By Emma Curchin, Brandon Novick and Peter Hart | –

( Commondreams.org ) – The quasi-privatized system called “Medicare Advantage,” otherwise known as Part C, was created in 2003 as a means of expanding the role of private sector corporations in the publicly-funded Medicare system. Proponents claimed it would lower costs and improve health care for seniors. It has achieved neither of those goals; instead, MA has become a wildly profitable scheme for private insurance giants, who have become adept at taking advantage of Medicare’s billing model to claim exorbitant profits. At this point, MA is more profitable for many companies than their conventional insurance businesses.

And the program continues to grow. Medicare Advantage now has more enrollees than traditional Medicare, thanks in no small part to aggressive public relations campaigns that sell seniors on the idea that the plans cut costs and increase choice. Congress has simultaneously failed to plug the holes in traditional Medicare, pushing seniors towards MA to avoid high out-of-pocket costs. Policymakers can fill these gaps and guarantee true comprehensive coverage simply by redirecting the overpayments to MA insurers into Medicare.

Numerous studies and media investigations have documented the problems with Medicare Advantage. What follows is a collection of some of the most notable figures documenting the high costs of this failed experiment in privatizing Medicare.

$88-$140 billion
The amount that the federal government overpaid private insurers under Medicare Advantage in 2022, according to the Physicians for a National Health Program (PNHP).

$612 billion
The amount that Medicare Advantage plans overcharged the federal government due to upcoding and favorable selection between 2007 and 2023, according to the Medicare Payment Advisory Commission (MedPAC), an independent congressional agency established to advise Congress on issues affecting the Medicare program.

$600 billion
According to one study, this is the projected excess spending between 2023 to 2031 due to the ways that Medicare Advantage plans use ‘upcoding,’ the process of classifying beneficiaries as being sicker than they really are in order to increase payments.

$35 billion
The amount that MedPAC estimates taxpayers will overpay MA insurers this year through ‘favorable selection,’ the practice of targeting healthy seniors for their plans.

$4.2 billion
The amount that MA insurers received for questionable home visit health risk assessments (and related chart reviews) in 2023, according to an October 2024 report from the Department of Health and Human Services.

80 percent
The percentage of mental health providers in a sample of MA plans that were determined to be “ghosts” (meaning they were unreachable, not accepting new patients, or not in-network), according to a recent Senate investigation.

1.8 million
Estimated number of Medicare Advantage customers whose health plans will be canceled in 2025.

167 percent
The amount that drug deductibles will increase for roughly two-thirds of all Medicare Advantage enrollees next year.

55.7 percent
The increase in MA care denials from 2022 to 2023, according to research from the American Hospital Association.

Image by Darko Stojanovic from Pixabay

54 percent
The increase in the denial rate for long-term acute care hospitals in Humana’s Medicare Advantage plans from 2020 to 2022 (Senate Majority Staff Report, 10/17/24).

$660 million
The amount of taxpayer money that CVS/Aetna stashed away in 2018 by denying Medicare Advantage patients’ claims for treatment at inpatient facilities (Senate Majority Staff Report).

78 percent
The percentage of physicians in a 2023 American Medical Association survey who said that Medicare Advantage’s prior authorization processes caused a recommended treatment for a patient to be abandoned.

$6 billion
One estimate of the amount spent in 2022 on the marketing companies that work to attract new subscribers in Medicare Advantage plans.

556,068
The number of English-language TV commercials touting Medicare Advantage that aired during the seven-week open enrollment period in 2022.

$50 billion
The amount that the Wall Street Journal estimates private insurers received between 2018 and 2021 for “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments.”

$2,329
The amount that MA insurers receive per beneficiary above the estimated costs of Medicare.

$1,730
The gross profit margin posted by MA companies in 2021 – more than double their profit margin on the individual market.

$172 million
The amount that Cigna agreed to pay in 2023 to “resolve allegations that it knowingly submitted and failed to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees to increase its payments from Medicare.” The Justice Department continues to investigate similar allegations involving other MA providers.

Emma Curchin

Brandon Novick

Peter Hart

A report published by the United Nations Commission regarded Israel’s attacks on Gaza’s health facilities as war crimes and crimes against humanity. Chair of the UN Commission, Navi Pillay, stated: “By targeting healthcare facilities, Israel is targeting the right to health itself, with significant long-term detrimental effects on the civilian population. Children in particular have borne the brunt of these attacks, suffering both directly and indirectly from the collapse of the health system.”

Moreover, Israel’s assault on the Palestinian healthcare sector has been unparalleled in its inhumanity. An analysis by the charity Save the Children, covering the period from October 7, 2023, to early April 2024, showed that the rate of Israeli attacks on healthcare in Gaza is higher than in any other conflict worldwide since 2018. According to Save the Children, on average, Israel carried out 73 attacks per month on Palestinian healthcare facilities. Ukraine followed with 67 attacks per month, while the Democratic Republic of Congo averaged 11 attacks per month.

As part of Israel’s strategy to destroy the health sector, it has also targeted healthcare staff. For example, last May, Dr. Adnan Al Bursh, head of the orthopedic department at Al-Shifa Hospital, was reportedly abducted by the Israeli army and tortured to death. After one year of the Israeli war on Gaza, an estimated 986 Palestinian healthcare personnel were killed by Israel, along with 85 civil defense workers. Al Jazeera indicated that 34 hospitals and 80 health centers became inoperative, in addition to the destruction of 131 ambulances.

International healthcare staff in Gaza do not feel safe from Israeli attacks either. For instance, in the previously mentioned Save the Children report, Dr. Simon Struthers, a pediatrician at a field hospital in Rafah, stated: “We can’t take risks and must be careful which route we take because of what’s going on. We’re fearful of what’s coming from Israeli forces, rather than the local population, who are very supportive of us.”

