Category Archives: The elderly & ageism

 THE PRESIDENT & UNENLIGHTENED APPROACHES TO ELDERHOOD.  HOW DID IT COME TO THIS?

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Dave Kingsley

    As Americans, we are instilled with the idea that we are the most enlightened and advanced society on the planet.  That may be true in some matters, but when it comes to biological aging it is patently false.  I’m not saying that most of the other societies of the World are more enlightened in the understanding and treatment of serious physical decline in the later stages of life, but we need to take a hard look at what we do in our families, nursing homes, politics, and other institutions.

    Let’s take the current imbroglio involving President Biden as a case study in how aging people and the people who surround them create a seriously dysfunctional and hurtful situation – indeed a heartbreaking situation that is resulting in humiliation to a man and his family because of past and ongoing family, media, and political irresponsibility.

    The biology of aging cannot be ignored – should not be ignored. This is especially true when the symptoms of clinical frailty are glaringly obvious as they have been with President Biden for the past two years.  I was aghast at noticeable changes in his appearance, movement, and speech.  I watched him closely on television and looked at video of his speeches in 2020.  The changes were palpable. 

    Cruel, agist jokes and snide remarks on late night television and in conversations I was having seemed to be on the increase.  The President ignored what so many people could see but couldn’t understand, or at least they couldn’t understand how to discuss it and deal with it appropriately.  The people around the President out of ignorance or venal political motivation rationalized, denied, or repressed the obvious when they had a duty to confront the president responsibly and compassionately.  All the political elites in the President’s circle had a responsibility to do the same thing.  It shouldn’t take a whole lot of brilliance to know when to consult geriatricians and neuroscientists.

    Unfortunately, politics in the United States have become increasingly characterized by delusion, narcissism, and self-interest over the public interest. Politicians are far too often deluded and overcome with narcissism.  The attitude is “what’s in it for me politically?” not “what’s my duty to the country?” I write this with the New York Times sitting on my desk with an above the fold headline: “Top Democrats Swallow Fears and Back Biden.”  Senate Majority Leader Schumer is quoted as saying, “I’m with Joe.” Congressman James Clyburn stated, “We are ridin with Biden.”

    This is despicable behavior on the part of two of the most powerful leaders in the Democratic party.  It is also an example of how congress is failing the American people.

    The president of a business corporation, a nonprofit, or a university would be asked to retire under the same set of circumstances – probably privately and compassionately.  Indeed, a few years ago the Chancellor of the University of Kansas was asked to step down because of confusion and lapses of memory due to aging.

    But the President’s top advisors and the First Lady are doubling down on their irresponsible claims that he can run a grueling race for President and serve our country for the next four years and a half years.  He cannot do that.  He won’t be fit to take office and carry out one of the most important jobs on the planet.  To say otherwise is sheer folly and dangerous.

    What we are seeing is sad and tragic.  It should never have come to this.  No doubt, the President’s opponent is a dangerous man leading a dangerous movement.  That is a primary issue in this looney political race.  But the American people deserve better than what is currently shoved down their throat on both sides.  Ordinary people can see what is happening.  The danger is that they might not show up to vote and a man will be elected who will do so much damage that the country will never be the same – in a negative way.

The “Budget Busting Baby Boomer Hypothesis:” Bogus Theories and Misguided Bioethicists

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Dave Kingsley

Yes We Can Afford to Care for Babies and the Elderly

    A mere thirty years ago, babies born at 24 weeks weighing 750 grams rarely survived.  Today, 70% of these children survive, thrive, and go home to continue their development as healthy human beings.[1] That is the wonderful side of medical technology.  Keeping pre-term babies alive is expensive – these are the rare multi-million-dollar hospital cases. No doubt, the 0- to 5-year age category includes a large proportion of the highest cost acute care patients.[2] But I believe it is fantastic that medical technology can accomplish that.  I also believe that it is the moral and medically ethical thing to do.

    The 65 to 70 age cohort is the other group with the most expensive hospital charges.  Most of the exceedingly high charges for this age-group are related to heart disease.  Charges drop precipitously for patients past the age of 70.  I discovered this phenomenon while doing research and teaching at Kansas University Medical School and discussed it with famed cardiologist Caldwell Esselstyne at the Cleveland Clinic.  Dr. Esselstyne explained that we were seeing the natural history of a disease – namely atherosclerosis.  Autopsies on soldiers during the Korean War revealed that this disease was well developed in a large number of young adults, which was a revelation to the U.S. medical profession.  Typically, it progresses untreated and results in a crisis by a person’s mid to late 60s. [3]

    The question that has arisen in treating patients with costly medical care is “should we provide or withhold care based on age?” Treating complicated diseases with advanced medical technologies is expensive, but the United States with the most abundant financial resources in the world can easily afford to save pre-term babies and 65- to 70-year-old patients with heart disease. If provided with necessary information regarding the realities of public finance and medical necessity and outcomes, the American people, would, I believe, want to spend whatever is possible, reasonable, and feasible to save and extend life regardless of disease and age.

The Dominant Bioethicist View in Scholarly Debate about Healthcare Justice: Depriving the Elderly of Beneficial Care is Justified

    In the past few decades, a consensus has formed among the most influential American bioethicists that the escalating cost of healthcare in the United States is unsustainable and, therefore, bioethics demands rationing of beneficial medical care.   Rationing of medical care could, in their view, be justified primarily by an individual’s years of future economic productivity and contributions to society. This is a chilling and horrifying mantra within a constricted context of neoliberal economics, erroneous conventional wisdom about public finance, and medical-industrial (Wall Street) narratives.

