Medical crisis with doctor shortages occur mostly in rural areas

Doctor treating elderly patient

“It is wonderful news that we are living longer, but it also creates an entirely new set of challenges for families and the health care system.  The face of medicine is going to start to change rapidly because of this transition.” 

  Stephen G. Jones, MD, a specialist in treating the aging population and director of the Center for Healthy Aging at Greenwich Hospital, wondered a few years whether there will be enough doctors available to treat the onslaught of baby boomers turning 65 in 2011 and who would be on Medicare.

The problem is felt from cities to small towns in America, even before 2011.  For example, a newcomer to Natchitoches, a baby boomer turned 65, in 2010 found that Dr. Ana Pere, a respected general practitioner in the area, was not taking new patients on Medicare, which is part of a trend, making people wonder about the potential shortage of doctors.

January 2011 began the "baby boomer" rush, when the first large group of the aging population became eligible for Medicare and demanding medical services through a government program for the elderly.

100 years ago the leading cause of death was infection, “now true diseases of aging; cancer, heart disease and Alzheimer’s disease are the leading causes,” reports Dr. Jones.

Dr. Jones tells us there are various issues that will be raised by this wave of baby boomers turning 65 next year.  The shortage of doctors is one of them, along with the low insurance reimbursements for the care given these people.  This comes at a time when there are fewer and fewer trained doctors in geriatric medicine, the sub-specialty that treats health issues of the elderly.

What is happening, according to Dr. Jones, is the merge of a number of problems related to treating the baby boomer populations.  Lower insurance reimbursements come at a time when physicians struggle to manage the costs in treating patients.  Longevity is advancing, and with it comes an increase in the diseases of aging.  Alzheimer's disease will more than double by the year 2030 and will be epidemic by 2050.

In 2010 this quote, “It is difficult to imagine the impact of this big wave of new seniors who will be tapping into Medicare over the next few years,” was offered by Richard Rathge, director of the State Data Center at North Dakota State University at the time who, like Dr. Jones expressed concern about the state of medicine in response to the needs of a growing number of seniors. “Nationwide, we will see more than 1.8 million people turn 65 each year beginning in 2011. This translates into more than 5,000 a day, which is a substantial number.”

In 2013 PBS Newshour carried an interview with a number of seniors, finding some of them with compromised immune systems found that it was difficult to find a doctor who would take Medicare.

On the other hand, Forbes, the same year, had an article maintaining that doctors were not declining Medicare patients and that the number of doctors who would take elderly patients was really on the rise.

So it may be where you live might make the difference.  Because news in 2013 found that there is a reduced number of primary physicians in rural areas to take patients in general--of any age and especially the elderly who may have more health complaints.  And that's true even though it has been found that in some places in California those doctors who work in rural areas make more money than those in San Francisco.

Brew for stormy aging: Medicaid, health care and economics

Home for the aging

Editor - We are facing the perfect storm of trouble, experts tell us  if we don't
have long-term health coverage. But the problem is more complex than that.  So what is the brew for stormy aging?

Medicaid, as economists and government experts have declared, is facing problems
with funding.  In fact, much of the upcoming storm for many is complicated by budgetary issues and an uncertain future.  

The economy is complicated with the issues of oil and an unstable world, and a past recession where many seniors lost money in the downturn of the economy in recent years. Budgetary issues can create complications that increase the impact of that perfect storm

Not only does caring for an elderly family member cost money, it takes time as well, time away from other family obligations.  In short caring for seniors puts pressure on individual budgets as well.

What's the answer?  While experts bandy about solutions, including national health care, what about long-term care insurance? Insurance agents will paint the picture, often quite accurate, of needs vs budgetary constraints; but the problems might be insurmountable in the face of the recession and the losses of senior's income.

In other words, the perfect storm is the loss of retirement income from stock market problems, loss of full-time work in the years near retirement, decline in health, increase in health costs, over-worked children and other family members.  So the extra cost might be
prohibitive. With an inflation clause a 50-year-old would pay $100 or more for coverage, 65 year old more than twice that.  In addition,pre-existing conditions are excluded during time periods and these areindividuals.

