64 posts categorized "Gray Matters"

Small Miracles (from 2010)

EDITORIAL NOTE: Time Goes By Sunday Elder Music columnist, Peter Tibbles and his Assistant Musicologist are visiting from Melbourne for a few days.

While they are here, in place of new posts are some vintage TGB stories that I kind of like and hope you will enjoy them in rerun. I won't disappear entirely. I'll be checking in now and then to see how it's going and perhaps join in the comments.

And, IMPORTANT, all Elder Storytelling Place stories linked at the bottom of these repeats are NEW.


ANOTHER EDITORIAL NOTE: For two years, a brilliant, Pulitzer Prize-winning journalist, Saul Friedman, wrote two regular columns for this blog, Reflections and Gray Matters. He was my friend, my teacher, a man I admired and respected beyond words.

He died at age 81 on 24 December 2010. It was a privilege to know this fine man and I miss him every day still. For readers who may have found TGB after Saul's death, you can learn more about him here and here.

Even better, however, is to let him speak for himself. Today's repeat column is Saul's last published just six days before he died when, I realize in retrospect, he undoubtedly knew how short his time was. It is titled Small Miracles

In this, the season of miracles, let me confess I have never believed in the big ones: the virgin birth, death and resurrection of the carpenter from Galilee or the lamp with oil for one day that somehow burned for eight days. I might as well have believed in Santa Claus.

But this did not mean I had no faith in the mysterious or the unexplainable. That would have meant having no room in one’s intellect for, say, beauty, love or music so lovely, like a Chopin etude, that it makes one cry. Here’s Artur Rubenstein playing one Chopin’s miracles.

In short, if you’ll indulge me for leaving, for a moment, my usual senior subjects, I truly believe in the smaller, more life-touching miracles. I am walking proof of such miracles.

A few years ago, when I was recovering from a stroke that partially paralyzed my right side, I worried that it might have affected my ability to hear and be moved by good music. Someone brought me a Sony Walkman (remember those?) and I cried with joy in my wheelchair when I discovered I could hear and even sing melodies.

My sound of music was not impaired. And I wheeled myself crazily down the hospital halls, singing (badly) a favorite opera aria.

Later, as I worked with a physical therapist, I watched in wonder as she coaxed from my stiff right hand some movement in my little finger. It was a small miracle, happening somewhere inside my brain, that marked my journey of recovery. And I did recover.

One dictionary says a miracle is an amazing, wonder-filled occurrence that cannot be explained by the laws of nature. Maybe, but I do not believe that the same unmoved mover that paralyzed my hand also moved my little finger. My faith in that patient and caring therapist brought us that miracle.

The esophageal cancer, discovered by accident because of the stroke, was the next big crisis - from years of smoking, competitive journalism, maddening editors and chewing Tums.

And the miracle worker was a young Chinese surgeon who specialized in dealing with older patients because, in his culture, old age is to be venerated as a kind of miracle. He once operated on and cured a 90-year-old woman of lung cancer because, he told me, reaching that age with lung cancer was, by itself, miraculous.

Most people don’t survive cancer of the esophagus because it’s discovered too late. The anti-acid remedies sold to millions of unsuspecting indigestion and acid reflux sufferers, relieve the discomfort but mask the dangers of cancer.

I was a victim and survivor of such dangers. I know of too many who have not been as lucky as I was - like the wonderful essayist and professional atheist, Christopher Hitchens, who says he’s dying.

So are we all. Both of us owe our cancers and/or the cures not to divine intervention, but to the miracles of illness and health. They are life affirming.

Life, illness, happiness, good fortune and bad, even good and bad presidents (I have covered) are all part of what the 11th Century Persian poet Omar Khayyam had in mind when he wrote, “Be happy for this moment. This moment is your life.” And,

That inverted bowl they call the sky,
Where under crawling, cooped we live and die.
Lift not your hands to it for help,
For it impotently moves as you or I.”

Too much of modern popular music and words that we don’t understand; the noise and screaming get in the way. Ella Fitzgerald, Billie Holiday and Peggy Lee were my kind of singers.

But not long ago, I listened carefully, above the hype, to a modern, miraculous piece by the late John Lennon, which voiced as well as Omar what life is and ought to be about. Pay attention to the miracle of these simple words:

The esophageal cancer was cured and I celebrated those five cancer-free years. But alas, earlier this year – again by accident – a new cancer was discovered in the lining of my stomach.

It has a fancy name – linitus plastica – and it’s unique in that there is no mass, only a few cells that don’t show up on a CT scan. And it is very slow-growing, if it grows at all, and it is without pain or symptoms.

So I live with it, as I’ve mentioned, under the care of the Hospice of the Chesapeake. And when an interviewer for a local paper asked how I live with such uncertainty, I told him, that there is no life without uncertainty.

But as Camus told us, we live and struggle and work and play and love, even in the face the inevitability of our own end. I am still lucky. I have my work, which seems to touch and help some people.

Each morning and afternoon, when the weather is moderate, I sit on my deck on the shores of Chesapeake Bay, where I sailed for many years and still have a (power) boat. And smoke one of my indulgences, a fine and expensive cigar.

The bay is ever changing and the prevailing winds from the south can be fierce, but she’s even more beautiful in a dark and clattering summer storm which I can watch as it passes over my house and heads east.

My daughters visit me often, although one is in California, and when the grandchildren are over to help me pick crabs, they understand about living with uncertainty without letting on. So we treasure those times, and we shrug off the future. And they believe me when tell them how lucky we are.

Now that the cold has closed in, my wife drives me to the nearby cigar lounge where Mike, the proprietor, picks me out a couple of good ones from his humidor. I can watch a game on the giant HDTV or simply chat with other patrons, who defer to me because of my age and experiences as a reporter.

Most of them have been in the military or they’re spooks, more conservative than I am.

One guy came in to smoke and clean his target weapons, a pistol and an elaborate 30.08 rifle with a scope. He is building a special hideaway in the woods outside Washington for the day “they” come to take away his freedoms. He was described by Mike as a RWNJ, a “right-wing nut job.”

Another smoker, between covert assignments for the Drug Enforcement Agency, is trying to develop a retirement community in Nicaragua.

The VA psychiatrist, watching a guest cigar roller at work, tells us about treating too many returnees from Iraq and Afghanistan for the shocks inevitable in war.

Mike’s wife, Connie, a nurse at Walter Reed recalls the hollow sadness in the eyes of loved ones when they come to visit their legless or armless kinfolk. Most of these testosterone-heavy cigar enthusiasts, isolationists in the best sense, don’t see why the hell we’re still in Afghanistan.

The point of all this, in a season made for reflection, is to tell the story of how it feels to become and stay old for one very lucky older American for most of us, despite and because of illness, embrace life more fully than ever.

I still order fresh cigars, as if trying to guarantee me the time to smoke them. If things go well, my wife and I will go on a cruise to the Mediterranean next month so Evelyn can see the Nile and the pyramids that I saw as a reporter. Too bad we can't visit Omar's country.

Before I leave, I came across another of these small miracles of beauty, combining great art with fine music, to rediscover words I have not understood – until now.

(View more presentations or Upload your own.)


At The Elder Storytelling Place today, Michael Gorodezky: Pinball Wizard


GRAY MATTERS: Lise's Tribute to Her Father, Saul Friedman

As you know, Gray Matters and Reflections columnist, Saul Friedman, died on 24 December 2010. He was beloved by his readers, a great man, a great journalist and teacher, someone we could all do well to emulate.

Saul's funeral was held on Tuesday, 28 December, and his family has made some some of the orations, tributes, remembrances and eulogies available to Time Goes By. Over the coming Saturdays, they will be published here in place of his column.

This is from one of his daughters, Lise Friedman Spiegel. Married for 25 years with three children, she is a licensed clinical psychologist where she lives in Encino, California

- Ronni


After Mom informed Dad’s oncologist that Dad had taken a sudden turn for the worse and had but days left, the doctor said he had never seen a case like Dad’s in all his years. No kidding.

No one has seen a case like this and I am not necessarily referring to his cancer. Personally, I keep waiting for Dad to call while he is out chasing down a story.

Many of you know the writer, the speaker, the reporter, the blogger and, of course, the sailor. But, I must express to you what this larger-than-life man, who was NEVER supposed to die, gave me.

There is not enough time for all of those things, but here are some highlights.

First of all, the love for just about anything with four legs, especially dogs. I have never known my father without a dog at his side, on the bed, at the computer, awaiting a treat under the table. Puppies born at the beach in Nags Head and naming a new mutt who we had for 16 years Ringo in 1964.

Dad knew that one of the most moving gifts he gave me a few years ago was a one-month supply of skin medicine ($200) for my debilitated rescued Akita.

It’s no accident that we have four family dogs one of which Mom and Dad had flown first class to California when they could not keep her.

Then, there are the Beatles. Dad came home one day in 1964, when I was six years old and said, “I think these kids are something special. Listen.” You know the rest.

And when Paul McCartney married Heather just a few years ago, Dad called me with condolences.

And when I was a little girl and he thought I was ready to understand it, he took me to a movie theater to see Gone With the Wind. Well, no one since has looked up a staircase like Clark Gable did and that one of my daughters is named Melanie is no accident. It is still my husband’s and my favorite film of all time.

Then there is the love of music, all kinds of music - classical, good rock, folk, bluegrass. We went to concerts and bluegrass festivals and, of course, Dad’s love for singing and playing the guitar shaped so much of my future.

He came to my concerts and recitals and paced because he wanted so much for them to go well. A friend of mine sent me an email yesterday which recalled his tears of pride as I performed solo in Carnegie Recital Hall because she watched him as he listened between bouts of pacing.

And all the while, Dad made sure [my sister] Leslie and I remained aware of the world around us, reading the newspaper, socially conscious and willing to make sacrifices to follow our beliefs.

What other father would make sure their child missed much of 6th grade to work at the Vietnam Moratorium Committee and demonstrate against the war in October and November 1969?

What other father would get a long-term press pass to make sure I could sit in the gallery every day during the Watergate hearings?

And what other father would make sure I was sitting behind Ted Kennedy at the Democratic convention in 1980 when he made one of his finest speeches?

And how many kids can say that they met presidents, went to White House Christmas parties and correspondents’ dinners? I know the answer.

A few stories:

In 1972, Dad took me out of school to hang out with him for the last two weeks of the Nixon-McGovern presidential race. I traveled all over Michigan and some of Canada, for fun, ending up in the Detroit Free Press newsroom to await election results.

It was such a sad time, but a time that I had with him as he worked and taught me how the election process worked and why the obvious man should win. And I was so proud when Nixon put Dad on the infamous White House enemies list which, appropriately, took up residence on our bathroom door.

I was celebrating my 16th birthday and Dad wanted to take me out, just the two of us, to a fine French restaurant in Gerogetown, Lion d’Or. He bought me a dress and shoes and we went.

He said I could order any drink I wanted so, like a big girl, I ordered a scotch on the rocks. At the next table was a senator who Dad went out of his way to introduce me to. I do not remember what I ate, but I so remember how that whole evening made me feel.

Then, at the beginning of 10th grade, he and Mom took me out of school to travel in England, Scotland and Wales for two months because he thought traveling was a better education than sitting in a classroom. I learned British history, a love of horse riding on the Scottish moors and that schooling shouldn’t interfere with one’s education.

Finally, as Dad coped with the effects of his stroke, his esophageal cancer and this last cancer, he showed everyone that each day can be valuable and productive if one has love, especially in the form of my mother, sister and brother-in-law, resilience and an open mind to change which, for a man in his 70s into 80s, was extraordinary.

He showed the African bush to his family for his 80th birthday and just notice the car he and Mom bought last July and drove to New York together six weeks ago.

But that is just what he was and will remain for me: simply extraordinary, full of love, life and adventure no matter what came his way.


GRAY MATTERS: Elke's Tribute to Her Husband, Saul Friedman

As you know, Gray Matters and Reflections columnist, Saul Friedman, died on 24 December 2010. He was beloved by his readers, a great man, a great journalist and teacher, someone we could all do well to emulate.

Saul's funeral was held on Tuesday, 28 December, and his family has made some some of the orations, tributes, remembrances and eulogies available to Time Goes By. Over the coming Saturdays, they will be published here in place of his column.

This is from his wife, Evelyn, known to the family as Elke which is Evelyn in Hebrew. The three boats they owned were named Elke I, Elke II and Elke III. On 20 January, Saul and Elke would have been married 59 years. - Ronni


One of the emails to [my daughter] Lise said:

“I am so deeply sorry for your loss. Your father was an amazing human being and quite an inspiration to me.”

This from a friend of our kids, some two generations removed from Saul, who now makes his living playing the guitar in his own band.

Saul played the guitar when his fingers still worked, and since we lived in Houston for several years in the 50s, we got to go to the “hootenannies” which were exhibitions of guitar playing by recognized artists.

We both learned a lot and especially about the condition of black musicians when they traveled to the South to perform.

Sometimes they had to wear turbans so locals would think they were exotic beings from other countries so that they could get a meal or a room in a hotel. If they just showed up off the road in ordinary clothes they could not get served. This was the South in the 40s and early 50s and it made a deep impression on Saul.

Later in the 50s, he decided to write a series about the condition of blacks in Houston. The Houston Chronicle, for whom he worked, said they would publish it.So he wrote a long series detailing the lives of blacks in Houston at the time.

It was factual and correct. It never saw the light of day. That’s the way it was in those days – the paper simply decided not to use it.

I was angry. He was not. He said he had expected it and so went on to the next thing. Which turned out to be the public hospital in Houston.

Jefferson Davis Hospital was the county hospital where the poor folks went and everybody else ignored. By that time, Saul had made friends with the Dutch writer, Jaan de Hartog, who had become interested in conditions at the hospital. Saul and de Hartog signed on to work at the hospital for several weeks to witness the hospital workings.

