Tuesday, December 23, 2008
May I wish for you and your family a very happy holiday. Where I live the ground and trees have been covered with white snow, slowing down traffic and making us all a little frustrated or in the holiday mood – depending on your perspective. In honor of the holiday season, I want to talk a little about perspective. All of us with investments have lost a great deal of money in the past several months. For some who are retired, that may be what they are living on. For others of us, those investments were what we hoped to retire on.
But remember those who don’t have investments; those who didn’t lose anything because they had nothing to lose. Those are the people, young and old, who will be worse off in this economy because they will lose their job or because the government program they relied on is now cutting benefits. They were never fortunate enough to have something to fall back on.
Those of us who lost much of our savings are feeling much poorer and are probably a little afraid of what will happen next. But this is the time of year to look at the glass and ask if it is half empty or half full. For those of us with half full glasses, now is the time to look to the charities that we support, and continue to support them. Although we feel poorer, we must ask ourselves whether we really are poor, for there is a big difference between feeling poor and being poor.
In this holiday season, let us remember those who are really poor.
Ellen A. Bruce
President, OWL Board of Directors
Wednesday, December 10, 2008
Aging in Place?
Many of us live in the house we raised a family or our parents still live in the house in which we were raised. The rooms that once held Legos are now guest rooms or dens. We may love the house for its memories or we may feel it is too big for the occasional visits of family and friends. Should we move?
I have often pondered the phrase “Aging in Place” which is so often held up as the goal for housing policy and long-term care policy for older persons. Does it make any sense?
As we get older our needs change and it seems that our housing should also change. We probably need less space and would appreciate less responsibility for the upkeep. The models of independent living that offer meals and relief from other burdens such as finding repair people have been very popular among those who have the financial means to afford them. They are also popular with the children who worry about their parents’ wellbeing.
For people whose houses were in the suburbs or rural areas, the independent living model can provide transportation when driving becomes unsafe. But perhaps, most importantly, living in these communities can provide an easily accessible social network. As we age, we lose not only some of our strength and stamina but also our friends and often our spouse, leaving us much more socially isolated and often lonely.
Aging in place sounds good but may not be the best choice of many of us. As we change and our lives change, it makes sense that our housing should also change. Certainly we do not want to be warehoused in an institution but there should be many other options between staying put and moving to an institution. The continuing care communities are a good start but they also pose problems. They are expensive and not available to most seniors. For those seniors who can afford them, they are viewed as a place you move to when you no longer want to cook or drive or your children are afraid of you alone in a big house. Why not make them more flexible so that you don’t have to have the meals if you still like to cook? Why not make them attractive to young seniors as well as older ones? Why not build affordable units with government support?
Some of these ideas are already in place but we need many more innovations which will encourage those in their sixties and seventies to downsize when they can do it themselves in a manner that they choose. Planning ahead is part of the puzzle but having the options is also an important piece.
Ellen A. Bruce
Friday, November 14, 2008
November 13, 2008
The Economical Way to Assure Medical Care for Children and Young People That Also Reduces Strains on Family, Business and State Budgets: Medicare
By Nancy J. Altman and Merton C. Bernstein. [Both have served as senior staff to the 1982-83 National Commission on Social Security Reform and in the
President-elect Obama’s proposed health care reform includes a requirement of mandatory, universal, and comprehensive health care coverage for all children. No reform is more urgent, offers greater returns, or is more readily achieved at such low cost.[i]
We suggest that Medicare offers the readiest and least expensive platform for this advance,[ii] one already familiar to the nation’s health care providers, insurers, and consumers. A straightforward, universal children’s health plan is extremely efficient. Social Security, which has low administrative costs (less than 1% of outgo), demonstrates how cost effective an objective test like age is. Using Medicare’s simple and low cost machinery, rather than the myriad private and public sector programs, like SCHIP[iii] and Medicaid,[iv] will assure universal coverage while eliminating a number of costly and time consuming steps, such as processing hundreds of thousands of billings using innumerable differing formulas.
Funds now applied to SCHIP and Medicaid will go farther by eliminating the costly means testing that must be done repeatedly – every thirteen weeks in the case of Medicaid. Indeed, the Urban Institute has concluded that Medicare’s administrative costs are about 4 percentage points lower than Medicaid’s.
In addition to its efficiency, a unitary, comprehensive program for children will improve health outcomes. When medical attention is needed, no one need first ascertain which program, if any, will foot the bill; patients can proceed directly to the intake nurse, without first stopping at the financial office.
Reducing the per capita cost of children’s medical care and shifting those costs to Medicare will reduce the financial stress upon families and business. Employers will find the costs of employment-based insurance reduced, as will their employees. Inclusion of children in employment-based insurance has always been a matter of convenience; consequently, it can be modified without violating principle.
