Will consumerism rise again?

For some reason, maybe it’s the stock market, maybe it’s just wishful thinking-of-anything-but-wars-&-health-reform, consumerism is all over the news of late. Summer tourists didn’t tour as much or buy enough, clunkers were eagerly turned in for cars, caution abounds in the land. People are even beginning to save for the rainy days that have not yet cloudburst upon them.

A closer look at all this was taken through a couple of recent studies reported on by the San Francisco Chronicle’s Tom Abate this morning. Abate focuses on California, but the trends are all over.

California will trail the nation in emerging from the Great Recession, as consumers save more and spend less in a behavior shift that will slow growth and job creation in the short term but eventually lead to a stronger economy.

That message emerged from two separate reports released Tuesday by the UCLA Anderson Forecast and Beacon Economics, a consulting practice with offices in San Rafael.

Both forecasts characterized California as the epicenter of back-to-back consumption binges fueled by the dot-com boom and the housing bubble, and argued that now the state faces big adjustments as it recovers from ills that have long plagued the U.S. economy.

“Consumers have been on a spending binge ever since 1995,” said Jon Haveman with Beacon Economics, as soaring 401(k)s and, later, inflated home prices made Americans feel so wealthy they stopped saving money.

California, of course, rather outdid itself in the business of spending too much, buying too much and borrowing to do more of the same, but none of this was peculiar to the left coast.

It did not go unremarked, however, by one of the current candidates for Mayor of New York, Rev. Billy. You don’t know Rev. Billy of the Church of Stop Shopping? You’ve been missing something. The Rev, probably going on the ballot as Bill Talen, does not get the coverage that other candidates do, but he is dead serious about his mission and pretty raucous about delivering the message. He is seriously running for Mayor. He doesn’t like consumerism, or the corporate takeover of America, or war. At times his church becomes the Church of Stop the Bombing. In any event, if we’d been listening to Rev. Billy all these years we might have missed getting in quite so deep a mess — but we’d also have missed a lot of Starbucks lattes.

Now comes word that senior shopping at Walgreen, Rite-Aid and Family Dollar stores is going to be made more comfortable, just in time for Boomers to start turning 65 in 2011. According to a recent Wall Street Journal story by Ellen Byron, in one exercise designed to help participants in a Kimberly-Clark program understand the difficulties confronting senior shoppers, Kimberly-Clark executive Don Quigley tried going through the aisles with dark-tinted glasses, un-popped popcorn in his shoes and his thumbs taped to his palms. This rather hurts my senior-shopper feelings if it is how Rite-Aid sees me, but I will try to appreciate the effort.

It appears that we current savers/cautious spenders are not expected to change back to rampant consumerism overnight, which is good news to the senior seniors of us, brought up so rigorously in the save-first-spend-later mode that we feel better within it anyway.

Ed Leamer, director of the UCLA Anderson Forecast, said consumers usually roar back from recessions with spending that lifts production and fuels hiring, but he thinks that is unlikely during this recovery because Americans have been living beyond their means for too long – borrowing too much and importing more than the country sells abroad.”We need to turn our shopping malls into factories,” Leamer said “Our economy over the next decade is going to have to build more of the stuff we buy.”

Haveman said the painful adjustments now under way should eventually benefit California and the Bay Area, which lead in technology, biotechnology, clean energy and other cutting-edge industries.

“The light at the end of the tunnel is visible, but it’s still a long way off,” he said.

That business about turning shopping malls into factories and living within means — that’s going to please Rev. Billy.

Fundamental economic shift underlies recovery.

Healthcare: Could We Get A Moral Commitment?

Is there a simple way to get universal healthcare in this country? In a word, yes. Or rather, in two words: moral commitment. If we were to make a moral commitment to what is, after all, only the fair, humane, equitable thing to do, author/reporter T. R. Reid told an audience at San Francisco’s Commonwealth Club today, there would be no problem.

Reid, a reporter for the Washington Post, documentary film maker and NPR commentator, was in town to promote his new book, “The Healing of America: A Global Quest for a Better, Cheaper and Fairer Health Care .” In it he tells the story of his journey around the world in the company of a painful shoulder, consultations about which were his introduction to personal encounters with health care systems of every sort. He also met with government representatives and policy makers across several continents.  It is an informative and highly readable (no pun intended, that’s just an appropriate adjective) book.

