Aging and Disability in America: 2/28/10

Saturday, March 6, 2010

HHS Secretary Sebelius Announces the Availability of Recovery Act Funds for Community Prevention and Wellness Initiative

Cooperative Agreement Opportunities for National Organizations

National organizations will have a key role in building a healthier nation as part of the new U.S. Department of Health and Human Services (HHS) Communities Putting Prevention to Work initiative. HHS Secretary Kathleen Sebelius today announced a funding opportunity for national public or private non-profit organizations to apply for $10 million in cooperative agreements to help communities decrease smoking and obesity, increase physical activity and improve nutrition.

"National organizations will help move America toward better health," said Secretary Sebelius. "Last month the First Lady announced the Let's Move campaign calling for public-private partnerships across states, local governments, and committed and trusted organizations to help communities implement proven prevention strategies. This opportunity is one of many steps HHS is taking to putting America on track to live longer, healthier lives while reducing health care costs."

Communities Putting Prevention to Work will change systems and environments-for example, improving access to healthy foods and opportunities for physical activity-and putting into place policies that will promote the health of populations. Funded by the American Recovery and Reinvestment Act of 2009 (ARRA), the $10 million in available funds will be awarded to national organizations through a competitive agreement process. With these funds, national organizations will provide expert guidance to communities, help sustain prevention efforts when recovery act funding ends, and foster a national movement toward prevention by implementing key practices across their networks and systems. The HHS Office of Public Health and Science is leading the national organizations component of Communities Putting Prevention to Work in partnership with the Centers for Disease Control and Prevention.

"In the United States, 7 of 10 deaths result from chronic disease," said HHS Assistant Secretary for Health Howard K. Koh, M.D., M.P.H. "Tobacco, obesity, poor nutrition and lack of physical activity are significant drivers of the nation's disease rates. National organizations have the knowledge and experience to help communities tackle these hard issues. Additionally, national organization's extensive networks will expand the reach and impact of the Communities Putting Prevention to Work initiative." National organizations interested in applying for Communities Putting Prevention to Work- Leveraging National Organizations cooperative agreements can find more information at www.grants.gov. The application deadline is April 19, 2010. To learn more about the Communities Putting Prevention to Work- Leveraging National Organizations program please visit: http://www.hhs.gov/ophs/funding/index.html

Medical News: PSA Debate Hashed Out in Congress - in Urology, Prostate Cancer from MedPage Today

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By Emily P. Walker, Washington Correspondent, MedPage Today

A day after the American Cancer Society (ACS) released updated prostate cancer screening guidelines, the group's chief medical officer was before Congress urging the government to fund research into alternative screening methods for prostate cancer.

Otis Brawley, MD, an oncologist and chief medical officer for the ACS, told the House Oversight and Government Reform Committee that the country needs to move beyond PSA tests and discover new screening modalities that can better detect only cancers that will turn deadly.
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Friday, March 5, 2010

American Workers Hit Hard by Decade of Doom - AARP Bulletin Today

By: Carole Fleck | Source: AARP Bulletin Today

It’s been a dismal decade for older workers. But it didn’t start out that way.

Americans age 55 and older entered the year 2000 with optimism. One-third of them worked, and their unemployment rate was a mere 2.7 percent in January.

Fast-forward to December 2009, when the unemployment picture darkened. The number of people age 55-plus without a job grew from 490,000 at the start of the decade to 2.1 million last December, according to an AARP analysis of government data on older workers released Thursday. Though nearly 40 percent of people in that age group were working, the jobless rate spiked to 7.2 percent.

To make matters worse for boomers and other older adults, the amount of time it took to find work was devastating—35 weeks in December 2009 compared with 19 weeks in January 2000.

Older adults’ nest eggs also suffered since the recession began in December 2007, resulting in dwindling property and retirement account values. Suddenly, workers who were approaching retirement were now eager to stay on the job longer to recoup some of those losses. Some retirees sought to return to the workforce in the face of falling retirement income.
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Making Broadway Accessible for the Disabled - ArtsBeat Blog - NYTimes.com

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By ERIK PIEPENBURG

The next time you complain about not being able to see the stage from the nosebleed sections of a Broadway theater, think about not being able to see the stage at all.

“No one wants to feel left out of a performance,” said Lisa Carling, the director of the Theater Development Fund’s accessibility program, which offers assistance to theatergoers with physical disabilities. “If you miss a punchline or a dramatic statement, everyone else is included but you are not.”

The Theater Development Fund, which also runs the city’s TKTS discount ticket booths, helps coordinate services for the blind or those with low vision, the deaf or hard of hearing and patrons who can’t climb stairs or need wheelchair seating.

“When we started 13 years ago, advocates for the disabled came to us and said, ‘Please, I haven’t been able to go to the theater for years because my hearing has deteriorated,’” said Ms. Carling. “People were staying away from the theater.”

Ms. Carling recently spoke to The Times about what kinds of services the TDF Accessibility Program, or TAP, offers to the disabled. Following are excerpts from her conversation. Continue Reading

Thursday, March 4, 2010

Changes in Medicare Tax on High-Income People Represent Sound Additions to Health Reform — Center on Budget and Policy Priorities

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By Chuck Marr

The President’s health reform plan would raise the Medicare tax rate for single filers with incomes over $200,000 and married filers with incomes over $250,000 — a provision that was included in the Senate-passed health bill — and also would extend this tax to the unearned income these affluent households receive such as income from capital gains, dividends, and royalties. These proposals, which would help finance the expansion of health coverage to more than 30 million Americans, would affect only U.S. households at the very top of the income scale while improving tax equity and economic efficiency.

These provisions would affect only the 2.6 percent of U.S. households with the highest incomes, according to the Urban Institute-Brookings Institution Tax Policy Center.[1] The Medicare taxes that the other 97.4 percent of Americans pay would remain unchanged. Among elderly households, only the top 2.2 percent would be touched, with the other 97.8 percent remaining unaffected.