    Not surprisingly, in the grand theories and scheme of the poohbahs of bioethics, the elderly and Medicare are primarily blamed for running up the cost of cost of medical care.  In an article titled “Rationing Just Medical Care,” [4] Lawrence Schneiderman, a proponent of medical care rationing, has incorporated and summarized the rationale of the rationing movement. Schneiderman states that a “decent minimum of care” would be at a level that “enables a person to acquire an education, seek or hold a job, or raise a family.” [5]

    In Schneiderman’s proposed system, age and productivity are criteria for providing or withholding care rather than individual medical diagnoses and prognoses.  The nature of care for persons with impaired health, unable to meet the three goals for qualifying for expensive, lifesaving, life extending care should, in his view, include “a reasonable level of comfort, whether it be from pain or other forms of suffering.”[6] A person not acquiring an education, seeking or holding a job, or raising a family would be accorded just enough health to ensure “a reasonable level of function within the person’s limits that is respectful of the person’s dignity, as well as a reasonable level of comfort, whether it be from pain or other forms of suffering.[7]

    Schneiderman is speaking for America’s preeminent bioethicists such as Peter Singer, Daniel Callahan, Zeke Emmanuel, and Norman Daniels – to name the top few.  Their utilitarian philosophy is compatible with neoliberal economics and Wall Street claims that Medicare plus an aging population is a major threat to the economic wellbeing of the United States.  Utilitarian ethicists consider individuals and their treatment in the medical system as “means to an end” – a perceived economic “greatest good for the greatest number” – rather than ends in themselves. This philosophical position is illustrated by the quote Schneiderman borrows from economist Paul Krugman:

“America has a long-run budget problem. Dealing with this problem will require, first and foremost, a real effort to bring healthcare costs under control – without that, nothing will work.”[8]

    This is an accurate quote, but one taken out of context.  Krugman also emphasized a flawed tax code, which has become even more obscenely tilted in favor of the wealthy and against the working classes since 2010 when he wrote the opinion piece in the New York Times.  He also refrained from blaming Medicare and the elderly for excessive healthcare spending.  If Krugman were engaged in a serious budget discussion today, he would probably agree that waste, fraud, and inefficiencies in privatized healthcare, defense, and other government programs turned over to industrial complexes are major contributors to federal deficits and debt.

Cruel Capitalism and Wall Street Hegemony over the U.S. Healthcare System:  The Elderly Can be Sacrificed for the Sake of Money

    The bioethics enterprise is dominated by a handful of white male neoconservatives. As their theoretical framework and publications make clear, their views are compatible with the mostly wealthy male financiers on Wall Street.[9] These doyens of neoliberal economic bioethics attack Medicare and fall in line with superrich financiers’ misinformation regarding “entitlements caused” deficits and debt white at the same time they ignore the ravages of privatization on the U.S.  healthcare system.

    Financiers at the top of the wealth pyramid want to distract attention from an obscene tax code, which is fueling deficit spending and draining resources from public health, education, and other major institutions that enhance the quality of a society.  Mainstream bioethicists are a perfect ancillary to their strategy.  The real out of control costs in the U.S. healthcare system is due to the amount of the public treasure funneled into dividends, stock buybacks, and executive/board compensation. Nevertheless, this incontrovertible fact is nowhere to be found in writings of the leaders in the bioethics enterprise.

    Bioethicists like Peter Singer,[10] Zeke Emmanuel,[11] Norman Daniels,[12] and Daniel Callahan [13] have shown a shocking disregard for scientific thinking and science in general.  They have failed to seriously examine their basic assumptions, nor have they engaged in serious data analysis based on medical care data and public finance – they accept the Wall Street narrative at face value. 

    One would think that the role of ethicists is philosophical and moral rather than budgetary and macroeconomic.  But that is not the role they are playing.  They have joined forces with conservative deficit and debt hawks by taking up the invalid argument that Medicare is not affordable; that given the continuing growth of the elderly population and costs of medical technology, the only means of sustaining the healthcare system is rationing – essentially shortening human life for the purpose of reducing costs.

     Daniels, Emanual, Singer, Callahan, and other economic-oriented bioethicists have no original scientific studies of their own to support their claim that a condition of growing elderly cohorts (65+ and 80+), advancing medical technology, and the constraints of limited U.S. wealth on government expenditures is unsustainable.  They rely solely on the Wall Street generated budget busting Medicare myth to make the case that beneficial medical care should be withheld from frail older Americans. Hence, their one solution and primary proposal are buttressed through confirmation bias.

    Callahan, founder of the prestigious and powerful Hastings Center on Bioethics, has stated that he believes the “only reasonable approaches are to concede the greater importance of children and younger age groups for the future than for the elderly and to make certain the economic imbalance does not increase.” [14] This arbitrary ingroup-outgroup construction typifies ordinary prejudice, stereotyping, scapegoating and discrimination that it generates. [15]

We cannot ignore the relationship between the cavalier attitude toward medical ethics in the warehousing and neglect of elderly and disabled “nursing home” patients and the ageism/physicalism of the bioethicists.

    There is no scientific evidence that the elderly are responsible for causing budget deficits and debts.  Conversely, considerable evidence is available to debunk the baby boomer budget busting narrative,[16] which has been ignored by policymakers, the media, and advocacy groups.

    Right wing narratives and political strategies for reducing Medicare and Social Security benefits have been effective and harmful to the well-being of older age groups in the United States.  The harm extends beyond Medicare and Social Security.  It is difficult to claim that patients in so-called “nursing homes” should receive better care than the pervasive neglect, abuse, and warehousing characteristic of the current profit-oriented system when the leading bioethicists are pushing Wall Street narratives.  The elderly have no powerful lobby with the mission of pushing back on the reduction of healthcare to dollars and care for the deserving.

