Wednesday, May 11, 2011

Nursing Homes: They Don't Have To Take You In

The Times this morning reviews that talk about cutting Medicaid will affect more people than those parasitic poor brown folk: many nursing home patients depend on it:

The House plan would turn Medicaid, which provides health coverage for the poor through a combination of federal and state money, into a block grant program for states. The federal government would give lump sums to states, which in turn would be given more flexibility and independence over use of the money, though the plan does not spell out what the federal requirements would be.

Beginning in 2013, these grants would increase annually at the rate of inflation, with adjustments for population growth, a rate far below that of inflation for health care costs. As a result, states, which have said that they cannot afford to keep up with the program’s costs, are likely to scale back coverage. Such a reduction, critics fear, could have a disproportionate effect on Medicaid spending for nursing home care for the elderly or disabled...

According to the Congressional Budget Office, in the 2010 fiscal year, 77 percent of people enrolled in Medicaid were children and families, while 23 percent were elderly or disabled. But 64 percent of Medicaid spending was for older Americans and people with disabilities, while 36 percent went to children and families.

According to the Kaiser Family Foundation, which analyzes health care issues, 7 of 10 nursing home residents are on Medicaid, in large part because even middle-class patients often run through their savings while in a nursing home and turn to the entitlement program.

This is a huge deal. Typically, a middle class aged person goes into a nursing home, where the meter runs quite quickly. They start on Medicare, and, after they spend down their assets and become poor, they go on Medicaid, which lets them stay in the nursing home, and lets the nursing home stay in business. You cut medicaid, not so much. You turn Medicaid into block grants to states hurting for money, and likely to use it elsewhere, worse yet.

Which means that a lot of old folk would be out of nursing homes. Their kids' houses, bank accounts and lives are poorly, if at all, equipped for it. Visiting nurse agencies, home physical therapy, home visits by doctors? You may say I'm a dreamer...

Currently the aging parent's finances are independent (mostly) of the adult child's. That'll change very, very quickly if the Medicaid cuts go through, unless they're content to leave Granny out on the street. What will also change very, very quickly is the sort of financial guarantees from patients and their families that nursing homes will demand before admitting a new resident.

These people vote. They won't like this at all.

Monday, May 9, 2011

Yogi In Middle School

My daughter, describing a classmate in eighth grade:

'She's one of the popular girls; that's why nobody likes her'

Saturday, May 7, 2011

Choose Wisely

I've been arguing against capital punishment for half a century, with little to show for it. I'll leave it at this: if one has a choice, one should not kill. I don't see it as a leap of logic at all to differentiate ourselves from murderers, and societies condoning murder, by making a choice not to kill when we can make that choice. Nor do I see it as a leap of logic, or flawed logic, to differentiate a society casually and brutally employing show trials, if even those, and executions, from one under the rule of law, restraining a state's power, requiring documentation of a crime and exacting punishment from those found guilty. Quite the contrary: I find the logic inescapable. That Al Qaeda and Bin Laden pose current threats that a defeated Germany did not only adds to my argument: recourse to the rule of law is a mark of courage rather than weakness, of confidence in one's values, and would resound throughout the world as an alternative to non-state actors', or state-sponsored, terror, brutality and murder. I believe such a course to be profoundly in America's national interests, even narrowly construed. Again, half a century's experience with the topic allows the safe prediction that many will disagree. But there it is.

We had a choice at Nuremburg, and tried the Nazis, affording them defense counsel. Israel had a choice with Eichmann, tried him, affording him defense counsel, and executed him. We might, or might not, have had a choice with Bin Laden. His capture was necessary, and if there was no other way to capture him than dead, it was worth doing. If we had a choice, which I don't know and have a hard time opining half a world and a week and a half away, we should have captured him and put him on trial for his crimes. And it is always, always unseemly to celebrate death, even if necessary. I predict disagreement on this point, over a gap that will not be closed by further argument.

