Caring for Aging Americans
Ways and Means, Caring for Aging Americans, November 14, 2019
Based on the hearing title, we assume that this hearing covers nursing home care rather than congressional pay or plans for incarcerating Prisoner 45. We submitted comments to the Senate Finance Committee in July and March of this year. Please find them in Attachment One. These comments expand our approach to providing better care for aging Americans.
Being cared for in retirement takes money. Social Security, Medicare and Medicaid are significant improvements in the quality of life for most of our nation's elderly. People with means are no worse off, while those without them can now expect a better and longer life, as can their families, mostly their daughters and daughters-in-law. Those who say differently are suffering from nostalgia for a time that never was.
The same people believe that setting Old Age, Survivors and Disability Insurance creates a moral hazard to discourage savings. This is non-sense. Lack of money is what decreases savings for retirement and other things. There are a variety of methods to increase income for seniors, as well as the population as a whole.
The best way to care for the aged is to care for everyone. People who have adequate income are less likely to be ill, especially the aged. Having enough money to shift from a cheap higher carbohydrate intensive diet to one with adequate protein reduces obesity, diabetes, heart attack and a host of other maladies. In the interim, higher Food Stamp allocations provide a Band-Aid.
The real benefits occur with an adequate minimum wage. Welfare economics (Econ 101) shows that higher wages mean more potential workers, not less jobs. Higher wages lead to higher incomes for the remainder of the bottom 90% of families and less economic rent for the top 10%. Higher wages lead to the recalculation of wage history levels for the retired and disabled. Any shortfall in the Trust Fund because of this will be made up with more payroll tax income with debt financing of immediate shortfalls.
A more generous refundable child tax credit at middle class levels, also called a negative income tax as proposed by radical economist Milton Friedman, will result in larger families, fewer abortions and a larger economy. Larger economies reduce burden on workers for a more generous OASI, payment. See Attachment Two for more information on how to fund this through an employer paid Subtraction Value Added Tax (S-VAT).
Another tax reform change proposed is to shift funding for the employer contribution to OASI (and all of DI and HI) to an invoice VAT (I-VAT), with equal dollar crediting for current and future beneficiaries. The same distribution rule would be applied to the distribution of insured personal retirement accounts invested in employer voting stock.
As stated in comments to the Finance Committee last month on Drug Misuse, care provided through a cooperative employer for both workers and retirees would be superior and less costly. Pardon me for burying the lead.
We mentioned in our comments to the Committee in June of this year on paths to single-payer insurance, Medicare for All is really Medicaid for All (no co-payments or premiums, current provider rates). This would certainly improve budgets for many of the Aged (and Disabled), although it would depend on higher funding, such as the S-VAT described in Attachment Two.
To improve funding for the Aged, money is not everything (although it effects everything). We are on record favoring shifting all Medicaid funding to the Federal government, eliminating the largest contingent liability faced in the near future by the states. (Adding the base costs for public pensions to Social Security would also do so).
Shifting management of those funds to the federal government can also improve care for the aged. As I am sure the invited witnesses will tell you, long-term care for aged Americans is sub-optimal. Private providers cut corners to increase profit and regulation is under-funded. Federalizing inspection systems with the same inspectors only shifts flags. It will not improve service and does not justify a shift in management.
To truly improve services, the more radical idea (perhaps more radical than employee-ownership), is to mandate that all providers be managed by a current or retired member of the Uniformed Public Health Service, with at least one such doctor on staff, even if the manager is a Registered UPHS nurse.
This profoundly improves quality and will push bad actors out of the system, reducing the number of corporate providers. Under-performing facilities be publicly purchased until they can be refitted and sold to non-profit providers or employee-owners. To current investors who put profit before care, we say good riddance. The nation should as well.
The size of the UPHS service must expand under this proposal, moving us closer to the British system. This would not be a bad thing, except for the ideologues who would defund social services anyway, until they need better care themselves.