    Unfortunately, the public is led to believe that the AARP is an advocacy group for “retirees,” when in fact over $1 billion of their revenue is from royalties for selling their brand to corporations preying on the elderly while $2 hundred million is from selling memberships.  They need to walk that fine line by burnishing their false image as a pro-senior organization.

    Other aging enterprises such as the National Council on Aging, National Institute of Aging, Area Agencies on Aging, and a plethora of other advocacy groups and organizations spawned by the Older Americans Act have been tepid at best in the fight against excess extraction of Medicare funds by mammoth insurance corporations, medical device manufacturers, pharmaceutical companies, and a host of financial intermediaries.

    Commissions and think tanks on nursing homes have shown no interest in a public discussion regarding medical ethics or the lack thereof in the outrageously poor care of patients.  Instead, I see an implicit sympathy with industry financial hardship disinformation. Consequently, the elderly are vulnerable to euthanasia by neglect – not just in nursing homes but throughout the healthcare system. Indeed, the categorization of human beings as more or less worthy of medical care is eerily similar to the 1930s eugenics movement in the United States – adopted and utilized in Nazi-era Germany as justification for extermination of seriously frail and physically limited people.

[1] Sandra Lane (2015) Why are Our Babies Dying. New York:  Imprint Routledge.

[2] David Kingsley (2015) “Aging & Healthcare Costs:  Narrative Versus Reality,” Poverty & Public Policy, 7:1, 9-15.

[3] Jack P. Strong (1986) “Coronary Atherosclerosis in Solders: A Clue to the Natural History of Atherosclerosis in the Young.”  JAMA, 256(20) 2863-2866; Young Mi Hong (2010) “Atherosclerosis Cardiovascular Disease Beginning in Childhood,” Korean Circ J 40, 1-9.It may very well be that playgrounds and “happy meals” along with double patty, cheese, bacon, hamburgers are a bigger threat to healthcare expenditures than health per se at any age.

[4] Lawrence Schneiderman (2011), “Rationing Just Medical Care,” American Journal of Bioethics, 11-7, pp. 7-14.

[5] Ibid., page 8.

[6] Ibid., page 8.

[7] Ibid., page 9.

[8] Opinion | Budget Deficits: Spend Now, Save Later – The New York Times (nytimes.com)

[9] The late Peter G. Peterson, multi-billionaire co-founder of Blackstone committed over a billion dollars to funding an anti-Medicare and anti-Social Security lobby in Washington, which includes the Concord Coalition, the Committee for a Responsible Budget, and other projects for providing disinformation and misinformation about programs for the elderly.  His lobbying organizations have been effective in injecting a political narrative into the mainstream media.  In his book Running on Empty (2004, New York: Picador), he states that, “whatever reforms talked about – be they more use of information technology or medical malpractice reform – we are going to have to give up some medical care that may be of some benefit,” p. xvii.

[10]Peter Singer,  “Why We Must Ration Health Care” New York Times, July 19, 2009.

[11] Zeke Emmanuel, “Why I Hope to Die at 75,” The Atlantic, October 2014.

[12] Norman Daniels (2013) “Global Aging and the Allocation of Health Care Across the Life Span,” American Journal of Bioethics. 13(8): 1-2.

[13] Daniel Callahan (2009) Taming the Beloved Beast: How Medical Technology Costs are Destroying Our Health Care System.  Princeton, NJ: Princeton University Press.

[14] Callahan, Ibid., p. 218.

[15] On prejudice, discrimination, & scapegoating, see:  Gordon Allport (1989),  The Nature of Prejudice. New York: Addison-Wesley, 243-260.

[16] Kingsley, (2015), Op. Cit.

Stereotyping & Scapegoating Older Americans: A Worsening Tragedy

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By: Dave Kingsley  Blaming the Elderly for U.S. Economic & Fiscal Problems As the first Baby Boomers hit retirement age in 2011, propaganda and misinformation regarding the impact of older Americans on federal spending began to accelerate. Some of the … Continue reading →

How the Health Insurance Industry is Using Disinformation to Take Over and Defraud Medicare

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Dave Kingsley

Corporate Greed in the Post-Truth Age

    Most Americans have never heard of the Better Medicare Alliance[1] – a Washington, D.C. think tank and front group for big health insurers such as UnitedHealth, Aetna, and Humana.  Also, the 2023 Super Bowl TV audience didn’t know who paid for a commercial at halftime claiming that President Biden had plans to “cut Medicare.” The ad included a message urging viewers to call the White House and “tell President Biden not to cut Medicare,”[2] but they – the TV viewers – didn’t know who was asking them to do it. Football fans had to be perplexed.  Medicare beneficiaries were most likely upset and worried by what they saw and heard.

    The ad, funded by Better Medicare Alliance, was a lie.  The truth is that President Biden had no intention and no plan to cut Medicare.  Contrary to what the ad claimed, he was planning to claw back $4.7 billion from UnitedHealth and other insurers for defrauding the program through false billing practices.  One illegal practice health insurers utilize to add unearned value to their Medicare Advantage (MA) reimbursement is called “upcoding.” Because sicker patients are reimbursed at a higher rate, the trick is to find ways to lie about how sick a patient is – to make them look sicker than they are.[3]

    MA beneficiaries tend to be healthier than Traditional Medicare (TM) beneficiaries.  Nevertheless, research indicates that when individuals move from TM to MA, their costs to the program increase.  The important point is that “total Medicare payments to MA plans in 2024 (including rebates that finance extra benefits) are projected to be $83 billion higher than if MA enrollees were enrolled in FFS Medicare.”  Furthermore, payments to MA plans average an estimated 122 percent of what Medicare would have expected to spend on MA enrollees if they were in FFS Medicare.”[4]

    After the Biden Administration’s proposal to recoup stolen money from MA insurers and prevent further fraud, the health insurance industry threw a conniption fit and went into overdrive.  The Super Bowl ad was only one tactic (costing eight figures, it was super expensive).  In addition, they sent their army of lobbyists crawling all over the Washington, D.C. beltway threatening and bribing legislators.  HHS backed down.  The cheating continues and costs the seniors of America – indeed all wage earners – hundreds of billions from their payroll deductions, premiums, co-pays, and nearly $200 out of every Social Security check.

