Boomers & Medicaid Expansion

ObamacareNow that the Affordable Care Act has been cleared constitutionally by the Supreme Court, it’s up to States individually to decide if they wish to use the monies set aside for expansion of their existing Medicaid programs, or some variation thereof (like subsidizing purchase of regular insurance), to cover low-income individuals who otherwise could not afford health coverage.  Currently, many State programs cover only children & folks on disability.

A number of States have accepted the money; a few States, my own included (Florida), have refused it.  To learn why, I wrote my legislators asking their reasons for turning away those dollars, in our case $51B over 10 years to cover the approximately 1.2M uninsured here; what follows are the reasons, similar to those heard around the nation by others who have refused to participate:

  • By refusing the money, it will go back into the general US treasury and help reduce the deficit (folks for the expansion claim the monies, taken from FL taxpayer dollars, will just be used by other States);
  • We don’t trust the Feds to live up to this stated commitment, so we’re afraid we’ll be on the hook for the expansion when they renege down the line;
  • Our current Medicaid system is terribly dysfunctional, so we don’t want to be forced to expand it.

Hmmmmm…..

Something just didn’t seem right to me, so I fact checked their reasoning; here’s what I discovered:

  • The way the law is written, the monies for it are in a separate fund (not the general treasury), coming from a combination of new taxes on wealthier Americans, fines from companies/individuals who don’t Obamacare factsadhere to it, and projected savings from folks no longer using uncompensated emergency room care, instead using the regular system (less costly) thus improving their health outcomes (also reducing costs); monies refused by States go back into this fund to be used for future health care, not into the general treasury to reduce the deficit nor to other States currently willing to accept these dollars;
  • Although the feds are notorious for their “unfunded mandates” (eg passing a law without dollars behind it for enforcement), the federal government has never stopped paying on its medical obligations (Medicare/Medicaid), nor anything for which funding has been allocated;
  • Many State Medicaid systems are in fact quite poorly run (and so underfunded that no decent doctors will participate) which is why alternatives like subsidizing the purchase of regular insurance is an option that can be permitted (the option forwarded by a FL legislator who believes in using the federal dollars – he’s Republican btw); no State is being compelled to simply expand their current faulty Medicaid system.

Knowing the facts is particularly germane to we Boomers, because many of us are without health insurance, not on disability, and quickly falling into (or already in) the category of adults who qualify for this expansion of State health benefits.  About 8.6 million of us in fact, who were found to be without health insurance according to a special 2009 report by Commonwealth Fund.  As a result of the Great Recession coupled with ever increasing health care costs, Boomers caught between drastically shrinking retirement accounts and high Boomer unemployment (with the lowest rate of re-employment) are the biggest casualties.

So, Boomers – a generation known for its high rates of diabetes, heart disease, and obesity – living in States refusing expansion of more affordable care to a larger number of their citizens, are the group to be hardest hit by such decisions.  Next are our many adult children who are unable to find work offering benefits, in a system that relies solely on such employer-based access for the most affordable coverage.

As you determine your position on this issue, may the facts be with you.

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How Boomers Will Choose a Retirement Locale: Weather? Taxes? Or One Other Key Factor…

retireesWhen our parents got down to choosing where to live out their years of retirement bliss, they based that decision, generally, on the following criteria:

  • warm climate
  • lower taxes (particularly for those in the Northeast)
  • affordable, senior-friendly communities
  • golf (or other favorite sport like boating)

Not in that order particularly; perhaps even equal in importance.

Then came Boomers’ turn to choose retirement Eden, and I predict – or hope, or both – we will include one key factor; for some of us, it may even trump one or two of the others on our list:

  • political & cultural climate

That portion of our youth, activism and strong political/social views, just might influence where we finally settle down to live out our last 30+ years.  After all, that’s almost 1/3 of our life, so we’re wanting more than early-bird specials and Jai-Alai.

As the country becomes ever more polarized (thanks to us…we started out polarized and remain so in our current dual roles as powerful voting block/generation in charge both legislatively & industrially), we will want to live in a place that shares our views governmentally & socially, from gun rights to health care.  Boomers who lean left politically will choose states like New Mexico and California. Boomers who lean right to far-right will love places like Arizona & Florida run by the Tea Party and the NRA, where their views are embraced by the populace and the leaders they choose.