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Social Security Does Not Need a “Bailout” — Center on Budget and Policy Priorities

By Kathy Ruffing

In recent weeks, a few commentators have sounded an alarm about the recession’s impact on Social Security’s near-term prospects, which may lead some people to think that the program faces financial problems in the next several years. Fortunately, that is not the case. Social Security continues to run annual surpluses and remains capable of paying scheduled benefits in full for the next three decades or so.

The deep recession has indisputably affected the Social Security system’s finances, and the next report of the Social Security Trustees — due this spring — is expected to show some deterioration in the program’s financial outlook. (Last year’s report estimated that starting in 2037, balances in the Social Security trust funds would be inadequate to pay full benefits promised under current law.) But Social Security faces no immediate threat.

Nevertheless, Congress and the Administration should act sooner rather than later to restore Social Security’s long-run solvency. Prompt action would allow changes to be phased in gradually and afford people ample time to adjust their financial plans.

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TIME GOES BY | GRAY MATTERS: Obama's Deficit Reduction Commission

by Pulitzer Prize-winning journalist Saul Friedman

This time President Obama, in his obsessive reaching across the political aisle, may have gone a stretch too far. For the Republican he picked to co-chair the so-called deficit reduction commission, former Senator Alan Simpson, has been a harsh critic of Social Security and Medicare. And he sought to destroy their most powerful defenders, especially AARP.

That was 15 years ago, but as recently as 2005, Simpson, a conservative from Wyoming who left the Senate in 1997, supported attempts by President George Bush to privatize Social Security by turning part of the pension and insurance program into millions of individual investment accounts, which by now would have lost 20 percent of their value.

Bush’s plan failed, largely because of the opposition of AARP and other advocates that Simpson sought to discredit.

Even now, Simpson, who should know better, conflates or deliberately confuses Social Security’s long term fiscal problems, which are minor, with its supposed contribution to the federal deficit, which is almost nil.

In an interview with the NewsHour after his appointment, Simpson said of Social Security,

“You have two choices...you either raise the payroll tax or decrease the benefits or start affluence testing. The rest of it is B.S. And if the people are really ingesting B.S. all day long, their grandchildren will be picking grit with the chickens. This country is gonna go to the bow-wows unless we deal with entitlements, Social Security and Medicare.”

His colorful language aside, what does one problem have to do with another? The Social Security trustees and the Congressional Budget Office have said the nearly $3 trillion trust fund will last for at least another 30 years. Former Federal Reserve Chairman Alan Greenspan said the projected shortfall after that is easily fixed for decades with a small raise (two percent split between employer and employee) in payroll taxes.

Obama also minimizes Social Security’s fiscal problem and suggests simply raising or removing the current $106,000 ceiling on salaries subject to the tax. Will his pledge to maintain Social Security as a pension program clash with Simpson?

But here’s my point: Social Security's long term fiscal problem has nothing, absolutely nothing, to do with Social Security’s role in the deficit. For, as I have emphasized in my column for years, Social Security costs the budget not one cent – aside from the one percent it spends on its thousands of employees and field offices.

Indeed, Social Security helps finance the deficit by loaning the treasury money, for which it earns interest (about $700 million a year.) If what’s owed to Social Security must be cut as part of deficit reduction, will that help Social Security?

Nevertheless, Simpson’s statements help perpetuate the myth among right-wingers that Social Security contributes to the deficit. Here is former Texas Representative Dick Armey, chief organizer of the Tea Baggers and a longtime enemy of Medicare and Social Security:

“If you’re not courageous enough to look at mandatory spending the two biggest components being Medicare and Social Security, then don’t tell me you’re serious about fighting the deficit."

Simpson’s record in the Senate raises questions about his appointment: Did the president have any notion of his background of hostility towards the twin pillars of American social insurance? Has Simpson left his right-wing politics far enough behind? Can he be an honest broker when, say, advocates for Social Security and Medicare come before his panel? Here’s why I ask.

In December 1994, when the Republicans were on the verge of taking over the House, the right-wing Capital Research Center, one of several relatively new think-tanks funded by prominent and wealthy conservatives, launched assaults on the Clinton administration and two major organizations that supported Clinton’s failed efforts to pass health care reform and resisted Republican efforts to cut Medicare funds.

The organizations were AARP and the labor-backed National Council of Senior Citizens (NCSC), which had played a major role in the 1965 passage of Medicare – over Republican objections. They were vulnerable because they held small federal contracts to train workers and also lobbied, which they were permitted to do.

According to consumer and medical affairs writer Trudy Lieberman, in her book, Slanting the Story, the conservative campaign took off when it was joined by Simpson, a rich rancher who was chairman of the Senate Finance subcommittee on Social Security and Family Policy.

A rather goofy dilettante, he was about to announce his retirement and had nothing to lose so he took on his antagonists, especially AARP, which had criticized him and lobbied against Republican efforts to slash Medicare funds and privatize Social Security. According to Lieberman,

“Simpson liked to tell stories about how he had to pay out of his pocket for his own parents’ care and believed everyone should do the same.”

Simpson’s father, Milward Simpson, had been Wyoming’s governor and a U.S. Senator.

Using what Capital Research had found, Simpson wrote an op-ed column in the conservative Washington Times in February 1995, attacking AARP’s director, Horace Deets for criticizing the Republicans and charged that AARP was illegally using member funds and the federal grants for lobbying.

Simpson also resented AARP’s opposition to the pending Balanced Budget Agreement. AARP had run afoul of the IRS for mixing its royalty revenues with its nonprofit business and was forced to pay a fine and separate its profit and nonprofit ventures.

But with the help of the press and the network of conservative groups, Simpson’s assaults –and his hearings – put AARP and the NCSC on the defensive. The latter folded and reorganized as today’s Alliance of Retired Americans. AARP’s Deets retired and was replaced by a Republican, public relations executive, William Novelli, who had become friendly with House Speaker Newt Gingrich.