When he would come home from the hospital he would shed his clothing outside the door and come in and shower before he would sit down for a meal. Later he and de Hartog wrote a series which changed the hospital into one of the better ones in the country, mostly due to their series.

Saul covered all kinds of stories, including a murder trial in Houston which resulted in a 3AM phone call from a male who said, “Is this Mrs. Friedman?”

I answered yes.

He then said, “You tell yo husband to quit writin’ all that stuff in the papers about my friend, else he be dead.”

It infuriated me and I said, “Listen, you son-of-a-unowat, don’t you ever call me in the middle of the night and threaten me.” And I hung up. And I got nervous.

I called the Houston police, the FBI, the Texas Rangers and every other law enforcement agency I could think of. About three days later, somebody arrested a local disc jockey and that was the end of that. I moved my young children back into the house from where they had been staying for safety’s sake, and we resumed our lives.

Saul was awarded a Nieman Fellowship for the academic year 1962-63 which gave him a year at Harvard to study what he wanted to. It was a very prestigious award and so we moved to Cambridge to a large house and he went to Harvard. And so did I.

It was a year to remember. His mother flew up from Texas so he could drive her to New York to visit her sisters during the Christmas-New Year holidays. A wild snowstorm was on when they left on New Year’s Eve. I did not want to stay alone during the New Year and one of our kids was sick.

So I called all the other Niemans and told them what was happening and would they bring some food and come to help me celebrate since I couldn’t leave the child. They did. They brought much food and wine and whiskey and we were having a good party when a loud knocking came at the back door.

It was Saul, covered in snow, having driven back from New York to be with me for the occasion. I was overwhelmed.

No matter what crazy things he did, he always made sure I was all right. He called from Zaire to request some money in order to ransom his passport but first asked me if I was okay. Yeah, I was. I had to be.

He was covering a presidential campaign when he became ill in New Hampshire. Would I come up and get him? Of course I would. And did.

He went to China. Would I come and join him there? Of course, I would. And did. And then how about coming to Israel to be with him? Of course I did.

And then there was South Africa where he was invited by his best friend, Allister Sparks, to come and teach at a school Allister had founded. This was a three-month stay.

The students were mid-career and their first language was not English. The trick was to teach them how to deal with their new-found freedom as apartheid had recently ended and they now could write what they wanted to. But they didn’t know how.

It was Saul's mission to teach them how to write in the active mode instead of the passive. He made an impact and was happy teaching there. And the students appreciated his efforts.

The thread running through his work was always the same: make the world a better place as best I can. In newspaperese: “The journalist’s job is to comfort the afflicted and afflict the comfortable.”

Whether he realized it or not, Saul was always teaching. No matter what he was talking about, he was teaching. And when I was on the plane with him to Georgia or California or on the plane by myself to meet him somewhere, I never felt alone.

He was always with me, taking care of me and making me feel special. And he still does.


Saul Friedman 1929 - 2010

Yesterday, on 24 December, Saul Friedman died at home on Chesapeake Bay surrounded by his family. His 23-year-old grandson, Benjamin T. Hall, wrote this remembrance to share with Saul's many readers.


As I sit here with a hint of scotch on my breath, watching the smoke from a cigarette roll upward, turning into something beautiful, I’m wondering where to begin. Today perhaps.

It is the 23rd of December, my birthday, and the cold in the air seems appropriate. My breath as I walk down the street. More smoke. Where does it go?

Now that I sit here, in these shoes I have so desperately wanted to fill since my youth, I am at a loss of words. I have always wanted to write, just like my Grandfather, Saul. I never anticipated writing about him or to an audience so close to his heart.

As Saul has alluded, and at times forthrightly said, he has been handed many small miracles in his life. He has been given music and been afforded the opportunity to grow with the music he loved, ranging from the Beatles to Chopin, up until his very last moments.

As he lies in bed, taking in the breaths that will be his last, Frank Sinatra, John Lennon and Ludwig van Beethoven accompany him. He shared his love of music with me many years ago when he gave me Beethoven’s piano sonatas, a gift I cherish to this day.

My favorite sonata will always remind me of his beautiful, tremendous nature.

Saul was once given the idea that things were not always as they seemed.

This simple idea led him to pursue a knowledge of philosophy that forever changed his life. He said this much to me two days ago during a conversation from his hospice bed. The bed lies beside the window to give him a view of the bay he adores so much.

Over the years we too have shared this love for a deeper understanding of things, which is how I have come to truly understand our friend Nietchze when he said

“The poison which weaker natures perish strengthens the strong - nor do they call it poison.”

Witnessing the greatest man I’ve ever known wither away, his mind peeling apart like the leaves of the grandest tree, will not kill me. His wisdom has assured me it will make me stronger.

I find solace in knowing Saul has helped so many people; that Saul truly cared for people the way he implores others to do. His work in politics has always been so profound because he has been more concerned with the consequences rather than with the present actions. His entire life has been based on the sole belief that people can, and should, be better to one another.

Spend an afternoon with his family and you can meet some of the most caring, genuine people on the earth. He has shaped his two daughters into women who care and give and love, women who never take the world for granted.

I know Because my Mother is a teacher whose students share holidays with us.

I know because my Aunt is a psychologist who takes feral dogs off the streets of L.A. and turns them into house pets; house guests really.

I know because my Grandmother, Evelyn, has been able to put up with Saul for over 50 years. Another small miracle if you ask me.

Saul Friedman is still with us for the moment, but the moment can never be everlasting, no matter how wonderful it may seem. He is resting comfortably and soon will be comfortable enough with what he’s done for the world to leave.

By the time this lamenting rambling of a mourning grandchild is before your eyes, the eyes of the Friedman family may be filled with the tears of the unknown future, a future we will have to find our way through without the guidance and love that only Saul could provide.

However, our faces will hold smiles of remembrance for the times we’ve been able spend with this beautiful, tremendous, unbelievable, blue-eyed man.

Written with sadness and gratitude,
Benjamin T. Hall


GRAY MATTERS: Small Miracles

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


In this, the season of miracles, let me confess I have never believed in the big ones: the virgin birth, death and resurrection of the carpenter from Galilee or the lamp with oil for one day that somehow burned for eight days. I might as well have believed in Santa Claus.

But this did not mean I had no faith in the mysterious or the unexplainable. That would have meant having no room in one’s intellect for, say, beauty, love or music so lovely, like a Chopin etude, that it makes one cry. Here’s Artur Rubenstein playing one Chopin’s miracles.

In short, if you’ll indulge me for leaving, for a moment, my usual senior subjects, I truly believe in the smaller, more life-touching miracles. I am walking proof of such miracles.

A few years ago, when I was recovering from a stroke that partially paralyzed my right side, I worried that it might have affected my ability to hear and be moved by good music. Someone brought me a Sony Walkman (remember those?) and I cried with joy in my wheelchair when I discovered I could hear and even sing melodies.

My sound of music was not impaired. And I wheeled myself crazily down the hospital halls, singing (badly) a favorite opera aria.

Later, as I worked with a physical therapist, I watched in wonder as she coaxed from my stiff right hand some movement in my little finger. It was a small miracle, happening somewhere inside my brain, that marked my journey of recovery. And I did recover.

One dictionary says a miracle is an amazing, wonder-filled occurrence that cannot be explained by the laws of nature. Maybe, but I do not believe that the same unmoved mover that paralyzed my hand also moved my little finger. My faith in that patient and caring therapist brought us that miracle.

The esophageal cancer, discovered by accident because of the stroke, was the next big crisis - from years of smoking, competitive journalism, maddening editors and chewing Tums.

And the miracle worker was a young Chinese surgeon who specialized in dealing with older patients because, in his culture, old age is to be venerated as a kind of miracle. He once operated on and cured a 90-year-old woman of lung cancer because, he told me, reaching that age with lung cancer was, by itself, miraculous.

Most people don’t survive cancer of the esophagus because it’s discovered too late. The anti-acid remedies sold to millions of unsuspecting indigestion and acid reflux sufferers, relieve the discomfort but mask the dangers of cancer.

I was a victim and survivor of such dangers. I know of too many who have not been as lucky as I was - like the wonderful essayist and professional atheist, Christopher Hitchens, who says he’s dying.

So are we all. Both of us owe our cancers and/or the cures not to divine intervention, but to the miracles of illness and health. They are life affirming.

Life, illness, happiness, good fortune and bad, even good and bad presidents (I have covered) are all part of what the 11th Century Persian poet Omar Khayyam had in mind when he wrote, “Be happy for this moment. This moment is your life.” And,

That inverted bowl they call the sky,
Where under crawling, cooped we live and die.
Lift not your hands to it for help,
For it impotently moves as you or I.”

Too much of modern popular music and words that we don’t understand; the noise and screaming get in the way. Ella Fitzgerald, Billie Holiday and Peggy Lee were my kind of singers.

But not long ago, I listened carefully, above the hype, to a modern, miraculous piece by the late John Lennon, which voiced as well as Omar what life is and ought to be about. Pay attention to the miracle of these simple words:

The esophageal cancer was cured and I celebrated those five cancer-free years. But alas, earlier this year – again by accident – a new cancer was discovered in the lining of my stomach.

It has a fancy name – linitus plastica – and it’s unique in that there is no mass, only a few cells that don’t show up on a CT scan. And it is very slow-growing, if it grows at all, and it is without pain or symptoms.

So I live with it, as I’ve mentioned, under the care of the Hospice of the Chesapeake. And when an interviewer for a local paper asked how I live with such uncertainty, I told him, that there is no life without uncertainty.

But as Camus told us, we live and struggle and work and play and love, even in the face the inevitability of our own end. I am still lucky. I have my work, which seems to touch and help some people.

Each morning and afternoon, when the weather is moderate, I sit on my deck on the shores of Chesapeake Bay, where I sailed for many years and still have a (power) boat. And smoke one of my indulgences, a fine and expensive cigar.

The bay is ever changing and the prevailing winds from the south can be fierce, but she’s even more beautiful in a dark and clattering summer storm which I can watch as it passes over my house and heads east.

My daughters visit me often, although one is in California, and when the grandchildren are over to help me pick crabs, they understand about living with uncertainty without letting on. So we treasure those times, and we shrug off the future. And they believe me when tell them how lucky we are.

Now that the cold has closed in, my wife drives me to the nearby cigar lounge where Mike, the proprietor, picks me out a couple of good ones from his humidor. I can watch a game on the giant HDTV or simply chat with other patrons, who defer to me because of my age and experiences as a reporter.

Most of them have been in the military or they’re spooks, more conservative than I am.

One guy came in to smoke and clean his target weapons, a pistol and an elaborate 30.08 rifle with a scope. He is building a special hideaway in the woods outside Washington for the day “they” come to take away his freedoms. He was described by Mike as a RWNJ, a “right-wing nut job.”

Another smoker, between covert assignments for the Drug Enforcement Agency, is trying to develop a retirement community in Nicaragua.

The VA psychiatrist, watching a guest cigar roller at work, tells us about treating too many returnees from Iraq and Afghanistan for the shocks inevitable in war.

Mike’s wife, Connie, a nurse at Walter Reed recalls the hollow sadness in the eyes of loved ones when they come to visit their legless or armless kinfolk. Most of these testosterone-heavy cigar enthusiasts, isolationists in the best sense, don’t see why the hell we’re still in Afghanistan.

The point of all this, in a season made for reflection, is to tell the story of how it feels to become and stay old for one very lucky older American for most of us, despite and because of illness, embrace life more fully than ever.

I still order fresh cigars, as if trying to guarantee me the time to smoke them. If things go well, my wife and I will go on a cruise to the Mediterranean next month so Evelyn can see the Nile and the pyramids that I saw as a reporter. Too bad we can't visit Omar's country.

Before I leave, I came across another of these small miracles of beauty, combining great art with fine music, to rediscover words I have not understood – until now.

(View more presentations or Upload your own.)


GRAY MATTERS: Potential Medicare Dangers

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Before Gray Matters leaves the dismal subject of President Obama’s misbegotten Frankenstein monster, the deficit reduction commission, there is one tiny sliver of decent news from its lone genuine liberal, Illinois Representative Jan Schakowsky.

In one of her many television interviews, she noted that the information that the members of the commission had at last come to terms with the fact that Social Security’s pension insurance system, which is self-supporting with payroll taxes and minimal administrative costs does not, repeat, not add to the deficit.

Therefore, she said their “proposed reforms,” like slowly raising the retirement age, are meant only to stabilize its finances for the next 75 years. We now know that nothing so drastic as cutting benefits, which is what raising the retirement age will do, is simply not necessary, as Obama has said.

But alas, our unpredictable president, of questionable principles, as Time Goes By as demonstrated on the past few posts, has done his damnedest – with the suspension of the payroll taxes – to make life more difficult than it needs to be for Social Security.

But that’s not what I wanted to draw from Schakowsky’s observation. Her fear is not for the long term future of Social Security, but the more immediate dangers for the 47 million of us who depend on Medicare.

It is true that the Affordable Care Act strengthened Medicare’s Part A trust fund, and that cutting the subsidy for Medicare Advantage has helped the finances and the fortunes of Part B. But except for Schakowsky, virtually every member of the commission is about to pounce on Medicare because health care – but not necessarily Medicare - is the largest and fastest growing target for cutting the deficit.

Never mind that our for-profit health care system is filled with greed and corruption and is a drag on Medicare.

But its advocates are being heard. As I mentioned last time, a coalition of liberal economists in a Citizens Commission, including former Labor Secretary Robert Reich, economist Dean Baker and, this time, joined by separate statements from AARP, have protested strongly that the problem is not Medicare.

As the Citizens Commission wrote,

“Alarming long-term projections of growing debt almost completely come from uncontrolled growth in health care costs. We do not have an entitlement crisis; we have an unaffordable health care system.”

Nevertheless, the key members of the deficit commission, with nods of approval so far from its creator, the president, would pick on what Obama’s co-chairman, Alan Simpson, called the “lesser people” for the unkindest cuts.

