Friday, December 27, 2013

Hospice companies make too much money off Medicare with long-term "survivors"

Hospice firms are draining Medicare and straining the budget process, according to a front page story in the Washington Post on Friday, December 27, 2013 by Peter Whoriskey and Dan Keating, link here
Hospice companies, while they say they follow the guidelines by taking on clients whose life expectancy is six months or less, have an incentive to stretch things.  Patients who “survive” longer add to their earnings.  They have to review “survivors” every two months and show medical evidence of further decline. 
The issue appears to occur mainly with in-home care, not with patients who go to hospice facilities for the last few days of their lives.  But it is conceivable for a patient to live longer than expected even there and then wind up in a nursing home.
The article mentions vague diagnoses like "adult failure to thrive".
My own mother entered in-home hospice in November 2009 and survived until December 14, 2010.  She entered the facility on the afternoon of Friday, December 10, 2010 and passed away at noon on December 14.  

Tuesday, December 17, 2013

CNN article on "bad value" for US health care disappears mysteriously; we spend too much at end of life, we sponsor processed foods

On Monday, Dec. 16, CNN’s Global Public Square Blog offered a perspective by Jody Heymann and Douglas Barthold, posted by CNN’s Jason Milks, “Why U.S, health care is a bad value for the money”.  Many sites linked to it, but the article disappeared.  I read it on my cell phone while on the road yesterday.
It did say a couple important things.  One of the most important points is that about a third of our healthcare costs are incurred at end of life, when desperate efforts are made to keep people alive as long as possible.  That certainly bears on the eldercare debate.
The other problem is that corporate America invests in “unwellness”.  The article mentioned that Iowa is always an early political caucus state, so politicians placate voters with farm subsidies encouraging the production and consumption of corn syrup, which contains a form of sugar that tend to promote obesity in people with genetic susceptibilities.   The processed food business has tremendous lobbying power with Congress.  So we invest in practices that promote chronic disease and “pre-existing conditions” in many people. 

Does anybody know why this article, so convenient to read at a McDonalds as a “roadside attraction” disappeared?

Monday, December 09, 2013

Politicians ignore the 'generational wars" because seniors make up so many votes

Here’s another perspective, this time by Robert Samuelson, on how politicians are blinded to population demographics, in the Washington Post on Monday, December 9, 2013, “America’s clash of generations is inevitable”, link.  

Samuelson says that within families and extended families, the proper personal responsibilities are still clear. “Parents are supposed to care for their children, and children are supposed to care for their aging parents. For families, these collective obligations may work.”  But politicians, spurred by the voting power of seniors, keep taxing the young to pay for longer retirements and deference to the old.
I was in the middle of this, when my mother was in her mid-nineties, but I was in my sixties myself, creating a dynamic that seemed almost unprecedented.
Samuelson sees Obamacare as part of the generational clash, as younger healthier adults pay for seniors just under 65 (Medicare).  But they could be seen as paying for their own health care in the early senior years. 

Wednesday, December 04, 2013

Detroit bankruptcy said to said new legal precedent in ability to cut back pensions, stiff bondholders

Federal bankruptcy law will trump over Michigan state law protecting pensions, but a Detroit Free Press (Gannett) article about the options available to emergency Kevyn Orr leave a lot of wiggle room for how pensions would be affected.  There could be a means-testing concept, or police and fire unions might fare better.  The Free Press analysis is here
The Washington Post on December 4, in a detailed story by Michael A. Fletcher and Reid Wilson, reported “Detroit eligible for bankruptcy filing; pension ruling could set precedent; unions vow to fight plan to shed $18 billion debt”, link here.  The story indicates that Judge Rhodes is setting a precedent in allowing municipal worker pensions, including those already retired, to be cut, as well as stiffing bondholders.  The main story is here  and there is some supplementary video.
There have been some other spectacular bankruptcies, such as Stockton CA, as reported by Morgan Spurlock.
Anthony Bourdain recently covered the plight of Detroit in his "Parts Unknown" series for CNN.  The city went into rapid decline after riots in the late 1960's, followed by departure of many employers to the suburbs or to southern cities or overseas.  

Retirees who hold a lot of tax-free municipal bond funds could see values go down, as more funds are seen as possibly at risk.  Less risky are holdings of specific securities, where the retiree or investment advisor knows the reputation of the local government or utilities authority

I visited the city on a Sunday morning in August 2012 and found the downtown area (near the new stadium for the Tigers) kept up, and did not see the blighted areas that are widely reported.