Elderlawgoes in more of these specifics, spelling out the barriers for many seniors and the issues involved.  "The biggest problem with policies now is the cost the premiums being out-of-reach for most seniors and the refusal of insurance companies to guarantee their rates. Another problem with long-term care insurance is that by the time many people purchase
policies, they are uninsurable due to health problems. One solution to this problem, of course, is to purchase policies while you are young and healthy. The other solution is to shop around. Every company has its own underwriting criteria."

The statistics, average costs and benefits are listed here and can be sorted out individually, but the answers aren't as simple as the insurance agent describes.

The problems, however, might mean other answers; and it becomes those issues that might really make the perfect storm.

Minimum wage raises will increase income gap and poverty for seniors

Loaves and fishes (Forsloff photo) where low income seniors receive help with food.[/caption]

Carol Forsloff---- "The average gross monthly Social Security benefit in 2014, before Medicare deductions, for retirees of all ages and earnings levels, will be $1,294 for a single and $2,111 for a couple, the Social Security Administration estimates,"Forbes wrote October 30, 2013.  According to the Center for Retirement Research at Boston College about one-third of household retirees live on nothing other than Social Security.  Among those with low incomes, 75 percent live on Social Security alone.  The 2014 Social Security increase was 1.5%, making it a guarantee that seniors will fall further and further behind the income levels of all Americans, when the minimum wage is raised to just over $10/hour.

There has been a stringent plan to save on the costs of Social Security and Medicare, with percentage increases either not occurring or very low in the past several years.  This means as incomes of workers rise, Social Security increases, limited as they are, more seniors will live in poverty, as they face paying the same bills as other groups, and more considering the high cost of medical care.

Following the Chained CPI, which is the present plan of determining increases for Social Security retirees, is a guarantee, experts say, that seniors will fall further and further behind.

As the nation worries over disparities between rich and poor, the truth is hidden in the hue and cry about the terrible gaps that exist at the low and high income levels.  Yet there is no plan to protect those groups who are not in the workforce and who are no longer able to work because of age-related disabilities and other factors.  And to add insult to injury, seniors are generally given part-time hours and the minimum pay when they do work.  Often that insult is multiplied by asking seniors to just volunteer, often in the same kind of jobs they left when they retired.

While people celebrate the solution of the workforce in raising the minimum wage, the balance will still not be reached and large swaths of people will be left out at the bottom.  What is not being underlined is that by not taxing the rich, and raising the minimum wage, there continues to be a tendency not to solve the problem at its source, which is in asking the rich to pay their fair share of taxes, so that all boats can rise and be able to pay their bills.  It will guarantee more seniors will live in poverty, if the solution is just to raise the minimum wage of the working class.

Here are prescription options and programs for low-Income and homelesspeople

Samantha Greenbaum----To be poor and homeless in the United States can be difficult. But to be sick and in need of medical care on top of being unable to pay for medicine can seem insurmountable and certainly dangerous. And, unfortunately, it’s not unusual: one in five people forfeit needed prescription medication because they can't afford to pay for it. However, there are agencies available for that can help get those in need the medical attention and prescription medications they require.

Patient Assistance Programs (PAP)
These types of services are run by pharmaceutical companies to help those who can't afford their medications. Beginning in the 1950s, these PAPs were encouraged through incentives by the United States government. They were set up to help pay for or provide low-cost prescription drugs for individuals who qualified with low income. With 250 Patient Assistance Programs set up across the United States, they have helped countless low-income citizens get the prescriptions they need. To qualify you must be a citizen, not have prescription insurance including Medicaid and have a minimum income level.

If your income is at least 200 percent below the federal poverty level, you will most likely qualify for the PAP prescription program.

Children's Health Insurance Program
This state-run program is specifically designed to help children whose parents cannot afford health insurance or prescription drug care for their children. Qualifications to receive CHIP include low-income and an absence of other health insurance.

Medicaid

Medicaid is a federal- and state-run program to help those individuals who cannot afford to pay for their medical bills. Income criteria must be met in order to qualify. A patient must lack insurance and be within the low-income guidelines in order to receive Medicaid.

Medicare

This is a federal program constructed to help people who are 65 and older meet their medical bills. To qualify for Medicare, an individual must be at least 65 or have specific disabilities or end-stage renal disease. There are different parts to Medicare that pay for different types of services. 