Even the mildest medicine, proposed by Simpson and his buddy, former Clinton aide Erskine Bowles, would put a cap on and stunt the growth of Medicare even though other health costs are mostly responsible for that growth. In addition, as I wrote, the eligibility age for Medicare – for your children – would rise to 68.

Your expensive Medigap policy will be worth less: Bowles-Simpson would exclude the first $500 of coverage and limit coverage to 50 percent of the next $5,000.

Your annual out of pocket costs could rise to $7,500.

And, as I mentioned, the experiment for getting the feds into long term care, called CLASS, proposed by a dying Ted Kennedy, would be abandoned. From Bowles-Simpson, the gutting of original Medicare goes from bad to worse.

Former Clinton Budget Director Alice Rivlin and former Senator Pete Domenici would raise the already onerous 20 percent co-insurance for Part B to 35 percent.

And starting in 2018, their plan would substitute the present system - the government pays the bills - with a “premium support” system in which the beneficiary would get a certain amount of money to shop for his/her coverage.

Can you imagine going from the current system, which is confusing enough, to one in which beneficiaries, including the oldest men and women living in nursing homes, must shop each year for private insurance? Who would regulate the insurers?

Even worse, Rivlin and her new ally, right-wing ideologue Representative Paul Ryan [R-Wis], would completely privatize what most Americans consider the best health insurance they can get.

What makes this a dangerous possibility is the fact that Ryan will become chairman of the House Budget Committee. Under his market-oriented proposal, we would take the system that accounts for most of the present problem and make it worse.

Starting in 2021, people who turn 65 will receive vouchers to buy private insurance through a new Medicare Exchange. Vouchers would be worth $11,000 (surely that will be enough to treat a cancer), although adjustment may be made depending on the illness.

Of course, it will be up to the sick or dying beneficiary to argue his/her case with the insurer.

“I don’t think there’s any question that there’s intensifying pressure to control Medicare costs and that pressure is going to intensify more over time when you look at the deficit and you see that really Social Security is a minor contributor. It’s mainly health care,” said Jonathan Oberlander, professor of social medicine at the University of North Carolina. “Medicare has long been about budget politics.”

While Medicare makes a tempting target for cuts, John Rother, AARP’s executive vice president said,

“The burden of Medicare’s out of pocket costs is already very high, to the point where many people are literally having to choose between the necessities of life and health care. I don’t think it’s possible or advisable to further load people of modest incomes with very high health care costs.”

Rother has signaled that AARP, which successfully fought off the 1995 Bush administration effort to privatize Social Security, will be even more militant on Medicare’s behalf.

As important, the American Medical Association, has become a strong Medicare defender, especially since the Congress last week stopped for a year the pending 23 percent cut in the program’s payment for doctors. The year is expected to give lawmakers time to rewrite the formula for setting the fees.

Tricia Neuman, director of the Kaiser Family Foundation’s Medicare Policy Project, decries the premium support and voucher proposals and says the Affordable Care Act can help keep Medicare costs down.

Recently, the Department of Health and Human Services began writing regulations for an important part of the new law, called the Medical Loss Ratio, requiring insurers to spend 80 to 85 percent of health care premiums on actual health care rather than executive salaries and other administrative costs.

Getting back to Ms. Schakowksy, she had only one Medicare reform to propose that would require Medicare to scrap Part D and establish a Medicare drug plan and that Medicare be required to negotiate prices with drug companies.

Since the deficit commission seems to agree that the present system is flawed and too costly, I’d go one step further and propose what Obama used to favor, Medicare for All. But that was before he lost whatever it is that he once believed.

Contact saulfriedman@comcast.net


GRAY MATTERS: The Simpson/Bowles Deficit Commission

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Who can forget that outburst from Alan Kooi Simpson, a former senator and now co-chairman the president’s flawed deficit commission, when he told a women’s group challenging his views: Social Security is like “a milk cow with 310 million tits?”

This was nothing new for Simpson, a conservative Republican, who has rarely had a kind word for Social Security or any government social insurance program.

Yet he has been on the public tit for much of his 79 years. His position on the deficit commission (he has served on others ) is only his latest government gig. And his reputation as a quotable, if often outrageous, character has served to get him such appointments. He certainly doesn’t know much about Social Security as in this interview. Here is a sample of his words to Alex Lawson, a Social Security expert and advocate:

“We’re trying to take care of the lesser people in society and do that in a way without getting into all the flash words you love dig up, like cutting Social Security, which is bulls--t. We’re not cutting anything. We’re trying to make it solvent. It’ll go broke in the year 2037.”

The $2.6 trillion in bonds held by Social Security, he called IOUs.

A third generation corporate lawyer, Simpson’s less than sterling political career was bestowed on him by his father, Milward Lee Simpson, a former Wyoming governor and U.S. Senator who distinguished himself by voting against the 1964 Civil Rights Act.

The son served a few years in the Wyoming legislature before going to the Senate in 1979, where one of his most signal accomplishments was an attack on AARP for its lobbying on behalf Social Security and older Americans. Simpson only succeeded in making AARP, the nation’s largest and most powerful voice for seniors, even larger, stronger and richer.

AARP’s senior vice president said Simpson’s comparison of Social Security to a “milk cow”

“is offensive...for belittling a bedrock program that is the foundation of family security for all generations. The vast majority of the 310 million Americans he insulted....don’t have access to the type of traditional pension that Senator Simpson has from his decades in Congress.”

Simpson, who retired from the Senate in 1997 and has taught at the Kennedy School at Harvard, enjoys a couple of healthy government pensions, the average value of which is over $60,000 a year, and he enjoys taxpayer supported lifetime health benefits which helped him get the best of care when he had a $70,000 knee replacement. Yet his latest epithet for older Americans who are anxious to protect Medicare and Social Security from Simpson and his commission:

“We had the greatest generation. I think this is the greediest generation.”

For the record, nearly half of the 43 million disabled and older Americans on Medicare have incomes below twice the poverty level, or $20,800 for an individual and $28,000 per couple. That’s per year, senator. Nearly 70 percent of black and Hispanic beneficiaries have similar incomes. And as drug prices, premiums and deductibles have risen, median out of pocket costs are approaching 20 percent of incomes.

Yet it’s these “lesser people” that will bear the burden of benefit cuts in Medicare and Medicaid. While much attention has been focused on Simpson’s and his allies’ intention to gradually raise the Social Security retirement age to 70, which would mean an absolute cut in benefits, members of the Commission also would raise the age of Medicare eligibility to 68, which could leave millions too old to work in an uninsured limbo.

In addition, Simpson would raise the 20-plus percent that beneficiaries pay for Part B to an astounding 35 percent. Since Part B, which pays for doctor visits and labs, is the most frequently used Medicare benefit, this would all but kill the program. To add insult to the devastation, Simpson and company would cancel the portion of the Affordable Care Act that would begin a voluntary, long-term care program championed by the late Ted Kennedy.

Don McCanne, an MD, and a spokesman for Physicians for A National Health Program, noted that Simpson and his co-chairman, Erskine Bowles who, while in the Clinton administration, sought cuts in Medicare, favor raising Medicare premiums, deductibles and co-pays.

“Shifting more costs from the federal government to the patient might reduce the federal budget,” said McCanne. “But it plays havoc with personal budgets”

of beneficiaries who would be obliged to buy increasingly expensive Medigap plans. In addition, Simpson and Bowles would cut the fees to doctors, many of whom are already deserting their Medicare patients because, they say, the fees are too low. The Congress keeps threatening cuts and so far has declined to end the threat.

President Drew Altman, CEO for the Kaiser Family Foundation, noted that Medicare cuts will be especially hard on beneficiaries.

“It will be difficult, if not impossible to ask a majority...to pay more and make do with less. Warren Buffet is not the typical Medicare beneficiary.

“Instead the prototype is an older woman with multiple chronic illnesses living on an income of less than $25,000 who spends more than 15 percent on health care. It is the people on these programs and the realities of their lives that have been left out of the discussion.”

Another plan, sponsored by former budget director Alice Rivlin and Republican Representative Paul Ryan of Wisconsin, who is to be chairman of the House Budget Commiittee, would end Medicare as we know it by giving beneficiaries vouchers to buy their insurance on the market.

Whether or not Simpson and Bowles are able to get 14 of the 18 Commission members to vote for a proposal that would then go to the Congress, liberal members and allies in lobbying groups have begun their campaign for less draconian alternatives to cut the deficit.

Representative Jan Schakowsky, an Illinois Democrat, put forward a plan which would strengthen Medicare and Social Security and fund programs to create jobs, but would lower the deficit by $427 billion in four years by, among other things, cutting military spending by $110.7 billion, increasing revenues by $151.6 billion, ending tax breaks which cost $132 billion and reducing farm subsidies by $7.7 billion.

Unfortunately, most of the press, enamored with Bowles and Simpson, has ignored Schakowsky, although at least two other commissioners support her. Their view is that deficit reduction should follow job creation and be delayed until unemployment is down to six percent.

The New York Times reports that several progressive groups – Demos, the influential Economic Policy Institute and the Century Foundation as well as a coalition of economists, labor leaders – the Citizens’ Commission on Jobs, Deficits and America’s Economic Future - are weighing in on their own plans to lower the deficit without further killing the working and middle classes and the nation’s social insurance programs.

So far AARP, which is opposed to cuts in Social Security, has not weighed in with its views of the Bowles-Simpson proposals.

Let us not forget, this is Barack Obama’s commission. He made the mistake of falling for the deficit reduction frenzy which stunted his efforts to revive the economy and create jobs; he reached out to right-wing Republicans, who wished to see his presidency fail; then he reached out (too far) for the likes of Alan Simpson; and now he’s stuck with him.

Let’s see where Obama really stands on Social Security, Medicare and Medicaid – if anywhere.

Contact saulfriedman@comcast.net


GRAY MATTERS: Social Security – The Anti-Ponzi Scheme

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Even before I spent a dozen happy years living and working in Texas, one of my heroes was Sam Houston, the first president of the Texas republic, the state’s first governor and its senator. He resigned as governor because he staunchly opposed its secession from the union. Today, such principled heroics are rare in Texas.

Instead, the Texas congressional delegation is larded with an abundance of dunces and demagogues, like Representatives Joe Barton who apologized to BP for having to pay for its oil spill and Louie Gohmert who warned that illegal immigrants were coming to the U.S. to have “anchor babies” who will grow up and become terrorists. And who can forget Tom DeLay and Dick Armey?

Which brings me to the present governor, Rick Perry, who was just re-elected to a third term and will become chairman of the Republican Governors Association. Although he’s a member of Lincoln’s party, Perry is a rabid supporter of states rights and earlier this year, he said he was considering secession from the union as if that was a success the first time.

More recently he has threatened to secede from Medicaid which would leave 3.1 million poor people, including 2.3 million Texas children, without health care. And in promoting his new book, Fed Up! Our Fight to Save America from Washington, Perry suggested the state and its counties could secede from Social Security, which he said is “bankrupt.”

And he has remonstrated fellow Republicans for not calling Social Security a “Ponzi scheme.” Last week he doubled down on the charge calling one of the most treasured programs serving more than 50 million Americans. “worse than a Ponzi scheme.”

Ordinarily I would not bother with such nonsense but like the urban legend that members of Congress don’t pay into Social Security (they do), this demagoguery keeps coming back from people who should know better.

Even CNBC’s Jim Cramer, who failed to see the financial crisis coming, has likened Social Security to a Ponzi scam. Worse, too many Americans don’t know enough about Social Security to dismiss these lies.

To dispose of Perry’s initial lie about Social Security, as any fool who can read knows by now, the most recent report of the program’s trustees said that even if no action is taken to shore up the long-term finances of Social Security, it won’t go into the red until 2037.

But if it does (and it won’t), the trustees figure its payroll tax income will enable it to pay 75 percent of benefits until 2084. Moreover, as Alan Greenspan and the trustees have said, it won’t take much adjustment – perhaps a two percent increase in taxes or eliminating the $106,800 salary cap on payroll taxes - to keep it in the black until the end of the century.

One big reason: It holds in reserve more than $2.6 trillion in Treasury Notes which pay nearly $1 billion in interest to Social Security each year.

And that, of course, is the largest difference between Social Security and the schemes made famous by Charles Ponzi and, more recently, Bernard Madoff: There were no such invested funds earning money for either of them. Indeed, they made no investments.

But more important, Social Security is not and was never meant to be an “investment program.” It is, rather, a mandatory pension insurance program, financed by mandatory payroll taxes equally contributed by workers and employers. And, as the financial service Motley Fool reported last year, “that helps shore up its foundation far more firmly than a typical Ponzi scheme.”

Charles Ponzi was a Boston investment broker who became infamous in early 1920, when he sold foreign postal coupons promising, and even paying, returns of 50 percent or more. What he did, as we shall see, was to use one victim’s money to pay off another. Madoff did the same, promising 12 percent returns when the market was struggling and losing value.

Mitchell Zuckoff, the author of a book on Ponzi schemes, wrote for CNNMoney in the wake of the Madoff affair that comparisons of such cons with Social Security are hard to knock down but “since I for one consider real Ponzi schemes too important...it’s worth rebutting the myth.”

Put simply, he writes,

“[A] Ponzi scheme is a fraud in which money from one group of people is used to pay promised returns to another group of people. The money isn’t invested; it’s just transferred and at some point the scheme collapses because there’s not enough income to satisfy the withdrawals...

“In the case of Social Security, no one is being misled...Social Security is exactly what it claims to be: A mandatory transfer payment system under which current workers are taxed (6.2 percent each from employee and employer) on their income (up to $106,800) to pay benefits with no promises of huge returns.”

Indeed, the genius of the Social Security system’s design, as its web site says,

“For an average worker, Social Security replaces about 40 percent of annual pre-retirement earnings.”

That’s not much for an affluent worker, but for a low-income worker who has no other retirement plan, it’s enough to avoid the abyss of poverty. Social Security, which insures surviving spouses and children, is one of the nation’s last of the traditional defined benefit pension programs which are fast disappearing.

