Category Archives: Medicare

The Future of Old Age in America

Note: James Ridgeway wrote this article as part of a MetLife Foundation Journalists in Aging Fellowship, a program of the Gerontological Society of America and New America Media. The article first appeared in The Guardian.

In her remarkable book The Coming of Age, Simone de Beauvoir observed that fear of aging and death drives younger people to view their elders as a separate species, rather than as their own future selves: “Until the moment it is upon us,” she wrote, “old age is something that only affects other people. So it is understandable that society should prevent us from seeing our own kind, our fellow-men, when we look at the old.”

This disconnect has, no doubt, been helpful to those who favor cutting the so-called old age entitlements, social security and Medicare – which, these days, seems to include just about everyone in Washington. Now that the congressional supercommittee charged with reducing the federal deficit has gone down in flames, some are calling for a return to the plan proposed by Obama’s Simpson-Bowles deficit commission last year. Amidst all the bipartisan warring, one thing most of these committee members agree upon is that the budget will, in large part, be balanced on the backs of old people, through cuts to social security and Medicare. The only differences are over how these cuts should be made, and how large they should be.

In the unlikely event that the rich are made to pay something toward deficit reduction, in the form of increased taxes, their contribution will pale in comparison to the share paid by elders in the form of reduced benefits. In part, that’s because the enemies of entitlements have succeeded in depicting these lifesaving government programs as the cause of our economic woes – a myth that has repeatedly been debunked, to little avail. By extension, they depict our current fiscal crisis as a standoff between the old and the young, rather than the rich and the poor. Former Senator Alan Simpson, handpicked by Obama to chair his deficit commission, was fond of talking about the perfidy of “fat cat geezers” who dared to oppose entitlement cuts at the expense of his – and everyone’s – grandchildren.

Simpson’s image of old people “who live in gated communities and drive their Lexus to the Perkins restaurant to get the AARP discount” seems to have gained traction as the dominant view of elders in this country. This belies the reality of the lives lived by millions of older Americans, for whom a comfortable retirement was never more than a distant dream. For them, old age means work or poverty – or, sometimes, both.

Recently, I attended the annual meeting in Boston of the Gerontological Society of America, a research and education organisation whose members study all aspects of aging. With 3,500 people in attendance, hundreds of sessions and a teeming exhibit hall, there was plenty of upbeat talk about the “encore years”. But there was also a body of research and discussion that presented a more rounded picture of old age in America – a place where “fat cat geezers” are far outnumbered by elders who, like Americans of all ages, are struggling to get by.

In one exhibit on “The Economics of Aging”, researchers from Wayne State University presented a study published earlier this year called “Invisible Poverty”, which found that one in three elders – including many living in middle-class suburbs – cannot fully cover their basic living expenses, including food, housing, transportation and medical care. It also found that certain shortcomings in the way federal poverty statistics are compiled meant that poverty among older people was more likely to be underestimated. “This widespread economic struggle faced by Michigan seniors is fairly hidden from public sight, making it an invisible poverty that takes its toll on older individuals, their families and caregivers and the community at large,” says the study.

Among the elderly poor are large and growing numbers of women. Consider the figures: over 40% of black and white women over 65 live alone, and over a quarter of these women are poor. They are likely to be isolated and they, too, are invisible. Also below the public policy radar, according to another study presented at the conference, are lesbian, gay, bisexual and transgender elders – who are now counted at over 2 million, and are expected to double in number by 2030. These people are far less likely to have partners or caregivers of any sort, because society banned or discouraged them.

For these elders, and millions of others, social security is more than an “entitlement” – it is a lifeline. According to a recent report by the Center on Budget and Policy Priorities, social security alone keeps 20 million Americans above the poverty line. It’s hard to argue that social security benefits are too generous, or that retirees enjoy extravagant lifestyles. The average social security benefit currently stands at just over $1,100 a month. As the Center for Economic and Policy Research’s Dean Baker notes, “More than 75% of benefits go to individuals with non-social security income of less than $20,000 a year and more than 90% of benefits go to individuals with non-social security income of less than $40,000 a year.” In addition, Baker points out:

“The private pension system has largely collapsed and the current group of near retirees saw much of their home equity disappear with the collapse of the housing bubble. As a result, the situation of retirees is likely to be worse in the near future, especially after taking into account the growing burden of out-of-pocket healthcare expenses projected in the decades ahead.”

