Monday, April 29, 2013

"Pension advances" may amount to legal loan-sharking

People short on cash have been approached online for “rapid pension advances”  (or "lump sum pension advances") which amount to loan-sharking, with interest rates from some companies over 100%.  Jessica Silver-Greenberg reported on this practice in the Sunday New York Times, April 29, front page, here

The “products” are also offered in local circulars.

Here's a typical pitch.  Take it with a grain of salt. 

Companies seem to bypass state usury laws by claiming that these products are “advances” not loans.  And outside of the military, most of these don’t seem to be illegal under federal law.

It is true, that other kinds of instruments can be "advanced" (lottery winnings, annuities).

There is a detailed discussion of the Times article on April 29 by "Pension Pulse", by L. Kolivakis (Canada),, link here.  Approach any financial product from Wall Street, especially if pitched on the Internet on YouTube or email or social media, with healthy skepticism.  Look for those financial lesions before you leap. 
Unemployed people short on cash and in danger of repossessions or foreclosures may be tempted by these products. 

Sunday, April 28, 2013

Health Quality Partners (PA) aims to keep elderly out of hospitals and nursing homes, but Medicare doesn't quite get that.

Medicare is cutting off an innovative program of home nursing visits, run by a Pennsylvania group called Health Quality Partners, when the impetus should be toward home management of chronic disease to prevent hospitalizations, as Ezra Klein explains in the Business Section of the Washington Post Sunday, in a very detailed, booklet-length article. The title is “If this were a pill. You’d do Anything to get it,” link here
Health Quality Partners has a very visible website and simple domain name, here
While Medicare says that it is working on coming up with quality management and getting away from so much reliance on “fee for service”, its bureaucratic assessment procedures seems to have obscured the value of home health.
I rather expect to see a paper on this from Lewin, a consulting company for which I worked in 1988-1990.  The closest I could find is a new paper on long term care here. (I note with regret  the passing of the company’s founder as explained on the site.)
My own mother had regular visits from hospice nurses during her last year, and quality control visits from a nurse for a company providing home care aides.
The tendency for families to become “fragmented” will make reliance on home care more difficult, as I’ve often noted on these pages.
There’s one particular angle to the Klein story that occurs to me.  Physicians often tend to press patients into more tests, partly to avoid malpractice liability, but also out of a mentality that early intervention on problems will prolong lives.  (Look at what happened to David Letterman in 2000.)  When the intervention is invasive and requires hospitalization of someone who is productive and has “momentum” in life, the end result could be counterproductive.  Don’t go to the hospital unless you absolutely have to,  The infection issue keeps getting worse.   

Thursday, April 25, 2013

Social Security drop dead date accelerates toward us; maybe by 2023?

In differential calculus, you learn about the “rate of change” to predict what is going to happen. That certainly applies these days to analysis of when the Social Security Trust Fund will run dry, even assuming no defaults or debt ceiling fiascos. 

In 2008, the dry date was 2041. If that is the slope in which it changes, then in 2018 the year would be 2025.  So, following eighth grade Algebra I, we really could run dry by about 2023, when I would be 80. 
According to current law, when the fund is running dry, it can only pay proportionately based on what it takes in.  Benefits, even for existing retirees, would be cut at least 25%.
The link from Daily Finance is here.
Several factors accelerate the drop-dead date:  low interest rates, and high unemployment.  President Obama’s “Chained CPI” proposal would only make up about 25% of the shortfall.
One issue is the payout for Social Security disability claims, which is separate from SSI (explanation here at SSA, link.
Of course, one of the biggest drivers of the problem is rapidly increasing longevity.
Is it thinkable for many people to go back to work at age 80?  I’ve assumed I will never have to stoop to hucksterism.  

Picture: From my Master's Thesis at the University of Kansas (1968);  there are more nodes on this curve than necessary to analyze Social Security!