Health Resources and Services Administration
There are HRSA centers set up across the country that treat the sick and allow the individual to pay on a sliding scale based on what the individual can afford. These centers can provide checkups, treatment for illnesses, pre-natal care, children's immunizations, dental care, prescription drugs, mental healthcare and substance abuse care.


To find a local health center, contact the Health Resources and Services Administration or visit http://findahealthcenter.hrsa.gov/Search_HCC.aspx.

These are but a few of the agencies available that will give individuals the help they need to recover or steer them in the right direction for necessary medical treatment.

Social service agencies such as Salvation Army, local churches and charities are other excellent resources for the homeless and low-income to get the attention they need. There are even non-profit services that will help with disease prevention, providing health educational seminars and exercise facilities and programs on a scholarship rate that is based on income.

In addition to the website above, visit or call your local United Way to learn more about your local non-profit resources. Learning more about what is available could be the difference between health and sickness for you and your family.

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This article was provided by Samantha Greenbaum, health-conscious mother of two. 

Corporate chieftains attack Medicare

[caption id="attachment_11048" align="alignleft" width="300"] Chase Bank[/caption]

Editor-----Business titans, many of whom have incomes far in excess of ordinary business owners and whose power has become increasingly felt in social and political areas, consider Medicare a program that needs to be cut, putting millions of seniors at risk.

What are these changes and cuts corporate executives want?  First of all, they want to raise the age beyond the current entry age of 65, considering that this will reduce the number of participants.  In addition, many executives want to see the program as private pay or relying on insurance companies as opposed to the government.  And finally, they want to make it dependent on income.

Let's examine some of those issues.  First of all, the United States is virtually the only developed nation in the world that still relies on private insurers for the bulk of the population's options for health care.  This has meant great profits for private insurance companies and the ability for these companies to restrict care, putting those with significant health problems at greater and greater risk.

The United States also has one of the largest groups of seniors, as a percentage of the population, facing bankruptcy because of medical care costs, as even with Medicare there are extra costs.  Medicare pays not all but much of health care costs for any given medical condition, but there are still residual costs that require seniors to use private savings.  Certainly nursing home and long-term care support requires private pay, something many seniors do not have the money for as lifespans have increased as have the costs of care.  So it is possible to have considerable savings and still become impoverished as a result of medical costs.  It must be added that attorneys often counsel the elderly on exactly how to transfer assets and impoverish themselves in order to quality for help when they need it, given the income qualifications that presently exist.  And the transfer of assets and other mechanisms used to reduce income to qualify for Medicaid has a series of rules that create barriers as well.

The Business Roundtable includes executives from  AT&T, Boeing, Dow Chemical, Exxon Mobil, General Electric, JPMorgan, Walmart and others.

So as companies consider options for Medicare and worry about their bottom line, the fact remains these same companies pay high salaries to their top executives that put them far beyond even the average business owner in the United States, and many of them represent companies whose actions helped to create the financial debacle that led to the recent recession.

Multigenerational families increasing in response to economy

Carol Forsloff - “We love having our grandchild right here so we can watch her grow up,” said Laura Tyler, in answer to how she feels about her daughter, son-in-law and two-year-old grandchild living with their parents in a small three bedroom home in Washington State, a response that more and more reflects what is happening with families in America.

Multigenerational families are increasing in response to the economy.  Altair Customer Intelligence,   a company involved in marketing research, has found multigenerational families now represent 14.4% of households in the United States.  20 million households have more than one generation represented in the family group, and four million of these represent three generations.

The fact that multigenerational families are developing at an increasing rate in the present economy means a different sort of marketing strategy to address family needs.  Issues regarding Medicare, long-term care, and senior needs as well as the concerns of infants and young children are now seen in families that would ordinarily be recent empty nesters of the baby boomer age.

“Isn’t it more stressful,” Tyler was asked about her extended family living.  “Sometimes it is, “Tyler explained, “But really the advantages weigh out the disadvantages for us.  We just feel closer and feel like we are able to help our children, which makes us feel good.  They add to our joy.”

