Maybe Medicare Was a Tactical Error
July 22, 2009
Maybe Medicare Was a Tactical Error
For progressives who now want universal health insurance, Medicare may have been a mistake — tactically, anyway.
So argues Tyler Cowen, a George Mason University economics professor and blogger:
The passage of Medicare meant that most old people get government-provided health care coverage. Yet the way to get things done in this country, politically, is to get old people behind them. Further health care reform doesn’t now seem to promise much to old people, except spending cuts on them. Given their limited time horizons, old people don’t so much value system-wide improvements, which invariably take some while to pay off.
If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?
It’s an interesting premise. Our most recent poll did indeed find that, compared to seniors, younger Americans are much more likely to favor some sort of health care overhaul:
DESCRIPTION Source: New York Times/CBS News poll, 6/12-16/09
DESCRIPTION Source: New York Times/CBS News poll, 6/12-16/09
This makes sense, and roughly corresponds with what you’d expect from the data showing which groups are mostly likely to benefit from an expansion of health insurance coverage. Here’s a chart showing the percent of people in each age group (age shown on the horizontal axis) who are uninsured:
[insurance]
As Professor Cowen notes, old people are usually the constituency you need in order to push through a major legislative overhaul of this kind.
But if any time were the right time to mobilize younger voters on an issue, now (or the 1960s) might be it. The youngest citizens, aged 18-24, were the only age group that showed a statistically significant increase in voter turnout this past presidential election, reaching 49 percent in 2008 compared with 47 percent in 2004. The percentage of youth who voted also rose in 2004 over 2000 levels, when just 36 percent of young citizens voted.
(But then again, it’s not hard to improve your political engagement when you’re starting from such a low baseline; in 2008, 2004 and 2000, young voters still had the lowest turnout rate of all age groups, with seniors generally in the lead.)
Catherine Rampell
Baby Boomers and Spirituality
July 6, 2009
To watch corn grow, or the blossoms set;
To draw hard breath over the plough share or spade;
To read, think, to love, to pray
Are the things that make men happy.”
— John Ruskin
America’s 76 million baby boomers are ushering in a new age of elder spirituality. Not only will they be the largest group of seniors this country has ever seen, but longer life spans mean they will be older longer. They will have more time than any previous generation to enjoy hobbies, travel and also contemplate the big questions.
Do people get more spiritual as they age? I posed this question to several religious leaders of different denominations and faiths and the answer was a resounding yes. It makes sense that people would seek solace and more connection with a higher power as they moved into the last half of their lives.
Does a person’s spirituality change across their life span? Research indicates that belief in God is highest in older people, those over age 75 are 95% likely to have a belief in God and the second highest group are those in their teens ranging in age from 13 to 17 are 85% likely to believe in God. Those in the middle, ages 17-34 are at 55% and least likely to have a religious belief and then after age 34- 60, 60% and ages 60 to 75, 75% believe in a higher power.
Many recent retirees are becoming more involved with spirituality because they feel for the first time that they have down time. One recent Williamson county retiree Dorothy Bartlesby said the following “When I was working full time the last thing I wanted to do was get up early on my days off and go sit in a pew for an hour. I’d do it occasionally and make my yearly tithe but I wasn’t really plugged in. Now that I have more downtime I not only get up early and go to church every Sunday but I also volunteer on several committees and done a spiritual retreat. I have thought more about God in last year than I have my entire life.”
Studies of baby boomers have shown increased reflection, less concern for material things and more interest in satisfaction with life. Many older adults may have experiences that that bring them closer to God. These may be responses to illness, death of a loved one or other life changing occurrences. One of my clients, who is now deceased, wanted to learn how to meditate when she found out she had terminal lung cancer, before she became ill she read the Bible occasionally but had very little interest in anything of a spiritual nature. Six months after her diagnosis she passed peacefully in her home and had become an avid meditator. She said it made the moments more precious and slowed life down.