So it is the search for work, not cleaning one’s fingernails, or studying French to stave off dementia, that is now a major concern for many older people. Historically they have been fired from long-held jobs because of their costly benefits and diminishing ability to handle the job, but now employers are taking a fresh look at this situation. Business, as it turns out, may very well embrace the old – because they often come at lower wages, with no benefits and scant legal protection. Given US supreme court rulings, the prospect of any of these people filing old age discrimination suits is unlikely. Rather than knocking them out of a job, it may turn out to be less expensive to keep on a skilled, elderly employee, perhaps at reduced salary and reduced hours,  than go through the rigamarole of hiring a young, inexperienced person who must then undergo training.

As the GSA conference showed, there is no point in cutting entitlements to the elderly when, in fact, so little is known about their lives and their emerging future. It means there must be a full, open debate – not backdoor political manoeuvring – on the issue. What may be happening here is the emerging outlines of a much different society than the one we now know: a society that, for example, will require a new service sector, a different slant towards medicine, which uses the old to assist the young, as friends and caregivers – instead of pitting generations against one another.

The late Theodore Roszak,who described and named the “counter culture”that took shape in the 1970s, thought old people were anything but a selfish bunch of useless geezers waiting to die, but an “audacious generation”, opening a new world of energy and hope. Let us hope, in de Beauvoir’s words, that moment is upon us.

The Myth of the Greedy Geezer

The following appeared today as an opinion piece on Al Jazeera English.

Old people are becoming everyone’s favourite scapegoat for America’s economic woes. Among the growing ranks of self-styled deficit hawks, Social Security and
Medicare are depicted as an intolerable burden to the nation’s already crippled
economy, which can only be saved through massive cuts to these so-called old-age entitlement programs. To advance this agenda, proponents of entitlement cuts have attacked not only the programs themselves, but the people who benefit from them – the selfish old folks like myself, who insist upon bankrupting the
country for the sake of their own costly health care and retirement income.

We in the over-65 set have become the present-day equivalent of Reagan’s notorious “welfare queens,” supposedly living high on the hog at the expense of the taxpayer. According to what I call the Myth of the Greedy Geezer, we lucky
oldsters spend our time lolling about in lush retirement villas, racing our golf
carts to under-priced early-bird dinner specials and toasting our good fortune
with cans of Ensure – all at the expense of struggling young people, who will
never enjoy such pleasures since the entitlement “Ponzi scheme” will collapse
long before they are old.

The fervour for entitlement-cutting remains strongest among conservatives, but these days, even President Obama is taking part, promoting the recommendations of his National Commission on Fiscal Responsibility and Reform, commonly known as the Deficit Commission (and to its opponents as the Cat food Commission, since that’s what old people will be eating when the Commission finishes its work).

The appointed chair of the Deficit Commission, Alan Simpson, is one of the primary promulgators of the Myth of the Greedy Geezer. A former Republican senator from Wyoming who is known for his colourful turns of phrase, Simpson insists that “This country is gonna go to the bow-wows unless we deal with entitlements, Social Security and Medicare.” The majority of the people opposed to such cuts, he claims, are “These old cats 70 and 80 years old who are not
affected in one whiff. People who live in gated communities and drive their
Lexus to the Perkins restaurant to get the AARP discount. This is madness.”…

Read the rest at Al Jazeera.

Soylent Greenbacks: David Brooks Wants Some People to Die for Debt Reduction

To help solve the debt crisis, the best thing I can do is die. Maybe not right now, but certainly before I put too much strain on the public purse—and since I’m 74, that means pretty soon. If I should be lucky enough to contract a fatal disease, I can do the right thing by eschewing expensive medical care that might extend my life. If that doesn’t happen, and I enter a slow and costly decline, then in the interests of the greater good I should take the Hemingway solution.

That’s pretty much the message of David Brooks’s column in today’s New York Times. “This fiscal crisis is about many things,” he writes, “but one of them is our
inability to face death — our willingness to spend our nation into bankruptcy
to extend life for a few more sickly months.”

Here’s how Brooks comes by his position: To begin with, he says: “The fiscal crisis is driven largely by health care costs.” Never mind two futile wars and ten years of tax relief for millionaires—it’s primarily health care that’s driving us into national penury.

