Monday, May 31, 2010

Paper-clip wireless device could monitor congestive heart failure medications

There was a movie named “Paper Clips” a few years ago, but medicine takes the simple device seriously. There is a paper-clip-like pressure monitor that can be inserted into the heart’s pulmonary artery to determine blood flow and fluid retention measurements, and a new study at Ohio State University in Columbus found that use of the device can help physicians effectively monitor medications (such as diuretics like Lasix and blood thinners like Coumadin) for patients with congestive heart failure, reducing hospitalizations for bleeding or extreme fluid retention.

The ABC News story, by John Berman, is “Paper Clip-Sized Implant Could Reduce Hospitalizations, Change Cardiac Medicine, Study Says: Tiny Implant Has the Promise to Save Thousands of Lives and Billions of Dollars,” link here.  It was presented on ABC “World News Tonight” on Monday May 31.

The device can be inserted with a groin catheter. Once a day, the patient or a caregiver moves a wand in the chest area to send a report to the doctor’s office through a wireless connection.

It would be important to verify that wireless routers or connections from home computers could not interfere with the device. I don’t think so, but I’m talking to Comcast (and Verizon) about a new wireless router that I just got now anyway. This sounds like a good question.

The manufacturer is Cardiomems, and its information sheet on the device for physicians is here. The device is called the The EndoSure® Wireless AAA Pressure Sensor.

ABC video on congestive heart failure, which is said to correlate directly to age:

Congestive heart failure (or “heart inefficiency”) also develops as a result of value stenosis or calcification and value opening narrowing, sometimes after coronary bypass surgery, sometimes merely as a result of genetics. Heart efficiency is measured by an echocardiogram.

Saturday, May 29, 2010

Younger workers should still buy stocks for their 401(k)'s and use dollar cost averaging

Here’s a good article from “Main Street” by Brian O’Connell, “Should You Adjust Your 401(k) Now?” The link is here.

The short answer is maybe not. Stocks are very elastic, as in 2009 they bounced back more than 50% from the 2008 crash. Furthermore, if you continue to buy, you get shares at lower prices with dollar cost averaging.

Some retirees today are relatively well off if they bought a lot of energy and/or a lot of utility stocks when young and held onto them. Of course, both are more fragile now, given the uncertainties as to how the green revolution will affect them by localizing production and demand.

Wednesday, May 26, 2010

PBGC insurance for union pensions can really leave retirees in the cold

A lead story in the Commentary section of the Wednesday May 26 edition of the Washington Times points out that the PGBC insurance for retirees in union pension funds are less than for those in single employer plans. In fact, the insurance goes up to $12,870 a year. This fact seems to be littke known.

The article goes on to describe another taxpayer bailout proposal, with what it calls a Fifth Fund, part of the Create Jobs and Save Benefits Act of 2010. The text for the bill seems to be on this pdf ; I couldn’t find it in govtrack yet.

The name of the article, by F. Vincent Vernucclo and Jeremy Lott, is “Look for the union fable: Taxpayers could be on the hook for pension bailouts,” link here.

(note: the url for this post is different because "PBGC" was at first mistyped in the title.)

Tuesday, May 25, 2010

Retiree savings may last much longer in the developing world

The New York Times has a special I.N.H. “Net Worth” report by Shelley Emling,”Americans who seek out retirement homes overseas”, link here.

The cost of living is lower in many warm-climate “third world” countries, some of them with less than the best reputations for one reason or another. Included in the list of destinations would be Colombia, Panama, Costa Rica, Malaysia, and some eastern Europe countries.

Rural areas in these countries are often quite inexpensive, with people living on less than $2000 a month and finding healthcare much cheaper than in the US. But retirees would have to deal with cultural and religious values and laws of some other countries.

The article even suggested that retirees part with everything they own in the US and start over with a sum that is their net worth.

A site that recommends countries for overseas retirement is here.  There are some advanced countries here, expecially Spain (which is in the midst of a debt crisis now).  Greece is on the list. But so is Australia, which is almost like another USA (look at its film industry).

Some economists, especially on the political right, have suggested that people should retire to developing world areas where (partly because of higher birthrates in these countries) labor for caregiving and health care is relatively available and less expensive and will put people in other countries to work and help their economies. One could read some intentions into these suggestions.

Sunday, May 23, 2010

New York continues its own pension tsunami

On Saturday May 21, the New York Times continued the debate on the public “pension tsunami” with an article by Mary Williams Walsh and Amy Schoenfeld, “Padded pensions add to New York fiscal years”, in a series called “Payback time: retired. With a raise”. It starts out by saying that in Yonkers, some police and firefighters retire on a pensions greater than when they worked.

