Tuesday, October 30, 2012

If you don't want to join the Letterman Zipper Club, never to go the doctor: active seniors may like things the way in the 50s, when we didn't try to live forever

I will have my annual Medicare physical Nov. 1 (it was postponed from today because of Sandy), and will follow up with a visit to an orthopedic surgeon about pain in my left hip, left over from an acetabular fracture from a convenience store accident in Minneapolis in 1998.

That could mean surgery, which could be simple (one morning, outpatient) or more complicated, meaning hospitalization and a period of no access to Internet (as I discussed on my main blog Oct. 27).  Or it could mean only medication and no interruption.

There’s always the possibility that any physical will turn something up.  In the generation in which I grew up (50s and 60s) people usually lived out their lives, productively in their own way, until something potentially fatal happened.  Usually, little could be done, and people died rather quickly after being active almost all of their lives.  That was “normal” and generally led to life spans of 65-85 years. 

Medicine can now prolong lives much longer, but this requires a change in heart of values from the patient, and it also demands social cohesion from family or others around him or her.  As Dr. Oz says, most radical treatment doesn’t work unless “you love somebody who loves you back.” Or as Jonathan Rauch, advocate of gay marriage, writes, a single person is an “accident waiting to happen.” Social isolation can preclude the possibility of life extension.

Yet, for me, the best result is to be 100% active as long as possible, and that may mean doing as little as possible.  As we know from prostate cancer, which often remains indolent for years, many men are better off for many years or decades if they do nothing.  (That doesn’t seem to be true of breast cancer for women.)  But prostate cancer can suddenly explode, as it did with my own father, who died after only four weeks of illness on New Year’s morning in 1986, just before his 83rd birthday.  But that was the way he wanted it.  He could not stand the idea of dependency or helplessness or shame, despite my mother’s devoted attention.  With less “pride” he probably could have lived much longer, but he didn’t want that.  He wanted to keep everything until the end.  Then he let go.

My mother broke her hip in 1996 at age 83, and during ensuing hospitalization the first sign of heart problems ensued.  Interns were surprised I didn’t “know” much more about her health, and there was a concern that the fracture had resulted from old breast cancer metastasis .  It had not. That blew over. In 1997, she had a hip replacement, which led to a more complicated hospitalization than had been expected. I arranged brief home health care.  Because of circumstances regarding my book publication and to avoid “conflict of interest”, I took a job transfer to Minneapolis in September of 1997.  In 1999, she had a heart attack (which had probably been detectable earlier, but it was easier for me that it was not), and that resulted in coronary bypass surgery in May 1999 at age 85 (after deciding that angioplasty was itself too risky).  I had never heard of bypass surgery, which in her case was very invasive, done at such a late age.  I had a concern that this could not be done unless I gave up the job and came back, but that did not happen. Nevertheless, this was a scary time for me, given filial responsibility.  It could have been fatal for my own intentions for my own life.  It could have meant sacrifice.

I could say, on an intellectual level, that we should have a real discussion about how far we should go with extending life.  In mother’s case, the surgery worked and she got at least eight good years out of the surgery despite the advanced age, before starting to decline at around age 94 (and passing away right after her 97th birthday).  So the surgery seems justified by the result.  But it’s clear that today, in comparison to times past, radical treatment at advanced age cannot be justified except for people who have strong social support systems, including other family members (not just spouses) who can deal with the personal sacrifice.  I can say that we should have a public policy discussion about his question, in light of all the concerns about the sustainability of our health care and Medicare systems.  People take offense when I say this, like how can I look at something in such an detached, “impartial” way when “she’s my mother”?  If I had children, I couldn’t afford to be objective.  But I think there is a point where we must become objective.  There are times when some people would let go.  I can be one of them some day.  Everyone of us will die of something (except those of us who get to become angels, as in my novel and screenplay).

Remember what happened to David Letterman in 2000, albeit it at age 50 or so?  He went to the doctor, and didn’t come home again until he was a member of the zipper club, his destroyed chest a subject for cartoonish, even clownish satire in Esquire.  That is not for me.  I must keep on trucking.  

Wikiepdia attribution link for picture of Asheville, NC (Oct. 1991 visit). 