Reid outlined the four primary models of health care currently in existence on our small planet, each with different versions of who pays and who provides. In Britain’s socialized medicine model, health care is the government’s job and it does both. A “mirror image” of this plan is that put into place in Germany shortly after the country was established in the late 18th century, a “National Health System” in which the providers — doctors, clinics, etc. — are private but the payer — government — is public. Workers are covered through their employers. One advantage to both, Reid points out, is that everyone buys into preventive care. He told of British ads asking passersby if their feet hurt, and urging them to visit a podiatrist right away if so; “It’s free.” Or commercials featuring a coughing “Mum” and giving a phone number to call so a nurse may visit. “It’s free.” Each is aimed at diagnosing other illnesses early, and/or preventing the spread of disease.

The Canadian Medicare (that’s where Lyndon Johnson got the name for our elder care) system now copied by Australia, Taiwan and others would have had Reid waiting an long as a year for consultation and treatment of his shoulder. Although he proclaimed his pain to be a very present issue, it was not seen as an urgent need to the primary care doctor he consulted. It is this often extensive wait for non-urgent care that is most criticized (especially by Americans) about the Canadian system. But Reid got a Canadian answer to that. “We Canadians,” he was told, “don’t mind waiting, as long as rich Canadians have to wait as long as poor Canadians.”

The fourth model cited is the out-of-pocket model, which Reid illustrated with a story of climbing a mountain in Nepal to seek shoulder relief. At the top of the mountain, in an extremely simple one-room building with its four walls painted in four different colors, the doctor explained his payment was generally in whatever the patient could afford. Someone relatively well off might pay in funds, others in whatever they had. Many of the patients could pay only by painting the facility, the doctor said; they seldom had the same color of paint, and thus the many-hued room.

“We have them all,” Reid told a hushed audience: Native Americans and veterans have the British/NHS; over-65, the Canadian Medicare; working people, Germany’s system. But 40+ million Americans have medical care equivalent to Afghanistan or Angola, and tens of thousands of Americans die every year because they cannot afford medical care.

One audience member called Reid on that issue, saying hospitals were required to treat people who came to them, but he was not backing down. True, he replied, if someone is actively dying or about to give birth, hospitals cannot turn him or her away. But for cases (such as one cited at the beginning of The Healing of America) of lupus, or diabetes, or in countless other instances, the inability to pay for necessary care causes ongoing pain and death for thousands.

Other audience questions raised the illegal immigrant issue. In most countries, it simply would not be an issue, he said. Citing Britain as an example, he said “you get (care) whether you’re a citizen or not.” Reid also said the public option is a non-issue elsewhere, because “you don’t need it.” And he threw in another few illustrations that argue for reform: In Britain, you have to cover everyone, you have to pay every claim, and you have to pay every claim fast. In Switzerland, if a claim is not paid within five days, the next month’s premium is free. In Germany you have a choice of well over 100 insurance companies; if you don’t like one, you simply switch to another.

Having set out to answer the question of how other countries provide health care for all of their citizens, Reid said he then turned to the why. Why every other wealthy, industrialized, developed country in the world has universal coverage and the U.S. does not. Others have it, he said, because “they think it’s fairer, equitable, humane, just — and these are moral issues. Health care reflects a country’s moral values.”

It was clear that Reid, like most in his audience, sees the U.S. as having moral values. “If we had the political will,” he commented, “other countries could show us the way.”

But the author was pessimistic about the possibility of universal care coming out of the current reform efforts. Asked how it might somehow come to the U.S., he said it could well be the way Canada’s plan came about; “we might get it state by state.” The Californians listening might have taken heart. Twice that state has passed single payer plans, only to have them vetoed by their governor. Reid suggested that other states might also be ready to implement statewide health coverage.

As to his painful shoulder, its current status was not given. Presumably, it will be necessary to read the book to find out.

An Immigrant, Undocumented, Uninsured

I have a friend I’ll call Maria. She lives in San Francisco, but her story is very probably the same as any number of Marias in Atlanta, New York, Chicago and elsewhere. You may not know her, but I’ll bet your paths have crossed.