Human Rights Watch (HRW) argued last year that the Israeli military’s persistent and seemingly illegal assaults on healthcare facilities, staff, and transportation were further dismantling Gaza’s medical infrastructure and said that they should be examined as potential war crimes. The HRW quotes special adviser on Palestinian health A. Kayum Ahmed: “Israel’s repeated attacks damaging hospitals and harming healthcare workers, already hard hit by an unlawful blockade, have devastated Gaza’s healthcare infrastructure. The strikes on hospitals have killed hundreds of people and put many patients at grave risk because they’re unable to receive proper medical care.”

Sadly, many Palestinians may have died from natural causes and diseases such as cancer, diabetes or other treatable conditions, whose lives might have been saved if not for Israel’s destruction of Palestinian hospitals. These victims are not counted among those who died due to direct Israeli fire, though their deaths can still be attributed to the conditions created by the occupation and blockade. Even in times of ceasefire, Palestinians will continue to die unnecessarily as it will take time for the Palestinian healthcare sector to recover to its previous state—which was already severely under-resourced due to Israel’s longstanding blockade on Gaza.

You may think that the circumstances of the Gaza War explain this attack on Palestinian healthcare. In fact, the targeting of healthcare facilities is not a new tactic in Israel’s conflict with the Palestinian people. According to a 2017 report issued by the charity Medical Aid for Palestine, 147 hospitals and clinics, along with 80 ambulances, were either damaged or destroyed in Israeli military offensives on Gaza between 2008 and 2017. Additionally, 145 medical staff, most of them ambulance drivers, were either injured or killed. In the West Bank, between October and December 2015, there were eight armed Israeli raids on Palestinian hospitals. The Palestine Red Crescent Society (PRCS) documented 92 instances of damage to ambulances and 147 injuries to medical workers.

Considering the scale and history of attacks on the health sector and the targeting of Palestinian healthcare personnel by Israel, along with the failure of governments and the international community to hold Israel accountable — often appearing complicit — healthcare professionals and their representative bodies across the world should show solidarity with their colleagues in occupied Palestine. Healthcare organizations should also express their support by boycotting healthcare products produced in Israel and its illegal settlements before it is too late.

—

Bonus video added by Informed Comment:

Al Jazeera English: “Israel shells Kamal Adwan Hospital in northern Gaza”

Although U.S. television news has firmly swept Gaza under the rug, the campaign against its civilians of Israeli Prime Minister Benjamin Netanyahu is ongoing. On Saturday morning, an Israeli airstrike on a house in Jabalia killed 32 Palestinians, bring the death toll to 44 just in the early morning alone.

Some 70% of those killed by Israeli forces in Gaza have been women and children, according to UN Human Rights Office (OHCHR). Counting confirmed deaths, the US said that Israeli forces killed eighty percent in residential buildings. CNN reports that OHCHR announced that it had found a consistent pattern of “high numbers of babies and young children, women, older persons, and families killed together in residential buildings.”

Regarding the famine, the head of the World Health Organization, Tedros Adhanom Ghebreyesus, posted on “X”:

Deeply alarming — @theIPCinfo warns there is a strong likelihood that famine in northern #Gaza is imminent.

We call for an immediate scale-up and safe access for humanitarian aid — primarily food and medicines for severe malnutrition — within days not weeks. https://t.co/YZtdPs4RXk

— Tedros Adhanom Ghebreyesus (@DrTedros) November 8, 2024

The IPC panel report “classified the entire Gaza Strip in IPC Phase 4 (Emergency) acute food insecurity.”

Phase 4 is defined as follows: “At least 20 percent of households in an area are experiencing Phase 4 or worse outcomes, and acute malnutrition rates are expected to be between 15 and 30 percent.”

The panel report added, “One hundred and thirty-three thousand people were classified as facing catastrophic food insecurity.” That is the entire population of Pasadena, California.

Catastrophic food insecurity is defined as “Even when using all of their coping strategies, people have almost no food and cannot support their basic needs. Starvation, death and destitution are apparent.”

They say that a risk of famine exists for all of Gaza for the next five months, and the odds would rise with heavy fighting.

“Famine,” Digital, Midjourney / Clip2Comic, 2024.

The IPC panel observed, “On 6 October 2024, Israel designated all of the northern Gaza Strip as a combat zone and ordered the entire civilian population to evacuate.”

The panel cautions that the availability of food in the Gaza Strip must be understood in the context of a collapsed food system. The report says that aid shipments into Gaza were lower in October, 2024, than at any time since the conflict began over a year ago. The panel says that the World Food Program is reporting that the average daily number of trucks entering Gaza dropped to just 58, the lowest since November 2023. Before the war, as many as 500 aid trucks entered Gaza daily — a necessity, since the Israeli government had blockaded the Strip.

And this low number of food shipments is being recorded at a time when severe food insecurity, escalating malnutrition, and the looming threat of famine were already evident in the northern governorates. The threat is especially potent in places where there is armed combat.

I then decided to explore the question with friends, including a retired teacher; a writer, a truckdriver, a community activist, a certified nursing assistant (CNA), and a poet.  And here is what they had to say.

“Walking in nature, I feel at peace.  I can hear that still small voice inside me, which we all have, that is often obscured in the hustle and bustle of daily life.”                                                                                                …….

Another said, “Because I have been living with Stage 4 cancer for over 6 years, I am focusing each day on becoming more deeply my true self.  I spent my first 17 years dodging the daily penalties of being myself. I learned by the age of 4 that in order to survive (at least psychically), I needed to follow my mother’s rules to the “t.”  Those rules made me small.

So, in these remaining days, I am consciously asking myself how I want to interact with the world around me.  I feel my true self when I communicate honestly – my values, passions, fears, joys, and decisions — not in a way to be contentious, but simply to let others know who I am — the deep, wide person I have always been.”

         ……

“When I am behind the wheel of the truck [an 18-wheeler]. I’m happy with what I do and it gives me purpose, moreso since my wife died.  It helped me get through.”