For years historians have debated the American family structure and whether it was the extended family to the nuclear family, a pattern described by many.  New information from revisionists maintain family structure has been relatively unchanged and for the most part nuclear for centuries.   So this new increase in multigenerational living is a phenomenon that reveals the concerns of families today, as the format of the family changes depending upon the economic and social needs of any given time.  What most sociologists and anthropologists say is that whatever the type of family, during difficult times these are the people members reach out to during a crisis.

Legally Socialable, a features site concentrating on social and legal aspects of American life, quotes Frances Goldscheider, a Brown University sociologist, as saying this:  “We haven’t seen anything like this since the Depression,” said Frances Goldscheider, a Brown University sociologist who has studied families and living arrangements. “Overwhelmingly, it’s the recession’s effect on people’s ability to maintain a house. You have the foreclosures on one hand, and no jobs on the other. That’s a pretty double whammy.”…

But experts tell us it is more than the economical factors have increased a pre-existing trend as baby boomers care for aging parents and new immigrants from Hispanic and Asian communities arrive with a culture that has had a history of several generations under one roof.

Whatever the reason, the trend toward multigenerational households will have a political impact and social impact as well as one on business, as more and more people decide that the family unit is the safe place to find respite in the ongoing “storms” of unrest, concerns for an aging population and economic pain

Long-term care for elderly a growing crisis for American families

[caption id="attachment_8996" align="alignleft" width="225"] Delphine at meeting hall[/caption]

The question is reasonable because even though financial planners advocate long-term care insurance, it’s likely if Grandpa has any real health problems he either won’t get it or will have premiums so high he will have to choose between eating at the present or having a nursing home bed in a decade.

The pitch for a sale sounds good from the insurance agent who gives all good reasons for buying long-term care and buying it early so premiums don’t become high.  Still there are enough exclusions to create barriers, even for the young adult.  These include using using certain medications over a period of time, for example prednisone, a drug that is recommended for a number of conditions, including asthma and arthritis. But many insurance companies will likely refuse, or seriously rate, the applicant with this situation.

Grandpa is 75. He has ocular myasthenia gravis, a condition that could or could not become systemic for many people, but not if the individual has had the condition for more than a couple of years. Grandpa was diagnosed three years ago and has no issues of balance or coordination that would imply a spread of the disorder beyond the ocular area. Still, Grandpa can’t get insurance from most insurance companies either because he takes prednisone (every four to six months for four to five days) or simply because of the diagnosis itself.

Lillian, a 60-year-old neighbor, is able to buy long-term care but has found it very expensive because she is a diabetic. The diabetes has been well controlled during the five years since her diagnosis, but the rating from a standard policy is 10% higher than others, making it unaffordable for her. Her insurance options are limited, with few companies willing to take Lillian as a customer among the number of companies available.

Medicare doesn’t cover long-term care, and as the recession has taken the savings and jobs of younger folk, the children might not have funds to help. Besides the numbers of baby boomers without children increase the problem as well, as more and more senior assistance centers won’t take Medicaid. This is even more likely to happen with the changes proposed by Republicans to slash Medicaid payments and raise the bar for qualification, as detailed by the American Association for Retired Persons who offer a synthesis of recent proposals.

The problem is made even more difficult by the fact that 40% of the elderly needing long-term care depend on Medicaid, which means the oldest and sickest of the group.   And that Medicaid only becomes available after the senior has exhausted virtually all of his/her assets. While the problem of what to do with the great numbers of seniors entering the health care system with complex diseases increased, politicians offer solutions that often don’t offer much hope. The liberal ones avoid the problem altogether, and the conservatives seem to say “tough luck.”  The problem, however, is anticipated to become very great with the growing number of seniors needing assistance. It is complicated because of the fact that middle and low income persons have less discretionary income for long-term care insurance or may not qualify for it.  Furthermore, the fact that the seniors must exhaust virtually all savings before using Medicaid creates problems for most people as the surviving spouse is virtually impoverished as well.

Some experts have recommended price-rewarded savings, now being used by some states to encourage savings. With this type of program, for every qualified portion of savings one receives a chance at a special prize, usually a substantial amount of money.

The options are few that seniors can use for long-term care as costs increase, restrictions develop and the number of users grows, but one of them is the senior community of people over 55 itself, where in many instances the more active of the group pitch in and help the others. This is true of the community of Ryderwood, for example, a town created for and by senior citizens, following its initial history as a loggers camp for families. As one elder recently said, “Who knows better what it takes to grow old and do it with dignity but people just like us?”