Pulling Back the Curtain on the Washington D.C. Policy Planning Network:  What is the Better Medicare Alliance & Who is Behind It?

    The insidious thing about think tanks set up inside the Washington, D.C. beltway is that they enlist the aid of seemingly legitimate advocates and scholars.  It is hard to know if the advocates and scholars are merely naïve or whether they are self-serving. Perhaps unwitting would be a kinder word. For instance, the Better Medicare Alliance board consists of Dennis Borel, Executive Director of Texans with Disabilities, Caroline Coats, Humana, Inc., Daniel Dawes, Meharry Medical College, Mary Beth Dawes, Former Congresswoman (President & CEO), Joneigh Kaldhun, CVS Health, Dan Lowenstein, Visiting Nurse Service, NY, Richard Migliori, UnitedHealth, Elena Rios, National Hispanic Medical Association, and Kenneth Thorpe, Emory University.

    The organizational structure of these industry front groups is a form of disinformation itself. On the board are big players in the MA industry – Humana, CVS, and UnitedHealth.  Interspersed with the representatives of these health insurance behemoths are executives and professionals from organizations with an ostensible mission to improve society in some manner.

    By placing their imprimatur on an industry lobbying group, NGOs, nonprofits with a stated humanitarian cause, and universities  are participating in a duplicitous tactic to confuse the public about the real purpose of nefarious industry think tanks like Better Medicare Alliance. Their support for various entities with a mission to preserve and strengthen the medical-industrial complex helps divert funds needed for care into the coffers of executives and shareholders.

Privatizing Medicare was Supposed to Reduce Costs and Give Beneficiaries More Choice:  It Hasn’t Worked Out that Way.

    MA is a creature of the Medicare Modernization Act of 2003. The right-wing of American politics accomplished a coup by setting Medicare on the road to privatization.  Currently over 50% of all beneficiaries have selected it over Traditional Medicare ™.  Federal policy is unfortunately driving Seniors into MA by allowing manipulative practices such as low premiums and a few benefits not available to TA beneficiaries.  Seniors are being led like lemmings into the arms of the insurance industry by disinformation and deceit. Organizations like the AARP in partnership with health insurers like UnitedHealth are the Pied Pipers.  

    MA is one of the most serious threats to the health and well-being of American seniors.  It robs money from care and transfers it into the pockets of investors and executives.  Many beneficiaries are happy with low premiums and add-ons not available under traditional Medicare such as Silver Sneakers plus some dental and vision care.  I can understand why many people who have it are pleased with their coverage.  It works for healthier beneficiaries until it doesn’t.      

    If MA beneficiaries should incur a costly service that is not in network, their assets could be wiped out.  Some retirees have no choice in the matter.  If their company or institution includes health insurance as a retirement benefit, it is most likely MA. Furthermore, I can’t blame anyone who is trying to avoid the premiums for supplemental coverage under traditional Medicare.  Avoiding bankruptcy and depletion of assets through a catastrophic sickness makes perfect sense for TA beneficiaries. But the supplemental insurance is a heavy burden that could be avoided if the Medicare program weren’t diverting so much funding to MA (see discussion below).

Seniors and People with Disabilities Would not be Struggling as Much If Big Health Insurance were not Stealing from Them.

    For seniors and disabled Americans to lose nearly $200 per month of their Social Security and choose between a large payout for supplemental or the risk of bankruptcy, is an injustice when privatized healthcare is stealing hundreds of billions of Americans’ tax dollars, payroll deductions, and hard-earned money through out-of-pocket expenses. The Physicians for a National Health Program (PNHP) has estimated that MA overcharged taxpayers by a minimum of 22% or $88 billion and potentially up to 35% for a total of $131 billion in 2022. If the high end of the estimate were correct, all of Part B premiums ($131 billion in 2022) or Part D premiums ($126 billion in 2022) could be covered by excessive corporate extraction of funds from Medicare.[5]  

    UnitedHealth is noting $25 billion in cash and cash equivalents on its 2023 balance sheet, CVS has noted $12 billion, and Humana is noting $5 billion. They have multiples of these amounts in long-term and short-term investments; they spend hundreds of billions on stock buybacks, dividends, and board and executive compensation. By digging into their assets, the cash rich health insurance business would be able to charge fair prices and stop their criminal behavior without much of a dent in a reasonable return on their investments.

In this Dark Age of Plutocracy, the Superrich & Corporations are Lying and Blaming Government & Ordinary Americans for Poor Healthcare and Excess Expenditures

     Americans earning wages and salaries are being subjected to a corporate network of disinformation and gaslighting.  President Biden is blamed for cutting Medicare when he is in fact attempting to protect the program.  The growing elderly population is blamed for federal debt and deficits when Medicare and Social Security have little impact on the federal budget (SS has none and over half of MC is paid through payroll deductions, premiums, and co-pays).  The nursing home industry blames taxpayers for failing to provide them with enough money to adequately care for the elderly and disabled patients in their beds while they spin a false hardship narrative.