Attachment One: Senate Finance: Not Forgotten: Protecting Americans Abuse and Neglect in Nursing Homes, March 6, 2019/Promoting Elder Justice: A Call for Reform, July 23, 2019
Attachment Two - Tax Reform, Center for Fiscal Equity, November 13, 2019
Based on the hearing title, we assume that this hearing covers nursing home care rather than congressional pay or plans for incarcerating Prisoner 45. We submitted comments to the Senate Finance Committee in July and March of this year. Please find them in Attachment One. These comments expand our approach to providing better care for aging Americans.
Being cared for in retirement takes money. Social Security, Medicare and Medicaid are significant improvements in the quality of life for most of our nation's elderly. People with means are no worse off, while those without them can now expect a better and longer life, as can their families, mostly their daughters and daughters-in-law. Those who say differently are suffering from nostalgia for a time that never was.
The same people believe that setting Old Age, Survivors and Disability Insurance creates a moral hazard to discourage savings. This is non-sense. Lack of money is what decreases savings for retirement and other things. There are a variety of methods to increase income for seniors, as well as the population as a whole.
The best way to care for the aged is to care for everyone. People who have adequate income are less likely to be ill, especially the aged. Having enough money to shift from a cheap higher carbohydrate intensive diet to one with adequate protein reduces obesity, diabetes, heart attack and a host of other maladies. In the interim, higher Food Stamp allocations provide a Band-Aid.
The real benefits occur with an adequate minimum wage. Welfare economics (Econ 101) shows that higher wages mean more potential workers, not less jobs. Higher wages lead to higher incomes for the remainder of the bottom 90% of families and less economic rent for the top 10%. Higher wages lead to the recalculation of wage history levels for the retired and disabled. Any shortfall in the Trust Fund because of this will be made up with more payroll tax income with debt financing of immediate shortfalls.
A more generous refundable child tax credit at middle class levels, also called a negative income tax as proposed by radical economist Milton Friedman, will result in larger families, fewer abortions and a larger economy. Larger economies reduce burden on workers for a more generous OASI, payment. See Attachment Two for more information on how to fund this through an employer paid Subtraction Value Added Tax (S-VAT).
Another tax reform change proposed is to shift funding for the employer contribution to OASI (and all of DI and HI) to an invoice VAT (I-VAT), with equal dollar crediting for current and future beneficiaries. The same distribution rule would be applied to the distribution of insured personal retirement accounts invested in employer voting stock.
As stated in comments to the Finance Committee last month on Drug Misuse, care provided through a cooperative employer for both workers and retirees would be superior and less costly. Pardon me for burying the lead.
We mentioned in our comments to the Committee in June of this year on paths to single-payer insurance, Medicare for All is really Medicaid for All (no co-payments or premiums, current provider rates). This would certainly improve budgets for many of the Aged (and Disabled), although it would depend on higher funding, such as the S-VAT described in Attachment Two.
To improve funding for the Aged, money is not everything (although it effects everything). We are on record favoring shifting all Medicaid funding to the Federal government, eliminating the largest contingent liability faced in the near future by the states. (Adding the base costs for public pensions to Social Security would also do so).
Shifting management of those funds to the federal government can also improve care for the aged. As I am sure the invited witnesses will tell you, long-term care for aged Americans is sub-optimal. Private providers cut corners to increase profit and regulation is under-funded. Federalizing inspection systems with the same inspectors only shifts flags. It will not improve service and does not justify a shift in management.
To truly improve services, the more radical idea (perhaps more radical than employee-ownership), is to mandate that all providers be managed by a current or retired member of the Uniformed Public Health Service, with at least one such doctor on staff, even if the manager is a Registered UPHS nurse.
This profoundly improves quality and will push bad actors out of the system, reducing the number of corporate providers. Under-performing facilities be publicly purchased until they can be refitted and sold to non-profit providers or employee-owners. To current investors who put profit before care, we say good riddance. The nation should as well.
The size of the UPHS service must expand under this proposal, moving us closer to the British system. This would not be a bad thing, except for the ideologues who would defund social services anyway, until they need better care themselves.
Attachment One: Senate Finance: Not Forgotten: Protecting Americans Abuse and Neglect in Nursing Homes, March 6, 2019/Promoting Elder Justice: A Call for Reform, July 23, 2019
Attachment Two - Tax Reform, Center for Fiscal Equity, November 13, 2019
posted by Michael Bindner at 10:00 AM
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