         ……                                                                                              ——

         “When I am walking in nature, stopping every few moments to gaze at a life form that astonishes me with its beauty—then I feel my truest self. I am one of those life forms (not the chief one) and an admirer and comrade of all the others.

When I set aside my own concerns of the moment and listen with full attention and compassion to another and with my listening provide the condition for her to find a portion of her truth and bring that truth out into the world, I feel my truest self. The world acts as if speaking is the big deal. It is a big deal but give listening its due: Deep listening enables speech. And as for compassion: There is a kind of knowledge that cannot form inside someone, cannot exist, without the presence of compassion.” 

         ——

“’Thich Nhat Hanh wrote, “‘You are not an isolated being. You are made of ancestors… There is no separate self.  We are a current.  We are a stream. We are a continuation.’” I was born in the babble of Stonecoal Creek, lapping the banks of Besoco, West Virginia. I am a wave in the mountain streams of my ancestors. We are one tributary, each generation flowing into the next.

My true self appears as a turtle, bravely and quietly revealing its sunbaked head in tender moments, in which the interconnectedness of life, and the spirits of my ancestors, and the shared trust of a vulnerable heart are all felt, or in the peaceful ambiance of a solitary occasion, before retreating to its hard shell.”

……

“When I am hiking in nature where I feel the true beauty of life.”

Pondering the question When am I my true self also led me back to some of the most authentic human statements/actions I have encountered over the years of writing on war and peace: those of veterans who spoke searingly against the immorality of the wars in which they fought.  Tens of thousands of US recruits and soldiers have declared themselves conscientious objectors to war, have gone AWOL or refused to re-deploy, risked prison, rejected their war medals in a public act of conscience. Their voices, like that of poet Namaya, have a deeply moral tenor:

“I burn with the shame
Of our wars!

Our shame should burn as bright
as the phosphorous bombs
that we dropped in Vietnam…”

This past August three 18-year-old Israeli conscientious objectors “declared their refusal to enlist” in required military service. Their reasons rise from the depths of their true, ethical selves.

Yuval Moav: “If you ask me why I refuse today, the answer is, ultimately, because of refusing to participate in genocide. I’ve been met with violence [for my decision]; but I will keep going.  The war has only strengthened my decision.”

Oryan Mueller: “Refusal is like holding up a mirror to Israeli society, first of all to show that it is possible to resist the militaristic death machine and the cycle of bloodshed. We don’t have to take part in it.”

Itamar Greenberg: “After growing up in an ultra-Orthodox home…I left religion and…this directed me to justice…I think the decision to refuse is a direct result of that.”

May they inspire their generation everywhere.

( Tomdispatch.com ) – After Joe Biden was shuffled off stage on trumped-up charges of senility, I started thinking seriously about the weaponization of old age in our world. Who gets credit for old age and who gets the boot?

At 86, I share that affliction, pervasive among the richest, healthiest, and/or luckiest of us, who manage to hang around the longest. Donald Trump is, of course, in this same group, although much of America seems to be in selective denial about his diminishing capabilities. He was crushed recently in The Great Debate yet is generally given something of a mulligan for hubris, craziness, and unwillingness to prepare. But face it, unlike Joe B, he was simply too old to cut the mustard.

It’s time to get real about old age as a condition that, yes, desperately needs and deserves better resources and reverence, but also careful monitoring and culling. Such thinking is not a bias crime. It’s not even an alert for ancient drivers on the roads. It’s an alarm for tolerating dangerous old politicians who spread lies and send youngsters to war, while we continue to willfully waste the useful experience and energy of all ages.

We have to weaponize old age for good causes. We have to shake a mindset that allows us to warehouse people because their presence is an inconvenience while covering up for those with money and power. Out of shame or guilt or that feeling of elder helplessness, even smart old people all too often go along with arbitrary cut-off dates. I remember my dad, at 75 and retired, inveighing against the “dead wood,” especially in his field (education) that blocked progress and discouraged young energy and innovation. By 75, he maintained, people were sliding downhill, which was his way of justifying being shelved himself. He became increasingly depressed and listless, not because he was too old but because he had been made to feel useless.

Then, at 76, he was given the chance to help other old people with their tax returns and, ultimately, their confrontations with local government. He promptly perked up and became an active advocate for elder rights until his accidental death at 100.

My old friends and I talk constantly about our aging, how to suffer it, outwit it, gang up on it, or even strategically give in to it. We’ve decided that nobody in power is doing anything meaningful about it because, beyond exploitive eldercare, they haven’t figured out how to turn a profit.

Meanwhile, the really rich coots like Rupert Murdoch, at 93, are still tomcatting around and fussing with succession plans, while Warren Buffet, at 94, is cagily toying with his billions to avoid inheritance taxes.

Those old boys are anything but role models for me and my friends. After all, they’ve been practicing all their lives how to be rich old pigs, their philanthropy mirroring their interests, not the needs of the rest of us. In my pay grade, we’re expected to concentrate on tips from AARP newsletters on how to avoid telephone scams and falls, the bane of the geezer class. And that’s important, but it’s also a way of keeping us anxious and impotent.

Those Falls

This screed isn’t just the product of my stewing over old age. An incident in the parking lot of a big box store on the day after The Great Debate set me off.

Here’s what happened: An elderly man in the car beside mine stepped out of the driver’s seat, lowered his cane to the concrete, and pitched over flat on his face. His wife immediately ran to him from the passenger’s seat. I got there next, phone out, and asked her if I should call an ambulance. She was adamant: No! Within two minutes there were six of us, including four elderly gents, helping him turn himself over and sit up. There was no blood on his face, just one skinned kneecap.

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He shook off attempts to help him stand, looking angry, humiliated, and embarrassed. I finally rolled a shopping cart next to him and he used it to clamber to his feet. Even with his cane planted on the concrete, he still seemed shaky, but he got right back in his car with his wife and hurriedly drove off. The rest of us looked at each other and wordlessly drifted away.