Furthermore, Brooks argues, the reason for these soaring health care costs is that very old and very sick people insist on clinging on to their miserable lives, when they ought to be civic-minded enough to kick off. It’s not the insurance companies, which reap huge profits by serving as useless, greed-driven middlemen. It’s not the drug companies, which are making out like bandits with virtually no government regulation. It’s not the whole corrupt, overpriced system of medicine-for-profit, which delivers the 37th best health care in the world, according to the WHO, at more than twice the cost of the best system (France). No. It’s all about us greedy geezers. We’re the ones who are placing an untenable burden on the younger, heartier citizenry, with our selfish desire to live a little longer.

Brooks cites the usual figures: “A large share of our health care spending is devoted to ill patients in the last phases of life,” he writes, and Alzheimer’s patients will soon cost us hundreds of billions. He continues: “Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside.” (Thanks, Dave.) “We are never coercively going to give up on the old and ailing.” Nonetheless, Brooks hopes than many “old and ailing” people will make the choice made by Dudley Clendinen, a man suffering from A.L.S., who wrote a moving essay in the Times about his decision to end his life before the disease takes its full course and renders him “a conscious but motionless, mute, withered, incontinent mummy of my former self.”

I have great respect for Clendinen’s decision. As I’ve written before in Mother Jones, I am a big supporter of what these days is called “choice in dying” or “death with dignity”—each person’s right to decide when and where and in what
circumstances they will die. But I don’t want anyone else making those decisions for me, or telling me when the time is right—not an insurance company or a Medicare bureaucrat, not Barack Obama or John Boehner, and certainly not
David Brooks. I have every intention of being my own one-man death panel. But I won’t be persuaded to die a moment sooner than I want to just because it might
save some money–money that could easily be saved by far more equitable and less draconian means.

Brooks writes that “it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing —confront death and their obligations to the living.” But why is it “hard to see us reducing health care inflation” any other way? Because conservatives like Brooks don’t believe in challenging the profit-driven health care system, and the people who pass these days for liberals lack the moxie to stand up to them.

Based on models from countries like France and Canada, we could bring about whopping savings in health care expenditures through a single payer system without rationing or compromising the quality of care. Short of this, we could opt for much more regulation and still save more money than we could by pulling the plug on every geezer in the land.

If I have any “obligation to the living,” it’s to leave them with a better health care system than we have now—a health care system that values all human life above profits. But I know that’s not likely to happen before my death—which, if I listen to Brooks, could be right around the corner.

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A Boomer’s Straight Talk

That’s a bit unfair,since Dave Lindorff (This Can’t be Happening blog) isn’t exactly the kind of person you’d label a boomer.He says he’s  turned 62. Even so, in this world of squirming,equivocating politicians and their Oh- so- smart expert slide rule advisors, his is a voice of passion about real things in real life. Such a relief after reading, or should I say, trying to read, all the sychophant journalists with their two bit sermons about how broke we are and how we all have to sacrifice.Do these guys seriously think this country is poor?

   Here’s a bit of Lindorff:

But here’s the thing. The reason these parties and lobbies are trying so hard now to use the recession and the national deficit as cover to decimate and destroy these two proven and critically important social programs into which all working Americans have been paying all our working lives, is that they realize what most 50 and 60-something Americans haven’t realized yet: that we are about to become the most powerful political force in the country, and that we are certainly going to demand both an excellent government Medicare program, and a decent retirement program.

Pres. Franklin Roosevelt signs the Social Security Act into law. Franklin Roosevelt signs the Social Security Act into law

The way I see it, we in the Baby Boom generation–those people born between 1946 and about 1964–are just starting to hit retirement age. In another 10 years, we will become a political force twice as powerful and certainly more than twice as noisy and demanding as the current senior lobby. We can either wait until then, after they have successfully gutted the two programs we depend on, making it so we have to fight to recreate or restore them, or we can start organizing now to defend and improve them, and save ourselves a whole lot of trouble.

Lindorff’s proposal,invoking what the Washington Post sneerlingly refers to as “common sense.”

Let’s start building a coalition of Baby Boomers, working through every conceivable organization–labor unions, churches, veterans organizations, alumni organizations, political chapters, etc.–with one goal: Defending and improving Social Security and Medicare.

Here’s the argument. Social Security is said to be in danger of “running out of money” in 2037, because there will supposedly be too many retirees drawing checks and too few younger workers putting money into the so-called Trust Fund. The Trust Fund itself had its trust broken by our politicians, Republican and Democrat, who have for years been raiding the money we put into it, leaving us with government IOUs. These IOUs, the Republicans and the corporatists now say, they don’t intend to honor. (The main reason for these raids has been to fund America’s imperialist wars, which the public never would support if they had to pay for them up front through higher taxes.) Well, first off, we need to demand that they honor those IOUs. Second, since that would mean raising taxes to fund our retirement, we need to demand that the money come not from our working kids and grandkids, but from the rich. It’s really an easy fix. Require that the FICA tax which pays for Social Security benefits apply to all income, not just the first $106,000 of income, and make it also apply to investment income, which currently pays no FICA tax. (I’m not talking about retirement investments. They can be exempted. I’m talking about regular taxable investment income.)

