Reality Bytes

In discussing economic recovery from the Great Depression, Franklin D. Roosevelt made the following statements to Congress: ".. in addition to these immediate tasks of relief and of recovery we have properly, necessarily and with over-whelming approval determined to safeguard these tasks by rebuilding many of the structures of our economic life and reorganizing it in order to prevent a recurrence of collapse." 
     Currently, the Dodd-Frank Wall Street Reform and Consumer Protection Act, signed into law by President Obama a little more than three years ago has yet to be implemented. Regulators now claim the provisions of Dodd-Frank will be implemented, beginning this month.

"We can never insure one-hundred percent of the population against one-hundred percent of the hazards and vicissitudes of life. But we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-ridden old age. This law, too, represents a cornerstone in a structure which is being built, but is by no means complete.... It is...a law that will take care of human needs and at the same time provide for the United States an economic structure of vastly greater soundness." -- Franklin D. Roosevelt, August 14, 1935

     Today we are in the grips of an argument over Social Security we should have retired months ago. President Obama proposes the government tie Security benefits to the Chained Consumer Price Index. According to Mr. Obama this is a technical matter. First, he argues, the proposed change will not cause benefits to be cut; it is a merely a slowdown in the rate of benefit increases. The problem is Cost of Living Adjustments are not benefit increases; they prevent benefit decreases over time, due to inflation. We call this payment reduction. 

     Second Mr. Obama contends the change will not result in higher taxes. The fact is, the current formula is designed to avoid bumping taxpayers into higher income brackets, while they are not earning more in actual dollars (i.e., post-inflation income.) Under President Obama's proposal, the CPI will land taxpayers in higher brackets more quickly. People will pay more taxes, although they actually are not making more actual money. We call this a rise in taxes.

  With regard to the federal deficit, Obama's budget proposal will not pass. Republicans will not close tax loopholes, nor will they eliminate deductions for the nation's top earners. Is this a presidential gambit? Or is the President, as he contends, trying anything and everything to get to a compromise with Republicans? One thing is certain, if the budget does not pass, we'll hear nothing more of the CPI. The GOP will be the obstructive ones, because, after all, Mr. Obama is bucking his own party, to try to accommodate some of their demands. 

     Someone once said, "Comparisons are odious." Roosevelt declared, "Among our objectives I place the security of the men, women and children of the Nation first." I'll let you draw your own conclusions about the genuine and the disingenuous.

The Pinnacle of Abuse

 

   What, to your way of thinking would be the height of abuse in a prison setting, or in a case of assault? Unquestionably it would be the use of drugs to subdue an unwitting victim, particularly, if death ensued. Nonetheless elder abuse and the abuse of younger, disabled people by prescription is not a possibility in this country. It is commonplace. If you are, as I was, under the impression Medicare is a gatekeeper, it is not. Think about the implications; we are left to our own devices.

The physicians of one class feel the patients and go away, merely prescribing medicine. As they leave the room they simply ask the patient to take the medicine. They are the poorest class of physicians. Ramakrishna

     Medicare does amass data regarding the kinds and numbers of medications physicians prescribe. However, even if it monitored providers, it does not regulate them. All the more reason why patients, families and caregivers should be informed regarding all medications (interaction with other medications and with supplements, allergic reactions, side effects, appropriateness, potential for abuse.) For more information and updates, regarding risky drugs for elderly patients, The American Geriatrics Society Beers pocket guide is a vital tool. It is a pocket reference, easy to download and print: 

http://www.americangeriatrics.org/files/documents/beers/PrintableBeersPocketCard.pdf

        Following years of investigation, ProPublica filed a FOIA (Freedom of Information Act) request with Medicare, and eventually received its data. (The data contained no patient information, in the event you were wondering.) In addition to uncovering alarming facts and figures about over- and inappropriate prescribing, ProPublica put the Medicare prescriber data into a database. It is worthwhile, if only it equips you to frame the right questions. It is a powerful tool and a step in the right direction for everyone, including the medical community:

http://www.propublica.org/article/prescriber-checkup-faq

        Here's to greater transparency -- ProPublica advocates making Medicare and Medicaid provider prescription and diagnostic activity a matter of public record. 

