Category Archives: Uncategorized

U.S. Must Cut $10 Trillion in 10 Years Or Taxes Will Skyrocket

This week’s debt ceiling deal seems not to have satisfied anyone on either side of the political spectrum. For the Tea Party and fiscal conservatives, the deal to cut $2.4 trillion in spending over the next 10 years does not go far enough. For liberals, the deal calls for too many spending cuts, especially to Medicare, without raising revenues, that is to say taxes.

John Mauldin, president of Millennium Wave Advisors and author of Endgame: The End of the Debt Supercycle and How It Changes Everything, says we need a combination for both. He’s calling for greater debt reduction through spending cuts and tax hikes, not an easy position for the Republicans to take. Here’s the “Must See” video interview with John Mauldin…

Medicare Cuts On The Table, or Off?

Lawmakers are eying possible changes in Medicare supplemental plans – moves that could increase seniors’ out-of-pocket costs.

Traditional Medicare, the federal health program for the elderly and disabled, requires beneficiaries to pay hospital deductibles and a portion of the cost of tests and doctor visits. To protect themselves from those out-of-pocket costs, about 17 percent of beneficiaries buy Medigap plans. Another 34 percent get such coverage through a former employer.

But some health policy experts say such “first-dollar protection” drives up demand for Medicare services, costing the government money for what may be unnecessary care. One proposal would bar supplemental insurance from completely eliminating out-of-pocket costs – or charge enrollees a $530 a year extra if they want to keep such protection. That change could save up to $53 billion over 10 years, according to a chart used during the bipartisan talks led by Vice President Joe Biden. See the full story here…

Boomers Worry Over Health Costs Founded

According to the Associated Press-LifeGoesStrong.com poll, 43 percent of boomers polled said they were “very” or “extremely” worried about being able to pay for their medical costs, including long-term care. Almost the same number, 41 percent, said losing their financial independence was a big concern.

One significant cost facing new retirees is health care. A study by Fidelity Investments estimated that a 65-year-old couple retiring this year with Medicare coverage would need $230,000, on average, to cover medical expenses in retirement. The estimate factors in the federal program’s premiums, co-payments and deductibles, as well as out-of-pocket prescription costs. 

The projection does not factor in long-term care, such as the cost of living in a nursing home — something most boomers in the Associated Press-LifeGoesStrong.com poll haven’t planned for yet. See the full story here…

The Debt Ceiling Deal At-A-Glance

Here is an analysis of the bill that became law this past Tuesday is by two of the top Elderlaw Attorneys in the country, Brian Lindberg and Fay Gordon, who conduct research on behalf of the National Association of Elderlaw Attorneys (NAELA):

The Basics: A two installment agreement with a down payment, congressional committee and a sequester:

The parties agreed to a two part installment of debt ceiling increases and spending reductions, totaling approximately $2.4 trillion in spending cuts over ten years. 

In the first installment, Congress will immediately vote to increase the debt by $900 billion.  The debt ceiling increase is accompanied by an immediate, ten year cap on discretionary spending, generating $1 trillion in savings. 

In the second installment, a bipartisan, bicameral committee (Joint Committee) is created to find cuts that match the next increase to the debt limit.  This second increase of $1.2 trillion to $1.5 trillion is also subject to a vote of disapproval from Congress, which the president can veto.  As a critical incentive, or threat, to urge the committee to create a plan, if the committee does not agree to a plan for long-term deficit reduction, then Congress will enact a trigger to automatically reduce entitlement and discretionary spending.

 Specifics: First installment-the down payment:

            In the first installment of the debt-ceiling plan, Congress and the president will agree to increase the debt limit by $900 billion.  At the same time, Congress will realize equal savings by capping discretionary spending for the next ten years. The savings in this down payment is balanced between defense and non-defense discretionary spending, with each facing 50 percent of the cut.  Specifically, this is about $350 billion in reductions to defense spending, and about $400 billion in reductions to non-defense spending over the next ten years.  According to a briefing sheet from the White House, this will reduce discretionary spending levels to their lowest levels since President Dwight Eisenhower.

