How to Get Republicans to Support the Affordable Care Act

[Joe Guy]

I've not spent much time studying statistics regarding life expectancy. Is there any data on the quality of lives that are extended?

If someone is 70 years old and becomes dependent on extensive medical care and medication to stay alive and lives 4 more years is that taken into consideration or is that person simply considered to have lived longer when these stats are assembled?

If quality of life is not considered, what does a longer life expectancy really mean?

[oldr_n_wsr]

what does a longer life expectancy really mean

More of a drain on limited resources (individual and governmental)

[oldr_n_wsr]

case in point:
.

WASHINGTON (AP) -- A global retirement crisis is bearing down on workers of all ages.

Spawned years before the Great Recession and the financial meltdown in 2008, the crisis was significantly worsened by those twin traumas. It will play out for decades, and its consequences will be far-reaching.

Many people will be forced to work well past the traditional retirement age of 65 — to 70 or even longer. Living standards will fall, and poverty rates will rise for the elderly in wealthy countries that built safety nets for seniors after World War II. In developing countries, people's rising expectations will be frustrated if governments can't afford retirement systems to replace the tradition of children caring for aging parents.

The problems are emerging as the generation born after World War II moves into retirement.

"The first wave of under-prepared workers is going to try to go into retirement and will find they can't afford to do so," says Norman Dreger, a retirement specialist in Frankfurt, Germany, who works for Mercer, a global consulting firm.

The crisis is a convergence of three factors:

— Countries are slashing retirement benefits and raising the age to start collecting them. These countries are awash in debt after overspending last decade and racking up enormous deficits since the recession. Now, they face a demographics disaster as retirees live longer and falling birth rates mean there will be fewer workers to support them.

— Companies have eliminated traditional pension plans that cost employees nothing and guaranteed them a monthly check in retirement.

— Individuals spent freely and failed to save before the recession, and they saw much of their wealth disappear once it hit.

Those factors have been documented individually. What is less appreciated is their combined ferocity and their global scope.

"Most countries are not ready to meet what is sure to be one of the defining challenges of the 21st century," the Center for Strategic and International Studies, a Washington think tank, concluded in a report this fall.

Mikio Fukushima, who is 52 and lives in Tokyo, is typical of those facing an uncertain retirement. Fukushima, who works in private investment, worries that he might have to move somewhere cheaper, maybe Malaysia, after age 70 to get by comfortably on income from his investments and a public pension of just $10,000 a year.

If he stayed in Japan, he says, "We wouldn't be able to travel at all."

People like Fukushima who are fretting over their retirement prospects stand in contrast to many who are already retired. Many workers were recipients of generous corporate pensions and government benefits that had yet to be cut.

Jean-Pierre Bigand, 66, retired Sept. 1, in time to enjoy all the perks of a retirement system in France that's now in peril. Bigand lives in the countryside outside the city of Rouen in Normandy. He has a second home in Provence. He's just taken a vacation on Oleron island off the Atlantic Coast and is planning a five-week trip to Guadeloupe. "Travel is our biggest expense," he says.

In Rochester, Minn., Elaine Case, 58, and her husband, Bill Wiktor, 61, both retired at 56 after three-decade careers at IBM. They have company pensions and will receive Social Security in a few years. They love to travel. Wiktor climbed Mount Kilimanjaro last year. They've taken a trans-Atlantic cruise and plan next year to hike Peru's Inca trail.

"We're both enjoying our second lives immensely and with gratitude," Case says.

A BRIEF GOLDEN AGE

The notion of extended, leisurely retirements, like the ones Bigand, Case and Wiktor are enjoying, is relatively new. German Chancellor Otto von Bismarck established the world's first state pension system in 1889. The United States introduced Social Security in 1935.

In the prosperous years after World War II, governments in rich countries expanded their pension systems. In addition, companies began to offer pensions that paid employees a guaranteed amount each month in retirement — so-called defined-benefit pensions.

It got even better in the 1980s. Many countries began to coax older employees out of the workforce to make way for the young. They did so by reducing the age employees became eligible for full government pension benefits. The age fell from 64.3 years in 1949 to 62.4 years in 1999 in the relatively wealthy countries that belong to the Organization for Economic Cooperation and Development.

That created a new, and perhaps unrealistic, "concept of retirement as an extended period of leisure, " Mercer consultant Dreger says. "You'd take long vacations. That was the Golden Age."

Then came the 21st century.