Tuesday, April 23, 2013

Seniors in "hot areas" often get offers for old homes, by developers wanting to do tear-downs

Annys Shin has a front page story in the Sunday, April 21 Washington Post, “Seniors’ homes are often hot properties”, titled online “In the hunt for tear-down properties, elderly homeowners often get offers”, link here
The practice is particularly common in north Arlington, VA, where there are few vacant lots, but some older post-WWII homes on lots large enough for much larger homes or condo developments.  Often the land is worth more than the cost of demolishing and building a new home.  In fact, real estate tax records in Arlington often show land that is worth several times the cost of the structure itself.  Homeowners sat that their taxes support increasingly comfortable wild animals (like the fox population) rather than people.
Seniors may benefit from the offers, but they need enough money for a cash purchase of a modern high rise condo, with income to pay the taxes and maintenance fees.  Entry into continuing care communities (some of which are condo-ized and some of which are all rental) tends to be very expensive, because of the flexibility to start assisted living if needed, and also because of enhanced security and very robust building construction. 
My own mother was very attached to “The House”  (Drohega) in her last years, but had considered the idea of purchasing a unit in The Jefferson (in Ballston) as far back as 1991. 

Sunday, April 21, 2013

"Sprinting toward the end": Some people produce record output in the last year of life

When my mother passed away in mid December 2010, she experienced a last instance of everything.  There was a last meal (ground beef, a Thursday night before), a last night in her own bed (that night), a last time she could speak to me (Friday evening in the hospice), a last glass of water.  It is a mathematical certainty that this will be true for every one of us. For me, there will someday be a last blog post.  I can imagine a short film based on going through a "last day" with certainty. 
The Friday that she took the turn for the worse for the end, I was at a rally at the Capitol for introducing the final legislation that would repeal “Don’t Ask Don’t Tell”, the cell phone from the hired caregiver ringing in the middle of a critical speech.  And on Saturday, I went  on Amtrak to New York for one day (anyhow) to hear a concert (in a stunning condominium overlooking Central Park) of Timo Andres’s “It Takes a Long Time to Become a Good Composer”. It does.  I went back on the train that night.  She was never able to speak to me again, passing into a coma and passing away Tuesday.  The concert, in particular, seemed to mark the end of one period of my life and the beginning of the next one.
The New York Times today offered an essay by Dwight Garner, “Sprinting Toward the End”, link here.  Some people, when they know they are terminally ill, race to the finish line to finish all their life’s output.  The article discusses Roger Ebert’s volume of movie reviews (and the acumen in them) in the last months, even when cancer had destroyed his face and concluded his ability to eat.  He also discusses the work of Nora Ephron.  “Death is a sniper”, she wrote. 

My own mother did not have a rush to the finish.  After eight good years on coronary bypass surgery at age 85 ion 1999, she declined in slow motion from about 2007.  It was imperceptible day-to-day.  She spent a lot of time on the house, but she didn't "accomplish things" in the sense of public output as described in the article.

Maybe, for some people, it is a dream that doesn’t stop.  The other night, I dreamed I had spotted a particular important friend on the street (not seeing all that I wanted to see), and wanted to catch up with him.  I went back to my car, knowing I had parked carelessly, and could not find it.  I was in a kind of Gotham, a city, but not quite one that fit on this planet.  (Maybe it was that Middle Eastern-looking city in AMC’s trademark  video, with an outdoor theater on another planet.  There are cars on other planets.)  I had to wake myself up deliberately to end this one.  Then everything was fine. 
I wonder if you only find out about other worlds, other universes, when you go.  Maybe only then you remember all of your lives, and can do nothing about them.  You can only be with those you loved.  Among all those souls, you know what is in their hearts and they know what was in yours, a kind of ultimate telepathy, or maybe shared "commons" of consciousness.   Maybe when you’re “back on the bench” you really know.  You have to give up the knowledge of good and evil to even come up to the plate, whether to strike out or hit a home run.  
 One other note:  A couple of times, people suggested to me that the most important thing I could do with my life was to have my mother reach age 100.  Imagine how that comes across!