Maria came here from Mexico 22 years ago. She has never applied for citizenship, largely because for the first few years she was in the country her English skills were so limited it would not have been remotely possible. Recently she has been afraid to try. Maria has a 20-year-old undocumented daughter, an extraordinarily smart illegal immigrant/recent college graduate niece and a large, extended family of mostly undocumented immigrant adults and American citizen children. The niece, tired of living in a very rough part of town, went online a few years ago and found them some minimally affordable rental housing toward the ocean. They have a strong sense of belonging.

Maria and the other women clean houses for a living; the men work for landscaping companies. They drive cars without licenses because they can’t get licenses. But they are little threat due to the fact that one minor brush with the law and (Maria’s daughter explained to me in some detail) you’re out $1,000 including towing charges and fines.

Maria’s family does not do in-home care; however, there is another large, mostly undocumented community of Pacific Islanders who are highly recommended and routinely called upon when seniors (and others) here require but cannot afford extended nursing care. Not nurses by a long shot, they are nevertheless highly skilled.

Whenever Maria or other members of these communities need medical care they go to the county hospital. If the need is sudden or extreme, they go to the emergency room. Either way, they pay small amounts and they get excellent care. I’m grateful for that. They are all truly good people, honest, hard-working and contributing members of the larger community. They don’t pay income taxes (and have no Social Security accruing) but they buy local, pay their rents on time and add to the economy.

I do not support illegal immigration and am SURELY not advocating health insurance coverage for the undocumented, the very mention of which is enough to sink any reform in a New York minute. But it is a subject of contention constantly just below the national surface — or sometimes above the surface, as with the ill-mannered Joe Wilson.  As reported last week in the San Francisco Chronicle (and widely elsewhere), the current policy is clear:

Under long-standing federal policy, people who are in the United States illegally don’t qualify for federal health programs, and the current proposals for reform in Congress hold to that. With the exception of limited emergency Medicaid primarily for pregnant women and children, and some hospital funding, federal dollars do not pay for the care of people who are in the country illegally.

The health care reform bill in the House explicitly bars “undocumented aliens” from receiving federally subsidized health benefits. A Senate version doesn’t address the issue, suggesting that current policy would remain unchanged. A second Senate bill has yet to be released.

Some would have us go farther, requiring a system verifying immigrant status to be incorporated in the final health bill.

“If you don’t have a provision that clearly requires applicants’ immigration status to be verified, just to state that illegals won’t be covered is misleading,” said Yeh Ling-Ling, executive director of the Alliance for a Sustainable USA in Oakland.

Opponents argue that such verification systems would add a layer of bureaucracy and cost, and unintentionally screen out U.S. citizens who lack proper documentation. They also contend that denying a segment of people access to health care, even if they are illegal residents, could increase costs for emergency care as well as the risk for contagious disease in the general population.

However angry those are who are raising their voices about “illegal aliens,” that last sentence is worth consideration. If you cannot bring yourself to care much about the health of uninvited fellow residents of our corner of the planet, you may still want to look at this reality: treating colds in emergency rooms is an expensive folly; colds left untreated for want of an option breed more colds.

A lot of the anger is easy to understand. The economy has tanked, times are tough, you gotta blame somebody. But until all we documented citizens are ready to quit eating strawberries and drinking wine, and to forgo such niceties as in-home care and mopped kitchens, we would probably do well to care about the lives of our undocumented neighbors.

Via: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/09/11/MN4A19GI9I.DTL#ixzz0R040rESh

Hospital Safety 101: Didn't Mom Teach You to Wash Your Hands?

San Francisco Chronicle Washington Bureau writer Carolyn Lochhead reported today on a new idea somebody had about making hospitals safer: get folks to wash their hands. Hello?

The president of a leading medical standards organization announced a new program Thursday that is designed to improve health care safety practices, starting with a rigorous approach toward hand-washing by hospital staffers.

And this is serious business.

Hand-washing failures contribute to infections linked to health care that kill almost 100,000 Americans a year and cost U.S. hospitals $4 billion to $29 billion a year to combat, said Dr. Mark Chassin, who leads the Joint Commission, which sets standards and accredits hospitals and health care organizations.