The problem is that because of age restrictions selling the property is said to be more difficult because the pool of buyers is limited. On the other hand, some folks say that the restrictions in many ways increase the number of buyers who seek that mutual support in lieu of assisted living seniors.

In the meantime as seniors explore options for care, the problems multiply as the typical caregiver, ordinarily other family members or children, are burdened with financial and physical demands from the lifestyle needed to keep up with the cost of living and the demands placed on growing families. In addition, there are many seniors who have either never had, lost children or have children with reduced capacity to act as caregivers in a crisis.

Potential solutions may develop as more and more seniors opt for community-based support. These include the Meals-on-Wheels programs, grocery store deliveries and home care assistance on a fee-for-service basis.

While seniors plan for the likely, experts say everyone should plan as early as possible for those declining years and then update those plans periodically as circumstances change. With the quarrel over “entitlements,” it is likely it may soon be time to change one’s plans again, as the changes are likely going to make long-term care more difficult and more expensive. Then what happens to Grandpa and Grandma when their options no longer exist?

Rep. Fleming at fault if La. man doesn't get Soc. Security

[caption id="attachment_7296" align="alignleft" width="300" caption="Representative John Fleming of Louisiana"][/caption]

Carol Forsloff - Robert Jordan is one among millions of senior citizens who could be impacted by a government default, and he points the finger of blame where many are sending it these days: straight to the right flank of the Republican Party.

Jordan works part-time for the Veterans Administration as a mental health counselor.  He is retired in Louisiana and supplements his income, as many seniors do, with part-time work.  Still Social Security income is part of that retirement plan, that promise he and other seniors were given for income after a lifetime of earnings contributions.  Now it hangs in the balance if Congress does not pass the budget.  He says he will blame Representative John Fleming of Louisiana, one of the House Republicans considered on the right wing of the plank.  Fleming has been  on Fox News discussing his position which is in line with the newest members of Congress, for no new taxes yet massive cuts in spending for programs like Medicare and Social Security.  Fleming is also on record against the health care programs and at one time agreed with someone at a forum in Natchitoches, Louisiana that the nation reconsider federal banking, something that was part of the civil war agenda.

Most Americans agree with Jordan, that it is the Republicans who are taking the most extreme position by listening to their most rightward flank.  These are the 80+ freshman class, many supported by the Tea Party, who took a pledge not to raise taxes for whatever reason.  This means no negotiation.  No negotiation, experts tell us, means a budget impasse and a debt crisis in less than a week.

Jordan is one of the lucky ones, however.  For 26% of senior Americans Social Security is their only source of income, according to the Council on Aging.  Then there is the ugly spectacle of seniors unable to get medical care during an economic catastrophe, as they may not have the means to pay for it.  While many seniors have already been impoverished in the downturn of the recession, they face even more devastation financially from the possibility of losing Social Security and Medicare at a time when they are most vulnerable.

As some people say, it is playing chicken with the ones who can’t get in the game at all because they no longer have the ability or the social recognition to play as well.

The media present the politicians point of view, but few ask those seniors how bad it is for them now and how much worse it can be.  Jordan sent the media an email, as the impetus for this article.

As for the blame?  Jordan has followed through with President Obama’s request.  He has pointed the finger at his Representative,  John Fleming, a man who ran against Obama even though he was only running for the House of Representatives and whose word for social support systems is “socialism,” a term used frequently by the right-wing plank of the Republican party.

What Jordan hopes, and millions of others of his certain age do too, is that Congressional members will put their ideological views on hold in favor of what surveys of Americans want now:  raise the debt ceiling so seniors don’t suffer more.

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This article is in response to a letter from a reader, as this site has no specific political category but addresses the issues.  Jordan is concerned about an issue that faces the country, specifically senior Americans, and like millions of seniors asks for a voice in the debate.  This article is in recognition of that voice to raise the debt ceiling and prevent a crisis.

The aging of the population and how it will change the world

[caption id="attachment_7133" align="alignleft" width="300" caption="PUSH"][/caption]

Carol Forsloff - In January 2011 the oldest of the baby boomers turned 65, with the first “shot over the cannon’ signaling a major shift in population that impacts the entire world,  while the US government labors over the budget crisis.