Such a program will increase the nation’s productivity. By assuring timely and adequate health care to all of our children, we reduce the disruptions to family life and employment that inevitably accompany child sickness, which can be especially disruptive for single parents. Fewer sick kids means fewer work absences by adults.
By assuming the cost of the state shares of SCHIP, Medicaid coverage for children, and similar state programs, the federal government can deliver effective assistance to state governments where they urgently need it. Expenditures for Medicaid and the health care costs of public employees have become the largest or second largest outlays by states.
We will all be better off by fully meeting the health needs of all the nation’s children in the most effective, least costly way. Providing health care to children is comparable to our national policy of providing education, free of cost, to all children. As a nation we debated and settled that policy in the 19th century. We decided as a nation that we all have a stake in the education of everyone’s children.
We must recognize children’s health and child education are as much a part of the national infrastructure as our ports, roads and bridges. Medicare provides an efficient, time-tested platform for making this goal a reality.
[i] In 2006, Medicaid covered more children (29.5 million) than any other beneficiary category and with the lowest per capita cost - $1,070 as compared with $1,310 for adults, $6,630 for aged, and $7,360 for blind and disabled (Congressional Budget Office fact sheet, March 6, 2007). What we propose here would lower per capita cost even further.
[ii] Out-of-control costs are pervasive throughout both public and private health care programs. Controlling all such costs are essential to overall health care reform.
[iii] State Children’s Health Insurance Programs, enacted in 1997, have substantially decreased the numbers of children lacking assured health care. Together, SCHIP and Medicaid have improved coverage of poor children. However, the older the youngster, the less likely such coverage is. Further, both programs are limited by income caps – typically 200% of the federal poverty level. The most dramatic element of the
[iv] Medicaid provides more extensive care than SCHIP. Both use federal and state funds with the federal share the larger. As with several other economic stimulus measures, this proposed shift of the state contributions would require deficit spending.
Wednesday, November 12, 2008
Obama wins the election! Now what?
In the last week, we have seen the incredible power of hope. The election of Barak Obama to the Presidency of the
Americans have reaffirmed the dream that you can succeed to the highest political office regardless of your race or ethnicity. At a time that our economy is failing and our reputation around the world is embarrassing, voters proved that our aspirations are most powerful when things seem most gloomy. As President-elect Obama encouraged us, we must believe in the “audacity of hope.”
Equally amazing in the last week has been the reaction of the world to Obama’s election. There literally has been dancing in the streets. People in all parts of the world care about what Americans do – with good reason. In the last eight years we have invaded two countries and started a global financial crisis. Can we also start a revolution of hope?
For individual citizens and members of OWL, we should learn from what has been accomplished. President-elect Obama is a man who believes in a vision of the country and has worked successfully to convince others to believe he can make a difference. If nothing else, he has shown us that he can convince thousands of volunteers to work for him, millions of people to contribute money, and tens of millions of people to vote for him regardless of race, party affiliation, or a funny name.
It is time for all of us to make the vision a reality. What are your hopes for which you would volunteer and contribute money?
For me, I can imagine a country where everyone has equal access to health care. Where women don’t pay more for health insurance or retirement annuities just because they are women. Where wage discrimination on the basis of gender is eliminated. Where elder abuse never happens.
Now is the time for us to hope, but hope is not enough. It must be followed by action. As Tish Sommers and Laurie Shields understood when they formed OWL – and Obama just demonstrated – “Organize, don’t Agonize”. Join with your neighbors & friends to support the change that is possible. Join with the women & men of OWL that are working to bring our vision of women in mid and later life to reality. Be the change you desire.
Friday, October 31, 2008
Health Insurance and Women, Why pay more?
If you didn't have enough reason to support universal health insurance, the New York Times' article on October 30, 2008 just gave you another one. Headlines read "Women Buying Health Policies Pay a Penalty."
The long and short of the article is that, in most states, insurance companies charge women more for an individual health insurance policy than they charge men. Up to 49% more! The justification is that women incur child bearing costs and that they use more health services than men. What is the problem with this logic? First, lets take the child-bearing argument. Biologically, having children is a project of a male and a female. Since women bear the responsibility for carrying the fetus prior to birth, maybe we should place the cost burden of the birth on the men? That makes more sense to me than putting all the burden on women.
I can hear the complaints -- why should all men bear the extra cost when many of them are not married or having children? But that same complaint goes for women who are paying the higher costs but aren't having children. This is insurance, which means there is a decision to spread the cost of having children to some group of people. The question is who should that group be. It makes more sense to spread it to all persons (i.e. universal health insurance) as both sexes are involved in incurring the costs. Also, having children benefits all of us even if they aren't our children.