Sunday, October 21, 2012

Increasing Social Security tax contributions and mitigating benefits will be a tricky proposition (Diamond/Orzag)

Dylan Matthews has an important article on p. G4 of the Washington Post, Sunday Oct. 21, 2012, “A nobelist’s views on Social Security”, in which he discusses the writings of Peter Diamond, and Peter Orszag, “Saving Social Security: A Balanced Approach”.  The Wonkblog that hosts the article was not available online Sunday morning.   But there is an earlier interview of Peter Diamond Oct. 14 here

Matthews points out that raising the full retirement age will reduce the benefits (by percentage) of those who retire early, and he also notes that those who retire early tend to have lower life spans.  He feels this is wrong.

Generally Diamond and Orszag favorite benefit cuts for the better off and progressive but small tax increases.
He also points out that Paul Ryan’s proposal includes health insurance premium income in the wage base, and effectively raises the FICA tax for ordinary workers, instead of raising the wage base maximum.

The nice thing about privatization is that, although the government could make savings mandatory and regulate the way they are invested, the account owner would get the actuarial value of his savings at retirement (calculated as an annuity) and would not be subject to the possibility of political expropriation for “means testing.”  But it is very difficult to get there without sacrifices.

The Diamond-Orzag plan goes all the way back to a paper published in 2005 by the Brookings Institution, Vol. 2, Issue 1, Article 8, “A special issue on Social Security”, link here.  

Wikipedia attribution link for Grandfather Mountain picture (my last visit, 1994). 

Tuesday, October 16, 2012

Social Security announces COLA benefit increase of 1.7% for 2013

The Social Security Administration has announced a 1.7% COLA (Cost of Living Adjustment) increase in benefit payments, to start in January 2013.

The basic link for the table is here

Since the average recipient receives about $1237 a month, the increase would typically be about $21.
But some of the increase will be consumed by an increase in Part B Medicare premiums, expected to be about $7 a month more.

The FICA tax rate 7.65% per employee, 7.65% to employer, of 15.30% total (which would be the self-employed rate).  And the FICA tax rollback of 2% probably won’t be continued.

Stephen Olemacher has an article in the Huffington Post, here. I’m not sure what he means by that “3.6%” increase number.  He also quotes a FICA  tax rate of 6.2%, but SSA says it is 7.65%.  The maximum wage base increases to $113,700.

I can remember as far back as 1975, when working for NBC in NYC and making $16,500 a year as a programmer, that we reached the Social Security cutoff around the end of September and had a “raise” for the rest of the year. 

Small Biz Tax Training has a video (Jan. 2012) explaining Social Security tax for self-employed individuals:

These rules can affect people forced to work as independent contractors by "employers", such as taxicab drivers and often home health caregivers.  

Monday, October 15, 2012

Many seniors would pay more out of pocket under a Romney-Ryan "premium support" plan

Most seniors would pay more for premiums out-of-pocket in a voucherized system to replace Medicare with what might resemble today’s Medicare Advantage plans. 

Ricardo Alonso-Zaldivar has a typical story in the Huffington Post, link here.  

A typical comparison would have to be made between today’s Part B Premium, plus typical Part B Supplemental (which tends to be reasonable if started at age 65 through AARP), plus Part D, and assume “free” Part A (almost, allowing for Part A deductibles largely covered by supplementals),  with the total premium for a voucherized system for all of this, minus the government voucher, which could be means-tested (it could be zero for some people).

The results came out to $200 more for many patients in Florida, $100 more for many in Nevada.
The latest Part A deductible sheet for 2012 is here

The study comes from the Kaiser Family Foundation, “Transforming Medicare into a premium support system: Implications for beneficiary premiums,” link here

The Associated Press supplied a YouTube video on President Obama's response to the Medicare premium support plan: 

Thursday, October 11, 2012

Younger seniors caught in the middle with obligations to the very old, and to the young; consider De Tocqueville

Eduardo Porter has an important perspective on the Business Day of the New York Times Wednesday, Oct. 10, “Cutbacks and the fate of the young”, link here

Porter notes that both (major) parties are promising to protect the benefits of current and near seniors. The "elders" just have too much political clout to be asked to sacrifice for the next generation to have its turn, he implies.

He recounts a list of cutbacks on programs that would help children and families, necessitated at least indirectly by the need to pay for seniors who are living longer.

Of course, one can say that, at least beyond a certain limit, it’s not the proper function of government to provide for the elderly; it is a duty of the adult children in families.  It strikes me that this idea in conservative though does indeed look back to De Tocqueville’s ideas about the proper granularity of individualism (as explained in a Wikipedia article link; look at the fourth paragraph in the “Democracy in America” section). 