Early this year Richard Johnson of the Urban Institute answered five questions about aging and its impact on the future of the United States and the rest of the world.   He tells us at the outset that the problems of the growing numbers of elderly persons is a global problem.

13 percent of Americans are age 65 and over by January of 2011, with the percentage anticipated to be 16 percent by 2020 and by 2040 to 20 percent.  In the meantime birth rates are falling.

This means fewer young people to economically support in some way a larger and continually growing older segment of society.

.By 2020, that share will jump to just over 16 percent. By 2040, it'll top 20 percent. The graying of the population is really a worldwide phenomenon as birth rates fall and longevity increases.

Those who follow the Ayn Rand philosophy maintain that as long as producers are allowed total freedom of production free of government restraints, then social upheavals will be prevented as people seek prosperity.  Those who believe government should step in and take care of people who can’t take care of themselves represent another major philosophy, in opposition to the first.  These two extremes remain the ongoing debate in the major countries of the world, with the labels for representative factions changing as the politicians shift with popular opinions during economic crises.

The first world impact of aging has to do with how choices have to be made among groups needing assistance vs. the needs of the greater culture as a whole.  Infrastructure maintenance, education, energy and defense form a rival with what some refer to as entitlements.  The problem with the word entitlements itself has to do with it means to their beneficiaries, some of whom see Medicare and Social Security as funds maintained by those beneficiary contributions.  It was anticipated that when retirees reached age 65 there would be sufficient money to pay out those benefits.  That was the case in theory when the institutions were created.  The problem, however, is that by 2015 the system will be paying out more money than it takes in.  Furthermore it is estimated that by 2040 as much as 9/10 of the Federal budget will consist of Social Security, Medicare and Medicaid payouts.

At the same time by 2030 it is estimated the elderly will pay ¼ of their incomes on health care costs.

Johnson believes we need to make it easier for older workers to be employed by taking away the taxes on incomes of people who continue to work after age 62 and the artificial ceiling for retirement at age 65 created by the culture.  He believes the elderly have information and skills society needs, and that more members of that group should be employed.  He calls for training for older people, along with raising the Social Security retirement age.

But while Congress continues to debate raising the Social Security retirement age, Johnson also recommends that people delay taking the benefits themselves in order to increase the payouts that will continue to grow with the additional months and years.  He also observes that people should educate themselves about financial products and save for retirement.

The problems of long-term care and how to finance it are major obstacles for seniors all over the world, Johnson explains, although he has no real answers for the problem outside of additional savings along with research studies on patterns of saving of present pre-retirement groups.

In his discussion Johnson doesn’t examine the unpredictability of economic trends that impact senior incomes, just as government begins to decide on debt limits and entitlement adjustments.

In Portland, Oregon Christopher D. Werner offers financial direction and investment products through his company the Werner Group.  He agrees, “We have to be defensive when we know some of our clients are seniors.  What is recommended for older folks in the investment mix will be somewhat different, of course.  On the other hand, I won’t advise someone at any age be involved in an investment vehicle I wouldn’t have for myself.  You have to look at how investment managers have performed over time.

As for the future, yes we can’t predict it.  We can only give our best answer based upon our knowledge of specifics now.  Saving is fundamental to getting to a safe retirement, and cash isn’t the only option.”

Chris Werner, a 30+, energetic man looks at the cup half full, as his life in most ways is beginning, with a future in the financial world.  His view continues to include the tried and true recommendations of balance, growth and saving.

It is, however, for Werner and for Johnson, as it is for seniors who did plan and save, the unknown face of the budget crisis aftermath that offers the greatest concern for elderly and for which there seem to be no good answers.  And while working longer may seem the easy answer, seniors continue to be the most vulnerable group to layoffs and unemployment, making it difficult, if not impossible, for those younger baby boomers to plan at all.

Economic predictions of increasing poverty for US elderly

[caption id="attachment_6861" align="alignleft" width="300" caption="Elderly woman"][/caption]

Carol Forsloff - In 1959 more than one third of the elderly lived in poverty without access to health care for complex diseases, as retirement plans often included living with children or in deprivation, facts politicians neglect in their discussion of the economy and the elimination of Medicare for other options.