The importance of these factors as we determine our retirement move is driven by the role cultural & political comfort plays for us (far more than it did for our parents): Culturally we care greatly about such things as quality elder care for our parents and then us, a supportive environment for mid-age & older workers/entrepreneurs as we pursue our “second act,” affordable health-care options (as we live longer and more active lives than our parents did), and 55+ communities’ emphasis on healthy lifestyles; politically we are not comfortable in a place where we would be surrounded & governed by those whose world view is the opposite of ours – and if we can’t move to a state that meets the criteria, we will at minimum find safe haven in a city/county that does.

So, states wanting to woo us, play this socio-political ace in your deck to attract our lucrative generation to your shores.

Boomers, pay close attention to this key ingredient when you make this very important decision.  I can tell you from personal experience; living in a state far removed from your cultural/political sensibilities is very painful indeed.

“Are We Better Off Now?” A Few Answers

I’d like to answer the question posed by the Republican candidate for President: “Are you better off today than you were four years ago?” in a way I keep hoping the Democratic candidate for President would respond but hasn’t; for a “real people/real lives” perspective:

  • Ask the spouses of military personnel brought home from Iraq – they will say “yes”…
  • Ask any GM or Chrysler employee, and the owners/employees of all the businesses fed by these companies – they will say “yes”… Continue reading

What I’ve Learned from My Cats

Here's one of them, Cat - yep, that's his name...

I have two of ’em – and they adopted me.  Both were abused, and then abandoned in my neighborhood, both decided on mine as their new home.  Obviously a good choice, because they’ve been living here for many years, now.

Both are now in fine health and living the good cat life: I am their concierge, feeder of exactly the right foods (or they shall not deign to eat it), back scratcher when they want attention & ignorer when they don’t, etc.

I’ve always been of the opinion that cats serve no useful purpose as companion animals – they don’t:

  • “come when you call” (although mine do sometimes…sort of…)
  • make you feel needed (more like tolerated when you do all of your cat-caring duties properly)
  • act like they care whether you live or die (see bullet #2)

But I have discovered something very important for our human well-being that I learned from them – just noticed it, actually.

When they are in their most relaxed state is when they groom themselves.  And then as a cyclic thing, grooming themselves perpetuates their state of relaxation.

With humans, one of the first outward signs of stress is letting go of our appearance – ignoring our “grooming”…

So, conversely, perhaps one of the best stress-reducers is grooming – whether going for the standard soak in a hot tub, or just taking some time to get (or give yourself) a manicure/pedicure, get your hair done, or taking some extra grooming steps at home as a treat.

Try it…and let me know how it works out!

Facts vs……Facts?

critical thinkingRecently, one column directly below the other in the Op Ed section of my newspaper, both about fixing Medicare, attempted to persuade us of each writer’s position on the issue…one from Right leaning David Brooks, the other from Ezra Klein who appears to be tilting more left-ish.  They did this by appealing to our Spock-selves, using the logic of statistics.

Mr. Brooks cited the following in his attempt to convince us that a system with greater government control by a team of experts is akin to a walk in Wonderland: “(existing competitive model)…costs are 41% below expectations”; Mr. Klein  tried to convince us that countries with greater government control have far better, and more cost-effective systems than do we, by citing the following statistic: “The Medicare Advantage (competitive model) program…ended up costing about 120% of what Medicare costs.”

Hmmmm… the competitive model costs us less, except when it’s costing us more.

This is the problem with statistics.  The numbers may be real, the science behind them solid, but you can easily find what you want to support your position, using numbers to tell a very different story about the same specific issue.

It is understandable, then, that folks with some willingness (and ability) to think critically, will rely only marginally on easily manipulated (or carefully chosen) numbers to make important decisions.

Instead, here is my recommended recipe for deciding the best course of action: start with your fact-based numbers – fine (I am a particular fan of cost/benefit analyses) – but then add a big dollop of common sense, a generous sprinkle of compassion, add plenty of historic track record, throw in a dash of learning from others (mistakes and successes), and season with what is best for the common good (my fellow Boomers, “keep your hands off my Medicare” is a fine example of thinking “me” vs. common good).

Crucial decisions on how to fix seriously dysfunctional systems without doing more harm in the process, like reducing our national debt while maintaining a decent quality of life for all Americans, depend on this balanced approach.