I then sat in my car trying to sort out what I had just experienced. On the one hand, the quick response of a largely elderly crew was thrilling proof that we were still up for the game, that we could still help each other. But I found the embarrassed, almost hostile response of the fallen man — and the wife who obviously knew what he wouldn’t stand for — discouraging. Why hadn’t he acknowledged our desire to help him? Why had he driven off so brusquely without even checking himself out?

And why should he have felt so obviously mortified by a common accident? Because it was such a marker of old age? Why hadn’t the rest of us, me included, tried to be more persuasive about helping him? Were we too inappropriately understanding of old age’s sense of vulnerability, weakness, helplessness? The seeming diminution of manhood? Would a woman have acted differently?

I then mentioned it to a woman — my wife Lois and she promptly asked me, “Did it remind you of your fall?”

How had I forgotten that?

Just last winter, while walking the dog, my legs had slid out from under me on my icy driveway. I was suddenly flat on my back. I thought about inching down the driveway to a fence where I might be able to pull myself up. It would be a long trip, but…

A voice suddenly boomed out behind me. “You alright?”

“I’m fine, thanks,” I said as cheerily as I could.

“Yeah, right. It’s Jim Read.”

The local chief of police! I felt embarrassed. Strong hands boosted me up, guided me down the driveway to safe ground, and frisked me for broken bones. I barely had a chance to say thanks, before he was back in his patrol car, pulling away.

A few months later I ran into him. He shrugged off my thanks, as if he either didn’t remember my fall or considered it too commonplace to dwell on.

Role Models

Those incidents stay in my mind as symbolic of how routinely we oldsters shrink from confronting our vulnerabilities. And then I thought about two people I had once known and one I still see who faced them head-on

My prime role model, my dad, helped form my attitude toward aging and, in my own old age, he — or at least his memory — lives with me still. Above all, he taught me not to be afraid of the whole process. The second crucial figure — remember for years I was a sports reporter for the New York Times — was New York Yankee and then New York Mets manager Casey Stengel who showed me how aging could be used, for better and for worse. And my current inspiration, the 95-year-old artist Jules Feiffer, continues to offer me a blueprint for having a late working life. What they’ve all taught me is this: once you’ve accepted that you’ll look, feel, and be treated differently in old age, you’re also ready to accept the fact that you can be the master of your attitude and response.

I met Stengel in 1962 at the first spring training of the New York Mets. He was then 71 years old, incredibly old to the 24-year-old sportswriter Robert Lipsyte. (And remember that “old” started much sooner then.) He was bitter at having recently been fired after a long and historic winning career with the Yankees. “I made the mistake of getting old,” he would tell me.

Most sportswriters readily accepted the decision of the Yankees and treated Stengel as a comical figure, too old to manage effectively. They wrote him off as “the ol’ Perfesser” and his rambling monologues as nonsensical “Stengelese,” when all conversation with him required was careful attention. (Mind you, I’m not innocent here. More than 60 years later, I still cringe at descriptions in articles I wrote then of his “pleated face” and scuttling, crab-like gait.)

Stengel could be cruel. One spring, he called a press conference and trotted out the two least talented rookies in training camp. He regaled the sportswriters with predictions about their potential and how they represented the future of the brand-new Mets. National and local press and TV outlets featured them. A few days later, they were cut from the team and never heard from again, corollary casualties of Casey’s revenge on the media.

At the time, I felt sorry for those young players. But even as one of the victims of his nasty prank, I couldn’t help appreciating how he had used our ageism against us. We swallowed his story. After all, how could that old coot bamboozle us?

But there was another side to Casey. That same first season with the Mets, on a muggy night in Houston during pre-game batting practice, I watched him respond to a middle-aged man, dragging a sullen-looking teenage boy, who beckoned from the stands. “I wonder if you remember me, Case,” he said, mentioning his name. “I pitched against you in Kankakee.” (He was referring to a pre-World War I minor-league team in Illinois at the start of Stengel’s long playing career.) The teenager kept trying to pull his father away.

Casey read the situation. He said, “The old fireballer himself. Why I was sure glad when you quit that league, I never could hit you a-tall.” Casey kept talking until it was time to manage the game.

The man and the boy returned to their seats, grinning, shoulders bumping. When I caught up to Casey, he just shrugged and then admitted he had no memory of who the man was.

Later, I told the story to one of the “Stengelese” sportswriters and he suggested Casey had staged the scene to impress the New York Times’s soft-hearted, liberal rookie reporter. “You should write that,” I responded. “It’s another way of looking at him, proves he’s still pretty sharp.”

“It’s not what the fans and the editors want,” the older sportswriter said. “They like the nutty old-fart stuff. It sells.”

The nutty old-fart stuff still sells — in the case of Joe Biden as a way to diminish, dismiss, or even demonize him. Soon after his debate debacle with Donald Trump, a stylish young editor at GQ asked me to write an old man’s take on the president’s situation, a welcome nod to experience. The first thing I thought of was how hard it is for any of us to give up what I call “the warm,” that cheering spotlight of attention. I thought of heavyweight champion Muhammad Ali, who I had ever so long ago covered as a reporter and how, in his final fights, he was humiliated because he couldn’t acknowledge getting older, losing strength and power, stuck as he was in the victory culture male’s sense of power and triumph, of never surrendering.

Biden must have shared that until he committed what functionally was political suicide, even if it was acclaimed as a selfless sacrifice.

My current inspiration, my friend and former neighbor Jules Feiffer, the famed Pulitzer Prize-winning cartoonist, is seriously hearing- and sight-impaired and can barely walk. But he can still think, laugh, and draw. Every day.