Being spiritual doesn’t always translate to being religious especially with baby boomers. Many baby boomers have less traditional religious beliefs. In the 1970s, 30 percent of baby boomers reported a great deal of confidence in organized religion. Thirty years later, only 13 percent of boomers had this same level of confidence, according to a 2007 study by the AARP. “I was raised a Methodist and was a Deacon in the Presbyterian Church in my 30s but have since left all formal religion, I consider myself an Esoteric Christian but can never see returning to any formal church” says Williamson County resident Sarah Cherry.
Boomers are looking to find meaning, certainly in ways that their own parents or grandparents didn’t do,” says Rabbi Cary Kozberg, chair of the American Society on Aging’s Forum on Religion, Spirituality and Aging. “They’re concerned with health. They’re concerned with wholeness and while people feel closer to God as they age, they may be doing it outside the walls of churches or synagogues.”
Kristy Robinson is a care manager with Robinson Kelley Care Consultants LLC, she lives on New Hwy 96 by the Trace with her husband Scott and three children
To watch corn grow, or the blossoms set;
To draw hard breath over the plough share or spade;
To read, think, to love, to pray
Are the things that make men happy.”
— John Ruskin
America’s 76 million baby boomers are ushering in a new age of elder spirituality. Not only will they be the largest group of seniors this country has ever seen, but longer life spans mean they will be older longer. They will have more time than any previous generation to enjoy hobbies, travel and also contemplate the big questions.
Do people get more spiritual as they age? I posed this question to several religious leaders of different denominations and faiths and the answer was a resounding yes. It makes sense that people would seek solace and more connection with a higher power as they moved into the last half of their lives.
Does a person’s spirituality change across their life span? Research indicates that belief in God is highest in older people, those over age 75 are 95% likely to have a belief in God and the second highest group are those in their teens ranging in age from 13 to 17 are 85% likely to believe in God. Those in the middle, ages 17-34 are at 55% and least likely to have a religious belief and then after age 34- 60, 60% and ages 60 to 75, 75% believe in a higher power.
Many recent retirees are becoming more involved with spirituality because they feel for the first time that they have down time. One recent Williamson county retiree Dorothy Bartlesby said the following “When I was working full time the last thing I wanted to do was get up early on my days off and go sit in a pew for an hour. I’d do it occasionally and make my yearly tithe but I wasn’t really plugged in. Now that I have more downtime I not only get up early and go to church every Sunday but I also volunteer on several committees and done a spiritual retreat. I have thought more about God in last year than I have my entire life.”
Studies of baby boomers have shown increased reflection, less concern for material things and more interest in satisfaction with life. Many older adults may have experiences that that bring them closer to God. These may be responses to illness, death of a loved one or other life changing occurrences. One of my clients, who is now deceased, wanted to learn how to meditate when she found out she had terminal lung cancer, before she became ill she read the Bible occasionally but had very little interest in anything of a spiritual nature. Six months after her diagnosis she passed peacefully in her home and had become an avid meditator. She said it made the moments more precious and slowed life down.
Being spiritual doesn’t always translate to being religious especially with baby boomers. Many baby boomers have less traditional religious beliefs. In the 1970s, 30 percent of baby boomers reported a great deal of confidence in organized religion. Thirty years later, only 13 percent of boomers had this same level of confidence, according to a 2007 study by the AARP. “I was raised a Methodist and was a Deacon in the Presbyterian Church in my 30s but have since left all formal religion, I consider myself an Esoteric Christian but can never see returning to any formal church” says Williamson County resident Sarah Cherry.
Boomers are looking to find meaning, certainly in ways that their own parents or grandparents didn’t do,” says Rabbi Cary Kozberg, chair of the American Society on Aging’s Forum on Religion, Spirituality and Aging. “They’re concerned with health. They’re concerned with wholeness and while people feel closer to God as they age, they may be doing it outside the walls of churches or synagogues.”
Kristy Robinson is a care manager with Robinson Kelley Care Consultants LLC, she lives on New Hwy 96 by the Trace with her husband Scott and three children. www.nashvillecaremanager.com
.