As for Medicare, which we’re told is going to run out of money sometime before 2017, the answer there is to stop making it a program just for disabled and old people, and to expand it to cover everyone, which is what President Obama should have proposed way back in 2008, instead of the outrageous health “reform” that was pushed through Congress and which is going to be undone by the courts anyhow.

 

Obama’s Tax Deal and the Future of Social Security

It’s worth pointing out once again that  last week’s  tax deal is hardly the victory for the American people it is made out to be. One of the biggest chunks —thirteen percent of the total monies — come from Social Security and Medicare in the form of a one-year cut in payroll taxes. The government promises to pay back what it is taking from the Social Security trust fund by borrowing the money, then floating bonds to guarantee  repayment.

This one year abeyance might not seem like much. But with the coming of a right-wing  Republican House, under pressure from the further fringes in the Tea Party, it does not augur well for the future of the program. From its inception under FDR, the Republicans have dreamed of getting rid of Social Security, along with such other things as the Federal Reserve, the income tax, the Department of Education and the UN.

“Social Security’s dedicated funding base is jeopardized by this deal in an unprecedented way and there is a grave risk now that the retirement benefits of America’s workers will have to compete with our other priorities for a share of the general budget,” said Texas Congressman Loyd Doggett at a press conference cheld by the National Committee to preserve Social Security and Medicare. “It would result in Social Security being as dependent on annual Congressional action as public television or our National parks.”

“If the recent debate on the Bush tax cuts has taught us anything, it is that taxes are easy to cut but hard to restore, said Florida Congressman Ted Deutch at the same press conference. “If this provision is made permanent, it will double Social Security’s long term funding gap and open a door that Democrats have long fought to keep closed – budgetary attacks on Social Security.’’ 

Cutting social welfare programs will be very much in vogue with the new Congress, especially as it ramps up for a showdown on raising debt limits this coming spring. Because the right wingers are out to get social programs and because all spending measures must start in the House, it is highly likely that Social Security and Medicare will occupy center stage in this debate, and that the proposals of various fiscal commissions will come into play. First, the suspension of a cost of living increase for Social Security recipients could well be extended. Second, the age at which one can begin to collect Social Security will most likely be raised from 67 to 69. And finally, the Bush tax cut deal digging into the Social Security trust fund certainly will be an opening for the right to further a  borrowing spree–ironically, all in the name of reducing the deficit.

However, there is a potential remedy. In 2012, the economy should be stronger than it is today, argues Robert Greenstein, executive director of the liberal Center on Budget and Policy Priorities. 

 In addition, Congress likely will have enacted some significant budget cuts, and the nation likely will be debating the sort of further cuts that various commissions have recently proposed, including cuts in Social Security and Medicare benefits for elderly widows and seriously disabled people with incomes as low as $20,000. At that point, the President will need to make clear that he will veto any legislation extending the high-end tax cuts or the weakening of the estate tax beyond its 2009 parameters, and he should use the bully pulpit to take this case to the country.

If only we could count on our president to do something like this at all, much less in an election year.

Behind the Battle Over Social Security

As the midterm elections near, the future of the Social Security system has become a hot-button issue–and a confusing one. A number of Republican politicians have hit on it as yet another way to undermine Obama and the Democratic leadership, by criticizing their supposed fiscal irresponsibility. Some must also see victory at hand in the conservatives’ longstanding battle to destroy one of the most hated remnants of the New Deal. These include the GOP’s chief architect of change Paul Ryan,who wants to turn Medicare into a voucher program and privatize Social Security. He is backed up by House minority leader John Boehner, who, if the Republicans take the House, could become the next speaker. 

Some Democrats have risen to defend the best–and most solvent–anti-poverty program the nation has ever known. But for other Democrats–including those in the White House–the response is more triangulation. It was Obama who set in motion the Fiscal Commission, supposedly to study the deficit but in fact, as just about everyone in Washington knows, to pare entitlements, cutting Medicare and Social Security. Originally, this commission was thought ready to propose lifting the limit at which one could draw Social Security from 62 to 67. Now scuttlebutt  is that the entry age should be 70. Our supposedly “socialist” president has placed the country’s premier social program in the hands of Alan Simpson, a Republican crank who views old people as the new welfare queens. 

