedly only gets 80% of their highest salary. Let's assume it never goes higher than now, that's $139,200. An O-3 with 40 years in would get $62,266.

So if we lowered the pay of Congressmen by 10%, it would lower it to $156,600, which would mean a retirement the same as it is now, because they go by the highest. I'm suggesting they use the last 3 years in office....which would mean $125,280. that would still be double what the O-3 got. So they should continue to lower it until they match.

If we add in the average reimbursements, you can add about $14,000 to the base pay, so we'll call it $58,543 for an O-3 just starting. I think House members should have time in rank requirements, just like our military, and start out with the salary of an E-6 ($41,374) and let it go up every time they get re-elected. I'll give Senators a starting salary of O-1 ($47,408).