Novelli, in 2003, stunned congressional Democrats when he threw AARP’s support behind George Bush’s private Part D drug program, which also provided huge subsidies for private Medicare Advantage plans.

Those plans, then called Medicare Plus Choice, became the first wedge in the privatization of Medicare in 1997. Under pressure from Republicans to slash Medicare funds, AARP was toothless, and Clinton agreed to allow private companies to sell insurance under Medicare.

That was part of the 1997 Balanced Budget Agreement, which slashed more deeply than ever into Medicare and Medicaid funds and severely restricted the use of Medicaid for long term care.

The Balanced Budget Agreement, which did produce a one-year balanced budget, was shepherded through the Congress by Clinton’s chief of staff, Erskine Bowles, now president of the University of North Carolina and the other co-chair of Obama's new Deficit Reduction Commission.

Write saulfriedman@comcast.net .Friedman also writes for www.timegoesby.net

TIME GOES BY | REFLECTIONS: On Being Too Nice

by Saul Friedman

Watching this Democratic Congress wasting our time reminds me of when I first became aware that what often ails American liberalism are liberals.

I was sitting in the Senate Press Gallery some years ago watching the floor action on a minor issue now obscured in my memory. I do remember that the protagonists were a liberal senator from Maryland, Joseph Tydings, from a distinguished political family, and Louisiana’s Russell Long, from a more infamous political heritage; he looked exactly like his father, Huey.

All I can recall is that Long, a conservative Democrat who called himself the “oil senator” (‘hell, I even use Vaseline in my hair”) and who had been in the Senate since 1948, out-maneuvered whatever it was that Tydings was trying to do and sent him from the floor frustrated. One of my colleagues had it right when he said, “Tydings is just too nice.”

That didn’t much matter back then; politics then was mostly civil. But recalling that now got me wondering if too many liberals are too nice for today’s highly partisan, ideological political wars.

Liberals, by nature, rarely have been as aggressive as committed conservatives who are passionate defenders of our brand of capitalism. And Marx criticized liberals because they were part of system but sought to save it by ameliorating its worst excesses.

Nevertheless, many liberal-voting Democrats today are timid about being called liberal while Republicans clamor to be labeled conservative, which was a pejorative not too many years ago. Those Democrats who are proudly liberal, like Representatives Dennis Kucinich of Ohio, Alan Grayson of Florida and Freshman Senator Al Franken of Minnesota, are considered by colleagues to be too far out or too outspoken.

And if a liberal Democrat shows some toughness, like House Speaker Nancy Pelosi who has been disappointed with Obama’s endless search for the mirage of bipartisanship, she’s criticized as being imperious or worse (rhymes with witch).

A senator friend a few years ago analyzed for me why liberals may indeed be considered too nice or soft: Almost by definition, he said, a liberal tends to be more introspective than a conservative, questioning his or her positions, giving weight to the possibility that he or she may be wrong and that the opposing position may have merit.

Thus, liberals seek to reach out to conservatives, even when they get their hands bitten off to a stump. Sound like a president you know? But liberal leaders in Congresses past weren’t always such pushovers.

I was in Texas when I began covering Congress, when it was run by a pair of Texans, Sam Rayburn, the House Speaker for 17 years and his political son and protege, Lyndon Johnson, the Senate Majority

Leader. Both were yellow-dog Democrats, loyal to the New Deal and Harry Truman’s Fair Deal. Here’s an example of their tough-minded liberalism. In 1956, despite panicky pleas from colleagues, they refused to sign the so-called Southern Manifesto denouncing the Supreme Court’s school desegregation ruling.

Rayburn’s mantra for members was said to be, “go along to get along,” and in those days the speaker had more powers than today. But Rayburn’s personal integrity became obvious when he died of cancer in 1961. His estate amounted to $15,000 plus his ranch in Bonham, Texas, where he was born. But his power also derived from his commitment to his party, his politics and his personal style.

At Rayburn’s “Board of Education,” the after-session meetings in one of his rooms in the Capitol where there were drinks, poker and politics, members and the leadership laid out strategy and dealt with the problems of members, promising help on tough votes or threatening punishment if a member strayed unnecessarily. It was considered an honor to be invited to a “board” meeting. Here was utilitarianism in real time: “Self interest rightly understood.”

Lyndon Johnson, a member of the House and an ardent New Dealer since he came to the House in 1937, became a senator in 1949 (with Truman’s upset victory) and in his second term, in 1954, he became Senate Majority Leader, probably the most powerful and influential in history.

He and Rayburn helped President Eisenhower pass his domestic agenda, including the 1957 Civil Rights Act, and the building of the interstate highway system with money from gasoline taxes. Johnson helped keep Eisenhower out of Vietnam. But the two Texans laid the political foundation for the Democratic victories of 1958 and 1960.

Johnson was said to be the greatest gatherer of intelligence on every member of the Senate, understanding their states, their political and personal needs. His Senate allies included a powerhouse of liberal legislators including John F. Kennedy, Paul Douglas, Albert Gore, Sr., Stuart Symington, Mike Mansfield, J. William Fulbright, Henry (Scoop) Jackson, William Proxmire, who had replaced Joe McCarthy, and Hubert Humphrey who was ostracized by southerners for his civil rights stands but adopted as a Johnson protege.

Johnson’s power and the liberal Democrats’ clout were further enhanced when the elections of 1958 brought in a post-war wave of more than a dozen feisty liberals who gave lie to those who believe today’s dithering, dishwater Democrats are representative of liberalism. Among them: Ernest Gruening and Bob Bartlett, the first senators from Alaska; Thomas Dodd, Connecticut; Philip Hart, Michigan; Ed Muskie of Maine; Jennings Randolph of West Virginia; and Gale McGee of Wyoming.

These Democrats, for 30 years, into the presidencies of John Kennedy and Johnson, gave the nation the most liberal legislative accomplishments since the New Deal, much of which the current crop of Democrats don’t seem able to defend even from a minority of Republican crackpots. Starting with their leader, the president, they seem to run for cover at the slightest rustle of dissent.