    The Medical-Industrial Complex has established a network of front groups with a duplicitous message of doing good for Americans and has enlisted the aid of do-gooder nonprofits, universities, and individuals. This system and its apparatchiks aren’t all that clever.  Their organizational tactics are rather easy to discern.  The problem is that it is happening stealthily behind the scenes in Washington, D.C. and the 50 state capitals. The media is ignoring it. We intend to expose it and encourage everyone we can to join us in that endeavor.

[1] https://bettermedicarealliance.org/

[2] You can see the ad here: https://www.ispot.tv/ad/2UHG/better-medicare-alliance-cutting-medicare-thats-nuts.

[3] Reed Abelson & Margot Sanger-Katz (2023), “Biden Plan to Cut Billions in Medicaid Fraud Ignites Lobbying Frenzy,” https://w.w.w.nytimes.com/2023/03/22/health/medicare-insurance-fraud.html?searchResultPosition=1.

[4] Medicare Payment Advisory Commission (MDPAC), 2024, p. March 2024 Report to the Congress: Medicare Payment Policy – MedPAC

[5] Physicians for a National Health Program, (2023), Our Payments their Profits: Quantifying Overpayments in the Medicare Advantage Program. MA Overpayment Report (pnhp.org)

Misinformation About Social Security & Medicare is Harming America’s Elderly

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Dave Kingsley

Scapegoating the Elderly for U.S. Budget Deficits & Debt

Pie charts, bar charts, tables, graphs, and other depictions of the federal budget abound in the media. These pictorial representations of what Congress budgets for such things as education, agriculture, health care, and so forth invariably include all of Social Security and Medicare. Hence, they are consistently wrong. None of the expenditures for Social Security are budgeted and have absolutely no impact on the budget or deficits. Less than half of Medicare expenditures are budgeted because beneficiaries pick up a large amount of the costs.

Social Security benefits are “earned” by beneficiaries who have paid in during their working years through a payroll tax. Benefits for each beneficiary are actuarily tracked and payouts are based on what is paid in.

Dr. Max Skidmore, University of Missouri Curators’ Distinguished Professor of Political Science (Emeritus) explains the history and functioning of Social Security in an accompanying blog post today. Dr. Skidmore is a leading expert on Social Security and colleague of those of us contributing to this blog (see e.g. his book Securing America’s Future: A Bold Plan to Preserve and Expand Social Security with a Foreword by former senator George McGovern).

Over Half of Medicare is Paid for by Beneficiaries Through Payroll Taxes, Premiums, and Out of Pocket Expenses. All of Social Security is Off Budget Because it is Earned by Beneficiaries.

In calendar year 2021, Medicare expended $839.3 billion, of which $405.4 billion (48.3%) was budgeted. None of the $1.14 trillion expended by Social Security for earned benefits are part of the federal budget. Hence, my estimation is that of an approximately $5.5 trillion 2022 FY budget, only $.405 trillion (7.4%) was budgeted for all of Social Security (0%) and Medicare (7.4%).

The Harm Done by Misinformation

Claims that the elderly are receiving the biggest share of the annual budget dampens the public’s support for much needed assistance with out-of-pocket Medicare costs, home health care, housing assistance (including assisted living), and other essential services and financial needs for daily living. Financial moguls such as the late multi-billionaire Peter G. Peterson and conservative politicians have been leading a propaganda war against Social Security and Medicare from their inception in the 1930s and 1960s.

Many seniors are suffering due to the cost of pharmaceuticals and co-pays, deductibles, and premiums. Transportation, housing, food, along with medical care and other costs for the needs of daily living are robbing a huge proportion of the growing 65+ population of a decent life in their elderhood. The blatant falsehoods coming from some super rich Wall Streeters and conservative politicians are causing pain for hardworking people who are being denied a decent quality of life. We intend to fight back!

Leading Bioethicists Do Not Believe that the Elderly Have Equal Rights in the U.S. Medical Care System

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Dave Kingsley

Nursing Homes & COVID:  200,000 Fatalities in One Institutionalized Population

Last week, the U.S. officially recognized a COVID death toll of one million U.S. residents.  An estimated 200,000 or 20 percent of those deaths have occurred in nursing homes. At any given time, individuals in long-term care/skilled nursing institutions comprise approximately three-tenths of one percent of the U.S. population.  One would think that an investigation would be under way to determine how such a tragedy could occur in one institutionalized population and who is accountable.

There is no doubt that a huge proportion of these deaths were preventable.  However, due to neglect and greed of corporate providers, paid by taxpayers to care for patients in LTC/SKN facilities, and lax government regulation, COVID was allowed to sweep through institutions housing frail elderly and disabled Americans. This resulted in the largest mass fatality of an institutionalized population in the history of the United States.   

Appallingly, interest in accountability for this human rights atrocity on the part of politicians, the media, the medical professions, government agencies, or any other relevant interest group is nonexistent.  Even two commissions on nursing homes – one specifically charged with investigating COVID in LTC/SKN institutions and one under the auspices of the National Academies Science Engineering & Medicine (NASEM released a report barely a month ago) – ignored the issue of industry culpability.

The industry is culpable.  It was well-known that a novel virus was likely to make its way to the United States eventually.  For decades, scientists have been sounding alarms.  Asian countries learned from the SARS pandemic and issued guideline for protecting patients from raging viral pandemics.  Those guidelines were ignored by the U.S. nursing home industry.