Zuckoff:

“Social Security is morally the polar opposite of a Ponzi scheme and fundamentally different from what Madoff did. At the height of the Great Depression, our society resolved to create a safety net in the form of a social insurance policy that would pay modest benefits to retirees (and later) the disabled and the survivors of deceased workers.

“By design, that means a certain amount of wealth transfer, with richer workers subsidizing poorer ones. That might rankle, but it’s no fraud.”

I would add, despite the bitching of conservatives and younger workers (who place too much faith in their bosses and those inadequate 401(k)s and resent the transfer of their tax dollars without a healthy return), there is something noble about a pension insurance system in which the younger generation helps support the retirement of their elders.

The young forget that, with luck and Medicare, they will grow old. And their benefits are guaranteed.

Yet today, Governor Perry and his right-wing cohorts, now in effective charge of American politics, would toss aside the morality of the Social Security system in exchange for the amorality of the stock market.

On November 8, 1954, President Eisenhower wrote his brother Edgar on “moderation in government.” He added,

“[S]hould any political party attempt to abolish Social Security, unemployment insurance, and eliminate labor laws and farm programs, you would not hear from that party again...There is a tiny splinter group that believes you can do those things...a few Texas oil millionaires...Their number is negligible and they are stupid.”

Write to saulfriedman@comcast.net


GRAY MATTERS: Raising the Retirement Age?

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


If the incoming Congress, especially the Republicans, are serious about paying attention to the American people, they could start with a couple of recent surveys, which are about life, health and even premature death.

The first, which shows how little confidence many Americans have in their newly elected lawmakers, found that

"on the heels of the 2010 midterm elections, 63 percent of retirees are not confident Medicare will be there for their children."

Indeed, according to the poll sponsored by Extend Health Inc., a private company which helps Medicare retirees choose health plans, 40 percent are unsure or not confident that Medicare will last through their lives. The rest are confident Medicare will continue to be available, but perhaps in altered form.

But on the downside, 17 percent are unsure, along with the 63 percent who are "not confident that Medicare will be available for the rest of their children's lives." That takes in a good portion of the 70-million men and women in the huge boomer generation, as well as families in their thirties who have reason to worry they will be shut out of Medicare as well as Social Security.

The reasons for the pessimism include signs among Republicans in the new Congress that they wish to cut funds for Medicare or, as the incoming Budget Committee Chairman, Representative Paul Ryan of Wisconsin, has suggested, privatizing Medicare into a system in which beneficiaries will use vouchers to buy private insurance.

In addition, the new health reforms have cut back on subsidies for Medicare Advantage plans and some of them are going out of business. Republicans favor saving Medicare Advantage in order to cut Medicare.

The other survey goes to the heartlessness of Republican efforts to raise the Social Security retirement age from 67 to 70 for if that is successful, millions of working people will be forced to delay retirement as well their enrollment in Medicare.

And the liberal Center For Economic and Policy Research (CEPR) has reported [pdf], with good documentation, that increasing the retirement age will not only be difficult for many who work in physically demanding jobs, but it would shorten the retirements and lives of many of those workers.

Using data based on the census and the Occupational Information Network, the CEPR said that "in 2009, 6.5 million workers age 58 and older had physically demanding jobs, while 5 million workers age 58 and older were employed in difficult jobs” that were physically demanding or with difficult working conditions.

In addition, many of the most physically demanding or difficult jobs were also poorly paid and most were held by Latino workers (54 percent), blacks (53 percent), Asian Americans (50 percent) and whites (43 percent).

Even higher percentages of Latinos and blacks in the most demanding jobs were much older than 58 and would be especially hurt economically by a raise in the retirement age.

The survey found that

"raising the retirement age is particularly concerning for near-retirement age workers with physically demanding jobs. Despite the fact that the retirement age increase is supposed to encourage workers to work longer, many workers would be physically unable to extend their work lives and they would most likely be left with no choice but to receive reduced benefits."

Or, after a life of hard work and paying taxes, they would go on welfare.

But that would not be the worst of it for CEPR found, in a companion survey, that many retirees from difficult jobs don't live long enough to collect benefits. Those who, like Ryan, intend to support raising the retirement age argue that life expectancy has increased and therefore the retirement age should likewise be increased.

Perhaps it doesn't occur to Ryan and his allies that Medicare and Social Security are largely responsible for increased longevity (which still lags behind other nations). Perhaps this will be the Republicans' “death panels.”

As CEPR reported,

"The average length of retirement has increased consistently since the program (Social Security) was started in 1937. However, the increase in the normal retirement age from 65 to 67 that is being phased in...largely offsets the increase in life expectancy. As a result, workers who work long enough to collect their full benefits will see little gain in the expected length of their retirement."

Graphs and charts in CEPR's paper illustrate the growing income inequality and life expectancy between minorities in difficult jobs and the rest of workers, especially those in white collar jobs that are less demanding.

"If the recent trend of growing inequality in life expectancy continues through the next three decades, these workers in the bottom half of the wage distribution can anticipate substantial reductions in the expected length of retirement, if the normal retirement age is increased...

A male worker born in 1973 retiring at age 70 can expect to live a full year less than the expected length of retirement for a worker born in 1912."

The study's conclusion:

"If the normal retirement age is increased to 70 over the next 25 years, as advocated by many policymakers, then the rise in the retirement age will continue to offset most of the increase in life expectancy....The expected years of retirement (meaning the years until death) will be less for the 1973 birth cohort than it was for the 1912 birth cohort."

We reported last August 7 on the book, The Spirit Level, which analyzed the growing income inequality in the U.S. compared to other countries, and the consequences for millions of Americans as they grow older and poorer. Trust the new Congress to do nothing to make it better for the American worker and his/her family.

The CEPR study added this note:

"From the probabilities of death, life tables were constructed based on standard methods as described by Social Security."

The bottom line: The higher the retirement age, the shorter the lives of retirees. That, of course is one way of saving money; widows and widowers don't cost taxpayers and Social Security as much as a retiree who lives a full life and draws a full benefit.

This study dealt only with the consequences of Social Security retirement longevity. But ignored during most of the debate on the subject have been the consequences for the quality of life for workers who also may be denied the protection of Medicare if its age of eligibility is also increased. Many employers have ended pension programs and most Latino, black and poor white workers in demanding blue collar jobs do not have 401(k) savings plans.

Nor do many employers provide good health coverage. And unless the recently passed health reforms continue in force, millions of America's hardest workers at the most physically demanding jobs will remain uninsured and at great risk of illness and high medical costs in their older years thanks to members of Congress who get taxpayer-funded health coverage.

Incidentally, if you wish to learn more about income inequality in the U.S., The Spirit Level is cited in a fine series in Slate called The Great Divergence, by Timothy Noah. And this U.K. site is worth examining.

Write to saulfriedman@comcast.net


GRAY MATTERS: Annual Medicare Enrollment Period Begins on Monday

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


The first shock comes when the kid in the movie booth asks if you’re a senior. Then AARP notifies you that you are eligible for membership. And three months before you turn 65, you should get some really good news - you’re about to get the nation’s best health care insurance, Medicare.

Medicare was passed in 1965 and went into effect within a year. And although it has expanded over the years and now serves more than 47 million older and disabled Americans, its basics have remained the same.

And despite what you may have been told, it is less complicated and more generous than the private insurance that you bought or had through an employer.

However, Monday, November 15 is the beginning of this year’s Open Enrollment period, which ends December 31, but you needn’t fret or rush into anything for it pertains to enrollment in private plans, not Medicare. We’ll get to that later.

SIGNING UP FOR MEDICARE
When you’re about to become 65 and if you’re eligible for Social Security (even if you’re not taking the benefits yet), you will be automatically signed up for Medicare Part A, which pays most bills for hospitalization. There is no cost for this Part A, for in-hospital costs, is financed by the Hospital Insurance Trust Fund and your new Medicare card will reflect you have that coverage.

But I’m getting head of myself. If you have not been notified by Social Security or Medicare that you’re eligible for Medicare, visit medicare.gov to sign up in seconds.

If convenient, visit your Social Security office. You should also explore the Medicare site and, if you’ve got a decent printer, download the guide Medicare & You 2011. You will get a print copy in the mail after you enroll.

For those of you who are new to this or if you need a refresher, today’s Medicare has four parts:

• Part A, as I said, covers hospitalization, rehabilitation in skilled nursing centers and nursing homes, hospice and home care

• Part B covers doctors, outpatient care, lab tests and x-rays. Parts A and B together are original, traditional Medicare

• Part C, the private insurance plans added relatively recently includes HMOs (Health Maintenance Organizations) and PPOs, (Preferred Provider Organizations), now called Medicare Advantage

• Part D, passed in 2003, which covers prescription drugs, either as stand-alone, drugs-only plan or as part of a Medicare Advantage plan

PART B
When you are signed up for Part A, you will be given an opportunity to enroll as well in Part B, which is the part of Medicare most often used. Because there was no cost of living adjustment in Social Security this year, the monthly premium for most beneficiaries remains at $96.40, but it’s more on a sliding scale for individuals earning more than $85,000, or $170,000 for couples.

Check the Medicare site for the amount of the higher premiums. This means test, the first ever for Medicare, helped pay for George Bush’s flawed Part D benefit with its donut hole.

If you decline Part B and don’t have other, equivalent coverage, you could be penalized when and if you do sign up. If you have private or employer coverage for doctor and lab visits, you may decline Part B, although some employers are insisting that Medicare-age employees take the coverage to save the company money.

Be careful. If you leave the company or your coverage ends, you have eight months to enroll in Part B with no penalty.

SUPPLEMENTAL (MEDIGAP) COVERAGE
Once enrolled in Part A and B, you have a few choices. Part A’s out-of-pocket costs, which you can learn about in the Medicare & You

That means if you don’t already have a supplemental policy from a spouse or former employer, you may buy one of several standard “Medigap” plans, which depending on cost, will cover part or all of those deductibles and co-pays. You may enroll in a Medigap plan almost anytime, and in most states, even if you have a pre-existing condition. The plan heavily marketed by AARP is as good as any, but the Medicare web site can help you shop.

PART D
If you do buy a Medigap policy, then consider a relatively inexpensive, stand-alone Part D drug plan. The advantage of this threesome – traditional Medicare (A and B) plus a Medigap policy and stand alone drug coverage – ends up being less costly, more stable and less risky than the next choice during open enrollment, a Medicare Advantage plan.

MEDICARE ADVANTAGE
Medicare Advantage, as I’ve written, grew out of Republican efforts in 1995 to partly privatize Medicare. Thus Part C, which is heavily subsidized by the federal government, pays private insurers to cover all the basic benefits of Parts A and B but in addition, the insurers offers a drug plan (for extra money) and perhaps some added benefits such as eye examinations.

Nevertheless, MA plans are in business to make profits and they could and do go out of business and leave beneficiaries without coverage if their profits are not high enough. There will be 2,011 MA plans next year, but that’s down from more than 2,800 in 2009. In some rural areas, there are few MA plans available.

Medicare Advantage plans are convenient because they are comprehensive, all-in-one insurance policies. But there are disadvantages of MA plans, aside from taking money from and undermining traditional Medicare:

• You must use doctors and hospitals in the insurer’s network

• You must get the insurer’s approval for some procedures, many doctors have dropped some MA plans because the insurers second-guess the doctor or they are slow in paying

• The monthly premiums for MA plans and their drug plans (in addition to the Part B premium you must pay) have been relatively stable, but increases are expected

• You must pay a co-pay for each doctor or lab visit

• You will need a referral from the primary care physician for each visit to a lab or specialist. If a hospital or doctor specializes in a certain illness or kind of cancer and is not in the network, it may be difficult getting the insurer to pay or continue coverage, especially if the illness is prolonged and costly.

The new Affordable Care Act will prohibit such coverage limits starting next year, but the limits permitted are quite high. Traditional Medicare has no such limit but you can keep track of what Medicare and your supplement pays in the periodic “Medicare Summary Notices” that you will receive. (You may check them to help guard against fraud).

A further warning: The new health reforms include cuts in the federal subsidy for MA plans, which angered thousands beneficiaries, but if the law survives, the subsidy may be cut further in coming years which will put many of these plans out of business.

ONLINE HELP
Meanwhile, if your MA plan or your stand-alone drug plan raised its prices, this enrollment period is the time to shop. While the Medicare web site is user friendly, some of the best information on Medicare can be found on the Kaiser Family Foundation website and for help with problems, try the Medicare Rights Center or the lawyers at the Center for Medicare Advocacy.

MEDICARE IMPROVEMENTS
I can’t end without a note on one of the most important improvements in Medicare under the Affordable Care Act. Beginning January 1, there will be no charge for a variety of preventive services including a number of life-saving cancer screenings, free flu and pneumonia shots, a “Welcome to Medicare’ physical exam and annual wellness visits to keep track of your health and possible cognitive problems.

Welcome to Medicare.

Write to saulfriedman@comcast.net


GRAY MATTERS: Misunderstanding Medicare

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


I read somewhere that the White House and congressional offices have been besieged by phone calls and emails from older people complaining at the news that, for the second consecutive year, there won’t be a cost of living increase in Social Security benefits.

I don’t take issue with those complaints, for most of us know that the cost of living has gone up measurably, especially for people who depend on those Social Security payments. But what caught my attention and disappointed me was the news that some seniors “erroneously believe it is the Congress and the White House that are denying them raises.”

It seems to me that people who are on Social Security ought to know enough about their most important federal program to understand that the Cost of Living Adjustment (COLA) is based on the rate of inflation measured by the Bureau of Labor Statistics in the Consumer Price Index for workers, called the CPI-W.

Some experts want to substitute the CPI-E (for experimental) which would be closer to the reality for elders, but that’s another subject.