Democrats and liberals should get real: Sarah Palin is an empty, ignorant demagogue; Glenn Beck and Rush Limbaugh are clowns who can be challenged but aren’t. I can understand why Republicans fear them, but when will the Democrats and liberals really take on these liars who are so far to the right of either Barry Goldwater or Ronald Reagan that they would be appalled?

Tom Dodd’s son, Chris, has virtually been run out of office and still runs from the bank lobbyists and Republicans rather than drive financial regulation through his committee.

New York’s Charles Schumer was quick to desert Attorney General Eric Holder’s constitutionally correct decisions to try terrorists in civilian courts.

In Indiana, Evan Bayh, the son of John Kennedy’s close pal, Birch Bayh, quivers at the possibility that health reforms may include a public option that would hurt his wife’s finances, then quits because the going is too tough in the center and endangers the party that has given him sustenance.

And the man who holds Johnson’s post, among this group of tough-minded liberals, many of whom had been in the war, Harry Reid, does not seem to know how to wield the power he has. I heard a commentator say, “He’s too nice.” Maybe.

A truly nice, professorial guy, Mike Mansfield, replaced Johnson but he was effective because the liberal cadre of Democrats in the Senate supported him. Reid is the “majority leader” but he complains that a majority of 59 is not enough - but even 60 did not seem enough either to keep the Republicans from running over him.

In Johnson’s day, one needed 67 votes to end a filibuster but it was rarely used except to bar civil rights legislation. Still, LBJ would not have put up with obstructionism, especially from Democrats. Democrats like Reid and Lincoln complain they’re in tough races; maybe if they showed some spine, their voters would respond. I can’t blame voters who don’t know what their Senators believe. There was no mistaking what LBJ stood for.

Perhaps I’ve gone on too long criticizing today’s “pathetic liberals,” as my favorite commentator, Chris Hedges, calls them. Maybe that shoe belongs on the presidential foot, but I hesitate to call Barack Obama a liberal; he seems proud that he’s not ideological.

Those of us who have sense know he’s not a socialist, which is too bad. But is he a liberal? I don’t think he knows, although he sounded like one in the campaign. But if so, he acts like the softie, dithering liberal LBJ would not have liked.

How else to explain it when he praises right-wing Republican Representative Paul Ryan for being as person with “ideas” when they include privatizing Social Security and ending Medicare? Or when Obama says the obscene salaries of the bankers who screwed us were okay because it was part of our free enterprise system. As Paul Krugman remarked, “Oh God...we’re doomed.”

Said Hedges, in a December 7, 2009 essay posted on Alternet:

“The gravest danger we face as a nation is not from the far right, although it may well inherit power but from a bankrupt liberal class that has lost the will to fight and the moral courage to stand up for what it espouses.”

TIME GOES BY | REFLECTIONS: On Being Too Nice

TIME GOES BY | Mean, Nasty, Hateful and Corrupt

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by Ronni Bennett

You could say that my mind is elsewhere right now what with selling my home and trying to survive the huge amount dental work that will go on throughout this month. You could say that I'm not paying my usual amount of attention to doings in Washington. But I don't think so.

I think the bit of distance my personal busy-ness gives me has created a new clarity uncluttered by the daily minutiae and maneuvering of Congress and the administration – a chance to see the big picture better.

And here's what I think: they are all hateful and corrupt.

There is so much rotten business going on with all federal elected (and not a few appointed) officials that it is impossible to keep track of it all (which may be what they're counting on.)

Two events (among others) this week illustrate my point:

One: Jim Bunning – one senator out of a hundred – prevented a vote that stopped unemployment checks to millions of people, furloughed 2,000 Department of Transportation employees without pay, shut down millions of dollars in highway payments to states and triggered an immediate cut of 21 percent in Medicare payments to physicians.

This Senate rule, allowing one member to halt forward movement, is the dumbest thing I've ever heard in a democratic republic. The Senate could change it, but they each want to retain the power for single-handed tyranny, at the expense of every citizen, so they won't change it.

Two: An administration official quit to become a lobbyist. He had signed an agreement when he hired on agreeing to not lobby the administration for two years after leaving his post. So, he says, he will lobby Congress instead. This is the essence of following the letter of a contract and not the spirit. It is as wrong as anything can be.

And it's like that every day in Washington on every issue: individual advantage to the powerful over the good of the nation.

What also stands out – someone, finally, needs to say this – is how deeply mean and nasty Republicans are. Undoubtedly there are Democrats who match them, but as a group over a long period of time, Republicans win the mean-and-nasty award – it is embedded in their political soul.

They don't want bank regulation that would ease the burden on citizens and help prevent future meltdowns because it would likely reduce Wall Street executives' obscene paychecks - and donations to their perpetual campaigns.

They don't want health care for everyone. Let's say what that really means: they believe it is fine for hundreds of thousands of people to die every year for lack of care as long as the health industry continues to rake in astronomical profits.

They want to kill Social Security and Medicare. That means they don't care that millions of future elders will become homeless and die in the streets for lack of income and health care.

They don't want climate change regulation. That means that even if Earth's rising temperature were not man-made, they believe it is fine to keep adding toxic waste to the air, land and water which will continue to sicken and kill millions of citizens, animals, plants and, eventually, humanity itself.

They want to lower (already low) taxes on corporations and the top one percent of earners who together control more than 70 percent of the wealth in the U.S. That means they are actively interested in turning 99 percent of American workers and families into serfs.

(On that last point, they like to tout “trickle-down economics” - the idea that if you give the wealthy and corporations more money through lower taxes, they will spend more on business development providing more jobs and money for we peons. That started under President Reagan and has failed; the rich keep their extra money and this is the direct cause of the current gap – the widest in history - between the haves and the have-nots.)

