Sunday, December 10, 2017

Medicare Cuts in the 2018 Budget

The new tax bill Congress is passing will increase the deficit. Although this might seem antithesis to the Republican doctrine, behind the obvious spindrift there lurks a clever ploy to trigger an automatic program that reduces funding to most social programs, including Medicare. Known euphemistically as PAYGO the Statutory Pay-as-You-Go Act of 2010, is a rule that requires any federal deficit to be paid for with spending cuts to social programs. With the exception of Social Security, unemployment benefits and food stamps, most mandatory spending programs—some 228 programs—will be cut or eliminated.  Specifically, Medicare will be cut by 4 percent a year. Medicare represents the most important program for older people after Social Security.

We got here because people, and some gerontologists, are ignorant of what really helps older adults and how we achieved a modicum of support for them. Without civic engagement and social protest, such laws breeze through without even a mention that Medicare is about to be cut.

Gerontology is full of experts. It is one of the richest disciplines, with academicians and researchers studying the whole spectrum from genetics to policy, from biology to geography, from architecture to neurology. They are all gerontologists. So it is common to find disagreements but we live happily in our own silos. How do we improve aging? We try and communicate the problems associated with aging in order to bring about change

Most communication techniques are embellishment of the 1954 Schramm's Model of Communication. Wilbur Schramm defined communication as a two-way street where both sender and receiver take turns to send (encode) and receive (decode) a message. We need messages that can be understood (decoded easier). And this what eight national aging-focused organizations tried to do when—AARP, American Federation for Aging Research, American Geriatrics Society, American Society on Aging, Gerontological Society of America, Grantmakers in Aging, National Council on Aging, and the National Hispanic Council on Aging—banded together and hired FrameWorks to create a strategy for helping the public understand aging issues. The result was a bible for an aging future. Like all bibles it is populated by don’ts:

  1. Don’t lead with the story of demographic shifts.
  2. Don’t talk about aging as a “civil rights issue.
  3. Don’t use language that refers to older people as “other.”
  4. Don’t overdo the positivity.
  5. Don’t cross-contaminate efforts to build public will with “news you can use.”

FrameWorks simplifies scientific and societal messages to a point that the general public can understand in order for them to act positively on it.  The problem with simplification is that it is false. Changing attitudes does not necessarily change behavior. We believe that communicating a good message changes attitudes and brings about concrete changes. We therefore also believe that laws are enacted as an act of benevolence. But this is misguided, as we are witnessing right now with PAYGO. "Reframing Aging" and "Disrupting Aging" are a ruse because they simplify a process that is messy and volatile and exclude the participation of individuals in civil disobedience. Worst still these approaches deny the social activists their true worth in our political world. What changes and improves conditions for older adults are laws that are enacted, implemented and enforced. And these steps are accomplished by civic engagement (or lack thereof.)

A livable income remains the lynchpin of wellbeing among older adults. Income, especially in the United States increases access to affordable health care, housing, transportation and food at a minimum. And we got here through the single enactment of the 1935 Social Security Act. The act was not some kind of reframing aging, or disrupting aging. The act was enacted because there was civil unrest and a swell of support for alternate provisions. FrameWorks by focusing solely on ageism and seeing the problem as a public relations issue, misses out on one of the tenants of an aging reality: heteroscedasticity. As we get older, we as a group, become more varied and different from each other. A schism as wide as that between Donald Trump and Noam Chomsky. FrameWorks remain at a loss in representing these two extremes.

Reframing, disrupting, renewing, or any public relations exercise cannot address aging, understand the changes and needs, develop effective responses and tackle problems associated with aging—on an individual or at a community level. That thinking is nonsense. Neither Trump nor Chomsky complain of ageism. The obvious reason is that they are at their zenith. Their basic civic responsibilities seem to be provided for. Their other very vocal issues—however grave and important—have nothing to do with age. Aging becomes a policy issue ONLY when individuals are at their lowest—their azimuth.

The azimuth for older adults is similar to those for other ages. It includes provision for shelter, health, food and income. You cannot have other ambitions before meeting these basic requirements. Right now those basic requirements are unmet for an increasingly large minority of the older adult population. Social gerontologists focus on this vulnerable and abused group. The answer how to help them is not by reframing of issues, but by blue-color provision of services. And services are created through policy.

We have been here before. During these economic failures older adults are worst hit. The Great Depression of the 1930s followed previous economic collapses—1840s and again in the 1890s. Poverty among older adults grew dramatically so that by 1934 over half of older adults in America lacked sufficient income to be self-supporting. They needed charity to survive. State welfare pensions were non-existent before 1930, and for those that later developed State pensions only provided 65 cents a day for about 3% of older adults. Millions of older people were homeless, hungry and desperate. Millions more were unemployed. By some estimates more than two million adult men—referred to as hobos, travelling workers, the word likely derived from the term hoe-boy meaning "farmhand"—wandered aimlessly around the country. Banks and businesses failed. From this morass of civil depravity rose one of the most important piece of legislation. The 1935 Social Security Act that in 1965 spawned Medicaid and Medicare is the bedrock of services for older adults. No single act has ever-improved older adult’s wellbeing as much, or since.

Social Security Act

Social Security Act—passed by the President Franklin D. Roosevelt (FDR) administration in 1935—created a right to a pension in old age, and an insurance against unemployment. This legislation was not passed because of the benevolence of Congress, or that of FDR (who won in 1932 and 1936). The act was passed because there was civil unrest and a threat of further social upheaval.

