Building It Up, Not Tearing It Down

By Christian E. Weller

Social Security is arguably the greatest progressive achievement of the last century, embodying the values of shared responsibility and economic security for everyone, not just a select few. When President Franklin D. Roosevelt formed the Committee on Economic Security—the basis for Social Security—he said he wanted a program that would “provide at once security against several of the great disturbing factors in life—especially those which relate to unemployment and old age.” Those values continue to be the foundation of Social Security today. The program represents a shared responsibility to one another and from one generation to another. It underpins the retirement income of 36 million Americans, provides basic survivor benefits for another 6 million widows or widowers, and delivers critical disability insurance to another 10 million working families.

Social Security, in short, is our bedrock for basic income insurance for all Americans.

Yet the program and its founding progressive values face two significant challenges: one short term and the other longer term. The immediate challenge is defending Social Security from decades-long conservative charges that the program is too costly. What Republican Presidential Candidate Alf Landon said about Social Security in 1936—that it would encourage wasteful spending and deliver children nothing but “roll after roll of neatly executed IOU’s” from their fathers’ safe deposit boxes—isn’t very different from what conservatives of the present day continue to predict. They always see disaster just over the horizon, and propose diminishing and now privatizing Social Security.

Progressives should reach out to all sides of the political spectrum, but we cannot pretend to give “even handed” treatment to arguments that have been wrong for 75 years. Social Security today faces a conservative onslaught seeking to undermine and dismantle the program. Congressman Paul Ryan (R-WI), who will certainly enjoy an elevated position in the new 112th Congress that convenes in January next year with its Republican majority, released a budget roadmap that privatized Social Security similar to President Bush’s unsuccessful privatization plan in 2005. This conservative plan, if enacted, would dismantle Social Security’s founding progressive principles and replace it with an “on-your-own” philosophy that guts benefits for middle-class families, explodes the national debt even fur- ther, and is not supported by the majority of Americans.

These challenges—both the conservative assault on Social Security and the need for modernization—cry out for progressive changes to Social Security to ensure the program’s long-term viability without jeopardizing the values on which it was built. Social Security is in no immediate danger of financial insolvency—the long-term financial challenge is being used by conservatives simply as an excuse to destroy the program. But Social Security does need to change in order to strengthen the program for the rest of this century.

Our nation must rise to meet these twin challenges today. Conservative plans to dismantle Social Security represent a clear and present danger, but another lesser danger is to reject any calls for updating the program. Progressive governance requires us to modernize this program to provide a strong and fiscally sustainable Social Security system to meet the economic challenges of our age. This is not the political fad of the moment, but an economic imperative for each and every generation of Americans.

In this paper, the Center for American Progress proposes a Social Security system worthy of meeting America’s challenges in the 21st century.
Full Article
Download this report (pdf)
Download the executive summary (pdf)
Download the fast facts (pdf)
Download the proposal comparison table (pdf)

Stop Elder Abuse

Image by AlaskanLibrarian via Flickr

Stopping Guardianships That Abuse & Exploit Seniors

Elder Abuse Victims Advocates was founded by Latifa S. Ring, a private guardian who rescued woman who was a victim of elder abuse and whose efforts result in gross abuse of her and her ward under guardianship in the State of Delaware. Ms. Ring also founder the National Elder Abuse and Guardianship Victims Taskforce for Change that worked to get Elder Abuse and Guardianship Abuse address on the 2008 DNC Platform and who was a National Delegate for Obama. Today Elder Abuse Victims Advocates works to educate others about the terrible crime of Elder Abuse in America that is not only happening in our communities but also in and through the guardianship systems in our courts and also works to educate our leaders and demand the change that we need.

Elder abuse and exploitation is an epidemic in every state. The very guardianship systems setup to protect the incapacitated have been turned into a weapon that is being used by unscrupulous perpetrators including lawyers, guardians and family members to unjustly enrich themselves from the estates of vulnerable citizens who lose their civic rights.

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Guardianship Reform Petition to Elected Officials

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Health Populi: CDHP and HDHP Plan Enrollment Still Tiny in 2009

by Jane Sarasohn-Kahn

On one hand, it can be said that enrollment in consumer-directed and high-deductible health plans in 2009 grew by 33% in the past year. On the other hand, the total proportion of Americans enrolled in private plans who was in a CDHP or HDHP was 4%.

While this represents growth by definition, it's instructive to look at the chart and note that 34% of employers did not offer employees an HDHP or CDHP in 2009 -- up from 28%. That is, substantially fewer employers offered a consumer-directed plan this year compared to the previous 3 years this survey has been conducted.
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Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities - The Commonwealth Fund

To be successful, "culture change" initiatives—efforts to help nursing homes transform from institutional hospital-like settings to homes that focus on residents' preferences—depend critically on the care provided for and directed by nursing homes' professional nursing staff. While the objectives of culture change and the goals of nursing are compatible in many ways, there are also points of friction—including those stemming from new notions of accountability for resident care and the necessity of new leadership styles. A recent "Issue Paper" from the Hartford Institute for Geriatric Nursing (New York University College of Nursing), Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities, explores these obstacles and makes recommendations about nurses' roles and competencies regarding nursing home culture change, as well as recommendations for nursing education. The publication, which resulted from a Commonwealth Fund–sponsored meeting of interdisciplinary experts in culture change and in gerontological nursing convened by the Hartford Institute in collaboration with the Coalition of Geriatric Nursing Organizations and the Pioneer Network, is organized in five sections covering: culture change and research supporting culture change; nursing in nursing homes; culture change, nursing practice, and nursing education; recommendations; and next steps.

