Medicare

My Experience at the American Society on Aging Conference

April 3, 2018 by Jan Robbins

The American Society on Aging held its annual conference in San Francisco in March. (Photo by Robin Evans)

SENIOR BEAT – I was excited. Never having been to a major conference of any kind, I felt fortunate to land a press pass to the American Society on Aging annual conference last month in San Francisco.

My first session was Monday morning at 9 a.m., so I set my iPhone alarm for 6:30. But I had never used the alarm and didn’t trust it would work – I’m such a Luddite. I woke and 5 a.m. and dozed and woke off and on until the alarm went off – as scheduled.

The conference was held at the Hilton Union Square, which I was sure was right on Union Square. So I got off the subway at Stockton Street and walked up the hill to discover not the Hilton but the Hyatt. The doorman pointed me toward Mason Street. Heading up Geary Street, I worried I was getting too far afield of Union Square. This time, I asked a woman on the street for directions. “I’m from out-of-town, honey, why don’t you look it up on your phone,” she said.

“Oh, sure,” I stammered, quite abashed.

Then there it was – right around the corner at 333 O’Farrell.

Frazzled but jazzed

By that time, I was frazzled, but glad I had set out early. Monday was registration day. I envisioned long lines – and wasn’t disappointed.

The next question on my conference journey: Is there a special line for the press? The monitor I asked didn’t know, so she set out to find out. Tailing her until she found the appropriate registrar, I was elated to find myself at the front of the line. What a coup!

I loved my badge. I felt it was a symbol of belonging to this large sea of humanity: 3,000 people from each of the 50 states and the District of Columbia gathered to share information to help older Americans and their families. (Conference attendees represent a population diametrically opposite of that segment of Congress constantly beating the drum for cutting social services, including Medical and Medicare.)

Reframing aging or freeze-framing?

My first seminar was called “Disrupting Aging,” although it was really about disrupting ageism. The former seems to imply you can freeze-frame yourself at 65. The session was a collaboration of the American Association of Retired Persons of Connecticut and the nonprofit education company Borrow My Glasses. Together they created a simple interactive video and card game that flips aging on its head. Like Humpty Dumpty, you put it all together again – but with a brand-new perspective. The women presenters were passionate, up-beat, creative and gracious. I was jazzed.

After lunch, I jack-rabbited around to a couple of seminars, quickly exiting ones that were uninteresting to me. Monday afternoon’s general assembly was fun and informative, but perhaps not in the way its title implied: “How Technology is Reinventing Aging.” It featured a discussion of developing technology in the field of aging. A woman from a health care company moderated a panel of young to middle-age tech innovators. One of them was from Great Call, which makes Jitterbug phones but also fall-detecting wearables, such as bracelets.

And on hand to offer feedback throughout the discussion – from a generational point of view – was researcher Kate Lorig, a professor at the Stanford University School of Medicine and director of the Stanford Patient Education Research Center.

Back to the drawing board, boys

Although she found no fault with the bracelet, for other products focusing on surveillance, her comments ranged from “It makes me feel dumb; I don’t like being told what to do; It threatens my privacy;” to “The directions are incomprehensible” and “OK, boys, back to the drawing board.”

Her sentiments were underscored by a short video showing an older man outsmarting smart technology: a cane that beeped to signal time for a walk; a fork that evaluated his food intake; and a bed sensor making sure he got enough sleep. He eventually tires of the surveillance – as would I.

He finds a neighborhood kid to walk his cane. A pile of books on his bed fakes the sensor into thinking he’s turning in at the designated time. At dinner, he eats pasta with a regular fork, while stirring the smart fork in a pile of vegetables – on a separate plate. The boisterous audience response indicated most people in sync with his frustration.

Every conference has its exhibit hall. This one was no exception. There were many helpful vendors making attendees aware of products such as a tele-rehabilitation solution that suits patients who have had a stroke, and Parkinson’s and orthopedic problems; chef-designed meal-delivery services; and adaptive telephone equipment.

Along with the helpful agencies and research companies, anti-aging companies were at work marketing ways to keep skin wrinkle-free with moisturizers and electrical face-lift equipment. One moisturizing company was selling white truffle day moisturizer. Truffles are a fungus sniffed out in nature by pigs and dogs. On the usual unpronounceable list of ingredients, white truffle came in 20th.

Identifying malnutrition

I finished the conference with two inspiring sessions, on malnutrition among older adults and stigmas still attached to mental illness.

Affecting all socio-economic classes, malnutrition is hard for medical personnel and caregivers to recognize. There are no screening tools, thus no ways to evaluate or intervene. Yet research shows 25 percent of Medicare recipients have “food insecurity,” which means they don’t have reliable access to a sufficient quantity of affordable, nutritious food.

Doctors don’t always ask patients about their food intake because they can’t offer solutions, according to Uche Akobundu, senior director of Nutrition Strategy and Impact for Meals on Wheels. Panelists representing other national agencies said their organizations are developing tools to help doctors and caregivers identify populations at risk for malnutrition, educate them and help them improve their nutrition.