Medicare Cuts
June 15, 2009
Something’s Got to Give in Medicare Spending
// //
MEDICARE expenditures threaten to crush the federal budget, yet the Obama administration is proposing that we start by spending more now so we can spend less later.
This runs the risk of becoming the new voodoo economics. If we can’t realize significant savings in health care costs now, don’t expect savings in the future, either.
It’s not the profits of the drug companies or the overhead of the insurance companies that make American health care so expensive, but the financial incentives for doctors and medical institutions to recommend more procedures, whether or not they are effective. So far, the American people have been unwilling to say no.
Drawing upon the ideas of the Harvard economist David Cutler, the Obama administration talks of empowering an independent board of experts to judge the comparative effectiveness of health care expenditures; the goal is to limit or withdraw Medicare support for ineffective ones. This idea is long overdue, and the critics who contend that it amounts to “rationing” or “the government telling you which medical treatments you can have” are missing the point. The motivating idea is the old conservative chestnut that not every private-sector expenditure deserves a government subsidy.
Nonetheless, this principle is radical in its implications and has met with resistance. In particular, Congress has not been willing to give up its power over what is perhaps the government’s single most important program, nor should we expect such a surrender of power in the future. There is already a Medicare Advisory Payment Commission, but it isn’t allowed to actually cut costs.
Scholars have been applying comparative-effectiveness research to Medicare for years, and the verdict is not altogether pretty. It turns out that some regions spend more on Medicare than others — sometimes two or three times as much, as documented by the Dartmouth Atlas Project. Yet the higher-spending regions often fail to produce superior health care results.
Robin Hanson, professor of economics at George Mason University, surveys evidence demonstrating the ineffectiveness of many medical expenditures in his 2007 paper, “Showing That You Care.”
If we are willing to take comparative-effectiveness studies seriously, we could make significant cuts in Medicare costs right now. We could cut some reimbursement rates, limit coverage for some of the more speculative treatments, like some forms of knee and back surgery, and place more limits on end-of-life-care.
Those cuts alone will not solve the fiscal problem, but if we aren’t willing to take even limited steps to conserve resources, we shouldn’t be spending any more money elsewhere.
Of course, we have not made such Medicare spending cuts yet, and there are few signs that we will. A Kaiser Family Foundation poll found that 67 percent of Americans believe that they do not receive enough treatment and that only 16 percent believe that they have received unnecessary care. If the Obama administration covers more people with government-supplied or government-subsidized insurance, the political support will broaden for generous benefits, their continuation and, indeed, expansion of current expenditures.
Suggested ways to lower costs include an emphasis on preventive care, the use of electronic medical records and increased competition among insurers. But even if these are likely to improve the quality of care, they are speculative and uncertain as cost-saving measures. Keep in mind that while computers were remarkably powerful inventions, it took decades before they showed up in the statistics as having improved productivity in the workplace.
One idea embodied in a bill sponsored by Senator Ron Wyden, Democrat of Oregon, and Senator Robert F. Bennett, Republican of Utah, is to finance new health care programs by taxing health insurance benefits. This makes sense in principle: why should insurance benefits be favored over salary by our tax system? But employer-supplied insurance is a mainstay of the current health care system, and there is no adequate replacement immediately in sight.
IT’S also hard to convince the American public that the solution to insufficient health insurance is to tax health insurance. And such a one-time tax increase would postpone but not eliminate the need to come to grips with ever-rising Medicare costs.
It sounds harsh to suggest that the Obama administration cut areas of Medicare spending, but, too often, increased expenditures and coverage are confused with good health care outcomes. The reality is that our daily environment, our social status and our behavior — including diet and exercise — have more to do with good health than does health care more narrowly defined.
The demand for universal coverage sounds like a moral imperative to “take care of everybody,” but in reality it would make only a marginal difference when it comes to the overall health of the American population. The sober reality is that universal coverage is another way to spend money, which may or may not be a good idea.
The most likely possibility is that the government will spend more on health care today, promise to realize savings tomorrow and never succeed in lowering costs. It is rare that governments successfully cut costs by first spending more money.