Jules is one of those “shining examples” — especially after his first attempt at a graphic novel for middle-graders, Amazing Grapes, just got a rave review in the New York Times and tons of attention (mostly because I’m so old,” he assured me). But it’s his spirit, often mislabeled as “youthful” instead of humane, that offers hope. Even as he admittedly struggles to hang on to what’s left of his Bronx-born American dream in the Age of Trump, he never gives up on himself or his ability to keep nudging his readers toward their own sense of possibility and change. His nearly completed next book — yes, there already is one! — will be an illustrated commentary on his (and our) strange times.

Okay, so where do I go from here? In fantasy, Dad, Casey, and Jules would make a fine team to deal with this increasingly disturbed and disturbing world of ours. If only. But how exactly do we put such a team together? We’re all short-timers, no matter how old we get, but we can’t let the bad guys wait us out. We need to treat old age as an identity and ourselves as part of an ethnic-style group deserving attention.

Yes, it does seem that old age almost always arrives at a bad time and it’s hard to kick the bad guys in the butt when you can’t raise your knee. And somehow the shining examples of individual super seniors like Dad, Casey, and Jules tend to remain just that — shining examples — rather than models for small-scale collective action.

But consider this my call to (old) arms. After all these years, haven’t we earned the right to be loud and obstreperous?

A Gang of Elders

As the former president of my town’s senior citizen organization let me tell you this: old age is just a wrinkled extension of who you’ve always been, whether you end up frolicking in a golf cart at a luxury retirement community or waiting in semi-darkness for Meals on Wheels.

The board of my group was made up of a dozen oldsters who variously worked remarkably hard or were remarkably lazy, proved innovative or simply obstructive in distinctly alert or zombie-like modes — pretty much, I thought, as they must have acted all their lives. The nice ones could be passive, the mean ones relentless. Institutional memory was generally a good thing, but all too often presented itself as numbing anecdotage. Those seniors I dealt with then defined themselves by class, education, or economic position, but rarely age. Beyond creaky joints, treated with wry humor, and recommended doctors, old never seemed to be a shared identity.

Why not? Maybe because we didn’t have a clear social mission. The group’s main job was supporting — by fund-raising and lobbying — the town’s senior services, mostly nutritional and logistical. We did that well, from buying an $85,000 wheelchair-accessible bus to renovating the local church kitchen that serves much of the food at senior events. But we could never get it together for the next major step — creating a political force. Maybe we could get seniors out on election day, but we couldn’t get them to vote for the candidates that might serve their immediate interests, much less help deal with climate change, water quality, community housing, medical and healthy food accessibility, and the like.

We couldn’t mount a resistance. We couldn’t recapitulate the spirit of the Gray Panthers, the group formed in 1970 to combat forced retirement, reform nursing home practices, and protect social security. Founder Maggie Kuhn said: “Old age is not a disease — it is strength and survivorship, triumph over all kinds of vicissitudes and disappointments, trials and illnesses.”

The Gray Panthers were created to be an intergenerational group although its energy came from the anger and experience of its older members. The Gray Panthers exist, working for peace and equal rights. Understandably it’s not a commercially sexy group and doesn’t get a lot of publicity. Still, in the age of Donald Trump, go join them anyway and remind the world that he is not what it means to be old, although statistically he would be our oldest president if the worst-case scenario occurs in November.

Or start your own club. Be a club of one. Register old people to vote and drive them to the ballot box. Don’t be shy. What have we got to lose? They can’t eat us, can they? Sharpen the end of your cane, affix spurs to the front of your wheelchair. Die trying.

While you’re at it just try not to fall. And if you do, let someone help you up.

Copyright 2024 Robert Lipsyte

Via Tomdispatch.com

“Our private, profit-driven system means that we are paying more for less,” said one progressive activist.

Jake Johnson

( Commondreams ) – A report out Thursday shows that the United States’ for-profit healthcare system still ranks dead last among peer nations on key metrics, including access to care and health outcomes such as life expectancy at birth.

The new analysis from the Commonwealth Fund is the latest indictment of a corporate-dominated system that leaves tens of millions of people uninsured or underinsured and unable to afford life-saving medications without rationing doses or going into debt.

“Despite spending a lot on healthcare, the United States is not meeting one of the principal obligations of a nation: to protect the health and welfare of its residents,” the report states. “Most of the countries we compared are providing this protection, even though each can learn a good deal from its peers. The U.S., in failing this ultimate test of a successful nation, remains an outlier.”

People in the U.S., which spends roughly twice as much per capita on healthcare as other rich nations, “live the shortest lives and have the most avoidable deaths,” Commonwealth noted, pointing to frequent “denials of services by insurance companies” and other systematic defects of the American system, including massive administrative costs.

Image by Stefan Schranz from Pixabay

Meanwhile, insurance giants and pharmaceutical companies are raking in huge profits, benefiting in particular from the growing privatization of Medicare. More than half of the Medicare-eligible population in the U.S. is currently on a privately run Medicare Advantage plan.

“Our private, profit-driven system means that we are paying more for less,” progressive activist Jonathan Cohn wrote in response to the Commonwealth report.

The Commonwealth Fund’s findings bolster progressives’ case for transitioning to a Medicare for All system that would provide comprehensive coverage to everyone in the country for free at the point of service. Studies have repeatedly shown that such a program would cost less than the immensely wasteful for-profit system—which is set to drive national healthcare spending to $7.7 trillion per year by 2032—while saving lives.

Commonwealth observed Thursday that while affordability “is a pervasive problem” in the U.S., Australia “offers free care in all public hospitals, and the nation’s universal Medicare system provides all Australians with coverage for all or part of the cost of [general practitioners] and specialist consultations and diagnostic tests, with additional subsidies available for private hospital care.”

“The U.S. continues to be in a class by itself in the underperformance of its healthcare sector,” the report continues. “While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.”

With the U.S. presidential election less than two months away, neither 2024 candidate for the two major parties has outlined a detailed healthcare proposal thus far.