Workers rose up, and although individual uprisings were ineffective, en masse this lead even the oligarchs of the time and the Supreme Court judges to back down. There are other interpretations of history. But a strong case can be made that civil uprising created dramatic political choices at the time. Characterized by worldwide turmoil that gave rise to communism, anarchist, fascism, and National Socialism—Hitler, Mussolini, Gandhi, Lenin/Trotsky/Stalin. Here in the United States it was Federalism as expressed through the many “alphabet agencies” created under the New Deal. Federalism emerged not in response to civic unrest but in competition. It managed to subdue it.

Before the Great Depression the poor already established a precedence of marching to Washington D.C. to express their ire.  The 1894 March of Coxey's Army after the industrialist Jacob Coxey organized tens of thousands of unemployed to march to Congress. Although this movement fizzled, Coxley later became an advocate of public works as a remedy for unemployment. But it was the Great Depression that awakened the masses. The story remains scattered among the literature. Six social movements have been etched in history and defined the New Deal, whether in competition or in promoting.

1.     With Every Man a King Governor and later Senator Huey Long wanted the Federal government to guarantee everyone over age 60 to receive an old-age pension while every family would be guaranteed an annual income of $5,000. He proposed to do this by limiting private fortunes to $50 million, legacies to $5 million, and annual incomes to $1 million. By 1935 the movement had 27,000 local clubs with 7.7 million members.

2.     The Long Beach physician Francis E. Townsend started the Townsend Movement. Long Beach in California was considered the “geriatric capital” of the United States at the time with over a third of its residents being elderly. After finding himself unemployed at age 67 with no savings and no prospects, Townsend proposed that the government should provide a pension of $200 per month to every citizen age 60 and older. The pensions would be funded by a 2% national sales tax. By 1933 there were 7,000 Townsend Clubs around the country with more than 2.2 million members.

3.     Fire & Brimstone movement takes its name from a radio preacher Father Charles E. Coughlin who rallied against the Social Security act as he did against FDR, international bankers, communists, and labor unions. In 1936, Coughlin, along with Townsend and the remnants of Huey Long's Share the Wealth Movement, would join to form a third party to contest the presidential election in the hopes of preventing President Roosevelt from being re-elected. They failed, but the preacher had some 35-40 million listeners.

4.     Upton Sinclair, a Californian novelist and social crusader, drafted a program called End Poverty in California (EPIC). In a 12-point program there was a proposal to give $50 a month pensions to all needy persons over 60 who had lived in California for at least three years. Using EPIC as his mandate, Sinclair was the Democratic nominee for governor in the election of 1934 that he lost.

5.     By 1938 there were approximately eighty different old-age welfare schemes competing for political support in California. The culmination of these different economic propositions was the Ham & Eggs movement. Named in response to a flippant put-down that this movement was for a common meal—Ham & Eggs was started by a radio personality Robert Noble. Based on the writings of Yale professor Irving Fisher, the movement demanded that the state issue $25 warrants each Monday morning to every unemployed Californian over the age of fifty. With more than 300,000 members with many more supporters it quickly grew into a movement. Although later the organization was co-opted by his two brothers advocating $30 every Thursday morning there remained a resilient support for this social program. Even after the passage of the Social Security Act in 1938 the successful Democratic candidate for governor Culbert Olsen openly supported the plan and an initiative was placed twice (1938 and 1939) on the ballot to adopt the Ham & Eggs plan as California state policy. Both propositions failed.

6.     In Ohio the Bigelow Plan named after Reverend Herbert S. Bigelow proposed a State amendment to guarantee an income of $50 a month ($80 for married couples living together) to those unemployed over sixty years of age. He proposed that funding would come from increased tax on real estate (2% increase on land valued at more than $20,000 an acre), and partly out of an income tax equal to one-fourth the federal income tax paid by individuals and corporations. This plan garnered nearly half a million voters before it was defeated.

All of these movements sometimes competed against the New Deal that FDR was pushing. There remains some resilient misunderstanding of the benefits of the New Deal. Most picture this as a battle between the good and evil, the benevolent against the greedy, the globalist against the small business. We have been here before. The true story is messier then as it is now.

When Kim Phillips-Fein, wrote Invisible Hands: The Businessmen's Crusade Against the New Deal the impression was that the New Deal was somehow transformative for the good. But at the time, the New Deal was anything but positive. Phillips-Fein has shown that unemployment during the New Deal remained high at around 17% (1934-40), and especially among African Americans and especially in the South, the economy was still depressed, federal income taxes were tripled, higher liquor taxes and (new) payroll taxes, high farm foreclosures (mainly African American farmers), and with more than 3,728 Executive Orders, the New Deal has been argued to have delayed recovery. It seems that the Social Security Act kept us lingering longer in depression. Only after the Second World War did the economy and public welfare improved. Despite this background, the 1935 Social Security Act, for the first time, provided a national safety net for older adults and transformed how we think about aging that still reverberates today.

The Social Security Act became a vehicle for social programs. In 1965, with the addition of Medicaid—health care for the poor and disabled—and then Medicare—healthcare for older adults—the social package was complete. Although Social Security is neither exclusively a social program nor an insurance program, so far is has resisted change. Until now.

What will protect and improve these services for older adults is not a reframing exercise, but a swell of civic protests and civic engagement that exposes and shames the architects of policy that will happily sell the future of our children (deficit increase), hit the poorest and most vulnerable members of our society (Medicare recipients) with only a murmur of protest from aging-focused organizations. Without protests to halt the cut to Medicare, no amount of reframing will ever reverse the damage done that will start over the next few months.



© USA Copyrighted 2017 Mario D. Garrett



Resources

Carlie, M. K. (1969). The politics of age: interest group or social movement?. The Gerontologist, 9(4_Part_1), 259-263.

Cushman, B. (1994). Rethinking the New Deal Court. Virginia Law Review, 201-261.

Phillips-Fein, K. (2009). Invisible hands: The making of the conservative movement from the New Deal to Reagan. Yayasan Obor Indonesia.

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