In 1959 seniors had no health insurance, unless a company pension offered it.  There was no Medicare, for example.  Those who were poor lived mostly on Social Security and could not afford medical care.  These numbers included legions of men who served in World War I.

Prior to the enactment of Social Security in 1935 about half of seniors lived in poverty.  This dropped to approximately 1/3 in 1959, with much of the continuing struggles occurring for lack of health coverage for the diseases impacting the elderly.  For that reason Medicare was enacted.

Half of all seniors had no health insurance until Medicare legislation in 1965.  Medicaid was instituted to cover the low-income elderly, the disabled, and the blind as well as parents with dependent children on welfare.

The poverty status of the elderly became the impetus for legislation to help this vulnerable group.  At the time, most elderly could depend on children for some minimum care.  Some seniors opt for special communities for over-55 folk where folks look after each other to some extent, as in Ryderwood, but even those towns with a built-in support system can't care for the most infirm.

By the year 2000 seniors were among the most solvent and were covered by Medicare, thus reducing the major source of economic damage on retirement planning.  This was the end of the Clinton era, before George W. Bush took office.

But times changed in 2011, and seniors and persons with disabilities are again the vulnerable groups, as the problem of advancing medical costs, decreasing pensions and program reductions strike hard at those least able to care for themselves independently.  It also comes at a time when an increasing number of seniors cannot rely on children for dependent care, either because the children are suffering from economic losses or because the new elderly have no children.  Research established that about ¼ of older Americans in 2008 were below 150 percent of the poverty line, and the estimates are about 1/3 when including the additional medical costs that force elders to choose between food and medicines.  Those statistics came in 2008 at the close of the Bush Presidency and before Obama took office.  They also came during a time when nearly 2/3 of all Americans favored some sort of national health insurance.

All of this means that even with Medicare,  1/3 of all seniors or more are living at or near poverty, a rate that approximates the rate when Medicare was first enacted.  And what the was stance of both political parties about Medicare at the time it was made law?

ThinkProgress offers the following quotations from key Republicans during that period:

"Ronald Reagan: “[I]f you don’t [stop Medicare] and I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”

George H.W. Bush: Described Medicare in 1964 as “socialized medicine.”

Barry Goldwater: “Having given our pensioners their medical care in kind, why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and of beer for those who drink.”

Bob Dole: In 1996, while running for the Presidency, Dole openly bragged that he was one of 12 House members who voted against creating Medicare in 1965. “I was there, fighting the fight, voting against Medicare . . . because we knew it wouldn’t work in 1965.”

In 1965 Democrats held the majority in Congress and passed Medicare into law under the Johnson administration.  As the Minnesota Post points out, the Republicans knew there were great numbers of Americans who wanted national health insurance according to polls at the time.  They proposed an alternative program for Medicare they named “Eldercare.” The plan required a means test for low-income seniors to receive federal subsidies for privately administered health insurance.

Today the Republicans offer a new program, one that promises current seniors to maintain the present Medicare system that would change in ten years to one that would offer coverage by selected insurance plans.  The cost of those plans relative to projected income, are not part of the promise of change that Republicans project.

The  claim the Republican plan would improve senior’s lot is not advanced by economists who have examined the plan.   This new plan has been advanced by Paul Ryan, who as a member of the House Budget Committee is upheld for his originality in devising it.  The plan would replace Medicare with a voucher program of $8000 to help seniors buy their own health insurance.  It would advance in cost in relationship with the consumer price index and is said to cover 32 percent of the cost equivalent of Medicare.  But the insurance beneficiary would be responsible for the rest, that is estimated at a total cost of more than $20,700, after the match of $9,750.

This plan is similar to that originally proposed by Republicans in 1965 when they voiced their opposition to Medicare.

Given the loss of real income of seniors experienced from 2000 to 2008, economists do not project that income will be advanced in the future with respect to medical and ordinary living costs.

How many seniors will be in poverty given the mounting health costs and the amount they are projected to pay in the next decade?  Experts predict  a 3 to 5 year timeline of recovery from the present economic problems, including job rate,  with more and more older persons in the ranks of the unemployed prior to age 65.  It is a recipe for future poverty for US elderly.