Demystifying mental illness

The last session focused on the innovative ways a group of social workers from New York City incorporate mental health services into their senior centers’ Asian population. In that culture, where negative emotions have been identified with insanity, the stigma is particularly dire. In an effort to build patients’ trust, mental health workers participate in senior center activities, becoming friendly with potential clients.

My conference days came to an end. I was sad and hopeful: Sad to leave this group of people dedicated to the well-being of others, but hopeful that many good changes in the world of aging are being cultivated and put into action.

I was particularly moved by a social worker on last panel as she recited a Jewish proverb she lives by, “If you’re saved one life, you’re saved the world.”

The Medi-Cal Expansion: Opportunities and Challenges

October 12, 2013 by Marie Jobling

California will take a significant step forward toward achieving access to health care for all in January 2014, when Medi-Cal expansion and subsidized coverage through Covered California will provide millions of low and middle income Californians with access to care.

We love the Medi-Cal Expansion. It will provide no-cost, comprehensive health insurance to 40,000 people in SF.

The Medi-Cal Expansion raises particular challenges and opportunities for older people and people with disabilities, so Friday’s forum was held to educate service providers and community leaders so they can help seniors and people with disabilities get the coverage and benefits they need.

· The good news about the Medi-Cal Expansion is:

o It will make it possible to get coverage for a larger number of people whose disabilities;

o It will be a huge financial help for people who are under 65 and have to pay a Share of Cost (SOC) to use Medi-Cal each month; they may be eligible for the Expansion with no Share of Cost.

· The challenges are:

o We don’t yet know how people on the Expansion will get long-term services and supports if they need them. We’re still waiting for federal guidance to clarify this.

o People on the Expansion may face disruptions in coverage when they turn 65 or qualify for Medicare, because the two programs have different applications and different income & asset limits.

The Forum was sponsored by Assemblyman Tom Ammiano, Senior and Disability Action (SDA), the SF Dept. of Aging and Adult Services, Bayview-Hunters Point Senior Center, Caring Across Generations, Family Services Agency, Community Living Campaign, California Alliance for Retired Americans, Openhouse, Coalition of Agencies Serving Elderly, ElderCare Network, and Shanti.

The handouts provided at the Forum, as well as other useful information, is available through the links below.

NSCLC Medi-Cal Expansion Factsheet

SDA Medi-Cal Factsheet

ACA & Medi-Cal Expansion Scenarios

Resources for Understanding Your Options

Share Your Story Flier

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Groups Stand Up to Protect and Improve Social Security and Medicare

July 24, 2013 by Marie Jobling

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The Chained CPI event, organized by the California Alliance for Retired Americans (CARA) with the support from lots of other labor and community groups, made a strong statement on July 2 in San Francisco and in 50 other communities across the country. Look and see if you can find someone you know! And keep the pressure on your representative to truly represent those of us who depend on every penny we get from Social Security.

5 Biggest Lies About Entitlement Programs

March 9, 2013 by Marie Jobling

This Thursday, March 14, from 10:00 to 12:30, lots of us will gather at the First Unitarian Church at 1187 Franklin for a Town Hall Meeting to learn what we can do to save Social Security, Medicare and Medicaid. If you can join us, RSVP to (415) 546-1333. We are being told a pack of lies. Come learn how we can help get out the truth.

Want to better understand what a few of those lies are? Take a minute to read exerpts from a March 8th column by Michael Hiltzik in the Los Angeles Times.

Social Security and Medicare are big issues, and not everyone is telling the truth about them.

Everybody loves lists. Most of those you see in the papers or online tend toward the inconsequential (The Six Best “Fast & Furious” Movies).

So here’s a list with a bit more gravitas: The five biggest lies you’re being told about entitlement programs.

Never mind that the very word “entitlement” is a lie. Social Security and Medicare got that name because workers became “entitled” to those benefits by paying into the system. In recent years, however, the term has become distorted to signify benefits people are entitled to without earning them.

Leaving that whopper aside, here are the top five.

Lie No. 1: The payroll tax hike is killing the retail economy.

As with all great lies, there’s a nugget of truth buried inside this one. Evidence exists that the lower paychecks most American consumers started seeing at the beginning of the year took a bite out of consumer spending. A slew of low-end retailers and merchants, including Wal-Mart, contend that the Jan. 1 change in the Social Security payroll tax, which lowered the average household income by about $80 a month, came out of their hides.

Blaming the payroll tax, however, ignores the whole story. First, on Jan. 1 the tax wasn’t hiked; it was restored to its 2010 level, after a two-year “holiday” that reduced the withholding to 4.2% of employees wages (up to wages of $101,800 in 2011 and $110,100 last year) from the 6.2% level in effect since 1990.

The idea was to deliver stimulus dollars to middle- and working-class families. But the holiday was always a wretched idea, in part because of what everyone knew would happen when the old rate reappeared —people treated it as a pay cut.

The worse flaw was that it was a lousy way to deliver targeted working-class relief. The change replaced the Obama administration’s previous Making Work Pay tax credit, which delivered up to $800 to families earning $12,900 to $150,000.