UNDER SIEGE

As the 2000s dawned, governments — and companies — looked at actuarial tables and birth rates and decided they couldn't afford the pensions they'd promised.

People were living longer: The average man in 30 countries the OECD surveyed will live 19 years after retirement. That's up from 13 years in 1958, when many countries were devising their generous pension plans.

The OECD says the average retirement age would have to reach 66 or 67, from 63 now, to "maintain control of the cost of pensions" from longer lifespans.

Compounding the problem is that birth rates are falling just as the bulge of people born in developed countries after World War II retires.

Populations are aging rapidly as a result. The higher the percentage of older people, the harder it is for a country to finance its pension system because relatively fewer younger workers are paying taxes.

In China, the 65-and-older population will rise from 11 percent of the working-age population in 2010 to 42 percent in 2050. In the United States, this old-age dependency ratio will rise from 20 percent to 35 percent.

In response, governments are raising retirement ages and slashing benefits. In 30 OECD countries, the average age at which men can collect full retirement benefits will rise to 64.6 in 2050, from 62.9 in 2010; for women, it will rise from 61.8 to 64.4. Italy is raising the age from 59 to 65.

In the wealthy countries it studied, the OECD found that the pension reforms of the 2000s will cut retirement benefits by an average 20 percent.

Even France, where government pensions have long been generous, has begun modest reforms to reduce costs. France has raised the number of years people must work before they can receive a full pension from 41.5 to 43. More changes are likely coming.

"France is a retirees' paradise now," says Richard Jackson, senior fellow at the Center for Strategic and International Studies. "You're not going to want to retire there in 20 to 25 years."

The fate of government pensions is important because they are the cornerstone of retirement income. Across the 34-country OECD, governments provide 59 percent of retiree income, on average. The government's share ranges as high as 86 percent in Hungary. In the United States, the world's largest economy, it's about 38 percent.

If rich countries don't cut pension costs even more, says Standard & Poor's, a credit-rating agency, their government debt will more than triple as a percentage of annual economic output by 2050. The debt of most countries would drop to what is commonly called junk status.

Many of those facing a financial squeeze in retirement can look to themselves for part of the blame. They spent many years before the Great Recession borrowing and spending instead of setting money aside for old age. In the U.S., households took on an additional $5.4 trillion in debt — an increase of 75 percent — from the start of 2003 until mid-2008, according to the Federal Reserve Bank of New York. The savings rate fell from nearly 13 percent of after-tax income in the early 1980s to 2 percent in 2005.

The National Institute on Retirement Security estimates that Americans are at least $6.8 trillion short of what they need to have saved for a comfortable retirement. For those 55 to 64, the shortfall comes to $113,000 per household.

"People are going to be shocked at how little they have," says Alicia Munnell, director of Boston College's Center for Retirement Research. "For some middle-income people, it will mean canceling the RV" — the recreational vehicle that has become a symbol of retiree life in America. For those worse off, she says, it could mean an old age in poverty.

THE FINANCIAL CRISIS MAKES THINGS WORSE

As if demographics weren't burden enough, the outlook became worse when the global banking system went into a panic in 2008 and tipped the world into the worst recession since the 1930s.

Government budget deficits — the gap between what governments spend each year and what they collect in taxes — swelled in Europe and the United States. Tax revenue shrank, and governments pumped money into rescuing their banks and financing unemployment benefits and other welfare programs.

That escalated pressure on governments to reduce spending on pensions or raise revenue. Hungary took one of the most draconian steps: It demanded that its citizens surrender their private retirement accounts to the government or give up their government pensions. Poland seized a portion of private retirement accounts. Ireland imposed an annual tax on retirement accounts.

The Great Recession threw tens of millions of people out of work worldwide. For many who kept their jobs, pay has stagnated the past five years, even as living costs have risen, making it tougher to save for retirement. In addition, government retirement benefits are based on lifetime earnings, and they'll now be lower. The Urban Institute, a think tank in Washington, estimates that lost wages and pay raises will shrink the typical American worker's income at age 70 by 4 percent — an average of $2,300 a year.

Leslie Lynch, 52, of Glastonbury, Conn., had $30,000 in her 401(k) retirement account when she lost her $65,000-a-year job last year at an insurance company. She'd worked there 28 years. She has depleted her retirement savings trying to stay afloat.

"I don't believe that I will ever retire now," she says.

She also worries about her children, all in their 20s: "I don't think my three sons will ever retire" because pay raises have been so weak for so long.