I wound up coming back “home” in 2003 to look after my own mother, who died at 97 at the end of 2010.  I did hire caregivers starting in 2009, and I’m grateful that my father left her with the resources to be cared for by his lifelong conservative investment strategies (lots of utilities and oil). Even so, I felt a certain shame in having become a 60-something man living with his mother (in his old house), being legally responsible for her without ever having succeeding (in “reproductive competition”) in having a lineage (and therefore domain) of my own (I would have felt OK if in a same-sex relationship taking care of her in my home, not hers).  Technically, I had a situation for about 19 months where I could not legally leave her alone and pursue my own choices without a caregiver present.  This whole episode certainly can affect my perspective on marriage and procreation.

The possibility that in the future people might not age at all (with biological engineering) could provoke a moral and policy debate the likes of which we can hardly imagine now. For example, see Discover, Oct. 19, 2012, “Forget immortality: live life without aging”, here

Tuesday, October 09, 2012

NBC revisits problem of disabled elderly drivers; when must adult children take away the keys? When must a physician?

Tuesday, October 09, 2012, NBC Nightly News revisited the problem of “taking the keys away” (even removing the car battery) from older drivers. 

Visit NBCNews.com for breaking news, world news, and news about the economy

Five states (including California and New Jersey) require physicians to report stroke patients to the DMV’s, but there is no national standard of potentially disqualifying conditions for driving.

With my own mother, at age 95, in 2009, I was told I might be liable if I let her continue driving, after her stroke (in Virginia) and she had a wreck.  (She passed away at the end of 2010.) 

States do have various medical standards. Virginia has a rule that no one may drive within six months of a seizure of blackout, link

A list of AMA guidelines for physician responsibilities is here

AARP and AAA offer a link giving licensing laws for seniors by state here

Thursday, October 04, 2012

Social Security FICA tax collection "insufficient" for second straight year

Siobahn Hughes, in a brief story in the Wednesday Wall Street Journal, reports that, according to the Congressional Budget Office, the Social Security program paid out more to beneficiaries in 2011 than it took in with FICA taxes, for a second straight year.

Nevertheless, Social Security may be able to short a “profit” in 2011 if interest on special-issue US Treasury securities is included later.

The link is here.

The very brief story appeared in print on p/ A2 on October 3. 

I don't know if these calculations are based on the federal fiscal year, which actually begins October 1 of the previous year. 

Wednesday, October 03, 2012

Family caregivers having to do more of the actual medical tasks

Michelle Singletary, author of “The Color of Money” column, has an important post in The Washington Post today, “The growing burden on caregivers”, link here

Specifically, she is referring to the challenge many family members face in learning to perform quasi medical or practical nursing procedures or tasks, as well as “normal” physical caregiving.  Hired caregivers cannot do some of these tasks (although private nurses can).

When I was looking after my own mother, who passed away at the end of 2010, the hospice did approach me about the idea of giving injections, but that did not happen. I did manage the pill boxes, however, and have all the prescriptions filled. 

Another issue that might occur is the possibility that a very elderly senior could have medically active tuberculosis (detectable by scratch and blood tests and chest Xray), which could make it impossible to move into normal assisted living or hire caregivers normally.  

These problems, and the challenges they create for family members (adult children as well as spouses) are partly the result of the fact that the extreme elderly can live much longer with severe disability than they could in the past.  Earlier generations often saw an unmarried woman staying home and taking care of the grandparents, but usually their period of extreme need was short compared to today.  

Monday, October 01, 2012

Temporary FICA tax cut (for social security) will probably expire on Jan. 1, 2013; workers paychecks heavily affected

The New York Times is reporting that Congress is quite unlikely to extend the FICA payroll tax cuts after the start of 2013, regardless of the outcome of the 2012 general election.

The major story by Annie Lowrey is here

The “automatic tax increases” and “automatic budget cuts” would start on January 1, partly because Congress failed to agree on a more specific plan in November 2011, as required by part of the debt ceiling extension after the silly partisan standoff all summer long, resulting in a lowering of the US credit rating.

However, continuing the FICA tax cut makes little sense in a world where Social Security is getting into trouble because of demographics.  People would get the same benefits (annuity) as others after paying less FICA taxes (or “premiums”).  In the end, the result would be more drastic raising of eligibility ages or benefits cuts, or possibly means testing, even of current or near-term retirees.