     Meanwhile here's to us, to arming ourselves with knowledge, participating in our care and in the care of those we love.

  

Feeding The Vulnerable

Where is our Summer going so quickly, and what will Fall bring? One thing we know it may bring is decreased levels of food security for millions of Americans. The USDA's Supplemental Nutrition Assistance Program (SNAP) benefit levels have been in place, since the passage of the ARRA in 2009. Let's be clear; the current eligibility and benefit levels were originally scheduled to phase out, as the economy recovers. Nonetheless the program was and has remained inadequate to meet the needs of the nation's poor. Benefit levels will be cut back in November 2013, because SNAP was stripped from the recent Farm Bill, which passed the House of Representatives last week. We can already anticipate the contentious process of a bitterly divided Congress drafting and enacting separate food assistance legislation.  

"The big majority of Americans, who are comparatively well-off, have developed an ability to have enclaves of people living in the greatest misery almost without noticing them."~ Gunnar Myrdal   

     Republicans will continue to allude to big government and excessive spending; the rhetoric has its own terminology. Just the term food insecurity has become the brunt of brutal humor! We are talking about hunger, malnutrition, dumpster-diving desperation, people! It translates to stunted physical and intellectual growth in children, disease at any age and premature death in the elderly. 

     The term entitlement comes with an onus that sticks like simple syrup to certain government programs. It does not matter whom these programs serve, the rationale behind the program or, for that matter, how efficiently the program runs. Contrary to the rhetoric surrounding so-called entitlement programs, over 90% of SNAP benefits go to disabled, elderly and working poor. Here are some facts from Feeding America:

1. Who receives assistance? To qualify for SNAP benefits, a household must have a gross income at or under 130% of the federal poverty guideline. 
2. How poor is poor? Slightly more than 80% of households currently receiving SNAP benefits are actually at or below 100% of the poverty line. That translates to an income of $19,530 for a family of three in 2013. These households receive a little over 90% of all SNAP benefits awarded. 
3. How much lower does it go? More than half the households receiving SNAP benefits have gross incomes at or below 75% of the poverty line, or $14,648 for a family of 3 in 2013. 
4. What is the financial picture for an average SNAP household? It is a gross income of $744 monthly; a net income after the standard deduction of $338 per month. This does not take into consideration deductions for child care, medical expenses, cost of shelter and "countable" resources. Anyone who has applied for nutritional assistance knows that a vehicle, insurance policy, bank account , or other common asset, will count against their household, in determining benefit level. 
5. What happens, when earnings return or increase? Flexibility is inherent in SNAP; a certain percentage of households recover financial stability; once that occurs, benefits stop and/or are recovered. 
6. How will the cutbacks affect the average SNAP household? A household of three will experience a reduction of $240 to $300 annually, in lost food assistance. Keep in mind these households are currently hard-pressed.

     To dispel any doubts about program integrity, SNAP is well-run. A high percentage (approximately 92%) of tax dollars go to target recipients. In 2011 SNAP's error rate was 3.80%, an all-time low for the program and exceptionally low by comparison to other government programs. Food stamp trafficking, an ugly reality of the 90s, has dropped precipitously in recent years, because of aggressive enforcement by the USDA.  

      Last, but, by no means least, SNAP benefits represent a leg up, rather than a handout for unemployed or underemployed individuals. Recipients of SNAP benefits are truly in need:  90% of SNAP benefits have been expended by recipient households by the third week of each month. More than half of SNAP households will turn to food banks for assistance at least six months of any given year. An average SNAP household's benefit per person is a little more than $130, less than $1.50 per person per meal. Periodic reporting is required by law, and any significant increase in income or assets, as well as any significant decrease in expenditures, must be reported within a ten-day window. Benefits diminish or cease within weeks of any significant change.

   This is only part of a rather grim picture. A little more than half the Americans who are deemed 'food insecure' are eligible for SNAP; nearly one third are not income-eligible for any federal food assistance. 

    In short it is the most vulnerable Americans, the disabled, including veterans, the very young and the elderly, who are most at risk here. Working poor, unemployed, single parent families will see grocery prices continue to rise, while SNAP benefits shrink or disappear. I've wondered aloud, and continue to wonder aloud, where is the outrage?