The public pension problem in many cities is help drive teacher layoffs and cutbacks in many other social services, including those for the elderly.

The link for the article is here.

The article has a graph noting that in 2008 the typical state or municipal pension was $15491, compared to $7904 in private enterprise. The later is a little less than what mine is (in private enterprise, based on 12 years service, with some effect from a social security offset).

Saturday, May 22, 2010

More ideas to fix social security: legacy tax, reduce spousal benefits, increase the top working years base

U.S. News and World Report has another list “12 Ways to Fix Social Security”, reprinted on Yahoo! fiancé, list here.

A couple of the more controversial proposals include a legacy tax to cover the expense of those who never paid in, back in the 1930s, with an extra tax on earnings over $106000.

Another bone of contention would be to lower spousal benefits.

Still another is to add in more working years (above the top 35), which would add in more years of zero for some people and lower benefits.

There is also a proposal for a 3 to 5 percent benefit cut for new beneficiaries starting in 2010. But there’s no mention of means testing for existing beneficiaries. Possibly that would be unwise given the enormous cost of long term care that is coming down the pike, where enormous savings and benefits are required to pay for them.

Friday, May 21, 2010

Yahoo! offers slideshow of seniors who continue working at extreme age

CNN and Yahoo! presented an honor roll of five seniors over 90 who stayed active in the workplace past the age of 90.

The oldest, Mildred Health still works as a reporter in Overton, NE at age 102.

Jack Borden still works as an attorney in Weatherton, TX at 101.

There were two female offices workers at 92 and 94, and a female yoga instructor at 91.

The link for the story is here.

An Oprah show once presented a Seventh Day Adventist in a “Blue Zone” in California still working as a heart surgeon at age 94.

As people live longer, some seniors are still able to continue working at extreme age. Some are self-employed, but in general employers have to want to keep them.

Monday, May 17, 2010

Healthy people may accumulate higher long term care and health care costs due to longer life expectancy (Boston College Study)

Boston College’s Center for Retirement Research has published a study indicating that the healthy may pay over $105000 more in health care costs than those in poor health, even though their health related expenses are lower when they are around age 70-80 ($6500 a year vs. $8000 for the less healthy).

That’s because the healthy early seniors have longer life expectancies, and eventually many people would get chronic disease (especially Alzheimer’s) if they live long enough, well past “natural senescence.”

At age 80, a healthy person has a 29% longer life expectancy. Yet, the statistical expectation is that a person of 80 can expect to spend one-third of his or her remaining years with a chronic disease.

All this appeared on Yahoo! and Market Watch in an article by John Powell ("Staying healthy may cost you in retirement") on Friday May 14, link here.  The URL for the Boston College study is here.  The title is "Does Staying Healthy Reduce Your Lifetime Health Care Costs?" and the authors are Wei Sun, Anthony Webb, and Natalia Zhivan. (Just an aside: I remember that Boston College students appeared on student television quiz shows back in the 60s.)  It appears that the numbers focus on out-of-pocket costs, including both conventional medical and dental care and especially custodial long term care (the latter of which is not normally reimbursed by Medicare, except for some limited benefits in Hospice).

Does this provide a rationalization to going back to smoking and eating hamburgers?

That’s hard to say, because many people with “Blue Zone” lifestyles reach extreme old age with no disability at all. But longer life spans while having disability can challenge others in the family, especially adult children, who then might have more difficulty remaining healthy themselves.

All of this invites robust policy debate that hasn’t happened yet. But the article suggests that people ought to be expected (maybe even legally mandated) to buy long term care insurance when relatively young, to avoid passing on costs to their children or to society as a whole. Premiums while people are young will vary a lot. Imagine the public policy debate that we could have over pre-existing conditions and long term care insurance down the road.

Genworth has a new website for helping people to estimate long term care costs, here. Genworth says that the cost of in-home care is not rising now as rapidly as the cost of assisted living or in-home care, and that may in part be related to measures like the Class Act. However, that could change if home health agencies have to provide their employees more health insurance or other benefits in the future (particularly 2014 and beyond), as with the recent Health Care Reform Act. In-home care costs also depend on the availability of willingness of family members to provide uncompensated care “off the books”.

Saturday, May 15, 2010

Previously planted defibrillators can cause end-of-life issues

Barry Meier has a noteworthy article in the Business Day section of the Friday May 14 New York Times, “Lifesaving devices can cause havoc at life’s end”, link here.

The gist of the article is that when pacemakers and defibrillators are installed surgically for heart patients, discussions should occur about possible deactivation of defibrillators toward life’s end. Defibrillators in some cases cause pain if they shock a patent actually dying. Some hospices have policies regarding deactivation. On the other hand, when installed earlier, both devices may help prolong life.