Former President Donald Trump, the Republican nominee, said during last week’s debate in Philadelphia that he merely has “the concepts of a plan,” while Harris—who once co-sponsored Medicare for All legislation in the Senate—said she “absolutely” supports “private healthcare options” and wants to “maintain and grow the Affordable Care Act.”

Just days after the debate, Sen. JD Vance (R-Ohio)—Trump’s running mate—said the Republican nominee prefers a system in which “a young American” and a “65-year-old American with a chronic condition” are not placed in “the same risk pools,” suggesting a rollback of the ACA’s protections for people with preexisting conditions.

“You can’t really say people with preexisting conditions are protected if they are in a separate insurance risk pool and can be charged exorbitant premiums,” Larry Levitt, executive vice president for health policy at the research group KFF, wrote in response to Vance’s comments.

Via Commondreams

Licensed under Creative Commons (CC BY-NC-ND 3.0).

Others among the victims of Monday’s bombardments were innocent male noncombatants, though note that the genocidal discourse in Israel alleges that there are no innocent Palestinians. The Israeli military is likely counting as Hamas militants all the able bodied males killed. As this carnage has become daily and routine, it has ceased being reported as significant news. As far as I can tell, US cable news simply ignores Gaza most of the time, with rare exceptions.

Although we concentrate on the estimate of at least 41,226 people killed in Gaza by Israeli bombs (and this is a gross underestimate) we often forget about the 95,413 wounded.

The World Health Organization estimates that 25% of of the wounded have undergone severe trauma (loss of limbs, severe burns, etc.) and require rehabilitative health care. That is, their injuries are life-changing.

TRT World Now: “WHO: 22,500 wounded Palestinians require long-term rehabilitation”

The estimate is based on records from Emergency Medical Teams on the ground in Gaza in the first half of this year

Injuries to major extremities — feet and hands — constitute a significant proportion of these injuries. WHO writes, “the majority are likely to be lower limb injuries, including complex fractures with peripheral nerve injuries.” There are on the order of 15,500 of these.

Then there are amputations (often done without anesthetic).

At one point in the war last winter, ten children a day had to have a limb amputated.

Video: The constant warfare in Gaza has created a new generation of child amputees | ABC News Australia

Who observes, “It is reasonable to expect that there are between 3105 and 4050 limb amputations.” At the upper range, that would be 22 amputations a day for the first half of this year.

Then, as the horror movie unfolds, WHO informs us that there have likely been 2000 or so spinal cord and severe traumatic brain injuries. That’s likely a lot of paralyzed or partially paralyzed people.

A similar number, about 2,000, have been badly burned.

One physician who worked in Gaza reported that 80% of the victims she saw were children.

Al-Jazeera Video: “80% of Gaza victims I treated were children – Surgeons in Gaza | Islamic Help ”

Under ordinary circumstances, providing rehabilitative care for a nearly 25,000 people would be a challenge. You’d need crutches and other prophylactics, wheel chairs, neck braces, spine braces, whirlpool baths for the burned to remove dead skin. Such things are now rare in Gaza or don’t even exist. The longer a patient with severe trauma goes without treatment, the greater the danger is that the injuries will never heal properly or will get worse. Israel keeps exiling Palestinians in Gaza from one place to the next. That would be hard on the ones with spine injuries or amputated legs. The ones with spine injuries could well be killed by such a move.

People ask me how they can help. Well, first chew out your Congressman and Senators for allowing this carnage to proceed. But here’s a link for UNICEF’s Gaza effort.

I’ve written before about how this works in the academic world, describing college and graduate school education as a classic pyramid scheme. Those who got in early got the big payoff — job security, a book-lined office, summers off, and a “sabbatical” every seven years (a concept rooted in the Jewish understanding of the sabbath as a holy time of rest). Those who came late to the party, however, have ended up in seemingly endless post-doctoral programs, if they’re lucky, and if not, as members of the part-time teaching corps.

Too Broke to Retire

For the most part, I’m sympathetic to Barton’s argument. There are too many people who are old and in the way at the top of various professional institutions — including our government (where an 81-year-old, under immense pressure, just reluctantly decided not to try for a second term as president, while a 77-year-old is still stubbornly running for that same office). But I think Barton misses an important point when he claims that “older workers are postponing retirement… because they simply don’t want to quit.” That may be true for high earners in white-collar jobs, but many other people continue working because they simply can’t afford to stop. Research described in Forbes magazine a few years ago showed that more than one-fifth of workers over age 55 were then among the working poor. The figure rose to 26% for women of that age, and 30% for women 65 and older. In other words, if you’re still working in your old age, the older you are, the more likely it is that you’re poor.

Older workers also tend to be over-represented in certain low-paying employment arenas like housecleaning and home and personal health care. As Teresa Ghilarducci reported in that Forbes article:

“Nearly one-third of home health and personal care workers are 55 or older. Another large category of workers employing a disproportionate share of older workers is maids and housekeeping cleaners, 29% of whom are 55 or older and 54% of whom are working poor. And older workers make up 34% of another hard job: janitorial services, about half of whom are working poor. (For a benchmark, 23% of all workers are 55 and up.)”

We used to worry about “children having children.” Maybe now we should be more concerned about old people taking care of old people.

Why are so many older workers struggling with poverty? It doesn’t take a doctorate in sociology to figure this one out. People who can afford to retire have that option for a couple of reasons. Either they’ve worked in high-salary, non-physical jobs that come with benefits like 401(k) accounts and gold-plated health insurance. Or they’ve been lucky enough to be represented by unions that fight for their members’ retirement benefits.

However, according to the Pension Rights Center, a non-profit organization working to expand financial security for retirees, just under half of those working in the private (non-governmental) sector have no employment-based retirement plan at all. They have only Social Security to depend on, which provides the average retiree with a measly $17,634 per year, or not much more than you’d earn working full-time at the current federal minimum wage, which has been stuck at $7.25 an hour since 2009. Worse yet, if you’ve worked at such low-paying jobs your entire life, you face multiple obstacles to a comfortable old age: pay too meager to allow you to save for retirement; lower Social Security benefits, because they’re based on your lifetime earnings; and, most likely, a body battered by decades of hard work.