Less money from a government pension isn't the only factor weighing on future retirees. When the financial crisis struck five years ago, the world's central banks cut interest rates to record lows to stop the economic free-fall. That also punished people with much of their money in investments that pay interest.

"The low-interest rate environment has been brutal," says Catherine Collinson, president of the Transamerica Center for Retirement Studies. She points out that $500,000 in savings would yield $25,000 a year at an interest rate of 5 percent, just $2,500 at 0.5 percent.

The crisis also frightened many away from the stock market. Stocks can be riskier than other investments, but they yield more long term. Many investors have shunned stocks while the world's stock markets have soared. In the United States, the Dow Jones industrial average has risen nearly 150 percent since March 2009. Japan's Nikkei index is up 56 percent just this year.

The past five years have been so tumultuous that some people have been reluctant to invest at all.

Olivia Mitchell, who studies retirement at the University of Pennsylvania's Wharton School, says her grown daughters rebuffed her when she urged them to save more for retirement. Stocks, they said, are too risky. And bonds don't yield enough interest to be worth the bother.

THE ASIA CHALLENGE

In Asia, workers are facing a different retirement worry, a byproduct of their astonishing economic growth.

Traditionally, Chinese and Koreans could expect their grown children to care for them as they aged. But newly prosperous young people increasingly want to live on their own. They also are more likely to move to distant cities to take jobs, leaving parents behind. Countries like China and South Korea are at an "awkward" stage, says Jackson at the Center for Strategic and International Studies: The old ways are vanishing, but new systems of caring for the aged aren't yet in place.

Yoo Tae-we, 47, a South Korean manager at a trading company that imports semiconductor components, doesn't expect his son to support him as he and his siblings did their parents. "We have to prepare for our own futures rather than depending on our children," he says.

South Korean public pensions pay an average of just $744 a month. South Korea has the rich world's highest poverty rate for the elderly. It has one of the world's highest suicide rates for the aged, too.

China, too, will struggle to finance retirement. China pays generous pensions to civil servants and to urban workers who toiled in inefficient state-owned factories. These workers can retire early with full benefits - at 60 for men and 50 or 55 for women, depending on their job. Their pensions will prove to be a burden as China ages and each retiree is supported by contributions from fewer workers. The elderly are rapidly becoming a bigger share of China's population because of a policy begun in 1979 and only recently relaxed that limited couples to one child.

The World Bank says the cost of those pensions could eventually reach twice the size of China's annual gross domestic product. That would put the bill at more than $16 trillion.

China is considering raising its retirement ages. But the government would likely meet resistance. "I heard that the authorities might postpone the age of the retirement, but I sure hope not, since I've already worked for almost 42 years," says Dong Linhua, 59, a former Shanghai factory worker and now a real estate investor, who owns three apartments and two small shop spaces.

China also tightly regulates investing, limiting access to assets that are more likely to generate the returns workers need to build a healthy retirement account.

"Things that you and I take for granted, like being able to invest in mutual funds or being able to buy stocks and bonds, are in their infancy in China," says Josef Pilger, leader of Ernst & Young's Asia-Pacific pension practice in Sydney, Australia. "The biggest fear the Chinese regulators have is: What if we relax investment restrictions and we have a financial crisis? People will be on the street, saying: 'You let me play with fire, and I burned my fingers.' "

THE END OF TRADITIONAL PENSIONS

Governments aren't alone in cutting pensions. Corporations are, too. The traditional defined-benefit pensions they long had provided are vanishing. Companies don't want to bear the risks and costs of guaranteeing employees' pensions. They've moved instead to so-called defined-contribution plans, such as 401(k)s in the U.S., which shift responsibility for retirement savings to employees.

The problem with these plans is that people have proved terrible at taking advantage of and managing them. They don't always enroll. They don't contribute enough. They dip into the accounts when they need money.

They also make bad investment choices; often buying stocks when times are good and share prices are high and bailing when prices are low. Investment returns from defined-contribution plans are typically 0.76 percentage points lower than returns on defined-benefit plans, according to the consulting firm Towers Watson. That difference adds up: At a 5 percent annual return, $100,000 becomes $432,000 after 30 years. At 5.76 percent, it's 24 percent higher — $537,000.