            Interestingly, although the discretionary spending cap is a concern, the cap will lead to a higher overall discretionary spending limit for fiscal year 2012 (FY 2012) than was approved in the House budget (also known at the Ryan budget).  Under the agreement, discretionary spending will be capped at $1.04 trillion for FY 2012, which means funding levels will be $24 billion more than was approved in the House budget.

Of comfort to aging advocates is the “firewall” that is enacted for discretionary spending.  With a firewall, any reductions in spending must be balanced between defense and non-defense discretionary spending, meaning, aging and poverty programs cannot be reduced to shoulder increased defense spending.

 The Bipartisan Committee: Second installment

            In addition to the immediate $900 billion debt ceiling increase and ten-year discretionary spending cap, the agreement authorizes President Obama to increase the debt limit once more before 2013.  However, the president can only enact a second increase if one of two events occur: 1) Congress approves a balanced budget amendment, or 2) a bicameral, bipartisan Congressional committee approves a federal savings plan in an amount greater than the debt-ceiling increase.

            The second installment is certainly thornier than the first, and it lends itself to different interpretations.  It is likely that Congress will not approve a balanced budget amendment when they vote on it later this year.  When it fails, a bipartisan, bicameral committee (the Joint Committee) will be tasked with creating a plan for federal savings by November 23, 2011, for a vote in Congress before December 23, 2011.  According to the White House, in order to avoid the recent failures of deficit reduction committees, the Joint Committee’s recommendations will be given fast-track privileges in the House and Senate, and will be assured of an up or down vote in both chambers.

            The Joint Committee is given few guidelines regarding requirements for deficit reduction.  Both discretionary and mandatory savings, meaning entitlements, can be included in the committee’s proposal for savings.  Also, according to the White House, President Obama will push the committee to include revenues and tax reform.  This counters a presentation from Speaker of the House John Boehner (R-OH) which says the committee is required to use current law as its baseline, effectively making it impossible for the committee to increase taxes. 

            History has demonstrated the difficulty of bipartisan committees in drafting a federal savings plan that can be translated into viable legislation.  Because of this, the proposal includes something that is referred to as a “sequester,” which is essentially an enforcement mechanism to encourage Congress to pass the Joint Committee’s plan.

 The enforcement mechanism: the sequester

            The inclusion of a sequester means that if the Joint Committee fails to meet the November 23 deadline for a deficit reduction plan, then automatic, across the board spending cuts will go into effect.  The idea behind a sequester is that it is so drastic, and such a threat to both parties, that the Joint Committee will be forced to enact a proposal that can pass in the House and Senate, and that the President will sign.  It is important to note that the sequester included in this proposal only enacts across the board spending cuts, but does not automatically raise taxes or increase revenues. 

            While the details on the sequester are sparse, there are a few guidelines.  First, the automatic, across the board cuts would not go into effect until July 1, 2013.  This is the same day that the Bush-era tax cuts will expire.  The sequester also has a firewall, meaning that all automatic spending reductions must be balanced between defense and non-defense spending.

            The most critical element of the sequester is what it includes and what it does not include.  Unlike the down payment in the first installment of the plan, the sequester is not limited to discretionary spending.  The sequester will automatically cut from discretionary and mandatory spending, which includes entitlements.  For this reason, the negotiators have set certain limitations and exemptions for sequester cuts.  First, several programs and populations are exempt from automatic cuts.  The exemptions include Social Security, Medicaid, veterans, military and civil pay.  Medicare is not exempt from cuts under a sequester, however, the agreement limits Medicare cuts to 2% and requires cuts come from providers and not beneficiaries.  In addition, under a sequester, defense spending would automatically be reduced by 8%, while non-defense spending would be cut by 4%.  This amounts to nearly $500 billion in automatic cuts to defense spending.  Advocates of this proposal believe that the sequester will be so damaging to each party that they will approve the Joint Committee’s plan.

From Bad To Worse: Senior Economic Insecurity On The Rise

Contrary to the popular belief that seniors have ample time and resources for a fulfilling retirement, objective measures show a dramatically different story. In fact, more that one of every three seniors (36 percent) is economically insecure today as measured by the Senior Financial Stability Index (see attached report). Combined with the 40 percent of senior households that are financially vulnerable three-quarters of all senior households find themselves in an economically precarious position with little or no buffer against financial ruin should they be faced with an unexpected illness or other traumatic life event.