My point is that most of us ought to know that neither the Congress nor the White House is responsible for the freeze; indeed, many congressional Democrats have been pushing for a one time payment of $250 for everyone on Social Security.

If that doesn’t happen in the lame duck Congress because of the coming changes in power, those deluded seniors who voted for Republicans because they were angry over the COLA will get what the rest of us don’t deserve – cuts in Social Security benefits or maybe an attempt at privatization.

Similarly, if the polling was accurate, millions of older voters who should have known better were suckered into falling for the ads of the phony right wing senior group, 60 Plus, the Republicans who all voted against health reform, the U.S. Chamber of Commerce and, of course, the health insurance lobby, and believing that the reforms will cut more than $500 billion from your Medicare over the next decade. They were wrong.

One of the best health care reporters, Trudy Lieberman, of the Columbia Journalism Review, put the so-called Medicare cuts in perspective on November 1:

“The health reform law cuts the growth in Medicare spending by $533 billion. Some might like to call that a saving [as President Obama has done] because Medicare might not be spending as much as it otherwise would, but the term can be confusing.

“But the law also adds $105 billion in new spending for more coverage for seniors who have very high drug expenses and the elimination of copayments for preventive services. The net reduction in Medicare spending is $428 billion over ten years...

“About 40 percent of these cuts come from cuts in payments to hospitals and other providers, except doctors. That money will be used to subsidize insurance policies for the uninsured.

“Another 25 percent comes from reductions in the overpayments to Medicare Advantage plans,” which cost nine percent more than Medicare spends per beneficiary.

“Phasing out the overpayments,” Lieberman continues, “will also hold down increases in Part B premiums...While cuts to MA plans may be unpopular with those who have them, they do strengthen Medicare for everyone.”

So, why will we haggle over the price of meat or an oil change, but we will believe the very people who voted against health reform and have promised to kill the best parts of the bill that passed? How come older Americans confused over the health care selfishly voted to put Medicare itself in danger?

Democratic pollster Celinda Lake said the right wing propaganda campaign was working in the mid-term elections.

“The biggest problem Democrats have with the health care bill,” she said,“ is the dislike of the bill by senior citizens, who have been scared to death about it.”

Judith Stein, who runs the Center for Medicare Advocacy, said of the ad campaign,

“It’s a way to get seniors to vote against those who supported health reform.”

President Obama shares some of the blame when he helped sell the reforms by emphasizing that they would “save” more than $500 billion in Medicare. The so-called savings strengthened Medicare. But because the reforms were themselves complex, what got lost in translation were at least two facts: the savings extended the life of the Medicare Hospital Insurance Trust Fund, and cut only some of the overpayments to private insurance companies that sell Medicare Advantage coverage. Those policies are not good for traditional Medicare.

Let’s recall that such policies were instituted by Republicans under Newt Gingrich in 1995 to wean seniors away from, and undermine, traditional Medicare in favor of HMOs and PPOs. Fifteen years later, only 25 percent of seniors have such insurance and under the reforms, they would not have lost their coverage.

The federal government has spent billions of Medicare dollars to subsidize that 25 percent. But these short-sighted Medicare beneficiaries were willing to privatize their Medicare. Some beneficiaries even declared during town meetings that “government should stay out of Medicare,” an obvious oxymoron since the government runs Medicare.

Now they may get their wish for they’ve opened the door to a new Republican effort to get the government out of Medicare. One coming proposal would substitute your Medicare benefits for vouchers, which beneficiaries would use to buy coverage from insurance companies.

To allay fear of change, none of the MA companies, under the law, are permitted to reduce Medicare benefits. But most were remaining in business despite the cutbacks in federal subsidies.

In any case, as Stein points out, nothing in the law could reduce Medicare’s benefits; indeed, they were expanded with the savings able to pay the full cost (no more co-pays) of yearly physical exams, preventive services such as mammograms, colonoscopies, prostate tests, flu shots and vaccinations.

Republicans, who will be in control of the House come January, have vowed to kill many of the health care reforms perhaps by starving the reforms of funds. And they want to hold hearings to grill Health and Human Services Secretary Kathleen Sibelius and the head of the Centers for Medicare and Medicaid Services, Dr. Donald Berwick.

But some of the reforms, like the free preventive services and coverage for children and adults with pre-existing conditions, may be too popular for Republicans to attack. In addition, the Democratic Senate can, in a turnabout, block the excesses of the right-wing House. And President Obama can use the power of the veto, if he hangs tough.

Sadly, though, nothing new for seniors - like long term care - will get done in this reactionary, penurious new Congress.

Lieberman concluded in the Columbia Journalism Review:

“Most people, especially those on Medicare, have never really understood how the program works. That made it easier for each side to get away with advertising flim-flam.”

I wonder if those older people have learned enough to protect not only Medicare, but the Republicans’ favorite target – Social Security.

Write to saulfriedman@comcast.net


GRAY MATTERS: A Ray of Light for Health Insurance Consumers

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


It’s nice to report, for a change, some good news for beleaguered consumers. The greedy health insurance industry, which has been lawyering up and lobbying to dodge the most important requirements of the Affordable Care Act has lost an important battle this month.

As Wendell Potter, former insurance company executive turned consumer advocate, put it at Huffington Post on October 21,

“This time our state insurance commissioners...did the right thing for consumers when they refused to cave in to intense pressure from the profit-obsessed insurance industry to gut an important provision of the health-care-reform law.”

Consumer Watchdog, covering the National Association of Insurance Commissioners (NAIC) meeting in Orlando, said it more simply: The commissioners

“sent rules to the Department of Health and Human Services that will require insurers to spend more money on health care and less on administration and profits.”

Now it will be up to HHS Secretary Kathleen Sibelius to write regulations that are designed to enforce the rules, and that will be tough. The insurance companies have not cooperated with the health reforms as President Obama naively hoped. Indeed, several companies have sharply raised premiums by double digits in advance of the rules and announced they would not offer the coverage the law promises.

As a result, Consumer Watchdog and other advocates have called on the White House to freeze premiums until the industry complies with the pricing provisions of the new law which requires them to explain further increases before they take effect.

Sadly, all Sibelius and the administration can do is appeal to the industry for there is little in the law, aside from light civil penalties, that they can do to punish the companies and there is no legislative limit on premiums.

What there is in the law, as I’ve discussed in an earlier post, is the crucial requirement called the “medical-loss-ratio”(MLR) that companies must spend 80 to 85 percent on premiums on actual health care; the former number is for smaller insurers, the latter for the big ones. The rest, 15 and 20 percent, is supposed to be spent on administration and profits. If enforced, insurers that do not meet these requirements must issue rebates to beneficiaries.

Some critics say the MLR, which grants insurers the possibility of making profits of 15 or 20 percent on the premiums is too generous. The insurance lobby has protested that the requirements will hurt beneficiaries and encourage fraud and cheating.

The law gave the task to the NAIC to look at the books of the companies and figure what costs can legitimately make up the MLR. The commissioners have been meeting for nearly six months to come up with recommendations designed to satisfy consumers and the insurers. But the companies, as you’d expect, have sought to cripple the MLR with amendments.

Aside from raising premiums to evade the effects of the MLR, the insurers have sought during the past six months to convince the commissioners to agree that every dollar they spend on sales personnel, advertising, marketing, phony promotions and other extraneous expenses should be categorized as “health care,” rather than administration.

For example, they sought to include community-based “wellness” promotion campaigns, which help publicize the insurer’s offerings and is nothing more than public relations. The companies also wanted some of their federal and state income taxes counted as health care expenditures to which the NAIC agreed.

But the commissioners turned down the insurers request to include as health care costs the taxes they pay on investment income. Similarly, the NAIC turned down the industry’s proposals to deduct broker fees, average their medical spending nationwide rather than state by state and loosen rules for smaller companies that don’t quite meet the 80 percent requirement.

As Potter pointed out, the timing of UnitedHealth’s announcement of a 23 percent increase in profits for the third quarter two days before the NAIC meeting undercut the insurers’ appeal for more loopholes to dodge the requirements. As a result, the commissioners rejected most of the insurers’ proposed amendments. Potter said the regulations approved by the commissioners represents a compromise that will make it easier for the industry to comply with the MLR.

But we can expect American Health Insurance Plans (AHIP) to take their lobbying effort to Sibelius who has already issued 30 waivers to company insurance plans that claimed they were having difficulty complying.

Consumer Watchdog said that despite the victory in Orlando, “the rules still contain significant concessions made to insurers.”

They include allowing companies to subtract the federal and state income tax they pay on premium revenues before calculating medical expenses; allowing companies to classify as “health quality improvements” the costs and salaries of clerks who reject claims; the cost of phone hotlines to handle consumer questions and complaints; and the cost of penalties the insurer are supposed to pay for not meeting the law’s requirements.

“Making these rules work,” said Carmen Balber, Washington director of Consumer Watchdog, “will require tough scrutiny of insurance companies’ spending to make sure they don’t use loopholes...to pass off overhead costs as health care.”

Sibelius said the commissioners’ recommendations “are reasonable, achievable for insurers” and she promised to “work quickly to promulgate this regulation” using the commissioners’ recommendations. But does the administration have the stomach to wage a constant fight with insurers for whom the health reforms were tailored? And will HHS have the financial expertise to examine and interpret the books of the companies? Can the insurance industry be required to cut their own profits, as the law intends?

Karen Ignani, president of the insurers’ lobby, signaled its intentions to fight and dilute the MLR on the grounds that stock prices may decline and discourage investment in insurance stocks. She commented on the NAIC meting:

“Defining health care quality initiatives in a way that is too narrow or static will turn back the clock on progress and create new barriers to investment in the many activities that health plans have implemented.”

Potter replied: “If the health plans that take our money but give us lousy coverage in return are forced out of the marketplace, I say good riddance.”

He acknowledged, however, that if smaller companies fail, concentration in the industry will increase. And so will the power of the large insurers to tailor the final regulations to their liking.

A final note: Medicare for All would generally eliminate the need for most health care insurance.

Write to saulfriedman@comcast.net


GRAY MATTERS: Possibilities for Medicare For All?

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Who would have guessed that one of the most right-wing Republicans in the Senate would predict that the American people, sooner rather than later, will see the passage of single-payer, universal health care such as Medicare for All?

I hasten to add that this prediction from Senator Tom Coburn of Oklahoma, would not be to his liking; indeed he’d probably fight to his last breath to prevent such a proposal from becoming law.

Coburn, a physician, is known as “Dr. No” because of all the nominations and legislation he has obstructed with his lone objection, the latest being the emergency aid to the earthquake victims in Haiti. He’s also the M.D. who suggested we pray that the late Senator Robert Byrd (D, WV), would be too ill to cast a crucial vote on health reform, which Coburn opposed. (Byrd voted and the health reforms passed.)

Now that the Affordable Care Act is law, Coburn predicted in a speech earlier this month to the Republican Women’s Club of Tulsa,

“There will be no insurance industry left in three years. That is by design. You’re going to make insurance unaffordable for everyone - which is what they want. Because if there’s no private insurance left, what’s left? Government-centered, government-run. Single-payer health care.”

The reforms, he said, will mean “the beginning of the end of America” unless they are killed by repeal, or the courts.

He didn’t explain who is the “they” who want insurance to be unaffordable. The Obama administration has criticized companies that have sharply raised premiums and asked them to desist. And the law’s requirement that individuals must buy insurance (the so-called individual mandate), subsidized by the government, is expected to add millions of new customers to the insurers’ rolls.

As far as I know, no one in the Obama White House is plotting to extend the health reforms into Medicare for All, which is too bad. But Coburn may be right without knowing why; the greed and stupidity of the insurance and drug industries could kill the reforms and bring on true universal health care if they continue their rapacious conduct.

That’s a strong possibility, according to a more rational and traditional conservative, Professor Paul J. Feldstein, of the University of California and an expert in Health Care Management in the school of business who has written text books on health economics. He was interviewed for the journal, Nursing Economics, by Peter I. Buerhaus, on the faculty of Vanderbilt University.

As Buerhaus wrote, he conducted the interview (may need free registration) because, while the health reforms

“did not include language to transition toward a single-payer system, this does not preclude that over time, and depending on how the legislation is implemented, a single-payer system might eventually be adopted as many people and advocacy groups desire.”

The description “single-payer” can be confusing, and Feldstein defined it:

“When a government is the only payer of health services. It does not mean that the government owns the health provider, like the U.S. owns VA hospitals. An example is Canada, where the government is the only payer for all the basic medical services provided to its citizens.”

Feldstein is not necessarily a fan of such systems; he’s a believer in the market, but he favors some regulation and restraints. When he was asked if the health reforms could lead to the adoption of a single-payer system, Feldstein said,

“I can see a scenario where there is very little cost containment and little pressure to keep insurance premiums from rising substantially. And if there is a weak mandate for individuals to purchase health insurance, then the resulting adverse selection [enrolling too many sick people] is likely to cause insurers to increase their premiums. People will become dissatisfied...and may become more supportive of a government funded public insurance option...

“Eventually, if many individuals purchase public insurance we could end up with a single-payer system or something close to one. We already pay the health care for tens of millions of people with the Medicaid and Medicare programs, and you can just pretty much put a public insurance option together with these programs into one system.”

He acknowledged that a single-payer system would cover more Americans, spend less money per patient and save on the vast administrative costs now spent on the fragmented private health insurance establishment. But Feldstein said a single-payer system would include budget restraints that could retard advances in technology and lead to rationing, inefficiencies and a reduction in preventive care because of the greater demands for acute and urgent care.

Dr. Don McCanne, of Physicians for a National Health Program (PNHP), praised Feldstein for “a more intellectual” and “sincere” discourse on the singe-payer issue. But

“it is distorted by exaggerated potential adverse consequences of single-payers,” he said, “by his failure to include certain inescapable benefits.”

Dr. Quentin Young, Barack Obama’s physician in Chicago before he became president, agrees that the new health reforms could lead to a single-payer system, if it is undermined by its critics, challenges in the courts and “destabilizing pressures” from the insurance industry. Indeed, he adds, “the law may unravel sooner than many suspect.”