Read Issue Paper

AMNews: Aug. 24, 2009. End-of-life care provision stirs angst in health reform debate ... American Medical News

The public outrage over reimbursement for patient counseling catches doctors by surprise but shows how delicate the discussion over advance-care planning can be. Read More

The Health Care Blog: Interview: Bob Wachter on reform, safety, primary care and everything

One of the best commentators around on the issues of patient safety, health care quality and basically everything to do with health care organizations is UCSF Professor Bob Wachter. Bob has been in the trenches as one of the leaders in the hospitalist movement, a major driver behind improving patient safety, and has also straddled the worlds of medical practice as a PCP, academia at UCSF, and been publicizing this all to a wider audience--particularly with his 2005 book Internal Bleeding and his more recent book Understanding Patient Safety. Then of course there are his occasional blog posts both on Wachter's World and here on THCB. This was a really fun conversation and somehow Bob remains an optimist.Here's the interview

The Health Care Blog: How to Rein in Medical Costs, RIGHT NOW

By GEORGE LUNDBERG - I believe that there are still many ethical and professional American physicians and many intelligent American patients who are capable of, in an alliance of patients and physicians, doing "the right things". Their combined clout is being underestimated in the current healthcare reform debate. Efforts to control American medical costs date from at least 1932. With few exceptions, they have failed. Health care reform, 2009 politics-style, is again in trouble over cost control. It would be such a shame if we once again fail to cover the uninsured because of hang-ups over costs. Read More

The Health Care Blog: AHLA on the Stark Law and its Revision: a Step Towards Holistic & Ethical Reform

By KATHLEEN M. BOOZANG Health reform that focuses exclusively on health care finance — that is, how we pay for universal access to insurance coverage — will not produce successful reform. Reform must be holistic, with a focus on the entire system, as well as its component parts, including whether the system is structured to deliver the right kind of health care services in the most appropriate setting, whether we have sufficient quantity and kind of health care professionals and technology geographically dispersed to provide the health care services that people will presumably have insurance to access, and whether the system properly incentivizes health care professionals to make decisions that are efficient, effective, and in patients’ best interests. This is a massive undertaking, with a tremendous risk that important components will be overlooked precisely because of the size of the undertaking. The Stark Law represents the kind of on-the-ground healthcare delivery problems that healthcare reform must tackle. Read More

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Why Health Reform Matters

New State-by-State Reports Show How Health Insurance Reform Will Benefit All Americans

HHS Secretary Kathleen Sebelius released Stable and Secure Health Care for America, a series of new state-by-state reports outlining how health insurance reform will improve health care for all Americans. Sebelius announced the availability of the new reports as part of a Webcast -- "Health Insurance Reform: What's In It For You?" -- where Sebelius and top HHS officials took questions from the American people and discussed the importance of health insurance reform. The new reportsvare available at www.HealthReform.gov. "These reports show how health insurance reform will help Americans save money, get better care, strengthen their insurance if they already have it, and afford insurance if they don't," said Sebelius. "Every American will benefit when we pass health insurance reform." The reports released today show reform will: * Lower health care costs; * Increase health care choices by protecting what works and fixing what's broken; and * Assure quality, affordable care for all Americans. Today's reports are the second in a series of state-by-state reports on health care across the country. Earlier this summer, Sebelius released The Health Care Status Quo in Your State, a series of state by state reports on the current state of health care in America. The reports are available at http://www.healthreform.gov/healthcarestatus.html.

TheHill.com - House panel approves healthcare reform bill

By David Shalleck-Klein Posted: 07/31/09 09:08 PM [ET] The House Energy and Commerce Committee on Friday night approved the Democrats’ healthcare reform bill, setting up a floor vote this fall. Read More

TheHill.com - Veterans groups have ‘grave concerns’ on health bill

By Roxana Tiron Six high-profile veterans groups are raising objections to the House healthcare reform bill, warning House Speaker Nancy Pelosi (D-Calif.) that it could jeopardize the care of millions of veterans. Citing “grave concerns,” the groups are urging Pelosi to modify the House bill. If changes are not made, the veterans groups say they will actively oppose the measure. Read More