Over Half of Alzheimer’s Cases May Be Preventable, Say Researchers

July 20, 2011 – Over half of all Alzheimer’s disease cases could potentially be prevented through lifestyle changes and treatment or prevention of chronic medical conditions, according to a study led by Deborah Barnes, PhD, a mental health researcher at the San Francisco VA Medical Center (SFVAMC). The research was presented yesterday at the Alzheimer’s Association International Conference 2011 (AAIC 2011) in Paris. The researchers reported the proportion of Alzheimer’s cases worldwide that are potentially attributable to each of the seven risk factors:    See the full report here:

Signs Of Normal Aging Or Dementia?

A FREE guide from Johns Hopkins specialists on how to recognize if symptoms are normal aging or something more worrisome.

A Quality of Life Perspective

 Nurses and Therapists Collaborate to Help Mrs. Wilson Manage Her Illnesses, Avoid Institutional Care and Live Independently at Home with Her Husband

The Patient: Grace Wilson (not her real name) is in her late 70s and lives in Washington’s Eighth Congressional District. She suffered from multiple medical complications, including encephalopathy (brain dysfunction) and diabetes. She was living with her husband in his 80s and his health wasn’t much better. She had been sent home by a skilled nursing facility and her doctor had referred her to Gentiva for home healthcare services.
 
Mrs. Wilson’s Challenges:
 
Evaluations of Mrs. Wilson by a Gentiva nurse and both occupational and physical therapists revealed the following:
 
Her diabetes was out of control and her medications were not properly managed.  
 
She was unsteady walking on all surfaces, used a broken walker and her risk of falling meant she wasn’t safe at home. She had to crawl in and out of the bathtub.
 
She didn’t appear to be able to perform activities of daily living. She wasn’t eating consistently and some of her food was spoiled, a condition neither she nor Mr. Wilson noticed.
 
Gentiva’s Solutions
 
Gentiva clinicians agreed to try more conservative treatment so that she could avoid institutional care and be allowed to age in place at home.
 
After a physical therapy assessment, Mrs. Wilson – with her doctor’s approval – was placed in Gentiva’s renowned Safe Strides balance dysfunction program.
 
Gentiva treated and educated her on the management of her diabetes and her medications, as well as her nutrition.
 
The Outcome
 
Because of Gentiva’s clinical teamwork, Mrs. Wilson responded remarkably well to her treatment and was able to remain secure, confident and independent, living with her husband in the home that they have shared for so many years. Through the treatment and education provided by Gentiva clinicians, she resumed the safe performance of her activities of daily living with real independence. She walks with a new walker and does so safely on all surfaces.
 
 Because of Gentiva, Mrs. Wilson was able to take control of her illnesses, improve her own health status and remain living in an environment less costly to Medicare than institutional care.
 
For additional information on this patient or other ways that home health is providing solutions for Medicare recipients, please contact Damien Weston, Vice President, Multi-Area Sales, Gentiva Health Services, Inc., damien.weston@gentiva.com, 253-395-0120.
 

Concerns About Costs Rise With Hospices’ Use

Over the 28 years that Medicare has reimbursed providers for hospice services, it has been praised for giving critical medical and emotional support to dying patients and their families. When properly used — that is, at the very end of life — hospice care also has saved the government money. Providing dying patients with palliative care in their own homes, or in a hospice facility or nursing home, is far less expensive than continuing to order up futile medical treatments, studies have shown.

This New York Times article touches on a key factor, length of hospice stays, that government officials are attempting to “get right” as more and more Medicare beneficiaries are tapping this alternative in an effort to keep family end-of-life costs down.

Financial Impact of Alzheimer’s

Disease experts testifying before the US House Committee on Foreign Affairs are warning that Alzheimers could cause a cash crunch on a global scale and must be considered a serious fiscal danger. With the disease costing 604 billion dollars worldwide, if Alzheimers were a country it would be the 18th largest economy based on GDP and is being called “the single most important health and social crises of the 21st century”.  So, imagine the impact on individual family “economies”, and the imperative for affected families to formulate their own action plans to stave off fiscal collapse. See the full story at: http://news.yahoo.com/alzheimers-may-cause-global-cash-crunch-experts-215237859.html