It’s not surprising, then, that a lot of older voters don’t know what to make of it. A piece in Sunday’s New York Times reported on “tales of political burnout and withdrawal among older voters” in one swing county in Colorado. Many in this consituency, which can usually be counted upon to vote in large numbers, seemed to be withdrawing altogether from the fray. Others were preparing to shoot themselves in the foot:

Bill Benton, 79, a lifelong Colorado resident who described himself as an Eisenhower Republican, supports Mr. Buck and believes that his comments suggesting that the private sector could perhaps do a better job with Social Security were “just talk.” Mr. Buck has said that despite his comments, he would not support privatizing the retirement program. “I like him, but he says some dumb things,” Mr. Benton said.

With all the rhetoric flying out of Washington, it’s likely that some older people have come to view the whole topic of Social Security as the centerpiece in a Washington charade of boasts and lies, another turn in the game of smoke and mirrors, much in the manner of the shouting match over health care. It turns the stomach, feeds the hate against Washington, and sends people fleeing to escape a nightmare they can’t understand–sometimes, it appears, right into the arms of the Tea Party.

And in fact, people who suspect a smoke-and-mirrors game are pretty much on the money. Social Security’s elevation to a central political debate is tied to another hot-button issue: The future of the Bush tax cuts. Those tax cuts, which benefit the very rich—the people who pump cash into a candidate’s campaign—are set to expire next year. “In 2010, when all the Bush tax cuts are finally phased in, a staggering 52.5 percent of the benefits will go to the richest 5 percent of taxpayers,” according to Citizens for Tax Justice, the Washington-based  public interest group that follows and analyzes tax policy.

The impact of these cuts on the national treasury–and the deficit–cannot be overestimated: “The tax legislation enacted under President George W. Bush from 2001 through 2006 will cost $2.48 trillion over the 2001-2010 period,” Citizens for Tax Justice reports. “This includes the revenue loss of $2.11 trillion that resultsdirectly from the Bush tax cuts as well as the $379 billion in additional interest.’’

Obama has declared his opposition to extending the tax cuts for the highest income brackets. But some conservative Democrats will have other ideas. And if the White House’s resolve fails, as it often does, there’s another deficit-cutting alternative at hand in Medicare and Social Security. It’s a lot easier for politicians to talk about paring down entitlements than it is to attack the rich on whose largesse they depend.

Republican Right Offers Reagan Redux

The Republican right’s Pledge to America is widely being compared with Newt Gingrich’s Contract with America. But for those of us with long enough memories, it more clearly harkens back a decade further, to the early days of the Reagan Administration. Now, as then, the Republican agenda has two major political thrusts.

First, the Republicans are advancing a Reaganesque program based around defense Keynesianism, an economic pump-prime through military spending. It signals a victory for the Pentagon generals who have been fighting Obama to further expand what certainly appears to be a futile war in Afghanistan and parts of Pakistan–one that can go on and on indefinitely. Moreover, the Republicans want to fund an expensive missile defense system. Just as with Reagan, once this kind of spending gets going, they will be congratulating themselves on new jobs making armaments. At the same time, they can talk of shrinking the deficit by reducing or eliminating domestic programs.

That’s the nub of the pledge, with one adroit addition. This document makes no mention of reducing or eliminating Social Security. This is good politics before the election, and it’s bound to undercut the Obama administration, which has created the fiscal commission to reduce deficits, and is widely assumed to have Medicare and Social Security in its sights. Reagan did his best to cut domestic programs of the New Deal sort. But in the end, he could never have entirely eliminated them because he always swore to maintain a basic safety net for the old and the poor–and such public pronouncements helped to undermine Democratic challenges.

The pledge provides a focus for Republican ambitions, but most importantly it removes any thought that the Tea Party people have or could ever have any real sway in Republican policy matters. During Reagan’s early forays into the countryside, there were plenty of what now would pass for Tea Party types, but they were largely excluded from the party’s overall direction. Gingrich and his New Right colleagues in Congress occupied the back benches of the House at the time, and they moved within the overall Republican party apparatus. There was–and is–no chance of a popular takeover from the fringes of the party. Instead, Reagan claimed the center, and then pushed that center further and further to the right, where it remains to this day.