Scare Tactics

Asclepios -- Your Weekly Medicare Consumer Advocacy Update from the Medicare Rights Center -- July 30, 2009 • Volume 9, Issue 30 The opponents of health reform will say anything to stop it, no matter how untrue. The latest falsehood alleges that the America’s Affordable Health Choices Act of 2009 (HR 3200) would require older adults to obtain counseling “that will tell them how to end their life sooner,” in the words of Betsy McCaughey, an employee of the conservative Hudson Institute. Representative Virginia Foxx, Republican of North Carolina, went a step further, implying that the House Democrats’ health reform bill would “put seniors in the position of being put to death by their government.” These falsehoods are designed to scare older adults and gin up opposition to health reform. In fact, HR 3200 provides Medicare coverage for a consultation with a doctor—not a government official—in which the patient can express her preferences regarding end-of-life care. The patient is not required to have this consultation, and there is no mandate for the patient to complete an advance directive (such as a living will) or forego aggressive treatment of a life-threatening illness. In fact, HR 3200 makes substantial improvements to Medicare. The bill would phase out the Part D “doughnut hole,” the built-in gap in Medicare drug coverage that requires older adults and people with disabilities to pay the full price for their prescriptions while still paying the premiums for the drug plan. Although it would take until 2023 to fully close the doughnut hole, people with Medicare will benefit immediately as the gap is narrowed with each passing year. The enhanced coverage is paid for by securing lower prices for prescription drugs covered under Medicare Part D. In addition, brand-name drugs for people who are in the doughnut hole would be subject to a mandatory 50 percent discount. The real threat to the lives of older adults and people with disabilities comes when they cannot afford to buy the medicines they need to treat a serious illness. That is happening right now when people enter the doughnut hole. Closing the doughnut hole is the right thing to do, and we need to pass health reform to make that happen. Please write your senators and representatives and tell them to Remember Medicare and pass health reform.

TheHill.com - Liberals strike healthcare deal with Blue Dogs

By Mike Soraghan Liberals on the House Energy and Commerce Committee have struck a deal with Blue Dogs that will restore some cuts by finding savings in other places, such as letting the government negotiate drug prices. The deal would allow the federal government to negotiate drug prices and use the savings to lower insurance premiums in the exchanges that would be established in the bill, according to a copy of the agreement obtained by The Hill. Read More

The Hill Blog» Blog Archive » The perils of socialized medicine (Rep. John Campbell)

by Representative John Campbell (California Republican) Regular readers [of the blog] know that I am a numbers, financial, and economic guy, as betrayed by my CPA certification. As important as these issues are, we are now presented with an issue even more vital. The socialized healthcare bill being considered by the House will likely result in tens of millions of Americans dying sooner than they otherwise would have to. When the free-market, doctors, and patients are taken out of health care decisions, and the care is paid for by somebody else, the establishment of an organization to ration care is inevitable. In fact, the legislation creates the National Institute of Comparative Effectiveness. As benign as it may sound, this is the bureaucracy that will be used to ration care. A similar institution exists in Britain, and has the rather ominous acronym of NICE (National Institute for Health and Clinical Experience). Rulings on whether people live or die are made frequently in Britain and Canada, and if you have a pre-existing condition, are elderly, or for some reason deemed ‘unfit’ for a life saving procedure, then your chances of being granted that life saving procedure become even murkier. Your life will hang in the balance, subject to the whims of government and its bureaucrats. This is why the survival rates from cancer, heart disease, and many other life-threatening diseases are 30-50% lower in countries with socialized medicine than they are in countries with private medicine. Read More

The Health Care Blog: Two rules by which to judge a health reform bill

By Matthew Holt

But all the hot air aside, even those of us in the punditocracy who know something about the subject matter (i.e. anyone reading THCB) seem to be so deep in the weeds that we have lost the basics about what we should be looking for from a health care bill. So it’s time to make that very clear, and here in my not so humble opinion are the rules by which to judge reform.

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State Variation and Health Reform - Kaiser Slides

"As the health reform debate progresses, the impact of reform on individual states will vary based on their economic situation, current health insurance coverage, and health care expenditures. This analysis pulls together key information related to state variation." Read More

Few See U.S. Health Care as 'Best in the World' - Pew Research Center

Most Americans rate the nation's health care as no better than average when compared with health care in other industrialized countries. Just 15% say health care in this country is the "best in the world," while 23% rate it as "above average"; about six-in-ten (59%) view U.S. health care as either "average" (32%) or "below average" (27%). Read More

How Can We Pay for Health Care Reform

by paffairs@urban.org ( Robert A. Berenson, John Holahan, Linda J. Blumberg, Randall R. Bovbjerg, Timothy Waidmann, Allison Cook, Aimee Williams ) In this paper and brief, the authors discuss alternative ways that health reform could be financed. They analyze different options including several proposals for delivery system reforms and for reduction in Medicare and Medicaid payments. They estimate the cost savings that could occur due to the introduction of a public plan option. Finally, they explore a range of revenue options. The key message of the paper is that health reform can be paid for, but it is best to obtain funds from a large number of measures to spread the burden broadly. Read More

FORA.tv - Howard Dean's Prescription for Real Healthcare Reform