And they lie. Every day they lie. And some number of uninformed Americans believe their lies which helps perpetuate the hateful and corrupt status quo. The most common and pervasive lie during this 111th Congress is that government-run social programs are, by definition, inefficient and will bankrupt the country. In fact, Social Security and Medicare are the most efficiently run of all big enterprises - government and private.

If there were Medicare for All, a single payer system, the price and risk would be spread across all 309 million Americans making it affordable, as it is in all advanced countries worldwide. But don't blame just the Republicans for denying this obvious solution: President Obama and a good number of Democrats are equally to blame.

Why are our leaders so mean and nasty? Because they are one and the same with the corporate elite bent on hoarding all of the planet's wealth for themselves. Our government is wholly owned by corporations and now that globalization is all but complete, they don't even need to worry about who among impoverished Americans will buy their expensive widgets to maintain their lavish lifestyles; the entire world is their customer base.

To remedy the people's agony, some say vote them all out. But no one wins an election without corporate money. (Something like 90 percent of elections are won by the candidate who spends the most money.) So we would just get the next generation of hateful legislators. This is the reason election reform will never happen, nor will the single private company that owns all electronic voting machines be divested of its no-paper-trail control over elections.

I have no answers. I just know that while I withdraw a bit from daily politics to concentrate on my tiny, little, personal world of home selling and teeth for awhile, the big picture looks nastier and meaner than when I get bogged down in the daily details.

For more information with a lot of the facts and details I have not bothered to track down for today's emotional diatribe, I urge you to read The Economic Elite vs. The People of the United States by David DeGraw published at AmpedStatus.
TIME GOES BY | Mean, Nasty, Hateful and Corrupt

Multinational Comparisons of Health Systems Data, 2009 - The Commonwealth Fund

by Gerard F. Anderson and Patricia Markovich

International comparisons of health care systems offer valuable tools to health ministers, policymakers, and academics wishing to evaluate the performance of their country's system. In this chartbook, data collected by the Organization for Economic Cooperation and Development (OECD)is used to compare health care systems and performance on a range of topics, including spending, hospitals, physicians, pharmaceuticals, prevention, and mortality. We present data across several industrialized countries: Australia, Canada, France, Germany, Italy , the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Whenever possible, the authors present the median value of all 30 members of the OECD.
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Ask the Expert: Parental Support and the Law - The New Old Age Blog - NYTimes.com

By CRAIG REAVES (Craig Reaves, immediate past president of the National Academy of Elder Law Attorneys, fields legal questions from New Old Age readers on occasion.)

Q. I’ve heard that there are circumstances where an insurance company or government agency will seek to recoup the costs of an elderly person’s care by going after assets belonging to adult children and their families. I’ve tried to research this online, but haven’t ascertained whether this is an urban legend or whether there’s advice for those of us concerned about doing right by our aging loved ones without ruining our futures in the process.
— D.D., Boston

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A Mother’s Decision to Die - The New Old Age Blog - NYTimes.com

by Paula Span

I was talking to a woman in Rhode Island the other day whose father is in a nursing home with advanced dementia. Her weary mother had voiced a fairly common sentiment: “When I reach that point, just leave a bottle of pills by the bed.”

Readers of this blog often express the same just-shoot-me idea whenever we discuss topics like increasing frailty, cruel progressive diseases and nursing homes. Sometimes the comments reflect jocular bravado: “My choice, of course, will be to OD on delicious biskits ‘n’ gravy,” Doyle wrote here a few weeks ago.

Sometimes, though, people sound quite serious. “Nature tells us when it is time to go,” Frank in Houston commented. “Sometimes it is up to us to listen to nature and take action.” I found myself wondering if Frank had already made arrangements, or at least started his research.

Expressing such opinions has been much easier and more common than acting on them. The religious and political opposition remains strong. A recent Montana Supreme Court decision brings the number of states where physician-assisted suicide is legal — the advocates at Compassion & Choices prefer to call it “aid in dying” — to just three. (Oregon and Washington are the others.) But even where it’s legal, when competent people suffering from terminal illnesses decide they want to end their lives, such decisions aren’t simple, and shouldn’t be. And their effects are rarely limited to the dying themselves.
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Will Boomers Be Any Different? - The New Old Age Blog - NYTimes.com

Image by Christchurch City Libraries via Flickr

By PAULA SPAN

Raise your hand if your elderly parents issue one of the following proclamations whenever you try to persuade them to accept some sort of assistance — wearing an emergency-response pendant, say, or hiring a home care aide, or moving into assisted living when remaining at home becomes too difficult to manage.

1) “It’s too expensive” — though you know they could afford it.

2) “I can manage on my own” — though a history of falls, missed medications and poor nutrition suggests otherwise.

3) “I don’t want a stranger in my house.”

4) “The only way I’m leaving here is feet first.”

Not every senior needs help, and not every senior who needs it resists it. But the number one question I encounter when I speak to family caregivers is how to nudzh old people into adapting to increasing disability when they are, to be a tad euphemistic, “fiercely independent.”

It makes me wonder how much of this apparently widespread intransigence has to do with a particular cohort — anyone over 80 was shaped by the Depression, whether they were old enough to remember it or not — and how much of it is intrinsic to aging itself.

In 20 or so years, when we baby boomers are entering the ranks of the “old-old” ourselves, will we be any different?
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Medicare Savings Programs: Analyzing Options for Expanding Eligibility

Medicare savings programs are designed to provide financial assistance to Medicare beneficiaries whose income and assets are too high to allow them to qualify for full Medicaid coverage. In examining policy changes that would expand eligibility by either relaxing resource requirements or increasing the income limit, the authors find a trade-off between making more beneficiaries eligible and targeting a smaller group of individuals with greater health care needs. Read More

Paul Ryan v. the President - WSJ.com

excerpt from Wall Street Journal Opinion article

'Every argument has been made. Everything that there is to say about health care has been said, and just about everybody has said it," President Obama declared yesterday as he urged Democrats to steamroll his plan through Congress. What hasn't been heard, however, is even a shred of White House honesty about the true costs of ObamaCare, or its fiscal consequences.