But logical arguments aside, shouldn't health care be a right of all Americans regardless of your race, gender, or age? And if it is a right, shouldn't we all share in insuring that everyone has it. This isn’t about what is logical, it is about what is moral. What is right. As a society we don't want some people being able to get health care while others, for lack of money, can't get the care they need. Why should individual women bear more of that cost. Already women loose earnings to care for children and other family members. Women still are paid less than men. The result is that women as a group are poorer than men. So why would we allow insurance companies to divide their markets into men and women and make the women pay more? It just isn't right.
Ellen A. Bruce
Saturday, October 18, 2008
As we walk down Elm Street, at least every fifth house contains a family that is providing care for an elder or an adult – a spouse or adult child – with long term care needs. This family includes a couple who are working and hoping that they aren’t personally affected by the lay-offs they are seeing around the neighborhood. There might be young children, friends or various other family members in the house as well. The person they are helping might live with them, around the corner or across the country.
In the US, as in other industrialized countries, families provide 80% of the long term care services for an adult with care needs. Families do everything that is needed by the person they are caring for – from simple errands to more complex medical care tasks. It is estimated that these “free” services save the nation’s health care budget a whopping 20% of overall costs each year. One big difference between the family caregivers in the US and those in other developed countries is that, in the US, we don’t have universal health care. Even older Americans covered by Medicare who have the closest thing to universal health care we have, have large out-of-pocket costs. The US has employer-based private market health care which means the only thing standing between you and ongoing health care services is the relationship between you, employer and external market forces.
Last winter the findings of a study looking at the out-of-pocket costs of family caregivers were released by the National Alliance for Caregiving. The study, sponsored by Evercare, examined what families were spending on behalf of the person they were helping and how they managed that expense. In a survey of 1,000 family caregivers across the country only 178 respondents said they were spending nothing. The remaining 822 respondents were spending an average of $5,500 a year on services and products needed by the person they were caring for; the most common category being medical expenses. One out of five respondents reported spending their own money to pay for the medical costs of the person they were helping at an average annual expense of over $1,100. This means that not only are these families spending hours of their time each week – an average of 35 hours weekly; roughly equivalent to another full-time job--providing hands-on assistance, they are also purchasing goods and services with their own funds. When asked how they manage the extra costs, half reported they cut back on their own spending for leisure activities, a third reduced or stopped saving for their own future and one out of five borrowed or used a credit card to finance these unexpected expenses.
In the US, nearly half of personal bankruptcies continue to be due to medical expenses and, even more shocking, 75% of those who file for bankruptcy as a result of medical expenses had health insurance when they became ill. The costs of a market-based health care system have become unsustainable to Main Street as employers find their own global competitiveness diminished by the cost of covering their employees and to Elm Street as families find they can not continue to pay for their own health care or the health care costs of an elder, spouse or adult child. We have the most expensive health care in the world and the largest group of uninsured citizens in any developed nation… 47 million and counting.
A full recovery from the nation’s financial woes cannot be accomplished without addressing our out-dated and inefficient health care system. It is shortsighted to suggest that, because we are increasing our national debt to bail out failed banks and mortgage lenders, we can’t afford to take on the needed change in our antiquated and inadequate health care system. Addressing the problems of Wall Street and Main Street cannot overshadow the problems on Elm Street or a full recovery from our sick economy will not take place.
Donna L. Wagner, Ph.D.
Professor of Gerontology, Health Science Department
Towson University, Towson, MD
Monday, October 6, 2008
"Regulation and Our Future"
Last week Congress passed and the President signed a $700 billion financial package aimed at stabilizing the banks, restoring confidence, and loosening credit. A huge bailout that we hope will stop the failure of even more financial institutions.
All this taxpayer money isn’t expected to get us out of a recession, won’t provide universal health care, won’t improve our schools, won’t help young parents pay for childcare, nor will it build low-income housing.
Liberals and conservatives alike are mad because we are spending taxpayer money (which by the way is yet to be collected) to make up for the excesses of greed. We –the country—are like a family with an uncle who went out drinking and gambling, spent the family savings, mortgaged the house, and ran up a debt the family now must pay. One member of the family just sucked up all the dreams of the rest of the family.
Why did we let this happen? Yes, we let it happen. This financial crisis is not a natural disaster, it is man-made (and most of the actors are men).
The greed and “irrational exuberance” at the base of this disaster is troublesome, but what worries me the most is the rhetoric we have lived with for over 28 years that government is bad and that we need to trust in individual ingenuity. Individual ingenuity can create great companies but it also destroys great companies. Government isn’t bad—it is as good as the people who make it up. A government that is made up of people who don’t believe in the role of protecting its citizens will fail, and fail it has.
The New York Times reported on Friday that the Securities and Exchange Commission in 2004 changed a rule that limited the amount of debt a large investment bank could incur, thereby opening up the opportunity to make more money but at great risk – risk not only to the bank, but as it turns out, to our economy and consequently to the wellbeing of all of us.