Friday, May 6, 2011

Ding Dong, The Witch is Us

How to have dealt with Bin Laden? The question, once asked, reflects far less Bin Laden's status as a moral agent than ours. It is, after all, our actions which we choose in an elective context, and, therefore, must take personal responsibility for.

The notion of war crimes recalls to me the entirely despicable Curtis LeMay's observation that a victorious Japan would have tried him for war crimes. Meanwhile, Robert Jackson remains amongst the most revered of American jurists, and his concurrence in Youngstown, oft cited as one of the finest ever advanced in the Supreme Court, is a fascinating book end to his Nuremburg role.

I remain of the opinion that Nuremburg was necessary, that the Nazi crimes were to some extent sui generis and required unambiguous documentation for the historical record. The comparison with the Soviet treatment of Stalin, or the current Chinese treatment of the Great Leap Forward and the Cultural Revolution, and with the Truth and Reconciliation Commission as apartheid ended, is, to my mind, only to the benefit of Nuremburg.

More so, I deeply believe terrorist acts to be unworthy (if that's the right word) of being defined as acts of war rather than crimes. And crimes are to be defined, their commission demonstrated, their perpetrators identified beyond a reasonable doubt and required to pay a price. War is far, far less defined than criminal justice, and invariably involves behavior on both sides which, outside the context of a war, would itself be criminal. A break from the formulation of 'war on terror', without in the least relaxing vigilance with a view towards prevention and punishment of the guilty, would, to my mind, be amongst the most helpful changes in our policy even with respect to our national interests narrowly and amorally construed, much less a renunciation of the perception that fighting terrorism requires terror. To that extent, an imperfect Nuremburg trial, or, with respect to a single actor, a far more appropriate exercise, mirroring the Eichmann trial, seems to me in order.

Bin Laden required capture. I am ambivalent about the violation of Pakistani sovereignty but reluctantly concede that it was necessary and, perhaps, in view of Pakistan's obvious complicity, even desirable. I would have had no problem with Bin Laden's death during his capture were there no other alternative. That isn't clear to me yet. I have great difficulty with exultant celebration, of the sort that one sign in my town rather revealingly summed up as 'Ding dong, Osama's dead.' Munchkins, indeed.

Those Dastardly Teachers and Their Thuggish Unions

Our local paper last week, appalled, exposed our town's teachers' union as guilty of (prepare yourself to be shocked) the excesses of spending money on a couple of newspaper ads and extending a speaking invitation to Ralph Nader. I wrote this letter in response to their story, which they printed unaltered:

Dear Editor:

It is indeed outrageous that the teachers' union, as one party to a contentious negotiation, seeks to put its views before the public via a couple of half-page newspaper ads and a speaking invitation to Ralph Nader. This sort of thuggish political intimidation shouldn't be tolerated. Only Fox News, Rush Limbaugh, most of the Republican Party, and other lonely patriots such as the Waltons of Wal-Mart and the Koch brothers (six of the world's top 30 richest billionaires on Forbes' list), balance unions' relentless zeal and enormous financial resources in pushing their members' agenda.

I'm grateful that politicians are demanding that unions and their members be denied fundamental rights to contract negotiation and collective bargaining. If prior contracts overly favor one of the two sides, the obvious remedy isn't more competence and courage from the other side, but a denial of long-established rights to the previously successful side. Anybody appalled by excessive government power would agree.

What shocking excess will the union resort to next? Merciful heavens. I'm sure that, as always, the vast majority of our town's voters and taxpayers will attend Town Meeting to make their voices heard.

(Full disclosure: my daughter, now majoring in linguistic anthropology, had many excellent teachers in )xxxx( High School, including )yyyyy(, who, in response to planned decreases in staffing, benefits and funding, and increased class sizes, had the nerve to suggest that he and his colleagues were being asked to do more for less. Another brazen attempt to suppress debate by stating facts. Disgraceful.)