The payroll tax break, by contrast, went only to those who pay into Social Security. So it left out 5.7 million state and local workers (mostly teachers). On the plus side, it fattened the paychecks even of the nation’s top earners by a much-needed $2,100 or so.

Lie No. 2: “Entitlement” benefits for millionaires and billionaires are a costly problem.

This is a favorite of people like hedge fund billionaire Peter G. Peterson, a sworn enemy of Social Security and Medicare. The theme is: Look how wasteful Social Security is — why it even goes to people like me! The goal is to “means test” these benefits so they go only to people who “need them,” as Peterson says.

The lie here is the assertion that a significant portion of benefits goes to multimillionaires. In fact, their share of benefits is minuscule. That’s because there aren’t very many of them, and they don’t get more than the maximum old-age benefit, which was $30,156 last year. According to the IRS, only 47,732 households reported income of more than $1 million, including Social Security benefits, in 2010. Their total take was about $1 billion, after paying income tax on their Social Security checks. They account for about 14 hundredths of one percent of all Social Security outlays.

By contrast, more than 75% of benefits go to recipients with $20,000 or less in non-Social Security income and more than 90% to people with incomes below $50,000, as economists Dean Baker and Hye Jin Rho of the Center for Economic and Policy Research showed in March 2011.

To reduce program costs by even a couple of percentage points, you have to start cutting benefits for people earning as little as $40,000 in non-Social Security income. So when Pete Peterson starts bemoaning how his Social Security check is cutting into his granddaughter’s future, it’s the working class that should bolt the door.

Lie No. 3: Social Security and Medicare are $60 trillion in the hole.

As efforts to cut Social Security and Medicare gather steam in the budget wrangling in Washington, you’ll hear these mega-trillions being thrown around more and more. Beware. They’re numbers designed to terrify, not edify.

The assertion comes from something called the “infinite horizon” projection. It’s a calculation of funding gaps projected out to the limitless future and then converted to present value — meaning what the cost would be if we had to pay it all today. For Social Security, the figure was $20.5 trillion, as reported in the program trustees’ latest report. For Medicare, the number comes to about $42.7 trillion.

Even professional actuaries say this calculation is bogus. In 2003, when it was first inserted into Social Security’s annual report, the American Academy of Actuaries warned the trustees that the infinite projection provides “little if any useful information” and is “likely to mislead anyone lacking technical expertise … into believing that the program is in far worse financial condition than is actually indicated.”

A big part of the lie is that these projections aren’t applied to the other side of the ledger — the programs’ revenues and growth in the U.S. economy projected out to infinity. The latter, the trustees calculate, would be about $1.5 quadrillion. (How’s that for a big number?) For Social Security, the infinite gap accounts for only 1.3% of infinite GDP, which would bring it about to the level we spend today on defense and veterans affairs.

Lie No. 4: You’re paying too much (or too little) for your benefits.

This is a double-barreled lie, based on the misconception that Social Security and Medicare are retirement funds. They’re not; they’re insurance programs. What you recover depends on your personal circumstances, but the point is they’re there when you need them.

The idea that the social insurance programs will impoverish today’s children while their grandparents make out like bandits was recently rehashed in a Wall Street Journal op-ed by former hedge fund manager Stanley Druckenmiller and two colleagues. “A typical third-grader will get back (in present value terms) only 75 cents for every dollar he contributes to Social Security over his lifetime,” they wrote. “Meanwhile, many seniors with greater means nearing retirement age will pocket a handsome profit.”

That isn’t true, according to C. Eugene Steuerle and Stephanie Rennane of the Urban Institute, whose 2011 calculations are the basis for most such assertions. They computed that a couple retiring in 2010 with annual earnings of $113,000 would have paid about $750,000 in 2011 dollars into Social Security over their working lives, and collect (on average) $665,000 in lifetime benefits. (The tax computation includes both the employee’s and employer’s share, and is adjusted for inflation and a small investment gain; the benefit calculation is also discounted for future inflation.)

Not exactly a “handsome profit,” but that’s how insurance works. Some people will die two years into retirement, others will live to 100. Some families will be sustained by Social Security, some will collect disability pay, some will receive dependent benefits, some won’t need any of those payments. But no other public or commercial insurer provides all those potential benefits at Social Security’s low cost.

What skews the calculations is Medicare, which leads us to:

Lie No. 5: Medicare, Social Security — it’s all the same.

Not at all. Medicare is in big trouble, almost exclusively because of rising healthcare costs. Social Security can be financially tweaked by changing its tax or benefit structure, or both. That won’t work with Medicare, which is the prisoner of this big external factor. Steuerle’s and Rennane’s calculations show how these costs outstrip individual contributions — our high-income couple retiring in 2010 will have paid $149,000 in taxes, yet receive $351,000 in lifetime benefits. The imbalance increases for future retirees.

The lesson is that it’s misleading to lump these two programs together as if they have the same issues amenable to the same solutions. But that’s what you usually hear: “Social Security is mostly OK, Medicare is in big trouble, so entitlement programs are in big trouble and we should cut Social Security.”

See how much trouble a lie can make?

Michael Hiltzik’s column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.