Young, a founding member of PHNP, warned that if the Affordable Care Act collapses, “Single-payer Medicare for all needs to be ready to fill the gap...”

And in the meantime, he hoped Obama would reject cuts in Medicare that may be suggested by his deficit commission. “Medicare should be strengthened by improving it and extending it to everyone,” he said.

There are two bills calling for Medicare for All, one (HR 676) that has been introduced by Representative John Conyers (D. Mich), the second longest serving member of the House. Information on his bill may be found at the healthcarenow website.

The second bill, introduced by Senator Bernie Sanders, (I, Vt.), is the American Health Act, S. 703, which calls for state based single-payer systems that combine all current programs such as Medicare and Medicaid. You can study this proposal at govtrack.

When Young was Obama’s doctor, Obama favored Medicare For All, as do many Democratic lawmakers who have co-sponsored the Conyers and Sanders bills. Obama now says he would favor Medicare for All, “if we were starting from scratch.”

Well, why not start? Maybe in the second term, if there is one.

Write to saulfriedman@comcast.net


GRAY MATTERS: Medicare for All

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


When I read that so many Americans don’t understand, don’t like or worse, don’t care about the health insurance reforms that were so hard to come by, I can’t help thinking of that wonderful, climactic scene in On The Waterfront in which Marlo Brando recalls a prize-fight he deliberately lost and tells his brother Charlie that he could have won that bout. “I coulda been a contender,” he says.

I believe people could have been more enthusiastic about the reforms, such as they are, if Barack Obama had not been so quick to compromise with big drug and insurance companies. He could have fought to give us, the American people, the change he promised - a universal health care bill they could understand, like the one he was for before he became president.

Why do today’s Democratic presidents (e.g., Bill Clinton) believe they must move to the middle to govern? Franklin Roosevelt and Ronald Reagan, whom Obama praised as transitional presidents, didn’t do that.

We could have had a less complicated, more easily understood bill without all the ifs, ands, buts and loopholes that the insurance and drug industries are wiggling through as we speak. It’s downright sad that so many good Democrats in Congress are running away from the reforms in the coming election.

Or, they’re having a hard time explaining and defending their votes for the thousand page Patient Protection and Affordable Care Act (PPACA), most of which won’t take effect for three more years by which time these lawmakers and the president will have had to run again.

In September, six months after the reforms became law and despite the administration’s efforts to publicize its accomplishments, the Pew Research Center reported that only 38 percent of the public approves of the law, while 45 percent disapproves and rather than wait to see if it works, 32 percent favor repeal.

The same poll, however, found large majorities of older Americans (69 percent) adamantly opposed to a Republican proposal to replace Medicare with vouchers for beneficiaries to use to pay for their care.

The popularity of Medicare, even among younger people, should have told the Obama White House which way to go with health insurance reform. An Associated Press poll in late September reported that 61 percent of respondents believe Obama should have gone further to change the system. A Kaiser survey found only a slight increase in support for the reforms.

I can understand why so many people are lukewarm towards the health reforms. They watched as the president, in order to get some cooperation from PhaRMA, the Pharmaceutical Research and Manufacturers Association, and America’s Health Insurance Plans, AHIP, the insurers, steadily gave in on key issues and then gave away the possibility of a public option, like Medicare.

A public option, as the president himself said, would have given consumers more choices and some leverage over the big insurers to bargain on premiums and hold them to the new regulations. Obama would have earned more support from the people who voted for him.

But now we know from former Senator Tom Daschle, among others, that Obama was ready to cave in on that issue early when PhaRMA and AHIP demanded that in exchange for their support. Daschle admitted as much in his account of the health reform battle in his new book. He later partially retracted his admission in an interview, but others knew the truth.

Senator Russ Feingold (D-Wis.) has said that there was no public option in the final bill because the White House never pushed for it unambiguously. Thus, the health care we’ll get is almost completely privatized, dependent on the insurance and drug companies, all of which can look forward to record profits because the reforms mandate that millions must buy insurance with premiums subsidized by Washington.

Despite the criticism from the right, the government is not taking over health care as much as it is trying (vainly) to regulate insurance companies in return for guaranteeing them tens of millions more customers.

To be fair those regulations, if enforced, will eventually help get coverage for most of the 50.7 million Americans who are uninsured, an increase of 4.3 million over last year. For when the reforms took effect on September 23, its supporters were able to point to some positive effects of the health insurance reforms:

• Covering young adults until age 26
• Helping people with chronic conditions by ending lifetime limits on new policies
• Covering children with pre-existing health problems
• Expanding preventive care such as free flu shots, mammograms and colon exams for persons not on Medicare

But as Daschle wrote for Kaiser Health News, the top-heavy complexity of the law and the resistance to it by insurers and several states have made it necessary for Kathleen Sibelius, the Health and Human Services Secretary to issue additional regulations, guidance and clarifications to keep up with puzzled inquiries from consumer groups and lawyers for providers who read the fine print, looking for ways to dodge the letter of the law.

As a result, she has sought to set up temporary “high risk pools” run by the states and the federal government to cover adults with pre-existing conditions who have been unable to get insurance. She has appealed to insurers who have sharply raised premiums or refused to cover children; six companies, including Anthem, Aetna, Cigna and Humana say they’ll stop writing policies for children not also covered by their parents’ policies.

A reader informs me that insurers are denying coverage for neurological testing of children, thus preventing diagnoses.

And insurers have lobbied furiously with state insurance commissioners to avoid the requirement that they spent 80 to 85 percent of premiums on health care. As a result, USA Today reports, Sibelius has had to issue 30 waivers to companies and their insurers, including Cigna, who say they can’t meet those requirements. The White House said it was the best way to keep people insured until the law fully takes effect in 2014.

Medicare went into effect a year after its passage in 1965. And even now, with four parts (A, for hospitalizations; B, for outpatient services; C, for Medicare Advantage - comprehensive, partly private coverage; and D, prescription drugs), it is not as complex as the Affordable Care Act. I’m attaching here a handy list of Medicare health and drug plans [pdf] for every state.

By 2019, when the ACA is to be fully implemented - if it is not whittled away by Republican enemies who don’t believe government should play a role in health care - there will still be 23 million uninsured, and there will have been 500,000 deaths among them. So says Dr. Henry Abrons, of the Physicians for a National Health Program in California.

Those figures, derived from the Census report, he added,

“underscores the urgency of going beyond the Obama administration and swiftly implementing a more fundamental reform – a single payer national health insurance program, improved Medicare-for-All.”

Right-wing critics charge that the Affordable Care Act is a foot in the door to get Medicare For All. Let’s hope they’re right.


GRAY MATTERS: Comparing Midterms 1934 and 2010

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


I was barely around in 1934 but I will lay odds that there was no argument in my parents’ household about the forthcoming midterm elections. Indeed, in virtually all of working class New York City, it would have been considered a sin not to vote straight Democrat – for the party of Franklin Roosevelt.

I have alluded to that election in other posts as a lesson for today and President Obama for Roosevelt’s New Deal, while full of promise and proposals, had not yet broken the death grip of the deep recession, which was to become known as the Great Depression.

It was to wear on until the eve of World War II. But, as I’ve said, Roosevelt’s support among voters (now called his “base”) lasted through 1945. And the New Deal’s legacy has outlived his detractors.

By 1934, Roosevelt had closed the banks, 9,000 of which had failed, to avoid further runs and losses of depositors’ money. He had shoved through a frightened Congress 100 days of action, including the Glass-Steagall Act, which barred commercial banks from speculating in investments the market with depositors’ money, and created the Federal Deposit Insurance Corporation (FDIC).

The Agriculture Adjustment Act stabilized farm prices, and the Tennessee Valley Authority held the promise of bringing electrification to the poverty-stricken deep south.

Nevertheless, in 1934, Roosevelt found himself beset by the impatience of supporters and the deep hostility of the powerful Republican money changers whose selfishness and conniving had brought on the worst domestic catastrophe of the new, 20th Century.

Roosevelt sought to save capitalism from the left- and right-wing radicals of the day, yet he was called “socialist,” “communist” and worse. Just over the horizon loomed the threats of Italian Fascism and German Nazism. And the polls of the day predicted losses in the elections for the Democrats and Roosevelt’s fledgling New Deal.

http://www.newdeal20.org/

It was therefore instructive to read on the web site, New Deal 2.0, a project of the Franklin and Eleanor Roosevelt Institute, an account of the 1934 election by Roosevelt historian David Woolner, a fellow in residence at Hyde Park.

“In spite of his overwhelming success in the presidential election of 1932, there was no guarantee that FDR would lead his party to victory in 1934,” Woolner wrote. “Then as now, it was something of a truism that the party in power would lose seats in the midterm election.

“Moreover, 1934 was the year that the arch right-wing and left-wing reaction to the launch of the New Deal would begin to coalesce around a variety of newly formed ‘populist’ organizations that claimed to represent the will of the people.

“It was in August of 1934, for example, that a group of hardcore conservative Democrats and Republicans – financed by some of the most prominent names in American business – formed ‘The American Liberty League,’ an anti-government, pro-market organization that accused FDR of leading the country down the path of a socialist dictatorship.”

Among the League’s backers were the DuPont family and the leaders of General Motors, General Foods, Chase National Bank and Standard Oil.

The League will sound familiar for, as Woolner wrote,

“it attacked nearly every New Deal measure under the guise of its goals ‘to defend and uphold the [U.S.] Constitution...to teach the duty of government to protect individual and group initiative and enterprise, to foster the right to work, earn, save and acquire property...’

“In hundreds of published pamphlets, the League sent mixed or contradictory messages, variously accusing the New Deal of being inspired by fascism, socialism or communism. And the president’s leadership of being so strong that it was tantamount to the establishment of a dictatorship, or so weak that he rendered himself unable to ward off the sinister influences of his socialist advisers.

“The league saw economic planning and regulation as a threat to American values, the growth of the national debt as a sign of permanent decline.”

But Roosevelt’s fireside radio chats, his magical voice and his optimism cut through the incessant criticism from virtually every newspaper, helped in part by a rebound in economic growth and the stock market.

Besides, Roosevelt held informal press conferences in the Oval Office every Monday morning, beginning with the president asking, “What’s on your mind, boys?” He had the reporters on his side, if not their publishers. And it was his way of keeping in touch with the public.

In addition to the attacks from big business, Roosevelt had to contend with challenges from phony populists. Senator Huey Long of Louisiana established the “Share the Wealth Movement,” which called for a 100 percent tax on earnings over a million dollars and a guaranteed income of more than $2,000 for millions of American families.

The so-called “Townsend Plan,” called for the a monthly pension of $200 for everyone over 60. And the radio priest, Father Coughlin, was as popular and as vitriolic then as the Becks, Limbaughs, O’Reilly et al are today.

Woolner writes that Roosevelt took on the League, using his friends in the press to expose its ties to the business elite and the U.S. Chamber of Commerce, one of

Obama’s arch critics today. And Roosevelt, from one of America’s most aristocratic families, never hid his disdain for the corporate captains, whom he derided as “economic royalists.”

He told the Democratic convention that nominated him in 1936, what had been on his mind:

“These economic royalists complain that we seek to overthrow the institutions of America. What they really complain of is that we seek to take away their power. Our allegiance to American institutions requires the overthrow of this kind of power. In vain they seek to hide behind the flag and the Constitution.

“In their blindness they forget what the flag and the Constitution stand for. Now, as always, they stand for democracy, not tyranny; for freedom, not subjection; and against a dictatorship by mob rule and the over-privileged alike.”

The Tea Party, Woolner writes,

“shares many of the same tenets and clearly emerged from the same forces and fears that gave rise to the American Liberty League in 1934...To date President Obama has chosen not to take on the Tea Party with anything like the same rhetorical conviction, preferring to take a more reasoned as opposed to emotional approach to a remarkably similar anti-government backlash in a time of crisis.”

Americans love a good fighter. In November 1934, against the odds and history, Roosevelt’s Democrats picked up nine House and nine Senate seats. In 1936, Roosevelt embarrassed the pollsters with a then unprecedented landslide over the Republican darling of big business, Kansas Governor Alf Landon.

Write saulfriedman@comcast.net


GRAY MATTERS: New Ideas For Social Security

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Here’s a novel idea. Instead of worrying that Social Security will go bust in 30 years (it won’t) and considering absurd and unnecessary cuts in benefits for millions of Americans, why not expand this, the most popular social insurance program in the country, to provide for a universal defined benefit pension for every worker and his/her family?

It’s really not such a unique idea; most modern and civilized industrial nations have in place such pension systems, although some are not as generous as Social Security. But while Social Security was designed to replace about 40 percent of a person’s final wages, and does a good job keeping most of us out of the poor house, it has some glaring weaknesses that could be addressed by expanding the program.

Social Security (average benefit, $15,588 for men; $12,012 for women) alone is not enough to provide a stable, poverty-free retirement for many Americans – the very old, especially widows who have not worked, workers who are too young to retire but have been unable to find steady jobs with decent salaries, students whose families have lost their breadwinners, Hispanics and blacks who have made little money during their life times.

Time was that a factory or white collar worker could count on a defined benefit company pension. But they have disappeared in favor on individual retirement savings plans like 401(k)s which shifted most of the responsibility for savings and investment from the company to the worker.

And, as we shall see, those plans have proven to be a mirage; even before the market bust, their value was not nearly enough for even a couple of years of retirement.

A favorite of mine, economist Teresa Ghilarducci of the New School for Social Research, was the first to call the 401(k) a failure for retirees and she shocked lawmakers when she suggested they be ended in favor of what she calls a Guaranteed Retirement Account that would be as safe and secure as defined benefit pension plans. Today, two-thirds of the few unionized workers have such defined pensions compared to only 15 percent of non-union workers.