Indifference to an unnecessary mass fatality event is occurring in a context of long-developing denigration of the worthiness and value of elderly and disabled Americans.  Religions and their leaders have been absent from and seemingly uninterested in the plight of institutionalized people needing nursing care. Indeed, many deplorable facilities are affiliated with major religious organizations.

And then there is the question of bioethics and decline of Enlightenment and Judeo-Christian ethics as they pertain to persons needing medical care.  Indeed, the current dominant bioethics movement supports withholding beneficial medical care from the elderly for the sake of the market economy and what they erroneously see as federal budgetary constraints.

The Elderly & Human Rights in a Neoliberal Capitalist Society

As a highly visible extremist Catholic majority on the nine member U.S. Supreme Court “legislates” on human rights for a population of 340 million citizens, a small group of America’s most prominent and powerful bioethicists are engaged behind the scenes in a chilling, ageist movement – mostly in academic journals. Few Americans are aware of the proposals for “rationing” medical care concocted by Daniel Callahan of the prestigious Hasting Center on Bioethics, celebrity physician Zeke Emmanuel, and other well-known bioethicists.[1]

The underlying philosophical/ethical, foundation of these physicians’-academicians’ rationale is a toxic, perverse, combination of utilitarianism and neoliberal economics rather than a profound and humane theoretical framework calling for reinforcement of universal human rights based on Enlightenment values and ethics.  The essence of their reasoning is that the U.S. cannot afford all the medical care needed by the U.S. population, therefore some needed care should be directed away from the elderly to young populations who are of more value to society, i.e., from the less productive to the more productive.

A review of the literature clearly exposes two unexamined and flawed premises of this horrifying philosophical/ethical position: (1) the U.S. economic system cannot absorb the cost of needed medical care for all citizens, and (2) the elderly are not as worthy as younger cohorts.  Proponents argue from these premises to the conclusion that it is OK to shorten the lives of elderly Americans for the sake of reducing costs.

Integral to their position is the concept of a “decent minimum level of medical care.”[2]  Schneiderman defines a decent level of medical care as:

“…a level of medical care that enables a person to acquire an education, seek or hold a job, or raise a family.  Or, if the person, because of impaired health, is unable to meet any of these goals, to attain a reasonable level of function within the person’s limits and respectful of the person’s dignity, as well as a reasonable level of comfort, whether it be from pain or other forms of suffering.”[3]

This statement clearly expresses an opinion contrary to humanistic ethics that grew out of the Enlightenment and formed the philosophical underpinnings of liberal democracy. The bioethicists in this movement have a perspective of human beings through the lens of bioethical utilitarianism in which their right to medical care is reduced to their worth in a radical free-market economic system.  As Schneiderman states: “Without the support of society, the individual would not prosper; in return, I argue, the individual has a duty to recognize society’s needs for productive citizenry.”[4]  He proceeds to claim that “The success of the society depends on the productivity and contributions of its individual members.”[5]

The Context of Rationing Bioethics

As prior quotes suggest, a powerful group of bioethicists are valuing humans for the purposes of medical care based on their value to the economic system.  Without operationalizing “productivity” and “contribution,” they presuppose a declining value of aging human beings because of less engagement in and usefulness to the economic sector of society. Wisdom, life experience, leadership ability, and other contributions needed by an enlightened, democratic society are not only discounted, but given no worth whatsoever. 

As Zeke Emmanuel, the most famous bioethicist in the U.S., wrote in the Atlantic, it is best to die by 75 because life is not worth living past that age and all productivity and contributions cease.[6] Dr. Emmanuel equates “living too long” with living beyond our 75th birthday.  He claims that longevity “robs us of our creativity and ability to contribute to work, society, the world.”  That it “transforms how people experience us, relate to us, and most importantly remember us.  Dr. Emmanuel believes we are, after age 75, “no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

Culling the Herd:  Let the Old Die

At some point in U.S. history, elders were no longer seen as important to the survival of the family, community, and nation.  That sociology and history – the history of transformation of valued elders to useless, dependent old people – has been covered elsewhere.  In radical free market economic systems, individuals not needed are vulnerable.  Public policy tends to reflect the power of industrialists and the economic values guiding politicians.

It has not been uncommon for media personalities to suggest that people dying in nursing homes were probably near death anyway.  So, not a big loss.  As Bill O’Reilly on FOX put it, “they had one foot in the grave any way.”  Some suggested that diseases “cull the herd,” and who better to go than old people. 

In a country as wealthy and advanced as the United States, there is absolutely no reason to deny health care to citizens and other residents based on their worthiness as human beings.  There should be no place in a humane society for “deserving” and “undeserving” people in need of medical care.  Medical ethics require nothing less than deference to physician-patient decisions about needed, beneficial, care.  Unfortunately, in the privatized system now dominating U.S. medicine, the needs of shareholders and executives take precedence over people with medical needs.

[1] See e.g., Daniel Callahan (2009) Taming the Beloved Beast.  Princeton University Press; Lawrence J. Schneiderman (2011) “Rationing Just Medical Care,” American Journal of Bioethics, Volume 11, Number 7, 7-14.; Norman Daniels (2013) “Global Aging and the Allocation of Health Care Across the Life Span” American Journal of Bioethics, American Journal of Bioethics, Volume 13, 2013, 1-2.

[2] Schneiderman, ibid, page 8.

[3] Schneiderman, ibid, page 8.

[4] Schneiderman, Ibid, page 8.

[5] Schneiderman, Ibid, page 8.

[6] Ezekiel J. Emmanuel (2014) “Why I Hope to Die at 75,” The Atlantic, October,2014 Issue. https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/.

What Does Ageism in the Media Look Like? Michelle Cottle’s Article re “The Villages” in the New York Times Today – That’s What It Looks Like.