Many have raided their retirement accounts to pay bills. In the United States, 26 percent of workers with 401(k) and other defined-contribution plans take loans or make hardship withdrawals before they reach retirement, according to a study by HelloWallet, which offers online services that help people with their finances. Working Americans withdraw $70 billion annually from retirement accounts — an amount that's 40 percent of the $175 billion put in. Employers add an additional $118 billion.

Retirement specialist Teresa Ghilarducci of the New School for Social Research in New York says the voluntary plans "work for a robot with an Excel spreadsheet," not for people trying to pay bills and care for children who aren't thinking decades ahead to retirement.

NUDGING WORKERS TO SAVE

Several countries are trying to force — or nudge — workers to save more for retirement.

Australia went the furthest, the soonest. It passed a law in 1993 that makes retirement savings mandatory. Employers must contribute the equivalent of 9.25 percent of workers' wages to 401(k)-style retirement accounts. (The required contributions will rise to 12 percent by 2020.) Australians can't withdraw money in their accounts before retirement.

When politicians were debating the plan, only about half of Australians supported it. Within six months, approval rose to 85 percent. The difference: Workers started receiving statements that showed retirement savings piling up, says Nick Sherry, who helped design the program as a cabinet minister.

In October 2012, Britain required employers to start automatically enrolling most employees in a pension plan. At the start, contributions must equal at least 2 percent of earnings, half provided by employers. By 2018, contributions must rise to 8 percent, of which 3 percentage points will come from employers.

In 2006, the United States encouraged companies to require employees to opt out of a 401(k) instead of choosing to opt in. That means they start saving for retirement automatically if they make no decision.

EASING THE PAIN

Rebounding stock prices around the world and a slow rise in housing prices are helping households recover their net worth. In the U.S., retirement accounts — defined-contribution and defined-benefit plans combined — hit a record $12.5 trillion the first three months of 2013, according to the Urban Institute. They've gone higher since.

However, net worth is merely climbing toward a level considered inadequate at its peak in 2007. Boston College's Center for Retirement Research says the recovery in housing and stock prices still leaves 50 percent of American households at risk of being unable to maintain their standard of living in retirement. That's down from 53 percent in 2010 but up from 44 percent before the Great Recession hit in 2007.

Only half of all Japanese say they've even thought about how to finance their retirement. And 63 percent are counting on getting most of their income from a government pension system that's going broke.

When they look into the future, retirement experts see more changes in government pensions and longer careers than many workers had expected:

— Pension cuts are likely to hit most retirees but should fall hardest on the wealthy. Governments are likely to spend more on the poorest among the elderly, as well as the oldest, who will be in danger of outliving their savings.

— Those planning to work past 65 can take some comfort knowing they'll be healthier, overall, than older workers in years past. They'll also be doing jobs that aren't as physically demanding. In addition, life expectancy at 65 now stretches well into the 80s for people in the 34 OECD countries, an increase of about five years since the late 1950s.

"My parents retired during the Golden Age of retirement," says Mercer consultant Dreger, 37. "My dad, who is 72, retired at 57. That's not going to happen to somebody in my generation."

LINK
http://finance.yahoo.com/news/ap-impac ... 14023.html

[rubato]

http://en.wikipedia.org/wiki/List_of_co ... ality_rate

As of 2005 we were 34th in infant mortality. Maybe you can make some lame-ass excuse about that?

"Well, they were born in the US where life is worth less than France, Singapore, Sweden or Iceland so fuck'em."

Morons.


yrs,
rubato

[Lord Jim]

GRATUITOUS INSULT ALERT!!!!

GRATUITOUS INSULT ALERT!!!!

GRATUITOUS INSULT ALERT!!!!

[rubato]

Lame method of avoiding the facts.



yrs,
rubato

[Lord Jim]

I'm glad to see that you've finally had the realization that gratuitous insults are a lame way to avoid the facts.

Now, if you can just manage to somehow retain and apply this new found knowledge, you'll be making some real progress.

[Andrew D]

And yet another potentially enlightening discussion degenerates into a bitchfest.

[oldr_n_wsr]

Rather than starting a new thread, came across this:

Opening Up the Black Box of U.S. Health Care Prices
The Fiscal Times
By John F. Wasik
5 hours ago

What if you could compare hospital and doctor's fees the way you could shop for something online?

For those expenses you pay out of pocket, it would make a huge difference. In theory, providers would compete to offer the highest-quality service at the lowest cost and would likely be "star" rated by consumers the way they are on hundreds of online sites.

That begs a critical question: Will the 2.2 million Americans who signed up for insurance through the Affordable Care Act – including some 1.8 million added just last month – be more demanding consumers?