Mr. Obama has pledged to be a fiscally responsible president. This is the biggest chance so far to see whether he means it.
Tyler Cowen is a professor of economics at George Mason University.
Sanwich Generation
June 6, 2009
Sandwich Generation……..Its Not Always a Picnic
You’re getting the kids off to school, making lunches, looking for lost backpacks, running behind and you get a phone call from your mothers neighbor telling you that she noticed your mother didn’t pick up her paper that morning as she usually does so she checked on her and found her on the floor where she had fallen the night before. Your mother is in the ER she has most likely broken a hip, your parents are divorced and she lives alone in a house 1000 miles away. You’re her only child and you have two children of your own that youre raising in addition to working full time, running a house, being a wife , your barely hanging on as it is.
You discover the plane ticket home is going to cost $ 1200.00, and you have to find someone to help with your own kids and take vacation days from work so you can go be with your mother.
Once you get there the doctor tells you that there is no way she is going to be able to return to her house and she shouldn’t have been living there alone any way as frail as she is so “what do you plan to do?” You start making plans for your mother to come live with you.
If you find yourself in this situation, you’re not alone, its estimated that 10 million baby boomers, one in eight (people born between 1946-1960) are raising their own children while caring for aging parents, this is aptly called the “Sandwich generation”.
The Sandwich generation, studies show as a group are stressed out emotionally, stretched to the limit financially, and physically fatigued.
Many boomers are watching aging parents decline in health and ability, witnessing the transformation of formerly strong authority figures in our lives, into vulnerable dependents who need their children to care for them emotionally and sometimes financially.
What can you do to navigate this phase of life with grace and foresight, and keep your emotional and physical health in a state of harmony?
Help your parents to remain independent and functional for as long as they can. Encourage them to be proactive about their health. Accompany them to doctor appointments if you can, so you can be their advocate.
Be attentive to cognitive decline. Check in with their primary-care doctor to make sure the medications they are taking are up to date, and don’t conflict with each other. Encourage social activities with their peers. Get your parents involved with a senior citizen’s group or the YMCA, The Turner Center in Bellevue has a very active senior center.
.Make a plan. It’s never easy to talk about difficult transitions, but you’d be wise to do so. Find out what your parents’ wishes are with regards to end-of-life planning. Help them make a will, living wills or advance directive are important docments to have in place and have copies of.
Decide in advance, and with your parents help, what actions you’ll take if and when a physical and/or cognitive decline makes it impossible for them to be self-sufficient, or for you to properly care for them.
Encourage multi-generational discussions in your home. Bring all generations together round the dinner table to share memories. Bring the parts of the “sandwich” together.
Most important if you’re the caregiver, take care of yourself. You can’t be much help to anyone, child or parent, if your own health deteriorates. Reach out for support from friends, clergy, and extended family members. It takes a village. Breathe. Meditate. Talk a walk. Take a hot bath. Keep up with friends. Stay connected.
Try to savor the moments you’ve been given. The history you’re making now with your family all together is actually a precious gift for all the generations. By overcoming some of the difficulties of a blended generational life, you’ll be gaining insights and a sense of closeness with your loved ones even with you in the middle , your parents on one side and your children on the other.
Stories to Tell
June 6, 2009
Writing Your Story
You are the hero of your own story.
Mary McCarthy
Recently I went to a conference given by the Mental Health Coalition I sat in on a talk by the director who is also psychiatrist. He said they with their patients who have experienced a loss of any sort, not just of memory but with mental illness and brain injury is to encourage them remember their life story. To go so far as to create a memoir either in written form or a video documenting their lives,—events, names, and faces. Who they were, who they are, who they love, what they like to do., who they want to become. A documentary to give their lives meaning to make sense of what has happened to them.
On the drive home from this conference it occurred to me that I should be writing my memoir now and not wait until I get dementia, brain injury or God forbid a mental illness, and that in fact we all should regardless of our age or mental functioning level. While I have kept a journal, I have never created a memoir. And I started thinking what even is a memoir? I mean I’ve read memoirs of famous people but what about every day people? Webster defines memoir as a report or record of personal events based on the writers observations.