Even Time magazine joined her criticism of 401(k)s and their like, pointing out in October of last year “the ugly truth is that the 401(k) is a lousy idea, a financial flop, a rotten depository for our retirement reserves.”

About half of American workers have such plans and their average value is just $45,519 and, of course, dependent on the roller coaster of the market and subject to the fees charged by fund managers.

Journalist James Ridgeway summed up the retirement dilemma for millions of American families in a recent issue of Mother Jones:

“I contemplate my future at a time of deep recession with no pension and a depleted 401(k). And it occurs to me that the very notion of a comfortable, paid retirement may turn out to have been a temporary phenomenon, with a life span almost precisely as my own...

"And I have to wonder if someday the tale of a foolish generation of Americans, who imagined that a lifetime of work would be rewarded with a comfortable and secure old age, will become just another footnote in the annals of the market.”

If I may digress, there is (and was) a difference between what Ridgeway called his “foolish generation” and mine, which weathered a depression and a really big war and learned a few things. We were unionized, we fought and bargained for company pensions (and health care) and we were not so trusting of the free and unregulated market to see us through our old age.

Sure, we saved, but our savings were to be one of three tiers for retirement, along with the guaranteed company pension and Social Security. It’s also been likened to a three-legged stool.

Now, according to Richard Trumka, president of the AFL-CIO,

“[O]nly 13 percent of workers say they are very confident about having enough money for a comfortable retirement – that’s the lowest level in 16 years...With the enactment of Social Security and the growth of union-negotiated pensions, elderly Americans became [and are still] the least impoverished age group.”

But for a younger generation, Trumka said, two of the three tiers (legs) are disappearing and “Social Security is the ONLY reliable guaranteed benefit for the growing number of people without pensions.”

Just as my generation fought for Medicare and universal health care, Trumka concluded, “Universal retirement security is our next hurdle.” He could have added that it’s an idea whose time is coming.

In the meantime, the National Academy of Social Insurance has some ideas to close some holes in Social Security – increase benefits for persons 85 and over; pay a widowed spouse 75 percent of the couple’s prior benefits instead of 50 percent; provide child care as a benefit; update the special minimum benefit to 125 percent of poverty; pay benefits to students who have lost a breadwinner up to age 22 instead of 18-19; increase benefits across the board for all individuals in the next year or so, to make up for losses in savings.

Stephen Hill, reported on a study by the New America Foundation [pdf], which outlined how Social Security could double its revenue and spread its enhanced benefits further, freeing employers from providing retirement, which would eliminate the employer tax deductions, which cost the treasury billions.

Hill called it “Social Security Plus,” and suggested that greater benefits could not only help the economy but could eliminate the individual tax deductions which only benefit people who can afford 401(k)s and IRAs.

Ghilarducci makes the same point, that 401(k)s and IRAs, in which taxes on earnings are deferred, reduce tax receipts by $193 billion a year. But, she says, 80 percent of these tax breaks go to the top 20 percent of taxpayers.

Her solution: “Guaranteed Retirement Accounts” to which employers and employees would each be required to contribute 2.5 percent of salaries, with a $600 refundable tax credit for the employee’s contribution.

The accounts, which could not be touched until retirement, would be pooled and managed by professionals as private defined pensions are now managed, with a target of a three percent return above the rate of inflation.

“National savings would get a boost,” she wrote in Bloomberg Business Week last July. “All Americans, including the 64 million who have no pension plan, would get one at no extra cost.”

Hers was one of a number of proposals for guaranteed, government-sponsored annuities or pension plans offered in September at a conference on retirement security, sponsored in part by Retirement USA, a new coalition of unions, senior groups, the liberal Economic Policy Institute and the non-profit Pension Rights Center.

This month it is in the midst of a campaign called Wake Up Washington, opposing cuts in Social Security while seeking a universal retirement system for America to replace what it calls “the patchwork of private plans.”

Why do we need it? On September 16, the non-partisan Center for Retirement Research at Boston College told Retirement USA that the gap between all the assets American households have, including homes, IRAs, 401(k)s and other savings, and the amount they will need for a decent retirement is $6.6 trillion. The calculation was based on the Federal Reserve’s Survey of Consumer Finance.

I can’t begin to fathom such a number. But even this “foolish generation” must know that unless things change, their lifetime of work may not be rewarded with a comfortable and secure old age.

Write to saulfriedman@comcast.net


GRAY MATTERS: A 21st Century New Deal

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


I first met Marcy Kaptur in 1982 when she was a long-shot Democrat running for a House seat in northern Ohio. As I recall, my story bet that she would win. Now Kaptur, who is from Toledo, is the longest serving woman in the House and named by her colleagues as one of the most valuable. She is also tilting at another windmill.

Because she’s a quintessential liberal Democrat with a moderate touch (she’s opposed to abortion) and 26 years of successful politics, you’d think that President Obama, who just got finished campaigning in depressed Ohio, would pay attention to her. But she’s among the progressive Democrats cursed by Rahm Emanuel as “f***ing retarded” and ignored by the rest of the White House honchos because they challenged Obama’s vain reach for the center and the mirage of Republican support.

Kaptur, who has been a Democratic activist since age 14, has deep roots in blue-collar America, which is where this administration needs help. She is the daughter of Polish-American grocers and still lives in her family home.

As a member of the Budget Committee and House Oversight and Government Reform Committee, she helped lead the grilling of the financial geniuses including Treasury Secretary Tim Geithner, who helped topple the economy then rewarded the banks for their generosity.

She is also on the Defense Appropriations subcommittee. Among her accomplishments was the success of legislation, after a 17-year battle with too many bureaucracies, for the creation of the vast World War II memorial on the Washington Mall which she helped dedicate in 2004. The idea for the memorial, which is a top tourist attraction, came from a constituent, Roger Durbin, a letter carrier who wondered why there were Korean and Vietnam memorials but none for America’s greatest conflict.

A bit of a throwback to the New Deal, she has pressed the White House and Congress to resurrect the very effective Glass-Steagall Act, which separated commercial banking from investment banking. But it was repealed in 1999 by some of the same people who are now top White House economic advisers.

And, she says, the new financial services regulations they helped craft are so full of White House compromises, few Americans understand it. Although the bankers seem to like it.

Now, once again, Kaptur finds herself backing a legislative long shot that makes sense to many economists, but not the president’s economic advisers who are stuck fast in the mud of a jobless recession and have no ideas about how to escape.

She may be whistling in the dark, but she introduced last December, HR 4318, which would

“authorize the president to reestablish the Civilian Conservation Corps as a means of providing gainful employment to the unemployed and underemployed citizens...through the performance of useful public work...”

She calls it the “21st Century” version of the CCC, one of the New Deal’s most politically popular jobs programs.

One of Kaptur’s aides called my attention to her bill which echoes the legislation proposed by Franklin D. Roosevelt in his first month as president in March 1933. As the Great Depression wore on, the CCC put three million young men to work planting trees, improving the national parks, building state parks, erecting fire towers, improving roads and dams.

The CCC’ genius is that it concentrated on jobless young men, 18 to 16, thousands of whom wandered the land as hobos. And much of their modest earnings was sent home. Kaptur’s bill, of course, would include women and there are no age limitations.

With more than 15 million Americans, including more than 10 percent of Ohioans out of work, the legislation says it is designed

“to relieve the acute condition of widespread distress and unemployment existing in the U.S. and to provide for the restoration of depleted natural resources...and the advancement of an orderly program of useful public works.”

The work to be done includes forestation of public lands, the prevention of forest fires, floods and soil erosion, pest control, construction, maintenance and repair of roads and trails, overseen by the Interior Department.

President Obama’s first stimulus proposal, which was watered down, and another just announced is running into the Republican “no.” But although they were meant to create public works jobs, the money did not go directly to hire workers, but to cities, counties and contractors and have made scarcely a dent in the jobless rate.

The CCC, like the New Deal’s Works Progress Administration, would hire and pay workers directly for their work as employees of the federal government.

Kaptur’s legislation asks for $16 billion for each of the next four years to finance the CCC. In a letter appealing to colleagues to co-sponsor her legislation (so far seven house members have signed on), Kaptur suggested that the National Guard and other federal and state agencies could help manage the corps. “We again have the opportunity to make as grand a contribution as President Roosevelt,” she said.

There is little doubt Republicans will resist the legislation but Obama could, like Roosevelt, put his power behind it, using labor unions and progressive groups to embarrass Republicans who claim they want to see progress on job creation. But I doubt the White House knows about the legislation or cares.

Obama claims he admires the New Deal, but so far he has not come close to employing its solutions despite appeals from the best economic minds in the country – including Nobelists Joseph Stiglitz and Paul Krugman.

In a New York Times Op-Ed entitled, How To End The Great Recession, former Labor Secretary Robert Reich noted that

“the Great Depression and its aftermath demonstrate that there is only one way back to full recovery – through more widely shared prosperity...New Deal measures, Social Security..unemployment insurance...the minimum wage...the GI Bill...created rapid growth and more jobs.”

Even more conservative economists have called for New Deal style job creation measures. But if Obama, mired in conventional, no-win proposals, does not respond, it would not be the first time Kaptur has been disappointed in her president. In an interview with Guernica Magazine, she blasted Obama’s economic advisers, specifically Lawrence Summers, who helped kill Glass-Steagall, and Geithner:

“Anyone who’s had their fingers on any of the financial damage that’s been done should not be allowed to serve in the federal government...That revolving door should be slammed shut How can you have the architects of the disaster in charge of the remediation?”

Asked about Obama’s record on the economy, she said,

“It’s not GDP, it’s JOB. That means we need jobs. “ She was asked, “What grade you would give him?” She replied, “The largest room is room for improvement. In my region, he wouldn’t be passing. He’s got the wrong economic advisers. But they seem to take care of Wall Street just fine.”

Perhaps that’s why he’s facing midterm losses; Roosevelt gained House and Senate seats in 1934.

Write to saulfriedman@comcast.net


GRAY MATTERS: How Socialism Really Works

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


There is at least one organization that won’t label President Obama a “marxist” or “socialist,” and it ought to know. I speak of the Democratic Socialists of America, a tiny group of less than 6,000 members that is rather benign and wholly within the American mainstream compared, say, to the extreme radicalism of the raucous anti-government Tea Parties.

The DSA was founded in 1982 by the late Michael Harrington who won fame in the Sixties for his book The Other America,” a passionate expose of rural and urban poverty that shocked the nation and brought about Lyndon Johnson’s war on poverty.

Harrington’s DSA co-founder was Barbara Ehrenreich, a prolific journalist whose books, Nickeled and Dimed and Bait And Switch, chronicled the business practices that have victimized low-paid workers and consumers. Unlike the far right Republicans and Tea Baggers, Harrington and Ehrenreich were (and are) people of talent and accomplishment and, as far as I know, they have not sought the overthrow of the government or the destruction of a president.

In fact, if you visit their web site, you will see how close to the American ideals these socialists are. They call themselves the Democratic Left and they have nothing in common with the centralized communist regimes of the former Soviet Union, Eastern Europe, North Korea and China.

It is true that Harrington embraced the theories of Karl Marx who held that unfettered capitalism would fail because the rich would get richer and the rest would be exploited by corporate excess. But those were also the views of Adam Smith and John Maynard Keynes, both of whom were in favor of government intervention to tame capitalism.

True to our Democratic values, the DSA does not call not for government ownership of private business, but for tempering the excesses of the unregulated, free-wheeling market economies with Social Democratic reforms such as health care, social insurance and public education like those in most of Europe, Japan and other enlightened countries.

As the DSA web site says,

“In the short term we can’t eliminate private corporations, but we can bring them under greater democratic control. The government could use regulations and tax incentives to encourage companies to act in the public interest and outlaw destructive activities such as exporting jobs to low-wage countries and our environment.”

These could have been the goals of Republican presidents like Teddy Roosevelt, creator of our national parks, trust buster William Howard Taft, Dwight Eisenhower, who sponsored the Interstate Highway system, or Democrats like Harry Truman who confronted Soviet communism, or John Kennedy, who championed civil rights.

Only the very far right, which is what Republicans have become, could disagree with those sentiments. But they seem so ignorant of the consequences of their hard shell, laissez faire views that they would destroy in government what is in their own best interests. Their targets include Social Security, Medicare, Medicaid, the Department of Education, public education itself (Thomas Jefferson’s idea), the civil rights laws, the Elementary and Secondary Education Act.

What’s next? The VA medical system? The Tennessee Valley Authority? Government owned military hospitals? The Post Office? Public highways? Public utilities? Surely many tea baggers use these services. Were millions of us un-American when we used the GI Bill?

My quarrel is not with these know-nothings who pop up now and again in American politics; they won’t succeed. My aim is to give lie to their fears and fear mongering of Democratic-based socialism. That happens to be as American as the pioneers who came west in communal wagon trains or the railroads, built with the help of government on public lands.

Even at its birth and in war, the government acts of 1787 and 1862, which opened the northwest territories, created land grant colleges and enabled farmers to stake their 40 acres. Jefferson’s Louisiana purchase was not specifically permitted by the Constitution, nor was the purchase of Alaska in 1867. Should we give them back?

When I wrote a few weeks ago that the VA health system, among other American enterprises, was socialist, most of my replies via the internet were positive and supportive. Many Americans, if truth be told to them, would welcome some democratic socialism - in health care and other public services like good roads and strong bridges and street lights, which are disappearing.

One of my readers, unsigned, wrote,

“The only thing better than Medicare or the VA is having both...I was on my way to the Minneapolis VA hospital for a 2PM MRI on a Sunday...when I had chest pains and shortness of breath. So I went to the VA emergency room...I had three doctors, three nurses and three technicians treat me before sending me on to my MRI (where the technician waited for me until 4PM.) Anyone who claims the government can’t do health care should walk a mile in my orthopaedic shoes.”

On the other hand, Marcelo M. writes,

“If anything, the VA system is the poster child as to why we shouldn’t have socialized Medicine...Mandates that require you buy health care violates the Constitution...”