Saturday, April 20, 2013

Companies put real objects, even food, into the balance sheets of their pension plans

Julia Werdigier and Mary Williams Walsh have a humorous analysis in the Business Day section of the New York Times Saturday, April 20, 2013, “What’s in Your Pension Plan? Companies substitute tangibles, likes cheese or aged wine, for investments”, link here
Companies have started placing tangible objects (as inventory) into the balance sheets for pension plans, and it is apparently not clear where Labor Department rules would allow it. But there is no rule against states doing this with public employees.  The state of Alabama put some of its golf courses into its public plans. 

If my “company” had employees, could I put copies (“instances”) of my book(s) in the “Plan”?  Could I put an unpublished novel manuscript in it, based on the theory of future value?
It seems like it’s easy to make up value.  That’s not even true for bitcoin. 

Wednesday, April 17, 2013

Seniors may need to be wary of stocks now

Money News and News Max have been reporting dire predictions of another stock market crash soon, claiming that Warren Buffett and other billionaires are dropping consumer-related stocks quickly. 

The story might be of interest to retirees living on investments so here is the link. 
The article links to a video of an “Aftershock Survival Summit”.  Yes, it sounds like a come-on.
Reuters and Yahoo! reported that Gold is suddenly falling, as are “risk assets”, link

My own financial planner recently had urged me to convert from a conservative portfolio to mostly bonds to many more stocks (25%).  He doesn't like utilities and energy -- and I think there is an issue of social responsibility here, because utilities may be compelled to harden their grids against possible big solar storms and various other terror threats, reducing earnings.  I think that retirees who have such stocks should learn about this issue and urge the companies to do what is right when they are shareholders.  
The one thing retirees won’t (or shouldn't) invest in domestically is bitcoin.  It seems to be undergoing “Skyfall”.  Where it sounds useful is overseas among dissidents who need to cover their tracks.  It’s popular with people under 30, perhaps.   It’s a long way from the world of financial planning and retirement. 
In the meantime, columnists like Michelle Singletary and Suze Orman try desperately to get middle agers to take retirement planning and saving seriously.  

Thursday, April 11, 2013

Alzheimer's cases will nearly triple by 2050

The number of people in the US  with Alzheimer’s Disease is expected increase from 5 million to 13.8 million by 2050, according to media reports this week, a typical story occurring in USA Today, by Janice Lloyd, today, link 

The nearly triple increase is largely the result of the aging of Baby Boomers, coupled with the fact that medical practice prevents deaths from other diseases from occurring first.

This will become an existential challenge to our economy and all of our basic assumptions about “choice” and responsibility for others.  This problem is one of a few unprecedented challenges that the next generation faces.

The study was sponsored in part by the National Institute on Aging and the Alzheimer’s Association. 

NIH reported that dementia care cost up to $215 billion in 2010. My mother died with milder forms of it at the end of 2010 at age 97.

Wednesday, April 10, 2013

Do relatives need to watch doctors collecting Medicare "like hawks"?

A cardiologist in New York City has admitted to making fake diagnoses to heart patients in order to collect more money from Medicare for unnecessary procedures, with an NBC New York report (website url) here
The doctor often ordered EECP therapy (Enhanced External Counterpulsation), as explained here on Wikipedia
Extra tests or treatments could put some patients at risk. 

I was sometimes criticized for not being aggressive myself with providers during mother’s treatment from 1999 (when she had bypass surgery at age 85) until her passing at the end of 2010.  She had four hospitalizations for bleeding problems from Coumadin until she was switched to Plavix.  A surgeon did a lumpectomy in the fall of 2009 that was probably unnecessary and even wanted to do a followup in the spring of 2010.

Do relatives really have to watch physicians using Medicare?
 A physician in Staten Island was convicted of a massive Medicare fraud scheme, according to this story.  

Tuesday, April 09, 2013

Checkup: can wireless or other devices harm a heart patient with a pacemaker or defibrillator? Probably not -- but it is life and death

A new laptop from Toshiba warns users to “Turn off your Product and.or all wireless functionalities where electronic devices are regulated or controlled or when near a person with any medical electric devices.”
But a recent page the website from the American Heart Association points to very little risk from most home electronics for patients with pacemakers (or implantable defribrillators), which seem to become more common.  That page is here

Cell phones pose no risk now but there is concern that use of other frequencies could pose a risk in the future. Some authorities recommend keeping cell phones at least ten inches away from the device.  MP3 headphones might pose some risk in some cases. 
My own mother (who passed at the end of 2010) never had a pacemaker, but she did have aortic stenosis and congestive heart failure; she survived eleven years after a coronary bypass at age 85 and as beginning to develop some dementia (especially short term memory), but milder than many people.