As a care manager working with people in last chapter of ther lives, I’ve been in the position of planning several funerals for clients that did not have any living family members or friends, sometimes these people have been in progressed stages of Alzheimer’s and I know very little about their lives. Upon their death while planning the funeral I try to piece together who they were, what was important to them…looking through their books for underlined passages, staring hard at photographs, trying to understand their lives. Finding a simple memoir would have provided me all the answers I need. Even if covered just one day.
Memoir is not a place to get revenge on a family member or friend that I feel has wronged me or to appear perfect. If I come out looking like an angelic person I am not being honest and not seeing myself clearly and perfection isn’t going to make an interesting memoir. While I cringe at the thought of my grandchildren or even my children reading my often whiny pithy self indulgent journals, a memoir would be something that they could learn from, not only about me, my struggles, my victories, but our family, the culture and history. Writing memoir is a way to figure out who you used to be and how you got to be who you are in the context of history and culture.
Writing a memoir can seem overwhelming but it doesn’t have to be expansive covering a whole life all at once, you can start with one special day….write about your wedding day, the day a child was born, the day you retired, be specific, be descriptive, lots of details, smells, colors, feelings, what time of day. Ask yourself questions like: What one thing would you tell your younger self if you could?, What was the favorite place that you ever visited and why?, What did you love to do when you were 12? Do you have a reoccurring dream? If you’re doing a video memoir have someone else ask you questions while they film you, its okay to ramble, free associate and not rehearse what youre going to say. Don’t feel obligated to unload your every thought in one long session, either in writing or on video.
Writing your memoir is an excellent way to explore how you became the person you are. It’s the story of how you got to here from there no matter where you are on the journey.
________________________________________
Kristy Robinson is a certified geriatric care manager with Robinson Kelley Care Consultants. She lives on New Hwy 96 by the Natchez Trace with her husband Scott and three children. She can be reached at 615-397-1078.
Home Not Always Best
June 6, 2009
June 4, 2009, 3:03 pm
Is Home Always So Sweet?
By Paula Span
Let me tell you about a couple of elders I happened to meet recently. Both lived in Washington, D.C., and both were insistent, like so many of their peers, on remaining in their homes even as their health declined.
One was a 95-year-old woman still reigning over the small brick colonial she and her husband had bought more than 40 years ago. Staying at home required a platoon of hired caregivers: a morning aide, an afternoon aide, a Tuesday helper with a van for doctors’ appointments, eventually an overnight aide. Her 74-year-old daughter, coordinating this demanding (and expensive) mission, was fraying under the strain.
But the woman relished her books, her daily newspaper and a stream of visitors: fellow church deaconesses, neighbors, friends and family.
She suffered from heart failure but resisted hospitalization, and in September she died at home, as she’d wished, a day shy of her 96th birthday.
Across town, a broad-shouldered former cab driver lived in a basement rec-room-turned-bedroom in his son’s house. He used a wheelchair and a walker, and he had Alzheimer’s disease, but I found him good-natured, chatty and gregarious. The problem: there was rarely anyone around to chat with.
His son worked long hours; other relatives called but could rarely visit. Aside from his home aide, who came three hours each weekday, he was usually alone. He seemed a good candidate for the activities and communal meals of a well-run assisted living facility, but to his son’s frustration, he was adamant about staying with family, even if that meant long hours of watching televangelists on a large-screen TV.
The contrast in these two elders’ lives raised a tough question. Research repeatedly confirms that most older people want to remain at home, with services brought to them in the places they choose. Government and social policies are moving, belatedly, in that direction. But is living at home always the wisest solution?
Musings about King Lear
June 4, 2009
I am sitting vigil with a dying client holding her hand looking at photos of her smiling she she was young.
Hello world!
June 4, 2009
Welcome to WordPress.com. This is your first post. Edit or delete it and start blogging!