(That is questionable, but the issue is before the courts.)

And Jerry L. says “medical care can’t be a free lunch,” and he suggests competition could hold down costs if patients and insurance companies can choose among doctors and hospitals.

But “kerewin21" asks,

“How does the VA system violate the Constitution? And he adds, “It’s really hard to make medicine into a truly competitive marketplace...Do you choose the doctor who costs half as much for your knee surgery? Do you call around to emergency rooms to find out who charges the least for a CT-scan?”

Americans who have not traveled abroad tend to belittle the experiences of Europeans like David Jordan, who is a British PhD, in geophysics and leader of a university research team. He was in business for many years and now lives in Germany’s social democracy.

“Politically,” he writes, “I’m a caring capitalist but my only affiliation is to Whatever Works. Ideologies give me the creeps.”

He’s a fan of Britain’s National Health Service even though the waiting room at a doctor’s office may include unwashed working stiffs. But he praised his emergency room treatment of a bad chest infection, and the NHS was there to help his wife give birth at home (his choice) to two children. “For free,” Jordan said. “It was wonderful. Can’t do that in the U.S....Isn’t socialism a bitch?”

The Nation’s Katha Pollitt, back in New York after a year in Germany, observed in a September 2 essay entitled, It’s Better Over There, that

“not once in my time in Berlin, which is a relatively poor city,” did she see “the kind of destitution we take for granted in the United States...The strong German safety net keeps people from plunging into the abyss.”

She cited a new book by Chicago labor lawyer and writer, Tom Geoghegan, Were You Born on the Wrong Continent?.

As Pollitt writes, Geoghegan contrasts the Western European social democracies with laissez faire America which victimizes not only the poor, but the middle class, which has meager economic protection compared to their counterparts in Europe. He argues,

“contrary to U.S. popular opinion, life is better for almost everyone in a social democratic system like those in Western Europe, especially Germany. ”Even with high taxes that support the system and its benefits for workers, the unemployed, students and new mothers, Germany’s economy is in better shape than ours.”

Also missing in Europe’s social democracies is the kind of irrational hostility towards government that has led Republicans to advocate deep cuts in taxes and government services. There are consequences: In wealthy San Diego, a two-year-old boy, Bentley Do, choked to death on a gum ball last July when help was delayed for a precious nine minutes because budget cuts had closed the nearest firehouse.

The next day, Bentley’s Vietnamese mother, six months pregnant, was sworn in as a U.S. citizen and collapsed from exhaustion and grief. I saw mention of the tragedy only in the New York Times, which reported that San Diego is still reluctant to consider a tax increase to restore public services.

Write to saulfriedman@comcast.net


GRAY MATTERS: Wiggling Out of Health Care Reform

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


Surprise! Surprise! The nation’s health insurance companies, while paying their executives handsomely, are trying every trick in their lobbyists’ books to wiggle out of some of the most important cost-savings and patient care provisions of the health care reforms.

One obvious reason can be found in the compensation paid in the last year to the CEOs of some of the top insurance companies as reported by Modern Health Care:

• Stephen Hemsley, UnitedHealth Group, $106.6 million

• H. Edward Hanway, Cigna, a retirement package worth $110.9 million

• His successor, David Cordani, $26 million for his first year

• Michael McCallister, Humana, $14 million

• Ronald Williams, Aetna, $13.6 million

• Allen Wise, Coventry, $10.2 million

• Angela Braly, Wellpoint, $10.1 million

All have sought steep increases in their premiums while enjoying healthier profits thanks to the health reforms which, among other things, requires that people obtain health insurance much of which will be subsidized by government.

Aside from satisfying our prurient interest about these outrageous salaries, there is a reason these compensation amounts are important; they may be counted as contributing to the quality of care, which helps the companies make a mockery of the new health reforms and the amount and quality of patient care they are supposed to deliver.

Their multi-million dollar salaries, bonuses, retirement packages and stock option dollars, in other words, come out of the premium money a large portion of which they are supposed to devote to patient care.

But here’s the ultimate in chutzpah: A spokesman for Wellpoint told the Los Angeles Times that the compensation reflects their effort to improve care and hit corporate goals, including profits. Yet the record of the insurance companies reflects their chiseling on patient care, not only through premium increases, but by arbitrarily droppng or refusing coverage for potentially expensive patients - a practice that eventually is supposed to be banned.

At issue are the requirements of Section 2718 of the Patient Protection and Affordable Care Act - that is, smaller insurance companies must spend 80 percent of the premiums on patient care; the larger companies, like those cited above, must spend 85 percent.

This is known as the Medical Loss Ratio (MLR). Some advocates say that a 15 to 20 percent margin is too generous, especially given the salaries of company executives. Yet the companies are trying to chip away at the MLR requirement, deducting more and more from the 80-85 percent, by labeling even more than the salaries as “medical expenses.”

The battle by the insurance companies over Section 2718 and the MLR took place recently at a meeting of the National Association of Insurance Commissioners, which has been charged by the law with reviewing and developing regulations that will be proposed by Kathleen Sibelius, the Secretary of Health and Human Services, who is supposed to oversee the implementation of the law.

Senator Jay Rockefeller, D-WV, who helped write the MLR into the law, said,

“I hope as the NAIC continues to meet...they will remember that the purpose of this law was to make sure Americans’ health insurance premiums are spent on actual care – not obscene CEO salaries and industry profits.”

Some of the best work monitoring the NAIC proceedings in Seattle was done by Ellen R. Shaffer, co-director of the California based EQUAL Health Network. In August she told Sibelius, in a detailed letter, that

“we are concerned that the standards” under consideration by the NAIC “include an edit that would allow the insurance industry to count marketing campaigns...in conjunction with state and local public health departments [including sales and brokers’ commission] as medical expenses.”

Thus, a company’s self-serving publicity advertising for “health awareness” campaigns would count as “activities that improve health care quality,” she wrote, “rather than the administrative expenses they are.

“The insurance industry has stated its intention to game the system by raising premiums to make up for any constraints imposed by the new law,” she added. And she noted that Rockefeller’ Senate Commerce Committee had “documented that Wellpoint has already ‘reclassified’ more than $500 million dollars of administrative expenses as medical expenses.”

The health reforms give the insurance companies exemptions for certain insurance company taxes in calculating the MLR, which lowers their income. But Shaffer asked the NAIC and Sibelius to “discourage efforts by insurance companies to create and benefit from insubstantial programs that masquerade as clinical treatments.”

Judy Dugan, of Consumer Watchdog, reported from the NAIC meeting that despite the intent of Congress to limit the taxes the insurance companies may claim as part of patient care, lobbyists and lawyers argued to allow industry to deduct “every tax on every part of their business when they’re calculating how much they spend on actual health care.”

The companies even argued to deduct taxes on investments from their premium revenues.

The NAIC came to a unanimous agreement, which some advocates hailed as a victory for consumers. But Don McCanne, of Physicians for a National health Program said,

“We are still stuck with a middleman industry that has been granted the right to keep 15 to 20 percent of our premium dollars to use for their own purpose.”

Now, we await Sibelius and the regulations and more lobbying from the insurance companies, which, according to Bloomberg News, are shifting their financial support to help Republicans who voted against the reforms.

In the meantime, there’s some good news from the health care reforms – “Promoting Prevention Through the Affordable Care Act” – which is the subject of a paper written for a recent issue of The New England Journal of Medicine by Sibelius and public health physician Dr. Howard K. Koh, assistant secretary for health. I know, everyone talks about prevention, but few have taken it seriously, until now.

As the paper says,

“The Act provides individuals with improved access to prevention services...For example new private health plans and insurance policies beginning on or after September 23, are required to cover a range of recommended prevention services at no cost.”

These may include vaccinations, screening for colon, breast and cervical cancer and for men, prostate cancer. These are the same prevention services available to Medicare beneficiaries, except as of January 1, there will be no cost for Medicare patients and for the privately insured.

As you may have read, the new health care reforms include, as of September 23, coverage with no cost sharing of tobacco-use counseling and evidence-based tobacco-cessation interventions as well as risk, alcohol-misuse counseling, depression screening and immunizations, along with obesity screening for adults and children.

In 2014, states will be forbidden from excusing from Medicaid coverage, drugs to help people quit smoking.

Alas, 45 million Americans still smoke, including 5.5 million on Medicare. They are high risk for the lung cancer that is killing a good friend. She quit, but too late.

For more information on preventive health and the Affordable Care Act, see the Health and Policy Reform section of The New England Journal of Medicine.

Write to saulfriedman@comcast.net


GRAY MATTERS: Of Death Panels and Palliative Care

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.


I assume you recall the summer of the “death panels.” That was last year when a few right-wing demagogues led by Sara Palin (who else?) warned that the health care reforms under debate would lead to deaths of patients whom doctors considered too old or ill to treat. Now we know they probably helped hasten the deaths of the desperately ill.

Here’s the background. In August, 2009, with the help of unthinking journalism and, naturally, the Fox loudmouths, Glenn Beck and Rush Limbaugh, the phrase “death panels” set off a fury of raucous town meetings with organized right-wing plants stirring up the mob, bringing confused innocents along with them on a tide of anger.

Few would listen to or even allow speakers, members of Congress, to explain the issue and call the lies for what they were. Even veteran Senator Charles Grassley, R-Iowa, who helped write the reform bill (he voted against), told a crowd that there was a genuine fear that “Granny” would die at the hands of a death panel. He regretted that stupidity, but the damage was done.

The section of the reform legislation that caused the furor, which was introduced by a Republican, was optional and totally benign. It merely authorized Medicare (and insurance companies) to pay physicians for their services if, during a period of five years, they are asked to and provide counsel to patients on alternatives to treatment, including hospice or palliative care.

Republicans and assorted right-wingers who did not support any health care reform cried “euthanasia.”

Cowed and frightened by the furor, President Obama and Democratic sponsors of the health reforms deleted the section. There have been sad consequences. Those fear mongers who raised the false alarm of “death panels” may have been responsible for the early deaths of terminally ill patients, who could have lived longer and more comfortably, free of pain, with hospice or palliative care.

That is one of the conclusions of a study in the August 18 New England Journal of Medicine on the value of palliative care for terminally ill patients. As The New York Times reported,

“[D]octors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier and in less pain as the end neared – but they lived nearly three months longer...The findings...confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.”

Palliative care, which is optional for the patient, means forgoing curative treatment such as surgery, radiation or chemotherapy any of which may be more painful or debilitating than the disease.

A physician, whose office visits, exams and treatments are partly covered by Medicare, may also advise a patient (for no extra fee) on the possibility of palliative care. If the doctor states that the patient has less than six months to live, the palliative care (which may include pain-killing drugs, physical examinations, and even chemotherapy that is not meant to cure) is usually provided by a hospice organization whose services are fully covered by Medicare.

And, as I’ve written, hospice care won’t end if the patient lives beyond those six months. It’s called “open access.”

Indeed (a personal acknowledgment), I have been on ‘open access” palliative care, with the help of the Hospice of the Chesapeake, for more than six months because the cancer I’m fighting seems not to be growing. I live with uncertainty, but I have the comfort of knowing the hospice professionals are there to help if things change.

Dr. Diane E. Meier, director of Mount Sinai School of Medicine’s Center to Advance Palliative Care told the Times, the study

“...shows that palliative care is the opposite of all that rhetoric about ‘death panels.’ It’s not about killing Granny; it’s about keeping Granny alive as long as possible – with the best quality of life.”

Dr. Atul Gawande, a Harvard Medical School surgeon who has written long articles on medical care for the New Yorker, called the results of the study “amazing.” His latest article, Letting Go – What Should Medicine Do When it Can’t Save Your Life, recounts the long suffering of patients who chose to fight cancer with radiation, surgery or poisonous chemotherapy before their deaths.

As the Times reported, while the study could not determine why the patients lived longer, experts pointed out that depression and constant pain deprived patients of sleep, and chemotherapy means th loss of appetite, nausea, hair loss and other debilitating side effects.

Dr. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine, told the Times that the study was the

“...first concrete evidence of what a lot of us have seen in our practices – when you control pain and other symptoms, people not only feel better, they live longer.”

Of course, depending on the diagnosis and prognosis, some people opt for any treatment no matter how painful to fight their disease. But there is no way of knowing how many people have been denied access to hospice and the comforts of palliative care for their terminal or extended illness, which may not be cancer. And there is no way of knowing how many people were denied a longer, better quality of life.

But my hospice social worker pointed out that many doctors are more inclined to treat illnesses and try for a cure than suggesting palliative care. That’s part of their training. End-of-life counseling and palliative care are fairly new developments in dealing with illness.

If my case is an indication of the process, my oncologist did not know how my cancer was progressing, but he told me that some chemotherapy could not cure it or get rid of it, but may curb its growth. That meant palliative, non-curative care. I could have opted for more aggressive treatment. But I was admitted to hospice, which has cared for me ever since, sparing me from having to go to emergency rooms for small problems. As luck would have it, something, perhaps the chemo, stopped the progress of the cancer – for now.

I’m not accusing doctors of being greedy but under our system, the vast medical industrial establishment of physicians, specialists, hospitals and labs get paid more by Medicare and insurance companies for the expensive efforts to cure, which may include CT scans, MRIs, blood tests, radiation, chemotherapy and surgery. And they have great investments in buildings and technology to pay for.

In addition, there is a natural conflict between palliative care specialists and oncologists and surgeons who are battling cancer and see palliative care as “giving up.”

Because of the “death panels” furor, doctors won’t get paid (the fees would have been relatively small) to counsel on end-of-life decisions for Medicare patients. But with that section no longer part of the health reforms, privately insured patients in their fifties who have spreading cancers or other terminal illnesses will have difficulty getting covered for getting access to information about palliative care and hospice unless the physician volunteers it.

A note to Sarah Palin, et al: your death panels rants have probably denied at least some Grannies of a longer, more comfortable life.

Write saulfriedman@comcast.net