The last two weeks have demonstrated in a very costly way why good government is important to all of us. Not since Katrina have we seen such disastrous results of government agencies that don’t function. I want a government that believes in its role of protector of its citizens, not only from foreign invaders but also from the excesses of individual citizens.
Because we, as a society and as world, are so interconnected we need to have a government that is not afraid to regulate individual behavior. Whether it is monetary risk-taking, pollution, the safety of our food, or a host of other dangers, we need a government that has the tools to protect and is run by people who believe in its role to regulate for the good of all of us, not the profit of a few.
Ellen A. Bruce
President, OWL National Board
Thursday, September 25, 2008
Monday, September 22, 2008
Social Security and the Economy
Was your seatbelt fastened last week? This rollercoaster we have for an economy took us on quite a ride. Actually, the image of a rollercoaster is not exactly accurate. It presumes there is a track and there is clearly no track for this ride. It is wild, unpredictable, and not many of us are having fun. Also, we don’t know where it ends.
I’m not sure we know the lessons to be drawn yet, but one obvious observation is that the only hope for preventing a complete financial meltdown is the federal government. Ironic, isn’t? An administration that has spent seven years pushing deregulation and private market solutions now looks to government and taxpayers to save us from the consequences of those policies.
I’m not unhappy about this solution. I am hoping it will work. There will be many lessons to be learned but two are very relevant to women and to OWL. The first is that our whole economy is so global and so interrelated that “safe” investments aren’t so “safe” when the credit house of cards falls down. The second is that the approach to many problems must be collective, not individual. If you have read or listened to the columnists and commentators within the last week who make a living telling you how to have a comfortable retirement, you will have noticed that they have no advice in this market beyond “don’t retire now”. Little comfort for those already retired or about to be laid off.
The most secure solution for those retired or looking to retire is Social Security – a government-sponsored, guaranteed income program. Who would have predicted that!! Well, OWL for one. While the Bush Administration advocated for individual accounts and the advantages of passing on the account to your heirs if you died young, OWL was concerned about women and men out-living their retirement funds and advocated to keep Social Security a progressive, social insurance program. It is not polite to say “We told you so” but we did.
OWL has long advocated that an appropriate role for government is to provide universal retirement benefits through a social insurance program. Preserving, defending, and improving Social Security has been one of OWL’s major issues for the past twenty years. This past week demonstrates what OWL has maintained all along, that OWL’s agenda is not just good for women, it is good for everyone.
Ellen A. Bruce
President, OWL National Board
Wednesday, September 17, 2008
Women candidates have been in the forefront this election year – first with Hillary Clinton running for the Democratic Presidential nomination and now with Sarah Palin nominated as the Republican Vice-Presidential choice.
The visibility of women in the political process is very positive for women for two reasons. First, it raises the public debate about what is sexist, and second, it offers the potential of having women’s policy issues debated and addressed.
Let me talk about sexism first. Some statements are clearly sexists such as a heckler shouting “iron my shirts” to Senator Clinton as she was campaigning. And some statements are clearly not sexist such as any candidate using the expression “…putting lipstick on a pig” when referring to another candidate’s policies. Sexism is very prevalent in our political and business dealings and a serious issue that hurts women of all ages. Twisting it for political gain belittles the issue and at a minimum is a cynical attempt to manipulate the vote of women. Understanding what is sexist and what isn’t is important to us.
What about asking a women with young children how she will handle being Vice President when reporters don’t ask male candidates that question? What about accusing women candidates of being “strident” or “shrill” or fawning over them because they are “cute” or “perky”. How are women running for office supposed to be both likeable and tough? The beauty of Sarah Palin on the Republican ticket is that it has silenced the conservative commentators. All of a sudden being the mother of a pregnant unwed teenager is not a reflection of the mother. Perhaps now we can put families off limits for the petty, vicious snipping that television passes off as news.
But let’s talk about the real issues women care about. What does the candidate, male or female, stand for? What policies will he or she support? As a woman, I would like to see more women in political life because I hope they will bring a sensitivity to the job founded in their life experiences – that they will support policies that help people who raise children and care for elders, who cannot afford health care and who have no place to live. I am not so naïve as to think that just because you are a woman you will support the OWL agenda and hopefully women generally don’t believe or vote that way. The true test of a candidate is whether they care about the issues you care about and will support the solutions you believe in.
So in this year of “women rising” let our voices be heard for what we believe in: access to high-quality, affordable health care, economic security, and dignity and respect for people of all ages and abilities and of course regardless of your gender.
Ellen A. Bruce, President
Ellen A. Bruce, President
OWL National Board of Directors
OWL National Board of Directors