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By:

Dave Kingsley

The Villages Is Not a Place I Want to Be in Elderhood. No One I Know Wants to Be There Either.

Michelle Cottle, a member of the New York Times editorial board, has demonstrated the type of dangerous stereotypes regarding so-called “Baby Boomers” that recur frequently in mainstream media. In her article today with the blaring headline “The Nihilism of The Golden Years,” she generalizes from attitudes and behavior of a few elderly residents of a senior housing and entertainment enclave in Florida to a group of people born between 1946 and 1964 that now comprises most of the 65+ population in the United States.

I’ve seen a documentary on the Villages and am frankly somewhat embarrassed for my fellow elderly Americans who choose a second childhood over a life of productivity, societal contributions, and family and community leadership. If that is indeed a fair statement about the people who choose to move there in their retirement years. I’ve never been to the Villages, so all I know is what I’ve heard, seen in the media, and learned from the documentary.

Ms. Cottle presents the residents of The Villages as hedonistic and politically oriented toward Trump’s MAGA movement. Two-thirds of a full two page spread was filled with photojournalism displaying golf courses, golf carts, dancing to “Jimmy Buffet’s Margaritaville,” and MAGA demonstrations. This may or may not fairly describe the people living in The Villages, but the article drags the entire group of 65+ Americans into the negativism she focuses on people living there. For instance, toward the end Ms. Cottle writes, “Big Government is eyed with skepticism, even as the aging populace commands an increasing larger chunk of the federal budget for programs such as Social Security and Medicare.”

That article also states that “Baby boomers long accustomed to setting the agenda are being eased out of their slot atop the sociopolitical ladder – especially conservative white boomers.” According to Ms. Cottle, the underlying problem, in the final analysis, are aging Americans: “…the community is a distillation of the cultural crosscurrents at play in an America that is simultaneously graying and diversifying.” I don’t think I need to tell the readers of this blog post how many ugly stereotypes and ill informed generalizations are included in these types of statements.

Scapegoating the Elderly

“Isms,” whether they be racism, sexism, ageism, or any other type of ism such as those against sexual orientation, and religion, are dehumanizing and damaging to the victims of stereotyping. In many cases they are dangerous and can lead to physical harm – indeed often do. A psychological boundary is placed around groups of individuals who are themselves often very diverse and then misinformation is used to scapegoat them. For instance, an aging population or the elderly in general are not causing an increase in the cost of government. That is well accepted in the literature. I have debunked that myth in my own research. I would be happy to supply a list of references to support that.

Not one bit of Social Security is “on budget.” Approximately two-thirds of all Medicare expenditures are paid into the program through payroll taxes, premiums, and other out of pocket expenses. Traditional Medicare and Social Security have administrative costs equal to 1.5% and .9% of revenue respectively. So Ms. Cottle is ill informed and misinforming her readers. These two programs are a model of government run retirement and medical programs. If that doesn’t remain as such, it won’t be the fault of the beneficiaries.

“The Nihilism of The Golden Years” Does Not Represent the 65+ Population of the U.S.

The 65+ population is comprised of veterans, poor people, middle class people, people who have worked hard throughout their lives, and on and on and on when we talk about 70 million Americans 65 years of age or older. They have raised families, robbed banks, worked for corporations at a variety of levels. Some have made a fortune, some are living in dire poverty, some are struggling to live on pensions and Social Security. The variety of people 65 or older is so diverse that it would take a book or volumes to describe it. What we all have in common are needs for healthcare, housing, and basic other living necessities.

Turning a group of people born in an 18 year span of time into a “thing” with negative characteristics is a form of human thinking that has led to more human tragedy and suffering than any other mental disposition characteristic of homo sapiens. It is one reason that we can institutionalize elderly people in subhuman nursing homes and mistreat them. They are seen as a “silver tsunami,” a disaster, a problem. What else are we going to do with them?

Attitudes Need Work in The United States

At Kansas University Medical School, I taught class after class of marvelous graduate students headed into health care professions. I designed and validated an attitudinal survey to measure their attitude toward the elderly. In the next few blog posts, I will report some results from that survey and write about the need to change the way we think of aging. Here is a hint at the findings from my survey: To the item “In the next 20 years, the 65+ population will have the greatest impact on health care costs,” only 12 of 100 of the students responded strongly disagree or disagree. Two were uncertain and the rest either agreed or strongly agreed. This is false and scapegoating. It should concern us.

Thank You For Your Service! Now Go Rot In A Veteran’s Nursing Home!

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By:

Dave Kingsley

As a veteran myself, I find the maudlin, mawkish, displays of affection for military personnel hypocritical and disgusting. Flyovers at football games, the shallow emotional “thank you for your service” cliché, and phony, baloney outpourings of appreciation through little privileges (first in line to get on an airplane) are no-sacrifice forms of super-patriotism that keep the real sacrifice of our troops out of sight and out of mind.

Elderly and disabled veterans in state run nursing homes are certainly out of sight and out of mind these days. We don’t know how many of these places are deplorable and full of neglect and abuse. However, I was initially alerted by family members about conditions in a very large state run veterans’ facility in New York. It appears that that their loved ones are not well treated, nor are they as family members. We are looking at COVID data in that facility and what we are finding is alarming. However, given the resistance of any state to come clean with the information advocates and family members need, we will need to keep fighting this out so that we can find out what really happened.

I’ve been reading the inspection reports for the Kansas Soldiers’ Home in Fort Dodge, Kansas. The staffing levels, condition of the facility, and treatment of patients are shocking. In the state of Missouri, we can’t see the inspection reports online. Missouri veterans’ facilities aren’t on Nursing Home Compare. We are told that we have to go into the facility and ask to see reports for those facilities.