Chassin’s announcement came after Hearst Newspapers published the results of an investigation, “Dead by Mistake,” which reported that 247 people die every day in the United States from infections contracted in hospitals.

Anyone who has ever come home from surgery with an infection, or more specifically anyone whose spouse has come home from surgery with an infection (nasty-wound-tending not having been fully explained in those for-better-or-for-worse lines) will applaud the new program, but it’s hard not to wonder what has taken the medical profession so long. Hospitals have found, Lochhead reports, that “caregivers washed their hands less than 50 percent of the time when they should.”

If there’s ever been a good example of potential savings to pay for universal health care, this is one to top the list. Consumers, we who would do well to wash our own hands when visiting or inhabiting hospitals, owe a debt of gratitude to the Joint Commission (and to Hearst Newspapers for the excellent ‘Dead by Mistake’ series.)

Maybe more sinks will be adorned with the sign that gave my husband and me a healthy chuckle during a recent visit to the Kaiser emergency room:

“Hand-wash unto others” it read, “as you would have them hand-wash unto you.”


Hospitals urged to strictly enforce hand-washing.

Obama plays the Medicare card

President Obama, with Vice President Biden and Speaker Pelosi behind him, delivers a joint address to Congress on September 9 (Alex Wong/Getty)
President Obama, with Vice President Biden and Speaker Pelosi behind him, delivers a joint address to Congress on September 9 (Alex Wong/Getty)

For almost anyone over 50, the central issue of health care boils quickly down to Medicare. Will I keep it? Will it be there when I need it? Will it change?

In his address to a joint session of Congress Wednesday night, President Obama looked straight at the camera while saying he wanted “to speak directly to seniors: Medicare has been here for four decades, and is a sacred trust that must be passed down” to future generations. Then he pointed out to those seniors that the legislators opposing his reform plan are the same “folks who voted against Medicare in the beginning” and this year voted for a budget that would privatize it. He said also that much of the plan will be paid for by reducing waste and inefficiency in Medicare and Medicaid. Anybody who’s had (and thank you, I have) Medicare coverage for more than 15 minutes knows about waste and inefficiency. So cut those, and leave the system, and we should all be happy.

We should all be happy, that is, if such care extends to everyone. And if Mr. Obama’s references to the U.S. being the only developed country that lets its citizens suffer daily for want of adequate health care didn’t communicate the moral wrong that reform will attempt to right, you weren’t listening. What we heard was outline, and the president’s throw-away line about a few details yet to be worked out got an expected congregational chuckle. Some of us are more optimistic than others about whether any substantive change for the common good will remain by the time the final bill is drawn.

The details are ahead for the devil to be in, and he/she is surely ready. Whether public support will be forthcoming seems likely to boil down to a whom-to-believe game. Obama repeatedly stressed that “nothing in our plan requires you to change what you have.” But in delivering the Republican response immediately after the speech, Representative Charles Boustany of Louisiana promised listeners that they would be in for “replacing your family’s current plan with government-sponsored healthcare.” Boustany also tossed in references to “rationing care” and to general “fear and anxiety,” giving a distinct impression that battle lines are still drawn.

About those battle lines: Republicans sat on their hands as Obama once again proclaimed the rumors about bureaucrats who would kill off senior citizens — he skipped dignifying Sarah Palin by using the death-panel words — to be “lies, plain and simple.” And although he got the other side of the aisle to stand when he insisted there must be reform of medical malpractice laws, there were no smiles when he pointed out that the cost of health reform will be less than the tax breaks for wealthiest Americans passed during the previous administration.

Somehow, what truths and certainties do exist must be kept alive in the fray: Medicare is not going away. End-of-life conversations won’t kill off grandma. (Sadly, this provision may be already dead anyway.) The plan’s not going to cover illegal immigrants or pay for abortions. Medical malpractice laws must be reformed. Nothing will adequately replace the public option. A health care plan that offers access to all, imperfect or not, is only common decency.

This senior’s trust is still in Barack Obama.