Many millions of Americans in such situations work well past the retirement age, not because they “simply don’t want to quit,” but because they just can’t afford to do so.

On the Road Again

It’s autumn in an even-numbered year, which means I’m once again in Reno, Nevada, working on an electoral campaign, alongside canvassers from UNITE-HERE, the hospitality industry union. This is my fourth stint in Washoe County, this time as the training coordinator for folks from Seed the Vote, the volunteer wing of this year’s political campaign. It’s no exaggeration to say that, in 2022, UNITE-HERE and Seed the Vote saved the Senate for the Democrats, re-electing Catherine Cortez Masto by fewer than 8,000 votes — all of them here in Washoe County.

Buy the Book

This is a presidential year, so we’re door-knocking for Kamala Harris, along with Jacky Rosen, who’s running for reelection to Nevada’s other Senate seat.

When I agreed to return to Reno, it was with a heavy heart. In my household, we’d taken to calling the effort to reelect Joe Biden “the death march.” The prospect of a contest between two elderly white men, the oldest ever to run for president, both of whom would be well over 80 by the time they finished a four-year term, was deeply depressing. While defeating Donald Trump was — and remains — an existential fight, a Biden-Trump contest was going to be hard for me to face.

Despite his age, Joe Biden has been an effective president in the domestic arena. (His refusal to take any meaningful action to restrain the Israeli military in Gaza is another story.) He made good use of Democratic strength in Congress to pass important legislation like the Inflation Reduction Act. That kitchen-sink law achieved many things, including potentially reducing this country’s greenhouse gas emissions by 40% by 2030, allowing Medicare to negotiate drug prices directly with pharmaceutical companies (while putting a $2,000 annual cap on Medicare recipients’ outlays for drugs), and lowering the price of “Obamacare” premiums for many people.

Still, Biden’s advanced age made him a “terrible, horrible, no good, very bad” candidate for president. Admittedly, a win for 59-year-old Kamala Harris in Nevada won’t be a walk in the park, but neither will it be the death march I’d envisioned.

Old and In the Way?

Government, especially at the federal level, is clearly an arena where (to invert the pyramid metaphor) too many old people are clogging up the bottom of the funnel. Some of them, like House Speaker emerita Nancy Pelosi, remain in full possession of their considerable faculties. She’s also had the grace to pass the torch of Democratic leadership in the House to the very able (and much younger) Hakeem Jeffries, representing the 8th district of New York. Others, like former California Senator Dianne Feinstein, held on, to paraphrase Rudyard Kipling, long after they were gone. Had my own great heroine Ruth Bader Ginsberg had the grace to retire while Barack Obama was still president, we wouldn’t today be living under a Supreme Court with a six-to-three right-wing majority.

What about the situation closer to home? Have I also wedged myself into the bottom of the funnel, preventing the free flow of younger, more vigorous people? Or, to put the question differently, when is it my turn to retire?

I haven’t lived out the past three stints in Reno alone. My partner and I have always done them together, spending several months here working 18 hours a day, seven days a week. That’s what a campaign is, and it takes a lot out of you. I’m now 72 years old, while my partner is five years older. She was prepared to come to Reno again when we thought the contest would be Trump versus Biden. Once we knew that Harris would replace him, however, my partner felt enormous relief. Harris’s chances of beating Trump are — thank God — significantly better than Biden’s were. “I would have done it when it was the death march,” she told me, “but now I can be retired.”

Until Harris stepped up, neither of us could imagine avoiding the battle to keep Trump and his woman-hating, hard-right vice presidential pick out of office. We couldn’t face a Trump victory knowing we’d done nothing to prevent it. But now my 77-year-old partner feels differently. She’s at peace with retirement in a way that, I must admit, I still find hard to imagine for myself.

I haven’t taught a college class since the spring semester of 2021. For the last few years, I’ve been telling people, “I’m sort of retired.” The truth is that while you’re part of the vast army of contingent, part-time faculty who teach the majority of college courses, it’s hard to know when you’re retired. There’s no retirement party and no “emerita” status for part-timers. Your name simply disappears from the year’s teaching roster, while your employment status remains in a strange kind of limbo.

Admittedly, I’ve already passed a few landmarks on the road to retirement. At 65, I went on Medicare (thank you, LBJ!), though I held out until I reached 70 before maximizing my Social Security benefits. But I find it very hard to admit to anyone (even possibly myself) that I’m actually retired, at least when it comes to working for pay.

For almost two decades I could explain who I am this way: “I teach ethics at the University of San Francisco.” But now I have to tell people, “I’m not teaching anymore,” before rushing to add, “but I’m still working with my union.” And it’s true. I’m part of a “kitchen cabinet” that offers advice to the younger people leading my part-time faculty union. I also serve on our contract negotiations team and have a small gig with my statewide union, the California Federation of Teachers. But this year I chose not to run for the policy board (our local’s decision-making body), because I think those positions should go to people who are still actually teaching.

Those small pieces of work are almost enough to banish the shame I’d feel acknowledging that I’m already in some sense retired. I suspect my aversion to admitting that I don’t work for pay anymore has two sources: a family that prized professional work as a key to life satisfaction and — despite my well-developed critique of capitalism – a continuing infection with the productivity virus: the belief that a person’s value can only be measured in hours of “productive” labor.

Under capitalism, a person who has no work — compensated or otherwise — can easily end up marginalized and excluded from meaningful participation in society. The political philosopher Iris Marion Young considered marginalization one of the most ominous forms of oppression in a liberal society. “Marginals,” she wrote, “are people the system of labor cannot or will not use,” a dangerous condition under which a “whole category of people is expelled from useful participation in social life and thus potentially subjected to severe material deprivation and even extermination.”

