Wednesday, September 19, 2012

A note about Advanced Medical Directives

NBC Rock Center recently aired a report, focusing on the end-of-life practices at Gundersen Lutheran Hospital in La Crosse, WI  (120 miles SE of Minneapolis), “In the end, making hard decisions about dying brings personal, financial benefits, here

The article discusses the use of the Advanced Medical Directive, which I did have my mother sign about eighteen months before she passed away (at the end of 2010).

Medical care can extend life almost indefinitely sometimes, posing unprecedented ethical problems that previous generations did not face. 

Sunday, September 16, 2012

Workers need "automated individual retirement accounts"

The Center for Retirement Research at Boston College has a report “The Pension Coverage Problem in the Private Sector”, September 2012,  link here

The New York Times picked up on this report in a lead-off editorial on p 10 of the Sunday (Sept. 16) paper, “The Road to Retirement: The recession and its aftermath spell insecurity and hardship for millions of Americans”, link here

The NYT points out the demographics will require people to work longer before retiring, but private companies have withdrawn from programs that help them with financial security.  The editorial discusses the idea of Automated Individual Retirement Accounts, which would assign 3% of an employee’s pay into a carefully constructed IRA.

401(k)’s are coming to be regarded as less reliable. 

Friday, September 07, 2012

NYT covers increasing strain on Medicaid from long-term care, likelihood that GOP will encourage states to enforce filial responsibility

The New York Times offers an important front page story Friday September 8, 2012 by Nina Bernstein, “With Medicaid, long-term care of elderly looms as a rising cost”, link here

As covered here before, Medicare does not normally care for nursing home or in-home caregiving (except for a short time when the patient is expected to get better). Medicaid can cover it when the patient has spent down assets to below certain numbers.  Federal look-back rules, going back for six years, prevent patients from giving away assets to adult children to qualify for Medicaid.

Also, as noted before here, many states have filial responsibility laws, which are rarely enforced, but there is an important recent case in Pennsvlvania (see May 22 on this blog, about John Pittas). 

Berstein’s article refers to “federal rules that now protect adult children from being billed for their parents’ Medicaid care.” I’m not sure what these rules are,  given the Pennsylvania case.

The GOP, if it gains enough political control in the November 2012 elections, wants to replace Medicaid federal participation (a term that I learned in the 1970s when working on New York State MMIS) with block grants that would give states more control, and some conservative states would probably become much more aggressive with their filial responsibility laws, given their budget problems. 

The article does cover examples of family members paying for their parents' long term care. 

Tuesday, September 04, 2012

Mitt Romney's "retirement" was very tax-privileged

Monday, Tom Hamburger published an article in the Washington Post “Mitt Romney exited Bail Capital with rare tax benefits in retirement”, link here

Romney, now 66, was able to obtain additional tax benefits from his Bain retirement (according to the Bain severance agreement)  IRA by remaining a partner after retirement, according to the story.

“Ordinary” employees of companies have had to fight to have the right to sell their employer’s stock, in some cases;  in a few cases, as reported before, they have had difficulty getting their own money out after employers went bankrupt.

And some employer severance agreements don't allow employees to get severance if they work for competitors or even work in their fields.  

Compare all that to Romney’s benefits. 

Update (Sept. 5):

Here's another video, by Todd Kating from early 2011, about the nasty secrets behind 401(k)'s.

Monday, September 03, 2012

"Fortune" writers recommend straightforward fixes for entitlements

Allan Sloan and Geoff Colvan had an article in Fortune Aug. 16, “Forget Washington: Here’s how we’ll fix the economy”.  In the Sunday Business section Sept. 3, in print, the article is called “Enough already! A common sense proposal for steering America’s economy out of its run”. The Fortune link is here

Perhaps their suggestions do come from Thomas Paine.

They want to limit end-of-life care support in Medicare.  That means that patients (or families) would have to pay for end-of-life care beyond a certain point.  Families, facing filial responsibility, could have to make very difficult decisions out of self-interest.  The authors say that insurance companies will offer supplemental end-of-life policies, which might be a tough sell.

I do recall that my mother was on Hospice for the last thirteen months of her life (you can get on it only when the normal life expectancy is six months or less, but she made it all the way to 97). I saw the bill once; from Capital Hospice in Arlington, the charge to Medicare was close to $4000 a month for weekly home visits by nurses, doctors (sometimes), and social workers.  It seems that this should have been less.

Sloan and Colvan would also raise Medicare premiums for smokers and the medically obese.

On Social Security, they want simply to raise the wage base maximum, and gradually increase retirement age, and reduce the growth in benefits for high-income retirees (mild means testing – would they look at accumulated net wealth?).  They say that doing so will make Social Security “pay as you go” again without today;s accounting gimmicks using the Trust Fund to loan to the Treasury. 

Sunday, September 02, 2012

Some "naive" investors came out of 2008 just fine: but NYT says we should regulate what is marketed to the inexperienced

The New York Times ran an editorial Aug. 31, “Risky and getting riskier”,. about loose regulation of advertising of financial products to investors, who are often retired seniors in practice. The link is here

The NYT claims that lax rules will allow seniors to be flooded with ads about financial products (that would include the Internet, where spam control is pretty much in private hands already), and that the only rule controlling who receives them is the net worth of the recipient.

The editorial points out that an individual’s wealth and annual earnings are no indication of investment savvy,  because wealth could have been accumulated from previous work or even inherited. 

Indeed, I’ve kept my own portfolio “simple”, relying heavily on immediate payoff of balances and compound interest math, and on alertness to unsound schemes.  I actually came out of the 2008 mess in pretty good shape – I may actually be better off than I would have been had it not occurred, and that is not a good moral reflection. 

Saturday, September 01, 2012

CNN Hero helps teens with eldercare responsibilities, to keep them in school

The CNN Heroes project, which will announce its awards soon on a special broadcast, has recognized Connie Siskowski, from Palm Beach County, FL, for organizing the American Association of Caregiving Youth, link here.

The CNN story by Danielle Berger, related Saturday afternoon by Frederica Whitfield, is here.  

The Bill and Melinda Gates Foundation, in a paper by “Ignite Learning”, had reported on the problem of teenagers dropping out of school to care for ill parents (or other family members sometimes) as early as 2006, here

In 2005, the National Alliance for Caregiving had reported that 1.3 million minors were involved in caregiving, link here.

The film “October Sky” (1999) had presented the idea that a teenager should quit school to work in a coal mine to replace his father (as part of a boy’s “family responsibility”) when the father gets black lung disease.  This film was shown to a high school physics class when I was substitute teaching (in 2005).

The idea of kids having to drop out of public school because of illnesses of their parents sounds shocking and, frankly, outrageous.  How does this even happen?