We will stay on this issue. This is just the beginning of our investigation into what is happening to veterans in America’s nursing homes. Let’s not overlook the $788 billion defense budget that sailed through the Senate this week, which doesn’t even include the VA and military retirement benefits. Nor does it include the nuke stuff in the Department of Energy. Can’t we spend an adequate amount on veterans’ in nursing homes in a $trillion military budget?

Watch this blog. We will keep investigating and writing about how our veterans are treated.

This Country Simply Does Not Care About Old And Disabled People: We Are Expendable for the Sake of Profit

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By:

Dave Kingsley

At Least 150,000 COVID Deaths in Nursing Homes & The House Select Subcommittee on the Coronavirus Crisis Doesn’t Even Bother to Mention It.

On any given day in the United States, approximately 1.5 million Americans will be patients in nursing homes. Throughout the year, 3 million people will either be permanent (long-term) or short-term rehabilitation patients in government-funded, long-term care/skilled nursing facilities. During the past two years, these institutionalized individuals have accounted for at least 150,000 of the 800,000 U.S. COVID deaths. Hence, nearly 20% of COVID fatalities occurred in one institutionalized group comprising less than 1% of the U.S. population.

Yesterday the House Select Select Subcommittee on The Coronavirus Crisis under the leadership of Chairman James Clyburn released a report of the committee’s oversight hearings regarding the COVID pandemic. The report entitled “More Effective More Efficient More Equitable: Overseeing an (sic) Improving and Ongoing Pandemic Response” (https://coronavirus.house.gov/news/press-releases/select-subcommittee-s-year-end-staff-report-highlights-oversight-work-releases) makes no mention that I can find of the largest mass fatality occurring in any institutionalized population in U.S. history. Not even the troops during WWI suffered as large a fatality rate from the flu pandemic as have elderly and disabled patients in U.S. nursing homes during the COVID pandemic.

Lack of the public’s interest in accountability for 150,000+ preventable deaths is a signal to the elderly and disabled that we are not valued as human beings. Politicians are acting like “nothing to see there.” The press, the public, and politicians, are ready to move on like “that didn’t really happen.” “Did it?” The nursing home system is sickening and disgusting as it is. But for a society to seemingly not care much about the failure of a very profitable, taxpayer funded industry to properly care for patients in their charge and agencies like CMS failing to make them care amounts to euthanasia by neglect.

I’m outraged that “aging enterprises” aren’t raising bloody hell about the disaster brought on vulnerable, unprotected, aging and physically challenged people. These organizations claim they represent the elderly, but their silence is deafening:

  • American Geriatrics Society (AGS)
  • American Society on Aging.
  • Leadership Council of Aging Organizations (LCAO)
  • National Association of Area Agencies on Aging (N4A)
  • National Council on Aging.
  • Justice in Aging.
  • Alzheimer’s Association.
  • Senior Medicare Patrol.
  • Administration on Aging.
  • National Center on Elder Abuse.
  • AARP
  • Kansas Advocates for Better Care
  • And Many Others

That the boards of these groups and their paid professional staffs haven’t come together in a coordinated effort to hold accountable a very profitable well-rewarded, industry and the agencies of government they have captured (e.g. CMS, KDADs, etc., etc., etc. …… .) is shameful. Congressman Clyburn and other politicians need to hear from organizations purporting to advocate for the elderly and disabled.

Congresspersons and Senators have certainly heard from the nursing home industry. Congressman Clyburn and Speaker Nancy Pelosi both received $10,000 from the AHCA PAC. Indeed, Democrats are beneficiaries of two-thirds of AHCA PAC money. They don’t need to buy the Republicans – they are on board with whatever corporations want. Any hearing, any report, any statement, from a politician regarding the elderly are of dubious value when the politicians involved are taking money from the industry.

I’m afraid that aging enterprises and paid professionals have fallen comfortably into the good ole boy and girl networks operating inside the Washington, D.C. beltway and all of the state capitols. Speaking truth to power is a risk that might get them marginalized and ousted from the group.

Stereotyping the Elderly

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Creating a dehumanizing, negative stereotype is a precursor to harming a demographic segment of a population.  Lack of respect displayed toward older Americans and blamed heaped on them for everything from traffic jams to bankrupting the health care system are evidence of creeping ageism in the United States.

While teaching a class a number of years ago on racism and groupism in general at Kansas State University, I found a full-page Newsweek  photo of nursing home residents sitting in chairs, holding their arms above their heads.  They were being led in exercises by a young woman.  The caption read, “Geezer Boom.”

These older Americans were characterized in the article as helpless invalids who are a burden to younger members of society.  This kind of portrayal of the elderly is pervasive in the mass media and is becoming fixed in the psyche of the under-65 population.  During the recent debates on health care, we heard “unplugging granny” over and over.  This metaphor is supportive of the notion that the fruits of a long life are, at the end, intubation and ventilation.  As I will discuss with very good evidence in a later post, nothing could be further from the truth.

Epithets are evidence of isms such as racism, sexism, gayism and ageism.  I find myself having to confront friends, students, and relatives for using terms like “geezer,” “codger” and “coot.”  These terms may seem funny but they are disrespectful, harmful and insulting.  I have the same concern about using “granny” in the context of plugging and unplugging.

Ageism is characterized by blaming, epithets, infantilization and neglect.  If older Americans can be reduced to being thought of as nothing more than a “pain in the neck,” it will be acceptable to commoditize them as revenue producing objects to be placed in sub-human, profitable, nursing home conditions.