Even when people’s material needs are met, as is the case for the luckiest retirees in this country, they can suffer profound loneliness and an unsettling disconnection from the social structures in which meaningful human activity takes place. I suspect it’s the fear of this kind of disconnection that keeps me from acknowledging that I might one day actually retire.

Jubilation and Passing the Torch

The other fear that keeps me working with my union, joining political campaigns, and writing articles like this one is the fear of the larger threats we humans face. We live in an age of catastrophes, present or potential. These include the possible annihilation of democratic systems in this country, the potential annihilation of whole peoples (Palestinians, for example, or Sudanese), or indeed, the annihilation of our species, whether quickly in a nuclear war or more slowly through the agonizing effects of climate change.

But even in such an age, I suspect that it’s time for many of my generation to trust those coming up behind us and pass the torch. They may not be ready, but neither were most of us when someone shoved that cone of flame into our hands.

Still, if I can bring myself to let go and trust those coming after me, then maybe I’ll be ready to embrace the idea behind one of my favorite Spanish words. In that language, you can say, “I’m retired” (“retirada”), and it literally means “pulled back” from life. But in Spanish, I can also joyfully call myself “jubilada,” a usage that (like “sabbatical”) also draws on a practice found in the Hebrew scriptures, the tradition of the jubilee, the sabbath of sabbaths, the time of emancipation of the enslaved, of debt relief, and the return of the land to those who work it.

Maybe it’s time to proudly accept not my retirement, but my future jubilation. But not quite yet. We still have an election to win.

Copyright 2024 Rebecca Gordon

Via Tomdispatch.com

(The Conversation) – A ten-month-old boy in the Gaza Strip was recently paralysed by poliovirus – the first such case in the region this century. Israel and Hamas have agreed to a limited ceasefire to allow 640,000 children in the enclave to be vaccinated against the virus.

We asked a virologist to explain how the virus emerged in the region after all this time, and how it will be dealt with.

Given that polio was all but eradicated in this region of the world, how might the ten-month-old baby in Gaza have caught it?

The sequences of the polioviruses detected in Gaza in July 2024 suggest that these viruses may be related to a strain circulating in Egypt, with the virus potentially being introduced to Gaza as early as September 2023.

This is probably due to the nature of the oral poliovirus vaccine (OPV), which contains a weakened live poliovirus that can be shed by vaccinated people. This suggests the virus may have been introduced by someone travelling to the region.

The war in Gaza has also provided an ideal environment for the virus to thrive and spread, due to the unhygienic conditions caused by little access to clean water and sanitation.

Can the virus “survive” (remain viable) for long periods without a human host?

Yes, poliovirus is an incredibly stable virus that can remain infectious for long periods outside of the human body, depending on the environmental conditions. For example, polioviruses are capable of surviving in groundwater for several weeks.

Can you explain what “wild type” poliovirus is, compared with vaccine-derived “variants”?

Wild type poliovirus is a virus that is circulating naturally in the environment, whereas vaccine-derived strains are related to the weakened virus present in the OPV, which in extremely rare cases is capable of reverting to a form capable of causing paralysis.

“Polio Swallows Gaza,” Digital, Dream / Dreamland v3, 2024.

Is the wild type still endemic anywhere in the world?

Due to the success of the Global Polio Eradication Initiative, led by the World Health Organization, that began in 1988, type 2 and type 3 polioviruses have been declared eradicated. Only type 1 poliovirus is currently circulating in Afghanistan and Pakistan where there have been 27 recorded cases so far in 2024.

Why are most cases of polio vaccine-derived variants?

Most cases of paralytic polio are now vaccine-derived due to the success of the Global Polio Eradication Initiative. OPV has been instrumental in the near-eradication of wild polioviruses around the world. However, in areas where vaccination rates drop and enough people are susceptible to infection, the weakened virus can replicate. Unfortunately, each round of replication increases the potential for the virus to revert to a form that causes illness and paralysis.

Why was the old oral polio vaccine shelved in 2016?

Following the eradication of type 2 poliovirus in 1999, the only cases of type 2 paralytic polio were vaccine derived. Therefore, to stop these cases, there was a decision to shift from the original trivalent OPV, which contained all three poliovirus serotypes, to a bivalent OPV vaccine, which only contained type 1 and type 3 poliovirus strains. With an additional type 2 specific monovalent vaccine available to contain any vaccine-derived type 2 should any cases arise.

Was that a mistake, as some experts have suggested?

Although this decision was well-intentioned, hindsight suggests that the level of vaccine-derived type 2 poliovirus was underestimated. The Global Polio Eradication Initiative commissioned a report into this decision and the draft report, which is open for public comment, has described the switch to bivalent OPV as an “unqualified failure”.

What type of poliovirus vaccine is being used in the current campaign in Gaza?

Over 1.6 million doses of the novel oral poliovirus vaccine type 2 (nOPV2) – a new poliovirus vaccine – will be delivered to the Gaza Strip to provide two doses to more than 640,000 children under the age of ten.

Will it have the same risks as the old poliovirus vaccine? That is, might it get in the wastewater and cause more polio cases?

No, the nOPV2 is a next-generation version of the traditional type 2 monovalent oral polio vaccine that is used to respond to vaccine-derived type 2 poliovirus outbreaks. The key difference is that the new vaccine contains a weakened virus that has been modified to make it more genetically stable and significantly less likely to revert to a more virulent form capable of causing paralysis, thereby increasing the chances of stopping these outbreaks for good.

What other diseases are likely to emerge in Gaza, given the interrupted vaccination campaigns?

Other vaccine-preventable diseases such as measles, pneumonia and diarrhoeal diseases, such as rotavirus, all have the potential to emerge. Each with its own dangers and complications, therefore it is really important that as many vaccines as possible are delivered into Gaza.

Lee Sherry, Postdoctoral Research Associate, School of Infection and Immunity, University of Glasgow

This article is republished from The Conversation under a Creative Commons license. Read the original article.