Nearby, we reprint Wisconsin Republican Paul Ryan's remarks at the health summit last week, which methodically dismantle the falsehoods—there is no other way of putting it—that Mr. Obama has used to sell "reform" and repeated again yesterday. No one in the political class has even tried to refute Mr. Ryan's arguments, though he made them directly to the President and his allies, no doubt because they are irrefutable. If Democrats are willing to ignore overwhelming public opposition to ObamaCare and pass it anyway, then what's a trifling dispute over a couple of trillion dollars?

At his press conference yesterday, Mr. Obama claimed that "my proposal would bring down the cost of health care for millions—families, businesses and the federal government." He said it is "fully paid for" and "brings down our deficit by up to $1 trillion over the next two decades." Never before has a vast new entitlement been sold on the basis of fiscal responsibility, and one reason ObamaCare is so unpopular is that Americans understand the contradiction between untold new government subsidies and claims of spending restraint. They know a Big Con when they hear one.
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Employee-Controlled Accounts Aid Education in Many Fields - NYTimes.com

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By ELIZABETH OLSON

About 50 companies nationwide offer employee-controlled education accounts. Some are large health providers like BJC Healthcare of St. Louis. Others, like the United Technologies Corporation of Hartford, also pay for education, but offer a different model. The company has an “employee scholar” program, begun in 1996, which pays colleges for its employees enrolled in degree programs.

The employee chooses the courses, but the program is not portable, a feature advocated by the Council for Adult and Experiential Learning, a Chicago nonprofit. It is urging nationwide adoption of portable Lifelong Learning Accounts. These are controlled by employees, with their costs partly matched by employers, and the money in the accounts earns interest.

The council is teaming with companies and foundations for three-year pilot programs across the country, the council spokeswoman, Amy Sherman, said. The companies include Sinai Health Systems in Chicago, whose program is backed by Illinois economic development funds, and City College of San Francisco, whose program is being financed by Atlantic Philanthropies and is aimed at older workers who want to retool themselves for second careers.

“These accounts are a great fit for mature workers who want to broaden their skills or use this as a career changer,” Ms. Sherman said.
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Bad Investment Advice Can Turn a Free Meal Costly - NYTimes.com

By MILT FREUDENHEIM

While the advisers deny misleading the Johnsons, Mrs. Johnson said she and her husband were not in a position to make well-informed decisions.

“We were frugal but not very smart about money,” she said. “We didn’t have the right knowledge to ask the right questions.”

The Johnsons, who were living on his retirement, lost most of their money. They were hardly alone.

“Financial fraud is the No. 1 consumer protection issue for AARP,” said Andres Castillo, who heads an AARP program that monitors free lunch seminars and similar presentations. In an AARP survey last year of people 55 and older, 9 percent said they had attended a free financial seminar within the last three years. That translates into approximately 5.9 million people, the group said.

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People 55 and Older Start Own Businesses in Growing Numbers - NYTimes.com

By STEVEN GREENHOUSE

AFTER 24 years as a marketing manager for Coors, Cinde Dolphin knew what was coming — Miller and Coors had just merged their United States beer operations, and hundreds of jobs were sure to be eliminated.

Worried that these youth-oriented companies might lay off an old-timer like her, Ms. Dolphin decided to take a buyout and relax. She sunned on the beaches of New Zealand, went whitewater rafting on the Yampa River in Colorado and saw friends and Broadway shows in New York.

But after a few months, she realized that she missed working. So at age 55, she began applying for marketing jobs, confident she would be quickly hired because of her Coors pedigree. “About four months into my job search, I realized I wasn’t getting many callbacks,” she said.

A Sacramento resident who has survived three bouts with cancer, Ms. Dolphin is not one to give up easily. She decided on an alternate tack — she would start her own business and thus join the nation’s fastest-growing group of entrepreneurs, those age 55 and above.
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Wednesday, March 3, 2010

Gov't adopts formula that doubles elderly poor

By HOPE YEN

The government took steps Tuesday to highlight the increasing numbers of poor Americans, adopting a revised formula that is expected to double the number of older people classified as living in poverty to nearly 1 in 5.

Under the new formula, overall poverty is expected to increase from 13.2 percent, or 39.8 million people, to 15.8 percent, or 47.4 million, mostly due to rising expenses from medical care and other factors.

The new measure will not replace the official poverty rate but will be published alongside the traditional figure next year as a "supplement" for federal agencies and state governments, according to the directive announced Tuesday by the Commerce Department and White House.
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STATE AND LOCAL GOVERNMENTS’ FISCAL OUTLOOK

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What GAO Found
The state and local government sector continues to face near- and long-term fiscal challenges which grow over time. Although the sector’s near-term operating balance remains negative, increases in federal grants-in-aid—largely from the Recovery Act—alleviated some near-term pressure. As shown in the insert to the figure below, the March 2010 operating balance measure (including 2009 Recovery Act funds) shows an improvement compared to the January 2009 simulation. In the near-term, the sector’s fiscal position can be attributed to several factors, including steep revenue declines.

GAO projects that the sector’s long-term fiscal position will steadily decline through 2060 absent any policy changes, as shown in figure 1. The decline in the sector’s operating balance is primarily driven by rising health care costs. The fiscal challenges confronting the state and local sector add to the nation’s overall fiscal difficulties. Because most state and local governments are required to balance their operating budgets, the declining fiscal conditions shown in GAO’s simulations suggest the fiscal pressures the sector faces and the extent to which these governments will need to make substantial policy changes to avoid growing imbalances.
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US Task Force Leads the way on Prevention Recommendations

by Kim Krisberg

For more than 25 years, the U.S. Preventive Services Task Force has been a pioneer in the fields of prevention and primary care, examining the evidence and using strict criteria to make recommendations that are often the gold standard for clinical preventive services.