There never was any cross interference between my own electronics and any devices she did have, like oxygen delivery and baby monitor.  

Saturday, April 06, 2013

Are Social Security and Medicare really to be called "earned benefits"?

Jackie Calmes has an important story in the New York Times Thursday April 3, p. A3, “Misperceptions of benefits making trimming harder”, link here

She explains that Medicare payroll taxes fund only Part A (hospitalization, and that Part B coverage (80%) has really been coming from the general treasury.  

Social Security, on the other hand, comes much closer to having been intended to fund itself. 

But in practice, the government has been paying benefits of the retired from taxes on the working. (We’ve discussed the “trust fund” mechanism, which seems legally binding here before).
She points out a single male who turned 65 in 2010 (I did so in 2005) would probably have paid in $300,000 in Social Security taxes and could expect to collect $277,00 in benefits.  With Medicare, he would have paid $61,00 in Medicare taxes but is likely to collect $180,000 in benefits, but some of those benefits might result from unnecessary tests and treatments and health care inefficiency.  Women fare better in this analysis because the live longer.  Younger workers will fare less well than older people.
She points out that we should use the term “earned benefits” for Social Security and to some extent Medicare, rather than “entitlements”.      

Thursday, April 04, 2013

Sequester caused clinics to turn away Medicare cancer patients

According to a Washington Post story today, clinics are having to turn away patients for some expensive chemotherapy treatments under Medicare because reimbursement has been cut by the sequester.  In most cases, patients can get the treatment at hospitals, which may be costlier for Medicare and may cost patients more out-of-pocket.
The story by Sarah Kliff has link here
The situation makes it seem silly that Congress can’t reach a deal.  It could save more money and still deliver needed therapy at reduced cost if it settled this mess. 
Part of the problem is that the more expensive drugs (which sometimes have fewer side effects) are covered by Part B instead of Part D, because they require more physician skill to administer.

Wednesday, April 03, 2013

Study suggests bald men are more susceptible to heart disease; I've heard this before

A British study found that men with male pattern baldness at the crown of the head (and not just a receding hairline or “widow’s peak”) are more likely to develop heart disease prematurely. 
James Gallagher has an article for the BBC here. The original dermatology article in BMJ Open is here
I can remember reading theories about baldness in newspapers back in the 1950s.  Sometime in the late 50s, there was a British study claiming that bald men have more chest hair than non-bald men, something that sounds only marginally correct.  And that study was done in a “segregated” world.
Some anthropologists say that the tendency for many men to lose scalp hair and (in many Caucasians) display more body hair, developed because (heterosexual)  women preferred men who looked for different from women.  A balding man was likely to be older and “mature” and “competent” enough to survive youth and young adulthood and be a responsible provider for children.
Nevertheless, the study supposes a connection between scalp hair loss and unusual sensitivity to testosterone, internal insulin resistance (diabetes), inflammation, and therefore  blood vessel and coronary artery deterioration.  Prostate cancer might appear earlier and become more aggressive.   The study didn’t say this in the article, but premature loss of leg hair would be a sign of deteriorating peripheral circulation.
The story was mentioned on NBC News tonight.

Monday, April 01, 2013

Elderly drivers who exercise perform certain maneuvers more safely

NBC Nightly News reported today that studies at MIT are finding that elderly drivers perform some tasks (changing lanes and parallel parking) when they follow flexibility exercise routines.  Some seniors may have difficulty with the extreme neck flexibility to merge into traffic and see into blind spots. 
New cars that are supposed to self-park might help solve these problems. Here is Gearburn's "top five self-parking cars" list
I don’t like fast lane changes.  On a few occasions, trucks have honked loudly at me when driving at a safe distance but not able to change lanes quickly because of traffic density. 

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