Given the notorious black box nature of U.S. health care – most patients have no idea what a service costs – such an idea seems unlikely and new tools to pry open medical pricing vaults may seem like a pipe dream of some tech-savvy entrepreneur.

There have been some attempts to make the mountain of provider data user friendly, but it's uneven. Healthgrades, for example, rates hospitals and doctors – highlighting doctor backgrounds and hospital safety information – but doesn't provide any pricing guidance. You can easily find specialists, scan their medical training and even see if they've had blots in their professional records. How much do they charge? That's not on the site.

Hospital pricing is available through the Centers for Medicare and Medicaid Services, but it only tells you what institutions are charging the government for Medicare and Medicaid patients. That's not particularly helpful if you are privately insured, covered by a company plan or a policy offered through the new state and federal policies.

What would be ideal is a mobile phone application that allows you to plug in a zip code, scan highly rated doctors, hospitals and clinics and see what they charge for basic services such as office visits, X-rays and other common tests and procedures. You'd have to same ability to shop for medical services the way you would for appliances, computers or gasoline.

For those facing out-of-pocket costs, such a service could save thousands of dollars.

What Would a Market-Driven System Look Like?
In an ideal world, medical service pricing would resemble what Amazon.com does with outside vendors. They are all rated and compete mightily on cost and service. None of them want a lower star rating or bad consumer reviews, so they bend over backwards to see that you're treated well.

A market-driven system driven by technology would increase transparency and reduce costs.

Displaying costs from various providers also might stem the huge disparity on pricing. It's well known that U.S. health care consumers spend more on medical care than residents of other affluent countries. Part of the reason is the opaque nature of the U.S. system and the fact that providers benefit from the lack of price discovery.

The Commonwealth Fund, a think tank that focuses on "a high-performing" health care system, found that:

The average cost for a day in a U.S. hospital is $4,287; in France, it’s $853. The total price for a normal birth is nearly $10,000 in the U.S.; in the United Kingdom, it’s $2,641. A knee replacement? Over $25,000 here — more than twice the cost in Switzerland. The price discrepancy extends to doctors' bills, too. U.S. physicians receive substantially more for office visits — for example, by Medicare and Medicaid — than their counterparts in other high-income countries. To make matters worse, prices for the same services, such as lab tests or mammograms, vary significantly between providers, even in the same city or county.

Although U.S. health care consumers won't be able to get their local doctors and hospitals to compete with single-payer programs in Europe, a market-driven system would force them to compete more effectively with each other. In one sense, that's already happening, although it's not been widely reported.

Under direct pressure from insurers and indirectly from the introduction of the Affordable Care Act – adding millions of new health insurance customers through private policies – pricing has been under the gun.

Related: Has the U.S. Found a Cure for Rising Health Costs?

Insurers running health care networks want the best prices and have moved to either exclude high-priced providers or negotiate lower bulk discounts for policyholders. So, absent consumer pressure, hospitals and doctors may already be in the throes of an insurer-driven price battle. Notes Jonathan Cohn in The New Republic:

"This market-driven approach could, in an ideal world, create a virtuous cycle that makes health care both cheaper and better. In response to price pressure, hospitals would actually find ways to be more efficient; in response to demands for better care, insurers would learn to construct networks that depend on quality and not just price."

What would jumpstart Cohn's "virtuous cycle?" A combination of newly insured patients demanding more information on services they needed to pay for out of pocket combined with insurers and government teaming together to make the system more efficient.

Those seeking quality health care at a reasonable price would do what they've always done: They shop around. But they can't do that without a means of comparison.

[Scooter]

I've not spent much time studying statistics regarding life expectancy. Is there any data on the quality of lives that are extended?

Quality-adjusted life year

It is a measure by which the U.S. also lags behind most other developed countries, alas.

[rubato]

Mortality amenable to health care. They have shown that the increase in longevity in the rest of the OECD is due to a great extent to saving lives of people in their 40s, 50s, and 60s; people who are working, productive and paying taxes.


http://www.oecd-ilibrary.org/social-iss ... 5f9f8s2-en

http://www.oecd-ilibrary.org/docserver/ ... CE0C24A0C0

In other words if we simply copied the rest of the OECD and only did as well as they do we would be saving costs and extending life.


This is an exceptional resource:

http://www.oecd.org/health/health-syste ... papers.htm


yrs,
rubato