First convened in 1984 by the U.S. Public Health Service and now sponsored by the Agency for Healthcare Research and Quality, the task force has a reputation for being fiercely diligent about sticking to the evidence — a characteristic that has garnered acclaim, respect and, most recently, national controversy. Most people outside of health, medical and policy circles probably knew little, if anything, about the U.S. Preventive Services Task Force until November, when the group released recommendations against routine mammography for women ages 40 to 49, recommending that such screening begin at age 50.
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ADVERSE EVENTS IN HOSPITALS: METHODS FOR IDENTIFYING EVENTS

OBJECTIVE To evaluate the usefulness of selected methods for identifying events that harm hospitalized Medicare beneficiaries.

BACKGROUND
The term “adverse event” describes harm to a patient as a result of medical care or harm that occurs in a health care setting. The term “never events” refers to a specific list of serious events, such as surgery on the wrong patient, that the National Quality Forum deemed “should never occur in a healthcare setting.” The Tax Relief and Health Care Act of 2006 (the Act) mandated that the Office of Inspector General (OIG) report to Congress about such events, including making recommendations about processes for identifying events. To meet the requirements of the Act, OIG published a series of reports in 2008 and will publish additional reports based on ongoing work.

In 2008, OIG conducted a case study to determine the incidence of adverse events (hereinafter referred to as events) by reviewing a random sample of 278 Medicare beneficiary hospitalizations selected from all Medicare discharges from acute care hospitals in two selected counties during a 1-week period in August 2008. Using a two-stage review process, the case study identified 120 events. The first stage consisted of using five selected methods to screen for events, including nurse reviews of medical records, interviews of Medicare beneficiaries, two types of billing data analysis, and reviews of internal hospital incident reports. Each time a screening method indicated the possibility that an event occurred during the hospitalization, researchers designated the possible event as a “flag.” The second stage consisted of physician reviews of medical records for 183 of the 278 beneficiary hospitalizations—those with at least 1 flag. This report provides an indepth examination of the usefulness of the five screening methods used for identifying events. OIG considered the most useful methods to be those that identified the greatest number of events.
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BENEFICIARIES REMAIN VULNERABLE TO SALES AGENTS’ MARKETING OF MEDICARE ADVANTAGE PLANS

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The Centers for Medicare & Medicaid Services (CMS) contracts with private companies, known as plan sponsors, to provide health insurance plans under MA. Plan sponsors may market their MA plans through independent sales agents, who may market on their own or through a field marketing organization (FMO), or by employing their own sales agents.

Between June 2007 and June 2008, Congress held three hearings examining sales agents’ marketing of MA plans. During these hearings, witnesses testified that sales agents had marketed without licenses, portrayed themselves as Medicare employees, and misled Medicare beneficiaries about plan benefits. These types of aggressive, deceptive, and fraudulent marketing practices could result in Medicare beneficiaries enrolling in plans that do not meet their health care needs. Several members of Congress raised concerns about sales agents’ marketing to Medicare beneficiaries to the Office of Inspector General (OIG); one specifically requested that OIG examine the marketing practices of MA plans.

In July 2008, Congress enacted the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which prohibited or limited certain marketing activities by sales agents and plan sponsors. In September 2008, CMS published regulations implementing the MIPPA’s marketing provisions, including limiting sales agent compensation to independent sales agents. In addition, CMS regulations required that all sales agents be trained and tested annually and be State licensed. To examine selected MA plan sponsors’ compensation of sales agents and determine whether the selected plan sponsors ensured that their sales agents were qualified, we reviewed compensation, testing, and licensure data for a random sample of sales agents. We purposively selected the plan sponsors based on their size and the rate of marketing complaints they received. We also compared complaints regarding sales agent marketing reported to CMS from 2008 and 2009 to determine whether the number and topics of Medicare beneficiaries’ complaints changed after implementation of the sales agent marketing regulations.

FINDINGS
*All five plan sponsors using independent sales agents had compensation practices that resulted in inappropriate financial incentives.
*Five of the six selected plan sponsors did not ensure that all sales agents were qualified under CMS’s regulations.
*The number and topics of sales agent marketing complaints remained unchanged after implementation of sales agent marketing regulations. Read More/Download Report

The MetLife Study of Boomers in the Middle

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This report is an in-Depth look at Americans born 1952 - 1958.

The Baby Boomer generation, typically, has been characterized as a bloc of people who think and act as one monolithic generation, when it actually comprises three separate cohorts. This study found that there are distinct differences between these Middle Boomers and their older and younger generation mates.
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Who blinks first? Dems can’t agree - TheHill.com

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By Alexander Bolton

Democrats’ final push on healthcare reform has become a game of chicken between the House and Senate.

Lawmakers are at an impasse over who should go first, and a lack of trust between Democrats in both chambers threatens to derail the effort in the final stretch. This is complicating an effort to use special rules to move the legislation with a simple majority vote in the Senate.

Each side is demanding that certain preconditions be met before acting.
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Sense of Purpose Staves Off Alzheimer's from MedPage Today

By Kristina Fiore, Staff Writer, MedPage Today

Patients who maintain a greater sense of purpose in life as they age may have greater protection against Alzheimer's disease, researchers have found.

Those with a purpose had more than a 50% reduced risk of the disease (HR 0.48, 95% CI 0.33 to 0.69, P<0.001), Patricia A. Boyle, PhD, of Rush University Medical Center in Chicago, and colleagues reported in the March Archives of General Psychiatry.

"The tendency to derive meaning from life's experiences and to possess a sense of intentionality and goal directedness are associated with a substantially reduced risk of Alzheimer's disease and a less rapid rate of cognitive decline in older age," the researchers wrote.

Some data have suggested that psychological factors such as extraversion and neuroticism, as well as experiential factors including social networks, are associated with risk of Alzheimer's disease.
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High Fat Intake Ups Stroke Risk in Older Women - in Meeting Coverage, ASA from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Postmenopausal women who eat the most fat have an elevated risk of ischemic stroke, researchers found.