Saving for Retirement Just Got Easier

Those Golden Years we used to hear about might yet come to pass for some — if the Obama administration gets its message across. The New York Times’ Edmund L. Andrews reported Sunday on four new initiatives aimed at helping Americans put aside something for the rainy days of their retirement.

President Obama, noting that millions of Americans do not have enough savings to cover their retirement, announced a package of initiatives on Saturday to spur increased savings.

The administrative actions, which do not require new legislation from Congress, are intended to make it easier and more automatic for people to put money into tax-advantaged retirement accounts.

The new initiatives address a substantial audience. “Half of America’s work force doesn’t have access to a retirement plan at work,” Obama said. “And fewer than 10 percent of those without workplace retirement plans have one of their own.”

Based on “behavioral research,” the initiatives include savings-encouraging devices such as automatic enrollment plans for retirement savings accounts, check-off boxes on tax returns allowing for refunds in the form of U.S. savings bonds, or the payment of unused vacation time or overtime into retirement accounts.

White House officials said the new initiatives would go into effect immediately and come on top of two related proposals that Mr. Obama sent to Congress as part of his budget.

One would compel all but the smallest employers to offer retirement savings plans, and the other would expand the saver’s tax credit, which matches a family’s savings up to $1,000 a year.

Mr. Obama’s mother would probably be bewildered by the need for such initiatives. Savings devices, from employer-sponsored automatic enrollment plans to the ridiculous no-interest Christmas Club monthly deposits so popular with banks (and even with rational people who proclaimed this the only way to accumulate holiday funds), were ubiquitous a generation or two ago. They managed at least to keep a lot of people from going into credit card debt.

Perhaps, if the instant gratification/super-consumer movement can be made to co-exist with the President’s plans, some balance of spending and savings will return to working Americans. Now, if a few more Americans can just find jobs…

via Obama Outlines Retirement Initiatives – NYTimes.com.

New Way to Count Old Poor

As if there weren’t enough bad news to go around, a new(ish) formula for calculating the national poverty rate could boost the number of over-65 poor from 9.7 percent — or 3.6 million of us — to 8.6 percent, or a hefty 6.8 million. Just like that, the poor get poorer; or in any event they get to be more of us.

It’s not really a new formula, it’s a revision of the half-century-old National Academy of Science’s formula…

which is gaining credibility with public officials, including some in the Obama administration. The original formula, created in 1955, doesn’t take account of rising costs of medical care and other factors.

If the academy’s formula is adopted, a more refined picture of American poverty could emerge that would capture everyday costs of necessities besides food. The result could upend long-standing notions of those in greatest need and lead eventually to shifts in how billions of federal dollars for the poor are distributed for health, housing, nutrition and child-care benefits.

Using this formula, overall poverty in the U.S. would rise to an estimated 15.3 percent, or 45.7 million.

The current calculation sets the poverty level at three times the annual cost of groceries. For a family of four that is $21,203. That calculation does not factor in rising medical, transportation, child care and housing expenses or geographical variations in living costs.

I’m not at all sure my current family of two could eat (OK, and drink too, with an occasional dinner out) on $21,203. It may certainly be time for a re-calculation. And a little more help.

via New measure doubles number of elderly poor.

Health Reform: The Mystery

Facebook friends of mine in the past few days have been turning up with a status line that reads, “No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree please post this as your status for the rest of the day.”

Well, I do agree. I haven’t posted it as my status yet, mainly because my True/Slant posts get posted as my status, and enough is probably enough. But I’ve been curious because friends who are not even Friends of friends have been posting it, some with additions (“I’m just sayin’…”) or (“E-mail your representatives!”)

So I just checked out Open Salon, and there’s OESheepdog’s blog reading “From my friend Leigh Bailey: “No one should die because… etc” followed by a long list of affirmative reactions. My personal favorite was John Blumenthal’s comment, “You’re right, of course, but I wouldn’t lose any sleep if someone took Glenn Beck’s insurance away. Pre-existing stupidity.”

But the question remains, Did OESheepdog’s friend Leigh Bailey start the whole movement? Kathleen Sebelius? Nancy Pelosi?

I’m just askin’.

Reforming US health care is not the end of the world – OEsheepdog – Open Salon.