Around 2006 many school systems started installing defibrillators and training teachers and administrators to use them. One of my screenplay scripts (“The Sub”) is predicated on an incident where a student saves an elderly substitute teacher’s life with a PE class defibrillator.

Picture: You can see the thunderstorm-driven rainbow

Tuesday, May 11, 2010

In 2011, Estate tax could come back with a vengeance: watch your politicians!

Linda Stern has an important article on the May 2010 AARP Bulletin, “Estate tax is dead, but confusion lives on; Law’s expiration can complete unpleasant surprises for heirs”, April 14, 2010, link (web url) here.

The federal estate tax lapsed on Dec 31, 2009, having been in effect since 1916; but it will come back in 2011, and with previous high estate tax levels unless Congress acts. The article describes the politicking in some detail, but fortunately for many families, there doesn’t seem to be a lot of interest in increasing the estate tax again.

Here's another article (more detailed and more technical), from SeniorLaw, "2010: is the federal estate tax really repealed for only one year", by Michael S. Kutzin. Goldfarb Abrandt Salzman & Kutzin LLP, link here. Notice that the "step up in basis" rules change of Congress does not act, and no repeal of federal gift tax in 2010.

What I recall from my dealings with the far Left in the early 1970s (especially Doctor Spock’s “People’s Party of New Jersey) was an incredible political or social indignation that saw all inherited wealth as immoral. On the other hand, Ayn Rand used to argue that “unworthy” people will squander wealth anyway, whereas the able and well-meaning will do good things with it for everyone out of “enlightened self interest.”

In fact, inheritances (both spousal and for older adult children) are an important way we pay for future eldercare needs, in practice. It’s going to be a long time before long term care insurance can cut in to the exploding eldercare bill.

Monday, May 10, 2010

More seniors start social security at 62 after being forced to "retire" by corporate America during the "early buyout" fad

The AARP Bulletin for May 2010 has, on p 14, has a sobering article by Carol Fleck, “Forced to Retire”, link here.

The trend of corporations (which started to pick up as early as the late 1980s) to encourage workers in their 50s or early 60s to take buyouts and early retirement has led to many more people starting social security early, at age 62. Right now. 42% of men and 48% of women do so, but that can permanently reduce benefits by about 25% a month, and with longer lifespans, the math of all this increases the chance of many people outliving their savings.

Older workers have gotten “creative” with second careers, and this article discusses one woman who bought a franchise when in her late 50s but economic weakness forced her to give it up and “retire” when she was 63. A number of retirees have tended to be drawn to “lifestyle” oriented sales careers like real estate, but much of this has been very vulnerable to recession.

Friday, May 07, 2010

California state pension system wil proceed with suit against major rating agencies

Karen Gullo reports on Bloomberg that a California state court has ruled that the California Public Employees Retirement System (CALPERS) can proceed with a suit against the three main ratings agencies: Standard and Poors, Moody’s Investors Service, and Fitch Ratings, link here

The suit for over $1 billion is for “wildly inaccurate” risk assessments and apparently for conflict of interest, an arrangement that ethically sounds a lot like the “insider trading” that used to put people on Wall Street in jail.

Wednesday, May 05, 2010

Employers trend toward automated retirement planning for associates

MSN Money Central and Bankrate recently provided an article pointing out three “hot trends” in retirement planning to “force” employees to help themselves (libertarian in nature or not). The link for the article is here.

The most important trend seems to be “target date funds”, which make the mix of investments more conservative as retirement date gets closer.

Another trend is automatic enrollment in 401K plans, with up to 30% of major employers participating. Generally the automatic payroll deduction is 3%.

Still another trend is automatic enrollment in IRA’s, but without a matching contribution from the employer.

Is all this automation a matter of efficiency, or of sending a message: worker, you'll have to take better care of yourself as you get older.  We may not need you forever.

Sunday, May 02, 2010

Many baby boomers will retire with way too much debt

MSN Money has an important article by Liz Pulliuam Weston on seniors retiring with heavy debt loads, link here.  The title of the article is “Growing old and going broke: Lots of retirees can't make ends meet, especially if they are in debt. Here's how to know if you (or your parents) are in trouble -- and what to do about it.”

She gives the story of one baby boomer who had gotten repeated “deferments” on an old student loan debt while she tried to run a business, so now she owed much more than the original principal of $200000.

Many boomers face heavy credit card debt and upside down mortgages.

One of the simplest ways to protect wealth is to get into the habit of paying off credit card bills in full each month while still young. Doing so can save a middle class person hundreds of thousands of dollars over a lifetime, literally.

You can connect to Liz on Facebook if signed on (link in the article).