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ICU Stay Hikes Mortality Risk

Tuesday, March 2, 2010

Nelson defends Senate health bill, signals strong backing for reform - The Hill's Blog Briefing Room

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By Jeffrey Young

Sen. Ben Nelson (D-Neb.), who withheld his support for the Senate-passed healthcare reform bill until practically the last minute, strongly hinted that he is prepared to back the final push to finish the job this spring.

"Doing nothing on healthcare reform might seem like a reasonable option to some, but in my opinion it’s not. Our nation’s healthcare crisis will only get worse the longer we delay," Nelson said at a conference hosted by the Federation of American Hospitals.

Nelson took aim at Republicans who have called for President Barack Obama and congressional Democrats to scrap the bills that passed the House and Senate last year and begin anew.

"There are those who’ve said, ‘Well, let’s start all over.’ Well, that’s a very appealing idea but for some, that’s code for doing nothing," Nelson said. "Some in Washington say we should do that, start all over with a clean piece of paper and now write a bipartisan health reform bill. Many who want that never started healthcare reform in the last decade. So saying, ‘Stop and start over again’ just means ‘Stop.' "
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Media Takes: On Aging Style Guide

About the Report

With the longevity revolution, humankind enters a new and unprecedented stage of development, the impact of which is even greater because of its rapidity. This report/style guide is an important step in overcoming ageist language and beliefs by providing journalists and others who work in the media with an appropriate body of knowledge, including a lexicon that helps redefine and navigate this new world.

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Bring an Elder to Work Day? - Guide to Retirement Living SourceBook

by Steve Gurney

I had a moment of clarity in the session regarding the similarities between being a working parent with young children and being a working caregiver for an elder. Since most of the attendees were parents, this seemed to be a fitting comparison.

I reflected on how I have personally been caught dozens of times over the years without a caregiver (babysitter) for my children and left with the only option of taking them into the office with me. As well behaved as they can be, this generally leads to a disruption in the workplace and very little work gets done by me or anyone else when my kids are in the office.

I rarely hear about employers or employees inviting aging parents into the workplace. However, in theory it makes a lot of sense. These are individuals that possess years of wisdom and they might actually volunteer to contribute to the productivity during their stay! I think most parents would also be very interested in seeing their children at work
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MetLife QuickFACTS - February Edition

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QuickFACTS is a monthly fact sheet produced by the MetLife Mature Market Institute. The focus is the emerging market of people 50+. MetLife compiles recent news and developments on multi-generational issues that impact its business and its customers.

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Spending, Beneficiary Cost Sharing, and Cost-Containment Efforts for High-Cost Drugs Eligible for a Specialty Tier

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Why GAO Did This Study

The Centers for Medicare & Medicaid Services (CMS) allows Part D plans to utilize different tiers with different levels of cost sharing as a way of managing drug utilization and spending. One such tier, the specialty tier, is designed for high-cost drugs whose prices exceed a certain threshold set by CMS. Beneficiaries who use these drugs typically face higher out-of-pocket costs than beneficiaries who use only lower-cost drugs.

GAO was asked to provide information about high-cost drugs eligible for a specialty tier. This report provides information on these drugs including spending under Medicare Part D in 2007, the most recent year for which claims data were available; how different cost-sharing structures could be expected to affect beneficiary out-of-pocket costs; how negotiated drug prices could be expected to affect beneficiary out-of-pocket costs; and information Part D plan sponsors reported on their ability to negotiate price concessions and to manage utilization.
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Personal Health - Studies Show Further Health Benefits of Exercise - NYTimes.com

By JANE E. BRODY

“I’m 86 and have walked every day of my life. The public needs to wake up and move.”

“I’m 83 going on 84 years! I find that daily aerobics and walking are fine. But these regimens neglect the rest of the body, and I find the older you get the more attention they need.”

These are two of many comments from readers of my Jan. 12 column on the secrets of successful aging. At the risk of sounding like a broken record, a new series of studies prompts me to again review the myriad benefits to body, mind and longevity of regular physical activity for people of all ages.
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Cases - Old Age, From Youth’s Narrow Prism - NYTimes.com

By MARC E. AGRONIN, M.D.

The old woman had drawn down the shade in her room — hoping, I imagined, to stop the midday Miami sun from penetrating her grief. But the sun still hit the window full force and illuminated the shade like a Chinese lantern.

She sat silently in a wheelchair, her 93-year-old silhouette stooped in the bathing light. I entered, held her hand for a moment and introduced myself. “Sit down, doctor,” she said politely.

I asked her why she had come to the nursing home, and she described the recent passing of her husband after 73 years of marriage.
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Medical News: Nap Habit Perks Up Diabetes Risk - in Primary Care, Diabetes from MedPage Today

By Crystal Phend, Senior Staff Writer, MedPage Today

Even intentional napping may increase older adults' risk of type 2 diabetes, according to a large Chinese cohort study.

A siesta most days of the week appeared to elevate the likelihood of diabetes by a significant 28% to 36% in adults ages 50 and older, after adjustment for other sleep habits, health status, and other important factors, according to an article in the March 1 issue of Sleep.
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Medical News: PET Scan Measures Brain Plaque Reductions in Alzheimer's - in Neurology, Alzheimer's Disease from MedPage Today

By Chris Emery, Contributing Writer, MedPage Today

A new PET scan neuroimaging technique measured drug-related reductions in the size of brain plaques thought to be responsible for the progression of Alzheimer's disease, a new study found.

The technique, known as ¹¹C-PiB PET, showed that the drug bapineuzumab reduced the amyloid-β deposits in the brains of patients with mild-to-moderate Alzheimer's disease by about 25% compared with placebo (mean difference in ¹¹C-PiB retention ratio change from baseline =–0.24; 95% CI –0.39 to –0.09; P=0.003).

The results were reported online in the March 1 issue of The Lancet Neurology. The study did not evaluate whether reduction in plaque size resulted in clinical improvement in patients' condition.
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Saturday, March 6, 2010

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